bluuebunny/crossref_metadata_2025 huggingface dataset:
Fetal Sclerotherapy for Hydropic Congenital Cystic Adenomatoid Malformations of the Lung Refractory to Steroids: A Case Report and Review of the Literature
Authors: Abbasi Nimrah , Morency Anne-Maude , Langer Jacob C. , Chiu Priscilla P. L. , Chami Rose , Windrim Rory , Keunen Johannes , Seaward Gareth , Ryan Greg
Published: May 2019

Microcystic congenital cystic adenomatoid malformations (CCAM), when associated with hydrops, carry a dismal prognosis. Options for treatment are limited and experimental, including antenatal corticosteroids, open fetal surgery, laser ablation and, more recently, sclerotherapy. We describe a case of a large, predominantly microcystic CCAM in a hydropic fetus treated successfully with direct interstitial injection of a sclerosant agent (3% sodium tetradecyl sulfate) at 23+3 weeks gestation, after multiple failed courses of steroids. Elective thoracoscopic right lower lobectomy was performed at 1 year of life and there have been no respiratory or other medical morbidities since. A literature review of fetal lung masses treated with sclerosants antenatally reveals that sclerotherapy may represent a novel treatment option for large hydropic microcystic CCAMs, which are unresponsive to corticosteroids. Further studies are required to evaluate the utility and safety of fetal sclerotherapy, as this may represent an alternative minimally invasive treatment option to fetal lobectomy.
Clinical, Electrocardiographic, and Echocardiographic Features in Hospitalized Nonagenarians (90+): Comparison between the Genders
Authors: Tsialtas Dimitri , Bolognesi Maria Giulia , Assimopoulos Stephania , Aldigeri Raffaella , Volpi Riccardo , Bolognesi Roberto
Published: May 2019

Objectives: We investigated the clinical, electrocardiographic, and echocardiographic determinants of the cardiac status in nonagenarian patients. Methods: We consecutively examined 654 Caucasian patients (232 males and 422 females) aged ≥90 years. All patients underwent clinical examination, ECG, and transthoracic echocardiography. Results: Their average age was 92.5 ± 2.5 years. Patients were predominately female of older age (p < 0.0001 and p = 0.02, respectively). A history of cardiovascular disease was present in 78.4% of the participants. One third of the patients was hospitalized for cardiovascular causes, with females being twice as many (p < 0.0001). Females showed higher levels of serum cholesterol, triglycerides, and glycemia (p < 0.0001, p< 0.0001, and p = 0.04 respectively). Sinus rhythm was detected in 65%, and atrial fibrillation in 31% of the overall population. Heart rate, PR and corrected QT (QTc) intervals, right bundle branch block (RBBB) and RBBB associated with left anterior fascicular block (LAFB) were higher in males (p < 0.0001, p = 0.036, p = 0.009, p = 0.001, and p = 0.004, respectively). Aortic root dimension, left ventricular (LV) mass index, and indexed LV systolic-diastolic volumes were higher in males (p < 0.001, p < 0.0001, p < 0.001, and p < 0.0001, respectively). Women showed fewer LV segmental kinetic disorders (p = 0009) and higher LV ejection fraction (LVEF; p< 0.0001). Hyperuricemia was positively associated with a history of cardiovascular disease (r = 0.15), glycemia (r = 19), creatininemia (r = 0.50), uremia (r = 0.51), triglycerides (r = 0.19), PR interval (r = 0.14), and left bundle branch block (r = 0.11), and inversely associated with sinus rhythm (r = –0.14) and LVEF (r = –0.17). Diabetes was positively correlated with PR and QTc intervals (r = 0.14 and r = 0.10, respectively), and RBBB with LFAB (r = 0.10), and inversely correlated with LVEF (r = –0.10). Conclusions: We found a remarkable presence of cardiovascular risk factors, ECG, and structural alterations in hospitalized nonagenarians, which presents more commonly in males.
Peripheral Inflammation Markers of Chemosensitivity to Induction Chemotherapy in Hypopharyngeal Cancer Patients
Authors: Sun Wei , Huang Jin-Qiang , Chen Lin , Wen Wei-Ping
Published: May 2019

Background: Induction chemotherapy (ICT) has become an initial treatment for late-stage hypopharyngeal squamous cell carcinoma (SCC); however, there are no data regarding ICT sensitivity for this population. Objective: This study investigated the predictive value of various inflammation markers for ICT responses in hypopharyngeal SCC. Methods: The data from 72 patients who received initial ICT treatment were obtained and associations between pretreatment inflammation markers and overall responses to ICT were calculated. Results: According to receiver operating characteristic curves, pretreatment lymphocyte count (PLC), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) achieved diagnostic accuracy for overall responses to ICT. These indicators were classified into two groups according to their cut-off values. Overall response rates were significantly higher in the low PLC (p < 0.01), high NLR (p = 0.035), and high PLR (p = 0.012) groups. Conclusion: Our results showed that low PLC, high NLR, and high PLR are predictors of positive responses to ICT in hypopharyngeal SCC patients.
Quantitative Analysis of Retinal Microvascular Changes after Conbercept Therapy in Branch Retinal Vein Occlusion Using Optical Coherence Tomography Angiography
Authors: Deng Yang , Cai Xiaojuan , Zhang Shaochong , Su Lishi , Chen Hui , Lin Ying , Sun Limei , Chen Guandi , Zhong Liting , Jin Chenjin , Chi Wei
Published: May 2019

Purpose: To quantitatively evaluate microvascular changes in eyes with macular oedema due to branch retinal vein occlusion (BRVO) using optical coherence tomography angiography (OCTA) before and after intravitreal conbercept injection and the correlation of such changes with best-corrected visual acuity (BCVA) and retinal thickness. Methods: Twenty-eight eyes of 28 patients treated with a single intravitreal injection of conbercept for macular oedema due to BRVO were included in this study. The automatically measured values of the vessel density in the superficial (SCP) and deep retinal capillary plexus (DCP), the foveal avascular zone (FAZ) area, the FAZ perimeter, the vessel density within a 300 μm wide ring surrounding the FAZ (FD-300), the acircularity index (AI), the choriocapillaris flow area and the retinal thickness were obtained via OCTA before and at 1 month after initial injection and compared with those of age- and sex- matched healthy subjects. Results: In BRVO eyes, the vascular density in the SCP and DCP, the FD-300 and the flow area of choriocapillaris were significantly lower than those in healthy eyes, while the AI and the retinal thickness were significantly increased. After treatment, the retinal thickness in eyes with BRVO was significantly decreased in all quadrants, and the mean BCVA dramatically increased from 20/162 to 20/78 (p = 0.0017). The mean flow area of choriocapillaris significantly improved after treatment. Moreover, negative correlations between the logMAR BCVA and the whole vascular density in the SCP and DCP as well as the flow area of choriocapillaris were observed. Conclusion: OCTA enables non-invasive, layer-specific and quantitative assessment of microvascular changes in eyes with BRVO before and after treatment, and it can be used as a valuable imaging tool for the evaluation of the follow-up in BRVO patients.
The Diagnostic Role of Methyl Green-Pyronin Y Staining in Oral Leukoplakia and Oral Squamous Cell Carcinoma: An Exfoliative Cytology-Based Cytomorphometric Analysis
Authors: Raman Rahul Kumar , Kamboj Mala , Narwal Anjali
Published: May 2019

Background: Oral exfoliative cytology is a noninvasive and nonpainful technique for early diagnosis of oral potentially malignant disorders and oral cancer, and the use of cytomorphometry ameliorates its diagnostic reliability. The objective of the present study was to analyze methyl green-pyronin Y (MGP)-stained oral exfoliated cells (OECs) of oral leukoplakia (OL) and oral squamous cell carcinoma (OSCC) by cytomorphometry. Materials and Method: An observational study was conducted on 150 individuals equally divided into three groups: normal mucosa, OL, and OSCC. Smears were prepared from OECs and stained with MGP. Cytomorphometry was done for 100 cells per subject, and various cell and nuclear parameters were measured and calculated. Results: The Kruskal-Wallis test with post hoc correlation showed significant differences in nucleus and cell diameter (ND, CD), nucleus and cell area (NA, CA), nucleus and cell perimeter (NP, CP), and nucleus to cytoplasmic (N:C) ratio for diameter, perimeter, and area. Spearman’s ρ correlation of various N:C ratio methods showed good correlation between N:C perimeter and diameter ratio, N:C diameter and ellipse ratio, and N:C area and ellipse ratio. Additional morphological factors showed significant relations for both cell and nuclear regularity factor, shape factor, and nuclear contour index. Discussion: MGP-based cytomorphometry showed a significant decrease in CD, CA, and CP and increase in ND, NA, NP, and N:C ratio from normal mucosa to OL and OSCC. MGP proved its worth as an effective stain for OECs, despite its strict standardization.
Hybrid Laparoendoscopic Single-Site Surgery Using a 2-mm Mini-Laparoscopic Instrument versus Conventional Three-Port Laparoscopy for Gynecologic Adnexal Diseases: A Prospective Randomized Trial
Authors: Shin In-Whoan , Park Hana , Kang Hyun , Jung Youn-Joon , Lee Eun-Ju
Published: May 2019

Background: Despite the advantages of laparoendoscopic single-site surgery (LESS), it has certain limitations that include longer surgical time, larger incision, and instrument collision. Objective: To overcome these limitations, we incorporated a suprapubic 2-mm needle forceps into our hybridized LESS (hLESS) and evaluated its efficacy for benign adnexal disease in comparison with three-port laparoscopy (TPL). Methods: This prospective study included 61 women randomly assigned in a 1:1 ratio. Incisions of 12 and 2 mm were made, respectively, at the umbilicus and suprapubic areas for hLESS. The length of surgery was compared. Postoperative pain was evaluated using a visual analog scale score, and consumption of analgesics. Cosmetic outcomes were assessed using a modified Vancouver Scar Scale and a body image questionnaire. Results: The length of surgery was found to be similar. The pain score 2-h postoperatively was significantly less in the hLESS group. The scar impact from the hLESS was significantly more favorable compared to that from the TPL. The patients in the hLESS group had a significantly better perception of their body image. Conclusion: Despite the reduced umbilical incision size and the absence of specialized instruments required in LESS, the hLESS revealed a similar surgical time, lower postoperative pain, and a better cosmetic outcome compared to TPL.
“Mercedes-Benz Sign” on CSF Cytology
Authors: Xu Xiaolu , Ren Haitao , Guan Hongzhi
Published: May 2019

Cryptococcus meningitis is a potentially lethal disease, and cerebrospinal fluid cytology is crucial in establishing diagnosis. We report a novel and interesting morphological sign of Cryptococcus neoformansin CSF cytology resembling the logo of Mercedes-Benz. The sign is highly suggestive of Cryptococcus infection and is a strong indicator for more specific tests and timely treatment.
Severe Daily Headache as an Uncommon Manifestation of Widespread Skull Base Osteomyelitis
Authors: van der Valk Jens , Treurniet Frank , Koopman Jan Pieter , Koppen Hille
Published: May 2019

Temporal bone osteomyelitis has been recognized for decades as a complication of otitis externa, specifically in elderly patients with diabetes. A much less prevalent form is skull base osteomyelitis. We report a 70-year-old man with diabetes who presented to our outpatient clinic with severe chronic daily complaints of headache. The headache was located frontoparietally and kept him awake at night. Imaging (nonenhanced computed tomography [CT], magnetic resonance imaging, and positron emission tomography/CT) showed a hypermetabolic mass on the right side of the skull base, in the middle ear, and in the mastoid process, with invasion and partial destruction of the surrounding elements of the petrous bone, the occipital bone, and the sphenoid bone on the right, with extension by way of the clivus into the apex of the left petrous bone. Diagnostic puncture revealed Streptococcus pneumoniae.The final diagnosis was severe daily headache due to central skull base osteomyelitis. Our case emphasizes the need for proper clinical and radiological investigation keeping the diagnosis of skull base osteomyelitis in mind with patients with diabetes or otherwise immunocompromised status who present with chronic daily headache and otalgia.
PD-L1 Expression in Unresectable Locally Advanced or Metastatic Skin Squamous Cell Carcinoma Treated with Anti-Epidermal Growth Factor Receptor Agents
Authors: Cavalieri Stefano , Perrone Federica , Milione Massimo , Bianco Alba , Alfieri Salvatore , Locati Laura D. , Bergamini Cristiana , Resteghini Carlo , Galbiati Donata , Platini Francesca , Licitra Lisa , Bossi Paolo
Published: May 2019

Background: Recurrent or metastatic (R/M) skin squamous cell carcinoma (sSCC) not amenable of surgery or irradiation may benefit from systemic therapies. Epidermal growth factor receptor (EGFR) inhibitors and, more recently, immune checkpoint blockers (ICBs) showed activity in R/M sSCC. In this study, we aimed at exploring the possible role of PD-L1 expression in predicting response to anti-EGFR agents. Methods: Patients affected by R/M sSCC, treated with pan-HER inhibitor dacomitinib or with platinum-based chemotherapy with cetuximab (CT-cet) from 2010 to 2016, were considered. PD-L1 expression was assessed with immunohistochemistry on tumor cells (TCs) and on microenvironment (TC and tumor-infiltrating lymphocyte [IC] scores, respectively). Prognostic role of PD-L1 and the correlation with response to EGFR inhibitors and survival were analyzed. Results: Twenty-eight R/M sSCCs were analyzed (19 treated with dacomitinib, 9 with CT-cet). TC and IC were negative in 82 and 45% of cases, respectively; 15% sSCCs were both TC and IC positive. Progression-free survival (PFS) was longer in IC-positive cases (median 7.5 months vs. 2.1 in IC0, p = 0.02). No statistically significant differences were observed between PD-L1 expression and both overall survival and response rates. Conclusion: PD-L1 expression in microenvironment predicted better PFS. The combination of EGFR inhibitors and ICB could help deepening the knowledge about the interrelations between the EGFR and PD-1/PD-L1 pathways.
Patients Who Attend Alone at a First Memory Consultation: Are They a Specific Population,or Is It an Instance of Confounding Bias?
Authors: Koskas Pierre , Romdhani Mouna , Drunat Olivier
Published: May 2019

As commonly happens in epidemiological research, none of the reported studies were totally free of methodological problems. Studies have considered the influence of social relationships on dementia, but the mechanisms underlying these associations are not perfectly understood. We look at the possible impact of selection bias. For their first memory consultation, patients may come alone or accompanied by a relative. Our objective is to better understand the impact of this factor by retrospective follow-up of geriatric memory outpatients over several years. All patients over 70 who were referred to Bretonneau Memory Clinic for the first time, between January 2006 and 2018, were included in the study. The patients who came alone formed group 1, the others, whatever type of relative accompanied them, formed group 2. We compared the Mini-Mental State Examination (MMSE) scores of patients; and for all patients who came twice for consultation with at least a 60-day interval, we compared their first MMSE with the MMSE performed at the second consultation. In total, 2,935 patients were included, aged 79.7 ± 8.4 years. Six hundred and twenty-five formed group 1 and 2,310 group 2. We found a significant difference in MMSE scores between the 2 groups of patients; and upon second consultation in group 2, but that difference was minor in group 1. Our finding of a possible confounding factor underlines the complexity of choosing comparison groups in order to minimize selection bias while maintaining clinical relevance.
How Are Self-Efficacy and Motivation Related to Drinking Five Years after Residential Treatment A Longitudinal Multicenter Study
Authors: Müller Anja , Znoj Hansjörg , Moggi Franz
Published: May 2019

Background: Abstinence-related self-efficacy and action-oriented motivation to change addictive behaviours have been demonstrated to be important predictors of post-treatment drinking. However, there are only a few studies that assess drinking outcomes through a long-term follow-up interval. Objectives: The purpose of this longitudinal observational study is to evaluate whether self-efficacy and motivation at a 1-year follow-up mediate the relationship of self-efficacy at discharge from residential treatment with drinking outcomes at 5-year follow-up. Method: Simple and serial multiple mediation analyses were conducted on data collected from 263 patients (174 men, 89 women) with severe alcohol use disorder (AUD). Self-efficacy was measured at discharge and 1-year follow-up, and motivation was also measured at 1-year follow-up. Abstinence, percent days of abstinence (PDA), and drinks per drinking day (DDD) were used as drinking outcomes at 5-year follow-up. Exploring the indirect paths provided details about the interrelationship between self-efficacy and motivation. Results: Self-efficacy at discharge predicted abstinence and PDA. The mediation models suggest that self-efficacy at discharge was associated with self-efficacy and motivation at 1-year follow-up, which in turn was related to better long-term drinking outcomes, in particular for abstinence and PDA at 5-year follow-up. No such effects were found for DDD. Conclusions: The results indicate that self-efficacy and motivation are interrelated in improving long-term abstinence and PDA following residential treatments and may play a substantial role in recovery from AUD.
Hydrocephalus of King Charles II of Spain, the Bewitched King
Authors: Turliuc Mihaela Dana , Cucu Andrei Ionut , Perciaccante Antonio , Tosolini Giulia , De Luca Stefano , Costachescu Bogdan , Costea Claudia Florida
Published: May 2019

King of the Spanish Habsburg dynasty and sovereign of the overseas Spanish Empire, Charles II of Spain, was physically disabled, disfigured, mentally retarded, and he proved impotent. He is known in history as El Hechizado (the Bewitched) because both him and the people believed that his mental and physical incapacity were due to a “witchcraft act.” Although several authors speculated about different diseases, most of them genetic such as pituitary hormone deficiency, distal renal tubular acidosis, Klinefelter syndrome, fragile X syndrome, or male XX hermaphroditism, the hypothesis of hydrocephalus was not taken into account. We don’t have clear elements to hypothesize a certain etiology of Charles II’ hydrocephalus; however, we think the herpetic infection he suffered of after his birth should not be ignored.
Treatment of Chronic Hepatitis C: Efficacy, Side Effects and Complications
Authors: Sandmann Lisa , Schulte Benjamin , Manns Michael P. , Maasoumy Benjamin
Published: May 2019

Background: Chronic hepatitis C virus (HCV) infection can lead to liver cirrhosis and its complications. Viral eradication is essential to prevent disease progression and reduces liver-related mortality and morbidity. Since the availability of direct-acting antivirals (DAA), HCV treatment has changed significantly. Current treatment strategies for different groups of patients as well as potential risks and caveats will be discussed in this review. Summary: Interferon-free (IFN-free) treatment not only shortens treatment duration, but also achieves high rates of viral clearance and is overall well tolerated. Genotype-restricted but also pangenotypic combinations are available. Usually two DAA of different drug classes are combined. For the majority of the patients, treatment duration ranges from 8 to 12 weeks. Liver and kidney function as well as prior treatment experience and potential drug-drug interactions influence substance choices and treatment duration. However, modern IFN-free treatment is not only safer, but also overall far more simplified and effective. Global HCV eradication might be an ambitious but not completely unrealistic goal to pursue. Key Messages: IFN-free antiviral treatment is safe and well tolerated. Patients can be treated almost independently of liver function or concomitant disease. Viral eradication is associated with reduced morbidity and mortality and better quality of life.
Apps and More: Potentials of Digitalization in Breast Medicine
Authors: Overkamp Friedrich
Published: May 2019

Digitalization in medicine is already being welcomed by some as a revolution and a deliverance, while others are still tending to take a more critical view of it. Digital tools are certainly still unfamiliar to the majority of physicians, and their potential benefits may not be immediately clear. As digitalization continues to advance, however, several exciting developments are emerging that may also be of interest in gynecology, and in particular for gynecological oncology and breast medicine. This note aims to outline a few examples in three areas: wearables, telemedicine, and “big data.” Two other areas of development – digital follow-up and digital knowledge transfer – are also discussed in more detail.
Genome-Wide Association Study–Driven Gene-Set Analyses, Genetic, and Functional Follow-Up Suggest
GLIS1
as a Susceptibility Gene for Mitral Valve Prolapse
Authors: Yu Mengyao , Georges Adrien , Tucker Nathan R. , Kyryachenko Sergiy , Toomer Katelyn , Schott Jean-Jacques , Delling Francesca N. , Fernandez-Friera Leticia , Solis Jorge , Ellinor Patrick T. , Levine Robert A. , Slaugenhaupt Susan A. , Hagège Albert A. , Dina Christian , Jeunemaitre Xavier , Milan David J. , Norris Russell A. , Bouatia-Naji Nabila
Published: May 2019

Background

Mitral valve prolapse (MVP) is a common heart valve disease, the most frequent indication for valve repair or replacement. MVP is characterized by excess extracellular matrix secretion and cellular disorganization, which leads to bulky valves that are unable to coapt correctly during ventricular systole resulting in mitral regurgitation, and it is associated with sudden cardiac death. Here we aim to characterize globally the biological mechanisms underlying genetic susceptibility to MVP to better characterize its triggering mechanisms.

Methods

We applied
i
-GSEA4GWAS and DEPICT, two pathway enrichment tools to MVP genome-wide association studies. We followed-up the association with MVP in an independent dataset of cases and controls. This research was conducted using the UK Biobank Resource. Immunohistochemistry staining for Glis1 (GLIS family zinc finger 1) was conducted in developing heart of mice. Knockdown of
Glis1
using morpholinos was performed in zebrafish animals 72 hours postfertilization.

Results

We show that genes at risk loci are involved in biological functions relevant to actin filament organization, cytoskeleton biology, and cardiac development. The enrichment for positive regulation of transcription, cell proliferation, and migration motivated the follow-up of
GLIS1
, a transcription factor from the Krüppel-like zinc finger family. In combination with previously available data, we now report a genome-wide significant association with MVP (odds ratio, 1.20;
P
=4.36×10
-10
), indicating that
Glis1
is expressed during embryonic development predominantly in nuclei of endothelial and interstitial cells of mitral valves in mouse. We also show that
Glis1
knockdown causes atrioventricular regurgitation in developing hearts in zebrafish.

Conclusions

Our findings define globally molecular and cellular mechanisms underlying common genetic susceptibility to MVP and implicate established and unprecedented mechanisms. Through the
GLIS1
association and function, we point at regulatory functions during cardiac development as common mechanisms to mitral valve degeneration.
Assessment and Validation of a Phenotype-Enhanced Variant Classification Framework to Promote or Demote
RYR2
Missense Variants of Uncertain Significance
Authors: Giudicessi John R. , Lieve Krystien V.V. , Rohatgi Ram K. , Koca Faruk , Tester David J. , van der Werf Christian , Martijn Bos J. , Wilde Arthur A.M. , Ackerman Michael J.
Published: May 2019

Background

Many rare, potentially pathogenic,
RYR2
variants identified in individuals with clinically definite catecholaminergic polymorphic ventricular tachycardia are classified ambiguously as variants of uncertain significance (VUS). We aimed to determine if a phenotype-enhanced variant classification approach could reduce the burden of
RYR2
VUS encountered during clinical genetic testing.

Methods

This retrospective study was conducted in 84
RYR2
-positive individuals from the Mayo Clinic (Rochester, MN) and validated in 149
RYR2
-positive individuals from Amsterdam University Medical Center (Amsterdam, NL). Using a newly developed diagnostic scorecard, the pretest clinical probability of catecholaminergic polymorphic ventricular tachycardia was determined for all
RYR2
-positive individuals. Each
RYR2
variant was then readjudicated using a phenotype-enhanced American College of Medical Genetics approach that incorporates new criteria that reflect the phenotypic strength associated with each individual
RYR2
variant.

Results

Overall, 72 distinct
RYR2
variants were identified among the 84 Mayo Clinic (39 unique) and 149 Amsterdam University Medical Center (30 unique) cases. Three variants were present in both cohorts. American College of Medical Genetics guidelines classified 47% of all
RYR2
variants as VUS. In the Mayo Clinic cohort, readjudication using amended phenotype-enhanced American College of Medical Genetics standards dropped the VUS rate significantly (20/42 [48%] versus 3/42 [7%];
P
<0.001) with 13/20 (65%)
RYR2
VUS promoted to likely pathogenic and 4/20 (20%) demoted to likely benign. A similar drop in VUS rate (14/33 [42%] versus 3/33 [9%];
P
=0.001) was observed in the Amsterdam University Medical Center validation cohort with 10/14 (71%)
RYR2
VUS promoted to likely pathogenic and 1/14 (7%) demoted to likely benign.

Conclusions

This multicenter study illustrates the potential utility of phenotype-enhanced variant classification in catecholaminergic polymorphic ventricular tachycardia.
Left Ventricular Flow Analysis
Authors: Stoll Victoria M. , Hess Aaron T. , Rodgers Christopher T. , Bissell Malenka M. , Dyverfeldt Petter , Ebbers Tino , Myerson Saul G. , Carlhäll Carl-Johan , Neubauer Stefan
Published: May 2019

Background:

Cardiac remodeling, after a myocardial insult, often causes progression to heart failure. The relationship between alterations in left ventricular blood flow, including kinetic energy (KE), and remodeling is uncertain. We hypothesized that increasing derangements in left ventricular blood flow would relate to (1) conventional cardiac remodeling markers, (2) increased levels of biochemical remodeling markers, (3) altered cardiac energetics, and (4) worsening patient symptoms and functional capacity.

Methods

Thirty-four dilated cardiomyopathy patients, 30 ischemic cardiomyopathy patients, and 36 controls underwent magnetic resonance including 4-dimensional flow, BNP (brain-type natriuretic peptide) measurement, functional capacity assessment (6-minute walk test), and symptom quantification. A subgroup of dilated cardiomyopathy and control subjects underwent cardiac energetic assessment. Left ventricular flow was separated into 4 components: direct flow, retained inflow, delayed ejection flow, and residual volume. Average KE throughout the cardiac cycle was calculated.

Results:

Patients had reduced direct flow proportion and direct-flow average KE compared with controls (
P
<0.0001). The residual volume proportion and residual volume average KE were increased in patients (
P
<0.0001). Importantly, in a multiple linear regression model to predict the patient’s 6-minute walk test, the independent predictors were age (β=−0.3015;
P
=0.019) and direct-flow average KE (β=0.280,
P
=0.035; R
2
model, 0.466,
P
=0.002). In contrast, neither ejection fraction nor left ventricular volumes were independently predictive.

Conclusions:

This study demonstrates an independent predictive relationship between the direct-flow average KE and a prognostic measure of functional capacity. Intracardiac 4-dimensional flow parameters are novel biomarkers in heart failure and may provide additive value in monitoring new therapies and predicting prognosis.
Not-so-working Memory: Drift in Functional Magnetic Resonance Imaging Pattern Representations during Maintenance Predicts Errors in a Visual Working Memory Task
Authors: Lim Phui Cheng , Ward Emily J. , Vickery Timothy J. , Johnson Matthew R.
Published: May 2019

Working memory (WM) is critical to many aspects of cognition, but it frequently fails. Much WM research has focused on capacity limits, but even for single, simple features, the fidelity of individual representations is limited. Why is this? One possibility is that, because of neural noise and interference, neural representations do not remain stable across a WM delay, nor do they simply decay, but instead, they may “drift” over time to a new, less accurate state. We tested this hypothesis in a functional magnetic resonance imaging study of a match/nonmatch WM recognition task for a single item with a single critical feature: orientation. We developed a novel pattern-based index of “representational drift” to characterize ongoing changes in brain activity patterns throughout the WM maintenance period, and we were successfully able to predict performance on the match/nonmatch recognition task using this representational drift index. Specifically, in trials where the target and probe stimuli matched, participants incorrectly reported more nonmatches when their activity patterns drifted away from the target. In trials where the target and probe did not match, participants incorrectly reported more matches when their activity patterns drifted toward the probe. On the basis of these results, we contend that neural noise does not cause WM errors merely by degrading representations and increasing random guessing; instead, one means by which noise introduces errors is by pushing WM representations away from the target and toward other meaningful (yet incorrect) configurations. Thus, we demonstrate that behaviorally meaningful drift within representation space can be indexed by neuroimaging.
Attentional Weighting in the Face Processing Network: A Magnetic Response Image-guided Magnetoencephalography Study Using Multiple Cyclic Entrainments
Authors: de Vries Eelke , Baldauf Daniel
Published: May 2019

We recorded magnetoencephalography using a neural entrainment paradigm with compound face stimuli that allowed for entraining the processing of various parts of a face (eyes, mouth) as well as changes in facial identity. Our magnetic response image-guided magnetoencephalography analyses revealed that different subnodes of the human face processing network were entrained differentially according to their functional specialization. Whereas the occipital face area was most responsive to the rate at which face parts (e.g., the mouth) changed, and face patches in the STS were mostly entrained by rhythmic changes in the eye region, the fusiform face area was the only subregion that was strongly entrained by the rhythmic changes in facial identity. Furthermore, top–down attention to the mouth, eyes, or identity of the face selectively modulated the neural processing in the respective area (i.e., occipital face area, STS, or fusiform face area), resembling behavioral cue validity effects observed in the participants' RT and detection rate data. Our results show the attentional weighting of the visual processing of different aspects and dimensions of a single face object, at various stages of the involved visual processing hierarchy.
The Influence of Hippocampal Dopamine D2 Receptors on Episodic Memory Is Modulated byBDNFandKIBRAPolymorphisms
Authors: Papenberg Goran , Karalija Nina , Salami Alireza , Andersson Micael , Axelsson Jan , Riklund Katrine , Lindenberger Ulman , Nyberg Lars , Bäckman Lars
Published: May 2019

Episodic memory is a polygenic trait influenced by different molecular mechanisms. We used PET and a candidate gene approach to investigate how individual differences at the molecular level translate into between-person differences in episodic memory performance of elderly persons. Specifically, we examined the interactive effects between hippocampal dopamine D2 receptor (D2DR) availability and candidate genes relevant for hippocampus-related memory functioning. We show that the positive effects of high D2DR availability in the hippocampus on episodic memory are confined to carriers of advantageous genotypes of the brain-derived neurotrophic factor ( BDNF, rs6265) and the kidney and brain expressed protein ( KIBRA, rs17070145) polymorphisms. By contrast, these polymorphisms did not modulate the positive relationship between caudate D2DR availability and episodic memory.
Buddhist Vegetarianism Views on Equivalent Reduction of Greenhouse Gas Emissions in China from 2017 to 2027
Authors: Tseng Ampere A.
Published: May 2019

The impact of Buddhist vegetarianism views on the equivalent reduction of greenhouse gas emissions (GHGE s) is evaluated. The vegetarianism views from three major Buddhist schools in China are first presented, since different views on vegetarianism can dictate the assessment of the equivalent of GHGE reduction. The populations of Chinese Buddhists in these three Buddhist schools are then estimated. A correlation formula is used to evaluate the equivalent GHGE reductions attributed to the vegan and vegetarian populations in the Chinese Buddhists from 2017 to 2027. The reduction results enable us to conclude that Chinese Buddhists with vegan or vegetarian diets account for the equivalent GHGE reduction of 54.560 MtCO2e in 2017 and 60.927 MtCO2e in 2027 with an average annual growth rate of 1.11 %. The reductions of 54.560 and 60.927 MtCO2e equal to 11.66 % and 13.02 % of the total GHGE s from the United Kingdom in 2016, respectively.
On Tools Making Minds: an Archaeological Perspective on Human Cognitive Evolution
Authors: Overmann Karenleigh A. , Wynn Thomas
Published: May 2019

Using a model of cognition as extended and enactive, we examine the role of materiality in making minds as exemplified by lithics and writing, forms associated with conceptual thought and meta-awareness of conceptual domains. We address ways in which brain functions may change in response to interactions with material forms, the attributes of material forms that may cause such change, and the spans of time required for neurofunctional reorganization. We also offer three hypotheses for investigating co-influence and change in cognition and material culture.
Cultural Models of Substance Misuse Risk and Moral Foundations: Cognitive Resources Underlying Stigma Attribution
Authors: Henderson Nicole Lynn , Dressler William W.
Published: May 2019

This study examines the cognitive resources underlying the attribution of stigma in substance use and misuse. A cultural model of substance misuse risk was elicited from students at a major U.S. state university. We found a contested cultural model, with some respondents adopting a model of medical risk while others adopted a model of moral failure; agreeing that moral failure primarily defined risk led to greater attribution of stigma. Here we incorporate general beliefs about moral decision-making, assessed through Moral Foundations Theory. Specifically, we examined commitment to each moral foundation in relation to stigma attribution while controlling for the specific model of substance misuse risk. We found an interaction between the purity moral foundation and the cultural model of risk. This suggests that broad moral orientations, along with more specific understandings of substance misuse risk, combine to orient an individual with respect to stigma attribution.
Ritualized Objects: How We Perceive and Respond to Causally Opaque and Goal Demoted Action
Authors: Kapitány Rohan , Nielsen Mark
Published: May 2019

Rituals are able to transform ordinary objects into extraordinary objects. And while rituals typically do not cause physical changes, they may imbue objects with a particular specialness – a simple gold band may become a wedding ring, while an ordinary dessert may become a birthday cake. To treat such objects as if they were ordinary then becomes inappropriate. How does this transformation take place in the minds of observers, and how do we recognize it when we see it? Here, we suggest that two under-examined elements of ritual need deeper consideration within the context of ritual cognition. We propose a fully integrated operational definition in which these two critical ritual elements – causal opacity and goal demotion – are included. In a pre-registered experiment one-hundred and one adults, in a 2 × 2 mixed-within participants design observed actions performed upon profane objects. These actions were either ordinary (causally transparent and goal apparent) or ritualized (causally opaque and goal demoted), and were described as a blessing, a curse, or were not described at all. Contrary to established findings and pre-registered predictions, we found that ritualized actions alone are not enough to influence perceptions of, and attributions towards, objects, and that positive goal information (blessings) are more behaviorally persuasive than negative information. However, we found that participants recalled ritualized action in greater detail and with more specificity than ordinary actions. In effect, we demonstrate that causal opacity and goal information interact to allow us to recognize a ritual as a ritual.
Manless Women and the Sex–Desire–Procreation Link in Song Medicine
Authors: Cheng Hsiao-wen
Published: May 2019

This article examines Chinese medical discussions about “manless women” (women without sexual contact with men) from the ancient period to the Song dynasty and whether, and how, such women were considered a medical problem. Through destabilizing the (hetero)sex–desire–procreation continuum seen in a number of historical sources and modern scholarship, I present a more complex picture of the medical developments in question during the Song. I observe that there was little medical discussion of female sexual desire in pre-Song sources except in “bedchamber” texts, which, in treating the ailments of manless women, gazed into women’s sexual desire and paid little attention to women’s generative or gestational body. Several Song medical writers, while consciously excluding bedchamber texts from what they considered orthodox medicine, shared with the bedchamber authors the medical gaze at female sexual desire. I further argue that Xu Shuwei and Chen Ziming were the first and only two Song medical writers to make explicit a (hetero)sex–desire–procreation link and to naturalize women’s sexual desire for men. Though anomalous in their time, their discussions tell us something about the heterogeneity of medical texts and the status of medical knowledge in Song society—two aspects often neglected in analyses of gender discourse in traditional Chinese medicine.
The 2017 Basham Medal Lectures
Authors: Messner Angelika C. , Samuel Geoffrey , Sakai Shizu , Farquhar Judith , Lo Vivienne
Published: May 2019

This report contains three lectures given during acceptance ceremonies by awardees of the International Association for the Study of Traditional Asian Medicine’s prestigious Basham Award. While they concern episodes in the modern history of Japanese medicine, the contemporary medicine of the Yao national minority in China, and ancient Chinese self-cultivation practices, all three engage in deeper reflections on the craft and methods of the historian that will speak to all readers of Asian Medicine.
Indian Therapeutic Hierarchies and the Politics of Recognition
Authors: Lambert Helen
Published: May 2019

Social science research on medicine in India has moved from village-based ethnographies to studies of the major medical traditions, and from a focus on indigenous folk practices to the influence of global biomedicine. This article shows how these academic trends have influenced the contemporary understanding of medical pluralism in India. The article then describes the socio-political structuring of medical plurality, by relating historical shifts in government policy on indigenous medicine to ethnographic material on “bone doctors” and other subaltern traditions in north India. It highlights the role of the state as constitutive of contemporary medical pluralism and suggests how current analytical frameworks for understanding the phenomenon of medical plurality might be reconceived to better characterise shifting relations of power among professional and vernacular therapeutic forms. It concludes that concerns over the decline of subaltern medical traditions, seen in government policies and vernacular explanations alike, can be understood as intracultural narratives that are replicated in academic scholarship.
Cumin, Capsules, and Colonialism
Authors: Nijhawan Shobna
Published: May 2019

The institutionalization of Western allopathic medicine in colonial India had significant implications for the cultural politics of the early twentieth century. The introduction of vaccinations, the establishment of hospitals and dispensaries, scientific discourses on hygiene, bacteriology, and nutrition, the emergence of obstetrics and gynecology as medical disciplines, and the commercialization of medicine—to name but a few aspects of the institutionalization or elements leading thereto—were all topics that also concerned the Hindi literary sphere. This essay investigates how the Hindi literary public tackled the colonial state’s promotion of allopathy and modern sciences while, within the same discourse, it (re)discovered, systemized, and modernized indigenous medical knowledge traditions—most notably Ayurveda but also homespun remedies and folk medicine—for the prevention, treatment, and cure of disease. Prose fiction and prose essays, alongside advertisements in Hindi periodicals, testify to a range of opinions on what constituted a “healthy” blend of diverse “Eastern” and diverse “Western” medical traditions. This essay argues that the Hindi discourse on medicine and colonial modernity was steered by gendered nationalist politics, modern Western sciences, and commercial interests in maintaining a healthy body and working toward a healthy nation.
A Reciprocal Relationship
Authors: Rageth Nina
Published: May 2019

This article studies the interplay between Siddha medicine and Santhigiri, a Hindu guru organization in South India. Based on insights gained through ethnographic research in Kerala and Tamil Nadu, it analyzes how Santhigiri fashions itself as an indispensable actor in the restoration of Siddha medicine and valorizes its current Siddha medical activities. The article examines the dynamics that facilitate Santhigiri’s patronage of Siddha medicine and contribute to its continuing participation in the Siddha medical system. This social formation is conceptualized through the Bourdieusian framework of capital, arguing that Santhigiri’s appropriation of Siddha medicine bestows symbolic capital upon the organization, enabling it to secure and maintain a favorable position in the field of Hindu guru organizations. Furthermore, the article shows how, by adopting Siddha medicine, a religious organization such as Santhigiri with the necessary structural and financial means and a reputation for transcending economic interests extends the distribution of Siddha medicine beyond the Tamil community. Thus, the article emphasizes the reciprocal relationship between a religious organization and a medical system, arguing for the explanatory potential of conceiving of medicine as effective capital for religious organizations and, vice versa, of religious organizations as actors shaping the realm of medicine in India.
Snake Charmers on Parade
Authors: Lorea Carola Erika
Published: May 2019

Festivals have often been described as ritual occasions in which members of a community get together and overcome internal divisions and conflicts. The festival of Jhāṃpān (or Jhāpān Melā) provides a different definition of festivals as mirrors of social dramas and hierarchical divisions.

The Ojhās of Bengal are low-class rural healers specializing in curing snakebites. The Bedes (or Bedias) are tribal snake catchers who extract venom and sell it to private clinics. Both groups perform snake charming, a popular entertainment as well as a ritual practice, during particular religious festivals, such as the Jhāṃpān.

The diffusion and government support of Western medicine and education have seriously compromised the indigenous knowledge of these groups and attacked it as irrational superstition. Some of the most popular Jhāṃpān celebrations have been coercively stopped, and yet the festival is still celebrated in several districts and practitioners have developed strategic narratives to protect their knowledge.

This article analyzes the changing role of snake specialists in Bengali rural society through a historical and contextual study of the Jhāṃpān. The decline of this festival mirrors the crisis of the transmission of indigenous knowledge, which can be understood only by considering the intersections between healing, ritual, and entertainment.
Politicking Ayurvedic Education
Authors: Cerulli Anthony
Published: May 2019

As the Indian population’s interest in biomedicine increased at the end of the nineteenth century, public confidence in India’s indigenous medicines flagged. Physicians of Ayurveda and officials of Indian medical organizations responded with discussions about and plans for reconfiguring the āyurveda (“life science”) of the Sanskrit medical classics of Caraka, Suśruta, and Vāgbhaṭa to be compatible with the anatomical, physiological, and pharmacological frameworks of biomedicine. This article considers some of the negotiations that shaped Ayurveda in late colonial and postcolonial India, paying special attention to how these debates affected the history of ayurvedic education. Reflecting on how the presence of biomedicine in India prompted ayurvedic practitioners to reimagine the history of their profession, it examines the revitalization of Ayurveda through the reinvention of ayurvedic education. It probes the historical move away from the gurukula as the seat of education and the institutionalization and standardization of education in the ayurvedic college. The historical record is expanded periodically with ethnographic data collected at gurukulas in South India to offer contemporary views on changes in ayurvedic education over the past 130 years.1
China’s External Energy Security: Energy Trade and Investment Along the ‘Belt and Road’
Authors: Boute Anatole
Published: May 2019

As the world’s largest energy consumer, China’s energy security policies have significant implications for global, regional and national energy governance. However, the legal dimension of China’s external energy security remains understudied, with most attention in the energy law literature focused on EU and US energy security. This Special Issue studies the legal aspects of Chinese external energy cooperation by focusing on energy trade and investment under the ‘Belt and Road Initiative’ – the Chinese foreign policy concept aiming to promote regional and global economic integration through infrastructure interconnectivity. Three research questions govern the Special Issue. How does China’s external energy policy rely on, and impact on, regional and global energy market governance? How does China seek to protect its foreign energy investments? How does China’s external energy policy impact on host countries’ energy and investment laws?