bluuebunny/crossref_metadata_2025 huggingface dataset:
Borderline existence and the glorification of a thrilled flesh
Authors: Stanghellini Giovanni
Published: December 2016

This chapter argues that in another emblematic form of existence—‘borderline existence’—we find to a certain extent the reverse of the preceding one. It lies in the glorification of an oceanic encounter with the Other, an encounter that a certain rhetoric would define as ‘authentic’, in the sense that it takes place outside of the social roles: the mystical encounter of a flesh with another flesh, of a thrilled flesh with another thrilled flesh. Emotions, for such a vulnerable mode of existence, represent life in its purest form. Any other form of encounter is seen as a fall. The borderline existence meets its defeat because it postulates as essential to life what is more alien and inaccessible to it, what in life itself is unstable and fleeting par excellence: the immediate encounter with the Other, the encounter between two desires.
Unfolding
Authors: Stanghellini Giovanni
Published: December 2016

This chapter discusses how the world the Other lives in is other with respect to mine. What must be assumed is not analogy, but a ‘different normality’ (i.e. hetero-logy)—a norm that is valid within another framework of experience. Understanding another person requires reconstructing her framework of experience. A fortiori, understanding a patient’s symptom requires reconstructing the framework of experience in which it is embedded. Reconstructing the other’s framework of experience needs a preliminary deconstruction. This deconstruction is made through a phenomenological unfolding of the experiential characteristics of the life-world inhabited by the other person. We need to identify, beyond the symptoms that the Other manifests, the fundamental structures of his existence. The experience of time, space, body, self, and others, and their modifications, are indexes of the patient’s basic structures of subjectivity within which each single abnormal experience is situated.
Perspective-taking
Authors: Stanghellini Giovanni
Published: December 2016

This chapter discusses how perspectivism is the device through which each one of us, who first and foremost sees the world from his point of view, is able to recognize that precisely as just one point of view, and thereby to change it. A healthy mental condition implies the ability to change one’s point of view and temporarily take the perspective of another person. The stronger the reciprocity of perspectives between my former and my present ego, and between my own vantage and the Other’s, the weaker the tendency to perceive my motivations as absolutely necessary. Perspectivism allows me to see myself as not strictly determined by the past and by the involuntary, and may restore a sense of agency. This explains why the reciprocity of perspectives is a therapeutic goal and perspectivism—the attempt to see things from the point of view of the Other—is a therapeutic device.
What is a story?
Authors: Stanghellini Giovanni
Published: December 2016

This chapter argues that care is the occasion to start a shared project of reciprocal understanding between patient and clinician, and this project implies taking each other’s values into account. Coexistence, rather than consensus, is the framework within which this encounter is posited. This practice entails supporting the patient in making explicit her personal horizon of meaning (values and beliefs, i.e. ‘culture’), within which her narrative is set, and encouraging the clinician in making explicit to the patient his own set of theoretical assumptions, personal experiences, values, and beliefs explicit. This promotes a reciprocal exchange of perspectives with his patient, as well as the co-construction of a new meaningful narrative that includes and, if possible, integrates contributions from both the original perspectives. The clinician tolerates diversity and potential conflicts of values and beliefs, and facilitates coexistence when it is not possible to establish consensus.
Epilepsy
Authors: Nageshwaran Sathiji , Wilson Heather C , Dickenson Anthony , Ledingham David
Published: December 2016

This chapter on epilepsy discusses the major classification of epileptic disorders, the management and evidence base for treatment of chronic epilepsy (focal-onset and generalized seizures), the use of antiepileptic drugs in young women, withdrawal of antiepileptic drugs, and the management of status epilepticus.
Neuropathic pain
Authors: Nageshwaran Sathiji , Wilson Heather C , Dickenson Anthony , Ledingham David
Published: December 2016

This chapter on neuropathic pain discusses the classification, clinical features, and evidence-based management of major neuropathic pain syndromes (painful polyneuropathy, diabetic neuropathy, post-herpetic neuralgia, HIV neuropathy, cancer neuropathic pain, phantom pain, traumatic neuropathic pain, chronic radiculopathy, central neuropathic pain, and trigeminal neuralgia).
Inflammatory disorders of the central nervous system
Authors: Nageshwaran Sathiji , Wilson Heather C , Dickenson Anthony , Ledingham David
Published: December 2016

Primary neuroinflammatory disorders of the central nervous system (multiple sclerosis, neuromyelitis optica (NMO), transverse myelitis, optic neuritis, acute disseminated encephalomyelitis (ADEM), primary angiitis of the central nervous system, autoimmune limbic encephalitis, and Susac’s syndrome) and multisystem diseases with inflammatory involvement of the central nervous system (sarcoidosis, systemic lupus erythematosus (SLE), giant cell arteritis, Behçet’s disease, Sjögren’s, and other vasculitides) are discussed in depth, covering the aetiology, clinical features and evidence-based treatment.
Disorders of muscle and neuromuscular junction
Authors: Nageshwaran Sathiji , Wilson Heather C , Dickenson Anthony , Ledingham David
Published: December 2016

This chapter discusses the clinical features and evidence base for the pharmacological treatment of muscular disorders (inflammatory myopathies: polymyositis, dermatomyositis, and inclusion body myositis), mitochondrial myopathies, Duchenne muscular dystrophy (DMD), myotonic dystrophy, inherited neuromuscular channelopathies, non-dystrophic myotonias (myotonia congenita, paramyotonia congenita), periodic paralyses, acquired neuromyotonia (Isaac syndrome and Morvan syndrome), stiff person syndrome, and disorders of the neuromuscular junction (myasthenia gravis (MG), myasthenic crisis, and Lambert–Eaton myasthenic syndrome (LEMS).
Dementia
Authors: Nageshwaran Sathiji , Wilson Heather C , Dickenson Anthony , Ledingham David
Published: December 2016

This chapter discusses the clinical features and evidence-based pharmacological management of dementia disorders (Alzheimer’s disease (AD), vascular dementia, dementia with Lewy bodies (DLB), Parkinson’s disease dementia (PDD), frontotemporal dementia (FTD), mixed dementia, and mild cognitive impairment (MCI)).
Spasticity
Authors: Nageshwaran Sathiji , Wilson Heather C , Dickenson Anthony , Ledingham David
Published: December 2016

This chapter discusses spasticity with respect to its pathophysiology and evidence-based non-pharmacological and pharmacological (systemic and localized) treatments.
Neuro-oncology
Authors: Nageshwaran Sathiji , Wilson Heather C , Dickenson Anthony , Ledingham David
Published: December 2016

This chapter discusses the classification and grading of primary brain tumours and their evidence-based treatment. The management of tumour complications (raised intracranial pressure and seizures) is also reviewed.
Drugs causing neurological disease
Authors: Nageshwaran Sathiji , Wilson Heather C , Dickenson Anthony , Ledingham David
Published: December 2016

This chapter describes concise lists of common drug causes of neurological symptoms (cerebellar syndrome, chorea, dystonia, myoclonus, myopathy, peripheral neuropathy, posterior reversible encephalopathy syndrome (PRES), tremors, tics, and seizures).
L
Authors: Nageshwaran Sathiji , Wilson Heather C , Dickenson Anthony , Ledingham David
Published: December 2016

This chapter includes drugs beginning with the letter [L]
The intensive cardiac care unit team
Authors: Quinn Tom , Swahn Eva
Published: December 2016

Effective, safe health care is a multidisciplinary undertaking. From its inception, half a century ago, the concept of intensive coronary (now cardiac) care has drawn on the expertise of a range of professionals, particularly physicians working closely with nurses. As the evidence base for some aspects of the intensive cardiac care unit care has developed, the intensive cardiac care unit, in some instances, has striking similarities to the general intensive care unit, while paradoxically traditional intensive cardiac care unit functions have been devolved to other parts of the health care system such as the emergency department or pre-hospital care, and the concept of critical care ‘outreach’ has been further developed to take the expertise to patients on the general ward or even in the pre-hospital phase. With more intensive treatment policies for older people becoming the norm, the range of multi-comorbidities to be addressed by the clinical team requires input from a range of other specialties. Moreover, the increasing complexity of diagnostic and interventional techniques requires close collaboration with laboratory and imaging personnel. Thus, the intensive cardiac care unit team arguably extends beyond staff working solely within the physical structure of the intensive cardiac care unit to encompass a range of other professional and support staff, both within and outside the hospital setting.
Mechanical ventilation
Authors: Grounds Robert O , Rhodes Andrew
Published: December 2016

Mechanical ventilation is used to assist or replace spontaneous respiration. Gas flow can be generated by negative pressure techniques, but it is positive pressure ventilation that is the most efficacious in intensive care. There are numerous pulmonary and extrapulmonary indications for mechanical ventilation, and it is the underlying pathology that will determine the duration of ventilation required. Ventilation modes can broadly be classified as volume- or pressure-controlled, but modern ventilators combine the characteristics of both in order to complement the diverse requirements of individual patients. To avoid confusion, it is important to appreciate that there is no international consensus on the classification of ventilation modes. Ventilator manufacturers can use terms that are similar to those used by others that describe very different modes or have completely different names for similar modes. It is well established that ventilation in itself can cause or exacerbate lung injury, so the evidence-based lung-protective strategies should be adhered to. The term acute lung injury has been abolished, whilst a new definition and classification for the acute respiratory distress syndrome has been defined.
A search for host galaxies of potentially extragalactic rotating radio transients
Authors: Rane A. , Loeb A.
Published: December 2016

We report on a search for host galaxies of a subset of rotating radio transients (RRATs) that possess a dispersion measure (DM) near or above the maximum Galactic value in their direction. These RRATs could have an extragalactic origin and therefore be fast radio bursts (FRBs). The sizes of related galaxies on the sky at such short distances are comparable to the beam size of a single-dish telescope (for example, the 7.0 arcmin radius of the Parkes beam). Hence, the association, if found, could be more definitive as compared to finding host galaxies for more distant FRBs. We did not find any host galaxy associated with six RRATs near the maximum Galactic DM. This result is consistent with the fact that the probability of finding an FRB host galaxy within this volume is also very small, therefore indicating a Galactic origin. We propose that future follow-up observations of such RRATs be carried out in searching for local host galaxies as well as the sources of FRBs.
High Incidence of Invasive Group A Streptococcal Infections in Remote Indigenous Communities in Northwestern Ontario, Canada
Authors: Bocking Natalie , Matsumoto Cai-lei , Loewen Kassandra , Teatero Sarah , Marchand-Austin Alex , Gordon Janet , Fittipaldi Nahuel , McGeer Allison
Published: December 2016

Background

Worldwide, indigenous populations appear to be at increased risk for invasive group A streptococcal (iGAS) infections. Although there is empirical evidence that the burden of iGAS disease is significant among remote First Nations communities in Northwestern Ontario, Canada, the epidemiology of iGAS infections in the area remains poorly characterized.

Methods

Individuals that met case definition for iGAS disease and whose laboratory specimens were processed by Meno Ya Win Health Centre in Sioux Lookout, Canada or who were reported to Thunder Bay District Health Unit, Canada were identified for the period 2009 to 2014. Case demographics, clinical severity, comorbidities, and risk factors were collected through chart review. Strain typing and antibiotic susceptibility were determined when possible. Basic descriptive statistics were calculated.

Results

Sixty-five cases of iGAS disease were identified, for an annualized incidence of 56.2 per 100 000. Primary bacteremia was present in 26.2% of cases, and cellulitis was identified in 55.4% of cases. The most common comorbidities identified were diabetes (38.5%) and skin conditions (38.5%). Prevalent risk factors included alcohol dependence (25%). Fourteen different emm types were identified among 42 isolates, with the most common being emm114 (17.4%), emm11 (15.2%), and emm118 (13.0%). Resistance to erythromycin and clindamycin was found in 24.6% of isolates.

Conclusions

Rural and remote First Nations communities in Northwestern Ontario experience iGAS infections at a rate 10 times the provincial and national average. Compared with other North American series, a lower proportion of isolates causing infection were of emm types included in candidate GAS vaccines.
Estimation of Mycophenolic Acid Area Under the Curve With Limited-Sampling Strategy in Chinese Renal Transplant Recipients Receiving Enteric-Coated Mycophenolate Sodium
Authors: Jia Yichen , Peng Bo , Li Long , Wang Jina , Wang Xuanchuan , Qi Guisheng , Rong Ruiming , Wang Liming , Qiu Jianxin , Xu Ming , Zhu Tongyu
Published: December 2016

Background:

The enteric-coated mycophenolate sodium (EC-MPS), whose active constituent is mycophenolic acid (MPA), has been widely clinically used for organ transplant recipients. However, its absorption is delayed due to its special designed dosage form, which results in difficulty to monitor the exposure of the MPA in patients receiving the EC-MPS. This study was aimed at developing a relatively practical and precise model with limited sampling strategy to estimate the 12-hour area under the concentration–time curve (AUC0–12 h) of MPA for Chinese renal transplant recipients receiving EC-MPS.

Methods:

A total of 36 Chinese renal transplant recipients receiving the EC-MPS and tacrolimus were recruited in this study. The time point was 2 weeks after the transplantation for all the patients. The MPA concentrations were measured with enzyme-multiplied immunoassay technique for 11 blood specimens collected predose and at 0.5, 1, 1.5, 2, 2.5, 3, 4, 6, 8, and 12 hours after the morning dose of EC-MPS. The measured AUC was calculated with these 11 points of MPA concentrations with the linear trapezoidal rule. Limited sampling strategy was used to develop models for estimated AUC in the model group (n = 18). The bias and precision of different models were evaluated in the validation group (n = 18).

Results:

C4 showed the strongest correlation with the measured AUC. The best 3 time point equation was 6.629 + 8.029 × C0 + 0.592 × C3 + 1.786 × C4 (R
2 = 0.910; P < 0.001), whereas the best 4 time point equation was 3.132 + 5.337 × C0 + 0.735 × C3 + 1.783 × C4 + 3.065 × C8 (R
2 = 0.959; P < 0.001). When evaluated in the validation group, the 4 time point model had a much better performance than the 3 time point model: for the 4 time point model: R
2 = 0.873, bias = 0.505 [95% confidence interval (CI), −10.159 to 11.170], precision = 13.370 (95% CI, 5.186–21.555), and 77.8% of estimated AUCs was within 85%–115% of the measured AUCs; for the 3 time point model: R
2 = 0.573, bias = 6.196 (95% CI, −10.627 to 23.018), precision = 21.286 (95% CI, 8.079–34.492), and 50.0% of estimated AUCs was within 85%–115% of the measured AUCs.

Conclusions:

It demanded at least 4 time points to develop a relatively reliable model to estimate the exposure of MPA in renal transplant recipients receiving the EC-MPS. The long time span needed restricted its application, especially for the outpatients, but it could be a useful tool to guide the personalized prescription for the inpatients.
Detection of Hydrocodone and Morphine as Metabolites in Oral Fluid by LC-MS/MS in Patients Prescribed Codeine
Authors: West Robert E. , Guevara Maria G. , Mikel Charles , Gamez Ruben
Published: December 2016

A retrospective analysis of oral fluid drug testing results using LC-MS/MS was performed to determine the prevalence rates in oral fluid for codeine (COD) and 3 COD metabolites—morphine (MOR), norhydrocodone (NHC), and hydrocodone (HCOD). Oral fluid samples were collected using Quantisal oral fluid collection device (Immunalysis Inc.) and submitted to Millennium Health, LLC for the routine drug analysis by LC-MS/MS. Consistent with previously published literature, COD was the primary analyte detected in oral fluid after the use of COD. In COD-positive samples, HCOD, MOR, and NHC were detected at rates of 68.4%, 18.4%, and 6.3%, respectively. Concentration ranges of these analytes were 1.0 to >2000 ng/mL for COD, 1.0–20.2 ng/mL for MOR, 1.0–740.0 ng/mL for HCOD, and 2.1–47.5 ng/mL for NHC. In contrast to urine, where HCOD is typically detected as a minor metabolite of COD, HCOD was the most commonly detected metabolite in oral fluid in samples testing positive for COD with reported prescriptions for COD. This observation suggests that care should be taken when interpreting HCOD positives in oral fluid results, and that the use of COD should be considered as one possible explanation for HCOD positives.
Aesthetic Applications of Botulinum Toxin A in Asians: An International, Multidisciplinary, Pan-Asian Consensus
Authors: Sundaram Hema , Huang Po-Han , Hsu Nai-Jen , Huh Chang Hun , Wu Woffles T.L. , Wu Yan , Cassuto Daniel , Kerscher Martina J. , Seo Kyle Koo-Il
Published: December 2016

Background:

Botulinum toxin type A remains the most popular nonsurgical aesthetic treatment worldwide. Previous consensus statements have focused on Caucasians and on Koreans as generally representative of Asians. However, indications and dosages vary among different ethnic groups. This publication reports the results of a multidisciplinary, pan-Asian consensus focusing on incobotulinumtoxinA.

Methods:

A consensus group of plastic surgeons and dermatologists from Asia, Europe, and the United States convened for a live meeting in Asia, followed by a questionnaire-based Delphi procedure. Treatment of Asians in both their native countries and countries of migration was discussed.

Results:

For most items, the group achieved a majority consensus. A number of treatment indications, strategies, and dosages were identified in Asians, which are distinct to those previously described for Caucasians due to differences in facial morphotypes, anatomy, and cultural expectations. The group also formulated position statements for intradermal botulinum toxin type A (“mesotoxin”), body shaping with the calves as a paradigm, and reduction of parotid glands. While Asians have previously been considered a homogeneous group for the purposes of aesthetic treatment, this publication considers regional variations. A new classification of Asian facial morphotypes is proposed to aid treatment planning and implementation.

Conclusions:

This is the first pan-Asian consensus for aesthetic use of botulinum toxin type A. Its unique objective is to optimize treatment safety and efficacy for patients of complete or part-Asian ancestry in all regions. The recommendations for incobotulinumtoxinA may be extended with care to other botulinum toxin formulations.
Management of a Complex Excoriation Disorder–induced Wound with a Viable Cryopreserved Placental Membrane
Authors: Bain Michael A. , Vincent Jennifer
Published: December 2016

Excoriation disorder (ED), also known as dermatotillomania, is a condition characterized by repeated “skin picking” that leads to the formation of skin lesions. Because of the similarity of its symptoms to obsessive compulsive disorder, ED is classified as a subcategory of obsessive compulsive disorder by Diagnostic and Statistical Manual of Mental Disorders Fifth Edition. Although the majority of the self-inflicted wounds are not clinically significant, many wounds lead to social and occupational dysfunction by becoming infected, chronic, and life threatening. This report describes the successful use of a viable intact cryopreserved human amniotic membrane in conjunction with selective serotonin re-uptake inhibitors in treating an ED patient who presented with a large calvarial wound of 3-year duration that had failed previous extensive medical and surgical interventions.
OCULAR MANIFESTATIONS AND TREATMENT OUTCOMES IN CHINESE PATIENTS WITH POEMS SYNDROME
Authors: Zhang Xiao , Cai Qian-qian , Huang Xu-fei , Cao Xin-xin , Cai Hao , Zhou Dao-bin , Dai Rong-ping , Li Jian
Published: December 2016

Purpose:

To evaluate the relationship of serum vascular endothelial growth factor (VEGF) levels and ocular manifestations in Chinese patients with POEMS syndrome.

Methods:

This is a prospective study. Forty-one treatment-naive patients were enrolled from April 2014 to November 2014. Among the 41 patients, 40 had complete ocular examination, spectral domain optical coherence tomography scan, and serum VEGF measurement before treatment and every 3-month interval after lenalidomide and dexamethasone treatment.

Results:

Twenty-seven (67.5%) patients had optic disk edema (ODE) at baseline. Retinal manifestations included retinal hemorrhage, subretinal fluid, macular edema, and cotton wool spot. The difference in mean serum VEGF concentrations between patients with and without ODE was significant (P = 0.017). Among patients with ODE, there was a significant positive correlation between mean serum VEGF levels and the binocular mean retinal nerve fiber layer thickness (P = 0.008), as well as mean peripapillary retinal thickness (P = 0.020) before treatment. After 3 months to 17 months treatment, mean serum VEGF concentrations decreased significantly (P < 0.001). Mean retinal nerve fiber layer thickness and mean peripapillary retinal thickness decreased significantly (P < 0.001). The remission rate of ODE was 87.5%, and complete remission rate was 58.3%.

Conclusion:

The ODE is a common manifestation in POEMS syndrome, and raised VEGF might explain the development and mechanism. Systemic treatment could lead to decrease in serum VEGF levels accompanied by regression of ODE.
OCCULT GLOBE PERFORATION DURING MEDIAL CANTHOPEXY
Authors: Manjunath Deepa , Kaiser Peter K. , Ehlers Justis P.
Published: December 2016

Purpose:

To report a case of occult globe perforation following craniofacial surgery.

Methods:

A 16-year-old girl presented with vision loss and hypotony of her left eye following a craniofacial procedure, including bilateral medial canthopexy. This report describes the evaluation and findings following the craniofacial surgery.

Results:

After recognition of vision loss and concern for rupture, surgical exploration was performed by an ophthalmologist at an outside institution on suspicion of globe penetration/perforation. Surgical exploration did not identify any scleral entry/exit sites. She was then referred for vitreoretinal consultation. Serous choroidal detachments and associated retinal detachment were identified on ultrasound. The patient was maintained on her postoperative oral antibiotics and followed closely. As the intraocular pressure improved, the choroidals began to resolve. Two retinal break sites were identified on opposite sides of the globe in the retinal periphery. Laser retinopexy was performed at the two penetration sites. The patient recovered excellent vision without any additional complications.

Conclusion:

Early recognition and high suspicion of globe injury is critical in cases of postoperative vision loss following craniofacial surgery.
SELF-PEELING EPIRETINAL MEMBRANE
Authors: Ozgonul Cem , Besirli Cagri G.
Published: December 2016

Purpose:

To present a self-peeling epiretinal membrane (ERM) in a patient with spontaneously improved retinal capillary hemangioma in the left eye.

Methods:

The authors demonstrate the improvement of an untreated retinal capillary hemangioma and resolution of ERM with fundus photography, fluorescein angiography, and spectral domain optical coherence tomography. Genetic testing excluded von Hippel–Lindau disease in this patient.

Results:

Evaluation of a patient with rheumatoid arthritis revealed retinal capillary hemangioma with retinal exudates at the temporal peripheral fundus and an ERM in the left eye. Patient was asymptomatic and elected observation. Three years after the initial examination, visual acuity and macular appearance improved after spontaneous resolution of the ERM. Capillary hemangioma was smaller and retinal exudates resolved without treatment.

Conclusion:

This case report demonstrates a self-peeling ERM associated with a retinal capillary hemangioma. This case contributes the literature describing the natural history of ERMs associated with peripherally located capillary hemangiomas in patients without von Hippel–Lindau disease.
Excimer Laser Versus Phakic Intraocular Lenses for Myopia and Astigmatism: A Meta-Analysis of Randomized Controlled Trials
Authors: Chen Haiting , Liu Yu , Niu Guangzeng , Ma Jingxue
Published: December 2016

Objective:

Meta-analysis of randomized controlled trials (RCTs) which compared excimer laser refractive surgery and phakic intraocular lenses (PIOLs) for the treatment of myopia and astigmatism.

Methods:

An electronic literature search was performed using the PubMed, EBSCO, CNKI, and Cochrane Library database to identify prospective RCTs which compared excimer laser refractive surgery and PIOL with a follow-up time of at least 12 months. Efficacy, accuracy, safety outcomes, and complications were analyzed by standardized mean difference, risk ratio, and the pooled estimates according to a fixed effect model or random effect model.

Results:

This review included 5 RCTs with a sum of 405 eyes. The range of myopia was 6.0 to 20.0 D with up to 4.0 D of astigmatism. The PIOL group was more likely to achieve a spherical equivalence within±1.0 D of target refraction at 12 months postoperatively (P=0.009), and was less likely to lose one or more lines of best spectacle corrected visual acuity than the LASER group (P=0.002). On the whole, there is no significant difference in efficacy and complications between the two kinds of surgeries.

Conclusions:

This meta-analysis indicated that PIOLs were safer and more accurate within 12 months of follow-up compared with excimer laser surgical for refractive errors.
Effect of Rivastigmine Augmentation in Treatment of Male Patients With Combat-Related Chronic Posttraumatic Stress Disorder
Authors: Rezaei Ardani Amir , Hosseini Golkoo , Fayyazi Bordbar Mohammad Reza , Talaei Ali , Mostafavi Toroghi Hesam
Published: December 2016

Background

Posttraumatic stress disorder (PTSD) is one of the chronic and disabling psychiatric disorders, particularly in combat veterans. In a case series, rivastigmine was suggested to be an effective augmentation in treatment of PTSD. The aim of the present study was to evaluate this finding in a randomized controlled trial.

Method

A 12-week, double-blind, placebo-controlled clinical trial was performed on 36 male patients (aged 42–60 years) diagnosed with chronic, combat-related PTSD. Subjects were screened for apparent cognitive deficits by means of Mini-Mental State Examination. All patients received selective serotonin reuptake inhibitors plus sodium valproate for 4 weeks and then reevaluated. Subjects who did not show adequate response were randomly assigned into 3 groups receiving rivastigmine (up to 6 mg/d), placebo, or the prior treatment regimen. Efficacy of medication was measured by administering PTSD Check List–Military Version at baseline and weeks 2, 4, 8, and 12. Collected data were analyzed by analysis of variance and repeated measurement. Reported differences were considered significant at the level of 0.05 or less.

Results

The 3 groups showed statistically significant reductions in the total PTSD Check List–Military Version, avoidance subscale, and the reexperience subscale but not in the hyperarousal subscale. No significant differences were found between the 3 groups.

Conclusions

In contrast to the previous case series, findings of the current study did not support the efficacy of adjunctive rivastigmine in treatment of PTSD. This hypothetically could be due to the fact that all the study's subjects scored higher than 25 on Mini-Mental State Examination.
Necrobiosis Lipoidica
Authors: Leigh Katherine , Miller Barbara , Mason Shawna M. , Armstrong Brittney
Published: December 2016

Necrobiosis lipoidica (NL) is a rare skin disorder that occurs more frequently among diabetic patients than the general population. The etiology is unknown for this disfiguring chronic condition. Typically, patients present with well-circumscribed papules and nodules with telangiectasias developing beneath the epidermis. It is estimated that 30% of lesions are induced by trauma. There are no specific laboratory tests required to establish the diagnosis of NL. Clinical management is challenging. The mainstay of treatment is topical steroids, intralesional steroids, immunosuppressants, platelet inhibitors, and phototherapy. Other options available include photodynamic therapy, hyperbaric oxygen, and CO2 laser. The cosmetic outcome for this disorder is poor, which can lead to other conditions such as depression. Long-term compliance is necessary for improved patient outcomes. Providers should stay abreast of available treatment options and individualized patient care support to assist in managing NL.
Medical Simulation Technology
Authors: Montgomery Jennifer
Published: December 2016

Medical simulation technology as a whole allows the clinical situation to be better understood, controlled, and practiced and is a reproduction of reality that provides a replication of clinical situations through the use of interactive videos, mannequins, and role playing (Cannon-Diehl, 2009). With the use of medical simulation technology, learners are able to practice skills and role-play different scenarios without causing harm to a patient, thus lessening stressful experiences during similar real-life situations (Hebda & Czar, 2013). This practice helps to improve the quality of care given to patients and, in turn, helps to save lives. Simulation also leads to increased confidence and skills of participants.

With an ever increasing importance placed on patient outcomes in regard to reimbursement from insurance companies and the Centers for Medicare & Medicaid Services, it is the responsibility of all medical professionals to perform at peak levels during all patient care situations, especially during emergent ones. This harkens back to both the Hippocratic Oath and the Nightingale Pledge in which respondents promise to practice to the best of their abilities and keep the patient's best interest in mind (American Nurses Association, 2012). The opportunity to participate in simulation allows these oaths to be upheld and patients to be cared for by practitioners who are comfortable conducting themselves appropriately and competently within high-stress situations.
Multifactor Influences of Shared Decision-Making in Acoustic Neuroma Treatment
Authors: Nellis Jason C. , Sharon Jeff D. , Pross Seth E. , Ishii Lisa E. , Ishii Masaru , Dey Jacob K. , Francis Howard W.
Published: December 2016

Objective:

To identify factors associated with treatment modality selection in acoustic neuromas.

Study Design:

Prospective observational study.

Setting:

Tertiary care neurotology clinic.

Patients:

Data were prospectively collected from patients initially presenting to a tertiary care neurotology clinic between 2013 and 2016. Patients who did not have magnetic resonance imaging (MRI), demographic, psychometric, or audiometric data were excluded from analysis.

Intervention:

Demographic information, clinical symptoms, tumor characteristics, and psychometric data were collected to determine factors associated with undergoing acoustic neuroma surgical resection using univariate and multiple logistic regression analysis.

Main Outcome Measure:

The decision to pursue acoustic neuroma surgical resection versus active surveillance.

Results:

A total of 216 patients with acoustic neuroma (mean age 55 years, 58% women) were included. Ninety eight patients (45.4%) pursued surgical resection, 118 patients (54.6%) pursued active surveillance. Surgical treatment was significantly associated with patient age less than 65, higher grade tumors, growing tumors, larger volume tumors, lower word discrimination scores, Class D hearing, headache, and vertigo as presenting symptoms, higher number of total symptoms, and higher headache severity scores (p < 0.05). There was no significant association between surgical intervention and preoperative quality of life, depression, and self-esteem scores. On multiple logistic regression analysis, the likelihood of undergoing surgical resection significantly decreased for patients older than age 65 (odds ratio [OR] 0.19; 0.05–0.69) and increased in patients with medium (OR 4.34; 1.36–13.81), moderately large (OR 33.47; 5.72–195.83), large grade tumors (OR 56.63; 4.02–518.93), tumor growth present (OR 4.51; 1.66–12.28), Class D hearing (OR 3.96; 1.29–12.16), and higher headache severity scores (OR 1.03; 95% confidence interval [CI] 1.01–1.05). The likelihood of undergoing surgical resection was completely predictive for giant grade tumors and not significant for small grade tumors and Class B or C hearing.

Conclusions:

Non-elderly acoustic neuroma patients with larger tumors, growing tumors, significant hearing loss, and worse headaches are more likely to pursue surgical resection rather than active surveillance. Psychological factors such as quality of life, depression, and self-esteem do not seem to influence decision-making in this patient population.
Granulocyte colony-stimulating factor improves survival of patients with decompensated cirrhosis: a randomized-controlled trial
Authors: Prajapati Ritesh , Arora Anil , Sharma Praveen , Bansal Naresh , Singla Vikas , Kumar Ashish
Published: December 2016

Background

Liver transplantation is the only curative option for patients with decompensated cirrhosis; however, many patients die while awaiting transplantation. Granulocyte colony-stimulating factor (GCSF) has shown promising results in improving outcomes in patients with advanced liver disease. We evaluated the efficacy of GCSF in patients with decompensated cirrhosis in an open-labeled randomized-controlled trial.

Methods

Consecutive patients with decompensated cirrhosis were randomized to receive either GCSF 300 μg twice daily for 5 days plus standard medical therapy (SMT) (GCSF+SMT group) or SMT alone (SMT alone group). Outcomes were assessed at 6 months from randomization.

Results

A total of 126 patients [median age: 53 (range: 31–76) years, 85% men] received GCSF+SMT and 127 patients received SMT alone. Baseline characteristics were similar in both the groups. The 5-day GCSF therapy did not lead to any significant adverse effects. At 6 months, in the GCSF+SMT group, 17 patients had died and nine were lost to follow-up, whereas in the SMT-alone group, 30 patients had died and 11 were lost to follow-up. By intention-to-treat analysis, cumulative survival was significantly higher in the GCSF+SMT group (79 vs. 68%; P=0.025). Also, significantly more patients (66%) showed improvement or stability in the Child–Turcotte–Pugh score at 6 months in the GCSF+SMT group compared with the SMT-alone group (51%, P=0.021).

Conclusion

GCSF therapy improves survival and clinical outcome in patients with decompensated cirrhosis. It may be useful in patients awaiting transplantation to prevent worsening during the waiting period. Further studies are needed to explore whether repeated periodic GCSF courses can further increase the survival and decrease the need for liver transplantation.

Clinical trial registered at
https://clinicaltrials.gov
vide NCT02642003.
Effect of E-OJ-01 on Cardiac Conditioning in Young Exercising Adults: A Randomized Controlled Trial
Authors: Girandola Robert N. , Srivastava Shalini
Published: December 2016

Background and Aim:

Cardiac health is a determinant of athletic performance. A body of data suggests that in healthy young adults, an increase in maximal cardiac output leads to an increase in endurance. Terminalia arjuna (TA) has been studied for multiple benefits in cardiovascular health although its effects as a cardioprotective ergogenic aid require further exploration. The current trial was planned to study the effect of the proprietary TA extract (E-OJ-01) on the markers of cardiac conditioning in healthy young adults.

Study Question:

No study has assessed the effect of TA extract on cardiac conditioning by improvement of left ventricular ejection fraction (LVEF) in young exercising individuals.

Study Design, Measures and Outcomes:

A randomized, double-blind, placebo-controlled, parallel group study was conducted to determine the efficacy and safety of E-OJ-01 for use as an ergogenic supplements in young exercising adults. This trial was registered at ClinicalTrials.gov (NCT02207101) and reported according to Consolidated Standards of Reporting Trials (CONSORT) requirements. Thirty-two healthy males, aged 18–40 years performing regular endurance exercise, were randomly assigned to 400 mg of E-OJ-01 or placebo for 56 days. LVEF, right and left ventricular Myocardial Performance Index, and Borg Rated Perceived Exertion (RPE) were assessed at baseline, day 28, and day 56; creatine kinase-MB and troponin-T were assessed at baseline and at day 56.

Results:

As compared with placebo, 56 days of E-OJ-01 supplementation significantly improved the LVEF (P = 0.0001) and decreased the right ventricular Myocardial Performance Index (P = 0.001). The fatigue level captured by Borg Scale after completion of exercise showed a greater decrease in the E-OJ-01 group as compared with placebo. Creatine kinase-MB and troponin-T did not change significantly.

Conclusions:

TA (E-OJ-01) significantly increased cardiovascular efficiency and improved the cardiac conditioning in young healthy adults.
NF1 and Neurofibromin: Emerging Players in the Genetic Landscape of Desmoplastic Melanoma
Authors: Mahalingam Meera
Published: December 2016

Neurofibromatosis type I (NF1), a monogenic disorder with an autosomal dominant mode of inheritance, is caused by alterations in the NF1 gene which codes for the protein neurofibromin. Functionally, NF1 is a tumor suppressor as it is GTPase-activating protein that negatively regulates the MAPK pathway. More recently, much attention has focused on the role of NF1 and neurofibromin in melanoma as mutations in NF1 have been found to constitute 1 of the 4 distinct genomic categories of melanoma, with the other 3 comprising BRAF, NRAS, and “triple–wild-type” subtypes. In this review, we parse the literature on NF1 and neurofibromin with a view to clarifying and gaining a better understanding of their precise role/s in melanomagenesis. We begin with a historic overview, followed by details regarding structure and function and characterization of neural crest development as a model for genetic reversion in neoplasia. Melanogenesis in NF1 sets the stage for the discussion on the roles of NF1 and neurofibromin in neural crest-derived neoplasms including melanoma with particular emphasis on NF1 and neurofibromin as markers of melanocyte dedifferentiation in desmoplastic melanoma.
Cytopathology of Follicular Cell Nodules
Authors: Rossi Esther D. , Bizzarro Tommaso , Martini Maurizio , Larocca Luigi M. , Schmitt Fernando , Vielh Philippe
Published: December 2016

The detection of thyroid nodules, consisting of different diseases, represents a common finding in population. Their evaluation and diagnosis are mostly achieved with fine-needle aspiration cytology (FNAC). Even though the majority of thyroid nodules are correctly diagnosed, a total of 25% to 30% of them are classified “indeterminate” comprising lesions with varying risk of malignancy and different types of management. Although the number of thyroid FNACs, including small lesions, is increasing due to the reliance upon sonographic and cytologic interpretations, there are issues concerning cytomorphologic interpretation and interobserver reproducibility. Different classification systems have tried to better define the criteria for inclusion in specific categories and to therefore reduce the rate of indeterminate diagnoses such as atypia of undetermined significance, follicular neoplasms, and suspicious for malignancy. However, the support of ancillary techniques (eg, immunocytochemistry and molecular analysis) are reshaping morphologic diagnoses made on materials obtained from FNAC.
Persistent Asymmetric Optic Disc Swelling After Long-Duration Space Flight: Implications for Pathogenesis
Authors: Mader Thomas H. , Gibson C. Robert , Otto Christian A. , Sargsyan Ashot E. , Miller Neil R. , Subramanian Prem S. , Hart Stephen F. , Lipsky William , Patel Nimesh B. , Lee Andrew G.
Published: December 2016

Background:

Several ophthalmic findings including optic disc swelling, globe flattening and choroidal folds have been observed in astronauts following long-duration space flight. The authors now report asymmetric choroidal expansion, disc swelling and optic disc morphologic changes in a 45-year-old astronaut which occurred during long-duration space flight and persisted following his space mission.

Methods:

Case study of ocular findings in an astronaut documented during and after a long-duration space flight of approximately 6 months. Before, during and after his spaceflight, he underwent complete eye examination, including fundus photography, ultrasound, and optical coherence tomography.

Results:

We documented asymmetric choroidal expansion inflight that largely resolved by 30 days postflight, asymmetric disc swelling observed inflight that persisted for over 180 days postflight, asymmetric optic disc morphologic changes documented inflight by OCT that persisted for 630 days postflight and asymmetric globe flattening that began inflight and continued 660 days postflight. Lumbar puncture opening pressures obtained at 7 and 365 days post-mission were 22 and 16 cm H20 respectively.

Conclusion:

The persistent asymmetric findings noted above, coupled with the lumbar puncture opening pressures, suggest that prolonged microgravity exposure may have produced asymmetric pressure changes within the perioptic subarachnoid space.
A Further Decrease in the Rates of Administration of Electroconvulsive Therapy in England
Authors: Buley Nicky , Copland Emma , Hodge Sophie , Chaplin Robert
Published: December 2016

Objectives

Electroconvulsive therapy (ECT) is an effective treatment of major depression, and there have been consistent improvements in the administration of ECT in the past decade. However, studies have reported a steady decline in the rates of use of ECT in the United Kingdom and Ireland. Despite this, there has been no consistent record of how much ECT is being given or to whom it is given, for more than 20 years. The purpose of this study is to estimate the change in frequency of ECT use, the length of courses, patient demographics, and clinical outcomes between 2006 and 2 periods of 2012/2013 and 2014/2015.

Methods

In 2012/2013, clinics were asked to complete an online survey giving details of every patient who started a course of ECT between April 1, 2012, and March 31, 2013. This was repeated for the same period in 2014/2015.

Results

There continues to be a striking decline in the number of courses of ECT prescribed. Course length has increased. Women are twice as likely to be prescribed ECT as men. Modal age is 60 to 80 years, and the most common diagnosis is depression. Most courses were rated as clinically effective, especially for people with severe illnesses. Maintenance ECT is used at half the clinics surveyed.

Conclusions

The use of ECT in England continues to decline. The reasons for this are unclear and need investigation.
Identification of Klebsiella capsule synthesis loci from whole genome data
Authors: Wyres Kelly L. , Wick Ryan R. , Gorrie Claire , Jenney Adam , Follador Rainer , Thomson Nicholas R. , Holt Kathryn E.
Published: December 2016

Klebsiella pneumoniae is a growing cause of healthcare-associated infections for which multi-drug resistance is a concern. Its polysaccharide capsule is a major virulence determinant and epidemiological marker. However, little is known about capsule epidemiology since serological typing is not widely accessible and many isolates are serologically non-typeable. Molecular typing techniques provide useful insights, but existing methods fail to take full advantage of the information in whole genome sequences. We investigated the diversity of the capsule synthesis loci (K-loci) among 2503 K
. pneumoniae genomes. We incorporated analyses of full-length K-locus nucleotide sequences and also clustered protein-encoding sequences to identify, annotate and compare K-locus structures. We propose a standardized nomenclature for K-loci and present a curated reference database. A total of 134 distinct K-loci were identified, including 31 novel types. Comparative analyses indicated 508 unique protein-encoding gene clusters that appear to reassort via homologous recombination. Extensive intra- and inter-locus nucleotide diversity was detected among the wzi and wzc genes, indicating that current molecular typing schemes based on these genes are inadequate. As a solution, we introduce Kaptive, a novel software tool that automates the process of identifying K-loci based on full locus information extracted from whole genome sequences (https://github.com/katholt/Kaptive). This work highlights the extensive diversity of Klebsiella K-loci and the proteins that they encode. The nomenclature, reference database and novel typing method presented here will become essential resources for genomic surveillance and epidemiological investigations of this pathogen.
Evolutionary patterns of metazoan microRNAs reveal targeting principles in the let-7 and miR-10 families
Authors: Wolter Justin M. , Le Hoai Huang Thi , Linse Alexander , Godlove Victoria A. , Nguyen Thuy-Duyen , Kotagama Kasuen , Lynch Alissa , Rawls Alan , Mangone Marco
Published: December 2016

MicroRNAs (miRNAs) regulate gene output by targeting degenerate elements in mRNAs and have undergone drastic expansions in higher metazoan genomes. The evolutionary advantage of maintaining copies of highly similar miRNAs is not well understood, nor is it clear what unique functions, if any, miRNA family members possess. Here, we study evolutionary patterns of metazoan miRNAs, focusing on the targeting preferences of the let-7 and miR-10 families. These studies reveal hotspots for sequence evolution with implications for targeting and secondary structure. High-throughput screening for functional targets reveals that each miRNA represses sites with distinct features and regulates a large number of genes with cooperative function in regulatory networks. Unexpectedly, given the high degree of similarity, single-nucleotide changes grant miRNA family members with distinct targeting preferences. Together, our data suggest complex functional relationships among miRNA duplications, novel expression patterns, sequence change, and the acquisition of new targets.