bluuebunny/crossref_metadata_2025 huggingface dataset:
14 Art. 13 GG: Inviolability of the Home
Authors: Christian Bumke , Andreas Voßkuhle
Published: July 2019

This chapter deals with the inviolability of the home, a fundamental right guaranteed by Art. 13 of the Grundgesetz (GG). Art. 13 GG offers protection to a spatially defined area in which one may do as he or she pleases undisturbed and unobserved. It thus secures the spatial aspect of the ‘right to be left alone’ which the Federal Constitutional Court created in the Microcensus Decision. The Court's ruling in a case concerning acoustic surveillance of the home illustrates the liberal manner by which this right has been interpreted. The chapter first examines the Court's jurisprudence regarding the scope of protection for the right of inviolability of the home, focussing on cases relating to express dry cleaning and tenants' property, before discussing the question of interference with this right, along with the constitutional justification of such interferences, especially with regard to search of a home.
31 Art. 92 et seq. GG: Jurisprudence
Authors: Christian Bumke , Andreas Voßkuhle
Published: July 2019

This chapter discusses the position of the Federal Constitutional Court with regard to judicial power, taking into account the relevant provisions of Art. 92 et seq. of the Grundgesetz (GG). In particular, it examines those aspects which cast light on the distinctive position of constitutional jurisprudence within the overall framework of judicial power. To this end, the chapter analyses the Court's jurisprudence, citing an instance in which it used a constitutional complaint concerning tax notices and penalties to address the concept of ‘judicial power’. It also considers a 2001 ruling by the Court, which added a functional element to the concept of the judicial power in a case involving the Election Review Court; the legal position of judges, which the Court describes as having three pillars — ‘objective independence’, ‘personal independence’, and ‘organisational independence’; and the Court's emphasis on the importance and substance of the right to a lawful judge.
Paraneoplastic and Idiopathic Autoimmune Neurological Disorders Affecting the Central Nervous System and Autoimmune Dysautonomia
Authors: Zalewski Nicholas L. , Pittock Sean J.
Published: July 2019

This chapter is an examination of immune-mediated central nervous system (CNS) disorders, which have increasingly been recognized as a critical disease category in the field of neurology. The chapter looks at clinical presentation, diagnostic evaluation, and treatment. The chapter also looks to the future. The field of immune-mediated neurological diseases is rapidly growing. New autoantibodies are being discovered at a rapid rate, helping unveil the mystery behind the challenging neurological presentations in many patients.
Anxiety and stress-related disorders
Authors: Semple David , Smyth Roger
Published: July 2019

This chapter covers the anxiety and stress-related disorders. Associated disorders, including panic disorder, generalized anxiety disorder, hyperventilation syndrome, obsessive–compulsive disorder, phobias, and post-traumatic stress disorder (PTSD) are covered. Each has its clinical features described and diagnostic requirements defined. Management guidelines are presented for each case, and any controversies in the field are outlined.
Sleep–wake disorders
Authors: Semple David , Smyth Roger
Published: July 2019

Covering sleep research, normal sleep, and then sleep–wake disorders, this chapter splits abnormal sleep into insomnia, hypersomnia, circadian rhythm disorders, and parasomnias. Individual cases, such as sleep-related epilepsy, panic attacks, and sleep-related violence, are all defined. The effects of psychiatric medication on sleep (either sedative or alerting) are defined, as well as the effects of recreational drugs. The intersection of other psychiatric disorders on the sleep schedule are described, and potential differential diagnoses listed.
Reproductive psychiatry, sexual health, and gender-related issues
Authors: Semple David , Smyth Roger
Published: July 2019

This chapter covers gender-related issues in psychiatry, alongside reproductive and sexual health. Fully updated to match the latest views on gender identity and dysphoria, given the developments in conceptualization of people who identify as transgender, both within the medical profession and in wider society, this chapter covers the diagnosis of gender dysphoria, assessment, and management. Menstrual and premenstrual conditions are also described, and disorders associated with pregnancy and childbirth are discussed. Sexual dysfunction and disorders of sexual preference are also covered.
Substance misuse
Authors: Semple David , Smyth Roger
Published: July 2019

This chapter defines substance abuse. Splitting up alcohol and other drugs, although recognizing that alcohol is a drug in its own right, it covers dependence, screening, assessment, planning treatment, management of withdrawal, and plans for maintaining abstinence. Also covering tobacco, illegal drugs, and novel psychotropic substances, substitute prescribing, and legal issues, this chapter has a table of street slang associated with drug misuse to aid the reader.
Intellectual disability
Authors: Semple David , Smyth Roger
Published: July 2019

This chapter covers intellectual disabilities. It provides a historical context and modern classification, before covering assessment, communication pathways, and management or treatment methods. Different types of intellectual disability, both genetic and non-genetic and pervasive developmental disorders, are covered in turn, and psychiatric comorbidities are also considered. The issues affecting transition periods are outlined, along with potential methods of alleviating stress.
Psychotherapy
Authors: Semple David , Smyth Roger
Published: July 2019

This chapter covers the psychotherapies, a collection of treatments for mental disorders which employ language and communication as a means of producing change. It covers assessment and selection of an appropriate method for the individual patient, a history of Freud and other pioneers of psychotherapy to provide a background context, before examining different types of therapy. Briefly explaining the theory of psychotherapy, the phases of psychosexual development, and the object relations theory, it goes into detail on behavioural therapies such as cognitive behavioural therapy, interpersonal psychotherapy, dialectical behaviour therapy, and solution therapy. Counselling methods are described to aid the reader in developing their skills.
Legal issues
Authors: Semple David , Smyth Roger
Published: July 2019

Practising psychiatrists must be familiar with the laws in their country relating to mental health. Five broad areas of interest include common law as it relates to medical treatment decisions, the law in relation to incapable adults, regulations around the treatment of patients with a mental disorder, confidentiality, and criminal law in relation to mentally disordered offenders. This chapter, in conjunction with the chapter on forensic psychiatry, provides the background of Mental Health Acts across the British Isles.
Transcultural psychiatry
Authors: Semple David , Smyth Roger
Published: July 2019

This chapter covers transcultural psychiatry and culture-bound disorders. It covers culturally influenced variants of universal broad categories of mental disorder, to enable meaningful diagnostic formulation and development of appropriate treatment plans. Summarizing the recent developments in global mental health, it puts cultural context to the presentation of psychiatric disorders, and examples of common cultural concepts of distress are defined.
Useful resources
Authors: Semple David , Smyth Roger
Published: July 2019

This chapter lists useful resources, both for patients and clinicians.
How screening started
Authors: Raffle Angela E. , Mackie Anne , Gray J. A. Muir
Published: July 2019

This chapter explains how health screening began, how the aims have evolved, how evidence and organisation influenced matters, and how challenges in the future will give rise to continuing change. It begins with Gould’s address in 1900 to the American Medical Association and charts events that led, almost by accident, to the institution of comprehensive annual testing of healthy adults in the USA, and to 5 day hospital-based ‘Human Dry Dock’ screening for Japanese executives. Scientific challenge then came from two randomised control trials, which failed to find benefit, but by then screening had become an important commercial activity. Using the UK cervical screening programme as a case study, the chapter explores how the optimism of the 1960s led through disillusionment, then to programme organisation and, by the 1990s, an era of realism. Evolution of the Wilson and Jungner criteria as an aid for policy making is covered. A key challenge now is to ensure best value policy, high quality systematic programme delivery and informed choice in the face of commercial forces that lead to the glossing over of screening’s complexities and far reaching consequences.
What screening does
Authors: Raffle Angela E. , Mackie Anne , Gray J. A. Muir
Published: July 2019

This chapter gives a deeper understanding of screening, and of the diverse consequences it brings. It illustrates the overdetection problem with reference to mammography breast screening programmes, and explains the ‘popularity paradox’ that this leads to. In the early days, the simplistic notion that screening must automatically be beneficial meant that people only asked ‘why are we not doing it?’ Later scientific challenges brought a new question, ‘How do we tell if screening succeeds in reducing risk?’ This served well as a driving force for better evaluation, but it ignored the need to assess harmful consequences. Growing experience has revealed the need to ask ‘what are all the consequences?’ Different observers see some consequences more starkly than others depending on their viewpoint. This chapter explains why it is important to consider a complete overview of an entire programme and to recognise that overdetection, overtreatment and underdetection, are inevitable features even when screening is delivered to a high quality.
Quality-assuring screening programmes
Authors: Raffle Angela E. , Mackie Anne , Gray J. A. Muir
Published: July 2019

This chapter explains why quality assurance is essential if screening is to do more good than harm. It describes some of the history and thinking that has shaped approaches to quality in industry and in healthcare, starting with an example from the American car industry and focusing on two founding fathers of quality - W Edwards Deming, and Avedis Donabedian. It outlines Donabedian’s seven components of quality, and shows how these encompass the notion of best value in healthcare so that efforts are devoted to improving health and social justice. It then goes on to explain some of the ways of measuring screening quality, setting standards and ensuring standards are met. It uses case histories and practical examples so that the reader can easily apply the lessons in their day to day work.
Day-to-day management of screening programmes for public health practitioners and managers
Authors: Raffle Angela E. , Mackie Anne , Gray J. A. Muir
Published: July 2019

This chapter gives the reader an appreciation of main issues that public health practitioners regularly deal with in screening, and how to approach them. This needs management skills and an understanding of screening programmes. Typical problems include preventing screening from starting when there is no sound evidence base, dealing with provision of poor quality screening, implementing policy changes within existing screening programmes, dealing with legal challenges relating to screening, and coping with damage caused by commercially driven provision of screening tests where there is lack of evidence, lack of informed choice, and no provision beyond the initial test. Dealing with any of these matters can involve using the media, and the final section of the chapter gives advice about how to cope when the media spotlight turns on screening. Prostate cancer and ovarian cancer screening are both used as case studies in this chapter.
Evidence mapping to assess the available research on fiber, whole grains, and health
Authors: McKeown Nicola M , Livingston Kara A , Sawicki Caleigh M , Miller Kevin B
Published: July 2019

Evidence mapping is a useful methodology for characterizing existing research on a broad topic and identifying gaps in the scientific literature. Evidence mapping entails conducting a systematic literature search and extracting information on study details, often in the form of a database. Researchers at Tufts University and the North American branch of the International Life Sciences Institute created the Diet-Related Fibers & Human Health Outcomes Database, which is publicly available and updated annually. The database captures intervention studies examining dietary fiber and 10 predefined physiological health outcomes, including weight/adiposity, blood pressure, gut microbiota, and bone health. The database and subsequent potential for evidence mapping may be particularly useful in light of new food labeling requirements by the US Food and Drug Administration that require fibers to have accepted scientific evidence of a physiological health benefit in order to be labeled as “dietary fiber.” Following the success of the fiber database, Tufts University and the General Mills Bell Institute of Health and Nutrition collaborated to develop a whole grain database and evidence map. This work successfully highlighted the need for better consistency in how whole grains are reported with respect to amount and type of whole grains and intervention compliance.
Molecular bow shock in the 3 kpc Norma Arm
Authors: Sofue Yoshiaki
Published: July 2019

A molecular bow shock (MBS) at G24.4+00+112 (l ∼ 24${^{\circ}_{.}}$4, b ∼ 0°, vLSR ∼ 112 km s−1) is studied using the 12CO(J = 1–0)-line survey obtained with the Nobeyama 45 m telescope at 20″ (0.71 pc) resolution. The terminal velocity uniquely locates the object at the tangent point of the 3 kpc expanding arm (Norma arm) with the distance of 7.3 kpc. The bow ridge extends over ∼160 pc (1${^{\circ}_{.}}$3) perpendicularly to the galactic plane, and is concave to a ring of H ii-regions centered on G24.6+00 at the same distance. The edge on the down-stream (higher longitude) side of the MBS is extremely sharp, and is associated with several elephant trunks in gear-to-gear contact with the H ii regions. On the up-stream (lower longitude) side of MBS, a broad H i bow is associated at the same velocity. The coherently ordered structure of H i, CO, and H ii gases indicates H i-to-H2transition at the galactic shock followed by efficient star formation due to dual compression, where the molecular gas is shock-compressed from the up-stream side by galactic shock and from the down-stream side by H ii expansion. We propose a scenario of galactic sequential star formation along the spiral arms. We also discuss related ISM phenomena such as the hydraulic jump, bow shock, and Rayleigh–Taylor instability occurring around the MBS.
Generics (UK) Ltd (T/A Mylan) v Warner-Lambert Company LLC
Authors:   Supreme Court
Published: July 2019

Patents – Swiss-form claims – Pregabalin – Use in the manufacture or preparation of a medicament for the treating of pain – Construction – Validity – Infringement – Meaning of “for treating” neuropathic pain – Whether central neuropathic pain included – Insufficiency – Biogen insufficiency – Plausibility – Whether plausibility required across full width of claim – Nature of the plausibility requirement – Direct infringement under s.60(1)(b) – Whether intention a necessary element – Nature of the infringement test in relation to claims in Swiss form – Manufacturer liability – “Downstream” liability – Whether subjective intention required – Reasonable foreseeability – The role of packaging – Indirect infringement – Amendment – Post-trial validating amendments – Abuse of process – Discretion – Appeal to Supreme Court
Maternal Care and Global Public Health: Bombay and Manchester, 1900–1950
Authors: Trivedi Lisa
Published: July 2019

In the nineteenth century, the British government at home and in the empire promoted the development of public health systems to contain epidemic diseases. By the early twentieth century, the government turned its focus increasingly to children’s physical fitness and, in turn, society’s capacity for both labour and military power. Given the role that women played in reproducing the nation’s prospective power, women were perceived to need intervention not only for their own sake but also for the well-being of the nation’s next generation. This essay considers the historical moment when government officials, social reformers and physicians realised that they needed mothers to live for their nations and states to survive. After reviewing discourses shared by social reformers and government officials in Bombay and Manchester, the essay considers the records of St. Mary’s Hospital and the Nowrosjee Wadia Maternity Hospital to explore the role of physicians in the medicalisation of maternal mortality.
Infraslow coordination of slow wave activity through altered neuronal synchrony
Authors: Dash Michael B
Published: July 2019

Slow wave activity (SWA; the EEG power between 0.5 and 4 Hz during non-rapid eye movement sleep [NREM]) is the best electrophysiological marker of sleep need; SWA dissipates across the night and increases following sleep deprivation. In addition to these well-documented homeostatic SWA trends, SWA exhibits extensive variability across shorter timescales (seconds to minutes) and between local cortical regions. The physiological underpinnings of SWA variability, however, remain poorly characterized. In male Sprague-Dawley rats, we observed that SWA exhibits pronounced infraslow fluctuations (~40- to 120-s periods) that are coordinated across disparate cortical locations. Peaks in SWA across infraslow cycles were associated with increased slope, amplitude, and duration of individual slow waves and a reduction in the total number of waves and proportion of multipeak waves. Using a freely available data set comprised of extracellular unit recordings during consolidated NREM episodes in male Long-Evans rats, we further show that infraslow SWA does not appear to arise as a consequence of firing rate modulation of putative excitatory or inhibitory neurons. Instead, infraslow SWA was associated with alterations in neuronal synchrony surrounding “On”/“Off” periods and changes in the number and duration of “Off” periods. Collectively, these data provide a mechanism by which SWA can be coordinated across disparate cortical locations and thereby connect local and global expression of this patterned neuronal activity. In doing so, infraslow SWA may contribute to the regulation of cortical circuits during sleep and thereby play a critical role in sleep function.
Irreversible metabolic abnormalities following chronic upper airway loading
Authors: Assadi Mohammad H , Segev Yael , Tarasiuk Ariel
Published: July 2019

Study Objectives

Treatment of obstructive sleep apnea increases obesity risk by an unclear mechanism. Here, we explored the effects of upper airway obstruction and its removal on respiratory homeostasis, energy expenditure, and feeding hormones during the sleep/wake cycle from weaning to adulthood.

Methods

The tracheas of 22-day-old rats were narrowed, and obstruction removal was performed on post-surgery day 14. Energy expenditure, ventilation, and hormone-regulated feeding were analyzed during 49 days before and after obstruction.

Results

Energy expenditure increased and body temperature decreased in upper airway obstruction and was only partially recovered in obstruction removal despite normalization of airway resistance. Increased energy expenditure was associated with upregulation of ventilation. Decreased body temperature was associated with decreased brown adipose tissue uncoupling protein 1 level, suppressed energy expenditure response to norepinephrine, and decreased leptin level. Upper airway obstructed animals added less body weight, in spite of an increase in food intake, due to elevated hypothalamic orexin and neuropeptide Y and plasma ghrelin. Animals who underwent obstruction removal fed more due to an increase in hypothalamic neuropeptide Y and plasma ghrelin.

Conclusions

The need to maintain respiratory homeostasis is associated with persistent abnormal energy metabolism and hormonal regulation of feeding. Surgical treatment per se may not be sufficient to correct energy homeostasis, and endocrine regulation of feeding may have a larger effect on weight change.
CE: Original Research: The Clinical Research Nurse: Exploring Self-Perceptions About the Value of the Role
Authors: McCabe Margaret , Behrens Liza , Browning Shaunagh , Vessey Judith , Williams Mary Jane
Published: July 2019

Background:Clinical research nursing is an emerging specialty practice. Clinical research nurses (CRNs) work to make protocol-related care safe for the research subjects while simultaneously maintaining protocol fidelity. They must continuously balance the needs of the research subjects and the study requirements.

Purpose:The purpose of this qualitative study was to describe CRNs’ perceptions of the value of their role.

Methods:Two focus groups were conducted with a purposive sample of 18 CRNs. An interview guide consisting of eight open-ended items was used. Data analysis used critical elements from Krueger's systematic steps for analyzing focus group data.

Results:Five major themes emerged from 168 coded statements contained within the focus group transcripts: comprehensive nursing care of research subjects, training and education of research subjects and staff, contributions to clinical science, unique combination of clinical and critical thinking skills, and CRN practice attributes. Subcategories were also identified. In general, participants felt strongly about the value they added.

Clinical research nursing requires the use of a variety of abilities and skills, including critical thinking and problem solving, as well as clinical and research knowledge. The CRNs in this study described incorporating these and other elements into their practice, which they associated with their specialized role. The five themes that emerged help elucidate the importance and utility of including CRNs on research teams.

Conclusions:The unique combination of applied research knowledge and expert clinical skills sets the specialty of clinical research nursing apart. The study findings, in particular the five themes, provide an evidence-based framework that will be useful in the development of competencies for CRN specialty practice. In helping to bring research findings to bear on clinical care, the impact of CRNs’ practice extends beyond the individual patient to larger patient populations.
UK Study Finds Benefit to Prophylactic Antibiotics After Operative Vaginal Births
Authors: Sofer Dalia
Published: July 2019

The approach significantly reduced maternal infection.
Common Insomnia Drugs Receive Black Box Warning
Authors: Aschenbrenner Diane S.
Published: July 2019

A black box warning about the risk of serious injury and potential death as a result of sleepwalking and other complex sleep behaviors has been added to the labeling of the sedative–hypnotic drugs zolpidem, zaleplon, and eszopiclone.

Serious adverse effects from use of these drugs to treat insomnia include falls with serious injuries, fatal falls, fatal motor vehicle accidents, self-injury, and suicidal attempts and suicides, among others.

NPs should not prescribe these drugs to patients who have a history of complex sleep behaviors after taking antiinsomnia drugs. The drugs should be discontinued if patients experience adverse effects.
First Oral Testosterone Product Now Available
Authors: Aschenbrenner Diane S.
Published: July 2019

A first oral testosterone product, testosterone undecanoate (Jatenzo), is now available for use in men with low testosterone levels due to medical conditions such as Klinefelter syndrome or tumors that have damaged the pituitary gland.

This form of testosterone can significantly increase blood pressure. It can also increase hematocrit and prostate specific antigen levels and decrease high-density lipoprotein cholesterol.
Caution Regarding Low-Dose Aspirin for Primary Prevention of Cardiovascular Events
Authors: Rosenberg Karen
Published: July 2019

According to this study:

Use of low-dose aspirin in people who don't have symptomatic cardiovascular disease is associated with an overall increased risk of intracranial hemorrhage.

The risk is particularly high in Asian populations and in populations with a lower mean body mass index.
Improving Screening and Education for Secondhand Smoke Exposure in Primary Care Settings
Authors: Middleton Chrissie , Bruns DebraWhisenant
Published: July 2019

Exposure to secondhand smoke (SHS), also known as environmental tobacco smoke, adversely affects human health across the life cycle and has important economic consequences. The fact that many health care providers don't routinely screen all patients for SHS exposure and educate them on the risks associated with it is exacerbated by the lack of any requirement to do so, as well as the absence of adequate SHS screening questions in many electronic health record (EHR) systems. Further research on improving screening and education interventions is therefore warranted. In this quality improvement initiative, we introduced flag reminders, visual reminders, education, and a monetary incentive for providers, which improved their screening for and education on SHS exposure in the patients in a primary care clinic. The clinicians' behavior change in response to these interventions supports our proposal that an effective screening question with a flag reminder be added to the EHR, and confirms the need for continued research on screenings, EHR efficacy, and clinical behavior change.
Limitations of the Envelope Difference Index as a Metric for Nonlinear Distortion in Hearing Aids
Authors: Kates James M.
Published: July 2019

Objectives:

The envelope difference index (EDI) compares the envelopes of two signals. It has been used to measure nonlinear distortion in hearing aids, but it also responds to linear processing. This article compares linear and nonlinear processing effects on the EDI.

Design:

The EDI for spectral tilt and peak clipping distortion is computed to illustrate the effects of linear and nonlinear signal modifications. The EDI for wide dynamic-range compression is then compared with that obtained for linear amplification for a set of standard audiograms to show the expected range of EDI values for linear and nonlinear hearing aid processing. The EDI for hearing aid amplification and compression is also compared with a measure of time-frequency envelope modulation distortion for the same conditions.

Results:

The EDI is shown to be as sensitive to linear amplification as it is to nonlinear processing. The EDI values for spectral tilt can exceed those for peak clipping, and the EDI values for linear amplification exceed those for wide dynamic-range compression for four of the nine audiograms considered. The agreement of the EDI with a nonlinear envelope distortion measure is shown to depend on the long-term spectra of the signals being compared when computing the EDI.

Conclusions:

The accuracy of the EDI as an indicator of nonlinear distortion for sentence materials can be improved by equalizing the long-term spectrum of the processed signal to match that of the unprocessed input. However, the EDI does not have a clear interpretation because of the confound between linear and nonlinear processing effects and the lack of an auditory model in calculating the signal differences.
AVATAR Assesses Speech Understanding and Multitask Costs in Ecologically Relevant Listening Situations
Authors: Devesse Annelies , van Wieringen Astrid , Wouters Jan
Published: July 2019

Objectives:

There is a high need among clinicians and researchers for an ecologically valid measure of auditory functioning and listening effort. Therefore, we developed AVATAR: an “Audiovisual True-to-life Assessment of Auditory Rehabilitation” which takes important characteristics of real-life listening situations into account, such as multimodal speech presentation, spatial separation of sound sources and multitasking. As such, AVATAR aims to assess both auditory functioning and the amount of allocated processing resources during listening in a realistic yet controllable way. In the present study, we evaluated AVATAR and investigated whether speech understanding in noise and multitask costs during realistic listening environments changed with increasing task complexity.

Design:

Thirty-five young normal-hearing participants performed different task combinations of an auditory-visual speech-in-noise task and three secondary tasks on both auditory localization and visual short-term memory in a simulated restaurant environment. Tasks were combined in increasing complexity and multitask costs on the secondary tasks were investigated as an estimate of the amount of cognitive resources allocated during listening and multitasking. In addition to behavioral measures of auditory functioning and effort, working memory capacity and self-reported hearing difficulties were established using a reading span test and a questionnaire on daily hearing abilities.

Results:

Whereas performance on the speech-in-noise task was not affected by task complexity, multitask costs on one of the secondary tasks became significantly larger with increasing task complexity. Working memory capacity correlated significantly with multitask costs, but no association was observed between behavioral outcome measures and self-reported hearing abilities or effort.

Conclusions:

AVATAR proved to be a promising model to assess speech intelligibility and auditory localization abilities and to gauge the amount of processing resources during effortful listening in ecologically relevant multitasking situations by means of multitask costs. In contrast with current clinical measures of auditory functioning, results showed that listening and multitasking in challenging listening environments can require a considerable amount of processing resources, even for young normal-hearing adults. Furthermore, the allocation of resources increased in more demanding listening situations. These findings open avenues for a more realistic assessment of auditory functioning and individually tuned auditory rehabilitation for individuals of different age and hearing profiles.
From hepatitis C virus immunoproteomics to rheumatology via cross-reactivity in one table
Authors: Kanduc Darja
Published: July 2019

Purpose of review

To give an overview of molecular and immunologic data that link hepatitis C virus (HCV) infection to rheumatic diseases in the human host.

Recent findings

A high level of peptide sharing exists between immunopositive HCV epitopes and human proteins that, when altered, associate with rheumatic manifestations.

The findings suggest the involvement of HCV infection in the induction of most rheumatic diseases via a mechanism of autoimmune cross-reactivity.
Preperitoneal Pelvic Packing Is Not Associated With an Increased Risk of Surgical Site Infections After Internal Anterior Pelvic Ring Fixation
Authors: Stahel Philip F. , Moore Ernest E. , Burlew Clay C. , Henderson Corey , Peña Austin J. , Harry David , Pieracci Fredric M.
Published: July 2019

Objective:

To investigate the risk of postoperative surgical site infections after plate fixation of the anterior pelvic ring subsequent to preperitoneal pelvic packing (PPP).

Design:

Retrospective observational cohort study.

Setting:

Level I academic trauma center.

Patients:

Adult trauma patients with unstable pelvic ring injuries requiring surgical fixation of the anterior pelvic ring.

Intervention:

Pelvic plate fixation was performed as a staged procedure after external fixation and PPP/depacking (PPP group; n = 25) or as a single-stage primary internal fixation (control group; n = 87).

Main Outcome Measure:

Incidence of postoperative surgical site infections of the pelvic space.

Results:

Anterior pelvic plate fixation was performed in 112 patients during a 5-year study period. The PPP group had higher injury severity scores and transfused packed red blood cells than the control group (injury severity score: 46 ± 12.2 vs. 29 ± 1.5; packed red blood cells: 13 ± 10 vs. 5 ± 2; P < 0.05). The mean time until pelvic depacking was 1.7 ± 0.6 days (range: 1–3 days) and 3.4 ± 3.7 days (range: 0–15 days) from depacking until pelvic fracture fixation. Two patients in the PPP group and 8 patients in the control group developed a postoperative infection requiring a surgical revision (8.0% vs. 9.2%; n.s.). Both PPP patients with a pelvic space infection had undergone anterior plate fixation for associated acetabular fractures.

Conclusions:

These data support the safety of the PPP protocol for bleeding pelvic ring injuries due to the lack of increased infection rates after fracture fixation. Caution should be applied when considering PPP in patients with associated acetabular fractures.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Statistical Significance in Trauma Research: Too Unstable to Trust?
Authors: Parisien Robert L. , Dashe Jesse , Cronin Patrick K. , Bhandari Mohit , Tornetta Paul
Published: July 2019

Objectives:

To evaluate the stability of statistical findings in the fracture care literature based on minor changes in event rates and to determine the utility of applying both the Fragility Index (FI) and Fragility Quotient (FQ) to comparative orthopaedic trauma trials.

Methods:

All fracture care studies from 1991 to 2013 in the Journal of Bone and Joint Surgery and the Journal of Orthopaedic Trauma were screened. The FI was determined by altering the number of reported outcome events, a single event at time, until a reversal of statistical significance was determined. The associated FQ was determined by dividing the FI by the total sample size.

Results:

Of the 4040 studies evaluated, 198 comparative studies met inclusion criteria with a reported 253 primary and 522 secondary outcome events. There were 118 randomized controlled trials and 80 retrospective comparative studies. Of the 775 total outcome events, 235 were initially reported as significant. The median FI for the entire study was only 5 with an associated FQ of 0.046. This represents just 3.8% of the total study population.

Conclusions:

The robustness of comparative trials in the orthopaedic trauma literature may not be as stable as previously thought with only a few event reversals required to alter trial significance. We therefore recommend triple reporting of a P value, FI, and FQ to aid in the evaluation and interpretation of statistical stability and quantitative significance in comparative orthopaedic trauma trials.
Brachial artery pseudoaneurysm after fixation of supracondylar fracture in a 9-year-old child
Authors: Cunha Luiz Antônio Munhoz da , Ávila Luiz Muller , Gonçalves João Rodolfo Radtke , Pereira Suelin , Jamur Carmen Mayanna , Souza Bruna Medeiros de
Published: July 2019

The supracondylar humerus fracture is the most common elbow fracture in children, corresponding to 58% of these cases. The objective of this study is to report a rare postoperative complication, the pseudoaneurysm of the brachial artery. A 9-year-old girl with was admitted with a Gartland III supracondylar fracture of the right humerus, presenting normal neurological and vascular exams. The patient underwent a surgical treatment with percutaneous fixation and immobilization and was re-evaluated after 2 and 4 weeks. In the last evaluation the immobilization and fixation were removed. She returned after 3 months, presenting a progressive palpable, painless mass in the 1/3 distal right arm. The arterial ultrasound showed a mass in the cubital fossa, which presented internal flow and some wall thrombi, compatible with pseudoaneurysm of the brachial artery. After diagnosis, the treatment was a vascular surgery for dissection and reconstruction of the artery. The incidence of vascular involvement in Gartland III fractures ranges from 2% to 38%. False aneurysms originate from arterial hematomas caused by trauma to the arterial lumen, and their developing time can vary. There are few reports of this complication, so there is no consensus about the treatment.
A Core Outcome Set for Critical Care Ventilation Trials
Authors: Blackwood Bronagh , Ringrow Suzanne , Clarke Mike , Marshall John C. , Connolly Bronwen , Rose Louise , McAuley Daniel F.
Published: July 2019

Objectives:

Our objective was to obtain international consensus on a set of core outcome measures that should be recorded in all clinical trials of interventions intended to modify the duration of ventilation for invasively mechanically ventilated patients in the ICU.

Design:

A two-stage consensus process was undertaken between December 2015 and January 2018. Stage 1 included an online three-round Delphi study and three consensus meetings. Stage 2 included three consensus meetings.

Setting:

The setting was international, including Europe, North and South America, Australia, Asia, and Africa.

Participants:

Organization members representing intensive care survivors and carers; nursing, allied health professionals, and critical care physicians; clinical trials groups and trial investigators; and industry.

Interventions:

None.

Measurements and Main Results:

Delphi study outcomes were scored by participants from one (least important) to nine (most important). Consensus criteria for including the outcome in the core set were more than 70% of responses rating the outcome above seven and not more than 15% rating the outcome less than 3. From 222 participants, 183 from 38 organizations in 27 countries contributed to the consensus process. Stage 1: Delphi response rates from 200 participants ranged from 89% to 90% across three rounds. Forty-seven outcomes were ranked as follows: 19 met consensus criteria for inclusion and were considered at three consensus meetings (33 participants). Six outcomes were agreed for the core set as follows: extubation, reintubation, duration of mechanical ventilation, length of stay, health-related quality of life, and mortality. Stage 2: Three consensus meetings (37 participants) agreed on the measures for each outcome.

Conclusions:

We used rigorous and well-established methods to develop a core outcome set for use in all clinical trials evaluating interventions intended to modify duration of mechanical ventilation. This core outcome set will inform the design of future trials in this field by strengthening methodological quality and improving comparability across trials.
Optimizing Mean Arterial Pressure in Acutely Comatose Patients Using Cerebral Autoregulation Multimodal Monitoring With Near-Infrared Spectroscopy*
Authors: Rivera-Lara Lucia , Geocadin Romergryko , Zorrilla-Vaca Andres , Healy Ryan J. , Radzik Batya R. , Palmisano Caitlin , Mirski Marek , White Mirinda Anderson , Suarez Jose , Brown Charles , Hogue Charles W. , Ziai Wendy
Published: July 2019

Objectives:

This study investigated whether comatose patients with greater duration and magnitude of clinically observed mean arterial pressure outside optimal mean arterial blood pressure have worse outcomes than those with mean arterial blood pressure closer to optimal mean arterial blood pressure calculated by bedside multimodal cerebral autoregulation monitoring using near-infrared spectroscopy.

Design:

Prospective observational study.

Setting:

Neurocritical Care Unit of the Johns Hopkins Hospital.

Subjects:

Acutely comatose patients secondary to brain injury.

Interventions:

None.

Measurements and Main Results:

The cerebral oximetry index was continuously monitored with near-infrared spectroscopy for up to 3 days. Optimal mean arterial blood pressure was defined as that mean arterial blood pressure at the lowest cerebral oximetry index (nadir index) for each 24-hour period of monitoring. Kaplan-Meier analysis and proportional hazard regression models were used to determine if survival at 3 months was associated with a shorter duration of mean arterial blood pressure outside optimal mean arterial blood pressure and the absolute difference between clinically observed mean arterial blood pressure and optimal mean arterial blood pressure. A total 91 comatose patients were enrolled in the study. The most common etiology was intracerebral hemorrhage. Optimal mean arterial blood pressure could be calculated in 89 patients (97%), and the median optimal mean arterial blood pressure was 89.7 mm Hg (84.6–100 mm Hg). In multivariate proportional hazard analysis, duration outside optimal mean arterial blood pressure of greater than 80% of monitoring time (adjusted hazard ratio, 2.13; 95% CI, 1.04–4.41; p = 0.04) and absolute difference between clinically observed mean arterial blood pressure and optimal mean arterial blood pressure of more than 10 mm Hg (adjusted hazard ratio, 2.44; 95% CI, 1.21–4.92; p = 0.013) were independently associated with mortality at 3 months, after adjusting for brain herniation, admission Glasgow Coma Scale, duration on vasopressors and midline shift at septum.

Conclusions:

Comatose neurocritically ill adults with an absolute difference between clinically observed mean arterial blood pressure and optimal mean arterial blood pressure greater than 10 mm Hg and duration outside optimal mean arterial blood pressure greater than 80% had increased mortality at 3 months. Noninvasive near-infrared spectroscopy-based bedside calculation of optimal mean arterial blood pressure is feasible and might be a promising tool for cerebral autoregulation oriented-therapy in neurocritical care patients.
Microneedling as a Treatment for Acne Scarring: A Systematic Review
Authors: Mujahid Nisma , Shareef Faizah , Maymone Mayra B.C. , Vashi Neelam A.
Published: July 2019

BACKGROUND

Microneedling is a popular, minimally invasive skin rejuvenation modality for acne scarring. Recent reports have evaluated the efficacy and safety of microneedling monotherapy and combination treatment for scarring.

OBJECTIVE

This review aims to systematically analyze the current literature on microneedling techniques used for acne scarring.

METHODS

A PubMed search (2009–current) was used to identify literature on microneedling treatment for acne. All randomized and nonrandomized clinical trials, case cohorts, case reports, and case series were included with the exception of 2 studies, which were excluded due to unavailability.

RESULTS

All 33 articles evaluated showed improvement of acne scar appearance after microneedling treatment. Evidence was inconsistent when comparing microneedling monotherapy to dual therapy or to fractional laser treatment.

CONCLUSION

Microneedling improves acne scarring, and further studies are needed to compare microneedling with other minimally invasive treatments.
Extramammary Paget Disease: A Review of the Literature—Part I: History, Epidemiology, Pathogenesis, Presentation, Histopathology, and Diagnostic Work-up
Authors: Morris Caroline R. , Hurst Eva A.
Published: July 2019

BACKGROUND

Extramammary Paget disease (EMPD) is a rare malignancy with unclear pathophysiology that occurs predominantly on apocrine rich skin. Surgery is the treatment of choice; however, procedures tend to be extensive and associated with a high rate of recurrence.

OBJECTIVE

To review the current literature on EMPD regarding epidemiology, pathogenesis, clinical presentation, histology, diagnostic work-up, treatment, and prognosis.

MATERIALS AND METHODS

Literature review using PubMed search for articles related to EMPD.

RESULTS

Extramammary Paget disease classically presents as a slowly growing red plaque, which often mimics an inflammatory condition leading to significant delay in diagnosis. Diagnosis requires histopathologic examination and is often supported by immunohistochemical analysis. Once a diagnosis of EMPD is made, the patient must be risk-stratified and evaluated for an underlying malignancy.

CONCLUSION

Standard of treatment is surgery, with data suggesting that Mohs micrographic surgery may have superior clinical outcomes and lower recurrence rates. Alternatives such as photodynamic therapy and topicals have been explored and may be appropriate in certain situations. Patients with EMPD generally have a good prognosis with a 5-year overall survival rate of 75% to 95%.
The Novel Inodilator ORM-3819 Relaxes Isolated Porcine Coronary Arteries: Role of Voltage-Gated Potassium Channel Activation
Authors: Márton Zoltán , Pataricza János , Pollesello Piero , Varró András , Papp Julius Gy.
Published: July 2019

Relaxation and changes in the transmembrane potential of vascular smooth muscle induced by ORM-3819, a novel inodilating compound, were investigated in isolated porcine coronary arteries. Isometric tone was studied on arterial rings precontracted by KCl (30 mM), and resting membrane potential was investigated by a conventional microelectrode technique. ORM-3819 in the concentration range 0.38–230.6 µM evoked concentration-dependent relaxation with a maximum value of 58.1% and an effective concentration of the relaxing substance that caused 50% of maximum relaxation of 72.2 µM. The maximum hyperpolarization produced by ORM-3819 at a concentration of 120 µM (−2.6 ± 0.81 mV, N = 10) did not differ significantly from that induced by C-type natriuretic peptide (CNP), an endogenous hyperpolarizing mediator, at a concentration of 1.4 µM (−3.6 ± 0.38 mV, N = 17). The same effect elicited by the known inodilator levosimendan was less pronounced at a concentration of 3.7 µM: −1.82 ± 0.44 mV, N = 22 (P < 0.05 vs. CNP). The voltage-gated potassium channel inhibitor 4-aminopyridine, at a concentration of 5 mM, attenuated the relaxation induced by ORM-3819 at concentrations of 41.6 or 117.2 µM. These results suggest that ORM-3819 is a potent vasodilating agent able to relieve coronary artery vasospasm by causing hyperpolarization of vascular smooth muscle cells through processes involving activation of voltage-gated potassium channels.
Infusion of Melatonin Into the Paraventricular Nucleus Ameliorates Myocardial Ischemia–Reperfusion Injury by Regulating Oxidative Stress and Inflammatory Cytokines
Authors: Yang Jin-Bao , Kang Yu-Ming , Zhang Chao , Yu Xiao-Jing , Chen Wen-Sheng
Published: July 2019

Melatonin, the receptors for which are abundant in the hypothalamic paraventricular nucleus (PVN), can protect the heart from myocardial ischemia–reperfusion (MI/R) injury. The aim of this study was to determine whether the infusion of melatonin into the PVN protects the heart from MI/R injury by suppressing oxidative stress or regulating the balance between proinflammatory cytokines and anti-inflammatory cytokines in MI/R rats. Male Sprague–Dawley rats were treated with a bilateral PVN infusion of melatonin. MI/R operation was performed 1 week after infusion. At the end of the third week after the infusion, all the rats were euthanized. This was followed by immunohistochemistry and immunofluorescence studies of the rats. MI/R rats showed larger infarct size, increased left ventricular (LV) end-diastolic volume, and decreased LV ejection fraction and LV fractional shortening. Moreover, MI/R rats had a higher level of norepinephrine in the plasma, heart, and PVN; higher PVN levels of reactive oxygen species, NOX2, NOX4, IL-1β, and NF-κB activity; and lower PVN levels of copper/zinc superoxide dismutase (Cu/Zn-SOD) and IL-10 compared with the sham group. Melatonin infusion in PVN reduced LV end-diastolic volume, norepinephrine, reactive oxygen species, NOX2, NOX4, IL-1β, and NF-κB activity, and increased LV ejection fraction, LV fractional shortening, Cu/Zn-SOD, and IL-10. Overall, these results suggest that the infusion of melatonin ameliorates sympathetic nerve activity and MI/R injury by attenuating oxidative stress and inflammatory cytokines in the PVN of MI/R rats.