bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of the Law of Unjust Enrichment in Singapore
Authors: Tang Hang Wu
Published: November 2020

Singapore’s unjust enrichment law may be described as a form of adoption with adaptation from English law, which is indicative of two phenomena: first, the idea of law as a travelling phenomenon and, second, the development of law as a circulation of ideas. In Singapore, unjust enrichment is now accepted as a distinct branch of the law of obligations alongside tort and contract, providing relief to a plaintiff who has transferred an enrichment to the defendant in circumstances where the plaintiff’s intent was vitiated. This vitiation of intent is expressed as an ‘unjust factor’. While certain ‘unjust factors’ are regarded as well established, Singapore’s jurisprudence has not confronted the difficult question of what are the proper considerations to consider before admitting new ‘unjust factors’. Hence, the unjust enrichment principle in Singapore may be described as positivist and weakly normative and operates as an organizing concept for pre-existing recognized ‘unjust factors’. Unlike civil law, unjust enrichment law in Singapore does not have a role to play when the enrichment is transferred where there is an absence of basis. This article also traces two constraints that limit the role of the law of unjust enrichment in other contexts—namely, the insistence that there must be a direct transfer of enrichment from the plaintiff to the defendant and that unjust enrichment claims may not operate where there is a valid contract conferring the enrichment. In terms of divergence, Singapore has charted its own course in terms of the role unjust enrichment law plays in the context of an illegal contract. Instead of relying on a range of considerations before allowing restitution, Singapore’s approach to restitution considers whether the claim would undermine the fundamental policy, be it statutory or of the common law, that rendered the contract in question void and unenforceable in the first place.
A case report of arterial and venous thromboembolism in a patient with severe COVID-19 pneumonia
Authors: Del Castillo-García Samuel , Minguito-Carazo Carlos , Echarte Julio César , Rodríguez-Santamarta Miguel , González Tomás Benito , Terroba Seara Sandra , Martìnez González Lara , Fernández-Vázquez Felipe
Published: November 2020

Background

Coronavirus disease 2019 (COVID-19) has spread rapidly worldwide since the outbreak originated in Wuhan, China in December 2019. Cardiovascular complications in patients with severe COVID-19 have been reported and are associated with a worse outcome. Coagulopathy is one of the most common life-threatening complication increasing mortality; however, little evidence is available regarding prevention strategies or its treatment in COVID-19 patients.

Case summary

We report a case of a 70-year-old woman admitted to hospital with severe COVID-19 bilateral pneumonia who developed severe coagulopathy with multiple both, venous and arterial, embolisms in major vessels such as bilateral pulmonary embolism, acute thrombus in abdominal aorta, and acute thrombotic occlusion of the right iliac common artery. The patient underwent emergent surgical thrombectomy of the right lower limb; in spite of anticoagulant treatment at therapeutic doses, patient presented poor clinical evolution and an infracondylar amputation of right lower limb was made finally. Subsequently, the patient received low molecular weight heparin (LMWH), antibiotics and antiviral therapy improving her renal function and her pneumonia, so she could be discharged safely.

Discussion

Prothrombotic coagulopathy due to enhanced acute inflammatory response and diffuse intravascular coagulation has been described in severe critical COVID-19 patients. This state of hypercoagulability is associated with organ dysfunction and mortality and may predispose to both, venous and arterial, thromboembolism. Little data are available regarding the best therapeutic and prevention strategies in this scenario, although thrombosis prophylaxis with LMWH has been associated with a better outcome.
Developing an authentication approach using SPME-GC-IRMS based on compound-specific δ 13C analysis of six typical volatiles in wine
Authors: Jin Xinyu , Zhang Limin , Wu Shimin , Huang Mingquan , Yu Wenjuan , Zhang Shanshan
Published: November 2020

An analytical method using gas chromatography isotope ratio mass spectrometry (GC-IRMS) combined with solid phase micro-extraction (SPME) was developed to measure the δ 13C values of six typical volatiles commonly occurring in wine (isoamyl acetate, 2-octanone, limonene, 2-phenylethanol, ethyl octanoate and ethyl decanoate) for the first time. SPME selected with a divinylbenzene/carboxen/polydimethylsiloxane fiber was combined with the GC-IRMS for pretreatment optimization. The optimized SPME parameters of extraction time, extraction temperature and salt concentration were 40 min, 40 °C and 10%, respectively. The δ 13C values measured by SPME-GC-IRMS were in good agreement with those measured via elemental analyzer (EA)-IRMS and GC-IRMS. The differences range from 0.02 to 0.44‰ with EA-IRMS and from 0 to 0.28‰ with GC-IRMS, indicating the high accuracy of the method. This newly established method measured the precision within 0.30‰ and was successfully validated to discriminate imported real wine samples with identical label but amazing price differences from different importers.
Achieving wind comfort through window design in residential buildings in cold climates, a case study in Tabriz city
Authors: Tamaskani Esfahankalateh Atefeh , Farrokhzad Mohammad , Saberi Ommid , Ghaffarianhoseini Amirhosein
Published: November 2020

Air movement affects thermal comfort both by increasing evaporative loss through the skin and heat transfer between the body and surrounding environment through convection. Generally, in cold climates, it is best to avoid wind to better control the thermal environment. However, crafted passive airflow is essential for providing fresh air and natural ventilation at certain times of year. The use of a window of the right size and location in a cold climate is also indispensable. In this study, the wind speed was calculated for the height of a residential building in the city of Tabriz. A computational fluid dynamics simulation was used to calculate the inflow air speed for each window and the comfort conditions were compared. The findings determined the months where window openings can be used to enhance thermal comfort. The analysis shows how the direction and shape of the window play a major role in directing outdoor air flow indoors at the right time in the right quantity. East- and west-facing windows are most favorable and north- and south-facing windows can only be used in some months. This shows how building designers can quantify the effect of window design in each climate for the occupant’s comfort.
Numerical analysis for nematic electrolytes
Authors: Baňas Ľubomír , Lasarzik Robert , Prohl Andreas
Published: November 2020

We consider a system of nonlinear PDEs modeling nematic electrolytes, and construct a dissipative solution with the help of its implementable, structure-inheriting and space–time discretization. Computational studies are performed to study the mutual effects of electric, elastic and viscous effects onto the molecules in a nematic electrolyte.
Enforcing China’s Anti-Monopoly law in regulated industries: a study of the airline industry
Authors: Cai Jingmeng , Lee Jae Woon
Published: November 2020

Since China enacted its Anti-Monopoly Law (AML) in 2007, foreign observers and business operators have constantly raised concerns as to whether the AML can inject a modern competition spirit into the world’s largest transitional economy or whether the AML will be overridden by policy objectives. These concerns become more obvious in industries that have been heavily regulated by the government. In this article, we choose the airline industry as a research target to explore possible ways to restrain industrial regulators from unduly interfering in competition and to reinforce the role of the AML. We focus on three kinds of administrative regulations in China’s domestic aviation market: limiting the threshold of market entry, price regulations, and subsidies. Then we analyse the policy objectives these regulations intend to achieve and their anti-competitive effects. Finally, we conclude with two suggestions from long-term and short-term perspectives: first, the newly established Fair Competition Review System (FCRS) should be effectively used to normalize and limit regulators’ policy-making authority. Moreover, the reviewing criteria should be made clearer and more meticulous to offer both FCRS reviewers and anti-monopoly agencies guidelines for assessing the effects of administrative behaviours on competition. Second, in the long term, industrial regulators are encouraged to set up competition-friendly industrial policies, embrace modern competition concepts in their traditional regulatory paradigm, and foster a competitive culture.
Prevalence of Gastroduodenal Polyps in Children With Familial Adenomatous Polyposis
Authors: Stone James K , Bernstein Charles N , Singh Harminder , El-Matary Wael
Published: November 2020

Objective

To assess the prevalence of upper gastrointestinal adenomatous polyps in a cohort of pediatric familial adenomatous polyposis (FAP) patients to determine if early screening is warranted.

Study Design

All 11 pediatric FAP patients diagnosed in Manitoba between January 2012 and December 2019 were recruited. Patient records were examined and data on age of diagnosis, gene mutation, age of first screening endoscopy, number of endoscopies, number of gastric and colonic polyps, associated pathology, medications, symptoms and FAP-related surgeries were extracted and descriptive statistics reported.

Results

A total of 11 children were diagnosed with FAP over the study period with a mean age at diagnosis of 6.3 ± 3.2 years with 72.3% males and median follow-up of 4.8 years. The mean age at first gastroscopy was 10.9 ± 2.9 years and 10.8 ± 3.0 years at colonoscopy. Eight patients (72%) had upper gastrointestinal polyps, with adenomatous changes seen in seven of them on pathology. No patients had invasive carcinoma or high-grade dysplasia. All patients developed tubular adenomas on colorectal polyp pathology. Four (36%) patients underwent surgical colectomy.

Conclusions

Early-onset upper gastrointestinal adenomatous polyps in a pediatric FAP are common. Our study provides further data to support consideration of further, large-scale research into the benefit of early endoscopic screening for upper gastrointestinal malignancy in FAP patients.
Using the rDNA Internal Transcribed Spacer 1 to Identify the Invasive PestRhagoletis cerasi(Diptera: Tephritidae) in North America
Authors: Barr Norman B , Garza Daniel , Ledezma Lisa A , Salinas David A
Published: November 2020

The cherry-infesting fruit fly Rhagoletis cerasi Loew is a significant commercial pest in Europe that has recently invaded North America. To date, it has been trapped only in Canada and northwestern counties of New York. It has the potential to spread further and threaten production and movement of cherry commodities. Timely diagnosis of the pest will facilitate surveys and quick response to new detections. Adult morphology of the pest is distinct from other flies in North America. However, when flies are significantly damaged on traps or the immature life stages are found in fruits, molecular methods of identification are important to confirm presence and host-use records. Other than DNA sequencing of genes from flies which takes over a day to complete, there are no timely methods of molecular identification for this pest. In this study, we report the first sequence record of the internal transcribed spacer 1 (ITS1) from R. cerasi and develop two diagnostic tests for the pest based on ITS1 differences among species in North America. The tests use loop-mediated isothermal amplification (LAMP) and multiplex, conventional polymerase chain reaction (mcPCR) technologies that target the same region of the R. cerasi ITS1 sequence. Both tests performed well when tested against collections of R. cerasi from North America and Europe, generating Diagnostic Sensitivity estimates of 98.4–99.5%. Likewise, the tests had relatively high estimates of Diagnostic Specificity (97.8–100%) when tested against Rhagoletis Loew species present in North America that also use cherry as a developmental host.
Sandwich freezing device for rapid freezing of viruses, bacteria, yeast, cultured cells and animal and human tissues in electron microscopy
Authors: Yamaguchi Masashi , Taguchi Masaki , Uematsu Katsuyuki , Takahashi-Nakaguchi Azusa , Sato-Okamoto Michiyo , Chibana Hiroji
Published: November 2020

We have been using sandwich freezing of living yeast and bacteria followed by freeze-substitution for observing close-to-native ultrastructure of cells. Recently, sandwich freezing of glutaraldehyde-fixed cultured cells and human tissues have been found to give excellent preservation of ultrastructure of cells and tissues. These studies, however, have been conducted using a handmade sandwich freezing device and have been limited in a few laboratories. To spread the use of this method to other laboratories, we fabricated and commercialized a new sandwich freezing device. The new device is inexpensive, portable and sterilizable. It can be used to rapid-freeze viruses, bacteria, yeast, cultured cells and animal and human tissues to a depth of 0.2 mm if tissues are prefixed with glutaraldehyde. The commercial availability of this device will expand application of rapid freezing to wide range of biological materials.
Unexpectedly low δ 13C in leaves, branches, stems and roots of three acacia species growing in hyper-arid environments
Authors: Uni Daphna , Groner Elli , Soloway Elaine , Hjazin Amgad , Johnswick Spencer , Winters Gidon , Sheffer Efrat , Rog Ido , Wagner Yael , Klein Tamir
Published: November 2020

Aims

In plant eco-physiology, less negative (enriched) carbon 13 (13C) in the leaves indicates conditions of reducing leaf gas exchange through stomata, e.g. under drought. In addition, 13C is expected to be less negative in non-photosynthetic tissues as compared with leaves. However, these relationships in δ 13C from leaves (photosynthetic organs) to branches, stems and roots (non-photosynthetic organs) are rarely tested across multiple closely related tree species, multiple compartments, or in trees growing under extreme heat and drought.

Methods

We measured leaf-to-root 13C in three closely related desert acacia species (Acacia tortilis, A. raddiana and A. pachyceras). We measured δ 13C in leaf tissues from mature trees in southern Israel. In parallel, a 7-year irrigation experiment with 0.5, 1.0 or 4.0 L day−1 was conducted in an experimental orchard. At the end of the experiment, growth parameters and δ 13C were measured in leaves, branches, stems and roots.

Important Findings

The δ 13C in leaf tissues sampled from mature trees was ca. −27‰, far more depleted than expected from a desert tree growing in one of the Earth’s driest and hottest environments. Across acacia species and compartments, δ 13C was not enriched at all irrigation levels (−28‰ to ca. −27‰), confirming our measurements in the mature trees. Among compartments, leaf δ 13C was unexpectedly similar to branch and root δ 13C, and surprisingly, even less negative than stem δ 13C. The highly depleted leaf δ 13C suggests that these trees have high stomatal gas exchange, despite growing in extremely dry habitats. The lack of δ 13C enrichment in non-photosynthetic tissues might be related to the seasonal coupling of growth of leaves and heterotrophic tissues.
CO2 stimulation and response mechanisms vary with light supply in boreal conifers
Authors: Dang Qing-Lai , Marfo Jacob , Du Fengguo , Man Rongzhou , Inoue Sahari
Published: November 2020

Aims

Black spruce (Picea mariana [Mill.] B.S.P.) and white spruce (Picea glauca [Moench] Voss.) are congeneric species. Both are moderately shade tolerant and widely distributed across North American boreal forests.

Methods

To understand light effects on their ecophysiological responses to elevated CO2, 1-year-old seedlings were exposed to 360 µmol mol−1 and 720 µmol mol−1 CO2 at three light conditions (100%, 50% and 30% of full light in the greenhouse). Foliar gas exchanges were measured in the mid- and late-growing season.

Important Findings

Elevated CO2 increased net photosynthesis (Pn) and photosynthetic water use efficiency, but it reduced stomatal conductance and transpiration. The stimulation of photosynthesis by elevated CO2 was greatest at 50% light and smallest at 100%. Photosynthesis, maximum carboxylation rate (Vcmax) and light-saturated rate of electron transport (Jmax) all decreased with decreasing light. Elevated CO2 significantly reduced Vcmax across all light treatments and both species in mid-growing season. However, the effect of elevated CO2 became insignificant at 30% light later in the growing season, with the response being greater in black spruce than in white spruce. Elevated CO2 also reduced Jmax in white spruce in both measurements while the effect became insignificant at 30% light later in the growing season. However, the effect on black spruce varied with time. Elevated CO2 reduced Jmax in black spruce in mid-growing season in all light treatments and the effect became insignificant at 30% light later in the growing season, while it increased Jmax later in the season at 100% and 50% light. These results suggest that both species benefited from elevated CO2, and that the responses varied with light supply, such that the response was primarily physiological at 100% and 50% light, while it was primarily morphological at 30% light.
Polyploidization and sexual dimorphism of floral traits in a subdioecious population of Dasiphora glabra
Authors: Wang Lin-Lin , Yang Na-Cai , Chen Min-Yu , Yang Yong-Ping , Duan Yuan-Wen
Published: November 2020

Aims

Sexual dimorphism is a common trait in plants with sex separation, which could influence female and male functions differently. In a subdioecious population of Dasiphora glabra on the Qinghai-Tibet Plateau, we investigated sexual dimorphism of floral traits and their effects on pollinator visitation, pollen flow and seed production. We also examined differences in genome size of hermaphroditic and dioecious plants.

Methods

We examined sexual dimorphism in flower number, flower size, and pollen and ovule production in a subdioecious population of D. glabra. We compared pollinator visitation, pollen dispersal and seed production between sexes. We also examined the genome size of three sex morphs using flow cytometry.

Important Findings

The number of hermaphroditic plants was significantly more than that of male and female plants, and dioecious plants accounted for ca. 40% in the study population. Hermaphroditic plants produced significantly more flowers than male and female plants. Flower size of male flowers was significantly larger than that of female and hermaphroditic flowers. Male flowers did not produce more pollen grains than hermaphroditic flowers, but female flowers produced more ovules than hermaphroditic flowers. Flies were the most frequent flower visitors and preferred large flowers, but their movements between flowers did not show any preference to large flowers. Simulated pollen flows suggested that effective pollen transfer was generally low for both hermaphroditic and male flowers, corresponding to the low seed set of naturally pollinated flowers. DNA contents of male and female plants were ca. four times than those of hermaphroditic plants. These results suggest male and female individuals have undergone polyploidy events and thus are not compatible with hermaphroditic individuals. Sexual dimorphism in floral traits in relation to pollination of dioecious plants might show an advantage in female and male functions, but this advantage is masked largely by low effectiveness of pollen transfer.
Spontaneous intestinal bleeding due to pseudoaneurism of the gastroduodenal artery: case report of a rare complication to median arcuate ligament syndrome
Authors: Jensen Kristian K , Bonde Peter , Storkholm Jan H , Heerwagen Søren T , Larsen Peter N , Eiberg Jonas
Published: November 2020

Median arcuate ligament syndrome (MALS) is the compression of the celiac artery (CA) by the median arcuate ligament. MALS can cause pseudoaneurysm of the gastroduodenal artery, which can lead to fatal bleeding. A 40-year-old male with no prior medical history presented with symptoms of upper gastrointestinal hemorrhage (UGIH). Severe duodenal bleeding was confirmed although endoscopic hemostasis was impossible and final hemostasis was achieved following a subsequent open duodenotomy. A postoperative computed tomographic angiography (CTA) visualized a significant CA stenosis, post-stenotic dilatation and an aneurysm on a jejunal branch artery. The patient underwent coiling of the gastroduodenal artery, gastroepiploic artery and two pancreaticoduodenal arterial branches. The patient was diagnosed with MALS and 6 months later underwent open resection of the median arcuate ligament. MALS should be considered as a rare cause of upper gastrointestinal bleeding. The literature and proposed treatments are discussed.
End of year editorial: hot topics in travel medicine
Authors: Wilder-Smith Annelies
Published: November 2020

COVID-19 will reshape travel medicine, in particular in relation to business travellers and the use of digital technologies. Although the hot topic in travel medicine was the COVID-19 pandemic, travel-associated measles, yellow fever and rabies deserve some special attention.
Camostat Mesylate May Reduce Severity of Coronavirus Disease 2019 Sepsis: A First Observation
Authors: Hofmann-Winkler Heike , Moerer Onnen , Alt-Epping Sabine , Bräuer Anselm , Büttner Benedikt , Müller Martin , Fricke Torben , Grundmann Julian , Harnisch Lars-Olav , Heise Daniel , Kernchen Andrea , Pressler Meike , Stephani Caspar , Tampe Björn , Kaul Artur , Gärtner Sabine , Kramer Stefanie , Pöhlmann Stefan , Winkler Martin Sebastian
Published: November 2020

Objectives:

Severe acute respiratory syndrome coronavirus 2 cell entry depends on angiotensin-converting enzyme 2 and transmembrane serine protease 2 and is blocked in cell culture by camostat mesylate, a clinically proven protease inhibitor. Whether camostat mesylate is able to lower disease burden in coronavirus disease 2019 sepsis is currently unknown.

Design:

Retrospective observational case series.

Setting:

Patient treated in ICU of University hospital Göttingen, Germany.

Patients:

Eleven critical ill coronavirus disease 2019 patients with organ failure were treated in ICU.

Interventions:

Compassionate use of camostat mesylate (six patients, camostat group) or hydroxychloroquine (five patients, hydroxychloroquine group).

Measurements and Main Results:

Clinical courses were assessed by Sepsis-related Organ Failure Assessment score at days 1, 3, and 8. Further, viral load, oxygenation, and inflammatory markers were determined. Sepsis-related Organ Failure Assessment score was comparable between camostat and hydroxychloroquine groups upon ICU admission. During observation, the Sepsis-related Organ Failure Assessment score decreased in the camostat group but remained elevated in the hydroxychloroquine group. The decline in disease severity in camostat mesylate treated patients was paralleled by a decline in inflammatory markers and improvement of oxygenation.

Conclusions:

The severity of coronavirus disease 2019 decreased upon camostat mesylate treatment within a period of 8 days and a similar effect was not observed in patients receiving hydroxychloroquine. Camostat mesylate thus warrants further evaluation within randomized clinical trials.
Immunotherapy combinations in advanced nonsmall cell lung cancer
Authors: Pirker Robert
Published: November 2020

Purpose of review

The purpose of the review is to summarize immunotherapy combinations in advanced nonsmall cell lung cancer (NSCLC).

Recent findings

First-line platinum-based chemotherapy plus an immune checkpoint inhibitor has improved progression-free and overall survival compared to chemotherapy alone in patients with advanced NSCLC. Although the benefits appear to increase with higher programmed death ligand 1 (PD-L1) expression, patients with low PD-L1 also benefit. Nivolumab plus ipilimumab has also been established as a treatment option. Combinations of immune checkpoint inhibitors with olaparib or lenvatinib are studied within phase 3 trials.

Platinum-based doublets combined with an immune checkpoint inhibitor have become standard first-line therapy. Other combinations are under clinical development.
GNE Myopathy as a Myofibrillar Myopathy: Potential Important Disease Mechanism Implied by Muscle Biopsy
Authors: Chrisman Christina , McKeever Paul E.
Published: November 2020

We report a case of 2 sisters in their 20s with genetically confirmed UDP-N-acetylglucoasmine 2-epimerase/N-acetylmannosamine kinase myopathy along with muscle biopsy findings. Both patients described slowly progressive signs of distal-predominant weakness since adolescence that had been dismissed as “clumsiness.” Exam and electrodiagnostic testing suggested a predominately distal myopathy. Muscle biopsy of the left tibialis anterior revealed rimmed vacuoles and, interestingly, also had characteristic features of a myofibrillar myopathy. Genetic testing confirmed a diagnosis of autosomal recessive GNE myopathy in both patients. GNE myopathy has not typically been considered a myofibrillar myopathy, but this case raises possibilities worthy of further exploration. It is possible that the unique combination of pathogenic alleles inGNEreported here has led to a novel form of GNE myopathy with muscle biopsy showing characteristic features of GNE myopathy and myofibrillar myopathy. The other possibility is that myofibrillar myopathy may be a more common feature of GNE myopathies than classically described.
Ultrasound-guided quadratus lumborum block for postoperative analgesia
Authors: Korgvee Andrus , Junttila Eija , Koskinen Heikki , Huhtala Heini , Kalliomaki Maija-Liisa
Published: November 2020

BACKGROUND

Ultrasound-guided quadratus lumborum block (QLB) is a truncal block with several technique variations. It has been reported as providing effective analgesia for postoperative pain.

OBJECTIVES

The aim of this review was to evaluate the efficacy and safety of QLB for postoperative analgesia. The primary outcome was cumulative opioid consumption at 24 h postoperatively. The main secondary outcomes were the time to the first rescue opioid analgesic, pain scores at 24 h postoperatively and the incidence of postoperative nausea and vomiting (PONV).

DESIGN

This was a systematic review and meta-analyses of observational studies and randomised controlled trials (RCTs). PRISMA-P guidelines were followed, and the review was registered in PROSPERO. GRADE was used to assess the quality of evidence.

DATA SOURCES

The search was performed from several databases (Ovid MEDLINE, PubMed, Scopus, Web of Science, CINAHL and the Cochrane CENTRAL) from inception up to June 2019.

ELIGIBILITY CRITERIA

RCTs and prospective observational studies that investigated the postoperative analgesic properties of US-guided single shot QLB in adult patients undergoing abdominal or hip surgery were included. QLB was compared with other analgesics.

RESULTS

Twenty-seven studies constituting 1557 patients were reviewed. Twelve studies with 803 patients were included in the meta-analysis on the primary outcome. Overall opioid consumption at 24 h postoperatively was reduced [mean difference, −11.15 (95% CI, −15.33 to −6.97) mg, I
2 = 99%, moderate certainty in GRADE] and the time to the first opioid analgesic was longer in patients with QLB: 7 studies with 499 patients, mean difference, 189.32 (95% CI, 114.4 to 264.23) min, I
2 = 98%. There were no differences in pain grades. The incidence of PONV was lower in patients with QLB [11 studies with 744 patients, OR 0.40 (95% CI, 0.27 to 0.58), I
2 = 7%]. Reported complications and adverse effects of QLB were minimal.

CONCLUSION

QLB reduced postoperative opioid consumption, prolonged the time to the first rescue opioid analgesic and diminished the incidence of PONV. QLB appears to be an applicable option for postoperative analgesia after abdominal and hip surgery.

REGISTRATION NUMBER

PROSPERO, https://www.crd.york.ac.uk/prospero/, CRD42016039921.
European Society of Anaesthesiology and Intensive Care Guidelines on peri-operative use of ultrasound for regional anaesthesia (PERSEUS regional anesthesia)
Authors: Boselli Emmanuel , Hopkins Philip , Lamperti Massimo , Estèbe Jean-Pierre , Fuzier Régis , Biasucci Daniele G. , Disma Nicola , Pittiruti Mauro , Traškaitė Vilma , Macas Andrius , Breschan Christian , Vailati Davide , Subert Matteo
Published: November 2020

Nowadays, ultrasound-guidance is commonly used in regional anaesthesia (USGRA) and to locate the spinal anatomy in neuraxial analgesia. The aim of this second guideline on the PERi-operative uSE of UltraSound (PERSEUS-RA) is to provide evidence as to which areas of regional anaesthesia the use of ultrasound guidance should be considered a gold standard or beneficial to the patient. The PERSEUS Taskforce members were asked to define relevant outcomes and rank the relative importance of outcomes following the GRADE process. Whenever the literature was not able to provide enough evidence, we decided to use the RAND method with a modified Delphi process. Whenever compared with alternative techniques, the use of USGRA is considered well tolerated and effective for some nerve blocks but there are certain areas, such as truncal blocks, where a lack of robust data precludes useful comparison. The new frontiers for further research are represented by the application of USG during epidural analgesia or spinal anaesthesia as, in these cases, the evidence for the value of the use of ultrasound is limited to the preprocedure identification of the anatomy, providing the operator with a better idea of the depth and angle of the epidural or spinal space. USGRA can be considered an essential part of the curriculum of the anaesthesiologist with a defined training and certification path. Our recommendations will require considerable changes to some training programmes, and it will be necessary for these to be phased in before compliance becomes mandatory.
Handling regular and irregular astigmatism during cataract surgery
Authors: Hardten David R. , Hardten Adeline G.
Published: November 2020

Purpose of review

There are several different approaches to handling regular and irregular astigmatism during cataract surgery, but still much debate on which solutions are most effective given unique patient circumstances. In this review, we examine recent literature and studies to highlight some of the most effective ways to plan preoperatively, manage regular and irregular astigmatism during cataract surgery, as well as managing postoperative complications.

Recent findings

Recent developments in technology have provided increased courses of action for astigmatism management during cataract surgery. Additional options of toric IOLs with presbyopic platforms, light adjustable lenses, intraocular pinhole lenses, online technological tools and platforms, wavefront or topographic laser technology, and phototherapeutic keratectomy are all effective solutions to managing regular and irregular astigmatism. In this review, we will explore optimal approaches for unique situations.

With increased technology, research, and methods, correcting regular and irregular astigmatism during cataract surgery is achievable in most patients. With in-depth preoperative planning, analysis of patient-specific factors, and a tailored approach, surgeons can obtain excellent uncorrected vision for patients.
Visual disturbances during prolonged space missions
Authors: Khossravi Emily A. , Hargens Alan R.
Published: November 2020

Purpose of review

During prolonged spaceflight, astronauts often experience ocular changes, due to constant head-ward fluid shifts in space as compared with Earth. This article reviews symptoms, likely causes, and potential solutions, such as lower body negative pressure, to counteract space-associated neuroocular syndrome (SANS).

Recent findings

Low gravity conditions and other aspects of spaceflight affect the eye detrimentally, causing SANS which is characterized by optic disc edema, choroidal thickening, cotton wool spots, and a hyperopic shift. SANS is probably caused by altered hemodynamic flows in the head and neck as well as mildly elevated intracranial and intraocular pressures. Carbon dioxide and other chemicals in space-craft may influence SANS as well. SANS may be counteracted by using lower body negative pressure, thigh cuffs, spacecraft engineering, and/or artificial gravity by a centrifuge.

Prolonged space missions are associated with optic disc edema, choroidal thickening, cotton wool spots, and a hyperopic shift. Possible causes and countermeasures are currently being researched to reduce the risk of SANS. Although many countermeasures to SANS are under investigation lower body negative pressure exhibits great promise in counteracting the headward fluid shifts in space. Understanding and prevention of SANS is critical to future space exploration, especially to long-duration missions to the moon and Mars.
Phase IV clinical study to evaluate the effects of an intracameral combined mydriatic and anesthetic agent and standard topical mydriatics and anesthetics on the ocular surface after cataract surgery
Authors: Souki Spyridoula , Cochener Béatrice , Labetoulle Marc , Güell José Luis
Published: November 2020

Purpose:

To compare intracameral and topical mydriatics and anesthetics in cataract surgery.

Setting:

Institute of Ocular Microsurgery, Barcelona, Spain.

Design:

Phase IV, open-label, randomized, single-center study.

Methods:

Patients were randomized in a 1:1 ratio to receive intracameral mydriatic–anesthetic (Mydrane/Fydrane) and anesthetic eyedrops or control (topical eyedrops only). The other treatment was administered for the second cataract surgery. Assessments were performed at presurgery and immediately postsurgery, at 12 to 36 hours postsurgery (day 1), and 7 days postsurgery. The primary endpoint was the change from baseline in corneal/conjunctival surface staining. The secondary endpoints included assessments of epithelial alterations, point-spread function, ocular surface disease index, conjunctival hyperemia, vision breakup time, ocular symptoms/signs, adverse events (AEs), corrected distance visual acuity, intraocular pressure, patient/investigator satisfaction, and procedure time.

Results:

A total of 50 patients undergoing sequential cataract surgery in both eyes were included. Baseline assessments were similar in each group. The difference between Fydrane and control groups for the change from baseline at day 1 in corneal and conjunctival surface staining was not statistically significant. For Fydrane, postoperative epithelial alterations were fewer at day 1 (P < .005), folliculopapillary reaction was less frequent (P < .05), some ocular symptoms were less frequent and milder (P < .05), length of procedure was shorter (P < .001), and patient and investigator satisfaction were better (P < .05). There were few AEs in both groups.

Conclusions:

Fydrane reduced ocular surface damage by decreasing corneal epithelial and conjunctival toxicity with faster recovery of surface integrity compared with topical eyedrops, improved patient and investigator satisfaction, and reduced procedure time.
Global sources of cryoprecipitate demonstrate variability in coagulant factor levels and functional hemostasis
Authors: Evans Brooke A. , Kamyszek Reed W. , Piegore Mark , Stoner Keaton , Fuller Matthew , Welsby Ian J. , Mooberry Micah
Published: November 2020

Cryoprecipitate (cryo) is a plasma-derived blood product utilized during trauma resuscitation, surgery, and other major bleeding. Although local quality control metrics exist, inherent donor variability, and processing may confer differences in hemostatic effect between sources. The purposes of this study were to quantify procoagulant content in three global sources of cryo and evaluate their functional hemostatic effect. In this Institutional Review Board exempt study, 24 units of group A cryo from three different sources, American Red Cross single donor and pooled donor, Australian Red Cross single donor, Southwestern United States single donor, and Southwest pooled donor, were evaluated. Procoagulant factors were quantified from each source using ELISA and automated clot-based assays. Functional hemostasis was evaluated using rotational Thromboelastometry (ROTEM). Microparticles isolated from cryo units were enumerated and evaluated for cellular origin by flow cytometry, as well as their capacity to support thrombin generation. Southwestern United States single donor units demonstrated highest levels of fibrinogen, fibronectin, factor VIII, and von Willebrand factor in the selected units. In the coagulopathy model, successive doses from all cryo units were significantly correlated to decreasing coagulation time (P = 0.0100), and increasing maximum clot firmness (P = 0.0002) and alpha angle (P = 0.0009). Southwest pooled donor demonstrated significantly shorter coagulation time at all three doses (P = 0.02) than other sources. Microparticles support prothrombinase activity and thrombin generation. In this study of global cryo sources, procoagulant activity and in-vitro clot formation varied by source. This could be explained by variance in production and storage protocols. Further study is warranted to assess functional variance in cryo to optimize and standardize the use of cryo products.
B-cell depletion or belimumab or voclosporin for lupus nephritis?
Authors: Lei Yutian , Loutan Jerome , Anders Hans-Joachim
Published: November 2020

Purpose of review

Despite ground-breaking innovations for most autoimmune diseases, the treatment of lupus nephritis has remained largely the same for decades because none of the tested drugs demonstrated superiority over standard-of-care in randomized controlled clinical trials.

Recent findings

Recently, the Belimumab in Subjects with Systemic Lupus Erythematosus – Lupus Nephritis trial tested belimumab, an inhibitor of B-cell activating factor, as an add-on therapy to steroids and either mycophenolate mofetil (MMF) or cyclophosphamide when given IV monthly over a period of 104 weeks at an effect size of 11% for a Primary Efficacy Renal Response. The NOBILITY trial reported positive results for the B-cell-depleting agent obinutuzumab as an add-on therapy to steroids and MMF when given IV every 6 months over a period of 76 weeks at an effect size of 22% for a complete renal response (CRR). The AURORA trial reported positive results for the calcineurin inhibitor voclosporin as an oral add-on therapy to low dose steroids and MMF when given twice daily over a period of 52 weeks at an effect size of 18.5% for a CRR.

These studies will change the treatment landscape of lupus nephritis. In which way is discussed in this article.
Application of dynamic contrast enhanced ultrasound in the assessment of kidney diseases
Authors: Selby Nicholas M. , Williams John P. , Phillips Bethan E.
Published: November 2020

Purpose of review

Many forms of acute and chronic disease are linked to changes in renal blood flow, perfusion, vascular density and hypoxia, but there are no readily available methods to assess these parameters in clinical practice. Dynamic contrast enhanced ultrasound (DCE-US) is a method that provides quantitative assessments of organ perfusion without ionising radiation or risk of nephrotoxicity. It can be performed at the bedside and is suitable for repeated measurements. The purpose of this review is to provide updates from recent publications on the utility of DCE-US in the diagnosis or assessment of renal disease, excluding the evaluation of benign or malignant renal masses.

Recent findings

DCE-US has been applied in clinical studies of acute kidney injury (AKI), renal transplantation, chronic kidney disease (CKD), diabetic kidney disease and to determine acute effects of pharmacological agents on renal haemodynamics. DCE-US can detect changes in renal perfusion across these clinical scenarios and can differentiate healthy controls from those with CKD. In sepsis, reduced DCE-US measures of perfusion may indicate those at increased risk of developing AKI, but this requires confirmation in larger studies as there can be wide individual variation in perfusion measures in acutely unwell patients. Recent studies in transplantation have not provided robust evidence to show that DCE-US can differentiate between different causes of graft dysfunction, although it may show more promise as a prognostic indicator of graft function 1 year after transplant. DCE-US can detect acute haemodynamic changes in response to medication that correlate with changes in renal plasma flow as measured by para-aminohippurate clearance.

DCE-US shows promise and has a number of advantages that make it suitable for the assessment of patients with various forms of kidney disease. However, further research is required to evidence its reproducibility and utility before clinical use can be advocated.
Regulation of renal pendrin activity by aldosterone
Authors: Bourgeois Soline , Wagner Carsten A.
Published: November 2020

Purpose of review

Pendrin resides on the luminal membrane of type B intercalated cells in the renal collecting tubule system mediating the absorption of chloride in exchange for bicarbonate. In mice or humans lacking pendrin, blood pressure is lower, and pendrin knockout mice are resistant to aldosterone-induced hypertension. Here we discuss recent findings on the regulation of pendrin.

Recent findings

Pendrin activity is stimulated during alkalosis partly mediated by secretin. Also, angiotensin II and aldosterone stimulate pendrin activity requiring the mineralocorticoid receptor in intercalated cells. Angiotensin II induces dephosphorylation of the mineralocorticoid receptor rendering the receptor susceptible for aldosterone binding. In the absence of the mineralocorticoid receptor in intercalated cells, angiotensin II does not stimulate pendrin. The effect of aldosterone on pendrin expression is in part mediated by the development of hypokalemic alkalosis and blunted by K+-supplements or amiloride. Part of the blood pressure-increasing effect of pendrin is also mediated by its stimulatory effect on the epithelial Na+-channel in neighbouring principal cells.

These findings identify pendrin as a critical regulator of renal salt handling and blood pressure along with acid--base balance. A regulatory network of hormones fine-tuning activity is emerging. Drugs blocking pendrin are being developed.
The quest for cardiovascular disease risk prediction models in patients with nondialysis chronic kidney disease
Authors: Streja Elani , Norris Keith C. , Budoff Matthew J. , Hashemi Leila , Akbilgic Oguz , Kalantar-Zadeh Kamyar
Published: November 2020

Purpose of review

Cardiovascular disease (CVD) is the leading cause of death in patients with chronic kidney disease (CKD). However, traditional CVD risk prediction equations do not work well in patients with CKD, and inclusion of kidney disease metrics such as albuminuria and estimated glomerular filtration rate have a modest to no benefit in improving prediction.

Recent findings

As CKD progresses, the strength of traditional CVD risk factors in predicting clinical outcomes weakens. A pooled cohort equation used for CVD risk prediction is a useful tool for guiding clinicians on management of patients with CVD risk, but these equations do not calibrate well in patients with CKD, although a number of studies have developed modifications of the traditional equations to improve risk prediction. The reason for the poor calibration may be related to the fact that as CKD progresses, associations of traditional risk factors such as BMI, lipids and blood pressure with CVD outcomes are attenuated or reverse, and other risk factors may become more important.

Large national cohorts such as the US Veteran cohort with many patients with evolving CKD may be useful resources for the developing CVD prediction models; however, additional considerations are needed for the unique composition of patients receiving care in these healthcare systems, including those with multiple comorbidities, as well as mental health issues, homelessness, posttraumatic stress disorders, frailty, malnutrition and polypharmacy. Machine learning over conventional risk prediction models may be better suited to handle the complexity needed for these CVD prediction models.
Convergence Insufficiency Neuro-mechanism in Adult Population Study Randomized Clinical Trial: Clinical Outcome Results
Authors: Alvarez Tara L. , Scheiman Mitchell , Santos Elio M. , Yaramothu Chang , d'Antonio-Bertagnolli John Vito
Published: November 2020

SIGNIFICANCE

These data confirm the effectiveness of office-based vergence/accommodative therapy for improving the near point of convergence and positive fusional vergence in young adults with symptomatic convergence insufficiency within a double-masked longitudinal randomized clinical trial.

PURPOSE

This study aimed to report changes in clinical signs and symptoms of convergence insufficiency from a randomized clinical trial evaluating the effectiveness of office-based vergence/accommodative therapy for young adults with symptomatic convergence insufficiency.

METHODS

In this double-masked, randomized clinical trial, convergence insufficiency patients (n = 50; average age, 21 ± 3 years; range, 18 to 32 years) were randomized to either office-based vergence/accommodative therapy or office-based placebo therapy. Improvements in (1) near point of convergence, (2) positive fusional vergence, and (3) self-reported symptoms (Convergence Insufficiency Symptom Survey [CISS] score) were evaluated after twelve 1-hour sessions of treatment within the office comparing the results from the vergence/accommodative therapy and the placebo therapy groups.

RESULTS

The mean near point of convergence improved by 6.0 and 3.1 cm in the vergence/accommodative and placebo therapy groups, respectively (mean difference of −2.9 cm; 95% confidence interval [CI], −4.6 to −1.0 cm; P < .01). The mean positive fusional vergence increased by 17.3 and 7.4Δ in the vergence/accommodative and placebo therapy groups, respectively (mean difference of 9.9Δ; 95% CI, 4.9 to 16.0Δ; P < .001). The mean CISS score improved by 12.4 and 10.1 points in the vergence/accommodative and placebo therapy groups, respectively (mean difference of 2.3 points; 95% CI, −8.3 to +4.6 points; P = .56).

CONCLUSIONS

Our results demonstrate that office-based vergence/accommodative therapy is effective for improving the near point of convergence and positive fusional vergence in young adults with symptomatic convergence insufficiency. However, given that both treatment groups had a similar reduction in self-reported symptoms, we recommend that the CISS be revised if it is to be used as an outcome measure in future studies of convergence insufficiency.