bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-term Outcomes for the Treatment of Paragangliomas in the Upfront, Adjuvant, and Salvage Settings With Stereotactic Radiosurgery and Intensity-modulated Radiotherapy
Authors: Anderson Joshua L. , Khattab Mohamed H. , Anderson Chelsea , Sherry Alexander D. , Luo Guozhen , Manzoor Nauman , Attia Albert , Netterville James , Cmelak Anthony J.
Published: November 2019

Objective:

To analyze local control (LC) and toxicity rates between stereotactic radiosurgery (SRS) and intensity-modulated radiotherapy (IMRT) in relation to reported surgical rates in the treatment of paragangliomas (PG) in the upfront, adjuvant, and salvage settings, and to explore factors affecting tumor size reduction, toxicity rates, and symptom control.

Study Design:

Retrospective cohort analysis.

Setting:

Tertiary referral center.

Patients and Interventions:

Thirty patients treated with either linear accelerator-based SRS or IMRT in the definitive, planned adjuvant, or unplanned salvage postsurgery settings.

Main Outcome Measures:

Local control, toxicities, symptom control, tumor size reduction, and factors affecting each.

Results:

Median follow-up was 4.16 years. LC rates were 100%. Acute grade >3 toxicity rate was 6.7%, 86.7% of tumors had a reduction in volume, and 76.7% of patients had improvement in at least one tumor-induced symptom by last follow-up. Larger tumor size at presentation and longer time to last follow-up were significantly associated with greater tumor size reduction on multivariate analysis.

Conclusions:

SRS and IMRT are safe and effective treatment for PG with high efficacy and low morbidity rates in the upfront, planned adjuvant, and unplanned salvage settings.
Quantifying Tertiary Referral Center Bias in Vestibular Schwannoma Research
Authors: Saba Elias S. , Marinelli John P. , Lohse Christine M. , Link Michael J. , Carlson Matthew L.
Published: November 2019

Objective:

The majority of research influencing our understanding of vestibular schwannoma (VS) comes from large tertiary referral centers, and as a consequence, is inherently prone to referral bias. The objective of the current study was to characterize tertiary referral center bias in VS research.

Study design:

Single-institution retrospective clinical, audiometric, and radiologic review.

Setting:

One tertiary referral center.

Patients:

One hundred twenty-three patients with sporadic VS treated at our institution, consisting of a local cohort of all 41 VS patients residing in the same US county as our medical center and a referral cohort of 82 patients from outside counties matched 2:1 based on age, sex, and year of diagnosis.

Intervention:

Surgical resection, stereotactic radiosurgery (SRS), observation.

Main outcome measures:

Clinical manifestations, audiometric and radiologic findings, elected treatment modality.

Results:

Local patients had significantly longer follow-up after initial presentation compared to referral patients (median 4.0 vs 2.2 yr; p = 0.007). Referral patients were significantly less likely to have an incidental VS diagnosis (1% vs. 29%; p < 0.001) and presented with worse symptomatology such as hearing loss (80% vs. 54%; p = 0.002), dizziness (72% vs. 44%; p = 0.002), headache (29% vs. 15%; p = 0.075), and other cranial nerve dysfunction (11% vs. 0%; p = 0.029). Audiometrically, referral patients had significantly poorer word recognition scores at presentation (median 70% vs. 90%; p = 0.043). Local patients were more likely to have tumors confined to the IAC compared with referral patients, and had significantly smaller tumors when restricted to this region (median 4.0 vs 6.5 mm; p = 0.005). Referral patients were significantly more likely to undergo definitive management with either radiosurgery or microsurgery following primary evaluation compared to local patients (48% vs. 24%; p = 0.013).

Conclusion:

These data suggest that the majority of existing literature surrounding VS likely suffers from referral bias, whereby disease characteristics and management decisions are distinct from that of the general VS patient population.
Influence of hemolysis, icterus and lipemia on coagulation tests as performed on Cobas t511 new analyzer
Authors: Montaruli Barbara , Guiotto Cristina , Cosseddu Domenico
Published: November 2019

In the coagulation laboratory, spurious hemolysis, icterus and lipemia (HIL) in test samples represent by far the leading diagnostic prenalytical challenges. The aim of this study was to assess the performance of the preanalytical module on the new hemostasis analyser Cobas Roche t511. We assessed the influence of HIL on prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib), antithrombin and d-dimer on plasma pools aliquots with different interference degrees. Moreover, we evaluated spontaneous hemolysis by comparing results on 50 paired samples (hemolysed versus nonhemolysed). Spurious hemolysis interference studies highlight the absence of a clinical significant impact on PT, APTT and antithrombin test results at all hemoglobin concentration investigated. For Fib and d-dimer assays a clinically significant difference was observed in the most hemolysed aliquot for Fib and in the two most hemolysed aliquots for d-dimer. Spontaneous hemolysis interference studies showed no clinical significant differences for PT and antithrombin assays, instead for APTT, Fib and d-dimer we found significant statistical and clinical differences between hemolysed and non hemolysed specimens. Bilirubin interference studies and lipemic samples interference studies enable us to confirm that the differences in the results obtained between the different aliquots and reference pool is not clinically significant for all assays. HIL check preanalytical module of Cobas Roche t511 analyzer displaied excellent performance for routine use in clinical laboratories. Regardless of analytical considerations, the type of interference encountered with spurious HIL is substantially different and requires different approaches.
Performance of liver biomarkers, in patients at risk of nonalcoholic steato-hepatitis, according to presence of type-2 diabetes
Authors: Poynard Thierry , Peta Valentina , Deckmyn Olivier , Pais Raluca , Ngo Yen , Charlotte Frederic , Ngo An , Munteanu Mona , Imbert-Bismut Françoise , Monneret Denis , Housset Chantal , Thabut Dominique , Valla Dominique , Boitard Christian , Castera Laurent , Ratziu Vlad
Published: November 2019

Objective

There is a controversy about the performance of blood tests for the diagnostic of metabolic liver disease in patients with type-2-diabetes in comparison with patients without type-2-diabetes. These indirect comparisons assumed that the gold-standard is binary, whereas fibrosis stages, steatosis and nonalcoholic-steato-hepatitis (NASH) grades use an ordinal scale. The primary aim was to compare the diagnostic performances of FibroTest in type-2-diabetes vs. controls matched on gender, age, fibrosis stages and obesity, and taking into account the spectrum effect by Obuchowski measure.

Methods

Data were retrospectively compared among patients prospectively included, with simultaneous biopsy and blindly assessed FibroTest, SteatoTest-2 and NashTest-2. The secondary aim was to construct an index (SpectrumF3F4-Index) to predict an adjusted-area under the receiver operating curve (AUROC) for F3F4 diagnosis from the prevalences of fibrosis stages, permitting to reduce the spectrum effect when performances of FibroTest, transient elastography and magnetic resonance elastography are indirectly compared.

Results

In 505 patients at risk of NASH, the Obuchowski measures [95% confidence interval (CI)] of FibroTest, SteatoTest-2 and NashTest-2 were all equivalent in 136 type-2-diabetes cases vs. 369 matched controls: 0.871 (0.837–0.905), vs. 0.880 (0.879–0.881), 0.835 (0.797–0.873) vs. 0.806 (0.780–0.832) and 0.829 (0.793–0.865) vs. 0.855 (0.829–0.869), respectively. Standard-AUROCs (95% CI) were 0.932 (0.898–0.965), 0.872 (0.837–0.907) and 0.834 (0.699–0.969) and reduced after adjustment by SpectrumF3F4-Index to 0.794 (0.749–0.838), 0.767 (0.750–0.783) and 0.773 (0.725–0.822) for transient, magnetic resonance elastography and FibroTest, respectively.

Conclusions

When compared by Obuchowski measures, the performances of tests were not different in patients with T2-diabetes vs. patients without T2-diabetes. When individual data are not available, adjusted-AUROCs reduced the spectrum effect.
Metabolomic and gene expression analysis to study the effects of dietary saturated and polyunsaturated fats
Authors: Ulven Stine M. , Holven Kirsten B.
Published: November 2019

Purpose of review

Give an update on recent dietary intervention studies that have used peripheral blood mononuclear cell gene expression analysis and/or metabolic profiling to understand how intake of polyunsaturated and saturated fat affects and biological pathways linked to cardiovascular disease.

Recent findings

Several studies showed that intake of fish oil and vegetable oil, high in omega-3 fatty acids, reduced expression level of genes involved in inflammation. One intervention study showed that gene transcripts encoding genes involved inflammation and lipid metabolism increased after intake of polyunsaturated fat (mainly omega-6 fatty acids) compared to saturated fat. Additionally, using targeted metabolomics, the concentrations of atherogenic lipoprotein particles and several metabolites including palmitoylcarnitine, myristoylcarnitine, and kynurenine were reduced after intake of polyunsaturated fat compared to saturated fat, whereas acetate and acetoacetate were increased. The use of targeted metabolomics showed that overfeeding with polyunsaturated fat reduced the serum concentration of ceramides, dihydroceramides, glucosylceramides, and lactosylceramides, whereas overfeeding with saturated fat increased serum concentration of these metabolites.

The use of gene expression profiling and metabolomics are promising tools to identify possible new biomarkers linking fat quality to cardiovascular disease risk.
Fatty liver, cardiometabolic disease and mortality
Authors: Bedogni Giorgio , Gastaldelli Amalia , Foschi Francesco G.
Published: November 2019

Purpose of review

We discuss the findings of the most recent metanalyses on the association between nonalcoholic fatty liver disease (NAFLD), cardiometabolic disease and mortality.

Recent findings

Recent metanalyses have shown that NAFLD is associated with incident type 2 diabetes mellitus (T2DM) and incident cardiovascular disease (CVD). Nonalcoholic steatohepatitis, which can be diagnosed by liver biopsy only in tertiary care centers, is often associated with liver fibrosis, which has been shown by metanalyses to increase both cardiovascular and liver-related mortality. Hyperlipidemia, lipotoxicity and impaired insulin secretion are among the possible mechanisms underlying the association of NAFLD with T2DM and CVD. Metanalyses of the association between NAFLD and mortality in the general population, where risk stratification cannot be performed on the basis of liver biopsy, have given contradictory results.

To establish conclusively whether NAFLD adds to known prognostic factors of death in the general population will require a shared operational definition of NAFLD, purposefully designed cohort studies, and the use of clinically relevant measures of effect size.
Advances in vaccinating immunocompromised children
Authors: Miller Katrina , Leake Katelyn , Sharma Tanvi
Published: November 2019

Purpose of review

Immunocompromised children are a largely under-vaccinated population and are vulnerable to acquiring vaccine-preventable infections (VPIs). A variety of factors contribute to poor vaccine coverage including: severity of underlying illness, sporadic contact with primary care physicians, and lack of awareness among specialty providers regarding vaccination status. In this review, we report recent data regarding incidence of VPIs, new approaches to vaccine use, rates of vaccine coverage, and strategies to optimize vaccine administration in immunocompromised populations.

Recent findings

Pediatric transplant recipients and patients with autoimmune disorders receiving novel biological therapies, represent growing immunocompromised patient populations. VPIs continue to be a concern for such patients. Underlying disease severity may limit efforts to immunize pediatric patients early in their disease process, prior to immunosuppression. Inactive vaccines are safe and immunogenic after the introduction of immunosuppression, but live vaccines are typically contraindicated. Emerging data support the safety and effectiveness of live vaccines in certain immunocompromised individuals. Care providers must remain vigilant in maintaining patients’ vaccination status based on current vaccination guidelines, and create a multidisciplinary approach to optimizing vaccination.

Immunocompromised children remain under-vaccinated and vulnerable to VPIs. Optimizing vaccines should be a priority for every provider caring for this population.
Targeting metabolic dependencies in pediatric cancer
Authors: Issaq Sameer H. , Heske Christine M.
Published: November 2019

Purpose of review

In an attempt to identify potential new therapeutic targets, efforts to describe the metabolic features unique to cancer cells are increasingly being reported. Although current standard of care regimens for several pediatric malignancies incorporate agents that target tumor metabolism, these drugs have been part of the therapeutic landscape for decades. More recent research has focused on the identification and targeting of new metabolic vulnerabilities in pediatric cancers. The purpose of this review is to describe the most recent translational findings in the metabolic targeting of pediatric malignancies.

Recent findings

Across multiple pediatric cancer types, dependencies on a number of key metabolic pathways have emerged through study of patient tissue samples and preclinical modeling. Among the potentially targetable vulnerabilities are glucose metabolism via glycolysis, oxidative phosphorylation, amino acid and polyamine metabolism, and NAD+ metabolism. Although few agents have yet to move forward into clinical trials for pediatric cancer patients, the robust and promising preclinical data that have been generated suggest that future clinical trials should rationally test metabolically targeted agents for relevant disease populations.

Recent advances in our understanding of the metabolic dependencies of pediatric cancers represent a source of potential new therapeutic opportunities for these diseases.
Challenges and solutions to the study of rare childhood tumors
Authors: Fair Douglas , Potter Samara L. , Venkatramani Rajkumar
Published: November 2019

Purpose of review

The majority of progress made in pediatric oncology over the past 50 years has been achieved in the most common cancers. Rare pediatric cancers, which collectively comprise more than 10% of all pediatric cancers, pose multiple challenges to researchers and clinicians, all which stem from the infrequency of these cancers. There has been a tremendous increase in focus on rare pediatric cancers by international consortia and registries, disease-specific clinics, and divisions of academic children's hospitals in the last 10 years. This focus, along with the progress made in cancer genomics, has changed the landscape for the study and treatment of rare pediatric cancers. This review focuses on the past, present, and future of the study and treatment of rare pediatric cancers.

Recent findings

Cancer genomics is changing the way some cancers are being diagnosed, categorized, and treated. Rare pediatric cancers potentially stand to greatly benefit from advances in precision diagnosis and treatment.

The challenges of studying rare pediatric cancers are well known. By utilizing similar techniques that allowed for progress in the common pediatric malignancies, namely collaboration, increased focus, greater funding, and utilization of cancer genomics, progress in the study and treatment of rare pediatric cancers is promising.
Self-Contempt as a Predictor of Suicidality
Authors: Rüsch Nicolas , Oexle Nathalie , Thornicroft Graham , Keller Johannes , Waller Christiane , Germann Ines , Regelmann Christina A. , Noll-Hussong Michael , Zahn Roland
Published: November 2019

People with mental illness can internalize public prejudice and negative emotional reactions to their group, leading to self-contempt. This study examined self-contempt related to having a mental illness as predictor of suicidality among 77 people with mental illness in Southern Germany. Self-contempt, depressive symptoms, hopelessness, and suicidality were assessed at baseline; suicidality was measured again 3 months later. High self-contempt at baseline predicted increased suicidality at follow-up, adjusting for baseline suicidality, symptoms, diagnosis, age, sex, and hopelessness. These results suggest that self-contempt may be a risk factor for suicidality and call for specific interventions targeting self-stigma and its emotional consequences.
What Does the World Say About Science and Health
Authors: Rowe Sylvia , Alexander Nick
Published: November 2019

In recent years, much has been written about the evolution of public trust in science and the scientists who immerse themselves, especially in health and nutrition research. Many of the articles in the literature have speculated on the reasons for an apparent decline in public trust or acceptance of science and have explored in some depth the challenges around promoting and retaining public trust. However, the associations between public trust and other factors have been largely speculative. Now, a first of its kind comprehensive survey of more than 140 000 people in more than 140 countries sheds new light on those associations. In the present article, the authors explore various findings from that survey, the Wellcome Global Monitor 2019-Wellcome Trust, completed in partnership with Gallup. They offer some analysis of the survey findings of varying levels of public trust in science around the world. It is worth noting that the survey results, although not specific to food, nutrition, and health, are extremely relevant to the communication of those issues.
Moving the Needle on Hypertension
Authors: Frame Alissa A. , Farquhar William B. , Latulippe Marie E. , McDonough Alicia A. , Wainford Richard D. , Wynne Brandi M.
Published: November 2019

This review highlights the gaps in knowledge and methodological challenges discussed during the Experimental Biology 2019 expert panel session titled “Moving the Needle on Hypertension: What Knowledge Is Needed?” Hypertension is a critical public health burden. Despite a demonstrated benefit of blood pressure reduction on measures of hypertension-related morbidity and mortality, rates for successful blood pressure control remain low. Dietary sodium reduction has been shown to reduce both systolic blood pressure by approximately 3.2 mm Hg and diastolic blood pressure by 2.3 mm Hg, depending on baseline blood pressure and degree of sodium reduction. The updated Dietary Reference Intakes for adults released by the National Academies of Sciences, Engineering, and Medicine include a Chronic Disease Risk Reduction sodium intake level of 2300 mg/d, highlighting the importance of dietary sodium intake in reducing elevated blood pressure and indicating that reducing intakes to this level is expected to reduce blood pressure and risk of cardiovascular disease. The average US daily sodium intake of 3400 mg/d is well above the Chronic Disease Risk Reduction of 2300 mg/d, suggesting that dietary sodium reduction has the potential to significantly improve public health. Although the National Academies of Sciences, Engineering, and Medicine report presents intake recommendations based on a systematic, comprehensive, and thorough evaluation of the evidence, several challenges to moving the needle on hypertension remain. Success will require a more advanced understanding of sodium and potassium physiology, as well as development of the tools needed to effectively address existing research gaps and reduce barriers to sodium intake reduction.
Effects of High-Protein and High-Carbohydrate Diets on Body Weight Were Similar in Healthy Young Vietnamese Women With Normal Body Weight
Authors: Phuong Nguyen Mai , Giang Nguyen Huong , Linh Nguyen Thuy , Hien Vu Thi Thu , Huong Le Thi , Yamamoto Shigeru
Published: November 2019

Recently, attention has been paid to the effects of certain nutrients on body weight. High-protein (HP) diets are recommended, and high-carbohydrate (HC) diets are discouraged. However, HP is costly, and recently, some adverse effects of prolonged HP diets have been reported, involving risk factors for coronary artery, kidney, bone, and liver disease and other effects. Given this background, the question arises whether an HP diet is appropriate for healthy young people with normal body mass indices, and so we compared it with an HC diet in such individuals. We recruited 20 healthy women subjects with normal body weight and formed 10 pairs matched by energy intake, physical activity, height, weight, living conditions, and other factors. One member of each pair was then randomly assigned to 1 of 2 groups—HP (approximately 30% energy from protein, 40% from carbohydrate, and 30% from fat) or HC (approximately 55% energy from carbohydrate, 15% from protein, and 30% from fat)—for 4 weeks. They were provided all food and drinks in 3-day cycle menus for 28 days. Diets provided basal and ad libitum components. Physical activity level was monitored everyday by a pedometer. The pedometers were worn everyday aside from sleeping and bathing. Body weight was measured before and after the intervention. During the 4-week intervention period, the HP group's protein intake was significantly higher at 30.1% energy than that of the HC group at 15.1% energy (P < .001). The HP group's carbohydrate intake was 41.1% energy, and that of the HC group was 56.3% energy; they were significantly different (P < .001). Daily energy, lipid, and fiber intakes were similar among the 2 groups (1558 and 1551 kcal, 49.4 and 49.5 g, and 8.9 and 8.9 g, respectively). Changes in body weight during the intervention period were similar in the HP and HC groups, being 0.00 ± 3.43 and 0.04 ± 0.65 kg, respectively (P > .05). In healthy young Vietnamese women with a normal body mass index, those who consumed the HP and HC diets were similar in their energy intakes and changes in body weight, indicating that neither an HP nor an HC diet had any advantage or disadvantage in weight control in healthy young nondieting women.
Christmas Fare
Authors: Gibney Michael
Published: November 2019

The human race has always celebrated great events with very special dinners and traditional menus. This short article traces some of the food history of Christmas celebrated by Christians. The editor tells me that this journal welcomes similar short articles on food traditions of other religious groups and their special dinners.
Predatory Publishers and Conference Organizers
Authors: Sewell Kerry A. , Firnhaber Gina Cahoon
Published: November 2019

The rise of disreputable and dishonest journal publishers and conferences organizers—known as “predatory” journals and conferences—has made deciding where to publish articles and attend conferences a surprisingly difficult task. Whereas some journals and conferences can easily be dismissed as untrustworthy, others require further investigation and evaluation. Awareness of the publishing practices and selection criteria used by a journal can help you avoid being drawn in by publishers whose review practices fail to exclude works of low value and by conference organizers whose lack of selectivity may result in a poor-quality conference experience for attendees. Neither for-profit nor open-access status necessarily tells you if a publisher or conference organizer is unworthy of your attention. This article outlines criteria you can use to determine if journals or conferences should be considered worthy of publishing your manuscripts or hosting your presentations. Your time and work are limited and valuable. Where you choose to showcase them is important to both you and to other professionals in your field.
EBV-Positive Primary Large B-Cell Lymphoma: The Role of Immunohistochemistry and XPO1 in the Diagnosis of Mediastinal Lymphomas
Authors: Maracaja Danielle L.V. , Puthenpura Vidya , Pels Salley G. , O’Malley Dennis P. , Sklar Jeffrey L. , Finberg Karin E. , Xu Mina L.
Published: November 2019

Primary mediastinal (thymic) large B-cell lymphoma (PMBL) is described as almost always negative for Epstein-Barr virus (EBV). In the context of a mediastinal lymphoma, the distinction between PMBL, classical Hodgkin lymphoma, diffuse large B-cell lymphoma, and mediastinal gray-zone lymphoma can be very difficult; hence, EBV positivity often argues against PMBL. We present a 19-year-old man with mediastinal mass morphologically consistent with PMBL. The tumor expressed classic immunophenotype, including positivity for CD20, CD19, MAL, OCT2, BOB1, BCL6, CD79a, and subset positivity for CD30. However, the tumor was EBV-positive by in situ hybridization. Next-generation sequencing detected somatic mutations in XPO1 (E571K), SMARCB1 (L356fs), and MYCC (T73A). Although the immunophenotype and XPO1 mutation are characteristic of PMBL, EBV expression is uncommon. Since EBV positivity can occur in rare PMBLs, it should not be the deciding factor in the diagnosis. This is the first EBV-positive PMBL in which mutational profiling has been reported. Aside from providing diagnostic support, the finding of the XPO1 E571K mutation may suggest a targeted therapeutic option.
Long-Term Results and Reconstruction Failure in Patients Receiving Postmastectomy Radiation Therapy with a Temporary Expander or Permanent Implant in Place
Authors: Dicuonzo Samantha , Leonardi Maria Cristina , Radice Davide , Morra Anna , Gerardi Marianna Alessandra , Rojas Damaris Patricia , Surgo Alessia , Dell’Acqua Veronica , Luraschi Rosa , Cattani Federica , Rietjens Mario , De Lorenzi Francesca , Veronesi Paolo , Galimberti Viviana , Marvaso Giulia , Fodor Cristiana , Orecchia Roberto , Jereczek-Fossa Barbara Alicja
Published: November 2019

Background:

This study investigated the risk of reconstruction failure after mastectomy, immediate breast reconstruction, and radiotherapy to either a temporary tissue expander or permanent implant.

Methods:

Records of women treated at a single institution between June of 1997 and December of 2011 were reviewed. Two patient groups were identified based on type of immediate breast reconstruction: tissue expander followed by exchange with a permanent implant and permanent implant. The study endpoint was rate of reconstruction failure, defined as a replacement, loss of the implant, or conversion to flap.

Results:

The tissue expander/permanent implant and the permanent implant groups consisted of 63 and 75 patients, respectively. The groups were well balanced for clinical and treatment characteristics. With a median follow-up of 116 months, eight implant losses, 50 implant replacements, and four flap conversions were recorded. Reconstruction failure occurred in 22 of 63 patients in the expander/implant group and in 40 of 75 patients in the permanent implant group. A traditional proportional hazards model showed a higher risk of reconstruction failure for the expander/implant group (hazard ratio, 2.01) and a significantly shorter time to reconstruction failure compared with the permanent implant group (109.2 months versus 157.7 months; p = 0.03); however, according to a competing risk model, the between-groups cumulative incidences were not significantly different (hazard ratio, 1.09).

Conclusions:

Radiotherapy to either a tissue expander or a permanent implant presented a fairly large risk of reconstruction failure over time. The expander/implant group was not more likely to develop reconstruction failure compared to permanent implant group, but the timing of onset was shorter. More complex techniques should be investigated to lower the risk of reconstruction failure.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
The KS-Pexy: A Novel Method to Manage Horizontal Lower Eyelid Laxity
Authors: Van Slyke Aaron C. , Carr Lauren A. , Carr Nicholas J.
Published: November 2019

Background:

Patients with horizontal lower lid laxity undergoing lower lid blepharoplasty are at a high risk for lid malposition. Prophylactic correction of horizontal lower lid laxity during blepharoplasty may alleviate this risk. In this article, the authors describe a novel lower lid blepharoplasty technique, the KS-pexy (named after its originators, Kuhnt and Szymanowski), for correcting horizontal lower lid laxity.

Methods:

All cases of KS-pexy between September of 2009 and June of 2018 from an aesthetic practice were reviewed retrospectively. All patients were diagnosed with horizontal lower lid laxity and requested lower lid blepharoplasty for aesthetic concerns. Patient demographics, clinical presentation, procedure details, and intraoperative findings were analyzed.

Results:

Sixty-two patients underwent KS-pexy performed by the senior author. The average follow-up was 41.1 months, ranging from 2 to 107 months. Thirteen patients had a negative vector, 54 patients received a KS-pexy in combination with another facial procedure, and 14 patients had their KS-pexy as a secondary procedure. The overall success rate was 96.8 percent. The complication profile was as follows: chemosis (27.4 percent), new-onset dry eyes persisting longer than 8 weeks (6.5 percent), temporary lower eyelid malposition (4.8 percent), lower eyelid malposition requiring surgical intervention (3.2 percent), poor scar quality (1.6 percent), lower lid abscess (1.6 percent), transient conjunctivitis (1.6 percent), lateral fat compartment swelling (1.6 percent), canthopexy dehiscence (1.6 percent), hordeolum (1.6 percent), and temporary V2 paresthesia (1.6 percent).

Conclusion:

The KS-pexy is an effective means to treat horizontal eyelid laxity prophylactically in patients requesting lower eyelid blepharoplasty for aesthetic reasons.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Probiotics to manage inflammation in HIV infection
Authors: Reikvam Dag Henrik , Meyer-Myklestad Malin Holm , Trøseid Marius , Stiksrud Birgitte
Published: November 2019

Purpose of review

To evaluate the current scientific basis for administering probiotics to people living with HIV (PLHIV) to alleviate chronic inflammation and subsequently improve their prognosis.

Recent findings

The gut microbiome is a potential contributing factor to low-grade inflammation in HIV infection, and there is a scientific rationale for attempting to attenuate inflammation by administering probiotics. Sixteen reports from clinical studies in antiretroviral therapy (ART)-treated PLHIV assessing inflammation after probiotic intervention have been identified; half of them randomized control trials (RCT). Some of the studies report improvement in some parameters of inflammation, but results are inconsistent. No studies report improvement of CD4 counts. None of the RCTs report improvements in any markers of inflammation when analyzed according to protocol.

Current scientific evidence does not support the use of probiotics to alleviate inflammation in HIV infection. The potential effect of probiotic intervention in ART-treated PLHIV with high risk for inflammation remains to be investigated.
Ocular and neurosyphilis: epidemiology and approach to management
Authors: Singh Ameeta E.
Published: November 2019

Purpose of review

In the context of a resurgence of syphilis worldwide, it can be anticipated that a rise in cases of ocular, otic, and neurosyphilis will also be seen. This article reviews the current epidemiology, manifestations, and approach to management and treatment.

Recent findings

Although studies continue investigating alternate approaches and new diagnostic tests for ocular and neurosyphilis, few data exist to change current diagnostic algorithms and approaches to diagnosis, management, or follow up.

The diagnosis of neurologic and eye/ear involvement with syphilis may be delayed because of a lack of specificity of findings, low suspicion for syphilis, fluctuation in symptoms, and/or similarities in presentation to other diseases. A high index of suspicion for syphilis and re-education about the protean manifestations of syphilis by all clinicians is required provide timely diagnosis and management of ocular, otic, and neurosyphilis.
Periarticular Neurofascial Dextrose Prolotherapy Versus Physiotherapy for the Treatment of Chronic Rotator Cuff Tendinopathy
Authors: Kazempour Mofrad Morteza , Rezasoltani Zahra , Dadarkhah Afsaneh , Kazempour Mofrad Reza , Abdorrazaghi Fateme , Azizi Sirous
Published: November 2019

Background/Objective

Rotator cuff tendinopathy is a common cause of shoulder pain. We aimed to compare periarticular (neurofascial) dextrose prolotherapy versus physiotherapy for treatment of chronic rotator cuff tendinopathy in the short term.

Methods

We carried out a randomized clinical trial with 2 arms at a university hospital. In total, 66 patients with chronic rotator cuff tendinopathy, proven by magnetic resonance imaging, were randomly allocated to 2 groups. The outcomes were change in shoulder pain intensity (primary) and disability (secondary) index using a questionnaire for Shoulder Pain and Disability Index. For physiotherapy, participants received superficial heat, transcutaneous electrical nerve stimulation, and pulsed ultrasound. Also, they carried out an exercise program, 10 sessions of 30 minutes for 3 weeks. For prolotherapy, we used 8 mL of 12.5% dextrose and 40 mg of 2% lidocaine. The mixture was injected 2 times with 1-week interval superficially around the shoulder joint and to tender points along the suprascapular nerve.

Results

Neurofascial dextrose was more effective than physiotherapy for alleviating pain in 2 weeks (p < 0.001), and they were similar 3 months after the interventions (p = 0.055). For disability, dextrose was more effective than physiotherapy 2 weeks and 3 months (both p < 0.001) after the interventions. However, the changes in the physiotherapy group seemed to be more sustained.

Conclusions

Both interventions are effective for the short-term management of rotator cuff tendinopathy. However, prolotherapy is more successful as the initial treatment. Besides, the treatment time is much shorter for dextrose prolotherapy compared with physiotherapy.
Cultural Adaptation and Validation of the Methotrexate Intolerance Severity Score in Brazilian Portuguese for Adults With Rheumatoid Arthritis
Authors: Amaral Jéssica Martins , Brito Maria José Menezes , Kakehasi Adriana Maria
Published: November 2019

Introduction

The Methotrexate Intolerance Severity Score (MISS) questionnaire is used to identify intolerance to methotrexate (MTX), but it is not available in the Brazilian Portuguese language.

Objective

The aim of this study was to adapt and validate the MISS in Brazilian Portuguese.

Methods

The Brazilian Portuguese version of the MISS was developed following the Guidelines for the Process of Cross-cultural Adaptation of Self-report Measures. The new version was tested in 120 patients with rheumatoid arthritis. For the reliability assessment, the Cronbach α coefficient was used. The receiver operating characteristic curve was constructed with the objective of finding the best cutoff point for MTX intolerance and weighing the sensitivity and specificity. The concordance among the results was analyzed using the κ coefficient and factorial analysis with varimax rotation.

Results

This methodological study developed and applied a culturally acceptable Brazilian Portuguese version of the MISS. The MISS questionnaire presented internal consistency classified as “very good” because Cronbach α is equal to 0.83 (95% confidence interval, 0.79–0.87). The suitability of the data for factorial analysis was demonstrated using the Kaiser-Meyer-Olkin sample adequacy test (KMO = 0.723) and Bartlett sphericity test (χ2 = 499.98, p < 0.001). It was observed that a factorial analysis with 3 factors is preferred; the receiver operating characteristic curve of the MISS score was considered the cutoff point at 6 points (sensitivity 100% and specificity 89.4%).

Conclusions

The Brazilian Portuguese version of the MISS is valid and reliable for the detection of MTX intolerance in clinical practice.
Hepatobiliary Scintigraphy—Role in Preliminary Diagnosis and Management of Biliary Tract Injuries
Authors: Kousik Vankadari , Bhattacharya Anish , Yadav Thakur Deen , Mittal Bhagwant Rai
Published: November 2019

Purpose

This study was conducted to identify the role of hepatobiliary scintigraphy (HBS) in the management of biliary tract injuries.

Methods

We retrospectively studied 54 patients (28 male and 26 female patients) aged 3 to 78 years with evidence of bile leak on HBS performed between January 2015 and October 2017. Following intravenous injection of 99mTc-mebrofenin, dynamic images were acquired for 30 minutes followed by static images until 24 hours. SPECT/CT was performed in patients with suspicion of bile leak on the planar images. Patients were classified as those with free intraperitoneal or localized bile leak. Any abdominal drain output was documented, and its statistical significance was assessed using Mann-Whitney U test. Subsequent management was also documented.

Results

Of the 54 patients, 28 demonstrated free intraperitoneal bile leak and 26 localized leak on HBS. Thirty-four patients (24 with free intraperitoneal leak and 10 with localized leak) had an abdominal drain. Drain output was significantly higher in patients with free intraperitoneal leak compared with patients with localized leak (370 vs 78 mL/d per patient, P < 0.01). All patients with free intraperitoneal bile leak underwent interventional procedures such as endoscopic retrograde cholangiopancreatography and stenting or Roux-en-Y hepaticojejunostomy later on. Patients with localized bile leak were managed conservatively and were free of symptoms at 1-year follow-up.

Conclusions

Our findings indicate that, in addition to detecting biliary leak, HBS may be used to identify patients with localized bile leak (48% of patients in our study) who do not require active intervention.
Immunological mechanisms in poststroke dementia
Authors: Doyle Kristian P. , Buckwalter Marion S.
Published: November 2019

Purpose of review

To review new evidence on links between poststroke dementia and inflammation.

Recent findings

Although there are still no treatments for poststroke dementia, recent evidence has improved our understanding that stroke increases the risk of incident dementia and worsens cognitive trajectory for at least a decade afterwards. Within approximately the first year dementia onset is associated with stroke severity and location, whereas later absolute risk is associated with more traditional dementia risk factors, such as age and imaging findings. The molecular mechanisms that underlie increased risk of incident dementia in stroke survivors remain unproven; however new data in both human and animal studies suggests links between cognitive decline and inflammation. These point to a model where chronic brain inflammation, provoked by inefficient clearance of myelin debris and a prolonged innate and adaptive immune response, causes poststroke dementia. These localized immune events in the brain may themselves be influenced by the peripheral immune state at key times after stroke.

This review recaps clinical evidence on poststroke dementia, new mechanistic links between the chronic inflammatory response to stroke and poststroke dementia, and proposes a model of immune-mediated neurodegeneration after stroke.
Loops linking secondary structure elements affect the stability of molten globule intermediate state of apomyoglobin
Authors: Majorina M.A. , Melnik B.S.
Published: November 2019

Apomyoglobin is a protein widely used as a model for studying globular protein folding. This work aimed to test the hypothesis on influence of rigidity and length of loops linking protein secondary structure elements on the stability of molten globule intermediate state. For this purpose, we studied folding/unfolding of mutant apomyoglobin forms with substitutions of proline residues to glycine and with loops elongated by three and six glycine residues. For all the protein forms, denaturation/renaturation kinetic curves at different urea concentrations were obtained, folding/unfolding constants were calculated and dependencies of rate constant logarithms on urea concentrations were plotted. All the data gave an opportunity to calculate free energies of different apomyoglobin states. As a result, the mutations in apomyoglobin loops were demonstrated to have a real effect on intermediate state stability compared to unfolded state.
Rapid Alkalinization Factor (RALF) gene family genomic structure and transcriptional regulation during host-pathogen crosstalk in Fragaria vesca and Fragaria x ananassa strawberry
Authors: Negrini Francesca , O’Grady Kevin , Hyvönen Marko , Folta Kevin M. , Baraldi Elena
Published: November 2019

Rapid Alkalinization Factor (RALF) are cysteins-rich peptides ubiquitous in plant kingdom. They play multiple roles as hormone signals, starting from root elongation, cell growth, pollen tube development and fertilization. Their involvement in host-pathogen crosstalk as negative regulator of immunity in Arabidopsis has also been recognized. In addition, RALF peptides are secreted by different fungal pathogens as effectors during early stages of infections. Campbell and Turner previously identified nine RALF genes in F. vesca v1 genome. Here, based on the recent release of Fragaria x ananassa genome and F. vesca reannotation, we aimed to characterize the genomic organization of the RALF gene family in both type of strawberry species according to tissue specific expression and homology with Arabidopsis. We reveal the presence of 13 RALF genes in F. vesca and 50 in Fragaria x ananassa, showing a non-homogenous localization of genes among the different Fragaria x ananassa subgenomes associated with their different TE element contents and genome remodeling during evolution. Fragaria x ananassa RALF genes expression inducibility upon infection with C. acutatum or B. cinerea was assessed and showed that, among fruit expressed RALF genes, FaRALF3-1 was the only one upregulated after fungal infection. In silico analysis and motif frequency analysis of the putative regulatory elements upstream of the FaRALF3 gene was carried out in order to identify distinct pathogen inducible elements. Agroinfiltration of strawberry fruit with 5’ deletion constructs of the FaRALF3-1 promoter identified a region required for FaRALF3 expression in fruit, but did not identify a region responsible for fungal induced expression.
Perceived value of social media in students’ participation in social movement
Authors: Akter Shohana , Islam Md. Anwarul
Published: November 2019

Purpose

The purpose of this study is to empirically investigate the use of social media (SM) and its influence for increasing students’ participation in the quota reform movement at the University of Dhaka, Bangladesh.

Design/methodology/approach

The revised technology acceptance model (TAM) was used to formulate this research’s hypotheses. A survey was administered to obtain data about students’ intention to use SM. The survey consisted of a set of questions based upon the revised TAM model. A total of 498 surveys were distributed and 304 students responded to it; hence, response rate was of 61.04%. A regression and single way ANOVA were conducted to test the hypotheses.

Findings

The results indicate that most of the students use SM for academic purposes and to get connected with friends. Among the social networking tools, Facebook is the most widely used by the respondents. Findings supported that perceived ease of use and perceived usefulness of SM affect student’s intention to increase participation in the quota reform movement. There were no significant relationships between gender and politics with the use of SM.

Research limitations/implications

A sample of students from Dhaka University was taken and the sample size was small. As a result, the findings of this study cannot be generalized in other settings. SM has a positive effect in the societies where change happens through collective actions.

Originality/value

Why and how students use SM has been widely discussed over the available literature, but students’ intention to use for it for social movements has not been studied. This study has made an effort to empirically examine the use of SM in the context of the quota reform movement in Bangladesh.
Harmonic form-finding for the design of doubly-curved shells
Authors: Brandt-Olsen Cecilie , Shepherd Paul , Richens Paul
Published: November 2019

Purpose

Shell structures are highly efficient and are an elegant way of covering large uninterrupted spaces, but their complex geometry is notoriously difficult to model and analyse. This paper aims to describe a novel free-form shell modelling technique based on structural harmonics.

Design/methodology/approach

The method builds on work using weighted eigenmodes for three-dimensional mesh modelling in a computer graphics setting and extends it by specifically adapting the technique to an architectural design context. This not only enables the sculpting of free-form architectural surfaces using only a few control parameters but also takes advantage of the synergies between eigenmodes and structural buckling modes, to provide an efficient means of stiffening a shell against failure by buckling.

Findings

The result is a flexible free-form modelling tool that not only enables the creation of arbitrary doubly curved surfaces but also allows simultan. The tool helps to assist in the design of shells at the conceptual stage and encourages an interaction between the architect and engineer. A number of initiatives, including a single degree of freedom design, boundary constraints, visualisation aids and guidelines towards specific spatial configurations have been introduced to satisfactorily adapt the method to an architectural context.

Originality/value

The tool helps to assist in the design of shells at the conceptual stage and encourages an interaction between the architect and engineer. A number of initiatives, including a single degree of freedom design, boundary constraints, visualisation aids and guidelines towards specific spatial configurations have been introduced to satisfactorily adapt the method to an architectural context. This paper includes a full case study of the iconic British Museum Great Court Roof to demonstrate the applicability of the developed framework to real-world problems and the software developed to implement the method is available as an open-source download.