bluuebunny/crossref_metadata_2025 huggingface dataset:
Importance of muldisciplinary management of giant mediastinal sarcoma: A case report with phrenic nerve reconstruction
Authors: Frasca Luca , Longo Filippo , Tacchi Giovanni , Stilo Francesco , Zito Anna , Brunetti Beniamino , Depalma Massimiliano , Crucitti Pierfilippo
Published: April 2020

Primary synovial sarcoma is a soft tissue tumor which originates from synovial‐like undeveloped mesenchymal structures. Here, we report the case of a giant mediastinal sarcoma in a 41‐year‐old female patient. After diagnosis, she underwent neoadjuvant chemotherapy. Due to its low efficacy, we collegially decided to undergo cytoreductive debulking surgery. The mass invaded the phrenic nerve bilaterally and its excision caused a severe lesion of the left nerve and a partial impairment of the right one. Thus, plastic surgeons decided to reconstruct the right phrenic nerve employing the contralateral remaining fibers.

The invasiveness of this tumor, its difficult removal, histological profile and the peculiar technique to preserve diaphragmatic function classify this case as very rare. The therapeutic strategy was based on interdisciplinary teamwork which comprised several specialists' opinions. Our strategy allowed us to pursue the challenging objective to give a young woman with a severe diagnosis the best possible chance of achieving a good quality of life.

To the best of our knowledge, this phrenic nerve reconstructive technique is very rare and has not previously been reported in the literature. The report emphasizes that it is possible to deal with an apparently impossible case through a collaborative approach involving several different medical specialist professionals.
Efficacy of dupilumab in atopic comorbidities associated with moderate‐to‐severe adult atopic dermatitis
Authors: Nettis Eustachio , Patella Vincenzo , Lombardo Carla , Detoraki Aikaterini , Macchia Luigi , Di Leo Elisabetta , Carbonara Monica , Canonica Giorgio W. , Bonzano Laura
Published: April 2020

Background

Dupilumab is an anti‐IL‐4Rα antibody used in the treatment of patients with moderate‐to‐severe atopic dermatitis (msAD).

This study explored the potential benefit of dupilumab in perennial allergic rhinoconjunctivitis (PAR) and perennial allergic asthma (PAA) caused by indoor allergens in adults with msAD.

Methods

This multicentric, prospective, observational, real‐life study included adult patients with msAD who had been treated with dupilumab in 16 Italian care centres. Efficacy outcomes regarding AD, PAR and PAA were collected at baseline and 16 weeks. Safety was also assessed.

Results

We enrolled 123 patients with msAD. Between baseline and 16 weeks of treatment, the following measurements decreased statistically significantly: Eczema Area and Severity Index, SCOring AD, Patient‐Oriented Eczema Measure, pruritus score, sleep score, Dermatology Life Quality Index and IgE.

Dupilumab treatment in patients with comorbid PAR (n = 41) was associated with significant improvements in PAR disease control (measured using a Rhinitis Control Scoring System) and in PAR Quality of life (QoL) (measured using the Rhinoconjunctivitis QoL Questionnaire scores).

In 32 patients with comorbid PAA, dupilumab significantly improved PAA control (measured using the Asthma Control Test and five‐item Asthma Control Questionnaire scores) and disease‐related QoL (measured using the Asthma QoL Questionnaire scores). Thirty‐five patients (28.5%) developed conjunctivitis during the study period.

Conclusion

These results support the benefits of dupilumab for adult patients with PAR and/or PAA associated with msAD.
Protecting vulnerable patients with inherited anaemias from unnecessary death during the COVID‐19 pandemic
Authors: Roy Noémi B. A. , Telfer Paul , Eleftheriou Perla , de la Fuente Josu , Drasar Emma , Shah Farrukh , Roberts David , Atoyebi Wale , Trompeter Sara , Layton D. Mark , Lugthart Sanne , Stuart‐Smith Sara , Chakravorty Subarna , Wright Josh , Porter John , Inusa Baba , Howard Jo ,   National Haemoglobinopathy Panel
Published: April 2020

With the developing COVID‐19 pandemic, patients with inherited anaemias require specific advice regarding isolation and changes to usual treatment schedules. The National Haemoglobinopathy Panel (NHP) has issued guidance on the care of patients with sickle cell disease, thalassaemia, Diamond Blackfan anaemia (DBA), congenital dyserythropoietic anaemia (CDA), sideroblastic anaemia, pyruvate kinase deficiency and other red cell enzyme and membrane disorders. Cascading of accurate information for clinicians and patients is paramount to preventing adverse outcomes, such as patients who are at increased risk of fulminant bacterial infection due to their condition or its treatment erroneously self‐isolating if their fever is mistakenly attributed to a viral cause, delaying potentially life‐saving antibiotic therapy. Outpatient visits should be minimised for most patients, however some, such as first transcranial dopplers for children with sickle cell anaemia should not be delayed as known risk of stroke will outweigh the unknown risk from COVID‐19 infection. Blood transfusion programmes should be continued, but specific changes to usual clinical pathways can be instituted to reduce risk of patient exposure to COVID‐19, as well as contingency planning for possible reductions in blood available for transfusions. Bone marrow transplants for these disorders should be postponed until further notice. With the current lack of evidence on the risk and complications of COVID‐19 infection in these patients, national data collection is ongoing to record outcomes and eventually to identify predictors of disease severity, particularly important if further waves of infection travel through the population.
Maintaining the Tension Between the Classic Seduction Theory and the Role of Unconscious Fantasies: A Contemporary Reconsideration
Authors: Harel Galit
Published: April 2020

This article describes the long‐term psychoanalytic psychotherapy of a young woman who had experienced trauma during her childhood. The details of the trauma were unknown, as all memory of the trauma had been repressed. Past trauma is analysable through a prism of transference, dreaming and dreams, mental states and thinking processes that offer an opportunity to explore and analyse the influence of both reality and fantasy on the patient. The presented case describes a therapeutic process that strives to discover hidden meanings through the unconscious system and illustrates the movement from unconscious to conscious during exploration of the patient's personal trauma in treatment. The author discusses the importance of classical and contemporary psychoanalytic models of childhood sexual trauma through the discovery of manifest and latent content, unconscious fantasies and actual events of trauma. It is suggested that the complexity of trauma is clarified by the tension between these models and by the inclusion of aspects of both of them for a complete understanding.
Social Media and its Impact on Therapeutic Relationships
Authors: Kaluzeviciute Greta
Published: April 2020

In the current age of social media, the boundaries between the online and the offline, the personal and the professional, have become blurred and ambiguous. This poses significant challenges to the practice of psychoanalysis, which for a long time has been thought of as a technology‐free and private space. This paper compares how social media impacts therapeutic relationships in the broader field of psychotherapy and in psychoanalytic psychotherapy in particular. Direct breaches in therapist privacy were found to be more frequent with non‐psychoanalytic psychotherapists due to therapists’ higher online presence. Psychoanalytic psychotherapists, on the other hand, generally have a lesser online presence because of different views on therapeutic anonymity from other clinical orientations. The author suggests that this leads to different forms of virtual impingements: due to the absence of psychoanalytic therapists’ online presence, patients seek to re‐create therapists (and, by extension, therapeutic situations) on a virtual level rather than discover something that was already ‘put out there’ by therapists. Virtual manifestations of anonymity, splitting, and solipsistic introjection processes are discussed with reference to John Suler's concept of the online disinhibition effect. Further recommendations for research on social media impact are discussed.
A modified sequential vascular control strategy in robot‐assisted level III–IV inferior vena cava thrombectomy: initial series mimicking the open ‘milking’ technique principle
Authors: Shen Donglai , Du Songliang , Huang Qingbo , Gao Yu , Fan Yang , Gu Liangyou , Liu Kan , Peng Cheng , Xuan Yundong , Li Pin , Li Hongzhao , Ma Xin , Zhang Xu , Wang Baojun
Published: April 2020

Objective

To introduce a modified sequential vascular control strategy, mimicking the open ‘milking’ technique principle, for the early release of the first porta hepatis (FPH) and to stop cardiopulmonary bypass (CPB) in level III–IV robot‐assisted inferior vena cava (IVC) thrombectomy (RA‐IVCTE).

Patients and methods

From November 2014 to June 2019, 27 patients with a level III–IV IVC tumour thrombus (IVCTT) underwent RA‐IVCTE in our department. The modified sequential control strategy was used in 12 cases. Previously, we released the FPH after the thrombus was resected and the IVC was closed completely, and CPB was stopped at the end of surgery (15 patients). Presently, using our modified strategy, we place another tourniquet inferior to the second porta hepatis (SPH) once the proximal thrombus is removed from the IVC below the SPH. Then, we suture the right atrium and perform early release of the FPH, and stop CPB. Finally, tumour thrombectomy, vascular reconstruction, and radical nephrectomy are performed.

Results

Compared with the previous strategy, the modified steps resulted in a shorter median FPH clamping (19 vs 47 min, P < 0.001) and CPB times (60 vs 87 min, P < 0.05); a lower rate of Grade II–IV perioperative complications (25% vs 60%, P < 0.05); and better postoperative hepatorenal and coagulation function, including better median serum alanine aminotransferase (172.7 vs 465.4 U/L, P < 0.001), aspartate aminotransferase (282.4 vs 759.8 U/L, P < 0.001), creatinine (113.4 vs 295 μmol/L, P < 0.01), blood urea nitrogen (7.3 vs 16.7 mmol/L, P < 0.01), and D‐dimer (5.9 vs 20 mg/L, P < 0.001) levels.

Conclusion

With the early release of the FPH and stopping CPB, the modified sequential vascular control strategy in level III–IV RA‐IVCTE reduced the perioperative risk for selected patients and improved the feasibility and safety of the surgery. We would recommend this approach to other centres that plan to develop robotic surgery for renal cell carcinoma with level III–IV IVCTT in the future.
Postglacial history of East European boreal forests in the mid‐Kama region, pre‐Urals, Russia
Authors: Shumilovskikh Lyudmila S. , Schmidt Monika , Pereskokov Mikhail , Sannikov Pavel
Published: April 2020

The Ural Mountains are an important climatic and biogeographical barrier between European and Siberian forests. In order to shed light on the postglacial formation and evolution of the boreal forests in the European pre‐Urals, we obtained a peat sediment core, Chernaya, from the Paltinskoe bog located between the southern taiga and hemiboreal forest zone in the mid‐Kama region. We carried out pollen analysis, non‐pollen palynomorph analysis, loss‐on‐ignition tests and radiocarbon dating. Radiocarbon dated records provide centennial to decennial resolution of the vegetation and environmental history of the European pre‐Urals for the last 8.8 ka. The postglacial formation of the pre‐Uralian hemiboreal forests reveals four important phases: (i) the dominance of Siberian taiga and forest‐steppe in the Early Holocene and beginning of the Middle Holocene (8.8–6.9 ka), indicating a dry climate; (ii) the spread of spruce and European broadleaved trees in the Middle Holocene (6.9–4 ka) under wetter climate conditions; (iii) the maximum extent of broadleaved trees coinciding with the arrival and spread of Siberian fir in the Late Holocene (4–2.3 ka); and (iv) the decline of broadleaved trees since the Early Iron Age (2.3 ka – present) possibly due to general climate cooling and logging. While temperate broadleaved trees possibly spread from local refugia in the Urals, fir arrived from Siberia and spread further west. The carbon accumulation rate of Paltinskoe bog (18.9±10.16 g C m−2 a−1) is close to the average value of carbon accumulation of northern peatlands. Local development of peat is characterized by non‐gradual growth with a phase of intensive carbon accumulation between 3.5 and 2.3 ka. The vegetation was strongly influenced by fire in the Early Holocene and by humans since the Early Iron Age practicing deforestation, agriculture and pasture. Phases of increased anthropogenic activity correlate well with the local archaeological data.
Paradox of Supply Chain Integration and Firm Performance: The Moderating Roles of Distributive and Procedural Justice*
Authors: Wei Shaobo , Yin Jinmei , Chen Xiayu
Published: April 2020

The existing literature has increasingly recognized the important role of supply chain integration (SCI) in shaping a firm's superior performance. However, our understanding on how to improve the creation and appropriation of the value from the SCI remains limited. On the basis of uncertainty management theory and social exchange theory, we theorize how distributive and procedural justice play distinctive roles in the SCI value creation and appropriation. Data collected from 113 manufacturing firms in China reveal that distributive justice negatively moderates the relationship between internal and external integration, but positively moderates the relationship between external integration and firm performance. By contrast, procedural justice positively moderates the relationship between internal and external integration, yet insignificantly moderates the relationship between external integration and firm performance. Theoretical contributions and managerial implications are also discussed.
Undertreatment of cardiovascular risk factors in the type 1 diabetes exchange clinic network (United States) and the prospective diabetes follow‐up (Germany/Austria) registries
Authors: Shah Viral N. , Grimsmann Julia M. , Foster Nicole C. , Dost Axel , Miller Kellee M. , Pavel Marianne , Weinstock Ruth S. , Karges Wolfram , Maahs David M. , Holl Reinhard W.
Published: April 2020

Aim

To examine the control of cardiovascular risk factors in type 1 diabetes (T1D) registries from the United States and Germany/Austria.

Materials and Methods

Data on individuals aged ≥12 years with T1D for ≥1 year, from the T1D Exchange Clinic Network (T1DX, United States) and the Prospective Diabetes Follow‐up Registry (DPV, Germany/Austria) from 1 January 2016 to 31 March 2018 were analysed. Linear and logistic regression models adjusted for age groups, sex, duration of diabetes and minority status were used to compare clinical characteristics and achievement of diabetes management targets between registries.

Results

The cohort consisted of 47 936 patients (T1DX, n = 19 442; DPV, n = 28 494). Achievement of HbA1c goals (<7.0%, ages 18‐65 years; all others, <7.5%) was better in the DPV for those aged <65 years (all P < .001). However, more older adults (aged ≥65 years) in the T1DX achieved an HbA1c goal of <7.5% compared with DPV (70% vs. 50%, P < .001). The frequency of patients with overweight (53% vs. 51%, P < .001) and obesity (19% vs. 9%, P < .001) was higher in T1DX. The frequency of meeting blood pressure goals (84% vs. 66%, P < .001) and lipid goals (73% vs. 62%, P < .001) was higher in T1DX; this was observed across all age groups (all P < .001). Few young adults aged <26 years received antihypertensive and lipid‐lowering medications, respectively, despite indications in both registries (T1DX: 5% and 3%, DPV: 3% and 1%).

Conclusion

A minority of patients with T1D achieve glycaemic targets and the majority are inadequately treated for hypertension and dyslipidaemia. This highlights the need for improved diabetes and cardiovascular risk management strategies in T1D.
Days absent from work as a result of complications associated with type 2 diabetes: Evidence from 20 years of linked national registry data in Sweden
Authors: Persson Sofie , Johansen Pierre , Andersson Emelie , Lindgren Peter , Thielke Desirée , Thorsted Brian L. , Jendle Johan , Steen Carlsson Katarina
Published: April 2020

Aims

To analyse days absent from work related to individual microvascular, macrovascular and other complications of type 2 diabetes (T2D) and to identify key drivers of absence.

Materials and methods

National health and socio‐economic individual‐level data were analysed for the years 1997 to 2016 for people with T2D, and age‐, sex‐ and residential region‐matched controls (5:1) using linkage to Swedish national administrative registers, based on personal identity numbers. Regression analyses accounting for individual‐level clustering and education were estimated to obtain days absent by individual complications. Alternative analyses, for example, workforce indicator and age subgroups, were explored for robustness and comparison purposes.

Results

A total of 413 000 people with T2D aged <66 years, comprising 4.9 million person‐years, was included. The crude proportion with any absence was higher among those with T2D compared to controls (47% vs. 26%) in the index year, and the median (IQR) number of days was higher (223 [77;359] vs. 196 [59;352]) if any absence. Regression analyses showed that complications per se were a key driver of days absent: stroke (+102 days); end‐stage renal disease (+70 days); severe vision loss (+56 days); and angina pectoris, heart failure, and osteoarthritis (+53 days each). The alternative analyses showed similar levels of days absent and age subgroups differed in expected directions.

Conclusions

This study provides evidence of the persisting impact on productivity from complications that supports continued efforts to reduce risk factors in T2D. Future studies on burden of disease and economic evaluations of new therapies and disease management may use this new set of complication‐specific estimates to improve understanding of the value of reducing complications.
From the Historical Reformation to the “Digital Reformation”
Authors: Puntel Joana T. , Sbardelotto Moisés
Published: April 2020

This article analyzes the challenges presented for contemporary theological thinking by the current shifts in communication, starting from the concept of a “digital reformation” as a counterpart to the theological revolution that occurred with the historical Reformation. It goes on to consider how processes of communication on the Internet require us to rethink certain theological categories – from the new and renewed ways of constituting and manifesting theological knowledge within the digital environment through the emergence of new loci, subjects, and theological syntheses. We conclude that the challenges of contemporary digital culture and the need for a connected theology mean that theology, as a field of knowledge, requires a new theological synthesis.
“Andif you gaze long into an abyss, the abyss gazes also into thee”: four morphs of Arctic charr adapting to a depth gradient in Lake Tinnsjøen
Authors: Østbye Kjartan , Hagen Hassve Marius , Peris Tamayo Ana‐Maria , Hagenlund Mari , Vogler Thomas , Præbel Kim
Published: April 2020

The origin of species is a central topic in biology. Ecological speciation might be a driver in adaptive radiation, providing a framework for understanding mechanisms, level, and rate of diversification. The Arctic charr Salvelinus alpinus L. is a polymorphic species with huge morphological and life‐history diversity in Holarctic water systems. We studied adaptive radiation of Arctic charr in the 460‐m‐deep Lake Tinnsjøen to (a) document eco‐morphology and life‐history traits of morphs, (b) estimate reproductive isolation of morphs, and (c) illuminate Holarctic phylogeography and lineages colonizing Lake Tinnsjøen. We compared Lake Tinnsjøen with four Norwegian outgroup populations. Four field‐assigned morphs were identified in Lake Tinnsjøen: the planktivore morph in all habitats except deep profundal, the dwarf morph in shallow‐moderate profundal, the piscivore morph mainly in shallow‐moderate profundal, and a new undescribed abyssal morph in the deep profundal. Morphs displayed extensive life‐history variation in age and size. A moderate‐to‐high concordance was observed among morphs and four genetic clusters from microsatellites. mtDNA suggested two minor endemic clades in Lake Tinnsjøen originating from one widespread colonizing clade in the Holarctic. All morphs were genetically differentiated at microsatellites (FST: 0.12–0.20), associated with different mtDNA clade frequencies. Analyses of outgroup lakes implied colonization from a river below Lake Tinnsjøen. Our findings suggest postglacial adaptive radiation of one colonizing mtDNA lineage with niche specialization along a depth–temperature–productivity–pressure gradient. Concordance between reproductive isolation and habitats of morphs implies ecological speciation as a mechanism. Particularly novel is the extensive morph diversification with depth into the often unexplored deepwater profundal habitat, suggesting we may have systematically underestimated biodiversity in lakes. In a biological conservation framework, it is imperative to protect endemic below‐species‐level biodiversity, particularly so since within‐species variation comprises an extremely important component of the generally low total biodiversity observed in the northern freshwater systems.
Modulations of the reduction potentials of flavin‐based electron bifurcation complexes and semiquinone stabilities are key to control directional electron flow
Authors: Sucharitakul Jeerus , Buttranon Supacha , Wongnate Thanyaporn , Chowdhury Nilanjan Pal , Prongjit Methinee , Buckel Wolfgang , Chaiyen Pimchai
Published: April 2020

The flavin‐based electron bifurcation (FBEB) system from Acidaminococcus fermentans is composed of the electron transfer flavoprotein (EtfAB) and butyryl‐CoA dehydrogenase (Bcd). α‐FAD binds to domain II of the A‐subunit of EtfAB, β‐FAD to the B‐subunit of EtfAB and δ‐FAD to Bcd. NADH reduces β‐FAD to β‐FADH−, which bifurcates one electron to the high potential α‐FAD•− semiquinone followed by the other to the low potential ferredoxin (Fd). As deduced from crystal structures, upon interaction of EtfAB with Bcd, the formed α‐FADH− approaches δ‐FAD by rotation of domain II, yielding δ‐FAD•−. Repetition of this process leads to a second reduced ferredoxin (Fd−) and δ‐FADH−, which reduces crotonyl‐CoA to butyryl‐CoA. In this study, we measured the redox properties of the components EtfAB, EtfaB (Etf without α‐FAD), Bcd, and Fd, as well as of the complexes EtfaB:Bcd, EtfAB:Bcd, EtfaB:Fd, and EftAB:Fd. In agreement with the structural studies, we have shown for the first time that the interaction of EtfAB with Bcd drastically decreases the midpoint reduction potential of α‐FAD to be within the same range of that of β‐FAD and to destabilize the semiquinone of α‐FAD. This finding clearly explains that these interactions facilitate the passing of electrons from β‐FADH− via α‐FAD•− to the final electron acceptor δ‐FAD•− on Bcd. The interactions modulate the semiquinone stability of δ‐FAD in an opposite way by having a greater semiquinone stability than in free Bcd.
Dual sensory impairment and healthcare use: Findings from a nationally representative sample
Authors: Hajek André , König Hans‐Helmut
Published: April 2020

Aim

Dual sensory impairment (DSI) is a common phenomenon in later life. However, only a few studies investigated whether DSI is associated with healthcare use. Therefore, our purpose was to determine whether DSI is associated with healthcare use among older adults.

Methods

Data were taken from the most recent sixth wave of the German Ageing Survey. When self‐reported hearing problems and visual impairment were both present, individuals were classified as dual sensory impaired. The frequency of general practitioner (GP) visits, frequency of specialist visits and hospitalization were used as outcome measures. Covariates (mainly based on self‐reports) were selected based on Andersen's behavioral model. In total, 5081 observations were in our analytical sample.

Results

Among individuals with DSI, mean ± SD number of GP visits was 4.4 ± 4.7, mean ± SD number of specialist visits was 3.7 ± 5.0, and 23.2% were hospitalized in the past 12 months. Among individuals without sensory impairment, mean ± SD number of GP visits was 3.0 ± 3.6, mean ± SD number of specialist visits was 2.4 ± 3.4, and 17% were hospitalized in the past 12 months. Negative binomial regressions revealed that the presence of DSI was associated with increased specialist visits (incidence rate ratio = 1.17 [95% confidence interval: 1.06–1.28]), whereas it was not associated with GP visits and hospitalization.

Conclusions

Even after adjusting for several covariates, individuals with DSI had higher specialist visits than individuals without DSI. As the presence of DSI is associated with an increased economic burden, efforts to prevent or delay DSI may be beneficial. Geriatr Gerontol Int 2020; 20: 602–606.
COVID‐19: A threat to educated Muslim women's negotiated identity in Pakistan
Authors: Safdar Muhammad , Yasmin Musarat
Published: April 2020

This study attempts to explore how the lockdown/containment measures taken by the government during the COVID‐19 pandemic have threatened educated Muslim women's negotiated identity regarding wifehood and motherhood in urban Pakistan and how they struggle to reposition to reconstruct it. Through semi‐structured interviews, making an in‐depth comparative study of three differently situated cases (Muslim women), this study argues that the abnormal situation that has ensued from the pandemic has reinforced the vulnerability of women's nascent negotiated identity by landing them in a space where they are supposed by the normative structures to step back to carrying out their traditional responsibilities as ‘good’ wife and mother during the crisis. It has found that the pandemic has similarity in its impacts for the women in their familial lives, despite their being variously situated and resistive, due to the general religio‐culturally defined patriarchal social behaviour of the place (Pakistan) toward women and lack of action on the part of the state for implementing its laws of women's empowerment.
Definitions used for a healthy periodontium—A systematic review
Authors: Li An , Thomas Renske Z. , van der Sluis Luc , Tjakkes Geerten‐Has , Slot Dagmar Else
Published: April 2020

Objective

To investigate the explicitness and variability of the definition of periodontal health in the current scientific literature.

Material and methods

The authors conducted a systematic literature review using PubMed and CENTRAL (2013‐01/2019‐05) according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines and the guidelines of the Meta‐analysis Of Observational Studies in Epidemiology (MOOSE) statement.

Results

A total of 51 papers met the predefined inclusion criteria. Of these, 13 papers did not report any explicit definitions of periodontal health. Out of the 38 remaining articles, half of them used a reference to support their definition and half of them not. The studies published in periodontics‐related journals or those that scored a low risk of bias for the methodical quality presented more explicit and valid definitions. Probing pocket depth was the most frequently used individual parameter for defining periodontal health. However, there were substantial variations in the methods of measurement and cut‐off values.

Conclusions

Given the diversity of periodontal health definitions, a cross‐study comparison is difficult. The results of this review may be useful in making others aware of the significance of standardizing the definition of a healthy periodontium.
Application of a portable instrument for rapid and reliable detection of SARS‐CoV‐2 infection in any environment
Authors: Martinelli Federico , Perrone Anna , Della Noce Isabella , Colombo Lorenzo , Lo Priore Stefano , Romano Simone
Published: April 2020

The ongoing outbreak of the novel coronavirus (SARS‐CoV‐2) infection is creating serious challenges for health laboratories that seek to identify viral infections as early as possible, optimally at the earliest appearance of symptom. Indeed, there is urgent need to develop and deploy robust diagnostic methodologies not only to use in health laboratory environments but also directly in places where humans circulate and spread the virus such as airports, trains, boats, and any public aggregation places. The success of a reliable and sensitive asymptomatic diagnosis relies on the identification and measurement of informative biomarkers from human host and virus in a rapid, sensitive, and inexpensive manner. The objective of this article is to describe an innovative multidisciplinary approach to develop an efficient, inexpensive, and easy‐to‐use portable instrument (bCUBE® by Hyris Ltd) that can be employed as a surveillance system for the emergency caused by SARS‐CoV‐2. A solution for Coronavirus testing, compliant with CDC guidelines, is scheduled to be released in the next weeks. In addition, we will describe a workflow and path of an integrated multi‐omic approach that will lead to host and pathogen biomarker discovery in order to train the instrument to provide reliable results based on a specific biomarker's fingerprint of SARS‐CoV‐2 infection.
Noninvasive programmed stimulation in the setting of ventricular tachycardia catheter ablation
Authors: Frontera Antonio , Prolic Kalinsek Tine , Hadjis Alexios , Della Bella Paolo
Published: April 2020

In the setting of catheter ablation of ventricular tachycardia (VT), invasive programmed ventricular stimulation (PVS) is considered an important tool to assess the (residual) inducibility of ventricular arrhythmias and determine the acute success of the procedure. In patients with cardiovascular implantable electronic devices, noninvasive programmed stimulation via implantable cardioverter‐defibrillator (ICD) leads can be an alternative to the invasive PVS with intracardiac catheters. The advantages of noninvasive programmed stimulation include preprocedure planning of the electrophysiology procedure to ensure optimal conditions for successful catheter ablation of VT. Following the procedure, noninvasive programmed stimulation has been shown to be used as a guide for repeat early ablation, to offer better programming of ICD, to offer prognostic value regarding the VT recurrence, and to guide antiarrhythmic drug therapy. The noninvasive nature of noninvasive programmed stimulation makes it an attractive alternative to PVS in patients with ICD who have not undergone catheter ablation of VT to obtain prognostic value regarding the occurrence of VT.
Characteristics of People with Dementia vs Other Conditions on Admission to Inpatient Palliative Care
Authors: Ding Jinfeng , Johnson Claire E. , Lee Yun Chong (Olivia) , Gazey Angela , Cook Angus
Published: April 2020

OBJECTIVES

Our aim was to (1) describe the clinical characteristics and symptoms of people diagnosed with dementia at the time of admission to inpatient palliative care; and (2) compare the nature and severity of these palliative care–related problems to patients with other chronic diseases.

DESIGN

Descriptive study using assessment data on point of care outcomes (January 1, 2013, to December 31, 2018).

SETTING

A total of 129 inpatient palliative care services participating in the Australian Palliative Care Outcomes Collaboration.

PARTICIPANTS

A total of 29,971 patients with a primary diagnosis of dementia (n = 1,872), lung cancer (n = 19,499), cardiovascular disease (CVD, n = 5,079), stroke (n = 2,659), or motor neuron disease (MND, n = 862).

MEASUREMENTS

This study reported the data collected at the time of admission to inpatient palliative care services including patients' self‐rated levels of distress from seven common physical symptoms, clinician‐rated symptom severity, functional dependency, and performance status. Other data analyzed included number of admissions, length of inpatient stay, and palliative care phases.

RESULTS

At the time of admission to inpatient palliative care services, relative to patients with lung cancer, CVD, and MND, people with dementia presented with lower levels of distress from most symptoms (odds ratios [ORs] range from .15 to .80; P < .05 for all) but higher levels of functional impairment (ORs range from 3.02 to 8.62; P < .001 for all), and they needed more assistance with basic activities of daily living (ORs range from 3.83 to 12.24; P < .001 for all). The trends were mostly the opposite direction when compared with stroke patients. Patients with dementia tended to receive inpatient palliative care later than those with lung cancer and MND.

CONCLUSION

The unique pattern of palliative care problems experienced by people with dementia, as well as the skills of the relevant health services, need to be considered when deciding on the best location of care for each individual. Access to appropriately trained palliative care clinicians is important for people with high levels of physical or psychological concerns, irrespective of the care setting or diagnosis. J Am Geriatr Soc 68:1825‐1833, 2020.
Associations of Coffee and Tea Consumption With Survival to Age 90 Years Among Older Women
Authors: Shadyab Aladdin H. , Manson JoAnn E. , Luo Juhua , Haring Bernhard , Saquib Nazmus , Snetselaar Linda G. , Chen Jiu‐Chiuan , Groessl Erik J. , Wassertheil‐Smoller Sylvia , Sun Yangbo , Hale Lauren , LeBoff Meryl S. , LaCroix Andrea Z.
Published: April 2020

BACKGROUND

Coffee and tea are two of the most widely consumed beverages worldwide and have been associated with reduced risk of mortality in some studies. However, it is unknown whether consumption of these beverages is associated with survival to an advanced age.

OBJECTIVE

To examine associations of coffee and tea consumption with survival to age 90 years.

DESIGN

Prospective cohort study among participants from the Womenʼs Health Initiative, recruited during 1993 to 1998 and followed up until March 31, 2018.

SETTING

The setting included 40 US clinical centers.

PARTICIPANTS

A racially and ethnically diverse cohort of 27,480 older women, aged 65 to 81 years at baseline.

MEASUREMENTS

Women were classified as having either survived to age 90 years or died before this age. Consumption of caffeinated and decaffeinated coffee and caffeinated tea was assessed at baseline and categorized as 0, 1, 2 to 3, or 4 or more cups/day. Associations of coffee and tea consumption with survival to age 90 years were examined using logistic regression models adjusted for sociodemographic characteristics, lifestyle behaviors, dietary quality, and chronic disease history.

RESULTS

A total of 14,659 (53.3%) women survived to age 90 years during follow‐up. Caffeinated coffee, decaffeinated coffee, or caffeinated tea consumption was not significantly associated with survival to age 90 years after adjusting for confounders. Findings did not significantly vary by smoking, body mass index, or race/ethnicity.

CONCLUSION

No amount of coffee or tea consumption was associated with late‐age survival among older women. These findings may be reassuring to older women who consume coffee and tea as part of their daily diets but do not support drinking these beverages to achieve longevity.
Sleep disorders and vascular responsiveness in patients with rheumatoid arthritis
Authors: Adawi M. , Sabbah F. , Tzischinsky O. , Blum N. , Bragazzi N. L. , Yehuda I. , Tamir S. , Romanenko O. , Blum A.
Published: April 2020

Background

Rheumatoid arthritis (RA) is the most common systemic autoimmune disease characterized by chronic systemic inflammation. Half of the deaths of patients with RA are due to cardiovascular diseases (CVD), considered to be 1.5 to −2.0‐fold that in the general population. Patients with RA also experience poor sleep, which by itself is associated with endothelial dysfunction, CVD events and sudden death. Our aim was to study the mechanistic pathways and the correlations between sleep efficiency and vascular reactivity of patients with RA.

Methods and results

A prospective study that evaluated quality of sleep using ACTi Graphs, vascular inflammation and endothelial function of 18 patients with RA. Inflammation was studied by levels of E‐selectin, intercellular adhesion molecule 1 (ICAM‐1) and NO in serum. Endothelial function was studied using the brachial artery plethysmography method. Eighteen RA patients (aged 57.56 ± 13.55 years; 16 women) with a long‐standing active RA: Eight patients had impaired sleep efficiency and 10 had a good sleep efficiency. Those who had an impaired sleep had larger baseline diameters of the brachial artery (0.39 ± 0.08 cm vs. 0.32 ± 0.04 cm; P = 0.02). Negative correlations were found between baseline brachial artery diameter and sleep efficiency (P = 0.01), and with NO level (P = 0.04). Stepwise regression found that brachial artery diameter at baseline and NO level could predict sleep efficiency (r2 = 0.543, P = 0.01).

Conclusion

Vascular reactivity could predict quality of sleep in patients with RA. Quality of sleep may serve as an independent CVD risk factor in patients with RA.
Producing the Eikaiwa English language lesson: A dialectical approach to the contradictions of commodity production
Authors: Simpson William
Published: April 2020

In building upon sociolinguistic work which highlights the continuities and contradictions of capitalism, this article proposes an understanding of Taylorised and flexible forms of production as a dialectical and contradictory unity, which can push and pull those within production in contradictory directions. As a means to illustrate what a dialectical approach to contradiction might offer sociolinguistics, the article discusses empirical work from corporate eikaiwa English language teaching, a form of commercial language teaching within Japan, where both Taylorised and flexible forms of producing the English language lesson exist in considerable tension. The article proposes a dialectical approach as a means of shedding light not only on how such contradictory regimes of production interrelate and play out in language work such as language teaching but also on how forms of subjectivity are produced among language workers, such as teachers, who are tasked with managing contradictory demands made of them in the workplace.
Neuronal ceroid lipofuscinosis type 2: an Australian case series
Authors: Johnson Alexandra M , Mandelstam Simone , Andrews Ian , Boysen Katja , Yaplito‐Lee Joy , Fietz Michael , Nagarajan Lakshmi , Rodriguez‐Casero Victoria , Ryan Monique M , Smith Nicholas , Scheffer Ingrid E , Ellaway Carolyn
Published: April 2020

Aim

Late infantile neuronal ceroid lipofuscinosis type 2 (CLN2) disease is a rare neurodegenerative disorder presenting in children aged 2–4 years with seizures and loss of motor and language skills, followed by blindness and death in late childhood. Initial presenting features are similar to a range of common epilepsies. We aim to highlight typical clinical and radiological features that may prompt diagnosis of CLN2 disease in early disease stages.

Methods

We present a series of 13 Australian patients with CLN2 disease, describing clinical features, disease evolution, neuroimaging, electroencephalogram, biochemical and genetic results. Expert neuroradiological magnetic resonance imaging (MRI) analysis was retrospectively performed on 10 cases.

Results

Twelve patients presented with seizures, with initial seizures being focal (n = 4), generalised tonic–clonic (n = 3), absence (n = 3) and febrile (n = 2). Eleven patients (85%) had a language delay before the onset of seizures. Cerebellar or cerebral atrophy was noted in all patients on centralised MRI review, with abnormalities of the brain‐stem, ventricles, corpus callosum and hippocampi.

Conclusions

Early language delay with the onset of seizures at 2–4 years of age is the hallmark of CLN2 disease. MRI findings of early subtle atrophy in the cerebellum or posterior cortical regions should hasten testing for CLN2 disease to enable early initiation of enzyme replacement therapy.
Immune‐related hepatitis related to checkpoint inhibitors: Clinical and prognostic factors
Authors: Riveiro‐Barciela Mar , Barreira‐Díaz Ana , Vidal‐González Judit , Muñoz‐Couselo Eva , Martínez‐Valle Fernando , Viladomiu Lluís , Mínguez Beatriz , Ortiz‐Velez Carolina , Castells Lluís , Esteban Rafael , Buti María
Published: April 2020

Background & Aims

Check point inhibitors (CPI) have improved survival of oncology patients but adverse effects that mimic autoimmune disorders have been reported. Our aim was describe the characteristics of immune‐related hepatitis (irH) and prognosis, and compared them to those of patients with autoimmune hepatitis (AIH).

Methods

This is a retrospective study including all grade ≥ 3 (severe) irH diagnosed among 414 patients treated with CPI from 2016 to 2018.

Results

Twenty‐eight cases of severe irH were recorded: 10 on anti‐CTLA‐4 ± anti‐PD1/PD‐L1 and 18 on anti‐PD1/PD‐L1. Half were female, age 63 years, median time on CPI three cycles. Four (14.3%) presented acute liver injury or failure and one (3.6%) died as consequence. 94% presented normal immunoglobulin G (IgG). Six (21.4%) patients were retreated with CPI and none presented relapse or new immune‐related adverse events after a median cycles of 11 (range 6‐36). Subjects with irH were older and had lower IgG values than a cohort of AIH (N = 38). Presentation tended to be more severe in AIH. Twenty‐five percent of irH and 84% AIH presented ANAs ≥ 1:80 (P = .001). In irH Initial dose of corticosteroids was higher (60 vs 30 mg, P < .001) but duration shorter (2.3 vs 7 months, P < .001) and frequently in monotherapy (41.7% vs 91.3%, P < .001).

Conclusions

Immune‐related hepatitis can lead to acute liver failure, with absence of increased values of IgG and ANAs. In contrast to autoimmune hepatitis, initial corticosteroids dose were higher, duration shorter with few requiring additional immunosuppression. Retreatment with CPI was not associated with recurrence.
Learning at home during COVID‐19: A multi‐institutional virtual learning collaboration
Authors: Zuo Leila , Dillman Dawn , Miller Juvé Amy
Published: April 2020

With this issue we begin print publishing the responses received in our call for Medical Education Adaptations: Lessons learned from educators' experiences rapidly transforming practice on account of COVID‐19 related disruption.
The impact of maternal asthma during pregnancy on offspring retinal microvascular structure and its relationship to placental growth factor production in utero
Authors: Jones Ailee R. , Tuckwell Christine , Wright Ian M. R. , Morrison Janna L. , Kandasamy Yogavijayan , Wittwer Melanie R. , Arstall Margaret A. , Stark Michael J. , Davies Michael , Hurst Cameron , Okano Satomi , Clifton Vicki L.
Published: April 2020

Asthma is a common chronic disease in pregnancy that affects placental function and fetal growth and associated with cardio‐metabolic disorders in the offspring but the mechanisms are unknown. This study explored whether maternal asthma in pregnancy is associated with the development of offspring microvascular structure and whether it was related to biomarkers of angiogenesis in utero. Children aged 4 to 6 years, born to either asthmatic mothers (n = 38) or healthy controls (n = 25), had their retinal microvascular structure examined. Maternal plasma PlGF concentrations at 18 and 36 weeks’ gestation were measured. There was a significant global difference in all retinal microvascular measures between children of asthmatic mothers relative to controls and increased retinal venular tortuosity in children born to asthmatic mothers (7.1 (95% CI 0.7‐13.5); P = .031). A rise in plasma PlGF from 18 to 36 weeks’ gestation was observed in the control population which was significantly lower in the asthma group by 190.9 pg/mL. PlGF concentrations were correlated with microvascular structure including arteriolar branching and venular tortuosity. These exploratory findings indicate that exposure to maternal asthma during pregnancy is associated with persistent changes in microvascular structure in childhood that may be driven by alterations to angiogenic mechanisms in utero.
Imagining Kawthoolei: Strategies of petitioning for Karen statehood in Burma in the first half of the 20th century
Authors: Garbagni Giulia , Walton Matthew J
Published: April 2020

Academic and media writing about the Karen ethnic group in Myanmar most often associates the group with war and insurgency. This article focuses instead on the different strategies and rhetorical arguments––and the ideological notions that underpinned them––adopted by the Karen in their informal and formal petitions for recognition and statehood from the early decades of the 20th century, through the Second World War, to the mid‐1950s, including previously unexamined evidence of an early Karen attempt to gain UN recognition. In following these efforts, we track imaginings of Karen nationhood over time through shifting and conflicting territorial claims and persistent, multifaceted diplomatic attempts to realize the material existence of the Karen homeland, Kawthoolei.
Is forest fecundity resistant to drought? Results from an 18‐yr rainfall‐reduction experiment
Authors: Bogdziewicz Michał , Fernández‐Martínez Marcos , Espelta Josep M. , Ogaya Romà , Penuelas Josep
Published: April 2020

Recruitment is a primary determinant of the long‐term dynamics of plant populations in changing environments. However, little information is known about the effects of anthropogenic environmental changes on reproductive ecology of trees.

We evaluated the impact of experimentally induced 18 yr of drought on reproduction of three contrasting forest trees:Quercus ilex,Phillyrea latifoliaandArbutus unedo.

Rainfall reduction did not decrease tree fecundity. Drought, however, affected the allocation of resources inQ. ilexandA. unedobut not the more drought tolerantP. latifolia. Larger crop production byQ. ilexandA. unedowas associated with a stronger decrease in growth in the rainfall‐reduction plots compared with the control plots, suggesting that these species were able to maintain their fecundity by shifting their allocation of resources away from growth.

Our results indicated resistance to change in tree fecundity in Mediterranean‐type forest subjected to an average 15% decrease in the amount of soil moisture, suggesting that these ecosystems may adapt to a progressive increase in arid conditions. However, the species‐specific reductions in growth may indirectly affect future fecundity and ultimately shift community composition, even without immediate direct effects of drought on tree fecundity.
The value of the financial structure to economic performance in oil‐producing countries
Authors: Oro Oro Ufuo , Ekpo Akpan H.
Published: April 2020

Is financial structure (FS) valuable to economic performance (EP) of countries? To answer this question, we investigated 23 oil‐producing and 18 non‐oil‐producing countries over the course of ten years (2006–2015). We found an increase in bank‐based FS decreases economic growth (EG) and amplifies growth volatility (GV) in the oil‐ and non‐oil‐producing economies. An increase in market‐based FS increases EG in the two samples but amplifies GV in the oil‐producing economies while dampening GV in the non‐oil‐producing countries. The uniqueness in our results is that between the oil‐ and non‐oil‐producing countries, where the relationship between FS and EP is negative, the negative effect is more in the oil‐producing countries. Where the relationship is positive in the two samples, the positive effect is smaller in the oil‐producing countries. We, therefore, recommend that any policy reforms in the oil‐producing economies should be context‐specific because oil‐producing economies appear to differ from the other economies.