bluuebunny/crossref_metadata_2025 huggingface dataset:
β-citronellol alters cell surface properties of Candida albicans to influence pathogenicity related traits
Authors: Sharma Yamini , Rastogi Sumit Kumar , Perwez Ahmad , Rizvi Moshahid Alam , Manzoor Nikhat
Published: January 2019

The pathogenicity of Candida albicans, an opportunistic human fungal pathogen, is attributed to several virulence factors. β-citronellol is a monoterpenoid present in several plant essential oils. The present study explores the antifungal potential and mode of action of β-citronellol against C. albicans ATCC 90028 (standard), C. albicans D-27 (FLC-sensitive), and C. albicans S-1 (FLC-resistant). Anti-Candida potential was studied by performing MIC, MFC, growth curves, disc diffusion, spot assay, and WST1 cytotoxic assay. Morphological transition was monitored microscopically in both solid and liquid hyphae inducing media. β-citronellol inhibits yeast to hyphal transition in both liquid and solid hyphae inducing media. It had a significant inhibitory effect on biofilm formation and secretion of extracellular proteinases and phospholipases. We showed that it has an adverse effect on membrane ergosterol levels and modulates expression of related ERG genes. Expression profiles of selected genes associated with C. albicans pathogenicity displayed reduced expression in treated cells. This work suggests that β-citronellol inhibits morphological transition in C. albicans and decreases the secretion of hydrolytic enzymes involved in the early stage of infection as well as modulates the expression of associated genes. Pleiotropic phenotype shown by β-citronellol treated Candida cells suggests various modes of action. Further studies will assess the clinical application of β-citronellol in the treatment of fungal infections.
Clinical course and outcome after kidney transplantation in patients with C3 glomerulonephritis due to CFHR5 nephropathy
Authors: Frangou Eleni , Varnavidou-Nicolaidou Agathi , Petousis Panayiotis , Soloukides Andreas , Theophanous Elena , Savva Isavella , Michael Nicos , Toumasi Elpida , Georgiou Dora , Stylianou Galatia , Mean Richard , Anastasiadou Natasa , Athanasiou Yiannis , Zavros Michalis , Kyriacou Kyriacos , Deltas Constantinos , Hadjianastassiou Vassilis
Published: January 2019

Background

Complement factor H-related protein 5 (CFHR5) nephropathy is an inherited renal disease characterized by microscopic and synpharyngitic macroscopic haematuria, C3 glomerulonephritis and renal failure. It is caused by an internal duplication of exons 2–3 within the CFHR5 gene resulting in dysregulation of the alternative complement pathway. The clinical characteristics and outcomes of transplanted patients with this rare familial nephropathy remain unknown.

Methods

This is a retrospective case series study of 17 kidney transplant patients with the established founder mutation, followed-up over a span of 30 years.

Results

The mean (±SD) age of patients at the time of the study and at transplantation was 58.6 ± 9.9 and 46.7 ± 8.8 years, respectively. The 10- and 15-year patient survival rates were 100 and 77.8%, respectively. Proteinuria was present in 33.3% and microscopic haematuria in 58.3% of patients with a functional graft. Serum complement levels were normal in all. ‘Confirmed’ and ‘likely’ recurrence of CFHR5 nephropathy were 16.6 and 52.9%, respectively; however, 76.5% of patients had a functional graft after a median of 120 months post-transplantation. Total recurrence was not associated with graft loss (P = 0.171), but was associated with the presence of microscopic haematuria (P = 0.001) and proteinuria (P = 0.018). Graft loss was associated with the presence of proteinuria (P = 0.025).

Conclusions

We describe for the first time the clinical characteristics and outcome of patients with CFHR5 nephropathy post-transplantation. Despite the recurrence of CFHR5 nephropathy, we provide evidence for a long-term favourable outcome and support the continued provision of kidney transplantation as a renal replacement option in patients with CFHR5 nephropathy.
Industry Input in Policy Making: Evidence from Medicare*
Authors: Chan David C , Dickstein Michael J
Published: January 2019

In setting prices for physician services, Medicare solicits input from a committee that evaluates proposals from industry. The committee itself comprises members from industry; we investigate whether this arrangement leads to regulatory capture with prices biased toward industry interests. We find that increasing a measure of affiliation between the committee and proposers by one standard deviation increases prices by 10%. We then evaluate whether employing a biased committee as an intermediary may nonetheless be desirable, if greater affiliation allows the committee to extract information needed for regulation. We find industry proposers more affiliated with the committee produce less hard evidence in their proposals. However, on soft information, we find evidence of a trade-off: private insurers set prices that more closely track Medicare prices generated under higher affiliation.
Compact groups in which all elements are almost right Engel
Authors: Khukhro E I , Shumyatsky P
Published: January 2019

We say that an element g of a group G is almost right Engel if there is a finite set R(g) such that for every x∈G, there is a positive integer n(x,g) such that […[[g,x],x],…,x]∈R(g) if x is repeated at least n(x,g) times. Thus, g is a right Engel element precisely when we can choose R(g)={1}. We prove that if all elements of a compact (Hausdorff) group G are almost right Engel, then G has a finite normal subgroup N such that G/N is locally nilpotent. If in addition there is a uniform bound ∣R(g)∣⩽m for the orders of the corresponding sets, then the subgroup N can be chosen of order bounded in terms of m. The proofs use the Wilson–Zelmanov theorem saying that profinite Engel groups are locally nilpotent and previous results of the authors about compact groups in which all elements are almost left Engel.
‘A Double Care’: Prayer as Therapy in Early Modern England
Authors: Mann Sophie
Published: January 2019

This article explores three central questions. What did people consider the physical effects of prayer to be? Why were these effects considered to be therapeutic? How did an awareness of prayer’s physiological benefits shape the practices of patients and practitioners? It also presents a wider attempt to incorporate the notion of ‘double care’ into our thinking about early modern medical treatment. To date, early modernists have demonstrated that the sick engaged in prayer in order to elicit the Lord’s mercy and bring about a recovery. What remains underexplored is the way in which prayer was believed to somatically manifest in the devotee’s own body. Exploring this theme will highlight that medical practitioners, clergymen and the laity perceived and invoked prayer as both a spiritual and physical aid. In this way, prayer was not only a central religious exercise but also could be an important component of early modern therapeutics.
Emergence of Leaf Spot Disease on Leafy Vegetable and Ornamental Crops Caused by Paramyrothecium and Albifimbria Species
Authors: Matić Slavica , Gilardi Giovanna , Gullino Maria Lodovica , Garibaldi Angelo
Published: January 2019

The genera Paramyrothecium and Albifimbria have been established from the former genus Myrothecium and they generally comprise common soil-inhabiting and saprophytic fungi. Within these genera, only two fungi have been recognized as phytopathogenic thus far: P. roridum and A. verrucaria, both of which cause necrotic leaf spots and plant collapse. Severe leaf necrosis and plant decay have been observed in Northern and Southern Italy on leafy vegetable crops. Thirty-six strains of Paramyrothecium- and Albifimbria-like fungi were isolated from affected plants belonging to eight different species. Based on morphological characteristics, 19 strains were assigned to A. verrucaria, whereas the remaining strains, which mostly resembled Paramyrothecium-like fungi, could not be identified precisely. Molecular characterization of six loci (internal transcribed spacer [ITS], β-tubulin [tub2], calmodulin [cmdA], translation elongation factor 1-alpha [tef1], large subunit ribosomal RNA [LSU], and mitochondrial ATP 6synthase 6 [ATP6]) of the 36 new isolates and three previously ITS-characterized isolates assigned all strains to four species: A. verrucaria, P. roridum, P. foliicola, and P. nigrum. Single and concatenated phylogenetic analyses were conducted, and they clearly distinguished the isolated fungi into four different groups. A. verrucaria, P. roridum, P. foliicola, and P. nigrum were able to induce leaf necrosis singly, and they were confirmed to be the causal agents of the leaf spot disease through pathogenicity assays. The involvement of fungi previously considered saprophytic (i.e., P. foliicola and P. nigrum) in the development of plant disease for the first time deserves particular attention because of the possibility of their transmission by seeds and the limited knowledge of their management with chemicals.
Using Clinical Instructor Perceptions to Improve a Pilot Simulation Course
Authors: Woda Aimee , Schnable Theresa , Alt-Gehrman Penny
Published: January 2019

Little is known about clinical instructors’ perceptions of student decision-making in relation to the block sequencing of simulation and traditional clinical experiences. Focus groups were conducted with 12 clinical instructors. Three common threads emerged from the data: right away, anxious but more confident, and scary and unsafe. Instructors noted that the more patient care experiences encountered, the more students developed efficient clinical decision-making skills. Major safety concerns regarding medication administration were identified, resulting in additional safety parameters instituted in the simulated environment.
Practices and Attitudes of Nursing Students Toward Patients With Disordered Eating Behaviors
Authors: Phillips Kathryn E. , LoGiudice Jenna A.
Published: January 2019

Disordered eating (DE) behaviors are associated with obesity and eating disorders. This study describes practices and attitudes of nursing students toward patients exhibiting DE and how personal DE behaviors affect practices and attitudes. Most respondents had a mental health rotation (74.7 percent) and DE education (68 percent); however, only 34.7 percent felt prepared to screen for DE, and only 44 percent were taught to screen. Those scoring high for DE behaviors (n = 7) indicated greater rates of feeling prepared to screen. This knowledge can help nurse educators design curricula to increase the preparation of nurses to address DE behaviors.
Methods for measuring patient preferences: an update and future directions
Authors: Meara Alexa , Crossnohere Norah L. , Bridges John F.P.
Published: January 2019

Purpose of review

The current review highlights the growing number of available methods used to measure patient preferences and discusses how this impacts preference research in rheumatology. Spurred by the growing role of preferences in regulatory decisions and drug development, researchers have begun applying preference methods to study questions beyond the clinical context. We explore these trends, provide case studies highlighting changes in measuring patient preferences, compare strengths and weaknesses of common stated-preference methods, and discuss considerations for the future use of these methods.

Recent findings

Early literature on patient preferences often mimicked clinical practice, asking whether treatment A is better or worse than treatment B for a patient. Early applications of patient preference methods in rheumatology aimed to value different attributes of treatments, but remained focused on informing clinical questions. Spurred by interest in preferences by regulatory agencies and patient-centeredness throughout the product lifecycle, there are now a wide array of methods available to measure preference.

Although these different preference methods have strengths and weaknesses, they serve to highlight the broad number of questions that could help rheumatology beyond the clinical context. Researchers in rheumatology now have the opportunity to better serve diverse stakeholders by considering how these methods could aid in clinical trial design, regulatory policy, and other elements of the medical product life cycle.
Cryolipolysis for Noninvasive Contouring of the Periumbilical Abdomen With a Nonvacuum Conformable-Surface Applicator
Authors: Friedmann Daniel P.
Published: January 2019

BACKGROUND

Although most cryolipolysis treatments are performed with vacuum applicators, some patients may have areas of fibrous, nonpinchable fat or find vacuum suction to be uncomfortable.

OBJECTIVE

This study evaluates a nonvacuum conformable-surface applicator for cryolipolysis of the periumbilical abdomen.

METHODS/MATERIALS

Twenty subjects with periumbilical subcutaneous fat were treated with a nonvacuum cryolipolysis applicator in this prospective, single-center, open-label clinical trial. Each subject underwent a single treatment cycle with an optional second treatment 10 weeks later. Efficacy was evaluated by blinded review of digital photographs. Subject satisfaction was assessed at 10-week follow-up.

RESULTS

Twenty subjects completed one treatment, of which 6 underwent the optional retreatment. Independent review demonstrated 77% correct identification of baseline photographs after one treatment, which improved to 100% after a second treatment. Patient questionnaires after one treatment revealed 50% satisfaction, with 60% willing to recommend the procedure and 60% reporting visible fat reduction. After second treatment, however, 100% were satisfied, 83% were willing to recommend, and 100% reported visible fat reduction.

CONCLUSION

Cryolipolysis with a nonvacuum conformable-surface applicator is safe, effective, and well tolerated for noninvasive reduction of fibrous periumbilical abdominal fat. Efficacy and subject satisfaction is significantly greater with 2 treatments than with a single session.
Life With HIV in a Canadian Suburban Community: A Qualitative Inquiry of Health Care and Social Services Access
Authors: Manis Derek , Gamble Brenda
Published: January 2019

HIV has been examined in urban and rural contexts, but the suburban gradient has not been sufficiently described, despite the fact that many Canadians live in suburbia. Using qualitative description, we investigated how people living with HIV in a suburban community in Ontario, Canada, accessed health care and social services. Posters at the regional AIDS Service Organization and snowball sampling were used to recruit and interview 13 adult participants with various experiences and perspectives. A content analysis identified three meta-themes in the interviews: (a) transportation cost and time: barriers to access, (b) isolation, and (c) defective primary care: unmet and deflected needs. The findings have implications for the (a) development of community-based groups, (b) the role of transportation in health care and social services utilization, (c) community-based, interprofessional health and social care services, and (d) aging with HIV.
A Mindfulness Workshop for Health Science Graduate Students: Preliminary Evidence for Lasting Impact on Clinical Performance
Authors: Willgens Annette , Palombaro Kerstin
Published: January 2019

Introduction.

Health science graduate students take high stakes examinations and experience stress and burnout, which can negatively influence performance in clinical courses. The intent of this study was to pilot a curriculum in mindful practice for graduate health science students under high levels of perceived stress. The purpose of this study was to determine the effectiveness of an abbreviated mindfulness workshop to determine if it would provide lasting benefit for students during clinical experiences 9 months later.

Methods.

Twenty-three graduate students across 4 health professions participated in a 6-week workshop for stress management in March 2017. Students were executed to practice mindfulness activities for 15 minutes daily over the 6 weeks. Weekly meetings included meditation, mindful movement, and small group discussion. A mixed methods approach incorporated pre- and postworkshop measures exploring students' levels of worry, perceived stress, feelings of isolation, self-judgment, self-kindness, overidentification, and mindfulness. Additional survey data were collected 9 months later to determine if the tools learned in the workshop influenced clinical performance. Qualitative comments were coded using generic qualitative analysis, and member checking confirmed themes.

Results.

Overall, students demonstrated improvements in all measures of stress over the 6-week workshop. Additionally, they reported positive influences on clinical performance in the affective and cognitive domains 9 months later. Four main themes were extracted from the data. These were I Have Tools; Think, Pause, Allow; Silence the Critic; and, I Am Not Alone. Overall, the participants experienced significant improvements in mindfulness scores and self-compassion, and showed improvements in perceived stress and worry (Cognitive-Affective Mindfulness Scale-revised).

Discussion and Conclusion.

Altogether, these data suggest that (1) graduate students can learn to manage worry, feelings of isolation, and self-judgment using tools and strategies from mindful practices; (2) students who practice mindfulness in a 6-week workshop report lasting effects during clinical performance 9 months later; and (3) students benefit from a community of peers and a shared space to share their thoughts and feelings as emerging health professionals. Suggestions are made for integrating mindful practices into graduate health science education.
Nonadherence after pediatric renal transplantation: detection and treatment
Authors: Holmberg Christer
Published: January 2019

Purpose of review

Nonadherence is a problem in adolescents and young adults. Risk factors are classified as those of the individual, family, health-care-system, or community. I present the latest reports and how to tackle nonadherence.

Recent findings

Nonadherence risk is independent of one's origin in a high-poverty or low-poverty neighborhood or having private or public insurance in respect to African Americans. Females with male grafts have higher graft-failure risks than do males. Female recipients aged 15–24 with grafts from female donors have higher graft-failure risk than do males. In study of nonadherence risks, such findings must be taken into account. Antibody-mediated rejection is seen in nonadherence. The sirolimus and tacrolimus coefficient of variation is associated with nonadherence, donor-specific antibodies, and rejection. Adolescents had electronically monitored compliance reported by e-mail, text message or visual dose reminders and meetings with coaches. These patients had significantly greater odds of taking medication than did controls. Transition programs have an impact on renal function and rejection episodes.

Individual risk factors are many, and methods for measuring nonadherence exist. Each transplant center should have a follow-up program to measure nonadherence, especially in adolescence, and a transition program to adult care.
Creation and Online Use of Patient-Centered Videos, Digital Storytelling, and Interactive Self-testing Questions for Teaching Pathophysiology
Authors: DeLenardo Samantha , Savory Joanne , Feiner Frank , Cretu Madalina , Carnegie Jacqueline
Published: January 2019

Background

Nursing students need to not only understand the pathophysiological basis of disease but also acquire insight into its effects on patients and their families.

Purpose

Digital storytelling was used to engage students in self-directed, online learning, allowing them to identify with patients dealing with disease and its consequences.

Methods

Scripts were written and videos created that simulated patient experiences with select diseases of the gastrointestinal and respiratory systems as well as diabetes. Videos plus online self-testing questions were provided to nursing students studying pathophysiology and student outcomes on summative examinations compared before and after introduction of the videos.

Results

Students had improved outcomes on summative examination questions that targeted diseases addressed in the video modules.

Conclusions

Digital storytelling is an effective way to portray illness from a patient perspective, and the addition of this approach to pathophysiology instruction can benefit student learning.
Normal Expression of SRY-related HMG-BOX Gene 10 (SOX-10) in Recent and Old Cutaneous Scars is a Potential Mimicker of Desmoplastic Malignant Melanoma
Authors: Febres-Aldana Christopher A. , Alexis John
Published: January 2019

Desmoplastic malignant melanoma (DMM) is an amelanotic spindle cell proliferation that can be mistaken for a cutaneous scar. The distinction can be difficult in reexcisions because DMM is negative for conventional melanoma markers such as HMB-45 and Melan-A, and scars may be positive for S-100 protein and SOX-10. We compare a total of 12 DMM cases with 8 reexcision and 35 old non–reexcision cutaneous scars using SOX-10 immunohistochemical stains. Cell quantification was performed on captured images using ImageJ 1.51t. SOX-10 was expressed in DMM (100%, 12/12), and reexcision (75%, 6/8), atrophic (88%, 22/25), hypertrophic (100%, 8/8), and keloid-type (100%, 2/2) scars. The cellular density of SOX-10 positive cells in DMM (822.9±116.9 cells/mm2, mean±SEM) was significantly higher than in any scar subgroup (hypertrophic: 188.4±20.40 cells/mm2, atrophic: 83.78±11.13 cells/mm2, reexcision: 96.72±30.13 cells/mm2, P<0.0001). Hypercellular areas in reexcision scars showed dense positivity as hypocellular areas in DMM (upper limit for scars: 258.42 positive cells/mm2 vs. lower limit for DMM: 292.42 positive cells/mm2). SOX-10 positive cells in scars are predominantly monomorphic and small following the overall directionality of the tissue. In contrast, DMM cells exhibited enlarged atypical nuclei with a haphazard distribution, invasion as single cells or in clusters, and tropism for adnexal structures (58%) and neurovascular bundles (67%). In conclusion, cutaneous scars contain SOX-10 positive cells. The evaluation of residual DMM needs careful attention to morphologic characteristics to avoid over-interpretation of SOX-10 immunostains.
23.4% Hypertonic Saline and Intracranial Pressure in Severe Traumatic Brain Injury Among Children: A 10-Year Retrospective Analysis
Authors: Wu Andrew G. , Samadani Uzma , Slusher Tina M. , Zhang Lei , Kiragu Andrew W.
Published: January 2019

Objective:

To explore the effect of 23.4% hypertonic saline for management of elevated intracranial pressure in children admitted to our institution for severe traumatic brain injury.

Design:

Single-center, retrospective medical chart analysis.

Setting:

A PICU at a level 1 pediatric trauma center in the United States.

Patients:

Children admitted for severe traumatic brain injury from 2006 to 2016 who received 23.4% hypertonic saline and whose intracranial pressures were measured within 5 hours of receiving 23.4% hypertonic saline.

Interventions:

None.

Measurements and Main Results:

Over the 10-year period, 1,587 children were admitted for traumatic brain injury, 155 of whom were deemed severe per this study’s criteria. Forty of these children received at least one dose of hypertonic saline, but 14 were excluded for insufficient intracranial pressure data. Among the remaining 26 children, one hundred one 23.4% hypertonic saline boluses were used in the analysis. Use of 23.4% hypertonic saline was associated with a decrease in intracranial pressure of approximately 7 mm Hg at both within 1 hour after the bolus (p < 0.01) and 4 hours after the bolus (p < 0.01) when compared with the intracranial pressure measured within 1 hour before the hypertonic saline bolus. These effects remained significant after adjusting for Functional Status Scale score and CT Marshall scores. There was no statistically significant association between adjunctive therapies, such as antiepileptics and analgesics, and changes in intracranial pressure. There was no laboratory evidence of hyperkalemia or renal injury after use of 23.4% hypertonic saline. Across all hospitalizations, 65% of the study population demonstrated an abnormally elevated creatinine at least once, but only three episodes of acute kidney injury occurred in total, all before hypertonic saline administration. Eight of the 26 children in this analysis died during their hospitalization. The Functional Status Scale scores ranged from 6 to 26 with a mean of 12.2 and sd of 5.7.

Conclusions:

Use of 23.4% hypertonic saline with children admitted for severe traumatic brain injury is associated with a statistically significant decrease in intracranial pressure within 1 hour of use.
Does Receiving a Text Message Reminder Increase Follow-up Compliance After Discharge From a Pediatric Emergency Department?
Authors: Salinero Efren A. , Ramirez Jose , Cramm-Morgan Kelly , Papa Linda
Published: January 2019

Objectives

Compliance with recommended follow-up from the pediatric emergency department (PED) has been shown to be poor. This study evaluated whether a text message reminder to the caregivers after discharge from the PED improved compliance with recommended primary care follow-up.

Methods

This was a blinded randomized control trial conducted at a level 1 pediatric trauma center. The intervention was a text message sent to the caregiver within 24 hours of discharge from the PED reminding them to follow up with their primary care doctor. Patients were eligible if the caregiver had text message capability on their cellular phones, they were currently established patients of the organization's Pediatric Faculty Practice, they were discharged home from the PED, and they were referred for follow-up within 1 week of discharge by the pediatric emergency physician. After informed consent, pediatric patients were randomized to either an intervention group (text message appointment reminder) or a control group (standard scheduling with no reminder). The patient, treating physician, and primary care outpatient center were blinded to the group assignment. Enrollment occurred 24 hours per day and 7 days per week.

Results

There were 123 patients enrolled in the study, 62 patients randomized to the control group (standard scheduling) and 61 randomized to the intervention group (text message appointment reminder). Of the patients, 58% were male and 42% were female, with the average age of the patients being 2.2 years (SD, 2.8). The majority of patients were seen in the PED on a weekday, with 24% presenting on a weekend. Only 28% of patients completed the recommended follow-up, and the average time from PED discharge to follow-up was 6 days (SD, 4.2; range, 0–17 days). There was no significant difference in follow-up in the standard treatment group (19/62, 31%) versus the text message intervention group (16/61, 26%) (P = 0.69; rate ratio, 0.94; 95% confidence interval, 0.75–1.18). When we assessed other variables, we found that parents of younger children were more likely to follow up as recommended by the pediatric ED physician. Of those who were compliant with follow-up, we found a mean age of 1.3 years (SD, 2.0; range, 0.8–9.1) versus 2.6 years (SD, 3.0; range, 0.08–15.3) for those who were not compliant with follow-up (P = 0.02).

Conclusions

In this randomized controlled study, a text message reminder to caregivers did not improve compliance for PED patients. However, caregivers of younger children were more likely to complete follow-up as recommended by the PED physician compared with caregivers of older children.
Distraction Using Buzzy or Handheld Computers During Venipuncture
Authors: Cozzi Giorgio , Crevatin Franca , Dri Veronica , Bertossa Gabriella , Rizzitelli Patrizia , Matassi Daniela , Minute Marta , Ronfani Luca , Barbi Egidio
Published: January 2019

Objectives

Venipuncture is one of the most frequently performed painful procedures in children. The aim of this study was to investigate the effectiveness of 2 analgesic strategies for venipuncture in children in a specific setting like a blood-drawing center.

Methods

This was a prospective randomized controlled trial. It was conducted in the blood-drawing center of a tertiary level children's hospital in Italy, between November 2014 and February 2015. Eligible patients were children aged from 4 to 12 years referred to the blood-drawing center for venipuncture. Enrolled children were randomized to be distracted by Buzzy device or by playing with a handheld computer. The procedural pain was measured with the faces pain scale-revised by children aged from 4 to 7 years and with a numerical rating scale by children aged from 8 to 12 years.

Results

Two hundred children with a median age of 8 years were enrolled in the study. The self-reported procedural pain was not statistically different between the Buzzy group and the handheld computer group: median (interquartile range) = 3.0 (1.0–4.8) and 2.0 (1.0–4.8), respectively (P = 0.72). Children reported significant pain in 25% of cases with both distraction strategies. The procedural success rate at the first attempt was not significantly different in the 2 groups.

Conclusions

Analgesia provided by Buzzy or by a handheld computer was not significantly different in children undergoing venipuncture in a blood-drawing center, with the great proportion of them reporting no or mild pain during procedure.
Identification and Characterization of Oral Injury in Suspected Child Abuse Cases
Authors: George Caroline L. S. , Theesfeld Samuel S. N. , Wang Qi , Hudson Mark J. , Harper Nancy S.
Published: January 2019

Objectives

Accurately differentiating inflicted from accidental injury in infants and toddlers is critical. Many studies have documented characteristics of inflicted bruises, fractures, and head injuries facilitating the development of clinical tools. There are few studies characterizing inflicted oral injuries, and no clinical tools exist. This study identified characteristics that differentiated inflicted from accidental oral injuries in children younger than 24 months.

Methods

Retrospective review using International Classification of Diseases, Ninth Revision billing codes and an internal clinical database tool identified children younger than 24 months between 2004 and 2014. Two groups were created according to the presence or absence of a child abuse diagnosis resulting in an accidental injury and suspected child abuse (SCA) group. Statistical analyses were performed on patient demographics, history of trauma, oral injury characterization, bruises, and fractures.

Results

Billing codes were applied differently between the accidental injury and SCA groups, even when the same injury was described. Patients with SCA were younger and less mobile when compared with those with accidental injuries (P < 0.0001). Tongue injuries (P < 0.0001) and oropharynx bruising (P = 0.0018) were observed more and lacerations were observed less (P < 0.0001) in the SCA group. The SCA group was less likely to have a trauma history than those with accidental injury (P < 0.0001).

Conclusions

Several differences in patient characteristics, trauma history, injury type, and location were identified between the accidental versus SCA groups. A future clinical tool that incorporates age, history of trauma on presentation, tongue injury, and oropharynx bruising may assist medical providers in placing child physical abuse in the differential diagnosis.
Bone Fractures in Children With Cholestatic Liver Disease May Mimic Those Seen in Child Abuse
Authors: Goldner Dana , Vittorio Jennifer , Barrios Dulce M. , McGuire Jillian , Brodlie Susan , Brown Jocelyn , Lobritto Steven , Martinez Mercedes
Published: January 2019

Certain fractures in children are highly specific for child abuse. Metabolic bone disease frequently develops in patients with cholestatic liver disease (CLD); this can result in weakened bones and a predisposition to pathologic fractures. Fractures that occur in patients with rickets and osteopenia may mimic a bone response to inflicted injury, which in children raise the concern of child abuse. Here we report a series of 15 patients with CLD who developed pathologic fractures in the setting of metabolic bone disease. During initial evaluation, the caretakers of 5 of these 15 patients were reported to child protective services and investigated for child abuse. Pediatricians should be aware that children with CLD have an increased incidence of pathologic fractures, even after the cholestasis has resolved.
Instant Outcome Evaluation of Microwave Ablation With Subtraction CT in an In Vivo Porcine Model
Authors: Bressem Keno K. , Vahldiek Janis L. , Erxleben Christoph , Poch Franz , Hiebl Bernhard , Lehmann Kai , Hamm Bernd , Niehues Stefan M.
Published: January 2019

Objectives

The aim of this study was to investigate whether the accuracy of multislice contrast-enhanced computed tomography (MS-CECT) may be improved by performing additional subtraction CT.

Materials and Methods

Thirty-five microwave ablations were performed under CT guidance in 12 healthy and anesthetized pigs. Preablation and postablation MS-CECT scans were obtained in arterial and venous contrast phases. These scans were reconstructed and subtracted from each other. Lesion size was measured in a region of interest drawn around the ablation area. Computed tomography measurements were compared with standardized macroscopic images of explanted liver tissue, obtained immediately after ablation. Paired correlation and Bland-Altman analyses were performed for assessing agreement between modalities and ratings.

Results

The correlation between lesion size measured in CT and histology was very strong for subtracted images (r = 0.91; 95% confidence interval [CI], 0.8–0.96) and strong for standard MS-CECT images (r = 0.85; 95% CI, 0.68–0.93). Interrater agreement for all measurements was excellent (intraclass correlation coefficient, 0.99; 95% CI, 0.98–0.99 for subtraction and intraclass correlation coefficient, 0.99; 95% CI, 0.98–1.00 for MS-CECT). All differences were statistically significant (P < 0.05).

Conclusions

Subtraction CT was superior to nonsubtracted MS-CECT in measurement of liver lesion size after microwave ablation in a porcine model, achieving a very strong correlation with pathologic measurement and a significantly lower overestimation of lesion size compared with MS-CECT.
SPECT/CT Findings in Scapular Notching After Reverse Shoulder Arthroplasty
Authors: Cieciera Matthaeus , Schoeniger Ralf , Bhure Ujwal , Strobel Klaus
Published: January 2019

Scapular notching (SN) is a unique complication in reverse shoulder arthroplasty, caused by repetitive impingement of the humeral polyethylene liner against the inferior scapular neck. It occurs in up to 96% of cases, with bone loss beneath the glenoid baseplate and polyethylene wear. SN can be associated with pain, decreased range of motion, and might result in glenoid implant failure. Modification of glenosphere design and humeral neck angle showed substantially less SN. SPECT/CT is a promising tool providing combined morphologic and metabolic information in symptomatic SN. We present SPECT/CT findings in 7 cases of symptomatic SN in reverse shoulder arthroplasty patients.
Asymptomatic Isolated Vulvar Metastasis in Old Treated Case of Carcinoma Rectum—Diagnosis and Treatment Response Evaluation by 18F-FDG PET/CT Scan
Authors: Elumalai Ram Kumar , Verma Ritu , Malik Dharmender , Belho Ethel Shangne
Published: January 2019

We report a clinically asymptomatic, old treated case of carcinoma rectum, presenting with raised serum carcinoembryonic antigen level, referred for 18F-FDG PET/CT scan for restaging. Whole-body PET/CT scan revealed an isolated FDG-avid lesion in the left labia majora region, which on histopathology was found to be metastasis from carcinoma rectum. Subsequent 18F-FDG PET/CT done after 4 cycles of chemotherapy revealed favorable response to therapy. 18F-FDG PET/CT facilitates the detection of unusual site of metastasis and its subsequent response evaluation in the index case.
Diffuse Intense Intestinal FDG Activity in a Patient With Familial Adenomatous Polyposis
Authors: Cai Liang , Shao Fuqiang , Zhang Jie , Chen Yue
Published: January 2019

Familial adenomatous polyposis is a rare autosomal dominant intestinal syndrome with a high rate of malignant transformation. Here, we report a 20-year-old woman with a diagnosis of familial adenomatous polyposis by pathologic examination after colonoscopy biopsy, who underwent an 18F-FDG PET/CT to assess the extent of this disease. The images showed diffuse elevated FDG uptake along the entire colorectum. Additionally, focal enlarged lymph nodes with increased FDG uptake were noted. These findings promoted proctocolectomy and lymphadenectomy.
Case of Solitary Peritoneal Metastasis From Atypical Bronchopulmonary Carcinoid on 18F-FDG PET/CT
Authors: Gawde Sachin , Singhal Ashok , Kasat Amrita , Parekh Siddharth , Ramaswamy Veena
Published: January 2019

Atypical lung carcinoids frequently metastasize to mediastinal nodes, liver, bone, lungs, and brain and rarely to ovaries, pancreas, subcutaneous, and skin. Solitary peritoneal metastasis is extremely rare and unreported previously. We present a case of a 36-year-old woman with cough, hemoptysis, dyspnea with detection of lung mass, and incidental detection of pelvic mass. Fine needle aspiration cytology failed to reveal the true nature of both the lesions. FDG PET/CT showed intensely avid mediastinal nodes, left lung, and rectouterine masses. Core biopsy from lung mass revealed atypical carcinoid without appreciable uptake on 68Ga-DOTANOC scan. Subsequent postchemotherapy CT scan shows significant regression in lung and peritoneal masses.
Colon Visualization on Bone Scan Due to Recto-abscess Fistula From Urinoma
Authors: Chao Kang-Hung , Yen Tsung-Hsien , Huang Cheng-Kai , Changlai Sheng-Pin
Published: January 2019

The accumulation of the bone-seeking agent in the bowel during a bone scan is rare. A 68-year-old man with colon cancer underwent bone scintigraphy for staging. Whole-body images revealed an abnormal accumulation of hot radioactivity in the abdominal cavity and the colon. Abdominal CT showed a recto-abscess fistula between the rectum and the urinoma. Incidental visualization of colonic radioactivity suggested the presence of a fistula between the bowel and the urinoma, explaining the peculiar finding of the bone-seeking agent in the bowel.
18F-FDG-Labeled Autologous Leukocyte PET-CT in a Patient With Aortic Valve-Tube Graft Infection After Bentall Procedure
Authors: Sood Apurva , Bhattacharya Anish , Aggarwal Pankaj , Basher Rajender Kumar , Mittal Bhagwant Rai
Published: January 2019

Infection of aortic valve-tube graft, although rare, is associated with high morbidity and mortality. Early identification of site and extent of infection is not only challenging but also crucial for adequate patient management and prognostication of disease. Combined clinical, laboratory investigation and imaging modalities assist in the identification of aortic valve graft infection. Molecular imaging techniques like PET/CT using 18F-FDG and 18F-FDG-labeled autologous leukocytes (LALs) have improved the sensitivity for detection of infection, resulting in better outcome for these patients. 18F-FDG-labeled autologous leukocyte PET/CT in our patient after Bentall procedure accurately localized the site and extent of infection.
Focal 123I-MIBG Uptake in the Medial Segment of the Normal Liver
Authors: Matsusaka Yohji , Nakahara Tadaki , Iwabuchi Yu , Minami Yasuhiro , Jinzaki Masahiro
Published: January 2019

An 84-year-old man with parkinsonism was referred for 123I-MIBG scintigraphy. Abnormal uptake in the right upper abdomen was incidentally seen in planar image, and SPECT revealed focal uptake in the medial segment (S4) of the liver. Subsequent triple-phase contrast-enhanced CT showed no evidence of hepatic tumors, although in the arterial phase, there were an enhanced region corresponding to the uptake area and the enhanced vein of Sappey that flowed into S4. In this case, the focal 123I-MIBG uptake would be attributable to hemodynamic change in the liver.
Diffuse Bone Metastases in Pancreatic Neuroendocrine Tumor Shown on Octreoscan
Authors: Adkins Jake , Lu Yang
Published: January 2019

A 32-year-old man with a pancreatic neuroendocrine tumor and known liver metastasis presented with diffuse back pain. Workup octreoscan showed newly developed diffuse bone metastases, in addition to the persistent liver metastases. The bone metastases were later confirmed on MRI spine images.
How Well Do the Popular Ultrasonic Techniques Estimate Amniotic Fluid Volume and Diagnose Oligohydramnios, in Fact?
Authors: Madendag Yusuf , Madendag Ilknur Col , Sahin Erdem , Aydin Emine , Sahin Mefkure Eraslan , Acmaz Gokhan
Published: January 2019

The aims of the study were to compare the different estimation methods for the diagnosis of oligohydramnios and to determine concordance between estimated amniotic fluid volume (AFV) measured by ultrasonography and actual AFV measured directly. Another purpose was to investigate the effect of oligohydramnios on neonatal outcome. This study was done at a tertiary care center. The participants were scheduled between 37 and 40 weeks for cesarean delivery. Estimated AFV was ultrasonographically assessed, and then actual AFV was directly measured during the cesarean delivery to compare the subjective method (SM), amniotic fluid index (AFI), single deepest pocket (SDP), and 2-diameter pocket. Totally, 138 patients were included in the present study. Of 35 (34%), 24 (21%), 12 (9.5%), and 10 (7.8%) were defined as oligohydramnios by the SM, AFI, SDP, and 2-diameter pocket, respectively. The number of patients with actual oligohydramnios was 35 (34%). Most authors suggest as a method use of the SDP more than the AFI, because of overmanagement through the AFI. However, this study, which was conducted using both nonprejudiced and criterion-standard methods, showed that the SM and AFI technique were more successful to estimate oligohydramnios than other methods. Also, adverse pregnancy outcome was not closely associated with isolated oligohydramnios.
A Low-Cost Highly Configurable Phantom for Simulation of Imaging-Guided Endocavitary Procedures
Authors: Li Qian , Yang Long , Duan Yu , Xiang Feixiang , McCarthy Colin J. , Thabet Ashraf , Cai Wenli , Grajo Joseph R. , Baikpour Masoud , McConnell Roland , White Phillip J. , Samir Anthony E.
Published: January 2019

We developed a method to create customizable phantoms suitable for endocavitary imaging and interventional research, based on the fabrication of an acrylic phantom mold, and development of a phantom matrix composed of gelatin, agar, graphite particles, and propanol. Our phantom was mechanically stable, easily fabricated, and highly adjustable, and its ultrasound (US) and magnetic resonance imaging (MRI) scans showed the qualification for the procedure guidance compared with the human prostate image using the same US system. To test the feasibility of the phantom for the research, the seeds placement guided by MRI/US fusion was performed, and the overall test error (distance from the seed center to the virtual lesion center in olives) was 2.59 ± 0.59 mm. We have created a simple, low-cost, configurable, gelatin-based phantom and tested its feasibility for simulating endorectal interventional US procedures. The design of the phantom mold and matrix is likely to be useful to the broader medical training community, and the preliminary data from the experiment of MRI/US-guided seeds placement showed its potential to test the clinical hypothesis in US research.
The Value of Superb Microvascular Imaging in Detecting Hepatic Artery Occlusion in Liver Transplantation
Authors: Güven Fadime , Karaca Leyla , Ogul Hayri , Sade Recep , Öztürk Gürkan , Kantarci Mecit
Published: January 2019

Superb microvascular imaging (SMI) is an innovative color Doppler technique that is used to evaluate low-velocity blood flow in particular. Our purpose in this study was to examine the sensitivity and specificity of SMI for assessing occlusion of the hepatic artery after liver transplantation. Ninety-five prospective patients who underwent liver transplantation were included in our study between April 2014 and February 2018. The patients were assessed with color power Doppler sonography and SMI method examinations in this study. Those who were suspected of having hepatic artery occlusion were assessed with computed tomography angiography. Computed tomography angiography was used in all the patients who were suspected of having occlusion of the hepatic artery on power Doppler and SMI method. The hepatic artery was considered to be patent and have normal flow on color Doppler examination in 72 (75.7%) of the total 95 patients. The hepatic artery was not observed in 23 (24.2%) of the patients with color Doppler sonography. In 3 of those 23 patients, arterial flow was detected with power Doppler sonography (31%). The sensitivity of SMI for the detection of hepatic artery occlusion was 100%, the specificity was 97.87%, the positive predictive value was 33.33%, and the negative predictive value was 100%. Thus, SMI is a noninvasive technique that is easy to use and has high sensitivity in patients who have undergone liver transplantation. In patients who are suspected of having hepatic artery occlusion with Doppler ultrasound, SMI can detect hepatic artery occlusion without the need for invasive techniques.
Tip Reinforcement Flap
Authors: Irmak Fatih , Serin Merdan , Sirvan Selami Serhat , Kurt Yazar Sevgi , Kuran Ismail , Sevim Kamuran Zeynep , Karsidag Semra
Published: January 2019

Background

Middle crura support deficiency and short middle crura can usually cause insufficient definition and projection of the tip and can sometimes result in a flat tip. The aim of this study was to investigate the effectiveness of a new technique involving a tip reinforcement flap to strengthen the middle crura and to achieve a well-projected and defined tip.

Methods

Twenty-nine patients who underwent primary open-approach rhinoplasty that included the use of tip reinforcement flaps were included in the study. Cartilage flaps that had been created from the excess cephalic portion of the lateral crura were prepared as medial crura-based cartilaginous flaps.

Results

There were 29 patients (17 women, 12 men) aged 18 to 44 years (mean age, 31 years). Follow-up time ranged between 3 and 25 months (mean, 21 months). Preoperative and postoperative average of nasal tip length was 10.84 (±1.07) mm and 14.32 (±2.34) mm, respectively (P = 0.0214). Preoperative and postoperative average of nasolabial angle was 97.42° (±9.84°) and 107.99° (±12.16°), respectively (P = 0.0344). Preoperative and postoperative average of nasal projection ratio was 0.53 (±0.04) and 0.57 (±0.03), respectively (P = 0.4347). The tip reinforcement flap technique provided strengthening and extra support for the middle crura and increased definition, projection, and stability to the domal area.

Conclusions

The tip reinforcement flap technique offers advantages for tip plasty in those cases with middle crural deficiency, short middle crura, and middle crural weakness. The technique also provides an additional projection, stabilization, and definition to the nasal tip while reducing lateral crural cephalic excess. This technique improves nostril-lobular disproportion and has the advantage of hiding extra support grafted into the folded flap. Complications such as graft visibility, malposition, and asymmetry, which may occur with the use of classic tip grafts, can be eliminated with the tip reinforcement flap technique.