bluuebunny/crossref_metadata_2025 huggingface dataset:
ELABELA Improves Cardio-Renal Outcome in Fatal Experimental Septic Shock
Authors: Coquerel David , Chagnon Frédéric , Sainsily Xavier , Dumont Lauralyne , Murza Alexandre , Côté Jérôme , Dumaine Robert , Sarret Philippe , Marsault Éric , Salvail Dany , Auger-Messier Mannix , Lesur Olivier
Published: August 2017

Objectives:

Apelin-13 was recently proposed as an alternative to the recommended β-adrenergic drugs for supporting endotoxin-induced myocardial dysfunction. Since Apelin-13 signals through its receptor (Apelin peptide jejunum) to exert singular inotropic/vasotropic actions and to optimize body fluid balance, this candidate pathway might benefit septic shock management. Whether the newly discovered ELABELA (ELA), a second endogenous ligand of the Apelin peptide jejunum receptor highly expressed in the kidney, further improves cardio-renal impairment remains unknown.

Design, Setting, and Subjects:

Interventional study in a rat model of septic shock (128 adult males) to assess the effects of ELA and Apelin-13 on vascular and cardio-renal function. Experiments were performed in a tertiary care University-based research institute.

Interventions:

Polymicrobial sepsis-induced cardiac dysfunction was produced by cecal ligation puncture to assess hemodynamic efficacy, cardioprotection, and biomechanics under acute or continuous infusions of the apelinergic agonists ELA or Apelin-13 (39 and 15 µg/kg/hr, respectively) versus normal saline.

Measurements and Main Results:

Apelinergic agonists improved 72-hour survival after sepsis induction, with ELA providing the best clinical outcome after 24 hours. Apelinergic agonist infusion counteracted cecal ligation puncture–induced myocardial dysfunction by improving left ventricular pressure-volume relationship. ELA-treated cecal ligation puncture rats were the only group to 1) display a significant improvement in left ventricular filling as shown by increased E-wave velocity and left ventricular end-diastolic volume, 2) exhibit a higher plasma volume, and 3) limit kidney injury and free-water clearance. These beneficial renal effects were superior to Apelin-13, likely because full-length ELA enabled a distinctive regulation of pituitary vasopressin release.

Conclusions:

Activation of the apelinergic system by exogenous ELA or Apelin-13 infusion improves cardiovascular function and survival after cecal ligation puncture–induced sepsis. However, ELA proved better than Apelin-13 by improving fluid homeostasis, cardiovascular hemodynamics recovery, and limiting kidney dysfunction in a vasopressinergic-dependent manner.
Nosocomial Infections During Extracorporeal Membrane Oxygenation: Incidence, Etiology, and Impact on Patients’ Outcome
Authors: Grasselli Giacomo , Scaravilli Vittorio , Di Bella Stefano , Biffi Stefano , Bombino Michela , Patroniti Nicolò , Bisi Luca , Peri Anna Maria , Pesenti Antonio , Gori Andrea , Alagna Laura
Published: August 2017

Objective:

To study incidence, type, etiology, risk factors, and impact on outcome of nosocomial infections during extracorporeal membrane oxygenation.

Design:

Retrospective analysis of prospectively collected data.

Setting:

Italian tertiary referral center medical-surgical ICU.

Patients:

One hundred five consecutive patients who were treated with extracorporeal membrane oxygenation from January 2010 to November 2015.

Interventions:

None.

Measurements and Main Results:

Ninety-two patients were included in the analysis (48.5 [37–56] years old, simplified acute physiology score II 37 [32–47]) who underwent peripheral extracorporeal membrane oxygenation (87% veno-venous) for medical indications (78% acute respiratory distress syndrome). Fifty-two patients (55%) were infected (50.4 infections/1,000 person-days of extracorporeal membrane oxygenation). We identified 32 ventilator-associated pneumonia, eight urinary tract infections, five blood stream infections, three catheter-related blood stream infections, two colitis, one extracorporeal membrane oxygenation cannula infection, and one pulmonary-catheter infection. G+ infections (35%) occurred earlier compared with G– (48%) (4 [2–10] vs. 13 [7–23] days from extracorporeal membrane oxygenation initiation; p < 0.001). Multidrug-resistant organisms caused 56% of bacterial infections. Younger age (2–35 years old) was independently associated with higher risk for nosocomial infections. Twenty-nine patients (31.5%) died (13.0 deaths/1,000 person-days of extracorporeal membrane oxygenation). Infected patients had higher risk for death (18 vs. 8 deaths/1,000 person-days of extracorporeal membrane oxygenation; p = 0.037) and longer ICU stay (32.5 [19.5–78] vs. 19 [10.5–27.5] days; p = 0.003), mechanical ventilation (36.5 [20–80.5] vs. 16.5 [9–25.5] days; p < 0.001), and extracorporeal membrane oxygenation (25.5 [10.75–54] vs. 10 [5–13] days; p < 0.001). Older age (> 50 years old), reason for connection different from acute respiratory distress syndrome, higher simplified acute physiology score II, diagnosis of ventilator-associated pneumonia, and infection by multidrug-resistant bacteria were independently associated to increased death rate.

Conclusions:

Infections (especially ventilator-associated pneumonia) during extracorporeal membrane oxygenation therapy are common and frequently involve multidrug-resistant organisms. In addition, they have a negative impact on patients’ outcomes.
Use of a Virtual Learning Platform for Distance-Based Simulation in an Acute Care Nurse Practitioner Curriculum
Authors: Carman Margaret , Xu Shu , Rushton Sharron , Smallheer Benjamin A. , Williams Denise , Amarasekara Sathya , Oermann Marilyn H.
Published: August 2017

Background:

Acute care nurse practitioner (ACNP) programs that use high-fidelity simulation as a teaching tool need to consider innovative strategies to provide distance-based students with learning experiences that are comparable to those in a simulation laboratory.

Objective:

The purpose of this article is to describe the use of virtual simulations in a distance-based ACNP program and student performance in the simulations.

Method:

Virtual simulations using iSimulate were integrated into the ACNP course to promote the translation of content into a clinical context and enable students to develop their knowledge and decision-making skills. With these simulations, students worked as a team, even though they were at different sites from each other and from the faculty, to manage care of an acutely ill patient.

Results:

The students were assigned to simulation groups of 4 students each. One week before the simulation, they reviewed past medical records. The virtual simulation sessions were recorded and then evaluated. The evaluation tools assessed 8 areas of performance and included key behaviors in each of these areas to be performed by students in the simulation. More than 80% of the student groups performed the key behaviors.

Discussion:

Virtual simulations provide a learning platform that allows live interaction between students and faculty, at a distance, and application of content to clinical situations. With simulation, learners have an opportunity to practice assessment and decision-making in emergency and high-risk situations. Simulations not only are valuable for student learning but also provide a nonthreatening environment for staff to practice, receive feedback on their skills, and improve their confidence.
Delays in Treatment-Seeking Decisions Among Women With Myocardial Infarction
Authors: Arslanian-Engoren Cynthia , Scott Linda D.
Published: August 2017

Background:

Minimizing the time from myocardial infarction (MI) symptom onset to the implementation of lifesaving interventions decreases morbidity and mortality of women who experience an MI. However, not all women seek timely evaluation and treatment for their MI symptoms.

Objectives:

The aim of this article is to describe reasons for decision treatment delays among women who experience an initial MI.

Method:

A secondary analysis of narrative data collected as part of a qualitative study examining the triage experiences of women (N = 14) who presented to the emergency department with symptoms of acute MI. The data were analyzed using the Krueger method.

Results:

Women with severe symptoms sought immediate evaluation. However, 9 of the 14 participants reported delays in seeking immediate evaluation and treatment for MI. Four of the participants who delayed were health care professionals (3 nurses, 1 respiratory therapist). Content analysis revealed 3 themes accounting for the delay: lack of association of symptoms with MI, personal/professional obligations, and refusal to arrive via ambulance.

Discussion:

Some women who experience MI continue to delay despite symptoms of nausea, indigestion, and fatigue as well as a family history of heart disease and recommendations to the contrary. Reducing delays will improve survival and minimize morbidity and mortality for women who suffer an acute MI.
The Relationship Between Professional Quality of Life and Caring Ability in Critical Care Nurses
Authors: Mohammadi Marzieh , Peyrovi Hamid , Mahmoodi Mahmood
Published: August 2017

Background:

Critical care nursing has some features that may affect the ability of critical care nurses to provide care. Professionals as critical care nurses who deal with peoples’ health and life often experience some levels of stress that affects their quality of life.

Objective:

This study examined the relationship between professional quality of life and caring ability of critical care nurses.

Method:

In this descriptive correlational study, 253 critical care nurses working in the medical and surgical intensive care units of Tehran University of Medical Sciences were recruited by convenience sampling method. The data collection tools included demographic data form, Caring Ability Inventory, and questionnaire for professional quality of life version 5.

Results:

There was a statistically significant positive relationship between the professional quality of life and the caring ability (P < .0001). A significant inverse relationship was found between burn-out subscale of compassion fatigue as one aspect of professional life quality with all 3 aspects of caring ability (knowledge, courage, and patience). Secondary traumatic stress, as another subscale of compassion fatigue (as one aspect of professional quality of life), had no statistically significant correlation with caring ability aspects of knowledge and patience. However, there was a significant inverse correlation between the secondary traumatic stress and courage aspect of caring ability (P < .0001). There was a statistically significant positive relationship between compassion satisfaction aspect of professional life quality with knowledge and patience aspects of caring ability, but there was not any relationship between the compassion satisfaction aspect of professional life quality and the courage aspect of caring ability.

Discussion:

Improvement of critical care nurses’ professional quality of life may increase their caring ability, thereby leading to better and more effective nursing care. Increased awareness by critical care nurse managers of the compassion fatigue phenomenon (secondary traumatic stress and burnout) and its effect on quality of critical care would be helpful in planning more specific strategies and preventing the onset and progression of these symptoms.
Endogenous and Agonist-induced Opening of Mitochondrial Big Versus Small Ca2+-sensitive K+ Channels on Cardiac Cell and Mitochondrial Protection
Authors: Stowe David F. , Yang Meiying , Heisner James S. , Camara Amadou K. S.
Published: August 2017

Both big (BKCa) and small (SKCa) conductance Ca2+-sensitive K+ channels are present in mammalian cardiac cell mitochondria (m). We used pharmacological agonists and antagonists of BKCa and SKCa channels to examine the importance of endogenous opening of these channels and the relative contribution of either or both of these channels to protect against contractile dysfunction and reduce infarct size after ischemia reperfusion (IR) injury through a mitochondrial protective mechanism. After global cardiac IR injury of ex vivo perfused Guinea pig hearts, we found the following: both agonists NS1619 (for BKCa) and DCEB (for SKCa) improved contractility; BKCa antagonist paxilline (PAX) alone or with SKCa antagonist NS8593 worsened contractility and enhanced infarct size; both antagonists PAX and NS8593 obliterated protection by their respective agonists; BKCa and SKCa antagonists did not block protection afforded by SKCa and BKCa agonists, respectively; and all protective effects by the agonists were blocked by scavenging superoxide anions (O2
·−) with Mn(III) tetrakis (4-benzoic acid) porphyrin (TBAP). Contractile function was inversely associated with global infarct size. In in vivo rats, infusion of NS8593, PAX, or both antagonists enhanced regional infarct size while infusion of either NS1619 or DCEB reduced infarct size. In cardiac mitochondria isolated from ex vivo hearts after IR, combined SKCa and BKCa agonists improved respiratory control index and Ca2+ retention capacity compared with IR alone, whereas the combined antagonists did not alter respiratory control index but worsened Ca2+ retention capacity. Although the differential protective bioenergetics effects of endogenous or exogenous BKCa and SKCa channel opening remain unclear, each channel likely responds to different sensing Ca2+ concentrations and voltage gradients over time during oxidative stress-induced injury to individually or together protect cardiac mitochondria and myocytes.
N-Methyl-d-Aspartate Receptor-Driven Calcium Influx Potentiates the Adverse Effects of Myocardial Ischemia-Reperfusion Injury Ex Vivo
Authors: Liu Zi-You , Hu Shou , Zhong Qin-Wen , Tian Cheng-Nan , Ma Hou-Mou , Yu Jun-Jian
Published: August 2017

Background:

Despite the adverse effects of N-methyl-d-aspartate receptor (NMDAR) activity in cardiomyocytes, no study has yet examined the effects of NMDAR activity under ex vivo ischemic-reperfusion (I/R) conditions. Therefore, our aim was to comprehensively evaluate the effects of NMDAR activity through an ex vivo myocardial I/R rat model.

Methods:

Isolated rat hearts were randomly segregated into 6 groups (n = 20 in each group): (1) an untreated control group; (2) a NMDA-treated control group; (3) an untreated I/R group; (4) an I/R+NMDA group treated with NMDA; (5) an I/R+NMDA+MK-801 group treated with NMDA and the NMDAR inhibitor MK-801; and (6) an I/R+NMDA+[Ca2+]-free group treated with NMDA and [Ca2+]-free buffer. The 4 I/R groups underwent 30 minutes of ischemia followed by 50 minutes of reperfusion. Left ventricular pressure signals were analyzed to assess cardiac performance. Myocardial intracellular calcium levels ([Ca2+]i) were assessed in isolated ventricular cardiomyocytes. Creatine kinase, creatine kinase isoenzyme MB, lactate dehydrogenase, cardiac troponin I, and cardiac troponin T were assayed from coronary effluents. TTC and TUNEL staining were used to measure generalized myocardial necrosis and apoptosis levels, respectively. Western blotting was applied to assess the phosphorylation of PKC-δ, PKC-ε, Akt, and extracellular signal-regulated kinase.

Results:

Enhanced NMDAR activity under control conditions had no significant effects on the foregoing variables. In contrast, enhanced NMDAR activity under I/R conditions produced significant increases in [Ca2+]i levels (∼1.2% increase), significant losses in left ventricular function (∼5.4% decrease), significant multi-fold increases in creatine kinase, creatine kinase isoenzyme MB, lactate dehydrogenase, cardiac troponin I, and cardiac troponin T, significant increases in generalized myocardial necrosis (∼36% increase) and apoptosis (∼150% increase), and significant multi-fold increases in PKC-δ, PKC-ε, Akt, and extracellular signal-regulated kinase phosphorylation (all P < 0.05). These adverse effects were rescued by the NMDAR inhibitor MK-801 or [Ca2+]-free buffer (all P < 0.05).

Conclusions:

NMDAR-driven calcium influx potentiates the adverse effects of myocardial I/R injury ex vivo.
IMPACT OF LONG-TERM INTRAVITREAL ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR ON PREEXISTING MICROSTRUCTURAL ALTERATIONS IN DIABETIC MACULAR EDEMA
Authors: Wirth Magdalena A. , Wons Juliana , Freiberg Florentina J. , Becker Matthias D. , Michels Stephan
Published: August 2017

Purpose:

Evaluation of the influence of long-term intravitreal anti–vascular endothelial growth factor treatment on preexisting retinal microstructural alterations in patients with diabetic macular edema.

Methods:

Eyes with diabetic macular edema and a history of ≥ 20 intravitreal anti–vascular endothelial growth factor (aflibercept and/or ranibizumab) injections were included in this retrospective study. Primary outcome was the extent of disorganization of retinal inner layers, alterations at the outer plexiform layer/Henle fiber layer junction, disruption of external limiting membrane/ellipsoid zone, disruption of retinal pigment epithelium/Bruch complex, and retinal atrophy at baseline versus after ≥ 20 intravitreal injections as visualized by spectral-domain optical coherence tomography images.

Results:

Of 383 eyes screened, 37 eyes were included in the current study. With the exception of outer plexiform layer/Henle fiber layer junction restoration, no significant changes regarding microstructural alterations between baseline and end of study were encountered after long-term anti–vascular endothelial growth factor (disorganization of retinal inner layers P = 0.381, outer plexiform layer/Henle fiber layer junction P = 0.001, external limiting membrane/ellipsoid zone P = 0.524, retinal pigment epithelium/Bruch complex P = 0.122, retinal atrophy P = 0.317). Best-corrected visual acuity significantly increased over the course of the study, corresponding to central retinal thickness and intraretinal fluid reduction (all P < 0.0001). The extent of microstructural alterations was negatively correlated with best-corrected visual acuity (P < 0.05).

Conclusion:

Apart from outer plexiform layer/Henle fiber layer junction layer restoration, no effect on preexisting retinal alterations was encountered after long-term intravitreal injections. Thus, intravitreal ranibizumab or aflibercept did not have a major effect (neither positive nor negative) on microstructural alterations.
The Relation Between Endothelial Nitric Oxide Synthase Polymorphisms and Normal Tension Glaucoma
Authors: Jeoung Jin Wook , Kim Dong Myung , Oh Sohee , Lee Jee-Soo , Park Sung Sup , Kim Ji Yeon
Published: August 2017

Purpose:

We investigated whether polymorphisms of the endothelial NO synthase (eNOS) gene are associated with normal tension glaucoma (NTG). We also investigated whether the eNOS polymorphisms are associated with NTG subgroups [NTG with and without optic disc hemorrhage (DH)].

Methods:

A total of 251 patients with NTG and 245 healthy volunteers were enrolled in this study. DNA from peripheral blood leukocytes was extracted, and the genotypes of 4 polymorphisms (rs2070744, rs1549758, rs1799983, and rs2566514) in the eNOS gene were determined using restriction fragment length polymorphism and the SNaPshot method. The primary outcome was to investigate the relation between eNOS polymorphisms and NTG. The secondary outcome was to compare the frequencies of the polymorphic genotypes among the NTG subgroups. Bonferroni correction was used to adjust for type I error.

Results:

In all subjects, the genotype distribution was in accordance with Hardy-Weinberg equilibrium. None of the 4 polymorphisms showed any significant difference in the frequencies of alleles or genotypes between the NTG patients and controls. In the further analysis comparing the genotypic frequencies between NTG with DH and normal controls, the CC/CT genotype of rs2070744 was significantly associated with DH in NTG patients (genotypic association test, P-value=0.0041). On the multiple logistic regression analysis adjusted for covariates such as sex and age, the NTG with DH was associated with polymorphic genotypes of rs2070744 with a borderline significance (additive genetic model, P=0.0070).

Conclusions:

Our results indicates that eNOS rs2070744 can be associated with NTG patients with DH. This finding suggests that the eNOS polymorphism may be a genetic risk factor in the development of DH in NTG patients.
Imported Schistosomiasis in Children: Clinical, Diagnostic Aspects And Outcome in 5 Tertiary Hospitals in France
Authors: Leblanc Claire , Pham Luu-ly , Mariani Patricia , Titomanlio Luigi , El Ghoneimi Alaa , Paris Luc , Escoda Simon , Lottmann Henri , Toubiana Julie , Paugam André , Ulinski Tim , Bouchaud Olivier , Brun Sophie , Izri Arezki , Faye Albert , De Pontual Loïc
Published: August 2017

The objective of this retrospective study is to describe imported schistosomiasis in children in the Paris region between 2010 and 2015. Forty children with a diagnosis of schistosomiasis were included. Thirty-seven (93%) had a chronic urinary form with hematuria. The lost-to-follow up rate for the second consultation was 25%. The diagnosis and management of imported schistosomiasis must be improved—notably by raising awareness among clinicians and providing families with more information.
Prevalence of Group B Streptococcus in Pregnant Women in Iran
Authors: Emaneini Mohammad , Jabalameli Fereshteh , van Leeuwen Willem B. , Beigverdi Reza
Published: August 2017

Background:

Group B Streptococcus (GBS or S. agalactiae) is a major cause of severe disease in neonates. In perinatal infections or early-onset disease, GBS is transmitted vertically to the newborn from the birth canal during labor and delivery. Limited information is available on the prevalence of GBS recto-vaginal colonization among pregnant women in Iran.

Methods:

We performed a systematic search by using different electronic databases including Medline (via Pubmed), Embase, Web of Science and Iranian Database. Meta-analysis was performed by Comprehensive Meta-Analysis (Biostat V2.2) software.

Results:

Of 250 articles published from January 2000 to September 2016, 25 studies that reported incidence of GBS colonization in pregnant women were included in this review. The meta-analyses showed that the prevalence of GBS colonization among Iranian pregnant women was 9.8% (95% confidence interval, 7.9–12).

Conclusions:

The results of this study indicate that GBS screening measures and chemoprophylaxis guidelines concerning GBS infections must be established for pregnant women in Iran, and these guidelines must provide guidance for obstetricians, midwives and neonatologists on the prevention of GBS infections.
Rapid Accurate Identification of Tuberculous Meningitis Among South African Children Using a Novel Clinical Decision Tool
Authors: Goenka Anu , Jeena Prakash M. , Mlisana Koleka , Solomon Tom , Spicer Kevin , Stephenson Rebecca , Verma Arpana , Dhada Barnesh , Griffiths Michael J.
Published: August 2017

Background:

Early diagnosis of tuberculous meningitis (TBM) is crucial to achieve optimum outcomes. There is no effective rapid diagnostic test for use in children. We aimed to develop a clinical decision tool to facilitate the early diagnosis of childhood TBM.

Methods:

Retrospective case–control study was performed across 7 hospitals in KwaZulu-Natal, South Africa (2010–2014). We identified the variables most predictive of microbiologically confirmed TBM in children (3 months to 15 years) by univariate analysis. These variables were modelled into a clinical decision tool and performance tested on an independent sample group.

Results:

Of 865 children with suspected TBM, 3% (25) were identified with microbiologically confirmed TBM. Clinical information was retrieved for 22 microbiologically confirmed cases of TBM and compared with 66 controls matched for age, ethnicity, sex and geographical origin. The 9 most predictive variables among the confirmed cases were used to develop a clinical decision tool (CHILD TB LP): altered Consciousness; caregiver HIV infected; Illness length >7 days; Lethargy; focal neurologic Deficit; failure to Thrive; Blood/serum sodium <132 mmol/L; CSF >10 Lymphocytes ×106/L; CSF Protein >0.65 g/L. This tool successfully classified an independent sample of 7 cases and 21 controls with a sensitivity of 100% and specificity of 90%.

Conclusions:

The CHILD TB LP decision tool accurately classified microbiologically confirmed TBM. We propose that CHILD TB LP is prospectively evaluated as a novel rapid diagnostic tool for use in the initial evaluation of children with suspected neurologic infection presenting to hospitals in similar settings.
History and Physical Examination for Shoulder Instability
Authors: Haley COL Chad A.
Published: August 2017

Glenohumeral instability frequently occurs in young active individuals especially those engaged in athletic and military activities. With advanced imaging and arthroscopic evaluation, our understanding of the injury patterns associated with instability has significantly improved. The majority of instability results from a traumatic anterior event which presents with common findings in the history, examination, and imaging studies. As such, a comprehensive evaluation of the patient is important to correctly diagnose the instability patterns and thus provide appropriate treatment intervention. With the correct diagnosis and improved surgical techniques, the majority of patients with instability can return to preinjury levels.
The Epidemiology of Glenohumeral Joint Instability: Incidence, Burden, and Long-term Consequences
Authors: Cameron Kenneth L. , Mauntel Timothy C. , Owens Brett D.
Published: August 2017

Acute traumatic glenohumeral joint instability is common within the general population and endemic in young athletes and physically active populations. Individuals who experience acute traumatic glenohumeral joint instability events are at high risk of recurrent injury. In addition, glenohumeral joint instability results in substantial short-term and long-term consequences, including significant time loss from activity, degenerative joint changes, and reduced quality of life. This review provides an overview of the epidemiology of glenohumeral joint instability, reviews the modifiable and nonmodifiable risk factors for glenohumeral joint instability identified in the literature, and discusses the need for developing and implementing effective multilevel strategies for the primary, secondary, and tertiary prevention of glenohumeral joint instability and the long-term consequences associated with injury.
Posterior Shoulder Instability
Authors: Brelin Alaina , Dickens Jonathan F.
Published: August 2017

Posterior shoulder instability is a relatively uncommon condition, occurring in ∼10% of those with shoulder instability. Because of the rarity of the condition and the lack of knowledge in treatment, it is often misdiagnosed or patients experience a delay in diagnosis. Posterior instability typically affects athletes participating in contact or overhead sports and is usually the result of repetitive microtrauma or blunt force with the shoulder in the provocative position of flexion, adduction, and internal rotation, leading to recurrent subluxation events. Acute traumatic posterior dislocations are rare injuries with an incidence rate of 1.1 per 100,000 person years. This rate is ∼20 times lower than that of anterior shoulder dislocations. Risk factors for recurrent instability are: (1) age below 40 at time of first instability; (2) dislocation during a seizure; (3) a large reverse Hill-Sachs lesion; and (4) glenoid retroversion. A firm understanding of the pathoanatomy, along with pertinent clinical and diagnostic modalities is required to accurately diagnosis and manage this condition.
The Modified Rambo Transcanal Approach for Cochlear Implantation in CHARGE Syndrome
Authors: Wick Cameron C. , Moore Amy M. , Killeen Daniel E. , Isaacson Brandon
Published: August 2017

Objective:

CHARGE syndrome is associated with a variety of temporal bone anomalies and deafness. The lack of surgical landmarks and facial nerve irregularities make cochlear implantation in this population a challenging endeavor. This study aims to describe a safe and efficacious transcanal approach for cochlear implantation that obviates the need to perform a mastoidectomy and facial recess.

Patients:

Three children with profound hearing loss secondary to CHARGE syndrome.

Intervention:

Transcanal cochlear implantation with closure of the ear canal via a modified Rambo meatoplasty.

Main Outcome Measure(s):

Retrospective chart review of temporal bone anomalies associated with CHARGE syndrome, technical nuances of this transcanal approach, and cochlear implant outcomes.

Results:

The mean patient age was 2.5 years (range 1.5–3.8 yr). Two were male and two were left ears. All patients had a hypoplastic mastoid, semicircular canal aplasia, and had some degree of cochlear dysplasia. A full cochlear implant insertion was achieved in all cases, even in the presence of grossly abnormal middle ear and facial nerve anatomy. There were no intraoperative or postoperative complications. The mean follow-up was 12.4 months (range, 3.9–25.2 mo). All three patients use their device daily. Their guardians report improved vocalization and environmental awareness.

Conclusions:

The modified Rambo transcanal approach provides a safe corridor for cochlear implantation in patients with CHARGE syndrome. This approach minimizes the anatomical variations associated with the syndrome and may reduce the risk of electrode extrusion. Implant outcomes in this patient population remain highly variable based on the patient's global cognitive capacity.
Retrospective Analysis of Transcranial Doppler Patterns in Veno-Arterial Extracorporeal Membrane Oxygenation Patients: Feasibility of Cerebral Circulatory Arrest Diagnosis
Authors: Marinoni Marinella , Cianchi Giovanni , Trapani Sara , Migliaccio Maria L. , Bonizzoli Manuela , Gucci Letizia , Cramaro Antonella , Gallerini Andrea , Picciafuochi Fabio , Valente Serafina , Peris Adriano
Published: August 2017

Transcranial Doppler (TCD) is able to detect cerebral hemodynamic changes in real-time. Impairment of cerebral blood flow during veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) treatment is referred to in the literature. Several cerebrovascular complications can affect VA ECMO patients, eventually leading to brain death (BD). Transcranial Doppler is a worldwide accepted technique for cerebral circulatory arrest (CCA) diagnosis for BD confirmation, and in Italy, it is mandatory in certain clinical conditions. Nowadays, no data have been published on the use of TCD as a confirmation test in VA ECMO patients evolved to BD. The aim of our study was to investigate the feasibility of TCD in CCA diagnosis during VA ECMO treatment. Thirty-two TCD examinations, performed in 25 patients on VA ECMO, were retrospectively analyzed, and factors that could be responsible for TCD waveforms abnormalities were reviewed. Differences in TCD patterns were detected depending on values of left ventricular ejection fraction and the absence or presence of intraaortic balloon pump (IABP). Four categories of different TCD patterns were then identified. In five BD patients, diagnostic CCA patterns in all cerebral arteries were identified by TCD. Our data suggest that cerebral hemodynamic changes due to both residual cardiac function and the effects of IABP can be detected by TCD in VA ECMO patients. In the case of BD, TCD seems to be a reliable instrumental test for CCA diagnosis in patients on VA ECMO when a pulsatile flow is maintained (native or IABP support).
Improving compliance with a chronic obstructive pulmonary disease bundle of care in Australian emergency departments: a clinical network quality improvement project
Authors: Kelly Anne-Maree , Pannifex Jan
Published: August 2017

Objective

The aim of this study was to describe the impact of a clinical network-led quality improvement project on compliance with bundle of care elements (individually and as a ‘bundle’) for patients treated for chronic obstructive pulmonary disease exacerbations in the emergency department.

Participants and methods

A 9-month quality improvement project was performed by a modified knowledge transfer methodology with analysis by before and after data collection. The primary outcomes of interest were compliance with key bundle of care elements (individually and as a ‘bundle’). The analysis is descriptive.

Results

Seven emergency departments participated in the project. A total of 179 patients were included in the predata and 203 in the postdata. Administration of controlled oxygen therapy (if oxygen given) increased from 74 to 80% (P=nonsignificant). Administration of inhaled bronchodilators increased from 80 to 91% (P=0.004). Administration of systemic corticosteroids increased from 76 to 88% (P=0.003). Administration of antibiotics (if evidence of infection) increased from 85 to 99% (P<0.001). Analysis of a blood gas in nonmild disease increased from 82 to 91% (P=0.04) and administration of noninvasive ventilation if pH less than 7.3 increased from 53 to 81% (P=0.01). Compliance with all appropriate elements of the defined bundle of care increased from 43 to 63% (P<0.001).

Conclusion

A locally managed, clinical network-supported quality improvement project resulted in significant improvements in compliance with chronic obstructive pulmonary disease bundle of care elements.
Role of Polyethylene Glycol in the Treatment of Functional Constipation in Children
Authors: Koppen Ilan J.N. , Broekaert Ilse J. , Wilschanski Michael , Papadopoulou Alexandra , Ribes‐Koninckx Carmen , Thapar Nikhil , Gottrand Frederic , Orel Rok , Lionetti Paolo , Benninga Marc A.
Published: August 2017

According to international guidelines, polyethylene glycol (PEG) is the laxative of first choice in the treatment of functional constipation in children, both for disimpaction and for maintenance treatment. PEG acts as an osmotic laxative and its efficacy is dose dependent. PEG is highly effective, has a good safety profile, and is well tolerated by children. Only minor adverse events have been reported. Overall the use of PEG in children has been reported to be safe, although in patients predisposed to water and electrolyte imbalances monitoring of serum electrolytes should be considered.
Antivertiginous drug therapy does not hinder the efficacy of individualized vibrotactile neurofeedback training for vestibular rehabilitation – a randomized trial
Authors: Basta Dietmar , Borsellino Liliana , Ernst Arne
Published: August 2017

Vestibular rehabilitation using individualized vibrotactile neurofeedback training (IVNT) can lead to significant improvement in the postural stability of patients with vestibular symptoms of different origins. However, some of these patients have complex, severe dizziness, meaning that a pharmacological pretreatment or parallel (to vestibular rehabilitation) treatment can help them perform the rehabilitation exercises. Hence, the present study investigated the influence of a pharmacological treatment on the efficacy of vibrotactile neurofeedback training in patients with chronic, noncompensated vestibulopathies. All participants performed IVNT for ∼10 min each day for 2 weeks. In addition, every second participant was selected randomly to receive oral medication (20 mg cinnarizine and 40 mg dimenhydrinate per tablet), taking three tables per day. Trunk and ankle sway and postural stability were measured. In addition, the dizziness handicap inventory was evaluated immediately before training on the last day of training and 6 months after training. After the 10-day period of IVNT, both groups showed a statistically significant improvement in all parameters tested. A follow-up analysis after 6 months showed a long-term efficacy for the IVNT, that is, the patients remained significantly improved in their postural stability. The antivertiginous therapy did not hinder the efficacy of the IVNT. The present results indicate that IVNT even in combination with an antivertiginous drug therapy is an effective treatment regime for patients with disabling vertigo of different origins.
Spinal cord injury following a mild trauma in homocystinuria-related bone frailty: neurorehabilitation and education on bone health management
Authors: Varghese Ginny , Al Yazeedi Wafa , Al Hamawi Mohammed , Awad Mohammed N. , Ferriero Giorgio , Giovanazzi Elena
Published: August 2017

Homocystinuria (HCU) is a rare autosomal recessive disease characterized by the deficiency of cystathionine β-synthetase, presenting with variable clinical features including micronutrient deficiency-related osteoporosis. Early-onset osteoporosis results in increased bone fragility, which is associated with low-impact fractures. To date, no traumatic myelopathy has ever been described in patients with HCU. This case report describes a 30-year-old male patient with HCU who was not aware that he was at high risk of sustaining debilitating bone fractures. After a mild trauma, he reported a T12 compression fracture with spinal cord injury. The patient underwent a tailored rehabilitation program, on the basis of multidisciplinary approach, and was educated about the increased risk of fractures, maintaining adherence to treatment and diet, having an active lifestyle, avoiding excessive weight loss, and preventing falls or other traumatic injury. To reduce the risk of fractures – with possible catastrophic consequences – patients with HCU, and their caregivers, should be educated about prevention of fractures.
Phosphorylated Histone H3 (PHH3) as a Novel Cell Proliferation Marker and Prognosticator for Meningeal Tumors: A Short Review
Authors: Elmaci İlhan , Altinoz Meric A. , Sari Ramazan , Bolukbasi Fatih H.
Published: August 2017

Cell proliferation markers are used in grading of brain tumors and in patient stratification for different treatments. Therefore, defining simple and accurate proliferation markers are of essential importance. Ki67 labeling index is widely studied, yet it is subject to interlaboratory variability. Ki67 protein is expressed on all cell cycle phases except G0 and does not precisely reflect proliferating cells. Counting mitotic figures (MFs) is used in World Health Organization grading of brain tumors (meningiomas), but the detection of MFs on conventional hematoxylin and eosin stained slides is very time consuming. Further, karyorrhexis and pyknosis in apoptotic or crushed cells may mimic mitotic morphology and falsify counting results. Histone H3 phosphorylation on serine-10 is specific to mitosis and phosphorylated histone H3 (PHH3) proliferation markers (as counts defined per area or as indices defined per cell numbers) are increasingly being used to evaluate proliferation in various tumors. Herein, we review current data on PHH3 proliferation markers in meningeal tumors. PHH3-staining highlights mitotic cells and makes easier of rapid grading by driving pathologist’s attention on the most mitotically active areas. Thereby, it would function more sensitive in detecting MFs that might be otherwise overloked and more precise by reducing interobserver variability through allowing the pathologist to analyze if the stained nuclei exhibit morphologic features of mitosis.
A Polyclonal Antibody to NKX3.1 Identifies Fungal Organisms From the Esophagus
Authors: Pejchal Martina , Pai Reetesh K. , Habib-Bein Nadia F. , Barasch Nicholas J. , Hartman Douglas J.
Published: August 2017

NKX3.1 is a transcription factor used to identify prostatic adenocarcinomas. We describe novel functionality for NKX3.1 compared with Grocott and periodic acid-Schiff-diastase (PASD) on esophageal biopsies. We identified esophageal biopsies on the basis of the search term “candida” from March 28, 2012 to December 27, 2013. Of 85 cases for which 3 stains were available and at least 1 stain was positive for fungus consistent with Candida, 83 cases stained as positive with NKX3.1, compared with 79 with PASD and 75 with Grocott. NKX3.1 was significantly superior to Grocott but not to PASD (P<0.05). NKX3.1 was significantly more efficacious in leading to a positive diagnosis of esophageal candidiasis compared with Grocott, resulting in a significantly higher number of positive fragments per slide as well as the number of organisms per fragment, but not PASD. NKX3.1 will be useful to add to the stain armamentarium for Candida and possibly other fungal organisms.
Malignant Melanoma Presenting as Thoracic Midline Malignancy: Clinicopathologic and Molecular Features
Authors: Yao Keluo , Zhao Weiqiang , Bajestani Saeed , Gru Alejandro , Otterson Gregory , Shilo Konstantin
Published: August 2017

Because of rarity, clinicopathologic and genomic profiles of noncutaneous malignant melanoma (MM) are not well characterized. In this study, we provide a detailed evaluation of 6 cases of MM presenting as thoracic midline malignancy. The tumors occurred in 6 white patients (5 males and 1 female; medium age, 71.5 y; range, 55 to 81 y). At presentation, the disease was confined to the chest (6/6) with 4 cases subsequently showing brain metastasis. All 6 tumors featured epithelioid and 1 case also spindle cell morphology. Three of 6 tumors had melanin and all 6 expressed melanocytic markers. Molecular characterization showed 2 of 6 tumors with BRAF“hot spot” genetic alterations (both with BRAFV600K) and 1 with NF1mutation. All 6 patients died of the disease within 1 year (mean survival, 4.8 mo). One patient showed a partial response to BRAF inhibitor. Our study shows that MM in this location has a spectrum of genetic alterations. The findings highlight the need for comprehensive next generation sequencing-based molecular testing to optimize targeted therapies of this aggressive malignancy.
Ataxia and Headache in a Child
Authors: Hewett Kathryn M. , Lorenzetti Brett , Jackson Benjamin F.
Published: August 2017

A 4-year-old female patient presents to the pediatric emergency department with acute onset of ataxia and occipital headache. Initial investigation, including computed tomography imaging, failed to demonstrate any focal neurologic lesion. Subsequent studies, however, reveal an acute thrombosis of the superior cerebellar artery. Further work up identified the likely causative factor to be a heterozygous mutation at the methylene tetrahydrofolate reductase gene. In this case report, we will discuss the work-up of pediatric ataxia, the evaluation and management of cerebrovascular accidents in children, and the association between stroke and mutation of the methylene tetrahydrofolate reductase gene.
Mistaken Identity
Authors: Owusu-Ansah Sylvia , Badaki-Makun Oluwakemi , Ngo Thuy L.
Published: August 2017

Cough is one of the most common presenting complaints encountered in primary care settings and the emergency department. In 2010, the Centers for Disease Control and Prevention reported approximately 31 million visits to ambulatory care centers for cough, making cough the most frequent presenting complaint in ambulatory visits (2010 National Ambulatory Medical Care Survey). Significant causes of cough can often be overlooked because it is a common symptom of a myriad of pathologies. We report the case of an otherwise healthy 9-year-old male who presented with worsening cough over a month and a half, subsequently noted to have a mediastinal mass, and diagnosed with lymphoma. We discuss the challenges of diagnosing life-threatening pathologies, which present with common symptoms.
Pediatric Life Support Update
Authors: Gill Carson , Kissoon Niranjan
Published: August 2017

Despite improving survival rates for pediatric cardiac arrest victims, they remain strikingly low. Evidence for pediatric cardiopulmonary resuscitation is limited with many areas of ongoing controversy. The American Heart Association provides updated guidelines for life support based on comprehensive reviews of evidence-based recommendations and expert opinions. This facilitates the translation of scientific discoveries into daily patient care, and familiarization with these guidelines by health care providers and educators will facilitate the widespread, consistent, and effective care for patients.
Carcinoid Arising From the Teratomatous Bronchial Mucosa in a Mature Cystic Teratoma of the Ovary: A Case Report
Authors: Niu Dongfeng , Li Zhongwu , Sun Li , Cao Dengfeng
Published: August 2017

Primary ovarian carcinoids are relatively uncommon, either pure (monodermal teratomas) or in association with mature cystic teratomas. Here we reported a unique case of carcinoid arising from the teratomatous bronchial mucosa in an ovarian mature cystic teratoma in a 22-year-old woman. This tumor showed a compact trabecular and nested growth pattern with salt-and-pepper chromatin pattern. Mitotic figures were identified (6/10 high power fields) and focal necrosis was present. Immunohistochemically the tumor cells were diffusely positive for TTF1 and CD56, focally positive for synaptophysin, and negative for chromogranin A and CDX2. Ki67 proliferation index was approximately 20% to 25%. This patient was alive with no evidence of disease at 3 years and 7 months after surgery. To our knowledge, this is the first case report of carcinoid arising from the teratomatous bronchial mucosa in an ovarian mature teratoma in the English literature.
Gonorrhea and Chlamydia Case Detection Increased When Testing Increased in a Multisite US HIV Cohort, 2004–2014
Authors: Raifman Julia R. , Gebo Kelly A. , Mathews William Christopher , Korthuis Philip Todd , Ghanem Khalil G. , Aberg Judith A. , Moore Richard D. , Nijhawan Ank E. , Monroe Anne K. , Berry Stephen A. ,   for the HIV Research Network
Published: August 2017

Objectives:

Annual screening for gonorrhea [Neisseria gonorrhoeae (NG)] and chlamydia [Chlamydia trachomatis (CT)] is recommended for all sexually active persons living with HIV but is poorly implemented. Studies demonstrating no increases in NG and/or CT (NG/CT) case detection in clinics that successfully expanded NG/CT screening raise questions about this broad screening approach. We evaluated NG/CT case detection in the HIV Research Network during 2004–2014, a period of expanding testing.

Methods:

We analyzed linear time trends in annual testing (patients tested divided by all patients in care), test positivity (patients positive divided by all tested), and case detection (the number of patients with a positive result divided by all patients in care) using multivariate repeated measures logistic regression. We determined trends overall and stratified by men who have sex with men (MSM), men who have sex exclusively with women, and women.

Results:

Among 15,614 patients (50% MSM, 26% men who have sex exclusively with women, and 24% women), annual NG/CT testing increased from 22% in 2004 to 60% in 2014 [adjusted odds ratio (AOR) per year 1.22 (1.21–1.22)]. Despite the increase in testing, test positivity also increased [AOR per year 1.10 (1.07–1.12)], and overall case detection increased from 0.8% in 2004 to 3.9% in 2014 [AOR per year 1.20 (1.17–1.22)]. Case detection was highest among MSM but increased over time among all 3 groups.

Conclusions:

NG/CT case detection increased as testing expanded in the population. This supports a broad approach to NG/CT screening among persons living with HIV to decrease transmission and complications of NG/CT and of HIV.