bluuebunny/crossref_metadata_2025 huggingface dataset:
Neurolinguistic Research on the Romance Languages
Authors: Bambini Valentina , Canal Paolo
Published: January 2021

Neurolinguistics is devoted to the study of the language-brain relationship, using the methodologies of neuropsychology and cognitive neuroscience to investigate how linguistic categories are grounded in the brain. Although the brain infrastructure for language is invariable across cultures, neural networks might operate differently depending on language-specific features. In this respect, neurolinguistic research on the Romance languages, mostly French, Italian, and Spanish, proved key to progress the field, especially with specific reference to how the neural infrastructure for language works in the case of more richly inflected systems than English.

Among the most popular domains of investigation are agreement patterns, where studies on Spanish and Italian showed that agreement across features and domains (e.g., number or gender agreement) engages partially different neural substrates. Also, studies measuring the electrophysiological response suggested that agreement processing is a composite mechanism involving different temporal steps. Another domain is the noun-verb distinction, where studies on the Romance languages indicated that the brain is more sensitive to the greater morphosyntactic engagement of verbs compared with nouns rather than to the grammatical class distinction per se.

Concerning language disorders, the Romance languages shed new light on inflectional errors in aphasic speakers and contributed to revise the notion of agrammatism, which is not simply omission of morphemes but might involve incorrect substitution from the inflectional paradigm. Also, research in the Romance domain showed variation in degree and pattern of reading impairments due to language-specific segmental and suprasegmental features.

Despite these important contributions, the Romance family, with its multitude of languages and dialects and a richly documented diachronic evolution, is a still underutilized ‘treasure house’ for neurolinguistic research, with significant room for investigations exploring the brain signatures of language variation in time and space and refining the linking between linguistic categories and neurobiological primitives.
How can the MHC mediate social odor via the microbiota community? A deep dive into mechanisms
Authors: Schubert Nadine , Nichols Hazel J , Winternitz Jamie C
Published: January 2021

Genes of the major histocompatibility complex (MHC) have long been linked to odor signaling and recently researchers’ attention has focused on MHC structuring of microbial communities and how this may in turn impact odor. However, understanding of the mechanisms through which the MHC could affect the microbiota to produce a chemical signal that is both reliable and strong enough to ensure unambiguous transmission of behaviorally important information remains poor. This is largely because empirical studies are rare, predictions are unclear, and the underlying immunological mechanisms governing MHC–microbiota interactions are often neglected. Here, we review the immunological processes involving MHC class II (MHC-II) that could affect the commensal community. Focusing on immunological and medical research, we provide background knowledge for nonimmunologists by describing key players within the vertebrate immune system relating to MHC-II molecules (which present extracellular-derived peptides, and thus interact with extracellular commensal microbes). We then systematically review the literature investigating MHC–odor–microbiota interactions in animals and identify areas for future research. These insights will help to design studies that are able to explore the role of MHC-II and the microbiota in the behavior of wild populations in their natural environment and consequently propel this research area forward.
Trivial, Interesting, or Overselling? The Microbiome and “What It Means to Be Human”
Authors: Parke Emily C
Published: January 2021

Discussions of microbiome research increasingly refer to the microbiome's impact on what it means to be human. These claims are rarely carefully explained or justified. Given the increasing importance of microbiome research across the life sciences, philosophy, and the public sphere, it is worth exercising more care in these discussions. This article offers a guide for doing so. There are many different ways to interpret the details of ambiguous claims about the microbiome and what it means to be human. I discuss some possible interpretations and show how the resulting claims can range from trivial to suggestive of interesting research to controversial and overhyped. I recommend greater caution and clarity in ongoing discussions of microbiome research and its implications.
Internal co-seismic displacement and strain changes inside a homogeneous spherical Earth
Authors: Dong Jie , Cheng Pengfei , Wen Hanjiang , Sun Wenke
Published: January 2021

In this study, we devised a new set of analytical foundation solutions to compute the internal co-seismic displacement and strain changes caused by four independent point sources (strike-slip, dip-slip, horizontal tensile and vertical tensile) inside a homogeneous spherical earth model. Our model provides constraints on the deformation properties at depth and reveals that the internal co-seismic deformation is larger than that on the surface. The deformation near the source is convergent with our formulae. For the internal deformation at radial section plane, the patterns of horizontal displacements ${u_\theta },{u_\phi }$ and strain changes ${e_{{ rr}}},{e_{\theta \theta }},{e_{\phi \phi }},{e_{\theta \phi }}$ caused by strike-slip and tensile sources appear symmetric at the equidistance above and below the source. Their amplitudes are not identical but with a small discrepancy actually. Unlike these, the patterns of radial displacements ${u_r}$ for strike-slip and tensile sources exhibit point symmetry with the equidistance from the source. Also, the corresponding amplitudes are slightly different. The displacements ${u_\theta },{u_\phi }$ and strain changes ${e_{{ rr}}},{e_{\theta \theta }},{e_{\phi \phi }},{e_{\theta \phi }}$ caused by dip-slip also show the same properties as ${u_{ r}}$ of the strike-slip source. The magnitudes of the displacements and strain changes depend on the source types. The curvature effect on the near-field surface deformations is small, and it increases with the studied depth. However, for the far-field deformation caused by the strike-slip source (ds = 20 km), the curvature effect can be as large as 77 per cent when the epicentral distance approximates to 1778 km.
Direct inversion of surface wave dispersion data with multiple-grid parametrizations and its application to a dense array in Chao Lake, eastern China
Authors: Luo Song , Yao Huajian , Wang Jiannan , Wang Kangdong , Liu Bin
Published: January 2021

The direct surface wave tomography has become an efficient tool in imaging 3-D shallow Earth structure. However, some fundamental problems still exist in selecting the grids to parametrize the model space. This study proposes to implement a model parametrization approach with multiple grids to the direct surface wave tomography. These multiple grids represent several overlapping collocated grids with the same or different grid spacings, such as staggered grids, multiscale grids and multiscale-staggered grids. At each iteration, direct inversion is applied to each individual set of collocated grids to invert for the shear wave velocity (Vs) model; the models are then projected onto a set of predefined base grids (usually the finest grids) using 3-D B-spline interpolation. At the end of each iteration, we average the Vs models of all sets of collocated grids to obtain the average 3-D Vs model, which is then used as the initial model for the next iteration. The properties of this approach are explored by applying it to a newly deployed dense array in Chao Lake (CL), eastern China. Synthetic and field data tests demonstrate that the method using multiple grids recovers anomaly patterns better than that using the individual set of collocated grids, though it does not necessarily achieve the smallest traveltime residual. We then obtain a high-resolution 3-D shallow crustal Vs model beneath the CL. The 3-D Vs model reveals two prominent features: (1) a stripe-like structural pattern of velocity variations, where the Hefei basin and eastern CL display low-velocity anomalies while the Tanlu fault zone (TFZ), Zhangbaling uplift and Yinping mountain present high-velocity anomalies and (2) north-shifted low-velocity anomalies beneath the eastern CL as depths go shallow. The shallow Vs features are consistent well with the local geological units and topography. We suggest that the two main features could be associated with the multistage tectonic activities of the Tanlu fault. The multiple-grid scheme proposed in this study could be conveniently extended to other 3-D direct inversion approaches in the near future.
Deliberative engagement methods on health care priority-setting in a rural South African community
Authors: Tugendhaft Aviva , Hofman Karen , Danis Marion , Kahn Kathleen , Erzse Agnes , Twine Rhian , Gold Marthe , Christofides Nicola
Published: January 2021

Public engagement in priority-setting for health is increasingly recognized as a means to ensure more ethical, inclusive and legitimate decision-making processes, especially in the context of Universal Health Coverage where demands outweigh the available resources and difficult decisions need to be made. Deliberative approaches are often viewed as especially useful in considering social values and balancing trade-offs, however, implementation of deliberative engagement tools for priority-setting is scant, especially in low- and middle-income settings. In order to address this gap, we implemented a context-specific public deliberation tool in a rural community in South Africa to determine priorities for a health services package. Qualitative data were analysed from seven group deliberations using the engagement tool. The analysis focused on understanding the deliberative process, what the participants prioritized, the reasons for these selections and how negotiations took place within the groups. The deliberations demonstrated that the groups often considered curative services to be more important than primary prevention which related to the perceived lack of efficacy of existing health education and prevention programmes in leading to behaviour change. The groups engaged deeply with trade-offs between costly treatment options for HIV/AIDS and those for non-communicable disease. Barriers to healthcare access were considered especially important by all groups and some priorities included investing in more mobile clinics. This study demonstrates that deliberative engagement methods can be successful in helping communities balance trade-offs and in eliciting social values around health priorities. The findings from such deliberations, alongside other evidence and broader ethical considerations, have the potential to inform decision-making with regard to health policy design and implementation.
Does Institutional Proliferation Undermine Cooperation? Theory and Evidence from Climate Change
Authors: Rowan Sam S
Published: January 2021

Global politics has undergone a tremendous institutional proliferation, yet many questions remain about why states join these new institutions and whether they support cooperation. I build on existing work to develop a general theory of state participation in dense institutional environments that also helps to explain cooperative outcomes. I argue that states may be dissatisfied when cooperation proceeds either too slowly or too quickly and that these two types of dissatisfaction motivate opposing participation behaviors. Deepeners are states that are dissatisfied with the slow pace of cooperation and join institutions to support cooperation, while fragmenters are states dissatisfied with the quick pace and join institutions to undermine cooperation. I evaluate my argument using new data on sixty-three climate institutions and states’ greenhouse gas mitigation targets in the Paris Agreement on Climate Change. I find that membership in climate institutions designed to facilitate implementation is associated with more ambitious targets, while membership in general is unrelated to targets.
Intramuscular abdominal hibernoma: case report of a rare tumour and a review of the literature
Authors: Baghaie Hooman , Chan Erick , Francisco Sewwandi , Rasheed Haroon , Puhalla Harald
Published: January 2021

Hibernoma is a rare benign tumour that was first described by Merkel in 1906. It arises from remnants of brown fat and has a differential diagnosis of lipoma and liposarcoma. This is a case report of a 31-year-old male with a slow-growing mass in the left flank that produced constant pain radiating to the groin. Computerised tomography localised the mass within the external oblique muscle, which showed some heterogeneity and low attenuation. The mass appeared hypodense to muscle on T1 and hyperdense to muscle on T2 weighted magnetic resonance images. Prominent vascularity of the mass was noted. Finally, the lesion was found to be a ‘typical’ hibernoma on core-needle biopsy. It was surgically resected with a cuff of muscle. He recovered without complication, and there is no clinical evidence of recurrence at 6 months.
Incarcerated sigmoid large-cell neuroendocrine carcinoma in an inguinal hernia
Authors: Gerosa Martino , Incarbone Niccolò , Di Fratta Emanuele , Mari Giulio Maria , Guttadauro Angelo , Cioffi Ugo , Maggioni Dario
Published: January 2021

Large-cell neuroendocrine carcinomas (NECs) of the colon are extremely rare aggressive tumors. A 79-year-old man presented at our hospital for muco-hematic diarrhea, weight loss and incarcerated hernia in his left groin. Colonoscopy revealed sigmoid stenosis. Computed tomography confirmed an incarcerated hernia containing sigmoid mass and massive abdominal adenopathy. In absence of colonic obstruction, the patient underwent elective palliative sigmoid resection and colostomy by laparoscopic approach, and direct hernia repair through inguinal access. Histopathological examination revealed a large cells sigmoid NEC. We report the first case of large-cell neuroendocrine colon cancer incarcerated in an inguinal hernia. Due to the advanced stage, we have performed a palliative laparoscopic resection in order to reduce surgical trauma, confirm pre-operative results and minimize post-operative complications, and direct hernia repair through inguinal access.
Vegetation cover and plant diversity on cold climate green roofs
Authors: Lönnqvist Joel , Blecken Godecke-Tobias , Viklander Maria
Published: January 2021

Both vegetation abundance and community composition play important roles in functions of green roofs (e.g. stormwater retention, habitat provision, aesthetic appearance). However, green roofs’ vegetation, and hence their functions, can change significantly over time. More understanding of these changes is required, particularly in cold climates. Therefore, this study investigated vascular plant covers and species compositions on 41 roof sections located in Sweden’s subarctic and continental climate zones. For the roof sections with a known originally intended vascular plant composition (n = 32), on average 24 ± 9% of the intended species were detected in surveys, and unintended species accounted for 69 ± 3% of the species found. However, most colonizing species formed sparse cover on the roofs. Thus, they may make less contributions to green roofs’ potential functionalities related to vegetation density (e.g. social perception, effectiveness in stormwater management and thermal performance) than the intended vegetation. The intended species dominated plant cover (93 ± 3%) and Sedum acre (58 ± 36% cover) was the most commonly detected species and as found in previous studies, substrate depth was positively related to both plant cover and species richness. Contrary to a hypothesis, the roofs’ vascular plant cover was not related to species richness but was significantly and negatively correlated with moss cover. The results highlight the importance of substrate depth for both plant abundance and species diversity and show that even in a cold climate, colonizing unintended species can strongly contribute to green roofs’ species richness.
Design and engineering of artificial metalloproteins: from de novo metal coordination to catalysis
Authors: Klein Andreas S , Zeymer Cathleen
Published: January 2021

Metalloproteins are essential to sustain life. Natural evolution optimized them for intricate structural, regulatory and catalytic functions that cannot be fulfilled by either a protein or a metal ion alone. In order to understand this synergy and the complex design principles behind the natural systems, simpler mimics were engineered from the bottom up by installing de novo metal sites in either natural or fully designed, artificial protein scaffolds. This review focuses on key challenges associated with this approach. We discuss how proteins can be equipped with binding sites that provide an optimal coordination environment for a metal cofactor of choice, which can be a single metal ion or a complex multinuclear cluster. Furthermore, we highlight recent studies in which artificial metalloproteins were engineered towards new functions, including electron transfer and catalysis. In this context, the powerful combination of de novo protein design and directed evolution is emphasized for metalloenzyme development.
Worldvolume approach to the tempered Lefschetz thimble method
Authors: Fukuma Masafumi , Matsumoto Nobuyuki
Published: January 2021

As a solution towards the numerical sign problem, we propose a novel hybrid Monte Carlo algorithm, in which molecular dynamics is performed on a continuum set of integration surfaces foliated by the antiholomorphic gradient flow (“the worldvolume of an integration surface”). This is an extension of the tempered Lefschetz thimble method (TLTM) and solves the sign and multimodal problems simultaneously, as the original TLTM does. Furthermore, in this new algorithm, one no longer needs to compute the Jacobian of the gradient flow in generating a configuration, and only needs to evaluate its phase upon measurement. To demonstrate that this algorithm works correctly, we apply the algorithm to a chiral random matrix model, for which the complex Langevin method is known not to work.
Presentations for Temperley–Lieb Algebras
Authors: East James
Published: January 2021

We give a new and conceptually straightforward proof of the well-known presentation for the Temperley–Lieb algebra, via an alternative new presentation. Our method involves twisted semigroup algebras, and we make use of two apparently new submonoids of the Temperley–Lieb monoid.
A Unified Approach to the Arens Regularity and Related Problems for a Class of Banach Algebras Associated with Locally Compact Groups
Authors: Lau Anthony to-Ming , Ülger Ali
Published: January 2021

Based on Katznelson–Tzafriri Theorem on power bounded operators, we prove in this paper a theorem, which applies to the most of the classical Banach algebras of harmonic analysis associated with locally compact groups, to deal with the problems when a given Banach algebra A is Arens regular and when A is an ideal in its bidual. In the second part of the paper, we study the topological center of the bidual of a class of Banach algebras with a multiplier bounded approximate identity.
The Rationality of the Moduli Space of Two-pointed Ineffective Spin Hyperelliptic Curves
Authors: Zucconi Francesco
Published: January 2021

By the geometry of the 3-fold quadric, we show that the coarse moduli space of genus g ineffective spin hyperelliptic curves with two marked points is a rational variety for every g ≥ 2.
House of Cards: Informal Housing Markets and Precarious Pathways to Homeownership in Baltimore
Authors: Jang-Trettien Christine
Published: January 2021

Homeownership is often tied to cultural conceptions of model citizenship, yet African Americans have long faced structural barriers to owning a home. Credit discrimination has often constrained black homeownership. However, missing from accounts of race, credit, and homeownership is how people purchase homes without mortgages. Through an analysis of public deed and mortgage records in Baltimore, I show that informal housing transactions – unregulated transfers outside of the mortgage market – are primarily located within majority-black neighborhoods. Using data from interviews with 336 homeowners, renters, and real estate investors, I show that informal markets put buyers in a uniquely vulnerable position. The exchange process in informal markets often consists of buyer and seller, with no third-party actor providing oversight to the transaction. Consequently, homebuyers face uncertainty over legal title and the value of the home, making it impossible to make informed decisions about the costs and benefits of homeownership at the time of purchase. Those who purchased from out-of-network real estate investors faced the harshest consequences, with sellers often structuring contracts to disadvantage consumers. Recent reports show that millions have purchased homes without institutional credit. It is worth examining how unregulated housing markets in neighborhoods of concentrated disadvantage contribute to racial inequalities.
How Advance Directives Help When Patients Refuse Life-saving Treatment Because of Their Substance Use
Authors: Tobias Paul
Published: January 2021

Patients with substance use disorder have higher rates of discharge against medical advice, despite frequently presenting to emergency departments with significant and life-threatening comorbid conditions. A Ulysses contract, in the form of a substance use advance directive, would allow these patients to maintain their autonomy while providing a means for them to complete treatment for these comorbid conditions.
It is Not the Patient, It is the System: Commentary on “How Advanced Directives Help When Patients Refuse Life-saving Treatment Because of Their Substance Use”
Authors: Dineen Kelly K.
Published: January 2021

Serious infections are common in patients with opioid use disorder who use injection drugs. Clinicians are often frustrated by the complexity and uncertainty involved in managing these patients, who also have a high rate of discharges against medical advice. The commentary addresses a proposal for a substance use advance directive that would bind the patient to involuntary future treatment, even over their contemporaneous objections. Although the problem is significant, this commentary challenges the legal and ethical justifications for the substance use advance directive and advances that instead, attention should focus on mitigating the harms of continued institutional and structural discrimination and advocating for evidence-based inpatient treatment.
Surgical Release of Gluteal Fibrosis in Children Results in Sustained Benefit at 5-Year Follow-up
Authors: Reilly Amanda L. , Owori Francis R. , Obaikol Ruth , Asige Elizabeth , Aluka Harriet , Penny Norgrove , Olupot Robert , Sabatini Coleen S.
Published: January 2021

Background:

Gluteal fibrosis (GF) is a fibrotic infiltration of the gluteal muscles resulting in functionally limiting contracture of the hips and is associated with injections of medications into the gluteal muscles. It has been reported in numerous countries throughout the world. This study assesses the 5-year postoperative range of motion (ROM) and functional outcomes for Ugandan children who underwent surgical release of GF.

Methods:

A retrospective cohort study of children who underwent release of GF in 2013 at Kumi Hospital in Eastern Uganda. Functional outcomes, hip ROM, and scar satisfaction data were collected for all patients residing within 40 km of the hospital.

Results:

One hundred eighteen children ages 4 to 16 at the time of surgery were treated with surgical release of GF in 2013 at Kumi Hospital. Of those 118, 89 were included in this study (79.5%). The remaining 29 were lost to follow-up or lived outside the study’s radius. Detailed preoperative ROM and functional data were available for 53 of the 89 patients. In comparison with preoperative assessment, all patients postoperatively reported ability to run normally (P<0.001), sit upright in a chair (P<0.001), sit while eating (P<0.001), and attend the entire day of school (P<0.001). Passive hip flexion (P<0.001) improved when compared with preoperative measurements. In all, 85.2% (n=75) of patients reported satisfaction with scar appearance as “ok,” “good,” or “excellent” 29.2% (n=26) of patients reported back or hip complaints.

Conclusions:

Overall, the 5-year postoperative outcomes suggest that surgical release of GF improves ROM and functional quality of life with sustained effect.

Level of Evidence:

Level IV—case series.
Raphael at the Temple
Authors: Rebello Gleeson , Joseph Benjamin
Published: January 2021

Raphael, in his painting “Healing of the Lame Man” shows one lame man encountering St. Peter and St. John while another lame man waits his turn. Children with unusually muscular bodies are also depicted in the painting. The possible causes of lameness in the men and muscle hypertrophy in the children are discussed.
The Relationship Between Heart Rate and Body Temperature in Critically Ill Patients
Authors: Broman Marcus E. , Vincent Jean-Louis , Ronco Claudio , Hansson Fredrik , Bell Max
Published: January 2021

OBJECTIVE:

The presence of tachycardia in critically ill patients is frequently used as an indication of severity of illness and to guide treatment decisions but can be influenced by body temperature, thus confounding its interpretation. There are few data available on the relationship between body temperature and heart rate in critically ill patients.

DESIGN:

Retrospective analysis of prospectively collected data.

SETTING:

Mixed medical-surgical university hospital ICU.

PATIENTS:

All patients admitted to the ICU between November 2006 and August 2019.

MEASUREMENTS AND MAIN RESULTS:

Body temperature was recorded in the electronic medical records at least hourly, from invasive measurements (esophageal probe, indwelling urinary catheter, pulse contour cardiac output monitoring system, or pulmonary artery catheter) or manual tympanic recordings. Heart rate was monitored continuously and hourly values were recorded in the electronic medical record. Change in heart rate with change in body temperature was assessed by extracting pairs of simultaneous body temperature and corresponding heart rate measurements from the electronic medical record: 472,941 simultaneous pairs were obtained from the 9,046 patients admitted during the study period. Each 1°C increase in body temperature between 32.0°C and 42.0°C was associated with an 8.35 beats/min increase in heart rate. Crude linear regression showed an r
2 of 0.855 between body temperature and heart rate. Heart rate increased more in females than in males (9.46 vs 7.24 beats/min for each 1°C, p < 0.0001); this relationship was not affected by age or adrenergic drugs. The increase in heart rate was related to the severity of organ dysfunction.

CONCLUSIONS:

Increase in body temperature is associated with a linear increase in heart rate of 9.46 beats/min/°C in female and 7.24 beats/min/°C in male patients. These observations will help to correctly interpret heart rate values at different body temperatures and enable more accurate evaluation of other factors associated with tachycardia.
Racial Disparities in Readmissions Following Initial Hospitalization for Sepsis
Authors: Lizza Bryan D. , Betthauser Kevin D. , Juang Paul H. , Hampton Nicholas B. , Lyons Patrick G. , Kollef Marin H. , Micek Scott T.
Published: January 2021

OBJECTIVES:

To assess whether Black race is associated with a higher rate of all-cause readmission compared with White race following community-onset sepsis.

DESIGN:

Retrospective cohort study.

SETTING:

One-thousand three-hundred bed urban academic medical centers.

PATIENTS:

Three-thousand three-hundred ninety patients hospitalized with community-onset sepsis between January 1, 2010, and December 31, 2017.

INTERVENTIONS:

Community-onset sepsis was defined as patients admitted through the emergency department with an International Classification of Disease, ninth revision, Clinical Modification code for either severe sepsis (995.92) or septic shock (785.52). Beginning in 2015, we used International Classification of Disease, Tenth Revision, Clinical Modification codes R65.20 (severe sepsis) and R65.21 (septic shock). We excluded those individuals hospitalized at another acute care facility that were transferred to our facility. Race was abstracted electronically, and patients who expired or self-identified as a race other than Black or White race were excluded. Patients who experienced a subsequent hospitalization at our facility were considered to be readmitted.

MEASUREMENTS AND MAIN RESULTS:

Compared with White race, Black race demonstrated a significantly higher rate of all-cause readmission (60.8% vs 71.1%; p < 0.001), including a higher rate of readmission for sepsis (14.0% vs 19.8%; p < 0.001). Black patients also resided in zip codes with a lower median household income and were more likely to use public insurance compared with White race. Similar rates of comorbid diseases and disease burden were observed between the two groups, but vasopressors were less likely to be administered to Black patients. Multivariable analysis showed that Black race was associated with a 50% increased odds (odds ratio, 1.52, 99% CI, 1.25–1.84) in all-cause readmission risk compared with White race.

CONCLUSIONS:

Black race was associated with a higher rate of all-cause and sepsis readmission, possibly as a result of unaddressed health disparities, compared with White race. Programs addressing healthcare disparities should use readmission as another marker of equity.
Age-Dependent Heterogeneity in the Efficacy of Prophylaxis With Enoxaparin Against Catheter-Associated Thrombosis in Critically Ill Children: A Post Hoc Analysis of a Bayesian Phase 2b Randomized Clinical Trial
Authors: Faustino E. Vincent S. , Raffini Leslie J. , Hanson Sheila J. , Cholette Jill M. , Pinto Matthew G. , Li Simon , Kandil Sarah B. , Nellis Marianne E. , Shabanova Veronika , Silva Cicero T. , Tala Joana A. , McPartland Tara , Spinella Philip C.
Published: January 2021

OBJECTIVES:

We explored the age-dependent heterogeneity in the efficacy of prophylaxis with enoxaparin against central venous catheter-associated deep venous thrombosis in critically ill children.

DESIGN:

Post hoc analysis of a Bayesian phase 2b randomized clinical trial.

SETTING:

Seven PICUs.

PATIENTS:

Children less than 18 years old with newly inserted central venous catheter.

INTERVENTIONS:

Enoxaparin started less than 24 hours after insertion of central venous catheter and adjusted to anti-Xa level of 0.2–0.5 international units/mL versus usual care.

MEASUREMENTS AND MAIN RESULTS:

Of 51 children randomized, 24 were infants less than 1 year old. Risk ratios of central venous catheter-associated deep venous thrombosis with prophylaxis with enoxaparin were 0.98 (95% credible interval, 0.37–2.44) in infants and 0.24 (95% credible interval, 0.04–0.82) in older children greater than or equal to 1 year old. Infants and older children achieved anti-Xa level greater than or equal to 0.2 international units/mL at comparable times. While central venous catheter was in situ, endogenous thrombin potential, a measure of thrombin generation, was 223.21 nM.min (95% CI, 8.78–437.64 nM.min) lower in infants. Factor VIII activity, a driver of thrombin generation, was also lower in infants by 45.1% (95% CI, 15.7–74.4%). Median minimum platelet count while central venous catheter was in situ was higher in infants by 39 × 103/mm3 (interquartile range, 17–61 × 103/mm3). Central venous catheter:vein ratio was not statistically different. Prophylaxis with enoxaparin was less efficacious against central venous catheter-associated deep venous thrombosis at lower factor VIII activity and at higher platelet count.

CONCLUSIONS:

The relatively lesser contribution of thrombin generation on central venous catheter-associated thrombus formation in critically ill infants potentially explains the age-dependent heterogeneity in the efficacy of prophylaxis with enoxaparin.
Presence of Incipient Fungal Infection in Atypical Squamous Lesions of the Lip
Authors: Cox Surget V. , Ambrosio Diego S. , Firetag Brandie , Lundquist Kurt , Moore Johanna B.
Published: January 2021

Epidermal barrier disruption caused by atypical squamous proliferations of the lip (SOL) creates an ideal environment for fungal growth. Histologic features of SOL include parakeratosis overlying partial- or full-thickness keratinocyte atypia with or without invasion of the dermis, dermal solar elastosis, and scattered inflammatory cells which are predominantly lymphocytes. Histologic features of SOL with fungal superinfections overlap those seen in primary fungal cheilitis with reactive atypia, creating a diagnostic challenge. One-hundred seventy SOL cases were examined for the presence of fungal elements, and the histological features associated with superinfection were identified. Cases diagnosed as actinic cheilitis with fungal superinfection were carefully examined to rule out the possibility of misdiagnosed primary fungal cheilitis with reactive atypia. Histopathological characteristics commonly present with fungal hyphae included intraepidermal or intradermal neutrophils, bacterial colonies, and erosion or ulceration. Medical record review of those patients treated conservatively with topical antifungals revealed persistent clinical neoplasm and histological evidence of residual SOL on repeat biopsy. Thus, when biopsies exhibit histological overlap between these 2 entities, clinicians should keep a high index of suspicion for underlying SOL and carefully follow these patients if conservative antifungal therapy is initially trialed.
Guidelines for Diagnosis and Treatment of Atopic Dermatitis in China (2020)#
Authors: Yao Xu , Song Zhi-Qiang , Li Wei , Liang Yun-Sheng , Zhao Yan , Cao Hua , Chen Tao , Chen Xue , Feng Ai-Ping , Geng Song-Mei , Gu Heng , Guo Shu-Ping , He Yan-Ling , Kuang Ye-Hong , Li Chun-Ying , Li Xiao-Hong , Li Zheng-Xiao , Liang Jun-Qin , Liu Hong-Ye , Liu Ling-Ling , Liu Yu-Mei , Liu Zhi , Long Hai , Lu Qian-Jin , Lu Yan , Luo Xiao-Qun , Lv Xiao-Yan , Ma Lin , Shen Zhu , Shi Xin , Shi Zhong-Xiang , Su Xiang-Yang , Sun Qing , Tang Jian-Ping , Wang Ao-Xue , Wang Hui-Ping , Wang Jian-Qin , Wang Ming-Yue , Wang Zai-Xing , Xia Yu-Min , Xiao Ting , Xie Zhi-Qiang , Xing Huan , Xiong Ying , Xu Zi-Gang , Yang Bin , Yao Zhi-Rong , Yu Jian-Bin , Yu Nan , Zeng Kang , Zhang Jian-Zhong , Zhang Jun-Ling , Zhao Hua , Zhao Zuo-Tao , Zhu Wei , Zhu Ying-Hua , Zou Ying
Published: January 2021

Atopic dermatitis (AD) is a common disease clinically characterized by chronic recurrent eczematous lesions, dry skin, and pruritus. AD can negatively impact patients’ quality of life. The prevalence of AD in China has been increasing during the past few decades. Based on the most recent advances in the treatment of AD, we updated the 2014 version of the Guidelines for Diagnosis and Treatment of Atopic Dermatitis in China regarding the definition, epidemiology, pathogenesis, clinical classification, diagnosis, prevention, and treatment of AD.
The Effect of Oral Montelukast Administration in Cholesteatoma Development and Inflammation: An Experimental Animal Model
Authors: Ocal Ramazan , Kargin Kaytez Selda , Yumusak Nihat , Akkoca Ozlem , Celik Hatice , Arslan Necmi
Published: January 2021

Hypothesis:

We hypothesized that oral montelukast treatment could inhibit cholesteatoma formation in an experimental animal model.

Background:

Inflammation and excessive proliferation have been described in the histopathology of cholesteatoma. The aim of this study was to determine the effect of oral montelukast on cholesteatoma development.

Methods:

Eighteen healthy female Wistar albino rats weighing 250 g were chosen for the study. The animals were divided into two groups: group 1 received montelukast and group 2 was the control group. Intratympanic propylene glycol injection was administered into the left ears and physiologic serum was instilled into the right ears of the animals on the first, eighth, and fifteenth days. The effects of montelukast administration were evaluated by histological examination of the tympanic membrane and middle ear.

Results:

Group 1 (montelukast group) showed significant differences in terms of cholesteatoma formation, granulation, epithelial invagination, and inflammation. Cholesteatoma formation in the left ear was observed in 2 (22%) and 8 (89%) rats in groups 1 and 2, respectively (p = 0.015).

Conclusion:

Development of cholesteatoma and inflammation was significantly lower in the montelukast-administered group. Thus, oral montelukast was found effective in preventing cholesteatoma formation.
Neurofibrosarcoma Revisited
Authors: Devereaux Kelly A. , Weiel Julianna J. , Mills Anne M. , Kunder Christian A. , Longacre Teri A.
Published: January 2021

Uterine sarcomas with variable CD34 and S100 expression represent an emerging class of tumor in the female genital tract which commonly presents in the endocervix of premenopausal women. Initial molecular characterization identified NTRK1 and NTRK3 gene fusions as oncogenic drivers in these tumors; however, the repertoire of genetic alterations is likely more diverse given the recent discovery of PDGFB and RET gene fusions in similarly described tumors. Importantly, these fusion events lead to the aberrant activation of kinases that are potentially therapeutically targetable; therefore, recognizing this class of tumor becomes critical for initiating the molecular testing required for an accurate diagnosis and identification of clinically actionable fusions. Here, we report our institutional experience with 12 cases of uterine spindle cell sarcomas harboring kinase-related fusions. Patients ranged from 21 to 80 years old (median, 38 y) and presented either asymptomatically or with pelvic pain and/or uterine bleeding. Eleven (92%; 11/12) tumors were localized to the cervix and 1 (8%; 1/12) tumor was localized in the anterior fundus of the uterine corpus. Tumors ranged in size from 1.5 to 15.0 cm (median, 6.0 cm) and were histologically characterized by a moderately cellular, infiltrative proliferation of spindle cells with features of benign gland entrapment, stromal collagen deposition, perivascular hyalinization, occasionally myxoid stroma, a lymphocytic infiltrate, occasional nuclear pseudoinclusions, and a pseudophyllodes architecture. RNA-sequencing identified NTRK1 (8/12), NTRK3 (1/12), and PDGFB (2/12) gene fusions, which have been previously implicated in this tumor class, as well as a novel FGFR1-TACC1 (1/12) fusion. All tumors in this cohort showed coexpression of CD34 and S100 by immunohistochemistry except for those tumors with PDGFB fusions which showed solely CD34 expression. Of the 10 surgically resected tumors with follow-up, outcomes best correlated with the stage of disease. One of 4 patients with stage IA tumors (1/4) had recurrences, half of the stage IB (2/4) tumors had recurrences and all of the stage IIB tumors (2/2) had recurrences and died of disease. Future studies are still required to better understand the spectrum of genetic alterations as well as evaluate the efficacy of targeted kinase inhibitors in this class of tumor.
Mediastinal Recurrence of Uterine Cervix Cancer on 18F-FDG PET/CT
Authors: Soldevila-Lozano Cristina , Sabaté-Llobera Aida , Robles-Barba Javier-Jesús , Mestres-Martí Judit , Cortés-Romera Montserrat
Published: January 2021

We report the case of a 64-year-old woman with a mediastinal relapse of a uterine cervix cancer with positive human papillomavirus, an unusual site of recurrence. She consulted because of solid and liquid dysphagia of sudden appearance. Endoscopic study and non–contrast-enhanced CT showed intraluminal esophageal stenosis with a retrograde esophageal distension. 18F-FDG PET/CT demonstrated an infiltrating hypermetabolic lesion in posterior mediastinum, middle and lower esophagus, and stomach, with no signs of local or regional relapse of the uterine neoplasm.
A Single Surgeon's Experience of Starting a New Ear Reconstruction Service in the UK
Authors: Kennedy Nithil Subash , Lloyd Mark S.
Published: January 2021

Autologous ear reconstruction is known as one of the most difficult types of reconstruction to perform in plastic surgery. Very rarely is a trainee exposed to the level of complexity and variety of cases they will treat as a sole care provider in a tertiary care setting. This is because the learning curve is steep and those few surgeons that already perform ear reconstruction are limited in what technical experience they can offer trainees due to the plethora of factors competing against the surgeon. These include patient expectations, level of experience, length of anesthetic and accountability for results and complications. For this reason, once a plastic surgeon is nominated to provide autologous ear reconstruction, they face the daunting prospect of not only performing what is a very complex surgery with a very steep learning curve but also the judgment of their patients and colleagues. This paper charts the endeavors of the senior author to provide a service over the last 5 years. It will hopefully provide insight and context on setting up a service, dealing with complications, patient and peer expectations, and finally acknowledgment from both alike as experience is gained and excellence is reached.
A Patient Presentation of Large Septal Perforation Repair Using Inferior Based Contra-Lateral Nasal Floor Flap, a New Surgical Technique for Large Septal Perforation
Authors: Jang Pilkeun , Kim Hyung Gu , Hong Seung-No
Published: January 2021

A nasal septal perforation is a defect of cartilage, bone, or mucosa of nasal septum, which is caused by previous septal surgery, trauma, chemicals, inflammatory disease, or drugs. If conservative managements, such as nasal saline irrigation or ointments, are not effective, surgical treatment can be considered. Various methods for the reconstruction of nasal septal perforation were reported, such as local flaps, free flaps, autografts, allografts, or xenografts. However, there is no standardized method due to low success rate and high recurrence rate, especially in large perforations. The authors report a successful repair case of large anteroinferior nasal septal perforation, using inferior based contralateral nasal floor flap. The authors believe that our method is an effective way to repair large nasal septal perforation and to minimalize donor site morbidity, without using other allografts.
Clinical effectiveness of convalescent plasma in hospitalized patients with COVID-19: a systematic review and meta-analysis
Authors: Abeldaño Zuñiga Roberto Ariel , González Villoria Ruth Ana María , Elizondo María Vanesa , Nicolás Osorio Anel Yaneli , Coca Silvia Mercedes
Published: January 2021

Given the variability of previously reported results, this systematic review aims to determine the clinical effectiveness of convalescent plasma employed in the treatment of hospitalized patients with diagnosis of COVID-19.

We conducted a systematic review of controlled clinical trials assessing treatment with convalescent plasma for hospitalized patients with a diagnosis of SARS-CoV-2 infection. The outcomes were mortality, clinical improvement, and ventilation requirement.

A total of 50 studies were retrieved from the databases. Four articles were finally included in the data extraction, qualitative and quantitative synthesis of results. The meta-analysis suggests that there is no benefit of convalescent plasma compared to standard care or placebo in the reduction of the overall mortality and in the ventilation requirement; but there could be a benefit for the clinical improvement in patients treated with plasma.

We can conclude that the convalescent plasma transfusion cannot reduce the mortality or ventilation requirement in hospitalized patients diagnosed with SARS-CoV-2 infection. More controlled clinical trials conducted with methodologies that ensure a low risk of bias are still needed.
A cross-sectional analysis of demographic and behavioral risk factors of SARS-CoV-2 antibody positivity among a sample of U.S. college students
Authors: Kianersi Sina , Ludema Christina , Macy Jonathan T. , Garcia Edlin , Chen Chen , Luetke Maya , Lown Mason H. , Rosenberg Molly
Published: January 2021

Background

Colleges and universities across the United States are developing and implementing data-driven prevention and containment measures against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Identifying risk factors for SARS-CoV-2 seropositivity could help to direct these efforts.

Objective

To estimate the associations between demographic factors and social behaviors and SARS-CoV-2 seropositivity and self-reported positive SARS-CoV-2 diagnostic test.

Methods

In September 2020, we randomly sampled Indiana University Bloomington (IUB) undergraduate students. Participants completed a cross-sectional, online survey about demographics, SARS-CoV-2 testing history, relationship status, and risk behaviors. Additionally, during a subsequent appointment, participants were tested for SARS-CoV-2 antibodies using a fingerstick procedure and SARS-CoV-2 IgM/IgG rapid assay kit. We used unadjusted modified Poisson regression models to evaluate the associations between predictors of both SARS-CoV-2 seropositivity and self-reported positive SARS-CoV-2 infection history.

Results

Overall, 1,076 students were included in the serological testing analysis, and 1,239 students were included in the SARS-CoV-2 infection history analysis. Current seroprevalence of SARS-CoV-2 was 4.6% (95% CI: 3.3%, 5.8%). Prevalence of self-reported SARS-CoV-2 infection history was 10.3% (95% CI: 8.6%, 12.0%). Greek membership, having multiple romantic partners, knowing someone in one’s immediate environment with SARS-CoV-2 infection, drinking alcohol more than 1 day per week, and hanging out with more than 4 people when drinking alcohol increased both the likelihood of seropositivity and SARS-CoV-2 infection history.

Conclusion

Our findings have implications for American colleges and universities and could be used to inform SARS-C0V-2 prevention and control strategies on such campuses.