bluuebunny/crossref_metadata_2025 huggingface dataset:
Stress Echocardiography
Authors: Wann L. Samuel
Published: January 2019

The Stress Echocardiography chapter reviews the opportunities to increase sensitivity and specificity of stress testing for the diagnosis of ischemic heart disease with adjunctive echocardiography with exercise or dobutamine-atropine stress. Baseline imaging prior to stress should include a comprehensive evaluation of cardiac structure and function, including the assessment of valvular disease with Doppler echocardiography. The chapter discusses stress echocardiography protocols; image analysis and reporting; sensitivity, specificity, and accuracy for detection of coronary artery disease; and evaluation of noncoronary cardiac disease. New and developing echocardiographic technology, including ultrasound assessment of myocardial perfusion, real-time 3D echocardiographic, and strain imaging are also discussed.
Stress X-Ray Computed Tomography
Authors: Wann L. Samuel
Published: January 2019

The chapter Stress X-Ray Computed Tomography reviews the history of cardiac computed tomography (CT) including electron beam and multidetector CT. After a brief history of CT, the chapter examines the opportunities and challenges of the use of electron beam and multidetector CT in the assessment of myocardial perfusion imaging. The practical use of multidetector CT at this time is for anatomic evaluation of epicardial coronary stenoses and pathology, assessment of coronary calcification, and increasing of a noninvasive assessment of fractional flow reserve. Limitations include the need to precisely time multiple CT scans with intravenous contrast injection; multidetector CT’s acute sensitivity to motion artifacts, requiring the latest generation CT scanners for optimal results; and, despite its excellent spatial resolution, the resolution of iodinated contrast in the myocardium as a measure of perfusion is suboptimal.
Metabolic Abnormalities and Drugs
Authors: Rowan Chris J.
Published: January 2019

The chapter Metabolic Abnormalities and Drugs reviews the changes that affect the electrocardiogram at rest and during exercise. Anticipating these changes often allows the exercise test to remain diagnostic without the need for adjunctive imaging. Changes between rest and exercise occur with metabolic acidosis, alkalosis, hyperthyroidism, hypothyroidism, estrogens, androgens, digoxin, diuretics, nitrates, ranolazine, dipyridamole, beta blockers, calcium channel blockers, anti-hypertensive agents, ivabradine, alcohol, nicotine, catecholamines, amphetamines, selective serotonin reuptake inhibitors, tricyclic antidepressants, lithium, and many anti-arrhythmics including quinidine, disopyramide, sotalol, flecainide, dofetilide, amiodarone, and dronedarone. Careful integration of all clinical variables, aided by the use of tools such as the Duke Treadmill Score, can reduce the need for additional testing including coronary angiography.
Gilles de la Tourette Syndrome
Authors: Walusinski Olivier
Published: January 2019

This chapter opens with a summary of Gilles de la Tourette syndrome as it is currently understood, then presents the lesson given by Gilles de la Tourette in 1899 on the subject. This lesson is indicative of the necessary perspicacity for isolating the pathology from “the choreas,” a catch-all term in Gilles de la Tourette’s day for abnormal movements. Initiated by the translation of an article by the American alienist Beard describing the “Jumpers of Maine,” Gilles de la Tourette’s work can be situated along a timeline that included errors and missing elements up to its publication in 1885. Also highlighted are Charcot’s role in this nosographical study, as well as the hidden contribution of Georges Guinon. The reception by European and American neurologists of this entity’s isolation concludes the analysis of this seminal work, which led to the now-famous eponym.
The Child with Autism Spectrum Disorder
Authors: Burton Laurie J. , Kamat Pradip P.
Published: January 2019

Children with autism spectrum disorders (ASD) require procedural sedation for a variety of diagnostic and therapeutic reasons. Patients with ASD present a challenge to the sedationist due to a variety of issues, including impairment in social interaction, barriers to communication, complex behavioral patterns, stereotyped repetitive behavior, mental health issues, and a need for consistency in terms of environment and caregivers. Children with ASD, especially teenagers, can exhibit aggressive behavior, self-injury, and temper tantrums, which can lead to issues with efficient and safe preparation for procedural sedation. Other challenges include the need for additional resources, difficulties in approaching the patient to perform a physical examination, delays in administering premedications, and difficulty obtaining intravenous access prior to the procedure. Children with ASD are more likely to be referred for general anesthesia due to these problems. This chapter discusses the role of the sedationist in the procedural sedation of these children.
Credentialing and Recredentialing for Pediatric Sedation
Authors: Tobias Joseph D. , Hollman Gregory A.
Published: January 2019

Given the complexity of the knowledge and skills required for the safe conduct of pediatric sedation, compounded by the diversity of sedation practitioners, a formal process for training and credentialing is recommended. Credentialing and recredentialing are the processes by which hospitals collect and review a practitioner’s qualifications as part of the initial step in granting clinical privileges. Regulatory boards mandate that each institution have a system in place that defines qualification requirements and approval of privileges for clinical practices such as procedural sedation. The credentialing process recurs at 2- to 3-year intervals along with renewal of privileges. Recredentialing of privileges may differ from the initial process.
A Patient with Morbid Obesity and OSA Presenting for Shoulder Arthroscopy
Authors: Muse Iyabo , Robertson Nii Amon
Published: January 2019

Peripheral nerve block is an excellent alternative to general anesthesia for optimal anesthesia and analgesia for shoulder arthroscopy. Interscalene brachial plexus block provides good coverage of the shoulder. Peripheral nerve block can be used as a primary anesthetic for various types of orthopedic surgery such as rotator cuff repair, humerus fracture, and total shoulder arthroplasty. Some of the benefits of using this technique include the decrease in pulmonary complications, surgical bleeding, and postoperative nausea and vomiting. However, there are absolute contraindications to performing a nerve block such as patient refusal and infection at the site of injection. There are also complications of local anesthetic injection that may occur, of which local anesthetic toxicity and neuronal injuries are the most detrimental. Even with the potential for complications, peripheral nerve block is still an excellent technique for use in certain cases in the hands of a skilled and well-trained regional anesthesiologist.
The Integrated Nurse: Way of the Healer
Authors: Quinn Janet F.
Published: January 2019

Integrative nursing invites nurses to reclaim their roots as healers in the lineage of Florence Nightingale, recovering the self-as-healer and acknowledging that their healing work is sacred. Healing, the emergence of right relationship at one or more levels of the human experience, is an emergent property and process of the whole person, bodymindspirit. It is facilitated by integrative nurses who put the patient in the best condition to elicit and support the innate healing response, or Haelan Effect. The way of the healer is a path that puts one in service to life, self, others, and creation as an instrument for healing. The way of the healer offers a spiritual practice for integrative nurses who choose to follow Nightingale’s injunction to “strive to awaken the divine spirit of love in yourself, to awaken it in doing your present work, however you may have erred in the past.”
Movement and Integrative Nursing
Authors: Koithan Matthew
Published: January 2019

Engaging in physical activity as a daily part of life plays a pivotal role in physical, mental, and social health and whole person wellbeing. Rather than focusing on structured exercise, current guidelines recommend focusing on unstructured, more primal movement to improve participation in physical activity and reduce the amount of time a person is sedentary. Physical activity can be integrated into anyone’s lifestyle, and there are a number of healthcare and fitness professionals who can serve as resources and allies in promoting wellbeing across the lifespan. This chapter identifies activity recommendations and limitations for those who want to improve overall wellbeing, including those with chronic conditions, suggesting ways that integrative nurses can encourage increased physical activity in their patient populations.
Integrative Nursing Practice
Authors: Ringdahl Deborah , Pool Natalie , Koithan Mary
Published: January 2019

The principles of integrative nursing provide a framework to guide the practice of nursing in a way that aligns our beliefs and values with actions and therapeutic strategies. When conceptualized from an integrative approach to care, nurses support the person’s innate capacity to heal by providing care based on symptom severity, physiologic response, the patient’s condition, patient/family needs and preferences, and available resources. This chapter describes whole-person/whole-systems assessment that focuses on health and wellbeing, clinical decision-making, and methods to apply the full range of therapeutic interventions to weave together a way of being-knowing-doing that honors nursing’s traditions and prepares them to lead integrative healthcare delivery models.
Integrative Nursing in Ireland
Authors: McNamara Martin , Teeling Seán Paul , Shannon Michael
Published: January 2019

National nursing strategy in Ireland aims to ensure that a distinctive Irish realization of integrative nursing principles—and the values of care, compassion, commitment, and trustworthiness in which they are grounded—inform broader policy developments in the health system. Irish nursing leaders, recognizing the historic undervaluing and underleveraging of nurses’ influence and impact throughout the system, increasingly position nursing as its key innovating and integrating force; this is a significant change to the status quo ante. Academic nurse leaders have established health systems programs in university nursing schools to build collaborative, integrative, and interdisciplinary programs and networks of education and research, recognizing that nurses are the key drivers of system reform and improvement and that their embeddedness and ubiquity offer a deeper and more holistic understanding of the patient and caregiver perspective.
Pharmacotherapy of Personality Disorder
Authors: Svrakic Dragan M. , Divac-Jovanovic Mirjana
Published: January 2019

Relevant neuroscience to guide pharmacotherapy of personality disorder is reviewed. Pharmacotherapy is either (a) mechanism based, aimed at correcting heritable neurobiological trait vulnerabilities that increase the risk of personality disorder, or (b) symptom domain based, aimed at correcting clinical symptoms of personality disorder arranged into four domains. The novel concept of harnessing the brain’s homeostatic functions in order to deliver treatment is introduced, drawing analogy from serotonergic antidepressants. The dynamics of homeostatic optimization is the conceptual basis of the mechanism-based pharmacotherapy. Pharmacological modulation of trait vulnerability associated with excessive Harm Avoidance, Novelty Seeking, Persistence, and low Reward Dependence is reviewed. Pharmacotherapy of impulsive-affective aggression, which is the default affect state of personality disorder, is discussed in detail. Symptom-domain pharmacotherapy, the current standard of care, targets four symptom domains: (a) mood dysregulation, (b) behavior dysregulation, (c) emotional detachment; and (d) cognitive dysregulation. Pharmacotherapy of each is discussed in detail.
The Roles of Combat Exposure, Personal Vulnerability, and Involvement in Harm to Civilians or Prisoners in War-Related Post-Traumatic Stress Disorder
Authors: Dohrenwend Bruce P. , Yager Thomas J. , Wall Melanie M. , Adams Ben G.
Published: January 2019

This chapter examines the central assumption in the DSM-III, DSM-III-R, and DSM-IV that potentially traumatic stressors are more important than personal vulnerability in causing PTSD. This chapter tests this assumption with data from a rigorously diagnosed male subsample (n = 260) from the NVVRS. It concludes that, of the three risk factors, only combat exposure proved necessary for disorder onset. Although none of the three risk factors proved sufficient, estimated onset reached 97% for veterans high on all three, with harm to civilians or prisoners showing the largest independent contribution. Severity of combat exposure proved more important than pre-war vulnerability in onset; pre-war vulnerability was as least as important in long-term persistence. Implications for the primacy of the stressor assumption are discussed.
Medical Science Versus Medical Technology
Authors: Montgomery Erwin B.
Published: January 2019

Until the 1940s, the relative advantages of allopathic compared to empiric medicine in patient treatment were not clear cut. The cell theory and the success of the pathological–clinical correlations advanced allopathic medicine; however, translation to superior medical treatments at the time did not vouchsafe allopathic medicine. It is tempting to look at the success of allopathic medicine as evidence of the fundamental soundness of the allopathic approach. Much of the history of medicine to date would suggest otherwise. Many medical therapies resulted from serendipity, “shot gunning” (trying everything without appeal to principles), or existing technologies looking for a problem. Experimentalism, the modus operandi of science, may be as much technical as it is science. Evidence-based medicine, as in randomized clinical trials, is more technical as tests of efficacy need not invoke causal mechanisms. Medicine and medical science, laid bare of its technological advances, may require viewing in a different light.
Pregnancy 2.0
Authors: Massa Eleonora , Simeoni Valentina
Published: January 2019

Based on the analysis of a corpus of 300 posts written on Facebook by 20 pregnant Italian women, this chapter discusses the role of this social network in structuring sharable and socially acceptable narratives of the complex human experience of pregnancy. First, pregnancy is defined as an exquisitely narrative phenomenon that stimulates intersubjective forms of construction and representation. Second, the structural peculiarities of Facebook as a narrative device are described. Finally, an analysis of the corpus is proposed that unfolds on three levels: a global narrative, a linguistic-rhetoric, and a socio-pragmatic one. Along with indications on the informative power such narratives may have for socio-anthropological and linguistic research, some first conclusions are proposed on the constructional power of the platform in shaping biographical experiences and producing pregnancy narratives that are partly similar, and partly different, from those of the offline culture.
Kinetic simulations of mildly relativistic shocks – I. Particle acceleration in high Mach number shocks
Authors: Crumley P , Caprioli D , Markoff S , Spitkovsky A
Published: January 2019

We use fully kinetic particle-in-cell simulations with unprecedentedly large transverse box sizes to study particle acceleration in weakly magnetized mildly relativistic shocks travelling at a velocity ≈ 0.75c and a Mach number of 15. We examine both subluminal (quasi-parallel) and superluminal (quasi-perpendicular) magnetic field orientations. We find that quasi-parallel shocks are mediated by a filamentary non-resonant (Bell) instability driven by returning ions, producing magnetic fluctuations on scales comparable to the ion gyroradius. In quasi-parallel shocks, both electrons and ions are accelerated into non-thermal power laws whose maximum energy grows linearly with time. The upstream heating of electrons is small, and the two species enter the shock front in rough thermal equilibrium. The shock’s structure is complex; the current of returning non-thermal ions evacuates cavities in the upstream that form filaments of amplified magnetic fields once advected downstream. At late times, 10 per cent of the shock’s energy goes into non-thermal protons and ${\gtrsim }10{{\ \rm per\ cent}}$ into magnetic fields. We find that properly capturing the magnetic turbulence driven by the non-thermal ions is important for properly measuring the energy fraction of non-thermal electrons, εe. We find εe ∼ 5 × 10−4 for quasi-parallel shocks with v = 0.75c, slightly larger than what was measured in simulations of non-relativistic shocks. In quasi-perpendicular shocks, no non-thermal power-law develops in ions or electrons. The ion acceleration efficiency in quasi-parallel shocks suggests that astrophysical objects that could host mildly relativistic quasi-parallel shocks – for example, the jets of active galactic nuclei or microquasars – may be important sources of cosmic rays and their secondaries, such as gamma-rays and neutrinos.
Most white dwarfs with detectable dust discs show infrared variability
Authors: Swan Andrew , Farihi Jay , Wilson Thomas G
Published: January 2019

Archival data from the WISE satellite reveal infrared flux variations of tens of per cent around numerous dusty white dwarfs. Data spanning more than 7 yr reveal more than half of known systems are varying in the 3.4 ${\mu}$m band, while the 4.6 ${\mu}$m data are challenging to interpret due to lower signal-to-noise ratios. The sparsely-sampled data limit interpretation, but the heterogeneous light curves suggest each source may be idiosyncratic, where there may be competing processes operating on different time-scales. Collisions are likely driving the observed decays in flux, and this finding suggests that dust production is operating more often than indicated by previous observations. The observed variation is at odds with the canonical flat disc model in isolation, and underscores the need for infrared monitoring of these evolved planetary systems to inform the next generation of theoretical models.
Rescuing Suboptimal Outcomes of Subthalamic Deep Brain Stimulation in Parkinson Disease by Surgical Lead Revision
Authors: Nickl Robert C , Reich Martin M , Pozzi Nicoló Gabriele , Fricke Patrick , Lange Florian , Roothans Jonas , Volkmann Jens , Matthies Cordula
Published: January 2019

BACKGROUND

Clinical trials have established subthalamic deep-brain-stimulation (STN-DBS) as a highly effective treatment for motor symptoms of Parkinson disease (PD), but in clinical practice outcomes are variable. Experienced centers are confronted with an increasing number of patients with partially “failed” STN-DBS, in whom motor benefit doesn’t meet expectations. These patients require a complex multidisciplinary and standardized workup to identify the likely cause.

OBJECTIVE

To describe outcomes in a series of PD patients undergoing lead revision for suboptimal motor benefit after STN-DBS surgery and characterize selection criteria for surgical revision.

METHODS

We investigated 9 PD patients with STN-DBS, who had unsatisfactory outcomes despite intensive neurological management. Surgical revision was considered if the ratio of DBS vs levodopa-induced improvement of UPDRS-III (DBS-rr) was below 75% and the electrodes were found outside the dorsolateral STN.

RESULTS

Fifteen electrodes were replaced via stereotactic revision surgery into the dorsolateral STN without any adverse effects. Median displacement distance was 4.1 mm (range 1.6-8.42 mm). Motor symptoms significantly improved (38.2 ± 6.6 to 15.5 ± 7.9 points, P < .001); DBS-rr increased from 64% to 190%.

CONCLUSION

Patients with persistent OFFmotor symptoms after STN-DBS should be screened for levodopa-responsiveness, which can serve as a benchmark for best achievable motor benefit. Even small horizontal deviations of the lead from the optimal position within the dorsolateral STN can cause stimulation responses, which are markedly inferior to the levodopa response. Patients with an image confirmed lead displacement and preserved levodopa response are candidates for lead revision and can expect significant motor improvement from appropriate lead replacement.
Use of Intra-Arterial Tissue Plasminogen Activator in Acute Stroke: Video Case
Authors: Munich Stephan A , Waqas Muhammad , Vakharia Kunal , McPheeters Matthew J , Siddiqui Adnan H
Published: January 2019

This video illustrates access to tortuous distal intracranial vasculature and the use of intra-arterial (IA) tissue plasminogen activator (tPA) for the revascularization of small vessel occlusion. IA tPA is a reasonable approach for distal arterial occlusion resistant to intravenous tPA or mechanical thrombectomy. In this video, the patient had a posterior circulation stroke with elevated time-to-peak in the cerebellar hemispheres. He had received intravenous tPA in the emergency room but ataxia and dysarthria symptoms persisted. Cerebral angiography showed right superior cerebellar artery (SCA) occlusion. Although his NIHSS score was low, his symptoms were disabling. While not standard of care, discussion with patients about potential options is crucial; and we believe that mechanical and localized therapies in these circumstances may be beneficial. A Velocity microcatheter (Penumbra, Alameda, California) was initially used to attempt SCA access but was unsuccessful. A second attempt was made with a Headway Duo (MicroVention, Aliso Viejo, California)―a smaller, more pliant microcatheter better suited to the acute turn in the SCA. A 2 mg IA tPA dose was administered at the occlusion site. A direct aspiration first-pass technique (ADAPT) and stent retriever were thought to be too aggressive in a small SCA. The proximal vessel was recanalized, and the microcatheter was advanced to the distal occlusion site before IA administration of another 2 mg of tPA. Post-tPA runs showed excellent SCA revascularization. For occlusion of small intracranial vessels where IV tPA is ineffective and mechanical thrombectomy is unsafe, local administration of IA tPA can be an effective therapy.

Consent was obtained from the patient prior to performing the procedure. Institutional review board approval is not required for the report of a single case.
Widespread Belief That Organic and Additive-Free Tobacco Products are Less Harmful Than Regular Tobacco Products: Results From the 2017 US Health Information National Trends Survey
Authors: Pearson Jennifer L , Moran Meghan , Delnevo Cristine D , Villanti Andrea C , Lewis M Jane
Published: January 2019

Significance

US smokers of Natural American Spirit, a brand marketed as “organic” and “additive-free,” are more likely than other cigarette smokers to believe that their brand might be less harmful than other brands. This article (1) describes the prevalence of belief that “organic” and “additive-free” tobacco is less harmful than regular tobacco products in the US population and (2) describes the sociodemographic characteristics of adults who believe tobacco products with these descriptors are less harmful.

Methods

Data were drawn from the 2017 Health Information National Trends Survey (HINTS), a nationally representative survey of US adults. Logistic regression models were used to examine correlates of the belief that “organic” or “additive-free” tobacco products are less harmful than regular tobacco products.

Results

Overall, 26.7% of US adults and 45.3% of adult smokers believe that “organic” tobacco products are less harmful than regular tobacco products. Similarly, 35.2% of US adults and 47.1% of smokers believe that “additive-free” tobacco products are less harmful. When examining gender, age, education, race/ethnicity, sexual orientation, and smoking status, only age (adjusted odds ratio [aOR] ~0.98, 95% confidence interval [CI]: 0.97, 0.99 for both outcomes) and smoking status (current vs. never smokers, aOR ~1.78, 95% CI 1.03, 3.07 for both outcomes) were correlates of believing that “organic” or “additive-free” tobacco is less harmful than regular tobacco products.

Conclusions

Belief that “organic” and “additive-free” tobacco products are less harmful than other products is widespread. Younger adults and current smokers are most likely to be misinformed by “organic” or “additive-free” tobacco product descriptors.

Implications

Belief that “organic” and “additive-free” tobacco products are less harmful than other products is widespread among US adults and most prevalent among smokers. Removal of terms that incorrectly imply reduced harm may correct current and future consumers’ misperceptions about the brand.
Do selective schooling systems increase inequality?
Authors: Burgess Simon , Dickson Matt , Macmillan Lindsey
Published: January 2019

We investigate the impact on earnings inequality of a selective education system in which school assignment is based on initial test scores. We use a large, representative household panel survey to compare adult earnings inequality of those growing up under a selective education system with those educated under a comprehensive system in England. Controlling for a range of background characteristics and the current location, the wage distribution for individuals who grew up in selective schooling areas is substantially and significantly more unequal. The total effect sizes are large: 24% of the raw 90–10 earnings gap and 19% of the conditional 90–10 earnings gap can be explained by differences across schooling systems.
Who Is Keeping Their Unused Opioids and Why?
Authors: Neill Luke A , Kim Howard S , Cameron Kenzie A , Lank Patrick M , Patel Deesha A , Hur Scott I , Opsasnick Lauren A , Curtis Laura M , Eifler Morgan R , Courtney D Mark , Wolf Michael S , McCarthy Danielle M
Published: January 2019

Objective

To better understand patients’ reasoning for keeping unused opioid pills.

Methods

As part of a larger study, patients were asked their plans for their unused opioids. Responses were categorized as “dispose,” “keep,” and “don’t know.” Baseline characteristics were compared between the “keep” and “dispose” groups. Verbatim responses categorized as “keep” were analyzed qualitatively using a team-based inductive approach with constant comparison across cases.

Results

One hundred patients planned to dispose of their pills; 117 planned to keep them. There were no differences in demographics between the groups. Among patients who planned to keep their pills, the mean age was 43 years and 47% were male. Analysis revealed four categories of patient responses: 1) plans to keep their pills “just in case,” with reference to a medical condition (e.g., kidney stone); 2) plans to keep pills “just in case” without reference to any medical condition; 3) plans to dispose in delayed fashion (e.g., after pill expiration) or unsure of how to dispose; and 4) no identified plans, yet intended to keep pills. In this sample, there were no differences in characteristics of those reporting planning to keep vs dispose of pills; however, there were diverse reasons for keeping opioids.

Conclusions

This manuscript describes a sample of patients who kept their unused opioids and presents qualitative data detailing their personal reasoning for keeping the unused pills. Awareness of the range of motivations underpinning this behavior may inform the development of tailored education and risk communication messages to improve opioid disposal.
Returns to Talent and the Finance Wage Premium
Authors: Célérier Claire , Vallée Boris
Published: January 2019

To study the role of talent in finance workers’ pay, we exploit a special feature of the French higher education system. Wage returns to talent have been significantly higher and have risen faster since the 1980s in finance than in other sectors. Both wage returns to project size and the elasticity of project size to talent are also higher in this industry. Last, the share of performance pay varies more for talent in finance. These findings are supportive of finance wages reflecting the competitive assignment of talent in an industry that exhibits a high complementarity between talent and scale.

Received October 11, 2017; editorial decision September 4, 2018 by Editor Stijn Van Nieuwerburgh. Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
Financial Markets with Trade on Risk and Return
Authors: Smith Kevin
Published: January 2019

In this paper, I develop a model in which risk-averse investors possess private information regarding both a stock’s expected payoff and its risk. These investors trade in the stock and a derivative whose payoff is driven by the stock’s risk. In equilibrium, the derivative is used to speculate on the stock’s risk and to hedge against adverse fluctuations in the stock’s risk. I analyze the derivative price and variance risk premium that arise in this equilibrium and their predictive power for stock returns. Finally, I examine the relationship between prices and trading volume in the stock and derivative.

Received July 31, 2017; editorial decision December 3, 2018 by Editor Stijn Van Nieuwerburgh. Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
Janus kinases to jakinibs: from basic insights to clinical practice
Authors: Gadina Massimo , Le Mimi T , Schwartz Daniella M , Silvennoinen Olli , Nakayamada Shingo , Yamaoka Kunihiro , O’Shea John J
Published: January 2019

Cytokines are critical mediators of diverse immune and inflammatory diseases. Targeting cytokines and cytokine receptors with biologics has revolutionized the treatment of many of these diseases, but targeting intracellular signalling with Janus kinase (JAK) inhibitors (jakinibs) now represents a major new therapeutic advance. We are still in the first decade since these drugs were approved and there is still much to be learned about the mechanisms of action of these drugs and the practical use of these agents. Herein we will review cytokines that do, and just as importantly, do not signal by JAKs, as well as explain how this relates to both efficacy and side effects in various diseases. We will review new, next-generation selective jakinibs, as well as the prospects and challenges ahead in targeting JAKs.
Platelets release proinflammatory microparticles in anti-neutrophil cytoplasmic antibody-associated vasculitis
Authors: Miao Di , Ma Tian-Tian , Chen Min , Zhao Ming-Hui
Published: January 2019

Objective

The biological functions of the platelets contributing to ANCA-associated vasculitis (AAV) are largely unclear. The current study aimed to investigate the potential role of platelet-derived microparticles (PMPs) in AAV.

Methods

In the current study, microparticles in AAV patients were analysed by flow cytometry, and PMPs were probed for relative levels of 640 bioactive proteins secreted from patients’ platelets using antibody microarrays. These data were then correlated with clinical and pathological parameters.

Results

PMPs were significantly increased in 69 AAV patients, predominantly MPO-ANCA positive patients in active stage compared with in remission [4406.8/μl (2135.4, 5485.0) vs 549.7/μl (350, 708.5), P < 0.0001], and 43% of microparticles in active AAV were PMPs. Compared with 15 patients in remission, highly expressed proinflammatory molecules in the microparticles from platelets in 15 AAV patients in active stage revealed that potential functions of PMPs were promotion of the effect of chemotaxis, adhesion, growth and apoptosis (all the patients for array analysis were MPO-ANCA positive). The level of PMPs had a significant association with disease activity, inflammation, and renal damage.

Conclusion

PMPs may serve as inflammatory propagators through their wide production of proinflammatory cytokines in AAV, potentially providing a novel therapeutic target.
Patients’ experience of shoulder disorders: a systematic review of qualitative studies for the OMERACT Shoulder Core Domain Set
Authors: Page Matthew J , O’Connor Denise A , Malek Mary , Haas Romi , Beaton Dorcas , Huang Hsiaomin , Ramiro Sofia , Richards Pamela , Voshaar Marieke J H , Shea Beverley , Verhagen Arianne P , Whittle Samuel L , van der Windt Danielle A , Gagnier Joel J , Buchbinder Rachelle ,   OMERACT Shoulder Core Set Working Group
Published: January 2019

Objectives

To describe the experiences (including symptoms and perceived impacts on daily living) of people with a shoulder disorder.

Methods

Systematic review of qualitative studies. We searched for eligible qualitative studies indexed in Ovid MEDLINE, Ovid Embase, CINAHL (EBSCO), SportDiscus (EBSCO) and Ovid PsycINFO up until November 2017. Two authors independently screened studies for inclusion, appraised their methodological quality using the Critical Appraisal Skills Programme checklist, used thematic synthesis methods to generate themes describing the experiences reported by participants and assessed the confidence in the findings using the Grading of Recommendations Assessment, Development and Evaluation Confidence in Evidence from Reviews of Qualitative research (GRADE-CERQual) approach.

Results

The inclusion criteria were met by eight studies, which included 133 participants (49 females and 84 males) with either rotator cuff disease, adhesive capsulitis, proximal humeral fracture, shoulder instability or unspecified shoulder pain. We generated seven themes to describe what people in the included studies reported experiencing: pain; physical function/activity limitations; participation restriction; sleep disruption; cognitive dysfunction; emotional distress; and other pathophysiological manifestations (other than pain). There were interactions between the themes, with particular experiences impacting on others (e.g. pain leading to reduced activities and sleep disruption). Following grading of the evidence, we considered it likely that most of the review findings were a reasonable representation of the experiences of people with shoulder disorders.

Conclusion

Patients with shoulder disorders contend with considerable disruption to their life. The experiences described should be considered by researchers seeking to select the most appropriate outcomes to measure in clinical trials and other research studies in people with shoulder disorders.
COMPARISON OF RADIATION EXPOSURE TO THE PATIENT AND CONTRAST DETAIL RESOLUTIONS ACROSS LOW DOSE 2D/3D SLOT SCANNER AND TWO CONVENTIONAL DIGITAL RADIOGRAPHY X-RAY IMAGING SYSTEMS
Authors: Abdi Ahmed Jibril , Mussmann Bo , Mackenzie Alistair , Klaerke Benedikte , Andersen Poul Erik
Published: January 2019

Purpose

To assess and compare the radiation dose and image quality of the low dose 2D/3D EOS slot scanner (LDSS) to conventional digital radiography (DR) X-ray imaging systems for chest and knee examination protocols.

Methods and materials

The effective doses (ED) to the patient in the chest and knee clinical examination protocols for LDSS and DR X-ray imaging systems were determined using the dose area product and PCXMC Monte Carlo simulation software. The CDRAD phantom was imaged with 19 cm, and 13 cm thick Polymethyl Methacrylate (PMMA) blocks to simulate the chest and knees respectively of a patient of average adult size. The contrast detail resolution was calculated using image analysis software.

Results

The EDs for the LDSS default setting were up to 69% and 51% lower than for the DR systems for the chest (speed 4) and knee (speed 6) protocols, respectively, while for the increased dose level setting then the EDs were up to 42% and 35% lower than for the DR systems for the chest (speed 6) and knee (speed 8) protocols respectively. At the default setting, the contrast detail was lowest for the default setting of the 2D/3D low dose slot scanner (LDSS) for both chest and knee examinations, but at the highest dose levels then the threshold were equal or higher than the contrast resolution of DR imaging systems.

Conclusion

The LDSS has the potential to be used for clinical diagnosis of chest and knee examinations using the higher dose level. For speed 6 in chest protocol and speed 8 in knee protocol, the measured contrast detail resolution was comparable with the DR systems but at a lower effective dose.
The Problem of the Rebellious Religious Women: Pakistan, Gender, and the Islamic Revival
Authors: Zaman Meryem F
Published: January 2019

Academic audiences and local commentators alike are perplexed by women’s participation in Islamic movements in urban Pakistan. Why are privileged women joining Islamic movements which call on them to limit their freedom at a time of growing economic and social opportunity? I argue that part of the answer lies in the formulation of Pakistani gender roles, and the ways in which Islamic movements interact with gendered ideas of virtues to offer women new modes of imagining themselves and their role in Pakistani society.
Neurodevelopmental Outcomes of Very Low Birth Weight Infants at 18–24 Months, Corrected Gestational Age in a Tertiary Health Centre: A Prospective Cohort Study
Authors: Oommen Samuel P , Santhanam Sridhar , John Hima , Roshan Reeba , Swathi T O , Padankatti Caroline , Grace Hannah , Beulah Rachel , Jana Atanu Kumar , Kumar Manish , Thomas Niranjan , Yadav Bijesh
Published: January 2019

Objective

To determine the prevalence and risk factors for poor neurodevelopmental outcome in a cohort of very low birth weight (VLBW) infants.

Subjects and methods

Four hundred and twenty-two infants of a total of 643 VLBW survivors from a teaching hospital in South India were followed up to assess their neurodevelopmental outcomes.

Results

Among the 422 children who completed the assessment, results of 359 children whose assessments were done between 18 and 24 months were analysed. Thirty-seven children (10.31%) had poor neurodevelopmental outcome, six children [1.67%] had cerebral palsy, one child had visual impairment and another had hearing impairment. Poor post-natal growth was independently associated with poor neurodevelopmental outcomes in the multivariate analysis (p = 0.045). Neonatal complications were not associated with the developmental outcome.

Conclusion

Despite lower rates of neonatal complications compared with Western cohorts, significant proportion of VLBW infants had poor neurodevelopmental outcomes. Poor post-natal growth was an important determinant of the developmental outcome
The Virulence Function and Regulation of the Metalloprotease Gene prtA in the Plant-Pathogenic Bacterium Burkholderia glumae
Authors: Lelis Tiago , Peng Jingyu , Barphagha Inderjit , Chen Ruoxi , Ham Jong Hyun
Published: January 2019

Bacterial panicle blight caused by Burkholderia glumae is a major bacterial disease of rice. Our preliminary RNA-seq study showed that a serine metalloprotease gene, prtA, is regulated in a similar manner to the genes for the biosynthesis and transport of toxoflavin, which is a known major virulence factor of B. glumae. prtA null mutants of the virulent strain B. glumae 336gr-1 did not show a detectable extracellular protease activity, indicating that prtA is the solely responsible gene for the extracellular protease activity detected from this bacterium. In addition, inoculation of rice panicles with the prtA mutants resulted in a significant reduction of disease severity compared with the wild-type parent strain, suggesting the requirement of prtA for the full virulence of B. glumae. A double mutant deficient in both serine metalloprotease and toxoflavin (ΔtoxA/prtA−) exhibited a further numeric but not statistically significant decrease of disease development compared with the ΔtoxA strain. Both the prtA-driven extracellular protease activity and the toxoflavin production were dependent on both the tofI/tofR quorum-sensing and the global regulatory gene qsmR, indicating the important roles of the two global regulatory factors for the bacterial pathogenesis by this pathogen.
Latent Infection of Powdery Mildew on Volunteer Wheat in Sichuan Province, China
Authors: Liu Na , Lei Yu , Zhang Min , Zheng Wenming , Shi Yongchun , Qi Xiaobo , Chen Huabao , Zhou You , Gong Guoshu
Published: January 2019

Wheat powdery mildew, caused by the fungal pathogen Blumeria graminis f. sp. tritici, is one of the most destructive wheat diseases in China, especially in Sichuan Province. Successfully oversummered B. graminis f. sp. tritici can become a primary infection source for wheat seedlings in the fall. Determining the latent infection level of B. graminis f. sp. tritici in volunteer wheat and the oversummering areas of B. graminis f. sp. tritici is important for estimating potential B. graminis f. sp. tritici epidemics. In this study, we clarified the critical role of volunteer wheat in the B. graminis f. sp. tritici oversummering cycle and determined whether latent B. graminis f. sp. tritici infection was present in volunteer wheat by using real-time polymerase chain reaction (real-time PCR). The results indicated that volunteer wheat was mostly found in the northeast and middle regions of Sichuan, where lower temperatures and higher precipitation are common. A total of 13.2% of samples showed symptoms of B. graminis f. sp. tritici (spores) in the field, and 36.8% of samples were found to carry the B. graminis f. sp. tritici pathogen, even though no symptoms were observed. Volunteer wheat with B. graminis f. sp. tritici infection symptoms was found at an altitude of 536 m but volunteer wheat latently infected by B. graminis f. sp. tritici was identified at the lowest altitude of 323 m. Crop shade (e.g., corn and lima bean) provided suitable conditions for the survival of volunteer wheat in the summer. In addition, volunteer wheat played a key role in the B. graminis f. sp. tritici oversummering cycle. Moreover, B. graminis f. sp. tritici could oversummer by infecting generations of volunteer wheat in the summer, thereby becoming the primary infection source for autumn-sown wheat. The results showed that the latent infection of wheat diseases could be rapidly quantified by real-time PCR. Here, the primary disease center of autumn-sown wheat in Ya’an and Wenjiang were detected accurately based on this method. This study provides solid evidence for identifying the disease center, which offers guidance for wheat disease control and management.
Control of Wheat Fusarium Head Blight by Heat-Stable Antifungal Factor (HSAF) from Lysobacter enzymogenes
Authors: Zhao Yangyang , Cheng Chao , Jiang Tianping , Xu Huiyong , Chen Yun , Ma Zhonghua , Qian Guoliang , Liu Fengquan
Published: January 2019

Heat-stable antifungal factor (HSAF), which belongs to the polycyclic tetramate macrolactam family, was isolated from Lysobacter enzymogenes fermentations and exhibited inhibitory activities against a wide range of fungal pathogens. In this study, the antifungal activity of HSAF against Fusarium graminearum in vitro and in vivo was investigated. A total of 50% of mycelial growth of F. graminearum was suppressed with 4.1 μg/ml of HSAF (EC50 value). HSAF treatment resulted in abnormal morphology of the hyphae, such as curling, apical swelling, and depolarized growth. Furthermore, HSAF adequately inhibited conidial germination and conidiation of F. graminearum with an inhibition rate of 100% when 1 and 6 μg/ml of HSAF were applied, respectively. HSAF caused ultrastructural changes of F. graminearum, including cell wall thickening and plasmolysis. Moreover, the application of HSAF significantly controlled Fusarium head blight in wheat caused by F. graminearum in the field. Overall, these results indicate that HSAF has potential for development as a fungicide against F. graminearum.
Detection of White Root Rot in Avocado Trees by Remote Sensing
Authors: Pérez-Bueno M. L. , Pineda M. , Vida C. , Fernández-Ortuño D. , Torés J. A. , de Vicente A. , Cazorla F. M. , Barón M.
Published: January 2019

White root rot, caused by the soilborne fungus Rosellinia necatrix, is an important constraint to production for a wide range of woody crop plants such as avocado trees. The current methods of detection of white root rot are based on microbial and molecular techniques, and their application at orchard scale is limited. In this study, physiological parameters provided by imaging techniques were analyzed by machine learning methods. Normalized difference vegetation index (NDVI) and normalized canopy temperature (canopy temperature − air temperature) were tested as predictors of disease by several algorithms. Among them, logistic regression analysis (LRA) trained on NDVI data showed the highest sensitivity and lowest rate of false negatives. This algorithm based on NDVI could be a quick and feasible method to detect trees potentially affected by white root rot in avocado orchards.
Potential for Seed Transmission of Verticillium longisporum in Oilseed Rape (Brassica napus)
Authors: Zheng Xiaorong , Lopisso Daniel Teshome , Eseola Alice Bisola , Koopmann Birger , von Tiedemann Andreas
Published: January 2019

Verticillium longisporum is a soilborne vascular fungal pathogen that has spread throughout the European oilseed rape cultivation area since the 1980s and was detected in canola fields in Canada in 2014. In a series of greenhouse and field inoculation experiments using V. longisporum-resistant and susceptible cultivars of winter and spring types of oilseed rape, the present study investigated the potential of V. longisporum dissemination by seeds of Brassica napus. Greenhouse inoculation studies with a DsRed-labeled isolate of V. longisporum confirmed the systemic growth of the pathogen from roots to seeds. Further monitoring of plant colonization in the greenhouse with a species-specific real-time polymerase chain reaction assay verified the pathogen growth from roots to stem bases, pods, and seeds in root-inoculated plants. The frequency of recovery of viable colonies of V. longisporum from seeds harvested from greenhouse-grown inoculated plants ranged from 0.08 to 13.3%. The frequency of seed transmission in the greenhouse differed in oilseed rape cultivars varying in susceptibility to V. longisporum. Subsequent studies on transmission of the disease into the offspring revealed that only 1.7 to 2.3% of plants showed disease symptoms as confirmed by the formation of microsclerotia in the stems. Results from field-grown plants differed from the greenhouse studies. The degree of seed transmission in the field was dependent on the crop type. Although only low concentrations of DNA of V. longisporum were detectable in seeds harvested from severely infected winter oilseed rape, significantly greater concentrations of fungal DNA were found in seeds of spring-type oilseed rape, at similar soil conditions and inoculum densities. Correspondingly, plating seeds that were harvested from infected plants on agar yielded viable V. longisporum colonies only from seeds of the spring-type but not of the winter-type plants. Lack of seed infection in the winter-type crop was confirmed in two seasons. Equally, none of the offspring grown from seeds from severely diseased winter oilseed rape plants developed symptoms of Verticillium stem striping. The results suggest that the rate of seed transmission of V. longisporum depends on the degree of plant colonization, which is significantly faster under greenhouse than field conditions and in a spring-sown crop compared with an autumn-sown oilseed rape crop. According to our studies, disease transmission by seeds from European winter oilseed rape production cannot be confirmed.