bluuebunny/crossref_metadata_2025 huggingface dataset:
Sexual Violence against Men and Boys during the Holocaust: A Genealogy of (Not-So-Silent) Silence
Authors: Glowacka Dorota
Published: May 2020

Although far more women than men are sexually violated in conflict settings, the records indicate that sexual violence against men and boys has been routinely practised as a weapon of war and genocide. Sexual violence against men and boys during the Holocaust was likely a regular occurrence, but it has remained undocumented and under-researched. Sexual violence against men, because it does not conform to prevalent gender norms and expectations, has been subjected to cultural and epistemic erasure. As a result, it is construed on the model of female rape, making it difficult to recognize male-victim specific forms of assault. Moreover, normative and legal frameworks developed to address it do not take into account the role that the stigma of homosexuality plays in male sexual violence. This article is based on oral testimonies by male heterosexual-identified Jewish survivors of the Holocaust. I focus on the survivors’ self-presentation as adult men in light of their past abuse and on the dynamic of the interviews. I also reference one memoir (Nate Leipciger’s The Weight of Freedom) and reinterpret a chapter from Elie Wiesel’s Night in light of my findings. Revealing the extent of sexual violence against men helps delegitimize harmful gender stereotypes and conceptions of manhood and ‘homosexuality’ and expose their central role in the perpetuation of genocidal violence.
Regulatory T Cells Expressing Tumor Necrosis Factor Receptor Type 2 Play a Major Role in CD4+ T-Cell Impairment During Sepsis
Authors: Gaborit Benjamin J , Roquilly Antoine , Louvet Cédric , Sadek Abderrahmane , Tessoulin Benoit , Broquet Alexis , Jacqueline Cédric , Vourc’h Mickael , Chaumette Tanguy , Chauveau Marie , Asquier Antoine , Bourdiol Alexandre , Le Mabecque Virginie , Davieau Marion , Caillon Jocelyne , Boutoille David , Coulpier Fanny , Lemoine Sophie , Ronin Emilie , Poschmann Jérémie , Salomon Benoit L , Asehnoune Karim
Published: May 2020

Sepsis causes inflammation-induced immunosuppression with lymphopenia and alterations of CD4+ T-cell functions that renders the host prone to secondary infections. Whether and how regulatory T cells (Treg) are involved in this postseptic immunosuppression is unknown. We observed in vivo that early activation of Treg during Staphylococcus aureus sepsis induces CD4+ T-cell impairment and increases susceptibility to secondary pneumonia. The tumor necrosis factor receptor 2 positive (TNFR2pos) Treg subset endorsed the majority of effector immunosuppressive functions, and TNRF2 was particularly associated with activation of genes involved in cell cycle and replication in Treg, probably explaining their maintenance. Blocking or deleting TNFR2 during sepsis decreased the susceptibility to secondary infection. In humans, our data paralleled those in mice; the expression of CTLA-4 was dramatically increased in TNFR2pos Treg after culture in vitro with S. aureus. Our findings describe in vivo mechanisms underlying sepsis-induced immunosuppression and identify TNFR2pos Treg as targets for therapeutic intervention.
MaxEnt Modeling of Dermacentor marginatus (Acari: Ixodidae) Distribution in Xinjiang, China
Authors: Huercha  , Song Ruiqi , Ma Ying , Hu Zhengxiang , Li Yingke , Li Min , Wu Lijiang , Li Caishan , Dao Erjiala , Fan Xinli , Hao Yunwei , Bayin Chahan
Published: May 2020

Dermacentor marginatus Sulkzer is a common tick species found in the Xinjiang Uygur Autonomous Region (XUAR) of China, and is a vector for a variety of pathogens. To determine the potential distribution of this tick species in Xinjiang, a metadata containing 84 D. marginatus presence records combined with four localities from field collection were used for MaxEnt modeling to predict potential distribution of this tick species. Identification of tick samples showed 756 of 988 (76%) were D. marginatus. MaxEnt modeling results indicated that the potential distribution of this tick species was mainly confined to northern XUAR. Highly suitable areas included west side of Altay mountain, west rim of Junggar basin, and Yili River valley in the study area. The model showed an AUC value of 0.838 ± 0.063 (SD), based on 10-fold cross-validation. Although tick presence records used for modeling were limited, this is the first regional tick distribution model for D. marginatus in Xinjiang. The model will be helpful in assessing the risk of tick-borne diseases to human and animals in the region.
Fibrous solitary tumor, a rare and ubiquitous neoplasy
Authors: Ros Alejandro , Cortés Javier , Belda Tatiana , Magán Alejandro , Illán-Gambín Francisco J , Aracil Elisa , Serra Carlos
Published: May 2020

Fibrous solitary tumors (FST) are mesenchymal tumors that can appear in different body regions. It is estimated that around 30% are found in the thoracic region, while rarely in meninges, abdomen, pelvis, extremities and bones. A correct diagnosis is important because 15–20% of cases develop a malignant behavior. Treatment of choice is surgical and posterior follow-up is essential. We present two atypical extrapleural FST cases, diagnosed in our center. Both were treated with surgery and in one case arterial embolization to reduce the bleeding risk was previously done.
Aspirin for primary prevention of cardiovascular disease in women
Authors: Shufelt Chrisandra L. , Manson JoAnn E.
Published: May 2020

For primary prevention, low-dose aspirin should be considered in women aged 40 to 70 years with a 10-year cardiovascular risk of 20% or more or in women with diabetes and a 10-year cardiovascular risk of 10% or more. The risk of bleeding outweighs the benefits in low-risk women and in women aged 70 years and older.
Workplace violence: Examination of the tensions between duty of care, worker safety, and zero tolerance
Authors: Beattie Jill , Innes Kelli , Griffiths Debra , Morphet Julia
Published: May 2020

Background

Workplace violence (WPV) remains an international problem. This raises challenges for staff in meeting their duty of care to consumers while enforcing zero tolerance for violence directed toward them.

Purpose

The aim of the study was to expose the values and beliefs underpinning practice and reveal any flawed assumptions or evidence, upon which decisions related to WPV are made. By increasing staff awareness, the secondary aim is to decrease staff stress when confronted with conflicting policies and duty of care responsibilities.

Methodology

Explanatory research as part of a larger descriptive study was used. Semistructured interviews with a sample of managers and staff (n = 99) in Victorian Health Services (Australia) were performed. Initial descriptive analysis identified a tension between duty of care, worker safety, and zero tolerance. This article reports the secondary analysis to examine these relationships in depth.

Findings

Feeling obligated and providing care for aggressive patients was difficult while maintaining own safety: “You cannot do both.” Although there were contrasting views about the merits of zero tolerance, policies were rarely enacted: “We cannot refuse to treat.” Incongruency between legislative requirements creates confusion for decision-making: “Which Act trumps what?”

Conclusion

Despite policies supporting zero tolerance, staff do not enact these because they prioritize duty of care to consumers before duty of care to self. Zero tolerance, with incongruent legislation, compounds this tension and impairs decision-making.

Practical Implications

This article exposes the underlying values, beliefs, and flawed assumptions underpinning practice related to WPV. Managers need to amend policies to reduce staff confusion, adopt a trauma-sensitive and resilience approach, and develop a clearly written framework to guide decision-making related to duty of care to consumers and staff safety. Incident reports and staff well-being/satisfaction surveys need to evaluate the effects of zero tolerance on staff and consumers. Regulators need to ensue legislative requirements are congruent with staff safety and well-being.
Postoperative Quality of Life in Oculoplastic Patients
Authors: Seo Shin Tien , Sundar Gangadhara , Young Stephanie Ming
Published: May 2020

Purpose:

To conduct a literature review on postoperative quality of life in oculoplastic patients.

Methods:

The authors conducted a database search to evaluate the evidence available for the change in quality of life after oculoplastic surgery.

Results:

There was a wide disparity of evidence available for different oculoplastic conditions. Certain conditions, such as nasolacrimal duct obstruction, were well-researched while other conditions, such as epiblepharon, had little to no research supporting improvement in quality of life after surgery. The scales used to measure quality of life displayed heterogeneity.

Conclusion:

There is a lack of published evidence concerning postoperative quality of life in patients with certain oculoplastic conditions such as brow ptosis, entropion, ectropion, epiblepharon, and orbital wall fracture. There is a need to standardize the quality of life data collection tools and scoring systems to allow better comparison and scrutiny of the current literature.
Slit-shaped artificial pupil and very dense nuclear cataract after early iridoplasty: May consultation #1
Authors: Menapace Rupert
Published: May 2020

A now-17-year-old girl was reportedly born with no pupil formed in her right eye. In her first week of life, she underwent attempted pupilloplasty at a foreign institution. Surgery was reported to have been complicated and followed by vitreous hemorrhage. Nine months later, the eye was reevaluated at another institution and the presence of primary persistent hyperplastic vitreous noted. Secondary widening of the artificial pupil was performed. She now presents with a slit-shaped pupil and a very dense nuclear cataract (Figure 1). She now desires removal of the cataract to regain the temporal visual field and at least some residual vision as well as reformation of the pupil for cosmetic reasons.

JOURNAL/jcrs/04.03/02158034-202005000-00026/figure1/v/2023-08-19T002547Z/r/image-tiff

Slitlamp examination shows superficial corneal scarring around a corneal incision and corneal sutures superiorly with iridocorneal synechiae between 10 and 12 o'clock confirmed on gonioscopy. It appears that a primary inferiorly displaced pupil was enlarged, and the iris shanks pulled up and incarcerated in the corneal incision, resulting in a slit-shaped cat's eye pupil. Intraocular pressure was 10 mm Hg. Light perception is uncertain but definitely positive on transillumination, and ultrasound reveals the retina to be fully attached (Figure 2).

JOURNAL/jcrs/04.03/02158034-202005000-00026/figure2/v/2023-08-19T002547Z/r/image-tiff

How would you counsel this girl, and what would be your surgical approach? Which specific techniques would you consider for removal of the cataract and reformation of the pupil?
Health Economic Evaluation of an Influenza Vaccination Program to Prevent Sick Leave in Employees
Authors: Lutz Nathanael , Deliens Tom , Clarys Peter , Verhaeghe Nick , Taeymans Jan
Published: May 2020

Objective:

To evaluate the cost-effectiveness of an influenza vaccination program (IVP) among employees.

Methods:

This health economic evaluation was embedded in a prospective cohort study of a voluntary IVP. Data on incidence, direct, and indirect costs were collected via questionnaires. Bootstrapping and modeling techniques were used to assess uncertainty of the results.

Results:

In the base-scenario, the IVP was less effective, more expensive and thus, neither cost-effective nor cost-beneficial. When applying a sensitivity analysis using published estimates of IVP effectiveness on the data, the IVP became cost-effective and cost-beneficial.

Conclusions:

Like in many evaluations of real-world settings, lack of randomization may have caused selection bias which may explain the surprising results of the main analysis. This indicates the importance of sensitivity analyses and modeling approaches for future studies assessing the cost-effectiveness of IVP in a real-world setting.
Chimeric antigen receptor-modified T-cell therapy for bone marrow and skin relapse Philadelphia chromosome-like acute lymphoblastic leukemia
Authors: Yang Mianzeng , Liu Bingcheng , Wang Ying , Liu Yuntao , Gong Xiaoyuan , Gong Benfa , Xu Yingxi , Mi Yingchang , Wang Min , Wang Jianxiang
Published: May 2020

Rationale:

Chimeric antigen receptor-modified T-cell (CART) therapy has revolutionized the treatment of patients with relapsed or refractory B-cell acute lymphoblastic leukemia (ALL). However, the capacity of CART therapy has not yet been fully elucidated.

Patient concerns:

An 18-year-old Chinese male patient presented with multiple firm masses on the skin all over his body following regular chemotherapy.

Diagnoses:

Bone marrow smear and skin biopsy confirmed that it was a bone marrow and skin relapse from the initial B-cell ALL.

Interventions:

CD19 CART-cell therapy was performed to manage the bone marrow and skin of the relapsed B-cell ALL.

Outcomes:

During CART-cell therapy, cytokine release syndrome and central nervous encephalopathy occurred. Eventually, the lesions disappeared, and the bone marrow and skin tested minimal residual disease (MRD) negative. The patient achieved complete remission (CR). Fourteen days after testing MRD negative, he received allogeneic hematopoietic stem-cell transplantation and has remained disease free to date.

Lessons:

The CR of this patient with leukemia cutis demonstrated that CART exhibited efficacy in this case. While further research is still required, this treatment could potentially be used as a therapy for skin leukemia, lymphoma, and other primary skin cancers.
Fall experience and cognitive function in middle aged and elderly population
Authors: Kim Jae-Hyun
Published: May 2020

This study estimates the association between the fall experience in the last 2 years and cognitive function and further evaluate the differences in this association between men and women and across different age groups. Data from the Korean Longitudinal Study of Ageing from 2006 to 2016 was used and 9279 research samples were included at baseline in 2006. To analyze the association between fall experience for the last 2 years and cognitive function, generalized estimating equation model and chi-square test were used. After adjusting for all confounders, those with fall experience were significantly associated with cognitive decline. With non-fall experience as reference: fall experience, B = −0.013 (P = .017). In the 64 years or less group, fall experience was significantly associated with cognitive decline (P-value: 0.006) to those with non-fall experience. In male group, with non-fall experience as reference: fall experience, B = −0.017 (P = .041). Fall experience in the last 2 years is associated with cognitive decline, especially in those 64 years or less and male group. Therefore, self-reported screening for fall experience might aid population-based prevention strategies for cognitive decline, especially in 64 years or less and male.
Meta-analysis of the efficacy and safety of non-vitamin K antagonist oral anticoagulants with warfarin in Latin American patients with atrial fibrillation
Authors: Su Zhiyu , Zhang Hao , He Wenfeng , Ma Jianyong , Zeng Junquan , Jiang Xinhua
Published: May 2020

Background:

Data of non-vitamin K antagonist oral anticoagulants (NOACs) in current management of atrial fibrillation (AF) are predominantly derived from North American and European regions. However, the effects of NOACs for stroke prevention in Latin America remain unclear. Therefore, we aimed to compare the efficacy and safety of NOACs with warfarin in Latin American patients with AF.

Methods:

The PubMed and Embase databases were systematically searched until July 12, 2019 for applicable randomized clinical trials. The risk ratios (RRs) and 95% confidence intervals (CIs) were pooled using a random-effects model.

Results:

Four trials involving 8943 Latin American patients were included in this meta-analysis. In anticoagulated patients with AF, Latin American patients had higher rates of stroke or systemic embolism and all-cause death compared with non-Latin American subjects. Compared with warfarin use, the use of NOACs was significantly associated with reduced risks of stroke or systemic embolism, major bleeding, intracranial bleeding, and any bleeding in Latin American patients. There were no significant differences in the risks of ischemic stroke, all-cause death, and gastrointestinal bleeding between Latin and non-Latin American groups. All the interactions between Latin and non-Latin American groups about efficacy and safety outcomes of NOACs compared with warfarin were non-significant (all P
interaction > .05).

Conclusions:

Our meta-analysis suggested that the use of NOACs was at least non-inferior to warfarin use for stroke prevention in Latin American patients with AF.
Observation for clinical effect of acupuncture combined with conventional therapy in the treatment of acne vulgaris
Authors: Kou Le , Yu Nan , Ren Junjie , Yang Bingyan , Tao Yun
Published: May 2020

Introduction:

Acne vulgaris is a chronic inflammatory disease of the sebaceous glands that occurs in adolescent men and women. In recent years, the incidence of acne has increased year by year, so it is of great significance to find a precise and effective treatment and further explore its possible mechanism of action. The purpose of this study will be to explore a treatment method that has both traditional Chinese medicine characteristics and significant effects, and provides a higher level of evidence for acupuncture for acne vulgaris. It also provides patients with more treatment options.

Methods/design:

The study will be a randomized controlled trial divided into 2 parallel groups. This pragmatic randomized controlled trial will recruit 66 patients who are diagnosed with acne vulgaris. 30-minutes acupuncture sessions will be provided to patients assigned to the intervention group. All participants will continue to receive conventional treatment. The selection of outcomes will be evaluated by the skin lesions score scale.

Discussion:

This trial may provide evidence regarding the clinical effectiveness, safety, and cost-effectiveness of acupuncture for patients with acne vulgaris.

Trial registration number:

CTR2000030427
Unexpected occult malignancy diagnosed during tonsillectomy surgery for obstructive sleep apnea
Authors: Park Donghwi , Lee Byung Joo , Go Minchul , Kim Jung-Soo , Heo Sung Jae
Published: May 2020

Rationale:

Many previous studies have investigated the necessity of routine histopathological analysis of tonsillectomy specimen, and most recent studies have suggested that such an analysis is not justified in asymptomatic patients or those with no risk factors for malignancy.

Patient concerns:

A 59-year-old man diagnosed with obstructive sleep apnea underwent surgery, including tonsillectomy; a tonsil specimen was sent to the department of pathology.

Diagnosis:

Although the patient did not exhibit any tonsil-related signs or symptoms, nor did the appearance of the tonsil appear to be pathological, the right tonsil specimen was diagnosed with squamous cell carcinoma, with detection of human papilloma virus 16.

Interventions:

Chemotherapy and radiotherapy were used to treat the tonsil cancer.

Outcomes:

No recurrence was observed during the 4-year follow-up.

Lessons:

In the future, it may be necessary to reinvestigate the necessity of routine histopathological analysis of tonsillectomy specimens in asymptomatic patients, considering the drastically increased rate of detection of human papilloma virus-related oropharyngeal squamous cell carcinomas in these patients.
Full recovery of near complete tear of anterior cruciate ligament without surgery: a case report
Authors: Kim Yoo Na , Baek Jungwon , Kim Young Hoon , Hwang Jaewoong , Ko Yu Ri , Lee Min soo , Kim Young chan , Park Hue Jung
Published: May 2020

Introduction:

The anterior cruciate ligament (ACL) is the region where spraining or tearing is most prevalent when the knee is injured. Complete ACL ruptures have a much less favorable outcome without surgical intervention. Polydeoxyribonucleotide (PDRN) is a relatively safe substance widely used for regenerative therapy.

Patient concerns:

A 43-year-old female patient visited our clinic with Rt. knee pain after slipping, which she rated as 7/10 on a numeric rating scale.

Diagnosis:

She was diagnosed as having a near complete tear of the ACL at the femoral attachment, partial tear of the lateral collateral ligament.

Interventions:

Ultrasound-guided PDRN injections were carried out 5 times at intervals of about 2 weeks.

Outcomes:

At 3-month follow-up, the patient demonstrated an improvement in knee symptoms (numeric rating scale 0) and ROM without any complications. Even after 2 years and 5 months since the diagnosis, she has been doing her daily life well without any pain.

Conclusion:

This is the first report of successful PDRN injection for near complete tear of ACL and partial tear of lateral collateral ligament without surgery.
Transesophageal echocardiography (TEE) in the detection of intraoperative cardiac arrest
Authors: Zhang Donghang , Yang Hui , Chen Mingjing , Zheng Zihao , Zhou Wenying , Song Haibo
Published: May 2020

Rationale:

Point-of-care ultrasound is widely used in patients with cardiac arrest, allowing for diagnosing, monitoring, and prognostication as well as assessing the effectiveness of the chest compressions. However, the detection of intraoperative cardiac arrest by Point-of-care ultrasound was rarely reported.

Patient concerns:

A 21-year-old male with Marfan syndrome which manifested Valsalva sinus aneurysms was admitted for aortic valve replacement. After endotracheal intubation, TEE transducer was inserted to evaluate the cardiac structure and function with different views. Severe aortic valve regurgitation was observed in the mid-esophageal aortic valve long and short axis view.

Diagnosis:

TEE showed that cardiac contraction was nearly stopped, the spontaneous echo contrast was obvious in the left ventricular and hardly any blood was pumped out from the heart despite the ECG showing normal sinus rhythm with HR 61 beats/min. Meanwhile, the IBP was dropped to 50/30 mm Hg.

Interventions:

Chest compressions were started immediately and epinephrine 100 μg was given intravenously. After 30 times of chest compressions, TEE showed that cardiac contractility increased and the stroke volume was improved in the TG SAX view.

Outcomes:

The patient was discharged 18 days later in a stable condition.

Lessons:

Continuous echocardiography monitoring may be of particular value in forewarning and detecting cardiac arrest in high-risk patients.
Case report of holocarboxylase synthetase deficiency (late-onset) in 2 Chinese patients
Authors: Xiong Zihong , Zhang Guoying , Luo Xiaoli , Zhang Ning , Zheng Jing
Published: May 2020

Rationale:

Holocarboxylase synthetase (HCLS) deficiency, especially the late-onset type, is a rare disease. Affected patients can present with irreversible metabolic acidosis and may be misdiagnosed with a glucose metabolic disorder. Prompt and correct diagnosis and treatment can reduce mortality to a great extent.

Patient concerns:

We report 2 Chinese patients who were diagnosed with late-onset HCLS deficiency. The age of onset of the 2 patients was approximately 8 months. The 2 patients had skin lesions, severe profound metabolic acidosis, dyspnea, and hyperglycemia.

Diagnoses:

The results of urinary and blood organic acid analysis with gas chromatography/mass spectrometry revealed multiple carboxylase deficiency. Maple syrup urine disease and diabetic ketoacidosis could not be excluded. This finding is different from those of hypoglycemic complications reported in previous reports. Human genetic analysis eventually provided a definite diagnosis.

Interventions:

Prompt oral treatment with biotin dramatically corrected the metabolic imbalances of the 2 patients, and continued oral biotin therapy was essential to the improvement of their prognoses.

Outcomes:

Their metabolic disorders were corrected within 48 hours. During long-term follow-up, the patients achieved developmental milestones.

Lessons:

Late-onset HCLS deficiency may present with obvious hyperglycemia. Human genetic analysis eventually provided a definite diagnosis. Prompt treatment with biotin is vital to correct metabolic imbalances, and continued therapy is essential to the improving long-term prognoses. Their mutations were p.R508W and c.1088T > A, and these mutations might represent hot-spot genes in Chinese populations with HCLS deficiency. The variants c.1484T > G(p.L495∗) and c.835G > T(p.E279x) are likely pathogenic, and more studies are needed to confirm these results.
Surgical or nonsurgical treatment for nontraumatic rotator cuff tears
Authors: Huang Ding-gen , Wu Ya-li , Chen Peng-fei , Xia Cui-lan , Lin Ze-jin , Song Jin-qi
Published: May 2020

Background:

The optimal treatment for symptomatic, nontraumatic rotator cuff tear is unknown. The primary aim of this randomized controlled trial is to compare functional improvement after surgical and conservative treatment of nontraumatic rotator cuff tears.

Methods:

This is a single-centre, randomized clinical trial with a follow-up of 12 months. Patients older than 18 years with magnetic resonance imaging – confirmed nontraumatic rotator cuff tears that are suitable for either surgery or nonsurgery treatment is enrolled. The primary outcome is Constant score. Secondary outcome measures include visual analog scale (VAS) score, patient satisfaction, and American Shoulder and Elbow Surgeons (ASES) score. All scores are assessed by an independent observer who is blinded to the allocation of groups.

Results:

The study will provide much needed data on surgical vs nonsurgical treatment for nontraumatic rotator cuff tears. Results of this study may help patients, clinicians, and policy makers assess the pivotal question on comparative effectiveness of surgery vs nonsurgical for rotator cuff tears.

Trial registration:

This study protocol was registered in Research Registry (researchregistry5442).
Risk of venous thromboembolism in elderly patients with vertebral compression fracture
Authors: Huang Ching-Hui , Wang Wei-Hsun , Kor Chew-Teng , Hsiao Ching-Hua , Chang Chia-Chu
Published: May 2020

Vertebral compression fractures (VCFs) are common in elderly and are treated with immobilization. Moreover, immobilization and old age may increase venous thromboembolism (VTE) risk. However, the incidence of VCFs-related VTE is unknown in elderly. The purposes of this study were to determine the incidence of VTE among VCF patients, to explore whether percutaneous vertebroplasty (PV) intervention may reduce VTE risk in VCFs patients.

We conducted a population-based case–control study by using the National Health Insurance Research Database. We identified 1407 patients aged ≥65 with VCF who received PV and 1407 VCFs patients who did not receive PV after developing a 1:1 propensity score-matched study cohort and were followed up for 5 years. Using PV intervention as the exposure factor, a cause-specific Cox's proportional hazards model was used to examine the association between PV and VTE.

After propensity score matching, the mean age of the study participants was 78 years and ∼23% of the analyzed participants were men, incidence of VTE in the PV and control cohorts was 5.77 and 4.19 per 1000 person-years, respectively. Both groups were nonsignificant difference after examination with different adjustment models. Patients with VCF and a history of heart failure, coronary artery disease, receiving antihypertension medication were at a significantly increased VTE risk.

Elderly patients with VCF who received PV had a neutral impact on risk of VTE. VCF patients with heart failure, coronary artery disease, and receiving antihypertension medication were prone to developing VTE should be monitored cautiously.
NKG2C+ natural killer cell function improves the control of HBV replication in individuals with acute HIV infection coinfected with HBV
Authors: Song Ting , Li Li , Su Bin , Liu Lifeng , Liu Yan , Yang Xiaodong , Zhang Qiuyue , Guo Na , Zhang Tong , Sun Guizhen , Wu Hao
Published: May 2020

Individuals infected with hepatitis B virus (HBV) are often coinfected with human immunodeficiency virus (HIV). However, individuals with chronic HBV infection living with acute HIV infection have a significantly lower HBV viral load, along with higher HBeAg and HBsAg loss than HBV-infected individuals alone. Here, we investigated the possible role of natural killer cells (NK cell) function in this progressive course to explore the relationship between phenotypic/functional changes in NK cells during acute HIV infection and HBV clearance in patients with HIV/HBV coinfection.

Peripheral blood NK cells from 38 patients with primary HIV infection, including 20 with untreated HIV infection and 18 treatment-naïve patients with HIV/HBV coinfection and 16 patients with chronic HBV infection, were enrolled in this study.

We found that the HIV/HBV-coinfected individuals had higher levels of NK cells than the HBV-infected individuals, due to expansion of the CD56neg NK cell population. The proportion of NK cells in CD56dim and CD56bri NK subsets was not found significant difference between HIV/HBV-coinfected and HBV-infected individuals. However, NKG2C levels on NK cells and subsets were significantly higher in HIV/HBV-coinfected individuals than in HBV-infected individuals, whereas NKG2A levels were unaffected or decreased. In addition, the levels of degranulation CD107a, cytotoxicity and IFN-γ production of NK cells were increased in HIV/HBV-coinfected individuals than in HBV-infected individuals. The level of IL-10 production of NK cells was decreased in HIV/HBV-coinfected individuals than in HBV-infected individuals. Furthermore, the level of HBV-DNA was inversely correlated with the proportion of NKG2C+ and NKG2C+NKG2A− NK cells, while positively correlated with the proportion of NKG2A+ and NKG2C-NKG2A+ NK cells. IFN-γ production was inversely correlated with levels of HBV-DNA, but the CD107a expression and IL-10 production of NK cells were not correlated with HBV-DNA levels.

These results demonstrate that the upregulation of NKG2C expression, but not of NKG2A expression on the surface of NK cells increases cytolytic capacity and the amounts of cytokines produced and may play a crucial role in HBV clearance during HIV/HBV-coinfection.
Cemented versus uncemented total knee arthroplasty in younger patients
Authors: Guo Yuning , Ma Shufang , Wang Junbo , Zhang Qin , Wang Shaowei , Du Zhipo
Published: May 2020

Background:

Recently, controversy still exists regarding the clinical effects of cemented or cementless technique in young patients in total knee arthroplasty (TKA). In this context, the present study aimed to determine the functional outcomes and clinical reliability of cementless components versus those of conventional cemented components for young patients in primary TKA.

Methods:

A retrospective review of primary TKAs performed with cementless or cemented fixation between May 2010 and February 2019 was conducted with Institutional Review Board approval. All cases were performed by a single surgeon. Institutional review board approval was obtained prior to conducting chart review and analysis. The primary outcome compared between the 2 fixation groups was the rate of postoperative complications and revision related to TKA, occurring at any point in follow-up. Secondary outcome measures included surgical time, Oxford Knee Score, range of motion, and radiographic outcomes such as progressive radiolucent lines, osteolysis, or component migration.

Results:

We were able to directly compare the outcomes of cemented versus cementless techniques and might reveal a better technique in TKA.

Trial registration:

This study protocol was registered in Research Registry (researchregistry5459).
Intramedullary cervical spinal cord teratoma
Authors: Wang Lishuai , Li Tongxiang , Gong Min , Xing Fei , Li Lang , Xiao Rui , Guan Qing
Published: May 2020

Background:

Intramedullary cervical spinal cord teratomas (ICTs) are extremely rare, and diagnosis and treatment are challenging. We conducted a systematic review of the literature on the diagnosis and treatment of ICT.

Method:

The presentation, imaging manifestations, diagnosis, management, surgery findings, prognosis and histology were reviewed following Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines. English-language studies and case reports published from inception to 2018 were retrieved. Data on presentation, imaging characteristics, diagnosis, management, surgery findings, outcomes, and histopathology were extracted.

Results:

Ten articles involving 10 patients were selected. The lesions were located in the upper cervical vertebrae in 4 cases, whereas in the lower cervical vertebrae in the remaining 6 cases. In 5 cases, the lesions were located on the dorsal side of the spinal cord, and in the center of the spinal cord in the remaining 5 cases. Quadriparesis (60%), paraplegia (30%), monoplegia (10%), and neck pain (50%) were the main presentations. The lesion appeared as a intramedullary heterogeneous signal during an MRI scan, and the lesion signal would be partially enhanced after the contrast medium was applied. All patients underwent surgical intervention through a posterior approach. Neurological function improved postoperatively in all patients. Two patients with pathology confirmed to be immature teratomas experienced recurrence.

Conclusion:

ICTs are extremely rare entities that are mainly located in the center or dorsal part of the spinal cord which mainly manifest as quadriplegia and neck pain. MRI is a useful modality that provides diagnostic clues. Surgery from a posterior approach is the primary treatment, and the effect of adjuvant therapy remains uncertain. The prognosis is mainly related to the pathological nature of the tumor and not the method of resection.
Membranous nephropathy and thymoma in a patient with ankylosing spondylitis
Authors: Lin Lirong , Zhao Lei , Huo Bengang , Zheng Luquan , Yu Rongjie , Li Weibing , Yang Jurong
Published: May 2020

Rationale:

We report a rare case with ankylosing spondylitis (AS), thymoma, and membranous glomerulonephritis. The pathogenic mechanisms of these 3 diseases may be associated with each other. Here, we discuss the course of diagnosis and treatment.

Patient concerns:

A 64-year-old woman with bilateral pain of the sacroiliac joints for 10 years and anasarca for 10 days.

Diagnoses:

A diagnosis of AS by HLA-B27 and pelvic X-ray tests, thymoma based on computed tomography and pathological diagnosis, and membranous glomerulonephritis based on renal biopsy.

Interventions:

We administered methylprednisolone 500 mg/d for 3 consecutive days, followed by methylprednisolone 40 mg oral QD, for a month.

Outcomes:

The patient was followed up once a month. In the sixth month, the patient's serum creatinine had decreased to 0.96 mg/dL, urine microalbumin/creatinine decreased to 173.3 mg/g, and albumin had risen to 33.1 g/L. Pain and morning stiffness were relieved, and the Bath Ankylosing Spondylitis Disease Activity Index score dropped to 4.0.

Lessons:

Although the causal relationship between AS, thymoma, and membranous nephropathy in this patient still needs to be established, the pathogenesis between the 3 diseases may have some association. In clinical practice, patients with AS need to be screened for tumors and renal complications.
The American College of Nuclear Medicine Guidance on Operating Procedures for a Nuclear Medicine Facility During COVID-19 Pandemic
Authors: Tulchinsky Mark , Osmany Saabry
Published: May 2020

The novel coronavirus 2 pandemic is causing widespread disruption in everyday life necessitating urgent and radical adaptations in operating procedures at nuclear medicine facilities. The potential for causing severe illness, COVID-19, calls for strict observance of preventive measures aimed to mitigate the spread of the virus. The threat of COVID-19 is particularly serious as there is no vaccine and no specific antiviral therapy. Further complications are introduced by shortages of personal protective equipment for healthcare workers who have direct contact with patients and effective testing to identify infected patients, raising the need for delaying some testing and therapies. Certain vulnerable segments of the general population have been identified (advanced age and certain comorbidities), which should heighten further their preventive efforts. Therefore, this guidance is intended to be operationalized depending on a facility’s specific needs and local disease prevalence.
Perceived Losses Following Stroke
Authors: Mumma Christina M.
Published: May 2020

Adjustment to disability following a stroke may involve coming to terms with a variety of losses. The purpose of this exploratory, cross-sectional survey was to describe losses experienced following a stroke as perceived by patients and their spouses. The data were derived from interviews with 60 middle-aged and older couples in which one person had suffered a stroke. Content analysis of the responses to open-ended questions about perceived losses yielded three major categories of loss: 1. activities, 2. abilities and characteristics, and 3. independence. The loss most often mentioned by patients was mobility; by spouses, traveling. When responses were examined by sex, the loss mentioned most frequently by both male and female spouses identified traveling as what they missed most after the stroke. Examination of losses in relation to length of time since the stroke revealed independence as a prominently mentioned loss for most groups. Comparison by cerebral hemisphere damaged revealed that patients with right-brain damage missed their independence while patients with left-brain damage missed mobility. The findings of this study support two major aspects of rehabilitation nursing practice: facilitation of patient independence, and consideration of spouse or caregiver’s need for support or respite care on a long-term basis.
The Metrics of Acute Care Reentry and Emergency Department Visits by Recently Discharged Inpatients
Authors: Hodgins Marilyn J. , Fraser Jacqueline M. , Filiatreault Sarah
Published: May 2020

Research on acute care reentry by recently discharged inpatients has generally focused on hospital readmissions, with less attention given to presentations to the emergency department (ED). This omission results in underestimation of the extent of reentry and its impact on ED patient volumes and flow. This project involved an analysis of administrative data to examine the rate of ED presentations by recently discharged inpatients using 3 time metrics—within 0–3 days, 0–7 days, and 0–30 days of discharge. Descriptive-correlational analyses were conducted to examine the rates of reentry and ability to predict ED presentations using patient demographic (age and sex) and clinical profile (length of hospital stay and day of presentation). Approximately 12% of hospital discharges to home involved patients who presented to the ED within 30 days, and almost half occurred within the first week. Results of multivariable analyses suggest that the influences of ED presentations differ depending on the time metric examined. Emergency department presentations within 3 and 7 days of discharge compared with 30 days were not predicted by patient age or sex but were more likely to involve those with shorter hospital stays. A weekend presentation was also more likely among case patients presenting within 3 days of discharge. Only about one third of ED presentations resulted in readmission. Emergency department presentations are an important component of acute care reentry. Establishment of a common reentry metric for ED presentations would facilitate efforts to determine the impact of these events. Emergency nurses working in advanced practice roles are ideally positioned to assume a leadership role in addressing the needs of recently discharged inpatients who present to the ED. By reviewing these cases and collaborating with the inpatient unit staff, it may be possible to identify strategies for augmenting discharge planning and the provision of transitional care.
Ketamine for Migraine in the Emergency Department
Authors: Bilhimer Matthew H. , Groth Meghan E. , Holmes Ashley K.
Published: May 2020

Ketamine is utilized often in the emergency department (ED) for rapid sequence intubation, procedural sedation, and acute pain management. The treatment of migraine headache in the ED varies widely and is dependent on several factors including migraine cause, previous successful abortive methods, and provider preference. Several medications are currently employed to treat acute migraine including nonsteroidal anti-inflammatory drugs, triptans, antihistamines, prochlorperazine, and corticosteroids, among others. Interest in ketamine as an abortive agent to treat migraine has increased as evidenced by recent studies evaluating its use in the ED. This review examines the data regarding the use of ketamine to treat migraine headache. The concept of treating migraine headache with ketamine has been studied for more than 20 years. Early studies conducted primarily in the outpatient setting evaluated ketamine through multiple routes of administration and differing migraine causes with varying results. These early data seem to suggest that ketamine provides relief from headache severity but provides little information regarding the optimal dose and route of administration. Recent active comparator and placebo-controlled trials in the ED utilizing subdissociative doses of ketamine (0.2–0.3 mg/kg intravenously) show conflicting results. To confound the decision regarding its use further, ED providers encounter differing recommendations regarding its place in therapy. Current data suggest that ketamine may provide pain relief to patients with migraine headache. Although there may be a role for ketamine in certain cases after more robust evidence becomes available, currently it is premature to incorporate ketamine into routine use. Several questions remain to be answered including its overall efficacy, place in therapy, dosage, and risk of undesirable side effects.
Optic Neuropathy Due to Compression by an Ectatic Internal Carotid Artery Within the Orbital Apex
Authors: Caton Michael T. , Zamani Amir A. , Du Rose , Prasad Sashank
Published: May 2020

Neurovascular compression is a rare but potentially treatable cause of optic neuropathy. Although incidental contact of the cisternal optic nerve and internal carotid artery (ICA) is common, compressive optic neuropathy occurring within the orbital apex has not been comprehensively described. We report a case of intra-orbital and intracanalicular optic nerve compression due to an ectatic ICA in a patient with congenital absence of the contralateral ICA. This report describes the complementary roles of advanced neuroimaging and neuro-ophthalmologic examination in rendering the diagnosis.
Relative fat mass is a better predictor of dyslipidemia and metabolic syndrome than body mass index
Authors: Kobo Ofer , Leiba Ronit , Avizohar Ophir , Karban Amir
Published: May 2020

Background

Relative fat mass (RFM) had been recently developed. We aimed to examine RFM predictability to various cardiometabolic risk factors, compared to BMI.

Methods

Observational, cohort study, among patients who visited the Rambam Periodic Examinations Institute (RPEI). We compared the correlation of BMI and RFM to hypertension, impaired fasting glucose, high LDL, low HDL and metabolic syndrome, by gender.

Results

During study years, 20 167 patients visited the RPEI and included in the trial. Compared to BMI, RFM showed significantly better predictability (odds ratio [OR], [95% confidence interval (CI), P value]) of high LDL [1.618 (1.441–1.816, P < 0.001) vs. 0.732 (0.67–0.8, P < 0.001) in men; 1.572 (1.377–1.794, P < 0.001) vs. 0.938 (0.849–1.163, P = 0.94) in women], low HDL [2.944 (2.569–3.373, P < 0.001) vs. 2.177 (2–2.369, P < 0.001) in men, 2.947 (2.519–3.448, P < 0.001) vs. 1.9 (1.658–2.176, P < 0.001) in women], high triglycerides [4.019 (3.332–4.847, P < 0.001) vs. 1.994 (1.823–2.181, P < 0.001) in men, 3.93 (2.943–5.247, P < 0.001) vs. 2.24 (1.887–2.62, P < 0.001) in women] and metabolic syndrome [7.479, (4.876–11.47, P < 0.001) vs. 3.263 (2.944–3.616, P < 0.001) in men, 16.247 (8.348–31.619, P < 0.001) vs. 5.995 (5.099–7.048, P < 0.001) in women]. There was no significant difference in the predictability of BMI and RFM to hypertension and diabetes mellitus.

Conclusion

RFM provides high predictability for dyslipidemias and metabolic syndrome.
Acute hyperglycemia and contrast-induced nephropathy in patients with non-ST elevation myocardial infarction
Authors: Baydar Onur , Kilic Alparslan
Published: May 2020

Introduction

Acute hyperglycemia and contrast-induced nephropathy (CIN) are frequently observed in non-ST elevation myocardial infarction (NSTEMI) patients undergoing percutaneous coronary intervention (PCI), and both are associated with an increased mortality rate. We investigated the possible association between acute hyperglycemia and CIN in patients with NSTEMI undergoing PCI.

Materials and methods

We retrospectively enrolled 281(149, 53% men) NSTEMI patients undergoing PCI. For each patient, plasma glucose levels were secreened at hospital admission. Acute hyperglycemia was defined as glucose levels > 198 mg/dl. CIN was defined as an increase in serum creatinine 25% or 0.5 mg/dl from baseline in the first 48–72 hours.

Results

Overall, 44 (15.7%) patients had acute hyperglycemia. Patients with acute hyperglycemia had higher incidence of CIN than those without acute hyperglycemia (29.5 vs 5.1%, P < 0.001). Also, in-hospital mortality, length of hospital stay, major bleeding, requirement of mechanical ventilation and dialysis were observed significantly higher in patients with hyperglycemia. Patients were then reallocated to two groups according to the presence or absence of CIN. Overall, 25 cases (8.9%) of CIN were diagnosed. Diabetes mellitus, weight, age, glucose level and estimated glomerular filtration rate (eGFR) were detected as independent risk factors of CIN. Additionally, admission glucose levels were significantly correlated with creatinine levels after PCI, eGFR and contrast volume/eGFR ratio.

Conclusion

In NSTEMI patients undergoing primary PCI, acute hyperglycemia may be associated with an increased risk for CIN and in-hospital mortality and morbidity.