bluuebunny/crossref_metadata_2025 huggingface dataset:
A high-frequency boundary element method for scattering by a class of multiple obstacles
Authors: Gibbs Andrew , Chandler-Wilde Simon N , Langdon Stephen , Moiola Andrea
Published: July 2020

We propose a boundary element method for problems of time-harmonic acoustic scattering by multiple obstacles in two dimensions, at least one of which is a convex polygon. By combining a hybrid numerical-asymptotic (HNA) approximation space on the convex polygon with standard polynomial-based approximation spaces on each of the other obstacles, we show that the number of degrees of freedom required in the HNA space to maintain a given accuracy needs to grow only logarithmically with respect to the frequency, as opposed to the (at least) linear growth required by standard polynomial-based schemes. This method is thus most effective when the convex polygon is many wavelengths in diameter and the small obstacles have a combined perimeter comparable to the problem wavelength.
Measles Virus Infects and Programs MAIT Cells for Apoptosis
Authors: Rudak Patrick T , Yao Tony , Richardson Christopher D , Haeryfar S M Mansour
Published: July 2020

Measles virus (MeV) binds, infects, and kills CD150+ memory T cells, leading to immune amnesia. Whether MeV targets innate, memory-like T cells is unknown. We demonstrate that human peripheral blood and hepatic mucosa-associated invariant T (MAIT) cells and invariant natural killer T cells express surprisingly high levels of CD150, more than other lymphocyte subsets. Furthermore, exposing MAIT cells to MeV results in their efficient infection and rapid apoptosis. This constitutes the first report of direct MAIT cell infection by a viral pathogen. Given MAIT cells’ antimicrobial properties, their elimination by MeV may contribute to measles-induced immunosuppression and heightened vulnerability to unrelated infections.
Forum: Militarization 2.0: Communication and the Normalization of Political Violence in the Digital Age
Authors: Jackson Susan T , Crilley Rhys , Manor Ilan , Baker Catherine , Oshikoya Modupe , Joachim Jutta , Robinson Nick , Schneiker Andrea , Grove Nicole Sunday , Enloe Cynthia
Published: July 2020

Scholars of international relations frequently explore how states normalize the use of military force through processes of militarization, yet few have analyzed how new information and communication technologies impact on these processes. The essays in this forum address this gap, and consider the political significance of new technologies, new actors, and new practices that shape “Militarization 2.0” and normalize political violence in the digital age. The authors in this forum rely, to varying degrees, on common militarized tropes and dichotomies (such as authenticity, belonging, and (de)humanizing framings) that are key to militarization, including those devices that rest on gender, race/ethnicity, and heteronormativity. Moving beyond a military-centered approach to militarization, the authors’ questions cover ministries of foreign affairs; the embodied performances of celebrity leaders and insurgency groups; arms producers, the military video game industry, and private military and security companies; and violence entrepreneurs. The forum closes with reflections from Cynthia Enloe.
Inducible biosynthesis and immune function of the systemic acquired resistance inducer N-hydroxypipecolic acid in monocotyledonous and dicotyledonous plants
Authors: Schnake Anika , Hartmann Michael , Schreiber Stefan , Malik Jana , Brahmann Lisa , Yildiz Ipek , von Dahlen Janina , Rose Laura E , Schaffrath Ulrich , Zeier Jürgen
Published: July 2020

Recent work has provided evidence for the occurrence of N-hydroxypipecolic acid (NHP) in Arabidopsis thaliana, characterized its pathogen-inducible biosynthesis by a three-step metabolic sequence from l-lysine, and established a central role for NHP in the regulation of systemic acquired resistance. Here, we show that NHP is biosynthesized in several other plant species in response to microbial attack, generally together with its direct metabolic precursor pipecolic acid and the phenolic immune signal salicylic acid. For example, NHP accumulates locally in inoculated leaves and systemically in distant leaves of cucumber in response to Pseudomonas syringae attack, in Pseudomonas-challenged tobacco and soybean leaves, in tomato inoculated with the oomycete Phytophthora infestans, in leaves of the monocot Brachypodium distachyon infected with bacterial (Xanthomonas translucens) and fungal (Magnaporthe oryzae) pathogens, and in M. oryzae-inoculated barley. Notably, resistance assays indicate that NHP acts as a potent inducer of acquired resistance to bacterial and fungal infection in distinct monocotyledonous and dicotyledonous species. Pronounced systemic accumulation of NHP in leaf phloem sap of locally inoculated cucumber supports a function for NHP as a phloem-mobile immune signal. Our study thus generalizes the existence and function of an NHP resistance pathway in plant systemic acquired resistance.
Reactive Law or Conservative Law? The Reform of Divorce Procedure in China
Authors: Shi Lei
Published: July 2020

A marriage can be terminated in two ways in China, by registration or by litigation. Recently, China’s crude divorce rate has been gradually rising. Reforms are being carried out by the judiciary by introducing more supportive measures in divorce litigation. The legislature is writing drafts of the marriage and family part in the Civil Code. In the third draft, proposed articles would change the law on divorce slightly. These reforms reflect some trends in the development of Chinese family law. With respect to some debates on these reforms, the author suggests there could be a better way to draw up drafts. At the level of the judiciary, the present family justice reform has its advantages, and this bottom-up reform should be adhered to.
Neurosurgical Choice for Glossopharyngeal Neuralgia: A Benefit–Harm Assessment of Long-Term Quality of Life
Authors: Du Tao , Ni Bing , Shu Wei , Hu Yongsheng , Zhu Hongwei , Li Yongjie
Published: July 2020

BACKGROUND

Microvascular decompression (MVD) and vagoglossopharyngeal rhizotomy (VGR) are effective treatment for glossopharyngeal neuralgia (GN). However, surgical choice is controversial due to the need to maximize pain relief and reduce complications.

OBJECTIVE

To retrospectively compare safety, efficacy, long-term quality of life (QOL), and global impression of change following MVD and VGR for treatment of GN.

METHODS

Patient database reviews and telephone surveys were conducted to assess baseline characteristics and long-term outcomes. The effects of pain and complications on QOL were assessed using Brief Pain Inventory-Facial (BPI-Facial) questionnaire. Complication tolerance and surgery satisfaction were sorted using the global impression of change survey.

RESULTS

Of 87 patients with GN, 63 underwent MVD alone, 20 underwent VGR alone, and 4 underwent VGR following a failed MVD. The long-term rate of pain relief was slightly, but not significantly, lower following MVD than VGR (83.6% vs 91.7%, P = .528). However, long-term complications occurred much more frequently following VGR (3.0% vs 50.0%, P < .001). The BPI-Facial, which evaluates pain and complications, showed that MVD had better postoperative QOL than VGR (P < .001). However, 91.7% of patients who underwent VGR experienced no or mild complications. There was no significant difference in the overall satisfaction rates between the groups (83.3% vs 83.6%, P > .99).

CONCLUSION

Although VGR resulted in lower postoperative QOL due to a high complication rate, most of these complications were mild. The overall satisfaction rates for the 2 surgeries were similar.
Low Detection Rate of Bordetella pertussis Using the BioFire FilmArray Respiratory Panel 2plus
Authors: Guillot Sophie , Mizrahi Assaf , Armatys Nathalie , Chat Laureen , Le Monnier Alban , Brisse Sylvain , Toubiana Julie
Published: July 2020

Syndromic respiratory panels are increasingly used worldwide. Their performance for detection of Bordetella pertussis needs to be evaluated. We found that the FilmArray Respiratory Panel 2plus (RP2+) assay, which uses the pertussis toxin promoter target for B. pertussis, can only detect highly charged samples. Negative RP2+ results should not be interpreted as an absence of B. pertussis in clinical samples.
Impact of Infectious Disease Consultation in Patients With Candidemia: A Retrospective Study, Systematic Literature Review, and Meta-analysis
Authors: Kobayashi Takaaki , Marra Alexandre R , Schweizer Marin L , Ten Eyck Patrick , Wu Chaorong , Alzunitan Mohammed , Salinas Jorge L , Siegel Marc , Farmakiotis Dimitrios , Auwaerter Paul G , Healy Heather S , Diekema Daniel J
Published: July 2020

Background

Morbidity and mortality from candidemia remain unacceptably high. While infectious disease consultation (IDC) is known to lower the mortality from Staphylococcus aureus bacteremia, little is known about the impact of IDC in candidemia.

Methods

We conducted a retrospective observational cohort study of candidemia patients at a large tertiary care hospital between 2015 and 2019. The crude mortality rate was compared between those with IDC and without IDC. Then, we systematically searched 5 databases through February 2020 and performed a meta-analysis of the impact of IDC on the mortality of patients with candidemia.

Results

A total of 151 patients met the inclusion criteria, 129 (85%) of whom received IDC. Thirty-day and 90-day mortality rates were significantly lower in the IDC group (18% vs 50%; P = .002; 23% vs 50%; P = .0022, respectively). A systematic literature review returned 216 reports, of which 13 studies including the present report fulfilled the inclusion criteria. Among the 13 studies with a total of 3582 patients, IDC was performed in 50% of patients. Overall mortality was 38.2% with a significant difference in favor of the IDC group (28.4% vs 47.6%), with a pooled relative risk of 0.41 (95% CI, 0.35–0.49). Ophthalmology referral, echocardiogram, and central line removal were performed more frequently among patients receiving IDC.

Conclusions

This study is the first systematic literature review and meta-analysis to evaluate the association between IDC and candidemia mortality. IDC was associated with significantly lower mortality and should be considered in all patients with candidemia.
Understanding microcystin-LR antibody binding interactions using in silico docking and in vitro mutagenesis
Authors: McPartlin Daniel A , Murphy Caroline , Fitzgerald Jenny , Ma Hui , Regan Fiona , O’Kennedy Richard J
Published: July 2020

Microcystins (MCs) are a group of highly potent cyanotoxins that are becoming more widely distributed due to increased global temperatures and climate change. Microcystin-leucine-arginine (MC-LR) is the most potent and most common variant, with a guideline limit of 1 μg/l in drinking water. We previously developed a novel avian single-chain fragment variable (scFv), designated 2G1, for use in an optical-planar waveguide detection system for microcystin determination. This current work investigates interactions between 2G1 and MC-LR at the molecular level through modelling with an avian antibody template and molecular docking by AutoDock Vina to identify key amino acid (AA) residues involved. These potential AA interactions were investigated in vitro by targeted mutagenesis, specifically, by alanine scanning mutations. Glutamic acid (E) was found to play a critical role in the 2G1-MC-LR binding interaction, with the heavy chain glutamic acid (E) 102 (H-E102) forming direct bonds with the arginine (R) residue of MC-LR. In addition, alanine mutation of light chain residue aspartic acid 57 (L-D57) led to an improvement in antigen-binding observed using enzyme-linked immunosorbent assay (ELISA), and was confirmed by surface plasmon resonance (SPR). This work will contribute to improving the binding of recombinant anti-MC-LR to its antigen and aid in the development of a higher sensitivity harmful algal toxin diagnostic.
Fear-induced increases in loss aversion are linked to increased neural negative-value coding
Authors: Schulreich Stefan , Gerhardt Holger , Meshi Dar , Heekeren Hauke R
Published: July 2020

Human decisions are often influenced by emotions. An economically relevant example is the role of fear in generating loss aversion. Previous research implicates the amygdala as a key brain structure in the experience of fear and loss aversion. The neural mechanism behind emotional influences on loss aversion is, however, unclear. To address this, we measured brain activation with functional magnetic resonance imaging (fMRI) while participants made decisions about monetary gambles after viewing fearful or neutral faces. We observed that loss aversion following the presentation of neutral faces was mainly predicted by greater deactivations for prospective losses (relative to activations for prospective gains) in several brain regions, including the amygdala. By contrast, increases in loss aversion following the presentation of fearful faces were mainly predicted by greater activations for prospective losses. These findings suggest a fear-induced shift from positive to negative value coding that reflects a context-dependent involvement of distinct valuation processes.
Anterior vs Posterior Hippocampal Subfields in an Extended Psychosis Phenotype of Multidimensional Schizotypy in a Nonclinical Sample
Authors: Sahakyan Lili , Meller Tina , Evermann Ulrika , Schmitt Simon , Pfarr Julia-Katharina , Sommer Jens , Kwapil Thomas R , Nenadić Igor
Published: July 2020

Numerous studies have implicated involvement of the hippocampus in the etiology and expression of schizophrenia-spectrum psychopathology, and reduced hippocampal volume is one of the most robust brain abnormalities reported in schizophrenia. Recent studies indicate that early stages of schizophrenia are specifically characterized by reductions in anterior hippocampal volume; however, studies have not examined hippocampal volume reductions in subclinical schizotypy. The present study was the first to examine the associations of positive, negative, and disorganized schizotypy dimensions with hippocampal subfield volumes in a large sample (n = 195) of nonclinically ascertained young adults, phenotyped using the Multidimensional Schizotypy Scale (MSS). Hippocampal subfields were analyzed from high-resolution 3 Tesla structural magnetic resonance imaging scans testing anatomical models, including anterior vs posterior regions and the cornu ammonis (CA), dentate gyrus (DG), and subiculum subfields separately for the left and right hemispheres. We demonstrate differential spatial effects across anterior vs posterior hippocampus segments across different dimensions of the schizotypy risk phenotype. The interaction of negative and disorganized schizotypy robustly predicted left hemisphere volumetric reductions for the anterior and total hippocampus, and anterior CA and DG, and the largest reductions were seen in participants high in negative and disorganized schizotypy. These findings extend previous early psychosis studies and together with behavioral studies of hippocampal-related memory impairments provide the basis for a dimensional neurobiological hippocampal model of schizophrenia risk. Subtle hippocampal subfield volume reductions may be prevalent prior to the onset of detectable prodromal clinical symptoms of psychosis and play a role in the etiology and development of such conditions.
Counteracting Challenges to Gender Equality in the Era of Anti-Gender Campaigns: Competing Gender Knowledges and Affective Solidarity
Authors: Korolczuk Elżbieta
Published: July 2020

This article focuses on the epistemic strategies employed by ultraconservative movements to oppose women’s reproductive rights and the ways in which the women’s movement counteracts these efforts. The core argument is that nowadays the opponents of gender equality and sexual democracy are seeking not only political but also epistemic power, producing a new body of gender knowledge. A detailed analysis of the struggles around the 2016 Stop Abortion bill in Poland shows, however, that the women’s movement can counteract these challenges by mobilizing not only medical and legal expertise, but also tacit knowledge and affects.
PCR performance for the diagnosis of cutaneous leishmaniasis caused by Leishmania viannia complex using biopsy samples, compared with exudate samples from skin lesions on filter paper
Authors: Apaza-Castillo Yahanda Gisela , Aguilar-Ancori Elsa Gladys , Quispe-Flórez Mercedes Maritza , Ramírez-Soto Max Carlos , Pacheco-Venero Rosa Luz
Published: July 2020

Background

Cutaneous leishmaniasis (CL) is generally diagnosed by molecular methods, including PCR, using biopsy samples, skin scrapings and clinical exudates. In this study, we assessed the PCR performance for diagnosis of CL using skin of biopsy samples vs PCR of skin lesion exudate samples on filter paper and compared the diagnostic concordance of PCR using both sampling methods.

Methods

We assessed the PCR performance using 80 skin biopsy samples and 80 filter paper samples containing exudates from skin lesions obtained from 74 patients with clinical suspicion of CL in Cusco, Peru.

Results

: PCR using skin biopsy samples had superior diagnostic accuracy compared with filter paper PCR (62.5% [50/80] vs 38.7% [31/80], respectively; p˂0.005) and the diagnostic concordance between both sampling methods was ‘moderate’ (kappa coefficient=0.50, 95% CI 0.98 to 1.0).

Conclusions

PCR using biopsy samples remains the standard for diagnosis of CL.
Latent tuberculosis infection prevalence in rural Madagascar
Authors: Sadananda Gouri , Knoblauch Astrid M , Andriamiadanarivo Andry , Razafindrina Kimmerling , Ambinintsoa Ideal , Rabetombosoa Roger Mario , Pando Christine E , Tsang Lai Yu , Small Peter M , Rakotosamimanana Niaina , Grandjean Lapierre Simon
Published: July 2020

Background

Understanding latent Mycobacterium tuberculosis infection (LTBI) prevalence is crucial for the design of TB control strategies. There are no data on LTBI in rural Madagascar.

Methods

Tuberculin skin tests were performed in 98 adults aged >15 y in five rural villages in the Ifanadiana district, Madagascar.

Results

Of adults, 78.6% were positive for LTBI, ranging between 28.6% and 95.0% among villages. The majority (65.3%) showed an induration reaction of >15 mm.

Conclusions

LTBI prevalence is high in rural Madagascar. Long-term TB control strategies including LTBI testing and treatment must account for high and heterogeneous prevalence in remote, underdeveloped areas.
Application of urine antigen assay to evaluate outcomes of praziquantel treatment and reinfection in opisthorchiasis in northeast Thailand
Authors: Worasith Chanika , Wangboon Chompunoot , Kopolrat Kulthida Y , Homwong Chutima , Sithithaworn Jiraporn , Techasen Anchalee , Thanan Raynoo , Khuntikeo Narong , Sithithaworn Paiboon
Published: July 2020

Background

A urine antigen assay was applied to evaluate chemotherapeutic outcomes and reinfection patterns of opisthorchiasis in Thailand.

Methods

We used a prospective study design by following opisthorchiasis subjects at baseline and post-treatment using a urine antigen assay and faecal examination by the formalin–ethyl acetate concentration technique (FECT).

Results

The antigen of Opisthorchis viverrini in urine diminished within 4 weeks after praziquantel treatment. Concurrent faecal examinations by FECT showed that faecal eggs were negative at 4 weeks after treatment. In a subsequent study, reinfection rates and intensity patterns of O. viverrini were evaluated at 48 weeks after praziquantel treatment. Within a group of subjects with curative treatment (n=137), 16.8% became reinfected according to FECT and 27.7% according to the urine antigen assay (p<0.05). There were significant correlations in intensity of infection between pretreatment and at 48 weeks post-treatment in both faecal egg counts and antigen levels in urine.

Conclusions

The results suggested that in addition to screening, the urine antigen assay is an efficient tool for monitoring outcomes of drug treatment and reinfection in opisthorchiasis. Due to the ease of urine sample collection and handling, the urine assay becomes an alternative method to faecal examination for diagnosis and monitoring of opisthorchiasis.
Emergence and evolution of highly pathogenic porcine epidemic diarrhea virus by natural recombination of a low pathogenic vaccine isolate and a highly pathogenic strain in the spike gene
Authors: Wang Huinan , Zhang Libo , Shang Yuanbin , Tan Rongrong , Ji Mingxiang , Yue Xinliang , Wang Nannan , Liu Jun , Wang Chunhua , Li Yonggang , Zhou Tiezhong
Published: July 2020

Outbreaks of a new variant of porcine epidemic diarrhea virus (PEDV) at the end of 2010 have raised interest in the mutation and recombination of PEDV. A PEDV strain (CN/Liaoning25/2018) isolated from a clinical outbreak of piglet diarrhea contained a 49-bp deletion in the ORF3 gene. This deletion is considered a genetic characteristic of low pathogenic attenuated vaccine strains. However, CN/Liaoning25/2018 was highly pathogenic. Complete genome sequencing, identity analysis, phylogenetic tree construction, and recombination analysis showed that this virus was a recombinant strain containing the Spike (S) gene from the highly pathogenic CN/GDZQ/2014 strain and the remaining genomic regions from the low pathogenic vaccine isolate SQ2014. Histopathology and immunohistochemistry results confirmed that this strain was highly pathogenic and indicated that intestinal epithelial cell vacuolation was positively correlated with the intensity and density of PEDV antigens. A new natural recombination model for PEDV was identified. Our results suggest that new highly pathogenic recombinant strains in the field may be generated by recombination between low pathogenic attenuated live PEDV vaccines and pathogenic circulating PEDV strains. Our findings also highlight that the 49-bp deletion of the ORF3 gene in low pathogenic attenuated vaccine strains will no longer be a reliable standard to differentiate the classical vaccine attenuated from the field strains.
Prospective Randomized Controlled Trial of Video- Versus Recall-Assisted Reflection in Simulation-Based Teaching on Acquisition and Retention of Airway Skills Among Trainees Intubating Critically Ill Patients*
Authors: Prakash Shivesh , Bihari Shailesh , Laver Russell , Chandran Giresh , Kerr Lachlan , Schuwirth Lambert , Bersten Andrew
Published: July 2020

Objectives:

Conventionally, simulation-based teaching involves reflection on recalled events (recall-assisted reflection). Instead of recall, video-assisted reflection may reduce recall bias and improve skills retention by contributing to visual memory. Here, we test the hypothesis that when compared with recall, video-assisted reflection results in higher acquisition and retention of skills involved in airway management among junior critical care doctors.

Design:

Randomized control trial. Participants were randomized 1:1 to video-assisted reflection or recall-assisted reflection group.

Setting:

University-affiliated tertiary care center.

Subjects:

Junior critical care doctors.

Intervention:

Video-assisted reflection.

Measurements and Main Results:

All participants underwent simulation-based teaching of technical and nontechnical airway skills involved in managing a critically ill patient. These skills were assessed before, post-workshop, and in the following fourth week, by two independent blinded assessors using a validated scoring tool. Quality of debrief was assessed using a validated questionnaire. Repeated-measures analysis of variance was used to assess time and group interaction. Forty doctors were randomized. At baseline, the groups had similar airway experience (p= 0.34) and skill scores (p= 0.97). There was a significant interaction between study groups and changes over time for total skill scores (F[2, 37] = 4.06;p= 0.02). Although both the study groups had similar and significant improvement in total skills scores at the postworkshop assessment, the decline in total skills scores at delayed assessment (F[1, 38] = 5.64;p= 0.02) was significantly more in the recall-assisted reflection group when compared with the video-assisted reflection group. This resulted in lower mean skill scores in the recall-assisted reflection group when compared with the video-assisted reflection group in the delayed assessment (89.45 [19.32] vs 110.10 [19.54];p< 0.01). Better retention was predominantly in the nontechnical skills. The perceived quality of debrief was similar between the two groups.

Conclusion:

When compared with recall, video-assisted reflection resulted in similar improvement in airway skills, but better retention over time.
Intravascular Cutaneous Disorders. A Clinicopathologic Review
Authors: Vilas Boas Pedro , Cerroni Lorenzo , Requena Luis
Published: July 2020

Intravascular proliferations of the skin are clinically heterogeneous and may present with a wide range of clinical features, including violaceous papules, nodules, plaques, or other unspecific cutaneous lesions. Histopathologically, these conditions are characterized by proliferation of different cell types within the lumina of dermal vessels and endothelial cell hyperplasia. Immunohistochemistry is the best tool to identify the nature of the intravascular proliferating cells and the type of involved vessel. In this review, we analyzed the clinicopathologic and immunohistochemical characteristics of intravascular large cell lymphoma, T-cell and natural killer-cell intravascular large cell lymphoma, intralymphatic variant of CD30+cutaneous lymphoproliferative disorders, benign atypical intralymphatic CD30+T-cell proliferation, reactive angioendotheliomatosis, intralymphatic histiocytosis, papillary intralymphatic angioendothelioma or Dabska tumor, glomeruloid hemangioma, papillary hemangioma, intravascular papillary endothelial hyperplasia or Masson phenomenon, and the intralymphatic involvement of Merkel cell carcinoma, cutaneous metastases, and cutaneous angiosarcoma.
Psoriasis With Eczematous Features: A Retrospective Clinicopathologic Study
Authors: Noorily Ariella R. , Criscito Maressa C. , Cohen Jeffrey M. , Brinster Nooshin K.
Published: July 2020

Background:

Dermatopathologists sometimes encounter patients with features of psoriasis vulgaris and additional changes of eczematous dermatoses. These cases are challenging to diagnose, and the clinical implications are unclear. In the age of targeted therapy, it is important to improve our understanding of these findings so that patients are managed appropriately.

Objective:

To characterize the clinical characteristics, histopathological features, diagnostic workup, successful treatment, and outcomes of patients with overlapping histopathologic features of psoriasis vulgaris and eczema.

Methods:

We conducted a retrospective chart review of 20 patients who had received the histopathologic diagnosis of psoriasis vulgaris with eczematous changes noted on skin biopsy. A database that included information about clinical characteristics, comorbidities, histopathological features, diagnostic workup, treatment modalities, and outcomes was created and analyzed.

Results:

Twenty patients were included in this study, with an average age of 57.3 years. After clinicopathologic correlation, most patients were diagnosed with psoriasis (85%), and the remainder were determined to have an eczematous dermatitis. Thirty-five percent of patients were diagnosed with allergic contact dermatitis, either in combination with psoriasis (6 patients) or alone (1 patient). Topical glucocorticoids were the most common effective therapy used, and systemic therapies were required in nearly half of patients for successful treatment.

Conclusion:

This study offers insights into the clinically and histopathologically challenging diagnosis of psoriasis vulgaris with eczematous changes and offers the diagnostic term “eczematized psoriasis” to describe these patients. The presence of allergic contact dermatitis should be considered in these patients.
Expression of androgen receptors in the structures of vulvovaginal tissue
Authors: Palacios Santiago
Published: July 2020

Importance and Objective:

Little is known about the role of androgens in the female genital tract, specifically in the vulvovaginal area. The abundance of androgen receptors in this area could help us to explain their role. The main objective of the present article is to review current data on androgen receptors in the different structures of vulvovaginal tissues.

Methods:

A review of the literature using data from PubMed was carried out on androgen receptors in the vulva, labia majora and minora, vestibule, clitoris, and vagina. The effects of androgens and regulation of androgen receptors both in the embryo and in premenopausal and postmenopausal women were also reviewed. Given the characteristics of this review, we also analyzed animal studies and animal models of human disease. There were no filters or restrictions with respect to the date of publication.

Discussion:

Androgen receptors have been detected throughout the genitourinary tract by means of Western blot, immunohistochemistry, ligand binding, and gene expression. They are present in the labia majora and minora, the clitoris, the vestibule, and in the three layers of the vaginal mucosa (epithelium, lamina propria, and muscularis). More specifically, studies on the labia majora have shown that androgen receptors seem to be particularly abundant in epidermal keratinocytes and in dermal fibroblasts. Androgen receptors are also abundant in the epidermis, especially in the keratinocytes, and in the dermis of the labia minora and vestibule, where they are more numerous than in the vagina. Androgen receptors have also been found in the Bartholin glands.

Conclusions:

Estrogens play a major role in the maintenance of vaginal physiology. Although little is known about the role of androgens in the genital apparatus of women, specifically in the vulvovaginal area, the abundance of androgen receptors could enable us to explain their role. Androgens and estrogens play a major role in the maintenance of vaginal physiology. Better knowledge of the role of androgens and their receptors in vulvovaginal tissue would make it possible to discern their effects on female genitalia and help us to understand new therapeutic strategies.
PARACENTRAL ACUTE MIDDLE MACULOPATHY AS A PRESENTING SIGN OF CENTRAL RETINAL ARTERY OCCLUSION IN SICKLE CELL DISEASE TREATED WITH TISSUE PLASMINOGEN ACTIVATOR
Authors: Chua Michael R. , Giovinazzo Jerome V. , Kaplan Richard I. , Connor Thomas , Kellner Christopher , Barash Alexander , Rosen Richard B.
Published: July 2020

Purpose:

We report the case of a 27-year-old monocular woman with a history of sickle cell disease who received intra-arterial tissue plasminogen activator (tPA) after presenting with acute painless vision loss secondary to incomplete central retinal artery occlusion presenting as paracentral acute middle maculopathy in her left eye.

Methods:

Ultrawidefield fundus photography, ultrawidefield fluorescein angiography, en face optical coherence tomography (OCT), and optical coherence tomography angiography (OCTA) were obtained and reviewed, followed by cerebral angiography and infusion of intra-arterial tissue plasminogen activator.

Results:

A patient with a history of sickle cell disease presented with a new onset of a dense central scotoma, and the visual acuity diminished to 20 of 200 from baseline 20 of 20 in her left eye. Fluorescein angiogram was nondiagnostic. Optical coherence tomography revealed perifoveal hyper-reflective bands in the inner nuclear layer in a pattern characteristic of paracentral acute middle maculopathy. The patient received intra-arterial tissue plasminogen activator through her left ophthalmic artery shortly after presentation, resulting in a gradual restoration of the visual acuity to 20 of 20 in the three months after the procedure.

Conclusion:

This is the first report describing the use of intra-arterial tissue plasminogen activator to treat incomplete central retinal artery occlusion presenting as a paracentral acute middle maculopathy lesion in a patient with sickle cell disease.
SURGICAL REMOVAL AFTER IATROGENIC SUBRETINAL INJECTION OF AN INTRAVITREAL DEXAMETHASONE IMPLANT
Authors: da Cruz Natasha F. S. , Kawamuro Mariana , Hilgert Gabriel R. , Pipolo Gabriel S. R. , Maia Mauricio
Published: July 2020

Purpose:

To report a rare case of subretinal migration of an intravitreal dexamethasone implant to treat macular edema secondary to diabetic retinopathy in a vitrectomized eye and the surgical outcome.

Observations:

A pars plana vitrectomy and a retinotomy were performed to remove the implant and restore vision.

Conclusion and Importance:

Subretinal dislodgement of intravitreal implants is a rare and preventable complication. In the current case, we speculated that this complication might have been related to the injection technique, a possible unrecognized retinal perforation before the injection of the implant, or delayed treatment with the implant. Because a retinal detachment and vitreoretinal proliferation were observed, surgical management was required. Increasing widespread application of any technology may lead to a more significant risk of complications, and ophthalmologists should be aware of this potential risk.
Immune Checkpoint Inhibitor Therapy as an Eye-Preserving Treatment for Locally Advanced Conjunctival Melanoma
Authors: Hong Bennett Yau-Bun , Ford Joshua R. , Glitza Isabella C. , Torres Cabala Carlos A. , Tetzlaff Michael , Prieto Victor G. , Parker Richard , Daniel Claire , Esmaeli Bita
Published: July 2020

The authors present 2 patients with locally advanced conjunctival melanoma for whom definitive surgery would mean an orbital exenteration with its associated inherent total visual loss and major facial disfigurement. Instead both patients were treated with immune checkpoint inhibitor therapy. In 1 patient neoadjuvant pembrolizumab was used for approximately 12 months and the patient experienced near-total clinical resolution of the conjunctival melanoma. Multiple surgical biopsies of very small residual pigmentation showed pigmented macrophages and a complete pathologic response. In the second patient who presented with a locally advanced and metastatic conjunctival melanoma, significant shrinkage of conjunctival mass was observed after treatment with a combination of ipilimumab and nivolumab for 5 months, and this allowed preservation of the eye and ocular function.
Implementation of a Vascular Access Experience Program to Train Unit-Based Vascular Access Champions
Authors: Goodfriend Lori , Kennedy Sherrie , Hein Angela , Baker Rachel
Published: July 2020

Vascular access team (VAT) nurses receive many consults to place short peripheral catheters (SPCs), a portion of which do not require skilled insertion by a VAT member. VAT nurses at a health care organization in the Midwestern United States developed a program to train direct care nurses as unit-based vascular access champions to increase and improve SPC placement, care, and maintenance. Twenty-one nurses from 6 units were selected to train as vascular access champions; knowledge and confidence around SPC placement were assessed before, immediately after, and 6 months after the training. The training sessions resulted in increased knowledge of SPC insertion, as well as care and maintenance by vascular access champions and other direct care nurses on the units. The percentage of unwarranted VAT referrals for SPC placement decreased on the participating hospital units.
Assessing and Restoring Patency in Midline Catheters
Authors: Hawes Michelle L.
Published: July 2020

Maintaining and restoring patency in midline catheters has been a significant issue in the hospitalized patient requiring a multitude of infusates and frequent blood specimen collection. Currently, clinicians may not use this device as often as clinically indicated because they lack an approved intervention to treat thrombotic occlusions. The purpose of this research was to show evidence that alteplase, a US Food and Drug Administration–approved thrombolytic for central vascular access devices, is a safe and effective thrombolytic for midline catheters. A prospective open label study of 497 midline catheters was conducted from July 2018 to December 2018. Of those studied, 112 devices were treated with 1 mg of alteplase, and 109 had patency restored with 1 dose. None of the 112 patients had a major adverse event, and only 1 minor event was recorded and was resolved without removal of the midline catheter. Treating occluded central vascular access devices with 2 mg of alteplase has been safe and effective since 2001. With this research, safety and efficacy appears to be established for 1 mg of alteplase, repeat times 1 mg if necessary, in midline catheters. With the option to treat patients with occluded midline catheters rather than replace, clinicians can reduce cost, increase patient satisfaction, and preserve vein health.
Challenges of Implementing the Choosing Wisely Guideline to Promote Sleep and Rest at Night for Hospitalized Patients
Authors: Graham Kimberly , Ogbuji Grace , Williams Zainab , Crain Maria , Rolin Barbara , Juala Jeremy , Larbi Ida , Bernard Noreen , Oster Cynthia A. , Baird Marianne , Gullatte Mary Magee
Published: July 2020

Background:

Evidence suggests that a lack of sleep among patients during hospitalization can impact their health and well-being.

Local Problem:

On inpatient units, patients experience lack of sleep due to noise and multiple interruptions at night.

Methods:

A pilot intervention to support the initiative, “Don't wake the patient for routine care unless the patient's condition or care specifically requires it,” was implemented on 3 units in 3 hospitals. All the 3 units had experienced patient concerns about lack of sleep at night.

Interventions:

Nurses implemented the project using a purposeful strategy of sleep masks, earplugs, noise detectors, and bundling care.

Results:

Positive experiences of those patients who participated in the sleep intervention.

Conclusions:

There was multidisciplinary support to promote a better patient experience of nighttime sleep. The experiences across the 3 hospital units were positive for providers, patients, and patients' families.
Metastatic Basal Cell Carcinoma of the Skin: A Comprehensive Literature Review, Including Advances in Molecular Therapeutics
Authors: Bisceglia Michele , Panniello Gaetano , Galliani Carlos A. , Centola Michele , D’Errico Maria M. , Minenna Elena , Tucci Francesco A. , Ben-Dor David J.
Published: July 2020

Basal cell carcinoma (BCC) of the skin is the most common type of malignant human tumor. In Europe, the incidence of BCC ranges from 44.6 to 128 cases per 100,000 inhabitants annually, whereas in the United States, the yearly incidence rate ranges between 500 and 1500. The global incidence has been calculated to be as high as 10 million cases of BCC per year. There are 2 main clinical patterns of BCC—the familial BCC in basal cell nevus syndrome and sporadic BCC. The etiology of cutaneous BCC is usually the result of the interaction between solar ultraviolet radiation and genetic factors. Somatic or germline mutations in the effector components of the hedgehog signaling pathway (ie,PTCH1,PTCH2,SMOorSUFUgenes) are responsible for ∼90% of the cases of both sporadic and familial BCC, all causing a constitutive activation of the hedgehog pathway. Cutaneous BCC very rarely metastasizes, and diagnosis in metastatic sites can be very difficult. Metastatic BCC has weakly effective therapeutic options with a poor prognosis until few years ago. In 2012, small-molecule therapies, involving inactivation of the hedgehog signaling pathway, and capable of reducing tumor growth and progression have been introduced into clinical practice for advanced (locally advanced or metastatic) BCC. We performed a comprehensive literature review on metastatic BCC and found at least 915 cases reported to date. In addition, we extensively discussed the differential diagnosis of metastatic BCC, and outlined the advances in clinical therapeutics involving these small molecules.
Early comprehensive testing for COVID-19 is essential to protect trauma centers
Authors: Hu Parker , Jansen Jan O. , Uhlich Rindi , Black Jonathan , Pierce Virginia , Hwang James , Northern David , Stephens Shannon W. , Lee Rachael A. , Gelbard Rondi B. , Holcomb John B. , Kerby Jeffrey , Cox Daniel ,   UAB Acute Care Surgery COVID-19 Consortium
Published: July 2020

BACKGROUND

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic presents a threat to health care systems worldwide. Trauma centers may be uniquely impacted, given the need for rapid invasive interventions in severely injured and the growing incidence of community infection. We discuss the impact that SARS-CoV-2 has had in our trauma center and our steps to limit the potential exposures.

METHODS

We performed a retrospective evaluation of the trauma service, from March 16 to 30, following the appearance of SARS-CoV-2 in our state. We recorded the daily number of trauma patients diagnosed with SARS-CoV-2 infection, the presence of clinical symptoms or radiological signs of COVID-19, and the results of verbal symptom screen (for new admissions). The number of trauma activations, admissions, and census, as well as staff exposures and infections, was recorded daily.

RESULTS

Over the 14-day evaluation period, we tested 85 trauma patients for SARS-CoV-2 infection, and 21 (25%) were found to be positive. Sixty percent of the patients in the trauma/burn intensive care unit were infected with SARS-CoV-2. Positive verbal screen results, presence of ground glass opacities on admission chest CT, and presence of clinical symptoms were not significantly different in patients with or without SARS-CoV-2 infection (p > 0.05). Many infected patients were without clinical symptoms (9/21, 43%) or radiological signs on admission (18/21, 86%) of COVID-19.

CONCLUSION

Forty-five percent of trauma patients are asymptomatic at the time of SARS-CoV-2 diagnosis. Respiratory symptoms, as well as verbal screening (recent fevers, shortness of breath, cough, international travel, and close contact with known SARS-CoV-2 carriers), are inaccurate in the trauma population. These findings demonstrate the need for comprehensive rapid testing of all trauma patients upon presentation to the trauma bay.

LEVEL OF EVIDENCE

Diagnostic tests or criteria, level III, Therapeutic/care management, level IV.
Lessons Learned About Peristomal Skin Complications
Authors: Salvadalena Ginger , Colwell Janice C. , Skountrianos George , Pittman Joyce
Published: July 2020

PURPOSE:

The aims of this study were to (1) describe the demographic and clinical characteristics of the individuals with peristomal skin complications (PSCs); (2) describe the PSCs; (3) examine the relationship of PSC occurrence and severity with possible risk factors, and (4) describe how PSCs were managed clinically.

DESIGN:

Secondary analysis of data from randomized controlled study, the ADVOCATE trial.

SUBJECTS AND SETTING:

Study participants (n = 153) were divided into 2 groups: those who did not experience a PSC (n = 80) and those who did (n = 73). A participant was considered to have sustained a PSC during the original study if his or her Discoloration, Erosion, and Tissue score increased above the baseline score.

METHODS:

Demographic and pertinent characteristics of participants with and without PSCs were compared. In addition, data from the 73 participants who sustained PSCs were further analyzed to characterize and describe the PSCs, to investigate potential risk factors associated with the occurrence and severity of a PSC, and for clinical management. Group comparisons were made via t tests for continuous variables, χ2 test or Fisher exact test for categorical variables, and generalized linear models for identification of risk factors.

RESULTS:

The majority of the PSCs were mild or moderate in nature, and they were most commonly categorized by the investigators as irritant dermatitis. Two risk factors were associated with an increased likelihood of experiencing a PSC: stoma duration and peristomal skinfold or creases. Within the study period, the odds of sustaining a PSC increased over time and the presence of skinfolds or creases increased the likelihood of PSCs. Peristomal skin complication severity was likely to be worse with an ileostomy and less severe as stoma duration increased. Products used to manage PSCs consisted of barrier rings/seals, skin barrier powder, and paste or paste strips.

CONCLUSIONS:

Ileostomy is associated with higher risk of a severe PSC and peristomal skin creases or folds. Patient follow-up should be on a structured schedule beyond the first few weeks after surgery because the likelihood of getting a PSC increases over time. This approach may help improve outcomes, particularly for those with an ileostomy and challenging skin contours.
Electroconvulsive Therapy in Germany
Authors: Jolivet Alix , Grözinger Michael
Published: July 2020

Objectives

The use of electroconvulsive therapy (ECT) in Europe varies broadly between the extremes of Sweden on one side and Italy on the other. Here, we document the frequency, practice and standards of ECT in Germany in 2016, compare it with a survey of 2008, and describe the historical background.

Methods

A questionnaire was sent electronically to the 396 psychiatric institutions in Germany. Repeated follow-up calls yielded a complete list of hospitals performing ECT and a high rate of detailed responses.

Results

Forty-five percent (178/396) of the psychiatric hospitals performed ECT. Of those, 73.6% (131/178) completed the questionnaire. Based on 2 procedures, we estimated an incidence of 60,000 single treatments and 5700 patients treated, with a rate of 6.9 patients per 105 inhabitants. As in 2008, regional differences proved to be significant. The rate at which patients are referred to ECT hospitals from other clinics for the special purpose of ECT has increased since 2008. Maintenance treatments and the use of ketamine for anesthesia have gone up considerably while fewer hospitals offered outpatient treatments.

Conclusions

The application of ECT has increased markedly in the last 8 years, showing an exponential growth over the last 4 decades in Germany. The accessibility to the treatment seems to have improved and some global trends have been well received. Electroconvulsive therapy has become a modern, increasingly used medical intervention.