bluuebunny/crossref_metadata_2025 huggingface dataset:
‘High’ Romanticism: Literature and Drugs
Authors: Ruston Sharon
Published: October 2018

This chapter places Thomas De Quincey’s Confessions of an English Opium-Eater alongside Humphry Davy’s nitrous oxide experiments in order to reveal both the medicalization of De Quincey’s account and the recreational aspects of Davy’s. In the context of other drug experiences in the period, De Quincey’s claims to be offering new medical research seem less hyperbolic than has been assumed. Conversely, Davy’s account of the euphoria produced by nitrous oxide can be read within the discourse of the sublime; his connection with literary figures such as Wordsworth and Coleridge, and his own ventures into Romantic poetry, underline this link. The similarities between De Quincey’s and Davy’s accounts demonstrate how contemporary understanding of drug-taking needs to be rethought in its historical context.
Orality and Improvisation
Authors: Simpson Erik
Published: October 2018

The presence of orality or improvisation in literary texts implies a process of remediation, or the reworking of one medium (speech) into another (print). This chapter addresses ways in which British Romantic writers effected this remediation, especially when portraying the creative processes of minstrels and improvisers in literary works. After introducing key works of theory and criticism bearing on Romantic orality, the chapter analyses the rise of literary minstrelsy in the work of writers such as Walter Scott, who used editorial paratexts to frame the content of minstrelsy in the scholarly conventions of print. It then examines the growth of improvisation as an alternative mode to minstrelsy and shows how literary improvisation was notable for the prominence of women writers in its creation and practice. The chapter closes with a treatment of later blackface minstrelsy’s complex relationship to Romantic representations of orality.
Oeuvre-Making and Canon-Formation
Authors: Gamer Michael
Published: October 2018

During the eighteenth century, the activities of oeuvre-making and canon-formation unquestionably—and increasingly—fed off one another. Much of the reason had to do with changing intellectual property regimes, which made the Statute of Anne law in Scotland by 1751 and in England by 1774. After these dates, publishers in each country could reprint the works of given authors both as stand-alone sets (oeuvres) and as parts of larger, national collections (canons). Between 1774 and 1824, enterprising booksellers did just that, with sales registering in the millions of copies. These publishers’ canons shaped how writers of the Romantic period thought about canonicity. In addition, their publications verify fundamental assumptions about the relative prestige of genres and the rivalries that exist between them, with poetry garnering the most cultural status, followed by drama, and then prose fiction.
Romantic Readers
Authors: James Felicity
Published: October 2018

This chapter examines both the excitement and the anxieties associated with Romantic reading. Thanks to increased literacy, heightened competition in the book trade, and technological advances in printing, eighteenth-century Britain had transformed itself into ‘a nation of readers’, as Samuel Johnson observed in his Lives of the English Poets. This chapter explores what the Romantic nation was reading and how it obtained its books, looking at different forms of libraries and book societies, and at the circulation and the cost of books. It discusses recent critical advances in understanding the complexities of reading practices, and sets these in a wider context of the thematization of reading in the period. The presentation of the Romantic reader is analysed through a range of texts from Lyrical Ballads to the letters of Jane Austen and Charles Lamb. These are placed alongside the testimonies of readers themselves and the traces of reading habits revealed by diaries, reviews, and library records.
Non-Publication
Authors: Pratt Lynda
Published: October 2018

Understanding of Romanticism is currently dominated and shaped by a belief in the primacy of print culture. This chapter explores a cultural phenomenon that coexisted with and ran counter to this familiar narrative: non-publication. In the late eighteenth and early nineteenth centuries, manuscript production massively outnumbered print publication. Manuscript culture was exuberant, wide-ranging, complex, and dominant. It also was symptomatic of a wider, more pervasive culture of non-publication. This encompassed the suppression of completed writings, bibliophobia (an aversion to publication and to print culture), and non-execution, including the refusal to write. Non-publication had a massive impact on writers and readers. It played a crucial, yet hitherto overlooked role in shaping both the Romantic period and our own sense of literary history.
The Ineffable
Authors: Behrendt Stephen C.
Published: October 2018

This chapter examines three figurative modes Romantic authors used to represent the ineffable: allegory, symbol, and myth. In literary studies, these terms identify verbal structures which are usually evaluated in linguistic or semantic terms, although visual expression also has a ‘language’. The chapter emphasizes the linguistic context while also exploring analogies with visual art, explaining how allegory, symbol, and myth provide familiar reference systems both for the verbal and visual artists who employed them and for the audiences who perceived them. All three modes offered ways of encoding, communicating, and interpreting human experience through semantically organized data whose complex referentiality seeks both to reconcile the differences and to reveal the continuities characteristic of a culture of shared experience during the Romantic era.
Literature and Philosophy
Authors: Milnes Tim
Published: October 2018

This chapter proposes that our very notions of ‘literature’ and ‘philosophy’ are, to a great extent, forged in the Romantic era. The chapter surveys the eighteenth-century background to this issue in the sceptical empiricism of David Hume and the German transcendental idealism of Immanuel Kant, F. W. von Schelling, and J. G. Fichte. In examining the writings of William Blake, Edmund Burke, Samuel Taylor Coleridge, William Wordsworth, and William Hazlitt, it also charts the ways in which the revolutionary debates of the 1790s politicized the disciplines of philosophy and ‘theory’, leading to an anti-philosophical rhetoric in the work of writers such as Thomas Love Peacock, Charles Lamb, and Lord Byron. Finally, the chapter scrutinizes the boundaries between Romantic philosophy and the Scottish common-sense philosophy of Thomas Reid and Dugald Stewart, before examining the philosophical significance of the idea of ‘Literature’ in the work of Romantic writers, particularly Percy Shelley and John Keats.
Word and Image
Authors: Thomas Sophie
Published: October 2018

This chapter examines the numerous places where words and images combine or collide in Romantic literature and culture, such as in book production and illustration; in poetry, painting, and theories of the two as ‘sister arts’; in ekphrastic literary texts; in prints and annuals; and in exhibitions and galleries. The chapter explores the historical and artistic context for a range of dynamic experiments that raise conceptual questions about visual and verbal representation, and the nature of the connections between them. At the same time, it unsettles the apparently dual nature of a relationship that in fact often includes objects and places, or extends into other media and forms. Writers and artists discussed include Blake, Wordsworth, Beaumont, Gillray, and Turner.
Orientalism and Hebraism
Authors: Watt James
Published: October 2018

This chapter begins by showing how Sir William Jones used ‘Eastern’ poetry as a means of regenerating English literary culture and expanding its range, exemplified by his role in mediating Hindu mythology for his readers. While works by Coleridge, Shelley, and others responded to this stimulus, a tradition of allegorical verse romance pioneered by Landor used Eastern settings to reflect on the politics of the revolutionary era. Southey’s Thalaba the Destroyer extends the Jonesian project by confronting readers with ‘significant otherness’, while his later poem Roderick, the Last of the Goths dramatizes instead the purging of foreign contamination. The chapter juxtaposes Roderick with Byron’s The Giaour and examines Moore’s Lalla Rookh as a literary pastiche offering readers access to an appealing exotic East. It concludes with Walter Scott’s representation of his heroine Rebecca in Ivanhoe as a retrospect on Orientalism and Hebraism in the Romantic period.
British Romantics Abroad
Authors: Vincent Patrick
Published: October 2018

This chapter explores two possible interpretations of the British Romantics abroad, the first referring to the many writers who travelled on the Continent in this period, the second to their texts that circulated outside of Britain. It argues that these travellers as well as their books contributed to a shared sense of European identity and helped foster liberal democracy in an age of political reaction. The first part of the chapter shows how, despite clear differences between the Grand Tour, Revolutionary travel, and modern tourism, Romantic-period travel writing shares common features, among them the opposition between traveller and tourist, and the ideal of Europe as a system of politically emancipated nations. The second part reviews the channels of transmission, notably foreign reviews and pirated editions, that enabled the transnational circulation and reputation of British-authored texts and helped place Britain’s liberal brand of Romanticism at the forefront of European culture.
Introduction
Authors: Duff David
Published: October 2018

The Romantic movement transformed the literary culture of Britain, and critical analysis of the nature, causes, and effects of that transformation began in the Romantic period itself. This Handbook analyses recent developments in criticism, synthesizing and extending previous scholarship, identifying emergent research trends, and proposing new lines of enquiry. Divided into ten sections, each containing four or five chapters, the Handbook offers a comprehensivesurvey of British and Irishliterature of the Romantic period; its historical, intellectual, and cultural contexts; and its connections with the literature and thought of other countries and periods. The Introduction explainsthe structure of the volume and the rationale that underpins it, summarizing each chapter and section, pinpointing common themes,and discussing the implications of this ambitious conceptual reorganization of Romantic literary scholarship.
Non-ordinary Gender and Sexuality in Indonesian Performance
Authors: Spiller Henry
Published: October 2018

A profusion of Indonesian performance traditions, past and present, involve non-ordinary gender identities and sexual practices. Western theorists might interpret these performances as “queer,” but from indigenous points of view, they articulate quite comfortably with the dominant values of the societies that fostered them and often serve conservative, rather than transgressive, purposes, such as affirming cosmological ideas of duality, complementarity, and the reconciliation of opposites. This chapter surveys traditions from Sulawesi, Kalimantan (Borneo), and Papua, as well as from Java and Bali, which present welcome correctives to oversimplified understandings of compulsory heterosexuality and binary gender/sexuality identities and provide entry points for more nuanced understandings of the relationship of performing arts with “queerness.”
Veiled Threats: Color-Blind Frames and Group Threat in Affirmative Action Discourse
Authors: Carter J Scott , Lippard Cameron , Baird Andrew F
Published: October 2018

This research examines the way color-blind rhetorical techniques are used by supporters and opponents in legal documents submitted to the latest U.S. Supreme court case on affirmative action. Eduardo Bonilla-Silva posited that color-blind ideology is the dominant racial ideology in the United States. We focused our critical discourse analysis particularly on the use of color-blind frames as described by Bonilla-Silva. This research also assesses how group threat was used within color-blind frames to activate feelings of racial animosity, a distinction from the color-blind frames that act to minimize race. Drawing on data from 184 amicus briefs submitted for 2013 and 2016 and using critical discourse analysis, we found both supporters and opponents used color-blind frames, but that these frames were more prevalent (and distinctively used) in opponents’ briefs, where we observed all four of Bonilla-Silva’s color-blind frames. We also found the use of threat by opponents to be distinct and prevalent, suggesting that affirmative action was framed as a source of competition that threatened resources held in high regard by white America. We discuss the implications of these findings for the future of affirmative action and make suggestions for future research.
Post-op capnography monitoring
Authors: Moses Margarie
Published: October 2018

Early identification of opioid-induced respiratory depression is a collaborative effort that requires the dedication of the healthcare team to increase patient safety outcomes.
Vulvar Cancer as a Result of GATA2 Deficiency, a Rare Genetic Immunodeficiency Syndrome
Authors: Toboni Michael D. , Bevis Kerri S.
Published: October 2018

BACKGROUND:

Vulvar cancer has become more prevalent, and its causes include chronic dermatoses and human papillomavirus (HPV)–mediated disease. Younger immunocompromised women can also be affected. We describe a case of vulvar carcinoma as a result of GATA2 deficiency.

CASE:

A 19-year-old woman presented to our gynecologic oncology clinic for management of a large vulvar mass. She was diagnosed with stage IB vulvar carcinoma after vulvectomy. GATA2 deficiency was the contributing factor causing vulvar carcinoma.

CONCLUSION:

GATA2 deficiency causes immunodeficiency in young women, and patients with early-onset HPV–related disease, a family or personal history of leukemia, recurrent infection, or immune irregularities should be screened. Health care providers for these women are often obstetrician–gynecologists, who can provide diagnosis, treatment, referral, and prevention of HPV–related diseases.
A Decision Analysis Model of 1-Year Effectiveness of Intended Postplacental Compared With Intended Delayed Postpartum Intrauterine Device Insertion
Authors: Sonalkar Sarita , Hunter Tegan , Gurney Elizabeth P. , McAllister Arden , Schreiber Courtney A.
Published: October 2018

OBJECTIVE:

To compare, using decision analysis methodology, the 1-year probability of pregnancy after intended postplacental intrauterine device (IUD) insertion with intended delayed insertion at an outpatient postpartum visit (delayed postpartum placement).

METHODS:

We developed an evidence-based decision model with the primary outcome of 1-year probability of pregnancy. We compared 1-year probability of pregnancy after intended postplacental or intended delayed postpartum IUD placement. We obtained estimates from the literature for the proportions of the following: mode of delivery, successful IUD placement, IUD type, postpartum visit attendance, IUD expulsion, IUD discontinuation, and contraceptive use, choice, and efficacy after IUD discontinuation. We performed sensitivity analyses and a Monte Carlo simulation to account for variations in proportion estimates.

RESULTS:

One-year probabilities of pregnancy among a theoretical cohort of 2,500,000 women intending to receive a postplacental IUD after vaginal birth and 1,250,000 women intending to receive a postplacental IUD after cesarean birth were 17.3% and 11.2%, respectively; the 1-year probability of pregnancy among a theoretical cohort of 2,500,000 women intending to receive a delayed postpartum IUD was 24.6%. For delayed postpartum IUD placement to have effectiveness equal to postplacental placement, 91.4% of women delivering vaginally and 99.7% of women delivering by cesarean would need to attend postpartum care. Once placed, the effectiveness of postplacental IUDs was lower than that of delayed postpartum IUDs: 1-year probabilities of pregnancy after IUD placement at a vaginal birth, cesarean birth, and an outpatient postpartum visit were 15.4%, 6.6%, and 3.9%, respectively.

CONCLUSION:

After accounting for factors that affect successful IUD placement and retention, this decision model indicates that intended postplacental IUD insertion results in a lower 1-year probability of pregnancy as compared with intended delayed postpartum IUD insertion.
What Is New in Bladder Pain?
Authors: Whiteside James L.
Published: October 2018

This month we focus on current research in bladder pain. Dr. Whiteside discusses four recent publications, which are concluded with a “bottom-line” that is the take-home message. A complete reference for each can be found in Box 1 on this page along with direct links to abstracts.
Renal Outcomes of Vasopressin and Its Analogs in Distributive Shock: A Systematic Review and Meta-Analysis of Randomized Trials
Authors: Nedel Wagner L. , Rech Tatiana H. , Ribeiro Rodrigo A. , Pellegrini José Augusto S. , Moraes Rafael B.
Published: October 2018

Objectives:

To systematically review the literature and synthesize evidence concerning the effects of vasopressin and its analogs compared with other vasopressors in distributive shock, focusing on renal outcomes.

Data Sources:

We performed a systematic review in MEDLINE, Embase, Cochrane Central, and Clinicaltrials.gov databases.

Study Selection:

Randomized clinical trials that compared vasopressin and its analogs with other vasopressors and reported renal outcomes in adult patients with distributive shock.

Data Extraction:

Paired reviewers independently screened citations, conducted data extraction and assessed risk of bias. Three prespecified subgroup analyses were conducted. Three main outcomes related to acute renal failure were analyzed: the need for renal replacement therapy, acute kidney injury incidence, and acute kidney injury-free days. I
2 test was used to evaluate heterogeneity between studies. Substantial heterogeneity was defined as I
2 greater than 50%. A random-effects model with Mantel-Haenszel weighting was used for all analyses. Heterogeneity was explored using subgroup analysis. The quality of evidence for intervention effects was summarized using Grading of Recommendations Assessment, Development, and Evaluation methodology. This study was registered in the PROSPERO database (CRD42017054324).

Data Synthesis:

Three-thousand twenty-six potentially relevant studies were identified, and 30 articles were reviewed in full. Seventeen studies met the inclusion criteria, including a total of 2,833 individuals. Of these, 11 studies (2,691 individuals) were suitable for quantitative meta-analysis. Overall, the evidence was of low to moderate quality. Patients who received vasopressin and its analogs had a reduced need for renal replacement therapy (odds ratio, 0.59 [0.37–0.92]; p = 0.02; I
2 = 49%) and a lower acute kidney injury incidence (odds ratio, 0.58 [0.37–0.92]; p = 0.02; I
2 = 63%). These results should be interpreted with caution, due to excessive heterogeneity. Acute kidney injury-free data was not pooled, since the small number of studies and extreme heterogeneity.

Conclusions:

In patients with distributive shock, vasopressin and its analogs use is associated with a reduced need for renal replacement therapy and lower acute kidney injury incidence. These results are supported by high risk of bias evidence.
CHANGES IN RETINAL SENSITIVITY AFTER GENE THERAPY IN CHOROIDEREMIA
Authors: Fischer M. Dominik , Ochakovski G. Alex , Beier Benjamin , Seitz Immanuel P. , Vaheb Yousof , Kortuem Constanze , Reichel Felix F. L. , Kuehlewein Laura , Kahle Nadine A. , Peters Tobias , Girach Aniz , Zrenner Eberhart , Ueffing Marius , MacLaren Robert E. , Bartz-Schmidt KarlUlrich , Wilhelm Barbara
Published: October 2018

Purpose:

Choroideremia (CHM) is a rare inherited retinal degeneration resulting from mutation of the CHM gene, which results in absence of functional Rab escort protein 1 (REP1). We evaluated retinal gene therapy with an adeno-associated virus vector that used to deliver a functional version of the CHM gene (AAV2-REP1).

Methods:

THOR (NCT02671539) is a Phase 2, open-label, single-center, randomized study. Six male patients (51–60 years) with CHM received AAV2-REP1, by a single 0.1-mL subretinal injection of 1011 genome particles during vitrectomy. Twelve-month data are reported.

Results:

In study eyes, 4 patients experienced minor changes in best-corrected visual acuity (−4 to +1 Early Treatment Diabetic Retinopathy Study [ETDRS] letters); one gained 17 letters and another lost 14 letters. Control eyes had changes of −2 to +4 letters. In 5/6 patients, improvements in mean (95% confidence intervals) retinal sensitivity (2.3 [4.0] dB), peak retinal sensitivity (2.8 [3.5] dB), and gaze fixation area (−36.1 [66.9] deg2) were recorded. Changes in anatomical endpoints were similar between study and control eyes. Adverse events were consistent with the surgical procedure.

Conclusion:

Gene therapy with AAV2-REP1 can maintain, and in some cases, improve, visual acuity in CHM. Longer term follow-up is required to establish whether these benefits are maintained.
Influence of Incision Size on Dry Eye Symptoms in the Small Incision Lenticule Extraction Procedure
Authors: Cetinkaya Servet , Gulmez Mehmet , Mestan Emine , Ucar Fikret , Ali Nermin
Published: October 2018

Purpose:

To evaluate the influence of incision size on dry eye symptoms in the small incision lenticule extraction (SMILE) procedure.

Methods:

Ninety-four eyes of 47 patients with myopia and/or myopic astigmatism who had undergone the SMILE procedure were enrolled in this study. The patients were divided into 3 groups according to the incision size (2, 3, and 4 mm) applied during the SMILE procedure.

Results:

There were no significant differences among the groups in respect to age and sex (P values 0.251 and 0.974, respectively) and in respect to preoperative, postoperative first day, first week, first month, third month, and sixth month values of the Ocular Surface Disease Index score, tear break-up time, ST1, and staining grades.

Conclusions:

There was no difference in dry eye symptoms with 2-, 3-, and 4-mm incisions. In the learning period of SMILE surgery, larger incision sites can be used to make the procedure easier.
Two Femtosecond Laser LASIK Platforms: Comparison of Evolution of Visual Acuity, Flap Thickness, and Stromal Optical Density
Authors: Parafita-Fernández Alberto , García-Gonzalez Montserrat , Katsanos Andreas , Gros-Otero Juan , Teus Miguel
Published: October 2018

Purpose:

To compare postoperative evolution of visual acuity, flap thickness, and stromal optical density during the first 3 months after femtosecond (FS) laser in situ keratomileusis surgery for correction of myopia using the iFS 150-kHz FS laser and LenSx FS laser platforms.

Methods:

This was a prospective case series. Thirty-nine eyes treated with the iFS 150-kHz FS laser versus 38 refraction-matched eyes treated with the LenSx FS laser platform were included. Visual outcomes, flap morphology, and optical density of the stroma (in both flap and residual stromal bed) were compared at 4 visits during a three-month follow-up period.

Results:

No significant differences were found in uncorrected distance visual acuity in any of the follow-up visits (1 day −0.02 vs. −0.03; 1 week −0.04 vs. −0.03; 1 month −0.04 vs. −0.04; 3 months −0.03 vs. −0.05 logarithm of the minimum angle of resolution). Flaps created with the iFS 150-kHz FS laser were closer to the intended thickness (110 μm) in every postoperative comparison (1 day 108.6 vs. 124.3; 1 week 107.6 vs. 123.6; 1 month 110.4 vs. 126.8; 3 months 116.2 vs. 126.5 μm; P < 0.0001). Dispersion of values, standard deviation, intraflap range, and differences in symmetric points were lower in the iFS 150-kHz FS laser group. Flap stromal optical density was significantly higher in the LenSx FS laser group at day 1 and week 1 (134.5 vs. 158.9 gray scale unit [GSU]; P < 0.0001 and 144.8 vs. 160.1 GSU; P = 0.011, respectively). Residual stromal bed optical density was higher in the LenSx FS laser group at all postoperative visits, and the differences reached significance at 1 week postoperatively (121.9 vs. 135.4 GSU; P = 0.03).

Conclusions:

Although both devices provided satisfactory visual outcomes, significant differences were detected in flap parameters. Flaps made with the iFS 150-kHz FS laser were thinner, more uniform, transparent, and accurate compared with those obtained with the LenSx FS laser.
Individualized Family-Centered Developmental Care
Authors: Lisanti Amy Jo , Vittner Dorothy , Medoff-Cooper Barbara , Fogel Jennifer , Wernovsky Gil , Butler Samantha
Published: October 2018

Background

Infants born with critical congenital heart disease (cCHD) who require surgical intervention in the newborn period are often hospitalized in a cardiac intensive care unit (CICU). Cardiac surgery and the CICU environment are traumatic to infants and their families. Infants are exposed to overwhelming stress, which can result in increased pain, physiologic instability, behavioral disorganization, disrupted attachment, and altered brain development. Individualized Family-centered Developmental Care (IFDC) is a model that can address the unique needs and developmental challenges of infants with cCHD.

Purpose

The purpose of this article is to (1) clearly describe the uniqueness of the infant with cCHD, including the medical, neurological, and parental challenges, and (2) propose methods to apply IFDC to support recovery of infants with cCHD in the CICU.

Conclusions

The experiences in the CICU shape the developing brain and alter recovery and healing, thus adversely impacting development. Individualized Family-centered Developmental Care is a promising model of care that nurses can integrate into the CICU to promote neuroprotection and development. Nurses can effectively integrate IFDC into the CICU by understanding the unique characteristics of infants with cCHD and applying IFDC interventions that include both maturity and recovery perspectives.

Clinical Implications

The incorporation of IFDC interventions is essential for the infant with cCHD and should be a standard of care. Applying IFDC with a recovery perspective in all aspects of caregiving will provide opportunities for individualization of care and parent engagement, allowing infants in the CICU to recover from surgery while supporting both short- and long-term neurodevelopment.
Cochlear Implant Insertion Depth Prediction: A Temporal Bone Accuracy Study
Authors: Anschuetz Lukas , Weder Stefan , Mantokoudis Georgios , Kompis Martin , Caversaccio Marco , Wimmer Wilhelm
Published: October 2018

Hypothesis:

The aim of this study was to present and validate the accuracy of a method to predict the required cochlear implant (CI) electrode array length for a specific angular insertion depth (AID).

Background:

The human cochlea exhibits remarkable interindividual morphological differences. The prediction of the required array length for a specific AID can help to improve the outcome of cochlear implant surgery.

Methods:

We estimated the linear insertion depth required for an angular insertion of 540 degrees using computed tomography images of 16 temporal bone specimens (eight Thiel fixed, eight formalin fixed). Free fitting electrode arrays were marked accordingly and inserted through a custom-made insertion guide tube. The achieved AIDs were assessed using postoperative micro-computed tomography scans.

Results:

In the Thiel specimens, the difference between the aimed depth of 540 degrees and achieved insertion depth was small (average 529 degrees, p = 0.076), with a mean prediction error of –11 degrees (maximum 30 degrees), indicating a small underestimation. By contrast, we observed early resistance during the insertions in the formalin specimens (average 409 degrees, p < 0.0001), resulting in a mean error of −131 degrees and bending of the electrode array in the cochlear basal turn in four of eight specimens.

Conclusion:

The equation presented in this study for calculating linear insertion depths can be helpful for the selection of adequate electrode array lengths in a clinical setting. The Thiel conservation is a highly suitable model for cadaveric electrode insertion studies. A free online calculator is available at http://www.hno.insel.ch/de/forschung/ci_estimator/.
A case report of a polytrauma patient with penetrating iron rods in thorax and head
Authors: Tang Xinpu , Chen Hongxu , Chen Chaoyue , Xu Jianguo
Published: October 2018

Introduction:

Impalement injury is an uncommon presentation, and penetrating chest injuries account for 1% to 13% of thoracic trauma hospital admissions. The vast majority of patients with penetrating thoracic trauma who survive to reach the hospital alive can be managed nonoperatively. Nevertheless, in 10% to 15% of cases, emergency operation is necessary due to the associated hemorrhagic shock and visceral injury.

Case presentation:

Here, we report on a 39-year-old male, a construction worker, who fell down from a height of a construction site, landing ventrally on a clump of iron rods with 4 projecting heavy metallic rods penetrating into his thorax and head (scalp pierced only). Emergency surgery was taken, and the patient had an uneventful successful outcome.

Conclusions:

After massive thoracic impalement, rapid transportation to a tertiary trauma center with the impaled objects in situ can improve the outcome. Video-assisted thoracic surgery (VATS) is recommended to remove the foreign body under direct vision and to reduce the incidence of missed, potentially fatal vascular or visceral injuries.
A 5-year follow-up of primary seminal vesicle adenocarcinoma
Authors: Yin Tiejun , Jiang Yueqiang
Published: October 2018

Rationale:

Primary seminal vesicle adenocarcinoma (PSVA) is an extremely rare malignancy that should be carefully differentiated from cancer originating in the prostate, colon or bladder. Without standard guidelines, radical resection is considered a mainstay treatment, providing the best prognosis. However, as manifestations of PSVA are not detected in early stages, the majority of cases of PSVA are diagnosed at late stages, contributing to poor prognosis.

Patient concerns:

We described the case of a PSVA patient confirmed by histopathology and immunohistochemistry (IHC) staining positive for carbohydrate antigen-125 (CA-125) and negative for prostate specific antigen (PSA).

Diagnosis:

Primary seminal vesicle adenocarcinoma.

Interventions:

Surgery was carried out at the beginning, however, residual tumor was verified; thus 3 cycles of chemotherapy with a regimen of paclitaxel and cis-platinum were performed, followed by radical pelvic radiotherapy with a dose of 60 Gray in 30 fractions; then, another 3 cycles of the same chemotherapy were carried out.

Outcomes:

At the moment, the patient is still under follow-up and has been disease-free for more than 5 years.

Lessons:

Our manuscript describes a patient with PSVA with long-term survival and supplies a successful management strategy for this malignancy.
Development in sunburn 2007–2015 and skin cancer projections 2007–2040 of campaign results in the Danish population
Authors: Køster Brian , Meyer Maria , Andersson Therese , Engholm Gerda , Dalum Peter
Published: October 2018

Exposure to ultraviolet radiation is the main risk factor for skin cancer. Denmark has one of the highest incidences of skin cancer in the world. In 2007, a long-term sun safety campaign was launched in Denmark. We have evaluated the effects on prevalence of sunburn and modeled the effects on future melanoma incidence.

Sunburn was evaluated by annual cross-sectional surveys representative for the Danish population on age, gender, and region. During 2007–2015, survey data were collected for 33.315 Danes. Cutaneous Melanoma incidences were modeled in the Prevent program, using population projections, historic incidence, sunburn exposure, and relative risk of sunburn on melanoma.

The prevalence of sunburn in Denmark was reduced with 1% annually during 2007 to 2015. The campaign is estimated to have reduced the number of skin cancer cases with 664 annually in 2040 and 14.326 totally during 2007 to 2040. If the campaign was terminated in 2015 and sunburn rates return to precampaign level there would be no annual reduction in 2040 while in total the reduction would be 4.024 cases for 2007 to 2040. A continuous campaign until 2040 would yield annual reductions of 2.121 cases by 2040 and a total of 29.729 cases for the entire period.

We have showed the value of prevention and the value of long-term planning in prevention campaigning. Sunburn use was reduced significantly during 2007–2015 and further reductions are possible. Consequently, we predict significant fewer skin cancer cases as anticipated.
Bone mineral loss and cognitive impairment
Authors: Kang Hyun Goo , Park Hyun Young , Ryu Han Uk , Suk Seung-Han
Published: October 2018

Low bone mineral density (BMD) is correlated with Alzheimer's disease and its severity, but the association remains unclear in adults (≥50 years) without a history of stroke or dementia.

We assessed BMD and cognitive function using the Mini-Mental Status Examination (MMSE) in 650 stroke- and dementia-free subjects (≥50 years) who were recruited for an early health check-up program between January 2009 and December 2010.

The mean age was 62.9 ± 8.0 years and mean MMSE score was 27.6 ± 3.6. A total of 361 subjects had reduced BMD: 197 (30.3%) had osteopenia and 154 (23.6%) had osteoporosis, based on criteria of world health organization. A total of 5.4% of the male subjects had osteoporosis, versus 19.8% of the female subjects. After adjusting for age, sex, education, and other possible confounding factors such as hypertension, diabetes mellitus, and smoking, the estimated odds ratio for cognitive impairment was 1.72 for the osteopenia group (95% confidence interval [CI] 1.09–2.14, P = .019) and 2.81 for the osteoporosis group (95% CI 1.78–4.45, P < .001).

Low BMD is correlated with cognitive impairment in community-dwelling adults aged 50 years and above without any medical history of stroke or dementia, especially in women. A community-based, early life, preventive osteoporosis education campaign might decrease the incidence of dementia.
A Morel-Lavallée lesion of the proximal calf in a young trauma patient
Authors: Kim Woo Jong , Lee Hong Seop , Won Sung Hun , Hong Yong Cheol , Lee Dhong Won , Lee Ji-Hye , Kim Chang Hyun
Published: October 2018

Rationale:

The Morel-Lavallée lesion (MLL) is a closed degloving injury developing when shear force acts between the muscle fascia and the subcutaneous layer. MLLs develop principally in the trochanteric area or the pelvis; lesions in the proximal calf are rare. Acute lesions can be treated conservatively, but chronic lesions are best treated surgically because of a high rate of recurrence. To the best of our knowledge, this is a rare case of successful treatment of an MLL in the proximal calf associated with tibio-fibular shaft fracture.

Patient concerns:

A 14-year-old male visited our emergency room after having been hit by a car. He exhibited direct trauma to the right lower leg and a distal tibio-fibular shaft fracture without an open wound. He underwent surgery to treat the fracture, which was immobilized with splint for 2 weeks post-operatively. At the 3-month follow-up, he complained of a painless, mobile, soft tissue mass in the posteromedial aspect of the proximal calf. Blood circulation was normal and we found no neurological abnormality in the distal region of the lower leg.

Diagnosis:

A plain radiograph of the right lower leg revealed a proximal, round, radiopaque soft tissue lesion. Ultrasonography revealed a homogeneous, hypoechoic fluid collection. Magnetic resonance imaging revealed fluid of homogeneous signal intensity between the subcutaneous layer and the underlying fascia of the gastrocnemius muscle.

Interventions:

Percutaneous drainage and intralesional steroid injection were performed on several occasions, but the lesion recurred every time. After 5 aspirations, we scheduled surgery. We radically excised the mass and sutured the superficial to the deep fascia to prevent shearing at the surgical plane.

Outcomes:

No complication or recurrence was noted at the 1-year follow-up.

Lesson:

An MLL in the proximal calf is an uncommon post-traumatic lesion and care must be taken to avoid misdiagnosis. If an MLL is suspected after imaging studies and physical examination, it is important to determine whether the lesion is acute or chronic and to plan treatment accordingly. Appropriate treatment should be given to patients to improve outcomes.
Lipoid pneumonitis in a patient with an accidental ingestion of kerosene successfully treated with bronchoscopic segmental lavage and systemic steroid
Authors: Kim Hyo-Jung , Lee Won Hyuk , Jeong Nari , Lee Jae Ha , Park Jin Han , Jang Hang Jea , Kim Hyun-Kuk
Published: October 2018

Rationale:

Standard treatment of lipoid pneumonitis remains unclear. This study reports a case of kerosene pneumonitis successfully treated with systemic steroid and segmental bronchoalveolar lavage (BAL).

Patient concerns:

A 30-year-old woman referred to our hospital because of worsening of respiratory symptoms and fever despite antibiotic therapy following accidental ingestion of kerosene. She had no underlying disease.

Diagnoses:

Chest CT scan showed necrotic consolidation, ground glass opacity (GGO), bronchial wall thickening in the right middle/lower lobe (RML/RLL) and right pleural effusion. The lipoid pneumonitis was confirmed by identification of a lipid laden macrophage in bronchoalveolar lavage fluid.

Interventions:

The patient was treated with systemic corticosteroid and segmental BAL.

Outcomes:

The patient's symptoms rapidly improved after treatment and she was discharged one week after admission. A follow-up CT scan a week after discharge revealed marked resolution of consolidation. No recurrence was reported for 8 months.

Lessons:

This is the first case of kerosene pneumonitis successfully treated with systemic steroid and bronchoscopic segmental lavage therapy in Korea. Very few cases have been reported worldwide.
Causative Agents of Drug-Induced Pancreatitis
Authors: Chung Eun Kyoung , Lee Ji Hyun , Jang Dong Kee , Lee Sang Hyub , Lee Jin Ho , Park Byung-Joo , Kwon Kyenghee , Lee Jun Kyu
Published: October 2018

Objectives

The aim of this study was to analyze causes of drug-induced acute pancreatitis (DIAP) in Korea and factors associated with serious DIAP.

Methods

Case records of DIAP voluntarily reported to the Korea Adverse Event Reporting System from 2004 to 2013 were reviewed. When a patient took 2 or more drugs, each drug was identified as a potential cause. The seriousness of each case was determined based on the International Conference on Harmonization E2D Guideline. Logistic regression was performed to identify factors associated with the seriousness of DIAP.

Results

During the study period, 210 (0.05%) of 442,523 adverse event reports were (0.05%) DIAP. The most common causative medication of the DIAP cases with certain, probable/likely, and possible causality (n = 74) was l-asparaginase (n = 18), followed by azathioprine (n = 6), methylprednisolone (n = 6), and fenofibrate (n = 5). Serious events occurred in 43 cases (58%) with certain, probable/likely, and possible causality. They were significantly associated with the year of report (odds ratio, 0.572; P = 0.025) and the number of concurrently used medications (odds ratio, 2.659; P = 0.006).

Conclusions

l-Asparaginase is the most common cause of DIAP in Korea. Serious DIAP is more likely to occur in patients taking multiple medications.
Clinical Characteristics and Genetic Causes of Infantile Exocrine Pancreatic Insufficiency in Chinese Patients
Authors: Ye Ziqing , Zhou Ying , Huang Ying , Sun Hua , Wang Huijun , Wu Bingbing
Published: October 2018

Objective

Infantile exocrine pancreatic insufficiency is a rare disease. We examined phenotypes and performed genetic sequencing in children with this disorder.

Methods

We enrolled 4 infants with exocrine pancreatic insufficiency. Patients were characterized by phenotypes and radiologic findings. Genetic sequencing was performed.

Results

Average age of disease onset was 2 months. Average (standard deviation [SD]) age at diagnosis was 11.9 (7.0) months. Patients presented with chronic steatorrhea and failure to thrive. Two had mild zinc deficiency. Imaging showed pancreatic lipomatosis and metaphyseal dysplasia among all patients. For these patients with similar phenotypes, genetic sequencing revealed that 2 patients had novel UBR1 mutations (c.[3043_3046delAAAG; c.3848 + 6T > C] and c.[1850-2A > T;c.4290T > G], reference sequence NM_174916), and another 2 patients had homozygous SBDS c.258 + 2T > C mutation and SBDS c.[258 + 2T > C;c.428C > T] mutations (reference sequence NM_016038.2). All patients received pancreatic enzyme replacement therapy.

Conclusions

Here we described 4 patients with infantile exocrine pancreatic insufficiency confirmed by laboratory tests and imaging. Whole-exome sequencing and Sanger sequencing showed that 2 patients had Johanson-Blizzard syndrome and 2 patients had Shwachman-Diamond syndrome. Genetic sequencing should be applied for definite diagnosis among these patients.
IDH1 mutation promotes lung cancer cell proliferation through methylation of Fibulin-5
Authors: Yan Bingdi , Hu Yanbing , Ma Tiangang , Wang Yanjun
Published: October 2018

Mutation in isocitrate dehydrogenase (
IDH
) leads to an aberrant function of the enzyme, leading to the production of hydroxyglutarate, as well as changes in cellular metabolism, DNA methylation and histone modification. Previous studies uncovered mutations in
IDH1
in several malignancies, with the most frequent mutation being IDH1 R132H. It has been demonstrated that IDH1 expression is induced in non-small-cell lung cancer (NSCLC). However, the contribution of IDH1 mutation in the malignant transformation and development of NSCLC is unclear. In our study, we show that IDH1 R132H enhanced the migration and proliferation of NSCLC cells. Moreover, IDH1 R132H was a crucial modulator of 2-hydroxyglutarate, whose production from cells with IDH1 mutation promoted the binding of DNA-methyltransferase 1 (DNMT1) to the Fibulin-5 promoter, leading to its methylation. As a result, Fibulin-5 silencing in cells with IDH1 mutation enhanced the migration and proliferation of NSCLC cells. We show that the IDH1 mutation was present in tissues sampled from patients with NSCLC, which was reversely linked to Fibulin-5 expression. In this study, we suggest an innovative model for IDH1 R132H/Fibulin-5 pathway, which could throw light upon the activity of IDH1 R132H in NSCLC.
Impaired development of neocortical circuits contributes to the neurological alterations in DYRK1A haploinsufficiency syndrome
Authors: Arranz Juan , Balducci Elisa , Arató Krisztina , Sánchez-Elexpuru Gentzane , Najas Sònia , Parras Alberto , Rebollo Elena , Pijuan Isabel , Erb Ionas , Verde Gaetano , Sahun Ignasi , Barallobre Maria J. , Lucas José J. , Sánchez Marina p. , de la Luna Susana , Arbonés Maria L.
Published: October 2018

Autism spectrum disorders are early onset neurodevelopmental disorders characterized by deficits in social communication and restricted repetitive behaviors, yet they are quite heterogeneous in terms of their genetic basis and phenotypic manifestations. Recently, de novo pathogenic mutations in DYRK1A, a chromosome 21 gene associated to neuropathological traits of Down syndrome, have been identified in patients presenting a recognizable syndrome included in the autism spectrum. These mutations produce DYRK1A kinases with partial or complete absence of the catalytic domain, or they represent missense mutations located within this domain. Here, we undertook an extensive biochemical characterization of the DYRK1A missense mutations reported to date and show that most of them, but not all, result in enzymatically dead DYRK1A proteins. We also show that haploinsufficient Dyrk1a+/- mutant mice mirror the neurological traits associated with the human pathology, such as defective social interactions, stereotypic behaviors and epileptic activity. These mutant mice present altered proportions of excitatory and inhibitory neocortical neurons and synapses. Moreover, we provide evidence that alterations in the production of cortical excitatory neurons are contributing to these defects. Indeed, by the end of the neurogenic period, the expression of developmental regulated genes involved in neuron differentiation and/or activity is altered. Therefore, our data indicate that altered neocortical neurogenesis could critically affect the formation of cortical circuits, thereby contributing to the neuropathological changes in DYRK1A haploinsufficiency syndrome.
Individual variability in behavior and functional networks predicts vulnerability using a predator scent model of PTSD
Authors: Dopfel David , Perez Pablo D. , Verbitsky Alexander , Bravo-Rivera Hector , Ma Yuncong , Quirk Gregory J. , Zhang Nanyin
Published: October 2018

Only a minority of individuals who experience traumatic event(s) subsequently develop post-traumatic stress disorder (PTSD). However, whether differences in vulnerability to PTSD result from predisposition or a consequence of trauma exposure remains unclear. A major challenge in differentiating these possibilities is that clinical studies focus on individuals already exposed to traumatic experiences, and do not take into account pre-trauma conditions. Here using the predator scent model of PTSD in rats and a longitudinal design, we measured pre-trauma brain-wide neural circuit functional connectivity (FC), behavioral and corticosterone responses to trauma exposure, and post-trauma anxiety. Individual differences in freezing responses to predator scent exposure correlated with differences in pre-trauma FC in a set of neural circuits, especially in olfactory and stress-related systems, indicating that pre-existing function in these circuits could predispose animals to differential fearful responses to threats. Counterintuitively, rats with the lowest freezing showed more avoidance of the predator scent, a prolonged corticosterone response, and higher anxiety long after exposure. This study provides a comprehensive framework of pre-existing circuit function that determines threat response strategy, which might be directly related to the development of PTSD-like behaviors.