bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-term Oncologic Outcomes After Neoadjuvant Chemoradiation Followed by Intersphincteric Resection With Coloanal Anastomosis for Locally Advanced Low Rectal Cancer
Authors: Park Jun Seok , Park Soo Yeun , Kim Hye Jin , Cho Seung Hyun , Kwak Sang Gyu , Choi Gyu-Seog
Published: January 2019

BACKGROUND:

To date only few data have been available relating to the oncologic safety of intersphincteric resection in such advanced tumors.

OBJECTIVE:

This study aimed to elucidate the oncologic outcomes and clinical factors affecting the long-term survival of patients who underwent preoperative chemoradiotherapy followed by intersphincteric resection for locally advanced rectal cancers.

DESIGN:

This was a retrospective analysis of prospectively collected departmental data.

SETTINGS:

The study was conducted at a department of colorectal surgery in a tertiary care teaching hospital between January 2009 and September 2015.

PATIENTS:

A cohort of 147 consecutive patients with low rectal cancer undergoing intersphincteric resection after preoperative chemoradiotherapy was included.

MAIN OUTCOME MEASURES:

Kaplan–Meier analyses were used to evaluate the 3-year disease-free survival and local recurrence rates. Logistic regression analyses were used to analyze the influence of tumor response and other prognostic factors on survival outcomes.

RESULTS:

Median follow-up was 34 months (range, 8–94 mo). The estimated overall 3-year disease-free survival and local recurrence rates were 64.9% and 11.7%. Circumferential resection margin involvement and pathologic T stage (ypT stage) were significant predictors of cancer relapse. The 3-year disease-free survival was 47.4% for patients with ypT3 tumors compared with 82.0% for those with ypT0–2 tumors (p = 0.001). The 3-year disease-free survival was 36.5% for patients with involved circumferential resection margins compared with 69.7% for those with a noninvolved circumferential resection margin (p = 0.003). On multivariate analysis, ypT stage, ymrT stage, and circumferential resection margin status were associated with worse disease-free survival. Clinical T-stage and pathologic distal margin status were not independent factors affecting oncologic outcomes.

LIMITATIONS:

This study is limited with respect to its retrospective design.

CONCLUSIONS:

In these patients with locally advanced low rectal cancers, intersphincteric resection after preoperative chemoradiotherapy was associated with acceptable oncologic outcomes. See Video Abstract at http://links.lww.com/DCR/A941.
Early Results of a Phase I Trial Using an Adipose-Derived Mesenchymal Stem Cell-Coated Fistula Plug for the Treatment of Transsphincteric Cryptoglandular Fistulas
Authors: Dozois Eric J. , Lightner Amy L. , Mathis Kellie L. , Chua Heidi K. , Kelley Scott R. , Fletcher Joel G. , Dietz Allan B. , Friton Jessica J. , Butler Greg W. , Faubion William A.
Published: January 2019

BACKGROUND:

Management of transsphincteric cryptoglandular fistulas remains a challenging problem and the optimal surgical approach remains elusive. Mesenchymal stem cells, increasingly being utilized for perianal Crohn’s disease, offer a novel therapy to treat cryptoglandular fistulas.

OBJECTIVES:

This study aimed to determine safety and feasibility of using an autologous mesenchymal stem cell-coated fistula plug in patients with transsphincteric cryptoglandular fistulas.

DESIGN:

This study is a phase I clinical trial.

SETTING:

This study was conducted at a tertiary academic medical center.

PATIENTS:

Adult (>18 years) male and female patients with transsphincteric cryptoglandular fistulas were selected.

MAIN OUTCOMES MEASURES:

The primary outcomes measured were the safety, feasibility, and efficacy of a mesenchymal stem cell-coated fistula plug in patients with transsphincteric fistulas.

RESULTS:

Fifteen patients (8 women, mean age 39.8 years) with a single-tract transsphincteric fistula received a mesenchymal stem cell-loaded fistula plug and were followed for 6 months. Duration of disease at the time of study enrollment was a median of 3.0 years (range, 1–13 years) with a median of 3.5 (range, 1–20) prior surgical interventions. Adverse events included 1 plug extrusion, 1 abdominal wall seroma, 3 perianal abscesses requiring drainage, and 1 patient with perianal cellulitis. There were no serious adverse events. At 6 months, 3 patients had complete clinical healing, 8 had partial healing, and 4 patients showed no clinical improvement. Radiographic improvement was seen in 11 of 15 patients.

LIMITATIONS:

This study was limited by the small cohort and short follow-up.

CONCLUSIONS:

Autologous mesenchymal stem cell-coated fistula plug treatment of transsphincteric cryptoglandular fistulas was safe and feasible and resulted in complete or partial healing in a majority of patients. See Video Abstract at http://links.lww.com/DCR/A897.
Anatomical Variations of Iliac Vein Tributaries and Their Clinical Implications During Complex Pelvic Surgeries
Authors: Kanjanasilp Prapon , Ng Jia Lin , Kajohnwongsatit Krittin , Thiptanakit Charnjiroj , Limvorapitak Thitithep , Sahakitrungruang Chucheep
Published: January 2019

BACKGROUND:

During high sacrectomies and lateral pelvic compartment exenterations, isolating the external and internal iliac veins within the presacral area is crucial to avoid inadvertent injury and severe hemorrhage. Anatomical variations of external iliac vein tributaries have not been previously described, whereas multiple classifications of internal iliac vein tributaries exist.

OBJECTIVE:

We sought to clarify the iliac venous system anatomy using soft-embalmed cadavers.

DESIGN:

This is a descriptive study.

SETTINGS:

This study was conducted in Chulalongkorn University, Thailand.

PATIENTS:

We examined 40 iliac venous systems from 20 human cadavers (10 males, 10 females).

INTERVENTIONS:

Blue resin dye infused into the inferior vena cava highlighted the iliac venous system, which was meticulously dissected and traced to their draining organs.

MAIN OUTCOME MEASURES:

Iliac vein tributaries and their valvular system were documented and analyzed.

RESULTS:

The external iliac vein classically receives 2 tributaries (inferior epigastric and deep circumflex iliac) near the inguinal ligament. However, external iliac vein tributaries in the presacral area were found in 20 venous systems among 15 cadavers (75%). The mean diameter of each tributary was 4.0 ± 0.35 mm, with 72% arising laterally. We propose a simplified classification for internal iliac vein variations: pattern 1 in 12 cadavers (60%) where a single internal iliac vein joins a single external iliac vein to drain into the common iliac vein; pattern 2 in 7 cadavers (35%) where the internal iliac vein is duplicated; and pattern 3 in 1 cadaver (5%) where bilateral internal iliac veins drain into a common trunk before joining the common iliac vein bifurcation.

LIMITATIONS:

This study is limited by the number of cadavers included.

CONCLUSIONS:

A comprehensive understanding of previously unreported highly prevalent external iliac vein tributaries in the presacral region is vital during complex pelvic surgery. A simplified classification of internal iliac vein variations is proposed. See Video Abstract at http://links.lww.com/DCR/A900.
A Comparative Dose-response Relationship Between Sexes for Mortality and Morbidity of Radiation-induced Lung Injury in the Rhesus Macaque
Authors: Thrall Karla D. , Mahendra S. , Jackson M.K. , Jackson William , Farese Ann M. , MacVittie Thomas J.
Published: January 2019

Radiation-induced lung injury is a characteristic, dose- and time-dependent sequela of potentially lethal, delayed effects of acute radiation exposure. Understanding of these delayed effects to include development of medical countermeasures requires well-characterized and validated animal models that mimic the human response to acute radiation and adhere to the criteria of the US Food and Drug Administration Animal Rule. The objective herein was to establish a nonhuman primate model of whole-thorax lung irradiation in female rhesus macaques. Definition of the dose-response relationship to include key signs of morbidity and mortality in the female macaque served to independently validate the recent model performed with male macaques and importantly, to establish the lack of sex and institutional bias across the dose-response relationship for radiation-induced lung injury. The study design was similar to that described previously, with the exception that female rhesus macaques were utilized. In brief, a computed tomography scan was conducted prior to irradiation and used for treatment planning. Animals in 5 cohorts (n = 8 per cohort) were exposed to a single 6‐MV photon exposure focused on the lung as determined by the computed tomography scan and treatment planning at a dose of 9.5, 10, 10.5, 11, or 11.5 Gy. Subject-based supportive care, including administration of dexamethasone, was based on trigger-to-treat criteria. Clearly defined euthanasia criteria were used to determine a moribund condition over the 180‐day study duration post-whole-thorax lung irradiation. Percent mortality per radiation dose was 12.5% at 9.5 Gy, 25% at 10 Gy, 62.5% at 10.5 Gy, 87.5% at 11 Gy, and 100% at 11.5 Gy. The resulting probit plot for the whole-thorax lung irradiation model estimated an LD50/180 of 10.28 Gy, which was not significantly different from the published estimate of 10.27 Gy for the male rhesus. The key parameters of morbidity and mortality support the conclusion that there is an absence of a sex influence on the radiation dose-response relationship for whole-thorax lung irradiation in the rhesus macaque. This work also provides a significant interlaboratory validation of the previously published model.
Assessment of miR-182, miR-183, miR-184, and miR-221 Expressions in Primary Pterygium and Comparison With the Normal Conjunctiva
Authors: İçme Gökhan , Yilmaz Ayça , Dinç Erdem , Görür Ayşegül , Fidanci Şenay Balci , Tamer Lülüfer
Published: January 2019

Objectives:

The aim of this study was to investigate the expression levels of miR-126-3p, miR-182-5p, miR-183-5p, miR-184, miR-221-3p, and miR-205-5p in primary pterygium tissue and compare these levels with those in healthy conjunctiva tissue.

Methods:

Twenty-four patients who were diagnosed with grade 3 primary pterygium and scheduled for surgery between January 2014 and January 2016 and had no systemic disease or other ocular pathology were included in the study. The control group comprised nasal interpalpebral conjunctival tissue specimens from 24 age- and sex-matched patients with no history of systemic disease or ocular pathology other than cataract. Expression levels of miR-126-3p, miR-182-5p, miR-183-5p, miR-184, miR-221-3p, and miR-205-5p were determined and compared between the pterygium and conjunctiva specimens.

Results:

Expression levels of miR-182-5p, miR-183-5p, and miR-184 were significantly higher in pterygium tissue compared with normal conjunctival specimens (P<0.0001, P=0.01, and P=0.01, respectively), whereas expression of miR-221-3p was significantly lower (P=0.02). Expression levels of miR-126-3p and miR-205-5p did not differ significantly between the 2 groups (P>0.05).

Conclusions:

Expression levels of miR-182-5p, miR-183-5p, and miR-184 are increased, whereas expression of miR-221-3p is decreased in primary pterygium tissue, and these miRNAs may play a role in the pathogenesis of pterygium.
Quality of CT Imaging of Periocular Metallic Foreign Bodies Using Artifact Reduction Software
Authors: Willett Keirnan L. , Sheng Mike , Gorry Thomasine , Woo John H.
Published: January 2019

Purpose:

CT is the standard of care for assessment of ocular and orbital trauma; however, artifacts from metallic foreign bodies can limit the utility of CT. The authors hypothesize that implementation of metal artifact reduction techniques can improve image quality and diagnostic confidence for a diverse group of interpreters.

Methods:

A case series of ten subjects with retained periocular metallic foreign bodies imaged with CT were identified retrospectively from a large urban trauma center. Postacquisition images were processed with an iterative-based metal streak artifact reduction software. The severity of the metal streak artifact was assessed by clinicians including radiologists (4), ophthalmologists (4), and oculoplastic specialists (3) using a numeric scale to grade images on seven clinically relevant criteria. Each image was also analyzed to measure the size of the artifact and degree of streaking.

Results:

Overall confidence in diagnosis and severity of metallic streak was improved with metallic artifact reduction (p < 0.001, Wilcoxon signed-rank test). Similarly, confidence in assessing specific features—including extra-ocular muscle, optic nerve, globe rupture, orbital fracture and identification of foreign bodies—was improved after metallic artifact reduction (p < 0.001, Wilcoxon signed-rank test). The standard deviation of pixel intensity for a path surrounding the foreign body as well as the area of the streak artifact decreased in the metallic artifact reduction-processed images (p < 0.001, paired t test).

Conclusions:

Metal artifact reduction in CT has potential benefits in improving image quality and reader confidence for periocular trauma cases in real-world settings.
What does brain imaging tell us about itch?
Authors: Mochizuki Hideki , Hernandez Loren E. , Yosipovitch Gil
Published: January 2019

Understanding the mechanism of itch as well as the pathophysiology of chronic itch is important for the development of effective treatments. In the past 25 years, researchers have investigated the cerebral mechanism of itch in healthy subjects and chronic itch patients using functional brain imaging techniques. These studies have demonstrated that a variety of cortical and subcortical areas are associated with itch. In addition, it has been found that there are differences in brain activity and brain anatomy between healthy subjects and chronic itch patients. In this review article, we discuss potential roles of those identified brain regions in itch perception, and associations of the functional and structural changes in the brain with chronic itch. Brain imaging studies of psychological modulations of itch are also discussed.
Safety With Mobilization and Ambulation During Physical Therapy Sessions for Patients on Mechanical Circulatory Support 50 Days or Greater
Authors: Decker Lauren M. , Mumper Valerie A. , Russell Scott P. , Smith Beth A.
Published: January 2019

Purpose:

The growing incidence of critically ill patients on mechanical circulatory support (MCS) for many weeks at our center prompted an institutional review of minor and major adverse events experienced by patients on MCS greater than 50 days, who participated in mobility both inside and outside of the intensive care unit as part of physical therapy (PT) treatment interventions.

Methods:

A retrospective medical chart review was conducted to collect information on adverse events and highest level of mobility reached during 454 PT sessions. Patients were receiving venovenous extracorporeal membrane oxygenation or Centrimag bilateral ventricular assist device support and were on prolonged MCS for 50 days or greater.

Results:

Patients participated in gait outside of the room and/or intensive care unit during 108 (23.8% of total) sessions. Major or minor adverse events occurred in less than 4% of 454 PT sessions.

Conclusions:

In one academic medical center, patients on prolonged MCS engaged in PT sessions that included ambulation outside of the intensive care unit and outdoors with infrequent adverse events. Effectiveness of PT sessions was not evaluated.
Oregon's Coordinated Care Organization Experiment: Are Members' Experiences of Care Actually Changing?
Authors: Wright Bill J. , Royal Natalie , Broffman Lauren , Li Hsin-Fang , Dulacki Kristen
Published: January 2019

In 2012, Oregon embarked on an ambitious plan to redesign financing and care delivery for Medicaid. Oregon's Coordinated Care Organizations (CCOs) are the first statewide effort to use accountable care principles to pay for Medicaid benefits. We surveyed 8,864 Medicaid-eligible participants approximately 1 year before and 12 months after CCO implementation to assess the impact of CCOs on member-reported outcomes. We compared changes in outcomes over time between Medicaid CCO members, Medicaid fee-for-service (FFS) members, and those who were uninsured. After 1 year, Medicaid beneficiaries enrolled in CCOs reported better access to care, better quality care, and better connections to primary care than Medicaid FFS or uninsured persons. We did not find early evidence of improvements in preventive care and screenings or in ED utilization. Although these are early indicators, results suggest that Oregon's delivery system transformation is having a positive impact on patient experience outcomes.
Mindfulness-Based Group Cognitive Behavior Therapy for Provoked Localized Vulvodynia: A Randomized Controlled Trial
Authors: Guillet Alyson D. , Cirino Nicole H. , Hart Kyle D. , Leclair Catherine M.
Published: January 2019

Objective

The aim of the study was to compare the effectiveness of mindfulness-based group cognitive behavior therapy (M-gCBT) versus education support group therapy for the pain and distress associated with provoked localized vulvodynia.

Materials and Methods

Participants were randomized to M-gCBT or education support group therapy. Mindfulness-based group cognitive behavior participants attended 8 weekly sessions. Education support group participants received 8 weeks of online education with 3 in-person group visits. Vaginal insertion pain (tampon test) was the primary outcome. Secondary outcomes (Generalized Anxiety Disorder 7, Beck's Depression Index, Female Sexual Distress Scale, Female Sexual Function Index, and Pain Catastrophizing) were administered before intervention and at the completion of the study period, 3 months, and 6 months. Sample size was based on the ideal number for group dynamics of 6 to 12 participants per group.

Results

Participants were enrolled from August 1, 2016, to January 30, 2017. Thirty-two participants were enrolled and 31 were randomized: 14 to M-gCBT and 17 to education support. Baseline characteristics did not differ significantly. Vaginal insertion pain decreased in both groups but was not statistically different between groups (difference of 1.23; 95% CI = −0.52 to 2.98). At 6 months, participants in the M-gCBT group showed statistically significant improvement in the Female Sexual Function Index, Generalized Anxiety Disorder 7, and Beck's Depression Index compared with the education support group.

Conclusions

Mindfulness-based group cognitive behavior and education support group therapy are effective in reducing pain and distress. However, women in the M-gCBT program showed greater improvement in certain secondary outcomes, indicating that M-gCBT may offer some advantages in reducing distress associated with provoked localized vulvodynia.
Should We Always Biopsy in Clinically Evident Lichen Sclerosus?
Authors: McCarthy Siobhan , MacEoin Neil , O'Driscoll Michael , O'Connor Roisin , Heffron Cynthia C.B.B. , Murphy Michelle
Published: January 2019

Objective

The aims of the study were to review cases of clinically diagnosed lichen sclerosus (LS) and to compare the histological features found on biopsy to clinical features seen on examination.

Methods

A retrospective chart review was undertaken of patients attending a specialist vulval service between 2013 and 2015 with a clinical diagnosis of LS. Patients in whom there was clinical diagnostic uncertainty or those with features of lichen planus or lichen planus/LS overlap were excluded. We determined the proportion of these patients who underwent vulval biopsy and reviewed their histology.

Results

One hundred fifteen charts were reviewed. Sixty-nine (69/115, 60%) had a firm diagnosis of established LS, and of these, 39 (39/69, 56.5%) had a biopsy performed in the previous 5 years. Thirteen (13/39, 33.3%) of these biopsies fell short of a diagnosis of LS histologically with some suggestive but nondiagnostic and some showing nonspecific features.

Conclusions

Reliance on biopsies solely to establish or exclude the diagnosis of LS is inadvisable. A good level of knowledge of the characteristic clinical features is imperative among gynecologists, dermatologists, and general practitioners.
Three-Year Clinical and Audiological Outcomes of Percutaneous Implants for Bone Conduction Devices: Comparison Between Tissue Preservation Technique and Tissue Reduction Technique
Authors: Kruyt Ivo J. , Kok Herman , Bosman Arjan , Nelissen Rik Chrétien , Mylanus Emmanuel Antonia Maria , Hol Myrthe Karianne Sofie
Published: January 2019

Objectives:

To evaluate the three-year clinical and audiological outcomes of soft-tissue preservation compared to soft-tissue reduction in linear incision surgery for percutaneous implant for bone conduction (BC) devices.

Methods:

Twenty-five patients (25 implants) were enrolled in a prospective cohort for implant surgery with linear incision and tissue preservation. The control group consisted of 25 patients (25 implants) from a previous randomized controlled trial in which a linear incision with soft-tissue reduction was applied. Follow-up visits were scheduled at 7 and 21 days (fitting of sound processor); 12 weeks; 6 months; and at 1, 2, and 3 years after implantation. Main outcome measures were skin sensibility, soft-tissue status, Implant Stability Quotient (ISQ), skin height, implant survival, revision surgery, scar assessment, and hearing thresholds (BC in-situ between 250 Hz and 8 kHz with BC device on testband and abutment, and BC thresholds at 250Hz–4 kHz with a B71 bone conductor).

Results:

Tissue preservation resulted in superior sensibility (mean percentage correct responses 99.7% [SD 1.7] vs 92.0% [SD 9.2], p = 0.0001). No spontaneous implant loss occurred in either group. The abutment was removed in two tests and in one control patient. Two control patients needed skin revision surgery. Although not statistically significant, more adverse soft-tissue reactions (Holgers ≥2) were observed in the test-group (n = 9 [36%] vs n = 3 [12%], p = 0.095). ISQ increased significantly more in the test group compared to the control group (7.64 [SD 4.05] vs 4.29 [SD 3.93]). Skin thickening, scar assessment, and hearing outcomes were comparable.

Conclusion:

Tissue preservation demonstrated superior skin sensibility compared to tissue reduction while other clinical outcomes were comparably excellent.
Prevalence of Sporadic Vestibular Schwannoma: Reconciling Temporal Bone, Radiologic, and Population-based Studies
Authors: Marinelli John P. , Grossardt Brandon R. , Lohse Christine M. , Carlson Matthew L.
Published: January 2019

Objective:

Reported epidemiologic data surrounding vestibular schwannoma (VS) are controversial. Temporal bone prevalence studies have suggested that VS affects up to 2.4% of the population, whereas magnetic resonance imaging (MRI) studies have reported VS to affect 0.017%. Moreover, existing population-based data seem to underestimate the commonness of VS. In an attempt to reconcile temporal bone, radiologic, and population-based reports regarding VS, the current study was conceived to determine the modern prevalence of VS using a unique epidemiological database.

Patients:

All persons living in Olmsted County, Minnesota on January 1, 2017 with a confirmed diagnosis of sporadic VS identified using the Rochester Epidemiology Project (REP) medical records-linkage system.

Main Outcome Measures:

Prevalence of all VS and asymptomatic, incidentally diagnosed VS.

Results:

Sixty-seven persons from a population of nearly 160,000 were living with VS on January 1, 2017, resulting in a point prevalence of 42.0 per 100,000 persons. The prevalence increased with older age, reaching 212.4 per 100,000 in those ≥ 70 years. Including only persons who have undergone head MRI, the prevalence of asymptomatic, incidentally diagnosed VS was 69.9 per 100,000 among adults age 20 years and older.

Conclusions:

Using the unique infrastructure of the REP, the current study suggests that the clinical prevalence of sporadic VS approximates 1 in 2,000 adults and 1 in every 500 persons aged 70 years and older, with the prevalence of incidentally diagnosed tumors closely paralleling past MRI studies. These data characterize a shift in the modern patient demographic of sporadic VS, as now many people bearing a diagnosis of VS would have previously died without knowledge of their disease. Moreover, they typify an unfolding transition from an era of microsurgery and radiosurgery to the beginnings of an era that will be largely comprised of “chronic disease management.”
Assessing Fine-Grained Speech Discrimination in Young Children With Bilateral Cochlear Implants
Authors: Peng Zhao Ellen , Hess Christi , Saffran Jenny R. , Edwards Jan R. , Litovsky Ruth Y.
Published: January 2019

Hypothesis:

Children of 2 to 3 years old with cochlear implants can perform consonant discriminations using fine-grained acoustic cues.

Background:

Children born with severe-to-profound deafness are provided with early cochlear implantation (<2 yr) to maximize oral communication outcomes. Little is known regarding their abilities to discriminate consonant contrasts for accurately identifying speech sounds.

Methods:

Using a Reaching for Sound paradigm to collect behavioral responses, consonant contrast discrimination was measured in 13 children with bilateral cochlear implants (BiCIs; aged 28–37 mo), and 13 age-matched normal-hearing (NH) children. Four contrast pairs were tested: 1) place + voicing, 2) place, 3) voicing, and 4) reduced voice-onset-time cue. Using standard processing strategies, electrodograms showing pulsatile stimulation patterns were created retrospectively to assess the spectral-temporal cues delivered through the clinical speech processors.

Results:

As a group, children with BiCIs were able to discriminate all consonant contrasts at a level that was above chance, but their performance was poorer than NH children. Larger individual variability in discrimination performance was found in children with BiCIs. Stepwise regression revealed that, in the place contrast, chronological age was correlated with improved discrimination performance among children with BiCIs.

Conclusion:

Children with BiCIs were able to discriminate consonant contrasts using fine-grained spectral-temporal cues above chance level but more poorly than their NH peers. Electrodogram analysis confirmed the access to spectral-temporal cues in the consonant contrasts through clinical speech processors. However, the cue saliency might not have be enough for children with BiCIs to achieve the same discrimination accuracy as NH children.
Mobile Internet Telephony Improves Speech Intelligibility and Quality for Cochlear Implant Recipients
Authors: Guignard Jérémie , Senn Pascal , Koller Roger , Caversaccio Marco , Kompis Martin , Mantokoudis Georgios
Published: January 2019

Objective:

The objective of this study was to investigate the benefit of mobile Voice over Internet protocol (VoIP) over conventional mobile phone calls (Global System for Mobile Communications, GSM) on speech intelligibility and quality for cochlear implant (CI) recipients.

Study Design:

Cross-sectional, prospective.

Setting:

Tertiary referral center.

Patients:

A volunteer sample of experienced, German-speaking, adult CI recipients was considered. Volunteers with less than 50% aided monosyllabic word discrimination were excluded.

Intervention:

Smartphone communication was changed from GSM to VoIP on two separate devices (A and B).

Main Outcome Measures:

Speech intelligibility was assessed with the Hochmair-Shulz-Moser (HSM) test in noise, speech quality with the mean opinion score (MOS) survey and the perceptual evaluation of speech quality (PESQ) algorithm.

Results:

With device A, the mean HSM scores were 64.40% ± 32.41 with GSM and 77.28% ± 21.60 with VoIP (p = 0.0573). 66.7% of patients had a higher score with VoIP. For device B the means were 53.90% ± 21.77 and 69.07% ± 21.09 (p < 0.0001). 94.1% patients scored better with VoIP.

With device A the average MOS scores were 3.12 ± 1.52 and 4.08 ± 0.95 (p = 0.0078). 76.9% of patients gave a higher score with VoIP. With device B the means were 2.71 ± 1.08 and 3.528 ± 1.44 (p = 0.0068). 56.3% of patients gave a higher score with VoIP. The effect was smaller when using an accessory cable. PESQ scores were significantly higher with VoIP (p < 0.001) in all configurations.

Conclusions:

CI recipients experience speech intelligibility and quality improvements using VoIP on a smartphone compared with conventional mobile phone calls.
Coexistent Vestibular Schwannoma and Creutzfeldt–Jakob Disease: Recognition and Infection Control
Authors: Thomas Andrew J. , Casazza Geoffrey C. , MacDonald Joel D. , Gurgel Richard K.
Published: January 2019

Objectives:

We describe the first known case of coexistent vestibular schwannoma (VS) and Creutzfeldt–Jakob disease (CJD). Our objectives are to use this case as a general lesson for the subspecialist otolaryngologist to remain vigilant to alternative diagnoses, and to specifically improve understanding of the diagnosis and management of CJD as relevant to the practice of otolaryngology and skull base surgery.

Methods:

Retrospective case review performed in June 2016 at an academic, tertiary, referral center.

Results:

A 55-year-old man presents with one month of worsening disequilibrium and short-term memory loss. Magnetic resonance imaging (MRI) (T1, T2) identified a 4 mm left VS which was then surgically resected. Postoperatively, his neurological status decline continued, and subsequent MRI identified patterns of FLAIR hyperintensity and diffusion restriction consistent with CJD. While CSF analysis (tau and 14-3-3) and EEG was inconclusive, serial imaging and the clinical course were highly suggestive of CJD. A probable diagnosis was made, surgical instruments quarantined, and infection control involved to minimize transmission risk. The patient died 6 months after symptom onset.

Conclusions:

Patients with CJD may initially present with otolaryngologic symptoms. MRI signal abnormality in the basal ganglia on diffusion weighted imaging and FLAIR sequences in conjunction with physical findings and clinical course may help make a probable diagnosis CJD. Prions are resistant to traditional sterilization and additional measures must be taken to prevent iatrogenic transmission.

Level of Evidence: Level 4—Case series
Coeliac disease and obstetric and gynaecological disorders: where are we now?
Authors: Schiepatti Annalisa , Sprio Elisa , Sanders David S. , Lovati Elisabetta , Biagi Federico
Published: January 2019

Coeliac disease (CD) is a chronic gluten-dependent enteropathy very common in the general population and characterized by an extremely heterogeneous clinical picture. Although its prevalence is growing worldwide, case-finding strategy remains the mainstay to diagnosis. Thus, correct identification of high-risk categories of patients who need to be tested for CD is an essential part of medical knowledge to a large number of specialists and primary care providers. In this regard, although CD might have a serious effect on women’s reproductive health, a widespread consensus is lacking on which categories of obstetric and gynaecological disorders should be tested for CD. The aim of this review is to critically summarize the current literature relevant to CD and obstetric and gynaecological disorders and to provide practical proposals that may be helpful to clinicians involved in the management of these patients.
Gastric Carcinoma as Second Malignant Neoplasm in a Survivor From High-risk Neuroblastoma
Authors: Hirano Naoki , Nishikawa Kazuo , Hiratsuka Takahiro , Suenobu Souichi , Ihara Kenji
Published: January 2019

Childhood cancer survivors (CCSs) from high-grade malignancies, such as high-risk neuroblastoma, have been increased, and second malignant neoplasm, becomes a serious problem for CCSs. However, detailed reports about rare types of second cancer such as gastric cancer remain limited. We herein reported a female patient who developed diffuse type gastric carcinoma after 21 years from completion of treatment to high-risk neuroblastoma. We reviewed the previous cohort studies for second gastrointestinal cancer in CCSs and the case reports with second gastric carcinoma for CCSs. We presumed second gastric cancer was refractory for CCSs as well as for adult cancer survivors.
Ganglioglioma in a Survivor of Infantile Glioblastoma
Authors: Scheuermann Amanda , Belongia Meghan , Lawlor Michael W. , Suchi Mariko , Kaufman Bruce , Vasudevaraja Varshini , Serrano Jonathan , Snuderl Matija , Knipstein Jeffrey
Published: January 2019

Congenital tumors account for 2% to 4% of all pediatric central nervous system tumors. Glioblastoma multiforme (GBM) represents a small subset of these tumors. Despite harboring histologic features similar to older patients, infants with GBM exhibit improved survival and respond more favorably to surgery and chemotherapy. To highlight this tumor’s unique behavior, we report the case of a survivor of infantile GBM who developed a recurrent tumor in the surgical bed 6 months after diagnosis. The tumor was ultimately resected and was a ganglioglioma. This case shows both a favorable clinical outcome to an infantile GBM and this tumor’s natural history.
Chemoport-related Fungemia Caused by Trichosporon asahii
Authors: Raju Dona S. , Sugunan Aadharsa , Keechilattu Pavithran , Philip Arun , Reghu Remya
Published: January 2019

Trichosporon asahii is a rare opportunistic fungal pathogen that causes fatal systemic infection in immunocompromised patients. Neutropenia developing due to malignancies is an important risk factor for fungal infection. Invasive infections due to T. asahii can be divided into disseminated and localized forms. The disseminated form is more common and usually occurs in neutropenic patients. The patient typically has an acute febrile illness that progresses rapidly to multiorgan failure. Here, we are presenting a case of fungal sepsis by invasive T. asahii in a 1-year-old child with Wilms Tumor. To the best of our knowledge, this is the first time that fungal sepsis due to T. asahii has been reported in a Wilms tumor patient. The incidence of rare invasive fungal infections is increasing in immunocompromised patients in whom management becomes difficult due to their heterogenous antifungal susceptibility pattern and intrinsic resistance to the standard antifungal agents that are routinely given. The patient was admitted with high spiking fever, and his laboratory investigations suggested neutropenia. T. asahii was isolated from the blood culture, for which he was started on inj. voriconozole. After 14 days of treatment, the fungus was cleared out from the patient’s blood.
Can Couples With MCV≥80, MCH<26, HbA2<3.2, HbF<3 be Classified as Low-risk β-Thalassemia Group?
Authors: Mirzakhani Mohsen , Tarrahi Mohammad J. , Baghersad Atefe , Maracy Mohammad R.
Published: January 2019

Background and Aim:

Thalassemia screening instructions in Iran categorizes couples with mean corpuscular volume (MCV)=75 to 80, mean corpuscular hemoglobin (MCH)=26 to 27, hemoglobin A2 (HbA2)<3.5, and hemoglobin fetal (HbF)<3 indices as low-risk couples, and therefore further genetic testing is not obligatory. This study examined the possibility of classifying couples with MCH<26 and MCV≥80 indices in the low-risk group when their HbF was <3 and HbA2 was <3.2.

Methodology:

This was a cross-sectional study. The data included results from cell blood count and HbA2 prenatal diagnosis (PND) and HbF tests taken by 22 health care centers in Esfahan province, central Iran, throughout the years 2012-2016. The inclusion criterion was the registering of MCV, MCH, and PND results of the participants. From the 5804 participants, 5624 individuals were included in the study.

Results:

The sensitivity and specificity of the screening program were 99.7 and 53.12, respectively. Ten cases (0.18%) with thalassemia trait had indices MCV≥80 and MCH≥26 including 3 cases (0.05%) with concurrent α and β-thalassemia mutations and 7 cases (0.12%) with HbS mutations. Altogether, 553 subjects (9.83%) had MCV≥80 and MCH<26 indices, and only 1 case (0.018%) was found with β-thalassemia mutations (codon8 (-AA)/WT genotype).

Conclusions:

Subjects with MCV≥80, MCH<26, HbA2<3.2, and HbF<3 cell blood count indices could be grouped as low-risk couples if normal HbA2 and HbF values are considered. The results of this study also indicate that there is a chance of missing concurrent α and β-thalassemia or HbS hemoglobinopathies in the current screening program given the fact that genetic testing is not considered for couples with MCV and MCH in the low-risk range. HbF testing could be conducted to prevent these missing cases.
An 18-Year-Old Male With X-linked Lymphoproliferative Syndrome Type 1 Who Developed Primary Central Nervous System Lymphoma 6 Months After Primary Epstein-Barr Virus Infection
Authors: Kusano Nobuyoshi , Sakata Naoki , Sugimoto Keisuke , Miyazawa Tomoki , Ueda Satoshi , Okano Munehiro , Imadome Ken-Ichi , Hoshino Akihiro , Kanegane Hirokazu , Kimura Masatomo , Sato Takao , Okada Mitsuru , Takemura Tsukasa
Published: January 2019

X-linked lymphoproliferative syndrome type 1 (XLP1) is a rare congenital immunodeficiency disease. We report the case of an 18-year-old male who developed hemophagocytic lymphohistiocytosis (HLH) with neurologic complications after primary Epstein-Barr virus (EBV) infection and subsequently developed EBV-related central nervous system lymphoma (CNSL). Given the vulnerability to EBV, he was finally diagnosed with XLP1 and treated with whole-brain irradiation along with chemotherapy and subsequent allogeneic hematopoietic stem cell transplantation from a SH2D1A wild-type sibling donor. Although the prognosis for CNSL is generally dismal, reconstitution of the immune system from a normal donor contributed to the patient remaining in remission for 30 months.
Evaluation of Insulin-mediated Regulation of AKT Signaling in Childhood Acute Lymphoblastic Leukemia
Authors: Wang Jian , Xue Hong-Man , Chen Yan-Ru , Xu Hong-Gui , Lin Shao-Fen , Tang Xi-Kang , Chen Chun
Published: January 2019

Objective:

Hyperglycemia increases the risk of early recurrence and high mortality in some adult blood cancers. In response to increased glucose levels, insulin is secreted, and several studies have shown that insulin-induced AKT signaling can regulate tumor cell proliferation and apoptosis. The AKT pathway is aberrantly activated in adult acute lymphoblastic leukemia (ALL), but the mechanisms underlying this activation and its impact in pediatric patients with ALL are unclear.

Materials and Methods:

We evaluated the insulin-induced chemoresistance and AKT pathway activation by measuring cell proliferation, apoptosis, and other parameters in ALL cell lines (Jurkat and Reh cells), as well as in primary pediatric leukemic cell samples, after culture with insulin, the chemotherapeutic drugs daunorubicin (DNR), vincristine (VCR), and L-asparaginase (L-Asp), or anti-insulin-like growth factor-1 receptor (IGF-1R) monoclonal antibody.

Results:

DNR, VCR, and L-Asp-induced toxicity in Jurkat and Reh cells was reduced in the presence of insulin. DNR promoted cell proliferation, whereas DNR, VCR, and L-Asp all reduced apoptosis in both cell lines cotreated with insulin compared with that in cell lines treated with chemotherapeutics alone (P<0.05). Furthermore, addition of an anti-IGF-1R monoclonal antibody promoted apoptosis, downregulated IGF-1R expression, and decreased the phosphorylation of AKT, P70S6K, and mTOR intracellular signaling pathway proteins in both cell lines, as well as in primary cultures (P<0.05).

Conclusions:

Our results suggest that insulin-induced chemoresistance and activation of the AKT signaling pathway in pediatric ALL cells.
Prevention of Long-term Adverse Health Outcomes With Cardiorespiratory Fitness and Physical Activity in Childhood Acute Lymphoblastic Leukemia Survivors
Authors: Lemay Valérie , Caru Maxime , Samoilenko Mariia , Drouin Simon , Alos Nathalie , Lefebvre Geneviève , Levy Emile , Lippé Sarah , Marcil Valérie , Sultan Serge , Bertout Laurence , Krajinovic Maja , Laverdière Caroline , Raboisson Marie-Josée , Sinnett Daniel , Andelfinger Gregor , Curnier Daniel
Published: January 2019

Background:

Most childhood acute lymphoblastic leukemia (ALL) survivors develop chronic treatment-related adverse effects several years after the end of therapy. A regular practice of physical activity and a good cardiorespiratory fitness have the potential to reduce the risk of chronic disease and improve quality of life. The aim of this study was to evaluate in a cohort of ALL survivors, the association between a good cardiorespiratory fitness or the respect of physical activity guidelines and major long-term health outcomes.

Methods:

In total, 247 ALL survivors underwent a cardiopulmonary exercise test, completed a physical activity questionnaire and a battery of clinical examinations. We calculated the odds ratio to obtain the preventive fraction (PF) to evaluate the effects of the cardiorespiratory fitness and physical activity levels on health outcomes (ie, obesity, metabolic health, cardiac health, cognitive health and mood, bone health).

Results:

Despite their young age, 88% of the participants presented at least one adverse health outcome, and 46% presented ≥3. Their cardiorespiratory fitness was also lower than expected with a median VO2 peak reaching 84% of the predicted value. In the analyses using cardiorespiratory fitness, statistically significant PFs were observed for obesity (0.30), low–high-density lipoprotein-cholesterol (0.21) and depression (0.26). In the physical activity level analyses, statistically significant PFs were observed for obesity, depression, and low bone mineral density, with a PF of 0.55, 0.81, and 0.60, respectively.

Conclusions:

Our results indicate that a good cardiorespiratory fitness and physical activity level induced a preventive action for most health outcomes studied and was associated with a lower late adverse effects prevalence in ALL survivors.
Health Coaching for Patients With Type 2 Diabetes Mellitus to Decrease 30-Day Hospital Readmissions
Authors: Sullivan Veronica H. , Hays Mary M. , Alexander Susan
Published: January 2019

Purpose/Objectives:

The purpose of this program was to provide health coaching to patients with a primary or secondary diagnosis of Type 2 diabetes mellitus (T2DM) to increase self-management skills and reduce 30-day readmissions.

Primary Practice Setting:

The setting was a 273-bed, acute care not-for-profit hospital in the southern region of the United States.

Findings/Conclusions:

Health coaching that emphasized self-management, empowered patients to set healthy goals, and provided support through weekly reminders to improve self-management for patients with T2DM in this pilot program. The majority of patients reported accomplishment of goals with 16 out of 20 patients who did not require inpatient stay 30 days after discharge from the acute care facility.

Implications for Case Management Practice:

The T2DM piloted program can easily be modified to fit other chronic illness that require routine monitoring and complex regimens to remain healthy. Case managers have the opportunity to coach on the importance of lifestyle modification and self-management support for patients with chronic illness with follow-up interactive phone visits after hospital discharge. Motivation and confidence through coaching may increase self-efficacy and better management of self-care and reduce the burden of unplanned hospital readmissions.
Improving Early Discharge Using a Team-Based Structure for Discharge Multidisciplinary Rounds
Authors: Patel Hemali , Yirdaw Essey , Yu Amy , Slater Lisa , Perica Katharine , Pierce Read G. , Amaro Connie , Jones Christine D.
Published: January 2019

Purpose of Study:

Miscommunications during the complex process of discharging patients from acute care facilities can lead to adverse events, patient dissatisfaction, and delays in discharge. Brief multidisciplinary discharge rounds (MDRs) can increase communication between stakeholders and shorten a patient's length of stay (LOS). At our tertiary academic medical center, case managers (CMs) have historically been assigned patients by physical unit location rather than by provider teams caring for patients. As a result, medicine teams often interact with several unit-based CMs due to lack of geographically cohorted patients, leading to inefficiency and fragmentation in discharge planning communication. Our aim was to implement and evaluate the impact of multidisciplinary, team-based discharge planning rounds (MDR) for general medicine patients.

Primary Practice Setting:

A tertiary academic medical center.

Methodology and Sample:

Using the model for continuous improvement, we implemented and optimized MDR on 2 of 4 internal medicine resident ward teams that care for general internal medicine patients, including creation of a multidisciplinary team, improving physician continuity.

Results:

During the pilot, 1,584 patients were discharged from all medicine teams—825 from pilot teams and 759 from control teams. The proportion of patients with discharge before noon (DBN) orders was 41.2% on pilot versus 29.6% on control teams. Length of stay was 92.2 hr versus 97.2 hr, and 30-day readmission rate was 16.0% versus 18.3% for the pilot versus control teams, respectively. After the pilot concluded, we continued to have resident continuity on pilot teams but returned to the unit-based CM model. During this time, the proportion of DBN orders and LOS were similar between the pilot and control teams (29.0% vs. 24.3% and 95.8 hr vs. 96.6 hr, respectively). The 30-day readmission rate was 12.6% compared with 18.9% for the pilot versus control teams.

Implications for Case Management Practice:

Our team-based MDR pilot improved interdisciplinary relationships and communication and resulted in shorter LOS, earlier discharge times, and lower 30-day readmissions.
Palliative Care Nursing Communication
Authors: Fuoto Abby , Turner Kathleen M.
Published: January 2019

Despite the frequency, complexity, and intensity of communication that occurs between nurses, patients, and families, palliative care nurses often struggle with end-of-life communication. The primary goal of this quality improvement project was to increase nurse confidence and satisfaction engaging in end-of-life communication following the implementation of the COMFORT model; the secondary goal was to improve patient-family satisfaction with care provided in the palliative care unit. Fourteen palliative care nurses attended a 4-hour course to learn the tenets of the COMFORT model and practice through role-play exercises. A repeated-measures design was used to measure nurse confidence and satisfaction precourse, postcourse, and 3 months postcourse. A between-subjects pre-post design was used to compare family satisfaction survey scores in the 3-month period before versus the 3 months after implementation. Analysis revealed a statistically significant increase in all measures of nurse confidence and satisfaction from precourse to postcourse and from precourse to 3 months postcourse. There was no statistical difference between the family satisfaction survey scores before versus after training, although survey results were generally high at baseline and most respondents rated palliative services with the best possible response. This project demonstrates that COMFORT model training increased confidence and satisfaction of palliative care nurses engaged in end-of-life communication and demonstrates potential for use in other clinical areas that do not specialize in end-of-life nursing (eg, critical care) but find themselves in need of the communications skills to address end-of-life care.