bluuebunny/crossref_metadata_2025 huggingface dataset:
Intellectual Property Justification for Artificial Intelligence
Authors: Hilty Reto M , Hoffmann Jörg , Scheuerer Stefan
Published: April 2021

Against the backdrop of the current discussion of how AI reshapes certain IP paradigms, this chapter reassesses the need for IP protection in AI markets per se. We assess the question of justification of IP rights for both AI as a tool and AI-generated output in light of the very theoretical foundations of IP protection (from both legal embedded deontological and utilitarian economic standpoints). Traditionally, IP protection is granted due to deontological reasoning, according to which a human creator’s personality and efforts have to be protected, and economic reasoning, according to which exclusive rights in intangible goods have to be established in order to remedy market failure in public goods markets. IP ought to serve as a regulatory system of stimulation of creation and innovation using market forces to achieve this goal. Based on the current state of knowledge, however, it seems that specific market implications of the widespread use of most AI applications may have altered the justification for AI-related IP protection in certain cases. Whereas this seems particularly true regarding AI tools, the case for AI outputs may be different.
Foes
Authors: Dean Andrew
Published: April 2021

This chapter examines the work of South African novelist J. M. Coetzee, drawing throughout from his archive at the Harry Ransom Center (housed at the University of Texas at Austin). The chapter begins by tracing Coetzee’s long-standing scepticism about whether literary criticism can access the significant knowledge of literature. The author voices his scepticism through different critical idioms. The chapter then continues to examine three of Coetzee’s books in particular—Dusklands, Foe, and Elizabeth Costello. Whereas Coetzee in his earliest fiction sought to integrate critical debates as he understood them, his later work seeks to disorient schematic literary critical discourse. The chapter demonstrates how in these later works Coetzee’s writing intervenes in specific ways into the literary culture in which he was enmeshed, and how these fictions think through the demands made on writers to contribute to political struggles and forms of flourishing. The chapter concludes with an account of how the self-reflexivity of Coetzee’s literary archive itself may be read, asking whether it may be considered another incursion into the author’s reception and the procedures of contemporary criticism more generally.
Introduction
Authors: Lindheim Sara H.
Published: April 2021

The introduction provides an overarching view of the book’s questions, texts, and theoretical concerns. It moves from a concrete detailing of the physical extent of geographical space the Roman empire added in the late Republic and in the Augustan age to a consideration of the effects that such an expansive increase in territory might have on a people’s worldview, relying on theories of cartography and the psychoanalytic theories of Jacques Lacan in conjunction with questions about how Romans conceptualized their world and what light the (no-longer-extant) late first-century bce or early first-century ce map of Agrippa can shed on it. The emphasis of the inquiry is on the subject in Latin elegy (including Catullus) in poems that turn out to be chock full of geographical references. The book traces the different ways in which, and the varying consequences with which, the elegiac subject encounters the space of empire depending on gender in the works of Catullus, Propertius, Tibullus, and Ovid.
Waiting for the Barbarians
Authors: Storey Mark
Published: April 2021

The final chapter moves to the future-oriented narratives of American science fiction, broadly conceived as a mode of representation committed to the imagination of alternative lifeworlds. The chapter opens with the Roman fragments of Michael Crichton’s Westworld and the remains of New York City in late nineteenth-century dystopian fiction in order to outline the paradoxical relationship between historical representation and the imagination of an imperial (or decolonized) future. The chapter then moves to its three key writers, Isaac Asimov, Edgar Rice Burroughs, and Samuel R. Delany. While each of them offer quite differently fantastical visions of antiquity’s place in the logics and aesthetics of the future, they all find connections through their employment of the ancient figure of the “barbarian” and its role in imperial philosophies and politics.
Migration
Authors: Gribben Crawford
Published: April 2021

The political and religious migration to the Pacific Northwest that has continued for forty years has recently picked up speed. In the last few years, media reports have suggested that a significant number of individuals have heeded the call to migrate, driving up local property prices and reprofiling political participation, especially in areas such as the north Idaho panhandle. The strategy of religious migration is gaining momentum, as the values and arguments of the migrants and those who identify with them make an impact on local political and economic life, while being repackaged for a wider audience in publications by a broader coalition of conservative commentators. These believers who are moving to the Pacific Northwest recognize that they have lost the culture war—despite or sometimes even because of the election of Donald Trump—and that another kind of conflict is beginning.
Government
Authors: Gribben Crawford
Published: April 2021

Driven by new hope, those born-again Protestants who expect to contribute to the long-term reconstruction of the United States of America agree that this renewal will have significant implications for government. This chapter will survey a variety of evangelical responses to recent trends in American government. It will argue that the large pan-denominational and politically pragmatic religious coalitions that dominated an earlier phase of evangelical political engagement have fractured, and have given way to a much more vigorous, variegated, and entrepreneurial evangelical political landscape. These believers are not sure how best to respond to their sense of marginalization, but many among their number are returning to and developing the arguments of earlier Reconstructionists. This chapter will explore the complexity of political thinking among those born-again Protestants who embrace their marginal status in order to propose strategies of survival, resistance, and reconstruction in evangelical America.
The Territorial Contamination of the Blood
Authors: Grosby Steven
Published: April 2021

The implicit paradoxical combination of monotheism and monolatry, characteristic of Hebraism, has consequences for law. This chapter discusses the legal anthropology of the territorial kinship found in the Hebrew Bible, by examining the categories of the native of the land, citizen, the alien who resides in the land, and the foreigner. This legal anthropology represents a Hebraic deflection from Christian universalism. The problem of describing that legal anthropology as Hebraism when it appears in the absence of references to the Old Testament, for example, in Frederic Maitland’s Constitutional History of England, is discussed. Finally, a re-examination of the concept of secularization is undertaken, with regards to the law of the land.
Small Fiber Functionality in Patients with Diabetic Neuropathic Pain
Authors: Unal-Cevik Isin , Orhan Diclehan , Acar-Ozen Nazire Pinar , Mamak-Ekinci Elmas Burcu
Published: April 2021

Objectives

Diabetic neuropathic pain is associated with small fiber neuropathy. We aimed to assess the functionality of small fibers in patients with diabetes by using a practical method.

Design

Patients with impaired glucose tolerance (IGT), diabetic neuropathic pain (DNP), type II diabetes mellitus without neuropathic pain, and healthy control were included. Axon-reflex flare responses were induced by the intradermal application of capsaicin and histamine at the distal leg. The associated flare characteristics (flare areas and flare intensities) were recorded by using Laser Speckle Contrast Analysis (LASCA). The pain and itch responses were rated while performing LASCA. To verify the structural properties of the small fibers, proximal and distal skin biopsies were performed.

Results

DN4, MNSI, NRS, evoked-burning pain scores, and HbA1c levels were the highest in the DNP group. Compatible with length-dependent neuropathy, the distal skin PGP9.5-positive intraepidermal nerve fiber densities (IENFDs) were the lowest, whereas TRPV1-positive IENFDs were the highest in patients with DNP. The distal leg LASCA data showed hypo-functionality in both patients with IGT and DNP and association with disease severity.

Conclusions

There is an unmet need to practically assess the functionality of small fibers in patients with pain. In this study, a practical and objective method that does not need special expertise for the measurement of the functional properties of small fibers by using axon-flare responses is presented. The LASCA method could potentially facilitate a practical, quick (within 5 minutes), and very early diagnosis of small fiber hypo-functionality in both patients with IGT and DNP.
Genetically proxied morning chronotype was associated with a reduced risk of prostate cancer
Authors: Sun Xiaohui , Ye Ding , Jiang Mengting , Qian Yu , Mao Yingying
Published: April 2021

Study Objectives

Observational epidemiological studies have suggested that chronotype may play a role in the pathogenesis and progression of prostate cancer. However, whether there is a causal association remains unknown. The aim of the present study was to examine the potential causal relationship between chronotype and prostate cancer risk using a Mendelian randomization (MR) design.

Methods

A total of 268 single nucleotide polymorphisms associated with chronotype were selected from a meta-analysis of genome-wide association studies of 697,828 individuals. The genetic association data for prostate cancer was derived from the Prostate Cancer Association Group to Investigate Cancer-Associated Alterations in the Genome (PRACTICAL) Consortium (79,148 cases and 61,106 controls). Inverse-variance weighted (IVW) method was used as the primary analysis to calculate the causal effect estimates. The weighted-median method, MR-Egger regression, MR-Pleiotropy Residual Sum and Outlier (MR-PRESSO) test, and multivariable MR analyses were applied as sensitivity analysis.

Results

Genetically predicted morningness (scaled to a sleep midpoint of 1 h earlier) had a reduced risk of prostate cancer, with an odds ratio of 0.71 (95% confidence interval [CI]: 0.54–0.94 by IVW), compared with the eveningness. Similar causal effect estimates were also observed by using the weighted median and MR-PRESSO analyses. In addition, results from the multivariable MR analysis supported the findings from the univariable MR analyses. No indication of horizontal pleiotropy was observed in the MR-Egger analysis (p for intercept = 0.234).

Conclusion

Our findings provide evidence of a causal protective effect of morning chronotype on the risk of prostate cancer.
Universal Screening for Lynch Syndrome in Uterine Cancer Patients: A Quality Improvement Initiative
Authors: Spinosa Daniel , Acosta Tatiana , Wong Janice , Kurtovic Kelli , Mewshaw Jennifer , Collins Sarah , Kauff Noah , Havrilesky Laura J. , Strickland Kyle C. , Previs Rebecca A.
Published: April 2021

(Abstracted from Gynecol Oncol 2021;160:169–174)

The Society of Gynecologic Oncology (SGO) recommends systematic clinical screening for Lynch syndrome through immunohistochemistry (IHC) testing of tumors identified in patients younger than 60 years or of any age and a thorough review of personal and family history. Testing targets expression of mismatch repair genes MLH1, MLH2, PMS2, and MSH6 to evaluate microsatellite instability.
Racial Disparities in Mental Health Outcomes Among Women With Early Pregnancy Loss
Authors: Shorter Jade M. , Koelper Nathanael , Sonalkar Sarita , Oquendo Maria A. , Sammel Mary D. , Schreiber Courtney A.
Published: April 2021

(Abstracted from Obstet Gynecol 2021;137:156–163)

It is estimated that 1 in 4 women will experience a pregnancy loss in her lifetime. The emotional impact of a pregnancy loss in many women is devastating.
Obstetrical and Perinatal Outcomes of Patients With Methamphetamine-Positive Drug Screen on Labor and Delivery
Authors: Pham Tiffany , Tinajero Yolanda , Mo Lihong , Schulkin Jay , Schmidt Loren , Wakeman Brooke , Kremer Mallory
Published: April 2021

(Abstracted from Am J Obstet Gynecol MFM 2020;2:100195)

Methamphetamine (Meth) is a highly addictive drug that has been recognized as a health threat. While opioid abuse and its pharmacological treatments have been well researched, there is much less on Meth addiction and its interventions.
Obstetric and Perinatal Outcomes of In Vitro Fertilization and Natural Pregnancies in the Same Mother
Authors: Herman Hadas Ganer , Mizrachi Yossi , Alon Ayala Shevach , Farhadian Yasmin , Gluck Ohad , Bar Jacob , Kovo Michal , Raziel Arieh
Published: April 2021

(Abstracted from Fertil Steril 2020; doi: 10.1016/j.fertnstert.2020.10.060)

In vitro fertilization (IVF) has been associated with higher risks of maternal and neonatal adverse outcomes, including preeclampsia, preterm birth and neonates who are small for gestational age (SGA). It is unclear whether these outcomes are due to treatment-related factors, such as an altered implantation process, suboptimal placentation and epigenetic changes, or maternal genetic or metabolic factors of the subfertile population.
Design and Performance of a COVID-19 Hospital Recovery Model
Authors: Hu Michael , Copenhaver Martin , Langle Ana Cecilia Zenteno , Koehler Allison , Daily Bethany , Levine Wilton C. , Dunn Peter F , Safavi Kyan C.
Published: April 2021

Objective:

To determine the accuracy of a predictive model for inpatient occupancy that was implemented at a large New England hospital to aid hospital recovery planning from the COVID-19 surge.

Background:

During recovery from COVID surges, hospitals must plan for multiple patient populations vying for inpatient capacity, so that they maintain access for emergency department (ED) patients while enabling time-sensitive scheduled procedures to go forward. To guide pandemic recovery planning, we implemented a model to predict hospital occupancy for COVID and non-COVID patients.

Methods:

At a quaternary care hospital in New England, we included hospitalizations from March 10 to July 12, 2020 and subdivided them into COVID, non-COVID nonscheduled (NCNS), and non-COVID scheduled operating room (OR) hospitalizations. For the recovery period from May 25 to July 12, the model made daily hospital occupancy predictions for each population. The primary outcome was the daily mean absolute percentage error (MAPE) and mean absolute error (MAE) when comparing the predicted versus actual occupancy.

Results:

There were 444 COVID, 5637 NCNS, and 1218 non-COVID scheduled OR hospitalizations during the recovery period. For all populations, the MAPE and MAE for total occupancy were 2.8% or 22.3 hospitalizations per day; for general care, 2.6% or 17.8 hospitalizations per day; and for intensive care unit, 9.7% or 11.0 hospitalizations per day.

Conclusions:

The model was accurate in predicting hospital occupancy during the recovery period. Such models may aid hospital recovery planning so that enough capacity is maintained to care for ED hospitalizations while ensuring scheduled procedures can efficiently return.
Simultaneous Posterolateral and Posteromedial Approaches for Fractures of the Entire Posterior Tibial Plafond: A Safe Technique for Effective Reduction and Fixation
Authors: Campbell Sean T. , DeBaun Malcolm R. , Kleweno Conor P. , Nork Sean E.
Published: April 2021

Objective:

To determine the short-term results of surgical treatment with dual posterolateral and posteromedial approaches for fractures of the entire posterior tibial plafond and secondarily to identify common fracture characteristics.

Design:

Retrospective.

Setting:

Single academic Level 1 trauma center.

Patients:

Thirty-five patients with posterior pilon fractures followed until fracture union (minimum 3 months).

Intervention:

Surgical treatment using simultaneous combined posterolateral and posteromedial exposures for fracture reduction and internal fixation.

Main Outcome Measurement:

(1) Surgical outcomes including rate of wound complications and accuracy of the articular reduction. (2) Fracture characteristics including the incidence of articular impaction, comminution interfering with reduction, syndesmosis injury, and the type of fibula fracture.

Results:

The rate of wound problems was low (6%), and 94% of patients had an articular reduction with less than 1 mm of step or gap. There were high rates of articular comminution (83%) and posteromedial articular impaction (63%) and a 17% rate of syndesmosis injury requiring repair.

Conclusions:

Surgical fixation using simultaneous, combined posterolateral and posteromedial approaches for posterior pilon fractures had a low rate of wound complications and was an effective strategy for obtaining an accurate reduction. The rate of syndesmotic instability requiring fixation was lower than previous work reporting on fixation using a single approach. This may be a useful technique for surgeons who treat these injuries. Careful assessment of the preoperative imaging is required in patients with posterior pilon fractures.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Intramedullary Screw Fixation of Olecranon Fractures Reduces the Risk of Early Unplanned Reoperation: A Retrospective Review of 556 Patients
Authors: Meals Clifton , Johnson Christopher , Reitz Logan , Hannan Zachary , Mulliken Alexandra , O'Hara Nathan N. , Pensy Raymond
Published: April 2021

Objectives:

To determine the effect of intramedullary screw–based fixation on early postoperative complications after olecranon fractures. We hypothesized that intramedullary screw–based fixation results in decreased need for reoperation compared with plate and screw–based and tension band–based fixation.

Design:

Retrospective cohort.

Setting:

Two academic Level-1 trauma centers.

Patients/Participants:

Five hundred fifty-six patients treated with a tension band–based, plate and screw–based, or intramedullary screw–based construct for an olecranon fracture over a 10-year period.

Intervention:

Open reduction and internal fixation.

Main Outcome Measurement:

Unplanned reoperation. Demographic, injury type and severity, supplemental fixation, and length of follow-up data were viewed as potential confounders and analyzed as such.

Results:

We identified 556 relevant patients. One hundred ninety-nine patients were treated with an intramedullary screw–based construct, 229 with a plate and screw–based construct, and 128 with a tension band–based construct. We observed significant differences in the age, fracture type, percentage of open fractures, use of supplemental fixation, and treating institution between the treatment groups. Ninety-five patients (17.1%) had an unplanned reoperation. When we adjusted for confounders, intramedullary screw–based fixation reduced the odds of an unplanned reoperation by 54% compared with plate and screw–based treatment. In the adjusted analysis, we did not observe a difference between plate and screw–based treatment and tension band–based fixation.

Conclusions:

Intramedullary screw–based fixation of olecranon fractures results in decreased need for early reoperation compared with more common olecranon fixation strategies.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Pathological and Immunohistochemical Characteristics of Granuloma and Lymphatics in Cheilitis Granulomatosa
Authors: Ramassamy Sivaranjini , Van Hoang Thi Ai , Chuang Jen-Yu , Wu Yu-Hung
Published: April 2021

Cheilitis granulomatosa (CG) is an idiopathic, rare, and chronic granulomatous disorder involving the lips. We characterized the pathological and immunohistopathological findings of these granulomas and their relationship with the lymphatic vessels. Pathologically confirmed cases of primary CG from 2001 to 2016 were collected. Cases of inflammatory cheilitis without the presence of granuloma were included in the control group. Demographic data, clinical presentation, response to therapy, and pathological differences were compared. Periodic acid–Schiff and acid-fast stains excluded patients having infections. CD68, CD163, and D2-40 stains demonstrated features of granuloma, macrophage polarization, and the relationship between granuloma and lymphatic vessels. Thirteen patients diagnosed with CG were enrolled. Thirteen people were enrolled in the control group. The granulomas were either mononuclear or sarcoidal. They were predominantly positive for CD68 but negative for CD163. Perilymphatic granulomas were found in all patients. Intralymphatic histiocytosis and lymphatic dilatation were more commonly observed in patients diagnosed with CG than those in controls (54% vs. 15%, P = 0.03 and 92% vs. 23%, P < 0.01). TH1 immune response due to CD68+ M1 macrophages results in CG. Perilymphatic aggregation of macrophages and intralymphatic histiocytosis were important pathological clues for diagnosis.
The Conjoined TUGPAP Flap for Breast Reconstruction: Systematic Review and Illustrative Anatomy
Authors: Karir Aneesh , Stein Michael J. , Zhang Jing
Published: April 2021

Background:

Although abdominally based flaps continue to be the gold standard for autologous breast reconstruction, alternative donor sites are necessary when the abdominal region is unavailable or inadequate for flap harvest. In this case, thigh-based flaps, such as the profunda artery perforator (PAP), transverse upper gracilis (TUG), or newly described TUGPAP, are thought to be reliable with low morbidity and satisfactory cosmesis. The objective of this study was to perform a systematic review of breast reconstruction with PAP, TUG, or TUGPAP, and present anatomy and surgical techniques through illustrative examples.

Methods:

A systematic review of the literature was conducted using PubMed, Embase, and Cochrane Library. Articles were included if they used a PAP, TUG, or TUGPAP flap for oncologic, traumatic, or congenital breast reconstruction in patients 18 years or older.

Results:

Forty-nine studies met inclusion criteria. Seven hundred five patients underwent 906 breast reconstructions with 1037 flaps (755 TUG, 230 PAP, and 52 TUGPAP). Mean patient age was 45.9 years. The mean flap weight for TUG, PAP, and TUGPAP flaps were 323.4, 346.9, and 437.0 g, respectively. The most common recipient vessel was the internal mammary artery in 821 flaps. The overall flap survival rate was 97.2% (1008/1037). TUG flaps had a significantly higher recipient and donor complication rate compared with both PAP (recipient: 18.1% versus 7.8%, P = 0.0001; donor: 25.8% versus 7.0%, P < 0.00001) and TUGPAP flaps (recipient: 18.1% versus 2.0%, P < 0.001; donor: 25.8% versus 7.7%, P < 0.01).

Conclusion:

The TUGPAP flap is a safe and effective alternative for autologous breast reconstruction when the abdominal donor site is unavailable.
Secondary Vulvar Reconstruction Using Bilateral Gluteal Fold Flaps after Radical Vulvectomy with Direct Closure
Authors: Roh Solji , Miyamoto Shimpei , Kitamura Yutaro , Mito Daisuke , Okazaki Mutsumi
Published: April 2021

Although primary vulvovaginal reconstruction after vulvectomy has high potential to improve patients’ outcomes, flap reconstruction is not an established part of the current standard treatment for vulvar cancer. We report a patient with successful secondary vulvar reconstruction 3 years after radical vulvectomy with direct wound closure. A 69-year-old woman presented with chronic, burning vulvar pain 3 years after radical vulvectomy without reconstruction for stage IB vulvar cancer. Her urethral orifice had everted because of the direct wound closure, which resulted in severe pain on contact. We performed secondary vulvar reconstruction using bilateral 14 × 5 cm2 gluteal fold flaps. Postoperative pain management and overall aesthetic outcomes were satisfactory. Secondary vulvar reconstruction with gluteal fold flaps can avoid the sequelae resulting from inadequate direct wound closure after radical vulvectomy. Thus, we strongly advocate immediate vulvar reconstruction to prevent such situations.
Carbon Fiber Two-Pull Solid Ankle-Foot Orthoses versus Serial Casting in the Treatment of Idiopathic Toe Walking with Ankle Equinus Contracture
Authors: Hoffman Nicole A. , Dallum Joanna R. , Hinshon Scott , Finch Michael D.
Published: April 2021

Introduction

Idiopathic toe walking (ITW) is a common pediatric diagnosis. Serial casting, a common treatment used for an ankle equinus contracture, may not be appropriate for all children. This pilot study investigated whether carbon fiber two-pull solid ankle-foot orthoses (CTP-AFOs) would have similar outcomes as serial casting in the treatment of children with a diagnosis of ITW and ankle equinus contracture.

Materials and Methods

Children with ITW (n = 35) were randomized to receive CTP-AFOs or serial casting. Assessments were at initial, posttreatment, and 4-month follow-up with therapy protocols until posttreatment.

Results

There was no statistical difference in active (<0.001) and passive (<0.001) dorsiflexion range of motion, the Observational Gait Scale (<0.001), the Pediatric Reach Test (<0.01) popliteal range of motion (<0.001), strength in dorsiflexion (<0.001) and plantarflexion (0.21), and the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (0.31). Both groups demonstrated significant improvement over time with therapeutic intervention performed by a physical therapist.

Conclusions

Carbon fiber two-pull solid ankle-foot orthoses are a noninferior alternative to serial casting in a population with ITW and ankle equinus contracture. Therapeutic interventions for treatment of ITW and ankle equinus contracture have demonstrated improvements in motor outcomes.
The Utilization of Consensus Techniques in Education and Research in Medical Professions
Authors: Block Zachary A. , Brinkmann John T. , Gard Steven A.
Published: April 2021

Study Design

This is a narrative review.

Introduction

Consensus techniques are an increasingly common research tool used to define levels of expert agreement on a topic where evidence is inconsistent or lacking. An assessment of commonly used consensus techniques can inform future education and research.

Objective

The aim of this study was to describe the use of various consensus techniques used in education and research in orthotics and prosthetics and closely related medical professions, to aid in choosing the most appropriate consensus technique for future research.

Methods

A systematic search of the literature was conducted using specific terms and keywords related to various consensus techniques, applications of consensus techniques in research and education, and medical disciplines related to orthotics and prosthetics. Studies were included if they described the use of a consensus technique for medical education or research and explained why the specific technique was used.

Results

Common consensus techniques were identified in the literature. To allow comparison of the techniques, the advantages, disadvantages, limitations, and previous applications of each were extracted from the literature.

Conclusion

Using the information from the literature, the most prevalent consensus techniques can be compared, aiding educators and researchers in choosing the technique most suitable for their topic of inquiry.
Weekly low-dose recombinant factor VIIa prophylaxis in Glanzmann thrombasthenia
Authors: Andiç Neslihan , Oğuz Nur , Gündüz Eren , Kiraz Bulduk Tuba , Üsküdar Teke Hava
Published: April 2021

Glanzmann thrombasthenia is an inherited disease causing bleeding episodes due to platelet dysfunction. The standard treatment for moderate-severe bleeding is platelet transfusion. Recombinant factor VIIa (rFVIIa) is successfully used in bleeding episodes and invasive procedures. Here, we present a patient with Glanzmann thrombasthenia, whose bleeding episodes could only be controlled by rFVIIa. The patient is a 28 years old male, who has had frequent bleeding episodes unresponsive to local hemostatic agents and tranexamic acid and had an anaphylactoid reaction to platelet transfusion. We started the patient on a low-dose (20 μg/kg) rFVIIa once a week. The patient has no spontaneous bleeding since then. This is the first case report of a Glanzmann thrombasthenia patient on routine prophylaxis with low-dose rFVIIa.
Clinical implications of arterial hypertension in patients with spontaneous coronary artery dissection
Authors: Alfonso Fernando , García-Guimaraes Marcos , Alvarado Teresa , Sanz-Ruiz Ricardo , Roura Gerard , Amat-Santos Ignacio J. , Abdul-Jawad Altisent Omar , Tizón-Marcos Helena , Flores-Ríos Xacobe , Masotti Mónica , Pérez-de Prado Armando , Ferre Georgina Fuentes , Ruiz-Poveda Fernando Lozano , Valero Ernesto , Portero-Portaz Juan José , Diez-Villanueva Pablo , Salamanca Jorge , Bastante Teresa , Rivero Fernando
Published: April 2021

Background

Spontaneous coronary artery dissection (SCAD) is a rare but increasingly recognized cause of acute coronary syndrome. Many patients with SCAD have associated coronary risk factors. However, the implications of arterial hypertension in SCAD patients remain unknown.

Objective

This study sought to assess the clinical implications of arterial hypertension in a nationwide cohort of patients with SCAD.

Methods

The Spanish SCAD registry (NCT03607981) prospectively enrolled 318 consecutive patients. All coronary angiograms were centrally analyzed to confirm the diagnosis of SCAD. Patients were classified according to the presence of arterial hypertension.

Results

One-hundred eighteen patients (37%) had a diagnosis of arterial hypertension. Hypertensive SCAD patients were older (60 ± 12 vs. 51 ± 9 years old) and had more frequently dyslipidemia (56 vs. 23%) and diabetes (9 vs. 3%) but were less frequently smokers (15 vs. 35%) than normotensive SCAD patients (all P < 0.05). Most patients in both groups were female (90 vs. 87%, NS) and female patients with hypertension were more frequently postmenopausal (70 vs. 47%, P < 0.05). Hypertensive SCAD patients had more severe lesions and more frequently multivessel involvement (15 vs. 7%, P < 0.05) and coronary ectasia (19 vs. 7%, P < 0.05) but showed a similar prevalence of coronary tortuosity (34 vs. 26%, NS). Revascularization requirement was similar in both groups (17 vs. 26%, NS) but procedural success was significantly lower (65 vs. 88%, P < 0.05) and procedural-related complications more frequent (65 vs. 41%, P < 0.05) in SCAD patients with hypertension.

Conclusion

Patients with SCAD and hypertension are older, more frequently postmenopausal and have more coronary risk factors than normotensive SCAD patients. During revascularization SCAD patients with hypertension obtain poorer results and have a higher risk of procedural-related complications (NCT03607981).
Menstrual patterns and disorders among Chinese women of reproductive age
Authors: Mao Lele , Xi Sisi , Bai Wenpei , Yao Chen , Zhou Yingfang , Chen Xing , Sun Yu
Published: April 2021

Menstruation is an important indicator of women's health. Identification of abnormal menstrual patterns in adolescence may improve early diagnosis of potential health concerns in adulthood. This study aimed to evaluate menstrual patterns and disorders of Chinese women of reproductive age based on an APP.

From December 2015 to January 2016, a cross-sectional study was conducted. We utilized a mobile application (APP) to collect information about participants’ age at menarche, length of menstruation, duration of menstruation, amount of menstrual flow, regularity of menstrual cycle, prevalence of abnormal uterine bleeding and dysmenorrhoea.

A total of 156,055 women (25,716 from the questionnaire survey and 130,000 from the mobile APP users) participated in the study. The average age of the subjects was 26.32 ± 6.97 years (median age, 25 years). Mean age at menarche was 13.08 ± 1.87 years; average length of menstrual cycle, 30.9 ± 4.28 days (median 30 days); and average duration of menstruation, 5.01 ± 1.13 days (median 5 days). Women with irregular menstrual cycles accounted for 36.41%. Women aged < 18 years and > 30 years were more likely to experience irregular menstrual cycles. The prevalence of secondary amenorrhoea was 4.07%. More than 20% of women reported abnormal menstrual flow. About 20.11% of women had abnormal uterine bleeding, and 77.65% had dysmenorrhoea. A hot compress was the most commonly used approach to ameliorate dysmenorrhoea. Women with low education and low income and those with high education and high income tended to have menstrual problems.

A mobile APP as a survey tool has the advantages of large sample size, low cost, and high efficiency. The use of a mobile APP is an emerging approach for collecting big data in the field of health research. The results showed that the prevalence of menstrual disorders among Chinese reproductive women was high. Healthcare providers should educate girls and their caregivers about menstrual physiology, normal menstrual pattern, and reproductive health to prevent long-term diseases.
Complementary and alternative therapies for tension-type headache
Authors: Zhai Xixi , Zhang Sishuo , Li Chuancheng , Liu Fei , Huo Qing
Published: April 2021

Background:

Tension-type headache (TTH) is the most common form of primary headache with high prevalence, which affects the quantity of life seriously. The pharmacological treatment of TTH is not the most effective. Meanwhile, complementary therapies and alternative therapies play an essential role in the treatment of TTH, and there is an absence of comparison between various interventions. Therefore, we propose the network meta-analysis protocol to compare the efficacy and safety of various complementary therapies and alternative therapies for TTH.

Methods:

From the beginning to February 2021, we will search the database to collect randomized controlled trials of complementary and alternative therapies for TTH. Two researchers will be responsible for screening retrieve documents, extracting data. The risk of bias will be assessed based on the Cochrane bias risk tool. We will use STATA16.0 and WinBUGS1.4.3 for paired meta-analysis and Bayesian network meta-analysis. The quality of evidence will be assessed using the grading of recommendations assessment development and evaluation.

Results:

This study will compare and rank the efficacy and safety of various complementary and alternative treatments for TTH.

Conclusions:

This study will provide more extensive evidence for the complementary and alternative therapies of TTH. We expect to assist clinicians and patients in choosing the optimum treatment.

Protocol registration number:

INPLASY202130088.
Long interspersed nuclear element-1 hypomethylation is associated with poor outcomes via the activation of ST18 in human hepatocellular carcinoma
Authors: Lee Yu Rim , Kim Gyeonghwa , Lee Hye Won , Tak Won Young , Park Soo Young , Jang Se Young , Kweon Young Oh , Park Jung Gil , Han Young Seok , Chun Jae Min , Han Ja Ryung , Hur Keun
Published: April 2021

The level of long interspersed nuclear element-1 (LINE-1) methylation, representing the global deoxyribonucleic acid methylation level, could contribute to the prognosis of cancer via the activation of oncogenes. This study was performed to evaluate the prognostic implications of LINE-1 hypomethylation in patients with hepatocellular carcinoma (HCC) and the possible mechanisms related to oncogene activation.

Seventy-seven HCC patients between October 2014 and September 2015 were enrolled in this prospective study. Quantitative pyrosequencing was performed to assess the LINE-1 methylation level of HCC and matched non-HCC tissue samples. The expression of suppression of tumorigenicity 18 was measured by immunohistochemistry and its correlation with LINE-1 methylation levels was examined.

LINE-1 was significantly hypomethylated in the HCC tissue compared with the matched nontumor tissue (64.0 ± 11.6% vs 75.6 ± 4.0%, P < .001). LINE-1 hypomethylation was an independent risk factor for overall survival (hazard ratio = 27.291, P = .032) and disease progression (hazard ratio = 5.298, P = .005). The expression of suppression of tumorigenicity 18 was higher in the hypomethylated LINE-1 HCC tissue than the hypermethylated LINE-1 tumor tissue (P = .030).

LINE-1 hypomethylation may serve as a potential prognostic marker for patients with HCC.
Sporadic amyotrophic lateral sclerosis with seropositive neuromyelitis optica spectrum disorder
Authors: Kim Jin Young , Oh Hye Jeong , Kim Yuntae , Seok Jin Myoung
Published: April 2021

Rationale:

Neuromyelitis optica spectrum disorder (NMOSD) is a severe inflammatory disorder of the central nervous system with an autoantibody against aquaporin-4 protein (AQP4), and amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease. We report a female patient with ALS who had asymptomatic AQP4 antibody at the diagnosis of ALS, and NMOSD occurred 4 years later after the diagnosis of ALS.

Patient concerns:

She was already bedridden and had tracheostomy because of ALS which was diagnosed at her age of 55. At the time of her ALS diagnosis, she had no brain or spinal cord lesions, but was seropositive for AQP4 antibody. At her age of 59, new-onset complete paralysis of all extremities and severe pain on the posterior neck and both shoulders occurred and visited the hospital.

Diagnosis:

Longitudinally extensive transverse myelitis was diagnosed, which was the onset attack of seropositive NMOSD. The diagnosis was confirmed based on the international consensus diagnostic criteria for NMOSD with MR imaging, cerebrospinal fluid exam and laboratory work-ups with AQP4 antibody test.

Interventions:

High dose methylprednisolone was administered for 5 days. Plasma exchange as a further treatment was recommended, but she and her family refused.

Outcomes:

Her pain was relieved after steroid treatment, but there was no improvement of her leg weakness.

Lessons:

This case is a rare combination of neuroinflammatory and neurodegenerative diseases. Considering the alterations of blood-brain barrier along with the progression of ALS, it highlights that the consequence of ALS pathogenesis might affect the development of NMOSD. And the careful follow-up is recommended even in patients with profound weakness, especially if those who were at risk of developing certain neurological disorders.
Analysis of metastasis and survival between extrahepatic and intrahepatic cholangiocarcinoma
Authors: Liao Peng , Cao Li , Chen Hang , Pang Shui-Zi
Published: April 2021

To date, extrahepatic cholangiocarcinoma (ECCA) and intrahepatic cholangiocarcinoma (ICCA) have rarely been compared; therefore, we attempted to learn more about the rates of metastasis and survival in both ICCA and ECCA.

Data of patients in the SEER database diagnosed with ICCA or ECCA were extracted to analyse the rate of metastasis and survival. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for metastasis. Propensity score matching (PSM) was used to compare survival rates between ECCA and ICCA.

Data from a total of 15,751 patients diagnosed with ICCA or ECCA were extracted to analyse the rate of metastasis. Metastasis was more common in ECCA than ICCA (42.62% vs. 31.46%, P < .05), while ICCA in the T1 stage had a lower rate of metastasis (25.35% vs. 30.61%, P < .05). Age, pathology grade, tumour size, lymph node metastasis and T stage were independent risk factors for metastasis in both ECCA and ICCA. There was an inverse correlation between age and metastasis in both ICCA and ECCA. Moreover, PSM demonstrated that patients with ECCA had a better prognosis than patients with ICCA. Patients with ICCA in the T1 stage had better survival than those with ECCA in the T1 stage.

Our study was the first to compare the rates of metastasis and survival between ECCA and ICCA. We observed an inverse association between age and metastasis, that patients with ECCA had a better prognosis than patients with ICCA, and that patients with ECCA in the T1 stage had worse survival than patients with ICCA in the T1 stage.
Comparison of straw and cup for liquid swallowing in poststroke patients
Authors: Bae Jin Seok , Suh InHyuk , Kim Jong Keun , Lim Jong Youb
Published: April 2021

The purposes of this study were to compare poststroke liquid swallowing methods by including a cup and a straw in videofluoroscopic swallowing studies (VFSS) and to test the hypothesis that increased aspiration would be observed with the cup compared to the straw. Eighty-five poststroke patients who had undergone VFSS using a spoon, cup, and straw were included. Penetration-aspiration scale and functional dysphagia scale (FDS) were used for assessment. These scores did not differ significantly between the cup and the straw. Higher FDS scores were found with the cup than with the straw in patients who had penetration/aspiration with both the cup and the straw and with the cup only. However, FDS scores did not differ significantly between the cup and the straw in patients who had penetration/aspiration with the straw only. Although advantages of the straw over the cup were clear, some patients showed penetration/aspiration only with the straw.
A Psychometric Evaluation of the Casey-Fink Graduate Nurse Experience Survey
Authors: Casey Kathy , Tsai Chia-Lin , Fink Regina M.
Published: April 2021

OBJECTIVE

The purpose of this study was to evaluate the psychometric properties of the Casey-Fink Graduate Nurse Experience Survey (CFGNES).

BACKGROUND

Transitioning from the student role to professional nurse is challenging and stressful. Accurate measurement of role transition is important because of concerns regarding retention.

METHODS

A secondary analysis of 71 919 graduate nurse responses to the CFGNES, collected 6 months into the Vizient/AACN residency program, was conducted. Psychometric testing included exploratory and confirmatory factor analysis. Internal consistency reliability was measured using Cronbach's α.

RESULTS

Analysis revealed a consistent 5-factor solution. Factors were labeled job satisfaction, support, organize/prioritize care, role confidence, and professional socialization. Results demonstrated the CFGNES is a reliable and valid instrument for measuring perceptions of role transition.

CONCLUSIONS

This study was needed to inform survey item revisions. The CFGNES continues to be valuable in providing voice to the needs of graduate nurses and evidence for improving nurse residency program outcomes.
Image Quality Assessment for Clinical Cadmium Telluride-Based Photon-Counting Computed Tomography Detector in Cadaveric Wrist Imaging
Authors: Grunz Jan-Peter , Huflage Henner , Heidenreich Julius Frederik , Ergün Süleyman , Petersilka Martin , Allmendinger Thomas , Bley Thorsten Alexander , Petritsch Bernhard
Published: April 2021

Objectives

Detailed visualization of bone microarchitecture is essential for assessment of wrist fractures in computed tomography (CT). This study aims to evaluate the imaging performance of a CT system with clinical cadmium telluride-based photon-counting detector (PCD-CT) compared with a third-generation dual-source CT scanner with energy-integrating detector technology (EID-CT).

Materials and Methods

Both CT systems were used for the examination of 8 cadaveric wrists with radiation dose equivalent scan protocols (low-/standard-/full-dose imaging: CTDIvol = 1.50/5.80/8.67 mGy). All wrists were scanned with 2 different operating modes of the photon-counting CT (standard-resolution and ultra-high-resolution). After reformatting with comparable reconstruction parameters and convolution kernels, subjective evaluation of image quality was performed by 3 radiologists on a 7-point scale. For estimation of interrater reliability, we report the intraclass correlation coefficient (absolute agreement, 2-way random-effects model). Signal-to-noise and contrast-to-noise ratios were calculated to provide semiquantitative assessment of image quality.

Results

Subjective image quality of standard-dose PCD-CT examinations in ultra-high-resolution mode was superior compared with full-dose PCD-CT in standard-resolution mode (P = 0.016) and full-dose EID-CT (P = 0.040). No difference was ascertained between low-dose PCD-CT in ultra-high-resolution mode and standard-dose scans with either PCD-CT in standard-resolution mode (P = 0.108) or EID-CT (P = 0.470). Observer evaluation of standard-resolution PCD-CT and EID-CT delivered similar results in full- and standard-dose scans (P = 0.248/0.509). Intraclass correlation coefficient was 0.876 (95% confidence interval, 0.744–0.925; P < 0.001), indicating good reliability. Between dose equivalent studies, signal-to-noise and contrast-to-noise ratios were substantially higher in photon-counting CT examinations (all P's < 0.001).

Conclusions

Superior visualization of fine anatomy is feasible with the clinical photon-counting CT system in cadaveric wrist scans. The ultra-high-resolution scan mode suggests potential for considerable dose reduction over energy-integrating dual-source CT.
#UTOPia: Urogynecology Tag Ontology Project
Authors: Davenport Abigail , Hoang Elizabeth , Jallad Karl , Park Amy J. , Fitzgerald Jocelyn , Iglesia Cheryl B.
Published: April 2021

Objective

The objective of this study was to review and analyze the current social media status of urogynecology/female pelvic medicine and reconstructive surgery on Twitter and create a tag ontology.

Methods

A “tag ontology” is a standardized list of hashtags used to organize specific subject matter within a social media platform. We used an online social media analytics tool, Symplur to identify tweets and hashtags related to #urogynecology between January 2018 and July 2020. Hashtags identified using Symplur were verified manually via Twitter inquiries and reviewed by urogynecology social medial influencers for external validation. The hashtags were selected based on frequency of use, social media influencer opinion, and clinical relevance.

Results

We identified 6,847 tweets and 2,946 users. Our ontology includes 67 terms categorized into 5 groups (urinary, prolapse, anus/rectum, vulva, and other). Using “Symplur Rank,” the 2 top influencers included @FPMRS and @FPMRSJournal.

Conclusions

Adaptation of a standardized hashtag ontology facilitates communication between providers and patients about pertinent health care issues. Our study has created a urogynecology-specific ontology based on 2018–2020 Twitter usage.
Substrate recruitment by zDHHC protein acyltransferases
Authors: Malgapo Martin Ian P. , Linder Maurine E.
Published: April 2021

Protein palmitoylation is the post-translational attachment of fatty acids, most commonly palmitate (C16 : 0), onto a cysteine residue of a protein. This reaction is catalysed by a family of integral membrane proteins, the zDHHC protein acyltransferases (PATs), so-called due to the presence of an invariant Asp–His–His–Cys (DHHC) cysteine-rich domain harbouring the catalytic centre of the enzyme. Conserved throughout eukaryotes, the zDHHC PATs are encoded by multigene families and mediate palmitoylation of thousands of protein substrates. In humans, a number of zDHHC proteins are associated with human diseases, including intellectual disability, Huntington's disease, schizophrenia and cancer. Key to understanding the physiological and pathophysiological importance of individual zDHHC proteins is the identification of their protein substrates. Here, we will describe the approaches and challenges in assigning substrates for individual zDHHCs, highlighting key mechanisms that underlie substrate recruitment.