bluuebunny/crossref_metadata_2025 huggingface dataset:
How Useful Are Tumor Markers in Detecting Metastases with FDG-PET/CT during Breast Cancer Surveillance?
Authors: Corso Giovanni , Gilardi Laura , Girardi Antonia , De Scalzi Alessandra Margherita , Pagani Gianmatteo , Rossi Elisabetta Maria Cristina , Montagna Giacomo , Veronesi Paolo , Pagan Eleonora , Bagnardi Vincenzo , Grana Chiara Maria
Published: June 2020

Background: To assess the clinical usefulness of serum tumor markers for early detection of distant breast cancer recurrence using FDG-PET/CT. Methods: We retrospectively analyzed 561 consecutive patients who underwent surgery for invasive primary breast cancer and had increased tumor markers (CA 15-3 and CEA) after completion of locoregional therapy. FDG-PET/CT data were reviewed for all cases. CA 15-3 and CEA were evaluated both in a continuous and in a quartile (Q) distribution. The Wilcoxon rank-sum test and logistic regression models were used to evaluate the association between increased tumor marker values and the presence (and type) of distant metastases. Results: The median value of CA 15-3 was 35.0 U/mL (IQR, 29.5–43.0) in cases where no distant metastases were detected, and it was 58.9 U/mL (IQR, 40.0–108.0) in cases where metastases were detected (p < 0.001). The median value of CEA was 6.6 U/mL (IQR, 4.4–10.0) in cases of no metastases and 12.4 U/mL (IQR, 6.9–30.0) in cases of metastases (p < 0.001). Increased levels of both tumor markers (Q3 and Q4) were strongly associated with the presence of distant metastases. The association between CA 15-3 and bone/liver metastases was stronger compared with other types of metastases (p heterogeneity between odds ratios [ORs] = 0.03 for Q3 and <0.001 for Q4), while no relevant heterogeneity between ORs emerged for CEA. Conclusion: Increased tumor marker levels detected in asymptomatic breast cancer patients during adjuvant therapies and follow-up are significantly predictive of distant metastases identified on FDG-PET/CT.
The Effect of Aromatherapy on Sleep and Quality of Life in Menopausal Women with Sleeping Problems: A Non-Randomized, Placebo-Controlled Trial
Authors: Gürler Meryem , Kızılırmak Aynur , Baser Mürüvvet
Published: June 2020

Introduction: Menopause is the termination of menstruation and fertility. Women commonly experience sleeping problems during the menopausal period. Aromatherapy is among the complementary therapies used to remedy sleeping problems. Methods:This study aims to investigate the effects of lavender oil on sleep and quality of life of menopausal women through steam inhalation. This study was quasi-experimental with pre-test/post-test placebo control groups. It was conducted with 57 women, 27 of whom were subject to aromatherapy and 30 to a placebo. Data were collected using the Questionnaire Form, the Pittsburgh Sleep Quality Index (PSQI) and the Menopause-Specific Quality of Life Questionnaire (MENQOL). Results: For the intervention group, the PSQI median scores after the administration of aromatherapy were found to be significantly lower than those before the administration (p < 0.001) and those of the placebo group (p < 0.001). Similarly, for the intervention group, the total median MENQOL scores after the administration of the aromatherapy were found to be significantly lower than the scores prior to the administration (p < 0.001) as well as the scores of the placebo group (p < 0.001). Conclusion: It was found that aromatherapy involving lavender-scented steam inhalation increased sleep quality and quality of life in women with sleep deprivation problems during menopause.
A Prospective Multicenter Study on the Prevalence of Fructose Malabsorption in Patients with Chronic Inflammatory Bowel Disease
Authors: Helwig Ulf , Koch Anna K. , Reichel Christoph , Jessen Petra , Büning Jürgen , Schreiber Stefan , Langhorst Jost ,   on behalf of the GISG
Published: June 2020

Background and Aims: Patients with chronic inflammatory bowel disease (IBD) might have a higher prevalence of fructose malabsorption than healthy controls. This study’s aim was to determine the prevalence and symptom severity of fructose malabsorption in patients with active and inactive IBD. Methods: The present study was a multicenter noninterventional diagnostic pilot trial. Two hundred fifty-one participants were recruited from 12 outpatient clinics for internal medicine across Germany and from the University of Kiel. Fructose malabsorption was diagnosed by hydrogen breath testing. Patients diagnosed with bacterial overgrowth, non-H2 producers, and patients who were tested positive for lactose malabsorption were excluded. Gastrointestinal symptoms during breath testing were evaluated using four-point subjective items to determine severity of bloating, abdominal pain, and diarrhea. Results: Two hundred five patients (45 with active IBD, 80 with IBD in remission, and 81 healthy controls) were analyzed. The number of patients diagnosed with fructose malabsorption – 35/44 (79.6%) in patients with active IBD, 59/80 (73.8%) inactive IBD, and 66/81 (81.5%) in healthy controls – did not differ between the groups (χ2 [2, N = 205] = 1.48, p = 0.48). However, abdominal pain was more frequent in patients with active IBD than patients with IBD in remission (z = −2.936, p = 0.010), and diarrhea was more frequent in patients with active IBD than in healthy controls (z = 2.489, p = 0.038). Conclusions: Fructose malabsorption is not more common among patients with IBD than healthy subjects. However, the greater prevalence of patient-reported symptoms among patients with IBD may be of pathological and therapeutic relevance.
Current Opinion about Hepatocellular Carcinoma <10 mm
Authors: Dong Yi , Teufel Andreas , Wang Wen-Ping , Dietrich Christoph F.
Published: June 2020

Background: Early detection of hepatocellular carcinoma (HCC) is important. Advances in liver imaging techniques have facilitated the detection of HCC at an early stage. However, there is a controversial discussion on how to diagnose very small HCC by imaging. The aim of the current review is to present current published data on HCC ≤10 mm and discuss on how to best diagnose and treat such lesions. Summary: It is still challenging, however, to accurately characterize HCC <10 mm. The accuracy of contrast-enhanced ultrasound may be critical for early treatment decisions for cancer patients, particularly when CECT and/or CEMRI are inconclusive. Key Messages: The characterization of focal liver lesions <10 mm is frequently delayed until a follow-up imaging procedure demonstrates growth or stability. A repetition of ultrasound examination after 3 months for new nodules <1 cm should be recommended.
A Comprehensive Evaluation of Mepolizumab Effectiveness in a Real-Life Setting
Authors: Cameli Paolo , Bergantini Laura , d’Alessandro Miriana , Perruzza Marco , Cekorja Behar , Perillo Felice , Massa Evaluna , Ruzza Annamaria , Fossi Antonella , Beltrami Valerio , Sestini Piersante , Bargagli Elena
Published: June 2020

Introduction: Interleukin-5 (IL-5) is the principal cytokine regulating eosinophil growth, differentiation, activation, and expression. It is a specific target of mepolizumab, an anti-IL-5 monoclonal antibody used in the treatment of severe eosinophilic asthma. This new drug can improve symptoms, reduce asthma exacerbations and steroid use. Few data are available on its efficacy for nasal symptoms. Objective: To describe the all-round clinical impact of mepolizumab in a real-life setting, evaluating the efficacy and safety of the drug in severe eosinophilic asthma patients. Population and Methods: We retrospectively collected the clinical and functional data on 27 patients (16 males) affected with severe eosinophilic asthma, diagnosed at the Siena Regional Referral Centre and monitored for 6 months. Clinical, immunological, and functional data at baseline and follow-up were entered in a database together with comorbidities, number of exacerbations, steroid treatment, multiple-flow exhaled nitric oxide, and validated questionnaires. Results: A significant reduction in asthma exacerbations was observed in all patients after 6 months of the biological therapy (p = 0.0009), and 4/6 patients discontinued chronic oral steroids. A significant improvement in ACT, FEV1, SNOT22, and alveolar nitric oxide was observed after 1 month of mepolizumab (p = 0.003, p = 0.007, p = 0.047, and p = 0.019, respectively) and maintained after 6 months of treatment. After 6 months, FeNO 50 was reduced as well (p = 0.030). Mepolizumab was very well tolerated, and no major side effects were observed. Conclusions: Our study suggests that mepolizumab is effective in improving control of asthma, lung function parameters, exhaled biomarkers, and nasal symptoms in patients with severe eosinophilic asthma.
IL-17D: A Less Studied Cytokine of IL-17 Family
Authors: Liu Xuying , Sun Siyu , Liu Dongyan
Published: June 2020

The interleukin-17 (IL-17) family is a relatively new family of cytokines consisting of 6 related factors (IL-17A–IL-17F), while the receptor family consists of 5 members: IL-17RA–IL-17RE. IL-17A is the prototype member of this family, which is also the signature cytokine of T helper 17 (Th17) cells. Th17 cells are involved in the development of autoimmune disease, inflammation, and tumors. Although IL-17D is similar to IL-17A in its ability to induce inflammatory cytokine production, there are fewer studies on IL-17D. Recently, the role of IL-17D in tumors and infections has attracted our attention. Some knowledge of function of IL-17D has been gained by studies using nonmammalian species. In this review, we introduce the structural characteristics, expression patterns, and biological characteristics of IL-17D along with its potential function in the pathogenesis of disease.
Visual Snow: A Case Series from Israel
Authors: Berkowitz Eran , River Yaron , Digre Kathleen , Tiosano Beatrice , Kesler Anat
Published: June 2020

Our aim was to examine the symptoms and clinical characteristics of visual snow in a group of 6 patients from a Department of Ophthalmology and a Department of Neurology. Visual snow is now recognized as a true physiological disorder. Previously, physicians unaware of this syndrome may have misinterpreted its symptoms as a persistent visual aura. By promoting awareness of this syndrome, greater quantitative and qualitative research may expand our understanding and treatment of this disorder.
Asthma and the Coronavirus Disease 2019 Pandemic: A Literature Review
Authors: Morais-Almeida Mário , Pité Helena , Aguiar Rita , Ansotegui Ignacio , Bousquet Jean
Published: June 2020

Even though respiratory viruses are one of the most common triggers for asthma exacerbations, not all of these viruses affect patients equally. There is no strong evidence supporting that patients with asthma have a higher risk of becoming seriously ill from coronavirus disease 2019 (CO­VID-19), although recent reports from the USA and the UK suggest that asthma is much more common in children and adults with mild to severe COVID-19 than has previously been reported in Asia and in Europe. As in previous severe acute respiratory syndrome (SARS) outbreaks, patients with asthma, especially children, appear to be less susceptible to the coronavirus with a low rate of asthma exacerbations. A different expression of viral receptors and T2 inflammation can be responsible for different outcomes. Future studies focused on asthma and on other allergic disorders are needed to provide a greater understanding of the impact of underlying asthma and allergic inflammation on COVID-19 susceptibility and disease severity. However, for the moment, it is crucial that asthmatic patients maintain their controller medication, from inhaled corticosteroids to biologics, without making any dose adjustments on their own or stopping the medication. New data are emerging daily, rapidly updating our understanding of this novel coronavirus.
SARS-CoV-2 Infection and High-Risk Non-Muscle-Invasive Bladder Cancer: Are There Any Common Features?
Authors: Busetto Gian Maria , Porreca Angelo , Del Giudice Francesco , Maggi Martina , D'Agostino Daniele , Romagnoli Daniele , Musi Gennaro , Lucarelli Giuseppe , Palmer Katie , Colonna di Paliano Ascanio , Muto Matteo , Hurle Rodolfo , Terracciano Daniela , de Cobelli Ottavio , Sciarra Alessandro , De Berardinis Ettore , Ferro Matteo
Published: June 2020

Background: The new severe acute respiratory syndrome virus (SARS-CoV-2) outbreak is a huge health, social and economic issue and has been declared a pandemic by the World Health Organization. Bladder cancer, on the contrary, is a well-known disease burdened by a high rate of affected patients and risk of recurrence, progression and death. Summary: The coronavirus disease (COVID-19 or 2019-nCoV) often involves mild clinical symptoms but in some cases, it can lead to pneumonia with acute respiratory distress syndrome and multiorgan dysfunction. Factors associated with developing a more severe disease are increased age, obesity, smoking and chronic underlying comorbidities (including diabetes mellitus). High-risk non-muscle-invasive bladder cancer (NMIBC) progression and worse prognosis are also characterized by a higher incidence in patients with risk factors similar to COVID-19. Immune system response and inflammation have been found as a common hallmark of both diseases. Most severe cases of COVID-19 and high-risk NMIBC patients at higher recurrence and progression risk are characterized by innate and adaptive immune activation followed by inflammation and cytokine/chemokine storm (interleukin [IL]-2, IL-6, IL-8). Alterations in neutrophils, lymphocytes and platelets accompany the systemic inflammatory response to cancer and infections. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio for example have been recognized as factors related to poor prognosis for many solid tumors, including bladder cancer, and their role has been found important even for the prognosis of SARS-CoV-2 infection. Key Messages: All these mechanisms should be further analyzed in order to find new therapeutic agents and new strategies to block infection and cancer progression. Further than commonly used therapies, controlling cytokine production and inflammatory response is a promising field.
First records of ectoparasitic insects (Diptera: Hippoboscoidea) of bats in the department of Caldas, Colombia
Authors: Raigosa Álvarez Jorge , García Osorio Carolina , Autino Analía Gladys , Gomes Dias Lucimar
Published: June 2020

In Colombia, the taxonomical understanding of ectoparasites (Diptera: Streblidae and Nycteribiidae) of bats is scarce, despite the high diversity of hosts. This fact reflects the lack of important information on the group and poses the need for studies that expand the knowledge on bat ectoparasites in different regions of the country. The aim of this study was to contribute pioneer knowledge on bat ectoparasitic insects in the department of Caldas, located in the Central Andes Mountain range of Colombia. We assessed 318 bats from four eco parks in the city of Manizales, and collected 234 ectoparasitic insects. We provide the first report of the family Streblidae for Caldas, with seven genera and eight species: Anastrebla caudiferae Wenzel, 1976, Anatrichobius scorzai Wenzel, 1966, Exastinion oculatum Wenzel, 1976, Megistopoda proxima (Séguy‚ 1926), Paratrichobius longicrus Ribeiro, 1907, Paraeuctenodes similis Wenzel, 1976, Trichobius longipes Rudow, 1871, and Trichobius tiptoni Wenzel, 1976. In addition, we report the species Basilia ferrisi Schuurmans Stekhoven, 1931 and Basilia sp. for the family Nycteribiidae.
Small mammal diversity in Semi-deciduous Seasonal Forest of the southernmost Brazilian Pampa: the importance of owl pellets for rapid inventories in human-changing ecosystems
Authors: Stutz Narla Shannay , Hadler Patrícia , Cherem Jorge José , Pardiñas Ulyses Francisco José
Published: June 2020

The Pampa biogeographic province covers a mere 2% of the Brazilian territory (176,496 km²). However, it stands out as a complex and diverse ecosystem, although its mammal communities are still scarcely understood. Human activities are transforming the territory into a mosaic of agroecosystems, native and exotic forest fragments, and grasslands. Here we conducted the first investigation to determine the richness of small mammal assemblages in the region based on extensive analyses of owl pellets (Tyto furcata). Craniodental remains were studied from samples collected from 12 Semi-deciduous Seasonal Forest sites in the municipality of São Lourenço do Sul, State of Rio Grande do Sul, Southern Brazil. A total of 2,617 individuals belonging to 19 taxa were recorded, including 2 marsupials (Didelphidae; 0.42%), 2 chiropterans (Molossidae, Phyllostomidae; 0.12%), and 15 rodents (Cricetidae, Muridae, Caviidae; 99.46%). The rodent genera Oligoryzomys, Mus, Calomys, and Akodon were the most common taxa. Large samples also included poorly known taxa, such as the cricetids Bibimys, Juliomys (recording here its southernmost occurrence), Lundomys, and Wilfredomys. From a biogeographical point of view, the recorded assemblage embraces a mixture of Platan, Pampean, and Atlantic Forest elements, highlighting the role of the southernmost Brazilian hills as a wedge favoring the penetration of forest micromammals to higher latitudes. Our findings testify to the great diversity of the Pampa, but also point to a growing homogeneity and dominance of rodent species that are widespread in agroecosystems. Rapid inventories based on owl pellets emerge as a suitable, economic, non-invasive tool to document these community changes.
New species and new records of Tonnoira (Diptera: Psychodidae) from Brazil
Authors: Bravo Freddy , Vilarinho Naiara , Araújo Maíra Xavier
Published: June 2020

A new species of moth-fly, Tonnoira igrapiunensis sp. nov. (Psychodidae, Psychodinae), from the Brazilian Atlantic Rain Forest is described. The new species can be distinguished from other species of the genus by its eye bridge separated by 0.5 facet diameter, R₅ ending slightly posterior to apex of the wing, gonostyli bifurcated with long arm shorter than length of gonocoxites, aedeagus bipartite and asymmetrical, and two asymmetrical parameres. The gonostylus is similar to that of Tonnoira andradei Santos, 2014, but in the latter species the aedeagus has only one shaft and not two as in the new species. Tonnoira bifida Bravo & Chagas, 2004, Tonnoira brisolaii Santos, 2014, and Tonnoira galatiae Santos, 2014 have their distribution expanded.
Antegrade Intentional Laceration of the Anterior Mitral Leaflet to Prevent Left Ventricular Outflow Tract Obstruction
Authors: Lisko John C. , Greenbaum Adam B. , Khan Jaffar M. , Kamioka Norihiko , Gleason Patrick T. , Byku Isida , Condado Jose F. , Jadue Andres , Paone Gaetano , Grubb Kendra J. , Tiwana Jasleen , McCabe James M. , Rogers Toby , Lederman Robert J. , Babaliaros Vasilis C.
Published: June 2020

Background:

Intentional laceration of the anterior mitral leaflet (LAMPOON) is an effective adjunct to transcatheter mitral valve replacement that prevents left ventricular outflow tract (LVOT) obstruction. To date, LAMPOON has been performed in over 150 patients using a retrograde approach that can be technically challenging. A modified antegrade transseptal technique may simplify the procedure.

Methods:

Antegrade LAMPOON was developed and tested in nonsurvival pig experiments. Thereafter, antegrade LAMPOON was performed in patients at prohibitive risk of LVOT obstruction. Clinical, procedural, and angiographic details were abstracted from medical records of their index procedure, and were compared with findings in comparable patients at risk of fixed-LVOT obstruction in the LAMPOON investigational device exemption trial.

Results:

Eight patients at risk of fixed LVOT obstruction underwent antegrade LAMPOON. Leaflet traversal and laceration were technically successful in all. There were no cases of clinically significant LVOT obstruction (mean LVOT gradient at discharge: 5.4±1.4 mm Hg). One patient suffered a ventricular wire perforation, unrelated to the antegrade LAMPOON technique, and did not survive to discharge. At the time of discharge, no patients had an increase of >10 mm Hg in LVOT gradient compared with baseline. Procedure times (from traversal to transcatheter mitral valve replacement) were shorter, compared with the retrograde technique in the LAMPOON investigational device exemption trial (39±09 versus 65±35 minutes). All patients survived (8/8, 100%) the procedure, and 7/8 (88%) survived to 30 days, similar to subjects in the LAMPOON investigational device exemption trial.

Conclusions:

Antegrade LAMPOON is an effective, reproducible, and simplified strategy to lacerate the anterior leaflet before transcatheter mitral valve replacement. The authors recommend the technique as the new standard for LAMPOON.
Cardiospecific Overexpression of ATPGD1 (Carnosine Synthase) Increases Histidine Dipeptide Levels and Prevents Myocardial Ischemia Reperfusion Injury
Authors: Zhao Jingjing , Conklin Daniel J. , Guo Yiru , Zhang Xiang , Obal Detlef , Guo Luping , Jagatheesan Ganapathy , Katragadda Kartik , He Liqing , Yin Xinmin , Prodhan Md Aminul Islam , Shah Jasmit , Hoetker David , Kumar Amit , Kumar Vijay , Wempe Michael F. , Bhatnagar Aruni , Baba Shahid P.
Published: June 2020

BACKGROUND

Myocardial ischemia reperfusion (I/R) injury is associated with complex pathophysiological changes characterized by
pH
imbalance, the accumulation of lipid peroxidation products acrolein and 4‐hydroxy
trans
‐2‐nonenal, and the depletion of
ATP
levels. Cardioprotective interventions, designed to address individual mediators of I/R injury, have shown limited efficacy. The recently identified enzyme ATPGD1 (Carnosine Synthase), which synthesizes histidyl dipeptides such as carnosine, has the potential to counteract multiple effectors of I/R injury by buffering intracellular
pH
and quenching lipid peroxidation products and may protect against I/R injury
.

METHODS AND RESULTS

We report here that β‐alanine and carnosine feeding enhanced myocardial carnosine levels and protected the heart against I/R injury. Cardiospecific overexpression of
ATPGD
1 increased myocardial histidyl dipeptides levels and protected the heart from I/R injury. Isolated cardiac myocytes from
ATPGD
1‐transgenic hearts were protected against hypoxia reoxygenation injury. The overexpression of
ATPGD
1 prevented the accumulation of acrolein and 4‐hydroxy
trans
‐2‐nonenal–protein adducts in ischemic hearts and delayed acrolein or 4‐hydroxy
trans
‐2‐nonenal–induced hypercontracture in isolated cardiac myocytes. Changes in the levels of
ATP
, high‐energy phosphates, intracellular pH, and glycolysis during low‐flow ischemia in the wild‐type mice hearts were attenuated in the
ATPGD
1‐transgenic hearts. Two natural dipeptide analogs (anserine and balenine) that can either quench aldehydes or buffer intracellular
pH
, but not both, failed to protect against I/R injury.

CONCLUSIONS

Either exogenous administration or enhanced endogenous formation of histidyl dipeptides prevents I/R injury by attenuating changes in intracellular pH and preventing the accumulation of lipid peroxidation derived aldehydes.
Novel Insights Into the Effects of Interleukin 6 Antagonism in Non–ST‐Segment–Elevation Myocardial Infarction Employing the SOMAscan Proteomics Platform
Authors: George Marc J. , Kleveland Ola , Garcia‐Hernandez Jorge , Palmen Jutta , Lovering Ruth , Wiseth Rune , Aukrust Pål , Engmann Jorgen , Damås Jan Kristian , Hingorani Aroon D. , Gullestad Lars , Casas Juan P. , Ueland Thor
Published: June 2020

Background

Interleukin 6 concentration is associated with myocardial injury, heart failure, and mortality after myocardial infarction. In the Norwegian tocilizumab non–ST‐segment–elevation myocardial infarction trial, the first randomized trial of interleukin 6 blockade in
myocardial infarction
, concentration of both C‐reactive protein and troponin T were reduced in the active treatment arm. In this follow‐up study, an aptamer‐based proteomic approach was employed to discover additional plasma proteins modulated by
tocilizumab
treatment to gain novel insights into the effects of this therapeutic approach.

Methods and Results

Plasma from
percutaneous coronary intervention–
treated patients, 24 in the active intervention and 24 in the placebo‐control arm, drawn 48 hours postrandomization were randomly selected for analysis with the
SOMA
scan assay. Employing slow off‐rate aptamers, the relative abundance of 1074 circulating proteins was measured. Proteins identified as being significantly different between groups were subsequently measured by enzyme immunoassay in the whole trial cohort (117 patients) at all time points (days 1–3 [7 time points] and 3 and 6 months). Five proteins identified by the
SOMA
scan assay, and subsequently confirmed by
enzyme immunoassay
, were significantly altered by
tocilizumab
administration. The acute‐phase proteins
lipopolysaccharide‐
binding protein, hepcidin, and insulin‐like growth factor‐binding protein 4 were all reduced during the hospitalization phase, as was the monocyte chemoattractant
C‐C
motif chemokine ligand 23. Proteinase 3, released primarily from neutrophils, was significantly elevated.

Conclusions

Employing the
SOMA
scan aptamer‐based proteomics platform, 5 proteins were newly identified that are modulated by interleukin 6 antagonism and may mediate the therapeutic effects of
tocilizumab
in
non–ST‐segment–elevation myocardial infarction
.
Impact of Sleep-Disordered Breathing on Functional Outcomes in Ischemic Stroke
Authors: Kang Dong Oh , Kim Chi Kyung , Park Yoonjee , Jang Won Young , Kim Woohyeun , Choi Jah Yeon , Roh Seung-Young , Choi Cheol Ung , Kim Eung Ju , Rha Seung-Woon , Park Chang Gyu , Seo Hong Seog , Oh Kyungmi , Na Jin Oh
Published: June 2020

Background and Purpose:

Cardiopulmonary coupling (CPC) analysis is an easily assessable method to evaluate sleep-disordered breathing (SDB); however, its prognostic impact in patients with acute ischemic stroke needs to be investigated. We performed a CPC analysis using Holter monitoring at the early stage of noncardioembolic ischemic stroke to investigate the prognostic effect of SDB on functional impairment at the 3-month follow-up.

Methods:

A total 615 patients with acute noncardioembolic ischemic stroke who underwent Holter monitoring within 30 days of stroke onset were enrolled from a multicenter, prospective, all-comer cohort. CPC analysis was conducted, and SDB was defined by the presence of narrow-band coupling during sleep time. We investigated the association between SDB and functional impairment at 3 months as measured by the modified Rankin Scale.

Result:

Narrow-band coupling was present in 191 (31.1%) of 615 patients (mean age 64.5±12.6 years). The narrow-band group showed a significantly higher rate of severe functional impairment (modified Rankin Scale score >2; 45.5% versus 12.9%,
P
<0.001) and persistent disability (Δmodified Rankin Scale score ≤0; 53.9% versus 39.8%,
P
<0.001) at the 3-month follow-up. In multivariate analysis, narrow-band coupling was an independent predictor of higher risk of severe and persistent functional impairment at 3 months (odds ratio, 3.98 [95% CI, 2.34–6.78];
P
<0.001; and odds ratio, 1.81 [95% CI, 1.23–2.66];
P
<0.001, respectively). The results remained consistent after propensity-score matched analysis with 157 patient pairs (
C
-statistic=0.770).

Conclusions:

SDB assessed by CPC analysis at the early stage of ischemic stroke could predict severe and prolonged functional impairment at 3 months. CPC analysis using Holter monitoring can help predicting functional impairment in acute ischemic stroke.
Acute Stroke in Times of the COVID-19 Pandemic
Authors: Hoyer Carolin , Ebert Anne , Huttner Hagen B. , Puetz Volker , Kallmünzer Bernd , Barlinn Kristian , Haverkamp Christian , Harloff Andreas , Brich Jochen , Platten Michael , Szabo Kristina
Published: June 2020

Background and Purpose:

This study aims to assess the number of patients with acute ischemic cerebrovascular events seeking in-patient medical emergency care since the implementation of social distancing measures in the coronavirus disease 2019 (COVID-19) pandemic.

Methods:

In this retrospective multicenter study, data on the number of hospital admissions due to acute ischemic stroke or transient ischemic attack and numbers of reperfusion therapies performed in weeks 1 to 15 of 2020 and 2019 were collected in 4 German academic stroke centers. Poisson regression was used to test for a change in admission rates before and after the implementation of extensive social distancing measures in week 12 of 2020. The analysis of anonymized regional mobility data allowed for correlations between changes in public mobility as measured by the number and length of trips taken and hospital admission for stroke/transient ischemic attack.

Results:

Only little variation of admission rates was observed before and after week 11 in 2019 and between the weeks 1 and 11 of 2019 and 2020. However, reflecting the impact of the COVID-19 pandemic, a significant decrease in the number of admissions for transient ischemic attack was observed (−85%, −46%, −42%) in 3 of 4 centers, while in 2 of 4 centers, stroke admission rates decreased significantly by 40% and 46% after week 12 in 2020. A relevant effect on reperfusion therapies was found for 1 center only (thrombolysis, −60%; thrombectomy, −61%). Positive correlations between number of ischemic events and mobility measures in the corresponding cities were identified for 3 of 4 centers.

Conclusions:

These data demonstrate and quantify decreasing hospital admissions due to ischemic cerebrovascular events and suggest that this may be a consequence of social distancing measures, in particular because hospital resources for acute stroke care were not limited during this period. Hence, raising public awareness is necessary to avoid serious healthcare and economic consequences of undiagnosed and untreated strokes and transient ischemic attacks.
“You Can’t Be a Teacher and Not Follow Politics!”: Teacher-Legislators and Their Pathway to the State Capital
Authors: Martinez Magdalena
Published: June 2020

Few studies have examined the growing trend of teacher-legislators, specifically teachers’ trajectory to elected office. Drawing on qualitative data and raced-gendered frameworks, this article examines how three female teachers of color in one Southwest state leveraged their teaching experiences to shape their policy priorities and how they navigated policy and political environments. The teacher-legislators in this article created counter-narratives on teachers and their abilities. Their experiences illustrate how teacher-legislators resisted and transformed state policies that affected urban students.
Artificial Intelligence Applications in Otology: A State of the Art Review
Authors: You Eunice , Lin Vincent , Mijovic Tamara , Eskander Antoine , Crowson Matthew G.
Published: June 2020

Objective

Recent advances in artificial intelligence (AI) are driving innovative new health care solutions. We aim to review the state of the art of AI in otology and provide a discussion of work underway, current limitations, and future directions.

Data Sources

Two comprehensive databases, MEDLINE and EMBASE, were mined using a directed search strategy to identify all articles that applied AI to otology.

Review Methods

An initial abstract and title screening was completed. Exclusion criteria included nonavailable abstract and full text, language, and nonrelevance. References of included studies and relevant review articles were cross‐checked to identify additional studies.

Conclusion

The database search identified 1374 articles. Abstract and title screening resulted in full‐text retrieval of 96 articles. A total of N = 38 articles were retained. Applications of AI technologies involved the optimization of hearing aid technology (n = 5; 13% of all articles), speech enhancement technologies (n = 4; 11%), diagnosis and management of vestibular disorders (n = 11; 29%), prediction of sensorineural hearing loss outcomes (n = 9; 24%), interpretation of automatic brainstem responses (n = 5; 13%), and imaging modalities and image‐processing techniques (n = 4; 10%). Publication counts of the included articles from each decade demonstrated a marked increase in interest in AI in recent years.

Implications for Practice

This review highlights several applications of AI that otologists and otolaryngologists alike should be aware of given the possibility of implementation in mainstream clinical practice. Although there remain significant ethical and regulatory challenges, AI powered systems offer great potential to shape how healthcare systems of the future operate and clinicians are key stakeholders in this process.
Outcomes of Dog Bite Avulsion Injury Reconstruction With Urinary Bladder Matrix
Authors: Ong Adrian A. , Nagy Ryan , Fincham Michelle R. , Nagy Mark L.
Published: June 2020

Dog bite avulsion injuries of the head and neck are difficult to manage in pediatric patients. This study assesses the outcomes of using porcine urinary bladder extracellular matrix (UBM) for reconstruction of these complete avulsion injuries. Five male pediatric patients underwent reconstruction using UBM. Two (40%) patients underwent reconstruction of the nose; the other 3 patients underwent reconstruction of the forehead, forehead/glabella, and auricle. The average size of the avulsion defect was 7.0 ± 2.4 cm2. No patient developed wound dehiscence, graft loss, or wound infection. Four (80%) patients received pulsed dye laser treatment to improve wound cosmesis. Use of UBM is a safe and effective reconstructive option after dog bite avulsion injuries of the head and neck. Given the advantages of convenient availability and avoidance of donor site morbidity, UBM can be considered for reconstruction of posttraumatic avulsion injuries or Mohs defects.
Pediatric, Family‐Centered, “At‐Home” Otologic Physical Examination in the COVID‐19 Era
Authors: Jayawardena Asitha D. L. , Mankarious Leila A. , Keamy Donald G. , Cohen Michael S.
Published: June 2020

SARS‐CoV‐2, the novel coronavirus resulting in the present COVID‐19 pandemic, has increased the otolaryngologist’s reliance on telemedicine to manage outpatient pathology. The nature of telemedicine, however, limits a provider’s ability to obtain a comprehensive physical examination, specifically of the tympanic membrane. Various smartphone‐based otoscopic attachments are now available that facilitate patient‐obtained otoscopic image capture of the tympanic membrane. Here, we present 3 cases in which a patient‐purchased, over‐the‐counter otoscope was utilized to alter otologic management during the time of social distancing. Further research is necessary to improve our understanding the safety and efficacy of patient‐based “at‐home” otoscopic examination and to optimize the use of these devices.
The effectiveness of extracorporeal shock wave therapy for improving upper limb spasticity and functionality in stroke patients: a systematic review and meta-analysis
Authors: Cabanas-Valdés Rosa , Serra-Llobet Pol , Rodriguez-Rubio Pere Ramón , López-de–Celis Carlos , Llauró-Fores Mercé , Calvo-Sanz Jordi
Published: June 2020

Objective:

To assess the effectiveness of Extracorporeal Shock Wave Therapy for reducing spasticity and improving functionality of the upper limb in stroke survivors.

Data sources:

A systematic review of MEDLINE, Cochrane Central Register of Controlled Trials, CINAHL, PEDro, REHABDATA, Scielo, Scopus, Web of Science, Tripdatabase and Epistemonikos from 1980 to April 2020 was carried out.

Review methods:

The bibliography was screened to identify randomized controlled clinical trials that applied extracorporeal shock waves to upper limb spastic muscles in post-stroke individuals. Two reviewers independently screened references, selected relevant studies, extracted data and assessed risk of bias using the PEDro scale. The primary outcome was spasticity and functionality of the upper limb.

Results:

A total of 1,103 studies were identified and 16 randomized controlled trials were finally included (764 individuals) were analyzed. A meta-analysis was performed and a beneficial effect on spasticity was found. The mean difference (MD) on the Modified Ashworth Scale for comparison extracorporeal shock wave versus sham was −0.28; with a 95% confidence interval (CI) from −0.54 to −0.03. The MD of the comparison of extracorporeal shock wave plus conventional physiotherapy versus conventional physiotherapy was −1.78; 95% CI from −2.02 to −1.53. The MD for upper limb motor-function using the Fugl Meyer Assessment was 0.94; 95% CI from 0.42 to 1.47 in the short term and 0.97; 95% CI from 0.19 to 1.74 in the medium term.

Conclusion:

The extracorporeal shock wave therapy is effective for reducing upper limb spasticity. Adding it to conventional therapy provides an additional benefit.
Beyond Trauma Exposure: Discrimination and Posttraumatic Stress, Internalizing, and Externalizing Problems Among Detained Youth
Authors: Mendez Lucybel , Mozley Michaela M. , Kerig Patricia K.
Published: June 2020

According to the race-based traumatic stress model, racial discrimination is proposed to comprise a traumatic experience that results in posttraumatic stress symptoms, as well as internalizing and externalizing problems among youth. Accordingly, a significant body of research has emerged that supports the associations among these constructs. However, the majority of these empirical studies have not accounted for the potential role of traditionally defined traumatic events in these associations. This study investigated whether self-reported racial discrimination was related to posttraumatic stress symptoms, internalizing, and externalizing symptoms above and beyond the impact of other trauma exposures in a sample of 266 detained youth (79% boys, 60% identified as an ethnic minority). Results of hierarchical linear regressions demonstrated that, after accounting for youths’ other trauma exposures, racial discrimination accounted for significant variance in the models predicting delinquency and risk-taking but no other externalizing and internalizing problems, or posttraumatic stress symptoms. These findings indicate that racial discrimination may be particularly important for understanding offending behavior among detained youth.
An uncommon overlap of two common rheumatological disorders
Authors: Guleria Sandesh , Jindal Ankur , Pilania Rakesh , Bhattarai Dharmagat , Kaur Amanpreet , Naganur Sanjeev , Pandiarajan Vignesh , Suri Deepti , Singh Surjit
Published: June 2020

Juvenile systemic lupus erythematosus (SLE) is a heterogeneous multisystem autoimmune disease. Kawasaki disease is a common vasculitic disorder in children that manifests with fever and mucocutaneous involvement. While overlap of childhood SLE with other rheumatological disorders has been described, it is extremely unusual in the context of Kawasaki disease. We report two children who had SLE and developed features of Kawasaki disease simultaneously, and the second child had myocarditis which could be a manifestation of Kawasaki disease rather than SLE. Two or more rheumatological diseases may coexist at the same time and one must always be vigilant.
The Nexus Between Infrastructure and Export: An Empirical Evidence from Pakistan
Authors: Rehman Faheem Ur , Ding Yibing , Noman Abul Ala , Khan Muhammad Asif
Published: June 2020

This research, by using the autoregressive distributive lag method, examines the long- and short-term causal relationship between infrastructure and exports in Pakistan over the period 1990–2017. The empirical results revealed the existence of short- and long-term bi-directional causality concerning infrastructure and export in Pakistan. The results demonstrated that infrastructure strongly improves export in the short and long run. Conversely, export encourages the quality and availability of infrastructure in Pakistan in the long run. Furthermore, this study also uses sub-indices of infrastructure individually as dependent and independent variables. The study result demonstrated that the long- and short-term effects of infrastructure and its sub-indices (transport, electricity, communication, finance) on export is positive and significant. Also, when infrastructure sub-indices are used as dependent variables, the results indicate that the effect of export on sub-indices is positive and significant in the long run; however, in the short run, it is insignificant. The bi-directional linkage between infrastructure and export suggests that improving the quality and increasing the availability of infrastructure would enable Pakistan’s economy to catch up with the advanced economies, specifically in export. Furthermore, control variables of per-capita GDP, exchange rates, human capital, and domestic spending also expand the bi-directional causal relationship between Pakistan’s infrastructure and exports.
A Systemic Conceptualization of Intimate Partner Violence: Attachment and Differentiation
Authors: Katafiasz Heather
Published: June 2020

Intimate partner violence (IPV) is a national public health concern that is often conceptualized individually. This article provides a systemic understanding of IPV through the separate and combined lens of Bowen family systems and Attachment Theories. A brief individual overview and application to IPV is provided for each theory, followed by a conceptual integration and then an application of the two theories combined to a case example.
Exploring Biologic Correlates of Cancer-Related Fatigue in Men With Prostate Cancer: Cell Damage Pathways and Oxidative Stress
Authors: Dickinson Kristin , Case Adam J. , Kupzyk Kevin , Saligan Leorey
Published: June 2020

The pathobiology of cancer-related fatigue (CRF) remains elusive, hindering the development of targeted treatments. Radiation therapy (RT), a common treatment for men with prostate cancer, induces cell damage through the generation of free radicals and oxidative stress. We hypothesized that disruption in cellular responses to this surge of nonphysiological oxidative stress might contribute to CRF in men with prostate cancer treated with RT. We evaluated the potential role of three cell damage pathways (apoptosis, autophagy, necrosis) and oxidative stress in CRF in men with prostate cancer receiving RT. Fatigue was measured by the Functional Assessment of Cancer Therapy-Fatigue (FACT-F) questionnaire. Gene expression was measured in whole blood using RT2 profiler™ PCR arrays. Data were collected at two time points: either baseline or Day 1 of treatment (T1) and completion of treatment (T2). Participants were grouped into either the fatigued or nonfatigued phenotype at T2 using the recommended FACT-F cut-off score for clinical significance. We observed significant upregulation of seven genes related to three cell damage pathways in the fatigued group from T1 to T2 and no significant changes in the nonfatigued group. We also observed significant downregulation of two genes related to oxidative stress in the fatigued group compared to the nonfatigued group at T2. These collective results provide preliminary evidence that cell damage might be upregulated in the CRF phenotype. Validation of these findings using a larger and more diverse sample is warranted.
Prevention of Sexually Transmitted Infections and Associated Factors Among Night School Students in Bahir Dar City, Ethiopia
Authors: Ayele Yilkal Tiruneh , Asemahagn Mulusew Andualem , Awoke Tadesse
Published: June 2020

Background:

Sexually transmitted infections (STIs) continued to be a global public health concern, primarily among adolescents in poor socioeconomic countries. This study was aimed to assess knowledge, practice, and associated factors of night school students to prevent STIs in Bahir Dar city, Northwest Ethiopia.

Methods:

An institution-based cross-sectional study was conducted among 422 students randomly selected from night schools. Data were collected using a pretested structured questionnaire. Data were entered, cleaned, and analyzed using SPSS version 16 software. Descriptive statistics were used to describe study variables. A multivariable logistic regression analysis was used to identify factors associated with knowledge about STI and its prevention. The strengths of associations were described using odds ratio at 95% confidence interval and a P-value of less than 0.05.

Results:

A total of 420 consented students were enrolled into the study. More than half, 420 (57.9%), and three-fourths, 332 (79%), of the students were women and married. Only 24.8% and 12.4% of the students had good knowledge and practice on the prevention of STIs, respectively. Age, educational status, information access, school health education, and consistent use of condoms were factors associated with the knowledge of students about STIs. Similarly, age, sex, knowledge about STIs, and discussion with families were factors of STI prevention practice among night school students.

Conclusions:

Giving special attention to awareness creation, information access, discussion with families, and improving family/individual income is vital to prevent STIs and its impact among night school students.
Patient-centered care in Russian maternity hospitals: Introducing a new approach through professionals’ agency
Authors: Borozdina Ekaterina , Novkunskaya Anastasiia
Published: June 2020

The article relies on qualitative research methods to investigate how by the means of institutional work healthcare professionals introduce patient-centered care in Russian maternity hospitals. Post-socialist healthcare is commonly viewed in academic literature as a highly centralized and state-controlled domain, where autonomy and agency of both patients and practitioners are significantly restricted. Our research contributes empirically to scholarly debate by questioning this assumption and by providing shreds of evidence of healthcare professionals’ ground-level initiatives. On the conceptual level, we add to the discussion about the dynamic interrelation between institutional change, clients’ demands, and the transformation of professionals’ position. We argue that neoliberal reforms in Russian healthcare have created institutional uncertainty which is strategically used by professionals to expand the scope of their workplace autonomy and to develop patient-centeredness as an institutional innovation. However, our research shows that the resulting model of patient-centeredness contributes to empowering healthcare practitioners, rather than to increasing patients’ participation in decision-making.
Innovation heterogeneity in family firms: Evidence from the date industry in Saudi Arabia
Authors: Alrubaishi Dalal , Alarifi Ghadah , McAdam Maura
Published: June 2020

Researchers have argued that family firm innovation is paradoxical in nature, in that family firms often display less innovation than their nonfamily counterparts, yet they are able to be more innovative. The aim of this article is to unpack this paradox by exploring how differences in family firms’ ability (discretion and resources) and willingness (economic and noneconomic) affect their innovation activities. We adopt a qualitative, interpretive methodology based on four case studies of Saudi family firms operating in the indigenous date industry. Our findings emphasize the importance of having all four sources of ability and willingness in order for innovation to occur and how, when the new generation enters the business, the family firm’s innovation posture changes to either ‘lagging’ or ‘reviving’. By exploring innovation in the date sector in Saudi Arabia, we contribute to the ability–willingness paradox by distinguishing between the different sources of ability and willingness and add to an emerging narrative that acknowledges the integration of past knowledge with new innovative practices as an important and unique mechanism by which family firms can harness innovation.