bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk Factors for the Development of Ocular Hypertension After Keratoplasty: A Systematic Review
Authors: Liesenborghs Ilona , Schouten Johannes S. A. G. , Berendschot Tos T. J. M. , Beckers Henny J. M. , Nuijts Rudy M. M. A. , Visser Nienke , Webers Carroll A. B.
Published: November 2019

Purpose:

To identify risk factors for the development of ocular hypertension after keratoplasty.

Methods:

A systematic search in PubMed and Embase identified 67 relevant articles published between January 1990 and 2019. We preferentially searched for data on an intraocular pressure increase above 21 mmHg at 6 months or a threshold or time point close to that and reported whether the preoperative or intraoperative status of risk factors was defined. The results were presented in evidence tables, visualizing the direction of the association, whether univariate and/or multivariate analysis was performed, and the significance level (P < 0.05). Four researchers, blinded for the risk factors, independently assigned a level of evidence (definitely, probably, possibly, not associated). Consensus was met during group meetings.

Results:

From the 110 studied risk factors, pre-existing glaucoma, high preoperative IOP and combined keratoplasty with removal or exchange of an intraocular lens (IOL) were definitely associated with an increased risk. In addition, if the pre-or postoperative lens status was undefined, aphakia and pseudophakia with the IOL in the anterior or posterior chamber were also definitely associated with an increased risk when compared to phakia. Glaucoma in the contralateral eye, indication of bullous keratopathy, African American descent, preoperative treatment with cyclosporine or olopatadine 0.1%, postoperative treatment with prednisolone acetate 1%, and combined surgery in general (ie, the type of surgeries undefined in primary studies) were probably associated. Multiple other identified risk factors lack sufficient evidence and need additional investigation.

Conclusions:

Risk factors with a definite association can help clinicians select patients at risk and adjust their follow-up and treatment. The other factors need further investigation.
Measurement tools for chronic pruritus: assessment of the symptom and the associated burden: a review
Authors: Pereira Manuel P. , Ständer Sonja
Published: November 2019

Chronic pruritus is a subjective, multidimensional and highly impairing symptom of difficult assessment. Its clinical features and secondary burdens may vary substantially between affected individuals and within the same patient across time. Standardized scales and questionnaires have been developed to assess the various dimensions of chronic pruritus. Instruments addressing the intensity, distribution, qualities of associated symptoms, skin status and course over time are available for clinical trials. In addition, patient-oriented questionnaires on reactive conditions, including sleep disorders, anxiety, depression, and impairment of quality of life can be used. Assessing the individual patient’s needs before and throughout the treatment is valuable in directing therapeutic priorities and maximizing patient’s satisfaction. Along with a detailed medical history and a comprehensive physical examination, these instruments should be implemented in the clinical routine to achieve a comprehensive assessment of each patient. European experts of the European Academy of Dermatology and Venereology (EADV) considered a priority the use of intensity scales and questionnaires on quality of life. Harmonization of the assessment procedures should be aimed for across attending physicians. New technologies including electronic diaries or the use of tablet computers to complete assessment tools constitute helpful aids in the clinical practice by facilitating data collection and saving time.
Sexual Assault Reporting and Emotional Distress Among College Female-Identified Victims/Survivors
Authors: Eisenberg Marla E. , Palacios Lena , Lust Katherine , Porta Carolyn M.
Published: November 2019

Purpose

The current study tests associations between reporting sexual victimization to a healthcare provider, campus authority, police, or social contact, and emotional well-being among college women.

Methods

Data from 2,162 women who participated in the 2015 College Student Health Survey at 17 colleges in Minnesota was used. Analyses tested associations between reporting sexual assault to formal or informal resources and diagnosis with anxiety, depression, panic attacks, and posttraumatic stress disorder, as well as self-rated health.

Results

Significantly higher rates of all four diagnoses were observed among those who reported to formal resources (e.g., healthcare provider, police) compared with those who reported to informal resources (i.e., friends, family). However, no differences were seen in self-rated physical or mental health.

Conclusions

Expansion of trauma-informed healthcare services and advocacy efforts is recommended to optimally support students who report sexual assault experiences.
A Systematic Review on Implementing Education and Training on Trauma-Informed Care to Nurses in Forensic Mental Health Settings
Authors: Maguire Donna , Taylor James
Published: November 2019

Background:

Engaging in trauma-informed approaches in nonforensic mental health settings improves therapeutic relationships, promotes healing, promotes posttraumatic growth, improves staff well-being, and fosters hope and empowerment, yet little is known of its influences in forensic settings. This literature review explores trauma-informed education and its training implications for nurses working in forensic mental health.

Method:

Using a range of electronic databases, a systematic search of literature was carried out focusing on trauma-informed practice in adult forensic mental health settings. Before searching, predefined inclusion and exclusion criteria were agreed.

Findings:

After duplication removal, abstract review, and full screening, nine articles met review criteria for inclusion. A thematic analysis of the literature identified two key themes: “education for trauma-informed practice” and “applying theory into practice.” Each had several subordinate themes.

Implications for Forensic Practice:

Organizations and their staff must recognize that operational change and ongoing training will be required. By adopting a trauma-informed approach, forensic mental health nurses can better understand their patients' traumatic experiences, improve their therapeutic relationships, and engage patients in collaborative care. Training in trauma-informed care should start with nurses who will change their personal practice and can support and train their colleagues.
Effect of Socioeconomic Factors on the Relationship Between Musculoskeletal Pain and Ill-Health Retirement in Korea
Authors: Lee Seyoung , Yoon Jin-Ha , Kang Young Joong , Kim Taeshik , Koo Jung-Wan , Kang Mo-Yeol
Published: November 2019

Objective:

To investigate the relationship between musculoskeletal pain (MSP) and ill-health retirement (IHR) and modifying role of socioeconomic factors.

Methods:

The data used were samples from the Korean Longitudinal Study of Aging from 2006 to 2014. IHR was defined as retirement due to health problems before regular retirement age. Hazard ratio (HR) was calculated using Cox proportional hazards model to determine the effects of MSP and covariance on IHR.

Results:

People who have “any site of pain” were more likely to experience IHR than people with no pain. In the subgroup analysis, risk of IHR due to MSP was higher in the 60s, white-collar, and high-income earners than the other groups.

Conclusions:

MSP has a substantial negative impact on labor force participation, and there was a clear effect modification of socioeconomic status on IHR risk.
Can pathologists reliably establish ampulla of Vater carcinoma histologic subtype on H&E alone? Concordance of subtype and comparison to immunohistochemistry-established subtype
Authors: Tanager Kevin S. , Li Yueying , Alpert Lindsay , Setia Namrata , Weber Christopher , Hart John , Xiao Shu-Yuan
Published: November 2019

Histologic subtyping of ampulla of Vater carcinoma (ampullary carcinoma, AC) may guide choice of adjuvant chemotherapy for advanced disease, as intestinal (INT) subtype may have a better treatment response and survival as compared to the pancreatobiliary (PB) and mixed (MIX) subtypes. However, ambiguous morphologic features can result in inconsistent subtyping among pathologists. Recently immunohistochemistry (IHC) for cytokeratin (CK)7, CK20, CDX2, and the Mucin (MUC) family proteins had been used to aid in the subtyping. It is important to determine if accurate subtyping can be achieved based on hematoxylin and eosin (H&E) evaluation alone, or if IHC is required. In this study, 5 gastrointestinal pathologists evaluated 34 cases of AC for histologic subtype (PB, INT, or MIX) based on H&E stain alone. IHC studies (CK7, CK20, and CDX2) were used to determine a gold standard subtyping for comparison (strong CK7 with weak CK20 and CDX2 = PB; strong CK20 or CDX2 and weak CK7 = INT; strong CK7 and CK20 or CDX2 = MIX). Interobserver concordance (kappa) was calculated. Percent correctness of subtyping was calculated in relation to IHC-established subtype gold standard. Interobserver concordance for subtype was fair (kappa 0.31). Percent correctness for subtype against IHC-established subtype was 50% for a majority (3 or more) of pathologists. In all 11 cases with 4 or 5 pathologists being concordant, the subtype was also correctly identified. In addition, data on chemotherapy regimen and overall survival was gathered from the electronic medical record. Patients who were assigned a subtype at time of diagnosis tended to receive gemcitabine for PB subtype, and FOLFOX-based therapy for INT subtype, with some cases diagnosed as “not-otherwise specified” typically also receiving gemcitabine. Survival data were limited by loss to follow-up. In conclusion, despite 11 cases with strong concordance and correctness, overall subtyping concordance was only fair, and a majority of the 5 pathologists correctly identified the subtype in only 50% of cases. Thus, while some AC cases yield clear-cut subtyping, significant discrepancy among pathologists remains. It appears that utilization of IHC to identify subtype in AC cases is necessary to provide accurate, reliable prognostic and therapeutic information.
The effect of pre-procedural sublingual nifedipine on radial artery diameter
Authors: Bi Xile , Jia Hongdan , Wang Qingsheng
Published: November 2019

Objective

This study aimed to investigate the effect of nifedipine on radial artery (RA) relaxation before puncture for coronary intervention.

Methods

In all, 120 patients were randomly assigned to nifedipine or control group. The diameter, resistance index (RI), and peak systolic velocity (PSV) of the RA were observed at 5, 15, and 30 min after nifedipine administration by a Doppler ultrasound examination.

Results

The greatest effect on RA diameter, PSV and resistance index (RI) was observed 5 minutes after sublingual nifedipine administration. The RA parameter were associated with the baseline diameter.

Conclusions

Sublingual nifedipine administration before RA puncture has an obvious dilatation effect on small diameter RAs.
The role of computer-based clinical decision support systems to deliver protective mechanical ventilation
Authors: Khemani Robinder G. , Hotz Justin C. , Sward Katherine A. , Newth Christopher J.L.
Published: November 2019

Purpose of review

Mechanical ventilation of adults and children with acute respiratory failure necessitates balancing lung and diaphragm protective ventilation. Computerized decision support (CDS) offers advantages in circumstances where complex decisions need to be made to weigh potentially competing risks, depending on the physiologic state of the patient.

Recent findings

Significant variability in how ventilator protocols are applied still exists and clinical data show that there continues to be wide variability in ventilator management. We have developed a CDS, which we are currently testing in a Phase II randomized controlled trial. The CDS is called Real-time Effort Driven ventilator management (REDvent). We will describe the rationale and methods for development of CDS for lung and diaphragm protective ventilation, using the REDvent CDS as an exemplar.

Goals for achieving compliance and physiologic objectives can be met when CDS instructions are simple and explicit, provide the clinician with the underlying rule set, permit acceptable reasons for declining and allow for iterative adjustments.
Adverse Events After Inpatient Colonoscopy in Octogenarians
Authors: Olaiya Babatunde , Adler Douglas G.
Published: November 2019

Background and Aim:

Colonoscopy is commonly performed in the elderly who have a higher proportion of lower gastrointestinal (GI) tract disorders. However, few studies have evaluated the safety of colonoscopy specifically in the octogenarian population. The goal of this study is to examine the safety of colonoscopy among octogenarians over a 16-year period. We also examine risk factors associated with morbidity and mortality in octogenarians after inpatient colonoscopy.

Materials and Methods:

We queried the National Inpatient Sample to identify octogenarians who had a colonoscopy during hospitalization from 1998 to 2013. We examined inpatient GI-related adverse events including colonic perforation, postcolonoscopy bleeding, and splenic injury. We also examined all-cause mortality rates after colonoscopy.

Results:

About a quarter of inpatient colonoscopies performed annually were in octogenarians. Of 296,385 colonoscopies included in our study, colon perforation, postcolonoscopy bleeding, and splenic injury occurred in 11, 9, and 0.22 per 1000 colonoscopies, respectively. Overall mortality rate was 2.8%, most (2.5%) dying within 30 days of colonoscopy. After controlling for covariates, those who had colon perforation, postcolonoscopy bleeding, or splenic injury were at a much higher risk of inpatient mortality.

Conclusions:

There seems to be a higher risk of adverse GI-related events after colonoscopy in octogenarians as compared with the general population. Furthermore, occurrence of adverse GI-related events increased the risk of mortality among octogenarians regardless of comorbid status.
Individualized intervention to improve rates of exclusive breastfeeding
Authors: Huang Pan , Yao Jianrong , Liu Xinghui , Luo Biru
Published: November 2019

Background:

Despite breastfeeding is significant benefits for maternal and infant, the discontinuation of breastfeeding is high. Some of studies showed that the effect of intervention in improving the rate of exclusively breastfeeding is unclear. The aim of this study is to investigate the effectiveness of individualized intervention compared with routine care in improving rates of exclusive breast feeding.

Methods:

Women were divided into two groups. We provided individual antenatal breastfeeding education and postnatal lactation support to intervention group. Control group received routine care. Significance was set at P < .05.

Results:

We recruited 352 women of whom 176 were randomized to intervention group, 176 to control group. In total, 293 (83.2%) completed 4 months of follow-up. At discharge from hospital, 43.2% of women randomized to intervention group were exclusively breastfeeding compared with 30.0% of women in control group (relative risk 1.78; 95% confidence interval [CI] 1.12–2.82). At 4 months, 70.9% of women in the intervention group were exclusively breastfeeding compared with 46.2% of the women in the control group (2.84; 1.76–4.60). At discharge from hospital, 95.1% of women in the intervention group were breastfeeding on demand compared with 68.1% of women receiving routine care (9.00; 4.09–19.74). At 4 months, 94.6% of women in intervention group were breastfeeding on demand compared with 75.9% of women in the control group (5.57; 2.48–12.49).

Conclusion:

The regular ongoing individualized antenatal education and postnatal support can effective increase the rates of exclusive breastfeeding from delivery to postpartum 4 months and change the breastfeeding behavior.
Small intestinal autotransplantation for spontaneous isolated superior mesenteric artery dissection
Authors: Wei Jiangpeng , Yang Yi , Zheng Jianyong , Chen Dongli , Wang Weizhong , Zhao Qingchuan , Li Xiaohua , Wu Guosheng
Published: November 2019

Introduction

Spontaneous isolated superior mesenteric artery dissection (SISMAD) is a rare differential diagnosis for patients presenting with abdominal pain. Due to limited cases reported, surgical management strategies are poorly defined.

Patient concerns

A 54-year-old man presented to our emergency department with a 4-day history of epigastric pain combined with nausea and vomiting. The pain was dull, constant, and unbearable. It was accompanied by abdominal distention, but there was no radiating pain, chills, fever, or hematochezia. The patient did not have a history of abdominal surgeries, or tobacco or illicit drug use.

Diagnosis

A contrast-enhanced computerized tomography (CT) scan demonstrated an isolated and spontaneous superior mesenteric artery dissection with aneurysmal evolution of the false lumen, involving multiple side branches. The middle-lower jejunum and the whole ileum were extensively dilated, and the middle jejunum was ischemic with edema.

Interventions

Exploratory laparotomy and autologous small bowel transplantation.

Outcomes

The patient was successfully treated using exploratory laparotomy and intestinal autotransplantation (IATx) without bowel resection and had a stable recovery without complications.

Conclusion

For patients with severe mesenteric ischemia or those who fail to respond to initial conservative treatment, IATx may be a reasonable treatment strategy.
Use of sacubitril/valsartan in Marfan syndrome–related cardiomyopathy
Authors: Spoto Silvia , Valeriani Emanuele , Locorriere Luciana , Anguissola Giuseppina Beretta , Pantano Angelo Lauria , Terracciani Francesca , Bono Maria Caterina , Costantino Sebastiano , Ciccozzi Massimo , Angeletti Silvia
Published: November 2019

Rationale:

Marfan syndrome is a rare cause of heart failure due to primary or secondary cardiomyopathy. Recently, sacubitril/valsartan—an angiotensin receptor blocker-neprilysin inhibitor—has been added in clinical practice as a standard therapy for heart failure. To our knowledge, there are no data on sacubitril/valsartan's effects on cardiovascular outcomes in patients with Marfan syndrome.

Patient concerns:

A 24-year-old man was admitted to our Internal Medicine Department due to dyspnea, ascites, and leg swelling. Arterial blood gas analysis revealed severe hypoxemia with respiratory and metabolic alkalosis. Hilar congestion was highlighted on chest x-ray.

Diagnoses:

Recurrent acute decompensated heart failure with reduced ejection fraction despite optimal medical therapy in Marfan-related cardiomyopathy.

Interventions and outcomes:

Sacubitril/valsartan was added to optimal medical therapy after hemodynamic stabilization allowing progressive clinical, laboratoristic, and echocardiographic improvement. Patient maintained a free survival from heart failure and a good quality of life until 9-month follow-up.

Lessons:

Sacubitril/valsartan should be effective on pathophysiologic mechanisms and cardiovascular outcomes of Marfan syndrome–related cardiovascular complications.
Mild encephalitis/encephalopathy with a reversible splenial lesion secondary to encephalitis complicated by hyponatremia
Authors: Shi Bi-chuan , Li Jiao , Jiang Ji-wei , Li Mei-xin , Zhang Jian , Shang Xiu-li
Published: November 2019

Rationale:

Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is an infection-associated encephalitis/encephalopathy syndrome that is predominately caused by a virus. MERS has no direct association with central nervous system (CNS) infections or inflammation. Non-CNS infections may cause reversible lesion in the splenium of corpus callosum. Recently, there have been reports of many patients with hyponatremia related MERS. Interleukin-6 (IL-6) was also found elevated in serum and in cerebrospinal fluid (CSF) in patients with MERS. The role of IL-6 in the non-osmotic release of vasopressin is crucial. Persistent hyponatremia may be linked to this effect. The following is a case report of MERS secondary to encephalitis, complicated by hyponatremia. We will summarize the latest research and progress regarding MERS.

Patient concerns:

A 31-year-old man was admitted to our department with a 5-day history of fever and headache. His initial diagnosis was encephalitis and hyponatremia; during this period the patient also developed MERS secondary to the encephalitis.

Diagnoses:

Encephalitis was diagnosed by reviewing the history of fever, headache, neck rigidity and Kerning sign (+) on clinical examination. Lab tests revealed: serum VCA IgG (+), EBNA-1 IgG (−), EBV IgM (−), and inflammation in the analysis of CSF. Cranial MRI+C showed that the blood vessels on the surface of the brain were obviously increasing and thickening and diffuse slow waves were detected on the electroencephalogram (EEG). The patient's hyponatremia aggravated on the third day of hospitalization. On the fourth day of hospitalization, the patient was somnolent, apathetic, and slow. Magnetic resonance imaging (MRI) of the brain, with a T2-weighted fluid attenuated inversion recovery image, showed high-signal intensity in the splenium of the corpus callosum (SCC) on the fifth day of hospitalization. Diffusion-weighted imaging (DWI) showed splenial hyperintensity as a “boomerang sign” and reduced diffusion on apparent diffusion coefficient (ADC) maps. Cranial MRI findings returned to normal after 1 month. The diagnosis of MERS was confirmed.

Interventions:

We administered an intravenous drip infusion of acyclovir and prescribed oral sodium supplementation.

Outcomes:

The patient's neurological symptoms gradually improved. The MRI lesion in the SCC disappeared on the 30th day.

Lessons:

In patients with encephalitis accompanied by hyponatremia, elevated IL-6 or urinary β2-microglobulin (β2MG), and exacerbations such as sudden somnolence, delirium, confusion, and seizures, the possibility of secondary MERS should be investigated, in addition to the progression of encephalitis.
The association between biologic agents and the risk of cardiovascular events in patients with psoriasis and psoriatic arthritis
Authors: Ma Jie , Liang Ning , Chen Jialiang , Bai Yanping
Published: November 2019

Background:

Psoriasis (Pso) is a chronic, recurrent, and inflammatory disease involving genetic and immune factors. Psoriatic arthritis (PsA), accounting for 30% of Pso, is an inflammatory arthropathy. Pso and PsA are associated with increased cardiovascular events (CVEs). Biologic therapies for Pso and PsA are drawing arising attention for its therapeutic effects. Large evidences have shown that biologic agents could lower the risk of CVEs in patients with Pso and PsA. However, not all studies support this point. A systematic review is needed.

Methods:

Four databases (PubMed, Web of Science, The Cochrane Library, and EMBASE) will be searched from the inception to July 1st, 2019. Randomized controlled trials and observational studies (including case-control studies and cohort studies) reporting CVEs in patients with Pso and PsA treated with biologic agents will be included. The primary outcome is the incidence of CVEs. The secondary outcome is the incidence of each individually reported cardiovascular event. Study selection, data extraction, and assessment of quality will be conducted independently by 2 reviewers. RevMan5.3.5 software will be used for data synthesis.

Results:

The results of this study will provide evidence for the effect of biologic agents on the risk of CVEs in patients with Pso and PsA, so as to further provide guidance for clinical management.

Conclusion:

The findings of this study will be published in a peer-reviewed journal.

PROSPERO registration number:

CRD42019142778
Effect of denosumab, a human monoclonal antibody of receptor activator of nuclear factor kappa-B ligand (RANKL), upon glycemic and metabolic parameters
Authors: Abe Ichiro , Ochi Kentaro , Takashi Yuichi , Yamao Yuka , Ohishi Hanako , Fujii Hideyuki , Minezaki Midori , Sugimoto Kaoru , Kudo Tadachika , Abe Makiko , Ohnishi Yasushi , Mukoubara Shigeaki , Kobayashi Kunihisa
Published: November 2019

Osteoporosis is a complication of type 2 diabetes mellitus (T2DM). Blockade of receptor activator of nuclear factor kappa-B ligand (RANKL) improves osteoporosis, but might also improve glucose tolerance through reduction of hepatic insulin resistance. However, the effect of denosumab (a human monoclonal antibody of RANKL) upon glycemic and metabolic parameters is controversial. We revealed the effect of denosumab upon glycemic and metabolic parameters for 52 weeks. We evaluated 20 individuals diagnosed with both osteoporosis (male and female: postmenopausal) and T2DM. We measured glycemic and metabolic parameters before and 26/52 weeks after administration of denosumab (60 mg per 26 weeks) without changing any other medication each patient was taking. All patients completed the study without complications and the T-score (lumbar spine and femoral neck) improved significantly from baseline to 52 weeks after denosumab administration (P < .001, .001, respectively). None of the glycemic parameters changed significantly from baseline to 26 weeks after denosumab administration, but levels of glycated hemoglobin and homeostasis model assessment of insulin resistance improved significantly from baseline to 52 weeks after administration (P = .019, .008, respectively). The levels of liver enzymes did not change significantly from baseline to 26 weeks after denosumab administration, but levels of aspartate transaminase and alanine aminotransferase improved significantly from baseline to 52 weeks after administration (P = .014, .004, respectively). None of the markers of lipid metabolism and body mass index changed significantly from baseline to 26/52 weeks after denosumab administration. These data demonstrated that denosumab is useful for T2DM patients with osteoporosis for glycemic control via improvement of insulin resistance. Also, the effect of denosumab might be due to improvement of hepatic function.
Three case reports
Authors: Carretero-González Alberto , Salamanca Santamaría Javier , Castellano Daniel , de Velasco Guillermo
Published: November 2019

Rationale:

Hepatotoxicity is a well-known adverse effect of vascular endothelial growth factor receptor (VEGFR) tyrosine-kinase inhibitors (TKIs), usually employed for the treatment of metastatic renal cell carcinoma (mRCC). Immune checkpoint inhibitors (ICIs) have been shown to improve survival in specific patients with mRCC, but concerns have arisen over their safety profile, particularly as regards the risk of liver damage in those patients receiving TKIs sequentially or concurrently with these new drugs. Here, we report three cases of hepatitis presentation in patients receiving TKIs after ICIs that should potentially be considered in current clinical practice, where a combination of these hepatotoxic drugs is becoming increasingly used.

Patients concerns:

All three patients were receiving TKIs therapy and presented with nonspecific clinical deterioration and liver enzyme elevation in different time frames according to the start of treatment. All were previously treated with ICIs.

Diagnoses:

After performing imaging techniques and complementary laboratory tests for the differential diagnosis of hepatic injury, the diagnosis of potentially TKI-induced hepatitis was assumed in all these cases. Hepatic biopsy was performed only in the first case in order to confirm the diagnosis.

Interventions:

Potential toxic drugs were interrupted and steroids course with slow reduction regimen was administered in all these cases because of the previous use of ICIs.

Outcomes:

The patients described improved with this conservative treatment without complications during the following weeks. Only one case presented a new episode of mild hepatic alteration while on treatment with following treatment.

Lessons:

Taking into account this new therapeutic context, stricter monitoring for potentially increased/altered adverse events should be indicated. Adequate patient selection and consideration of the safety profile of the different drugs used could help to optimize treatment in the near future.
Bilateral diffuse retinal pigment epithelium proliferation induced by choroidal inflammation
Authors: Tanaka Miyuki , Kamoi Koju , Nagaoka Natsuko , Ishida Tomoka , Karube Hisako , Takase Hiroshi , Ohno-Matsui Kyoko
Published: November 2019

Rationale:

Proliferation of retinal pigment epithelium (RPE) is typically observed in limited ocular disorders, in connection with the local mechanism of RPE proliferation-mediated wound repair. Bilateral and diffuse type RPE proliferation is considered to be associated with paraneoplastic syndromes, such as a bilateral diffuse uveal melanocytic proliferation. However, other reported diseases that induce bilateral diffuse RPE proliferation are quite rare, especially for patients who are considered to have a non-malignant status.

Patient concerns:

The bilateral eyes of a 47-year-old woman with bilateral ocular inflammation, presented united multiple small to medium white retinal lesions during the disease progress.

Diagnoses:

Optical coherence tomography showed scattered serous retinal detachments, choroidal folds, choroidal thickening and diffuse RPE proliferation. As autofluorescence and angiography showed a “giraffe pattern”, bilateral diffuse uveal melanocytic proliferation was suspected. However, systemic investigations identified no malignancy. In consideration of the above findings, choroidal inflammation was thought to be the major cause of this condition.

Interventions:

The patient was administered intensive systemic steroids. Over the next 2 months, the amount of steroid was tapered off.

Outcomes:

After administration, the bilateral diffuse RPE proliferation settled down. During the 2-year follow-up, there was no recurrence of ocular inflammation and diffuse RPE proliferation, or any other malignancy found.

Lessons:

This finding demonstrates that bilateral diffuse RPE proliferation can be generated as a secondary phenomenon of choroidal inflammation in patients with a non-malignant status.
Role of gamma probe-assisted intraoperative sentinel lymph node evaluation in predicting axillary breast cancer metastasis after neoadjuvant chemotherapy
Authors: Berberoglu Kezban , Erdemir Ayhan , Rasa Kemal , Baloglu Huseyin , Cakmakci Metin
Published: November 2019

Objective

Intraoperative sentinel lymph node biopsy is a universally accepted technique to identify patients who are candidates for axillary lymph node dissection during breast cancer surgery. However, there is controversy over its use in patients who underwent preoperative neoadjuvant chemotherapy. This study aimed to examine the diagnostic value of gamma probe-assisted intraoperative sentinel lymph node examination with frozen section in breast cancer patients who had undergone preoperative neoadjuvant chemotherapy.

Methods

This retrospective study included 94 tumors diagnosed with stage IIA, IIB or IIIA invasive breast cancer with locoregional lymph node metastasis who underwent surgical treatment after neoadjuvant chemotherapy. Intraoperatively, axillary sentinel lymph node sampling was done using radioactive colloid and gamma probe and materials were examined with frozen section method. Patients with positive sentinel nodes underwent axillary resection. Histopathological examination of all surgical samples was done postoperatively.

Results

In 87 of 94 tumors (92.6%), a sentinel lymph node could be identified using the method. The sensitivity, specificity and accuracy of the method for predicting axillary macro metastasis were 85.7, 86.5 and 86.2%, respectively, with 5.7% false negative rate.

Conclusions

Sentinel lymph node identification using preoperative scintigraphy and intraoperative use of gamma probe seems to be a feasible and efficient method in terms of differentiating patients that require axillary lymph node dissection during breast cancer surgery, even when they have received neoadjuvant chemotherapy. Further large prospective studies allowing subgroup analyses are warranted.
A microdosimetry model of kidney by GATE Monte Carlo simulation using a nonuniform activity distribution in digital phantom of nephron
Authors: Jabari Masoud , Rajabi Hossein , Dadashzadeh Simin
Published: November 2019

Objectives

As the main pathway for the clearance of radiopharmaceutical from the body, kidney is a dose-limiting organ in medical application of radionuclides. Because of its unique physiology, radioactivity is seen to concentrate on kidney nonuniformly. This nonuniformity can be considered in nephron microstructures. A microdosimetry model of kidney is necessary to include the nonuniform distribution in internal radiation dosimetry.

Method

Implementing the microdosimetry model requires, first, a geometry phantom of nephrons. Stylized phantoms cannot distribute activities inside nephron compartments nonuniformly. A phantom of nephron was generated by a preliminary three-dimensional graphic model and was converted to a proper format of digital phantom. The phantom was fed to GATE Monte Carlo toolkits. Simulations were performed and S-values for five radionuclides (Tc-99m, In-111, Lu-177, Ac-225 and Bi-212) were calculated and compared with corresponding results published in the literature derived with a stylized phantom of nephron. Activity was distributed nonuniformly according to the kinetics of two mainly used diagnostic tracers (diethylenetriaminepetaacetate and ethylenedicysteine) and absorbed dose of nephron cells were calculated.

Results

A good correlation was shown between the generated phantom microdosimetry model and stylized model and revealed the phantom can be used for future microdosimetry studies of kidney to evaluate radiobiological effects of internal radiation from various diagnostic and therapeutic radiopharmaceuticals. Absorbed dose of cells for nonuniform distribution showed that some cells in a nephron compartment receive higher dose than (more than two-fold) that of compartment average dose.

Conclusion

Average dose of nephron is not a reliable parameter for nephrotoxicity evaluation.
Predicting large-volume lymph node metastasis in the clinically node-negative papillary thyroid microcarcinoma: a retrospective study
Authors: Shen Guohua , Ma Huan , Huang Rui , Kuang Anren
Published: November 2019

Objective

Large-volume lymph node metastasis (LNM) has been believed to be an important predictor for recurrence in papillary thyroid microcarcinoma (PTMC). However, the clinical predictors for large-volume LNM have yet to be established. This study aimed to determine clinical predictors for large-volume LNM in clinically node-negative PTMC.

Methods

A total of 947 clinically N0 PTMC patients who received total thyroidectomy with lymph node dissection and radioiodine therapy were included. Based on the LNM status, they were divided into two groups: large-volume LNM and small-volume LNM including those patients without LNM. The association between age, gender and other clinical factors and large-volume LNM were investigated. The recurrence-free survival was also compared among these groups.

Results

We found that male gender [odds ratio (OR) = 1.865, P = 0.015], young age (OR = 2.743, P < 0.001) and extrathyroid extension (OR = 5.352, P < 0.001) were independent predictors for high prevalence of large-volume LNM. Young (<40 years) and male patients tended to have large-volume LNM with the highest prevalence of 17.20%, whereas old (≥55 years) and female patients had the lowest prevalence of 2.02%. After median follow-up of 71 months, the recurrence rate was significantly higher for large-volume LNM compared with small-volume LNM (15.48 vs 0.72%, P < 0.05). Large-volume LNM status was significantly associated with decreased recurrence-free probability, while small-volume LNM had little effect on the recurrence-free survival.

Conclusions

This study showed that in clinically node-negative PTMC, young male patients had a greater incidence of large-volume LNM.
Intralesional Steroid Injection Therapy for Esophageal Anastomotic Stricture Following Esophageal Atresia Repair
Authors: Ngo Peter D. , Kamran Ali , Clark Susannah J. , Jennings Russell W. , Hamilton Thomas E. , Smithers Charles J. , Zendejas Benjamin , Yasuda Jessica L. , Zurakowski David , Manfredi Michael A.
Published: November 2019

Objectives:

The role of intralesional steroid injection (ISI) in the treatment of anastomotic stricture in patients with esophageal atresia remains unclear. The aim of this study was to evaluate the efficacy and safety of ISI.

Methods:

A total of 158 patients with esophageal atresia with at least 1 ISI for the treatment of esophageal anastomotic stricture between 2010 and 2017 were identified. The change in stricture diameter (ΔD) was compared between procedures with dilation alone (ISI−) and dilation with steroid injection (ISI+).

Results:

A total of 1055 balloon dilations were performed (452 ISI+). The median ΔD was significantly greater in the ISI+ group: 1 mm (interquartile range [IQR] 0, 3) versus 0 mm (IQR −1, 1.5) (P < 0.0001). The ISI+ group had greater percentage of improved diameter (P < 0.0001) and lesser percentages of unchanged and decreased diameters at subsequent endoscopy (P = 0.0009, P = 0.003). Multivariable logistic regression confirmed the significance of ISI on increasing the likelihood of improved stricture diameter with an adjusted odds ratio of 3.24 (95% confidence interval: 2.15–4.88) (P < 0.001). The ΔD for the first 3 ISI+ procedures was greater than the ΔD for subsequent ISI+ procedures: 1 mm (IQR 0, 3) versus 0.5 mm (IQR−1.25, 2) (P = 0.001). There was no difference in perforation incidence between ISI+ and ISI− groups (P = 0.82).

Conclusions:

ISI with dilation was well tolerated and improved anastomotic stricture diameter more than dilation alone. The benefit of ISI over dilation alone was limited to the first 3 ISI procedures.
Role of Thiopurines in Pediatric Inflammatory Bowel Diseases
Authors: Atia Ohad , Ledder Oren , Ben‐Moshe Tehila , Lev‐Tzion Raffi , Rachmen Yelana , Meyer Esther O. , Beeri Rachel , Renbaum Pinhas , Shamasneh Ibrahim , Shteyer Eyal , Turner Dan
Published: November 2019

Objectives:

Use of thiopurines for inflammatory bowel diseases (IBDs) is declining in some parts of the world. We aimed to explore outcomes of thiopurines and predictors of response in a real‐world prospective cohort of children with dose optimization.

Methods:

Children with IBD treated with thiopurines without biologics were enrolled. Dosing was guided by thiopurine S‐methyltransferase‐activity at baseline and by clinical response and toxicity at 4 months; 1 year into the study, therapeutic drug monitoring at 4 months was also considered in the decision making. The primary outcome was steroid‐free remission without treatment escalation by 12 months (SFR), using the intention‐to‐treat approach.

Results:

A total of 129 children were included (74% Crohn disease [CD] and 26% ulcerative colitis [UC]). SFR was achieved in 37 (39%) CD and 13 (39%) UC patients, and SFR with normal erythrocyte sedimentation rate/C‐reactive protein in 20 (21%) and 9 (27%), respectively. At 4 months, mean corpuscular volume/white blood cell ratio and Δ absolute neutrophil count weakly correlated with 6‐thioguanine (r = 0.33, P = 0.02 and r = 0.32, P = 0.02, respectively). In CD, SFR was associated with 4‐month median weighted Pediatric Crohn Disease Activity Index (2.5 [IQR 0–7.5] in responders vs 5 in nonresponders [0–12.5], P = 0.048) and Δabsolute neutrophil count (1.7 [IQR 0.7–4.1] vs 0.05 [−2.3–0.9]; P = 0.03). Mild drug‐related adverse events were recorded in 30 children (22%), 3 required stopping the drug.

Conclusions:

In this real‐life prospective cohort using dose optimization, thiopurines were safe and effective in 21% of CD and 27% of UC patients, including normalization of C‐reactive protein and erythrocyte sedimentation rate. Thiopurines remain a viable option in the treatment algorithm of mild‐moderate pediatric IBD, especially in girls whose risk for lymphoma is lower.
Infantile Myofibromatosis: 32 Patients and Review of Literature
Authors: Zhao Guoqiang , Zhu Ming , Qin Chaojin , Liu Xiwang , Zhao Xufei
Published: November 2019

Background:

Infantile myofibromatiosis (IM) is a rare benign tumor in the infants, but it has a bad prognosis if IM erncroaches on the viscera. Multiple tissues can be invaded by IM, including the subcutaneous tissue, the muscle of the neck, back, and head, but seldom in the bones and the viscera. The histopathologic and immunohistochemical examinations are necessary in daigonosis of IM as it might be misdiagnosed as the malignant tumor.

Materials and Method:

Thirty-two consecutive patients with IM in our hospital (2003-2013) were enrolled and the clinical date were analyzed to understand IM better, such as the feature of clinical manifestations, pathology, imaging tests, and treatment.

Results:

All of them underwent excision operations, 4 of them with invasion in the bones, 2 with invasion in the craniums, and the rest in the ulna and the humerus. The immunohistiochemical analysis shown that the tumor cells were positive to vimentin and smooth muscle actin while negative to the S100 protein and desmin. Twenty-five patients were in follow-up, 2 cases recurred.

Conclusions:

IM is a benign tumor, but IM with the viscera involvement has a bad prognosis. The strategy of waiting and observation for IM without visceral involvement could be selected.
Therapeutic Hypothermia and Leukocytosis in Newborns: An Unusual Association
Authors: De Rose Domenico Umberto , Lazzareschi Ilaria , Serrao Francesca , Maggio Luca , Coppola Maria , Hindocha Hirvi , Vento Giovanni , Gallini Francesca
Published: November 2019

Therapeutic hypothermia is a standardized intervention for the treatment of moderate-severe hypoxic-ischemic encephalopathy in newborns with gestational age ≥35 weeks. Several complications have been described. Our aim was to report a case of leukocytosis, for the first time in the literature, in a term newborn who underwent therapeutic hypothermia.
Clinicopathologic and Molecular Analysis of the TFEB Fusion Variant Reveals New Members of TFEB Translocation Renal Cell Carcinomas (RCCs)
Authors: Xia Qiu-Yuan , Wang Xiao-Tong , Fang Ru , Wang Zhe , Zhao Ming , Chen Hong , Chen Ni , Teng Xiao-Dong , Wang Xuan , Wei Xue , Ye Sheng-Bing , Li Rui , Ma Heng-Hui , Lu Zhen-Feng , Zhou Xiao-Jun , Rao Qiu
Published: November 2019

Xp11 renal cell carcinoma (RCC) with different gene fusions may have different clinicopathologic features. We sought to identify variant fusions in TFEB translocation RCC. A total of 31 cases of TFEB RCCs were selected for the current study; MALAT1-TFEB fusion was identified in 25 cases (81%, 25/31) using fusion probes. The remaining 6 cases (19%, 6/31) were further analyzed by RNA sequencing and 5 of them were detected with TFEB-associated gene fusions, including 2 ACTB-TFEB, 1 EWSR1-TFEB, 1 CLTC-TFEB, and 1 potential PPP1R10-TFEB (a paracentric inversion of the TFEB gene, consistent with “negative” TFEB split FISH result, and advising a potential diagnostic pitfall in detecting TFEB gene rearrangement). Four of the 5 fusion transcripts were successfully validated by reverse transcription-polymerase chain reaction and Sanger sequencing. Morphologically, approximately one third (29%, 9/31) of TFEB RCCs showed typical biphasic morphology. The remaining two thirds of the cases (71%, 22/31) exhibited nonspecific morphology, with nested, sheet-like, or papillary architecture, resembling other types of renal neoplasms, such as clear cell RCC, Xp11 RCC, perivascular epithelioid cell tumor (PEComa), or papillary RCC. Although cases bearing a MALAT1-TFEB fusion demonstrated variable morphologies, all 9 cases featuring typical biphasic morphology were associated with MALAT1-TFEB genotype. Accordingly, typical biphasic morphology suggests MALAT1-TFEB fusion, whereas atypical morphology did not suggest the specific type of fusion. Isolated or clustered eosinophilic cells were a common feature in TFEB RCCs, which may be a useful morphology diagnostic clue for TFEB RCCs. Clinicopathologic variables assessment showed that necrosis was the only morphologic feature that correlated with the aggressive behavior of TFEB RCC (P=0.004). In summary, our study expands the genomic spectrum and the clinicopathologic features of TFEB RCCs, and highlights the challenges of diagnosis and the importance of subtyping of this tumor by combining morphology and multiple molecular techniques.
Cost-effectiveness of New Targeted Agents in the Treatment of Chronic Lymphocytic Leukemia
Authors: Harkins R. Andrew , Patel Sharvil P. , Flowers Christopher R.
Published: November 2019

Chronic lymphocytic leukemia (CLL) is the most common adult leukemia and is clinically heterogeneous. Integration of oral targeted therapies (OTTs) in the management of CLL has fundamentally altered CLL treatment pathways and improved outcomes for patients with CLL.

We review the cost-effectiveness of OTTs in the treatment of CLL. We used MeSH (Medical Subject Heading) terms and keywords to search the National Library of Medicine online MEDLINE database (PubMed) for articles related to cost-effectiveness of OTTs in CLL care.

Oral targeted therapies add considerable expense to the treatment of CLL for patients and the health care system. Cost-effectiveness analyses of OTTs are not uniform in their conclusions and depend on patient groups selected for analysis. Given the substantial increase in expense associated with integration of OTTs in CLL treatment, cost reduction methods are needed to ensure equitable access to novel therapies for all patients with CLL.
Developing a Lymphatic Surgery Program: A First-Year Review
Authors: Johnson Anna Rose , Fleishman Aaron , Tran Bao Ngoc N. , Shillue Kathy , Carroll Brett , Tsai Leo L. , Donohoe Kevin J. , James Ted A. , Lee Bernard T. , Singhal Dhruv
Published: November 2019

Background:

Lymphedema is a chronic condition that carries a significant physical, psychosocial, and economic burden. The authors’ program was established in 2017 with the aims of providing immediate lymphatic reconstruction in high-risk patients undergoing lymphadenectomy and performing delayed lymphatic reconstruction in patients with chronic lymphedema. The purpose of this study was to describe the authors’ clinical experience in the first year.

Methods:

A retrospective review of our clinical database was performed on all individuals presenting to the authors’ institution for lymphatic surgery consideration. Patient demographics, clinical characteristics, and surgical management were reviewed.

Results:

A total of 142 patients presented for lymphatic surgery evaluation. Patients had a mean age of 54.8 years and an average body mass index of 30.4 kg/m2. Patients with lymphedema were more likely to be referred from an outside facility compared to patients seeking immediate lymphatic reconstruction (p < 0.001). For patients with lymphedema, the most common cause was breast cancer related. Thirty-two percent of all patients evaluated underwent a lymphatic procedure. Of these, 32 were immediate lymphatic reconstructions and 13 were delayed lymphatic reconstructions. In the authors’ first year, 94 percent of eligible patients presenting for immediate lymphatic reconstruction underwent an intervention versus only 38 percent of eligible lymphedema patients presenting for delayed lymphatic reconstruction (p < 0.001).

Conclusions:

First-year review of our lymphatic surgery experience has demonstrated clinical need evidenced by the number of patients and high percentage of outside referrals. As a program develops, lymphatic surgeons should expect to perform more time-sensitive immediate lymphatic reconstructions, as evaluation of chronic lymphedema requires development of a robust team for workup and review.