bluuebunny/crossref_metadata_2025 huggingface dataset:
The BODY-Q: A Patient-Reported Outcome Instrument for Weight Loss and Body Contouring Treatments
Authors: Klassen Anne F. , Cano Stefan J. , Alderman Amy , Soldin Mark , Thoma Achilles , Robson Sam , Kaur Manraj , Papas Athanasios , Van Laeken Nancy , Taylor Valerie H. , Pusic Andrea L.
Published: April 2016

Background:

Body contouring performed for cosmetic purposes, or after weight loss, has the potential to improve body image and health-related quality of life (HRQL). The BODY-Q is a new patient-reported outcome (PRO) instrument designed to measure patient perceptions of weight loss and/or body contouring. In this article, we describe the psychometric properties of the BODY-Q scales after an international field-test.

Methods:

Weight loss and body contouring patients from Canada, United States, and United Kingdom were recruited between November 2013 and February 2015. Data were collected using an iPad directly into a web-based application or a questionnaire booklet. Rasch measurement theory analysis was used for item reduction and to examine reliability, validity, and ability to detect change.

Results:

The sample included 403 weight loss and 331 body contouring patients. Most BODY-Q items had ordered thresholds (134/138) and good item fit. Scale reliability was acceptable, ie, Person separation index >0.70 for 16 scales, Cronbach α ≥0.90 for 18 of 18 scales, and Test–retest ≥0.87 for 17 of 18 scales. Appearance and HRQL scores were lower in participants with more obesity-related symptoms, higher body mass index, and more excess skin and in those pre- versus postoperative body contouring. The 134 weight loss patients who completed the BODY-Q twice, either 6 weeks (weight loss/nonsurgical body contouring program) or 6 months (bariatric program) later, improved significantly on 7 appearance and 4 HRQL scales.

Conclusion:

The BODY-Q is a clinically meaningful and scientifically sound patient-reported outcome instrument that can be used to measure outcomes in patients who undergo weight loss and/or body contouring.
Exercise in Pregnancy: First Trimester Risks
Authors: HEGAARD HANNE K. , ERSBØLL ANNE S. , DAMM PETER
Published: April 2016

Most national guidelines recommend moderate exercise during pregnancy, but this is not followed by the majority of pregnant women. Fear of exercise risks is among reported barriers. In contrast to most reviews focusing on late pregnancy risks, this review evaluates the association between exercise in the first trimester and the risk of miscarriage. A systematic review based on the EMBASE and PUBMED databases was conducted and 5 studies assessing the association between early pregnancy exercise and miscarriage were identified. Diverging findings were reported making no clear conclusion possible. New studies with participants included in the prepregnancy period are needed.
Altered Bulbar Conjunctival Microcirculation in Response to Contact Lens Wear
Authors: Chen Wan , Xu Zhe , Jiang Hong , Zhou Jin , Wang Liang , Wang Jianhua
Published: April 2016

Purpose:

This study was conducted to determine blood flow velocities and corresponding vessel diameters to characterize the response of the bulbar conjunctival microvasculature to contact lens wear.

Methods:

A functional slit-lamp biomicroscope (FSLB), an adapted traditional slitlamp, was used to image the temporal bulbar conjunctiva of 22 healthy subjects before and after 6 hr of contact lens wear. All of the measurable venules on the conjunctiva were processed to yield vessel diameters and blood flow velocities.

Results:

The average blood flow velocity increased from 0.51±0.20 to 0.65±0.22 mm/sec (P<0.001) after 6 hr of lens wear. The blood flow velocity distribution showed a velocity increase that correlated with the vessel diameter increase from the baseline (r=0.826, P<0.05). This pattern maintained a similar trend after 6 hr of lens wear (r=0.925, P<0.05), and increased velocities were found across all of the vessel diameter ranges (P<0.001).

Conclusions:

Blood flow velocity increases across all of the vessel diameter ranges in response to contact lens wear. Functional slitlamp biomicroscope is capable of characterizing the bulbar microvascular response to contact lens wear.
Shave Excision With Keratopigmentation for Limbal Dermoid
Authors: Bandivadekar Pooja , Agarwal Tushar , Temkar Shreyas
Published: April 2016

Objectives:

To describe a modified technique of corneal tattooing for concomitant cosmetic rehabilitation in eyes with limbal dermoid.

Study:

Case series.

Methods:

Three patients between 12 and 20 years of age with grade I limbal dermoid underwent shave excision with corneal tattooing. All patients had dark brown irides. Chemical keratopigmentation was performed over the bed using 2% gold chloride with 1% hydrazine hydrate as reducing agent to yield a dark brown color. Bandage contact lens was applied.

Results:

Epithelium over the operated area healed by day 10. Visual acuity was maintained in all eyes with minimal change in keratometry. The dye was well retained in the tattooed area at 1 year. No complications such as infection, pseudopterygium, or local limbal stem-cell deficiency were observed.

Conclusion:

Corneal tattooing along with simple shave excision provides good cosmetic results in cases of limbal dermoids.
Orbital Compartment Syndrome Following Post-Traumatic Subgaleal Hematoma
Authors: Jenkins Thomas L. , Zheng Cindy X. , Murchison Ann P. , Bilyk Jurij R.
Published: April 2016

Orbital extension of subgaleal hematoma is rare. This report describes the case of an otherwise healthy 10-year-old girl who developed delayed contralateral proptosis and external ophthalmoplegia after relatively minor right-sided forehead trauma. She was found to have bilateral subgaleal hematomas communicating with a left superior subperiostial orbital hematoma. Over the course of 2 days, she developed an orbital compartment syndrome requiring emergent canthotomy and cantholysis, followed by surgical incision and drainage of her scalp hematoma without orbitotomy. Hematologic work-up revealed heterozygous factor VII deficiency.
Acute Orbital Syndrome in Herpes Zoster Ophthalmicus: Clinical Features of 7 Cases
Authors: Temnogorod Jenny , Pointdujour-Lim Renelle , Mancini Ronald , Chang Shu-Hong , Allen Richard C. , Shinder Roman
Published: April 2016

Purpose:

To report a series of patients with herpes zoster ophthalmicus and associated acute orbital syndrome with corresponding radiographic findings.

Methods:

Medical records of 7 patients with herpes zoster ophthalmicus with acute orbital findings were reviewed. Clinical presentation, radiography, and treatment outcomes were assessed.

Results:

One man and 6 women with a median age of 70 years (range 47–84) presented with herpes zoster ophthalmicus with acute clinical orbital signs. Two of the 7 patients had compromised immune systems, with 1 patient having chronic lymphocytic leukemia and another infected with human immunodeficiency virus. Clinical orbital findings included proptosis, blepharoptosis, ophthalmoplegia, diplopia, and visual loss. Orbital imaging detailed such findings as myositis in all 7 patients, dacryoadenitis in 2 patients, and optic nerve sheath enhancement in 1 patient. Treatment with intravenous acyclovir was universal in all 7 patients and in 2 cases systemic corticosteroids were also administered. Orbital signs improved in all patients over several months.

Conclusions:

Herpes zoster ophthalmicus can rarely cause an acute orbital syndrome and the authors present what may be the largest series of such patients to date. Herpes zoster ophthalmicus can affect various orbital structures including the lacrimal gland, extraocular muscles, cranial nerves and optic nerve sheath. A careful clinical examination and detailed orbital radiography are critical in proper diagnosis and treatment of such patients. Improvement of symptoms and signs with antiviral therapy can be expected; however, complete resolution does not always occur. The role of systemic steroids in treatment of orbital disease is yet to be determined.
Hyaluronic Acid Gel Injection for Multiple Eyelid Folds in Asian Eyelids: A Novel Approach
Authors: Tamboli Diana , Mancini Ronald
Published: April 2016

Purpose:

Upper eyelids of the Asian population have several unique anatomical characteristics that result in the characteristic absence of a native eyelid fold; however, 40% to 60% of the Asian population do exhibit a naturally occurring fold. Aging-associated soft tissue atrophy and loss of skin elasticity can lead to periorbital volume loss and subsequent development of multiple eyelid folds in patients previously with a native single-fold. The authors describe a nonsurgical technique for the management of multiple eyelid folds in Asian patients using hyaluronic acid gel (HAG) injection.

Methods:

In this retrospective review, 6 upper eyelids of 5 Asian patients who underwent HAG injection for multiple eyelid folds were identified. Patients were injected with HAG superior to the native eyelid fold in a superficial plane just deep to the orbicularis oculi muscle and in the suborbicularis oculi plane of the superior sulcus.

Results:

Five Asian patients with prior history of a single naturally occurring upper eyelid fold who developed age-related unilateral multiple eyelid folds underwent injection with HAG. All patients tolerated the procedure well and without complication. Restoration of a single-fold with bilateral upper eyelid symmetry was achieved successfully in all patients.

Conclusions:

Multiple eyelid folds may occur in Asian patients with an established naturally occurring single eyelid fold as a result of periorbital volume loss. HAG injection in the periorbital region provides a nonsurgical solution to restore volume and reform a single eyelid fold.
Pain facilitation and pain inhibition during conditioned pain modulation in fibromyalgia and in healthy controls
Authors: Potvin Stéphane , Marchand Serge
Published: April 2016

Although fibromyalgia (FM) is associated with a deficit in inhibitory conditioned pain modulation (CPM), the discriminative power of CPM procedures is unknown. Moreover, the high intersubject heterogeneity in CPM responses in FM raises the possibility that a sizeable subgroup of these patients may experience pain facilitation during CPM, but the phenomenon has not been explicitly studied. To address these issues, 96 patients with FM and 71 healthy controls were recruited. Thermal stimuli were used to measure pain thresholds. Pain inhibition was elicited using a tonic thermal test (Peltier thermode) administered before and after activation of CPM mechanisms using a cold pressor test. Thermal pain thresholds were lower in patients with FM than in healthy controls. Pain ratings during the cold pressor test were higher in patients with FM, relative to controls. The CPM inhibitory efficacy was lower in patients with FM than in controls. The CPM procedure had good specificity (78.9%) but low sensitivity (45.7%), whereas a composite pain index had good sensitivity (75.0%) and specificity (78.9%). Finally, the rate of patients with FM who reported pain facilitation during the CPM procedure was found to be significantly increased compared with that of controls (41.7% vs 21.2%). The good discriminative power of the composite pain index highlights the need for further validation studies using mechanistically relevant psychophysical procedures in FM. The low sensitivity of the CPM procedure, combined with the large proportion of patients with FM experiencing pain facilitation during CPM, strongly suggests that endogenous pain inhibition mechanisms are deeply impaired in patients with FM, but only in a subgroup of them.
Temporal preference in individuals reporting chronic pain: discounting of delayed pain-related and monetary outcomes
Authors: Tompkins D. Andrew , Johnson Patrick S. , Smith Michael T. , Strain Eric C. , Edwards Robert R. , Johnson Matthew W.
Published: April 2016

Opioid therapy for pain is associated with an increased risk for substance use disorders. This study's purpose was to determine the association between opioid misuse propensity (Screener and Opioid Assessment for Patients in Pain–Revised) and delay discounting (DD), a behavioral process linked to substance use disorders, which quantifies the extent to which outcomes are devalued because of their delay. Participants reporting chronic pain (N = 249) answered pain and opioid use questions and then completed 4 DD tasks. Each of these tasks assessed either money or pain consequences, framed as either rewards or punishments. Each task involved hypothetical choices between immediate smaller vs delayed larger consequences. The extant Monetary Choice Questionnaire assessed DD of money rewards, and a modified version assessed discounting of money losses (immediate smaller loss vs larger delayed loss). Based on the Monetary Choice Questionnaire, the novel Pain Relief Choice Questionnaire assessed choices between an immediate short duration of pain relief vs a longer duration of pain relief. Similarly, the novel Additional Pain Choice Questionnaire assessed choices between an immediate short duration of additional pain vs a longer duration of additional pain. Discounting of both additional pain and money losses were significantly associated with high Screener and Opioid Assessment for Patients in Pain–Revised scores—indicating participants at greatest risk for opioid misuse discount future punishments rather than future rewards compared with those at low risk. Measures of DD may have promise in more accurately identifying individuals at highest risk for opioid misuse during chronic opioid therapy.
Patient vs provider reports of aberrant medication-taking behavior among opioid-treated patients with chronic pain who report misusing opioid medication
Authors: Nikulina Valentina , Guarino Honoria , Acosta Michelle C. , Marsch Lisa A. , Syckes Cassandra , Moore Sarah K. , Portenoy Russell K. , Cruciani Ricardo A. , Turk Dennis C. , Rosenblum Andrew
Published: April 2016

During long-term opioid therapy for chronic noncancer pain, monitoring medication adherence of patients with a history of aberrant opioid medication-taking behaviors (AMTB) is an essential practice. There is limited research, however, into the concordance among existing monitoring tools of self-report, physician report, and biofluid screening. This study examined associations among patient and provider assessments of AMTB and urine drug screening using data from a randomized trial of a cognitive–behavioral intervention designed to improve medication adherence and pain-related outcomes among 110 opioid-treated patients with chronic pain who screened positive for AMTB and were enrolled in a pain program. Providers completed the Aberrant Behavior Checklist (ABC) and patients completed the Current Opioid Misuse Measure (COMM) and the Chemical Coping Inventory (CCI). In multivariate analyses, ABC scores were compared with COMM and CCI scores, while controlling for demographics and established risk factors for AMTB, such as pain severity. Based on clinical cutoffs, 84% of patients reported clinically significant levels of AMTB and providers rated 36% of patients at elevated levels. Provider reports of AMTB were not correlated with COMM or CCI scores. However, the ABC ratings of experienced providers (nurse practitioners/attending physicians) were higher than those of less experienced providers (fellows) and were correlated with CCI scores and risk factors for AMTB. Associations between patient- and provider-reported AMTB and urine drug screening results were low and largely nonsignificant. In conclusion, concordance between patient and provider reports of AMTB among patients with chronic pain prescribed opioid medication varied by provider level of training.
Multiple faces of pain: effects of chronic pain on the brain regulation of facial expression
Authors: Vachon-Presseau Etienne , Roy Mathieu , Woo Choong-Wan , Kunz Miriam , Martel Marc-Olivier , Sullivan Michael J. , Jackson Philip L. , Wager Tor D. , Rainville Pierre
Published: April 2016

Pain behaviors are shaped by social demands and learning processes, and chronic pain has been previously suggested to affect their meaning. In this study, we combined functional magnetic resonance imaging with in-scanner video recording during thermal pain stimulations and use multilevel mediation analyses to study the brain mediators of pain facial expressions and the perception of pain intensity (self-reports) in healthy individuals and patients with chronic back pain (CBP). Behavioral data showed that the relation between pain expression and pain report was disrupted in CBP. In both patients with CBP and healthy controls, brain activity varying on a trial-by-trial basis with pain facial expressions was mainly located in the primary motor cortex and completely dissociated from the pattern of brain activity varying with pain intensity ratings. Stronger activity was observed in CBP specifically during pain facial expressions in several nonmotor brain regions such as the medial prefrontal cortex, the precuneus, and the medial temporal lobe. In sharp contrast, no moderating effect of chronic pain was observed on brain activity associated with pain intensity ratings. Our results demonstrate that pain facial expressions and pain intensity ratings reflect different aspects of pain processing and support psychosocial models of pain suggesting that distinctive mechanisms are involved in the regulation of pain behaviors in chronic pain.
Predicting preschool pain-related anticipatory distress: the relative contribution of longitudinal and concurrent factors
Authors: Racine Nicole M. , Pillai Riddell Rebecca R. , Flora David B. , Taddio Anna , Garfield Hartley , Greenberg Saul
Published: April 2016

Anticipatory distress prior to a painful medical procedure can lead to negative sequelae including heightened pain experiences, avoidance of future medical procedures, and potential noncompliance with preventative health care, such as vaccinations. Few studies have examined the longitudinal and concurrent predictors of pain-related anticipatory distress. This article consists of 2 companion studies to examine both the longitudinal factors from infancy as well as concurrent factors from preschool that predict pain-related anticipatory distress at the preschool age. Study 1 examined how well preschool pain-related anticipatory distress was predicted by infant pain response at 2, 4, 6, and 12 months of age. In study 2, using a developmental psychopathology framework, longitudinal analyses examined the predisposing, precipitating, perpetuating, and present factors that led to the development of anticipatory distress during routine preschool vaccinations. A sample of 202 caregiver–child dyads was observed during their infant and preschool vaccinations (the Opportunities to Understand Childhood Hurt cohort) and was used for both studies. In study 1, pain response during infancy was not found to significantly predict pain-related anticipatory distress at preschool. In study 2, a strong explanatory model was created whereby 40% of the variance in preschool anticipatory distress was explained. Parental behaviours from infancy and preschool were the strongest predictors of child anticipatory distress at preschool. Child age positively predicted child anticipatory distress. This strongly suggests that the involvement of parents in pain management interventions during immunization is one of the most critical factors in predicting anticipatory distress to the preschool vaccination.
Effectiveness of dry needling for chronic nonspecific neck pain: a randomized, single-blinded, clinical trial
Authors: Cerezo-Téllez Ester , Torres-Lacomba María , Fuentes-Gallardo Isabel , Perez-Muñoz Milagros , Mayoral-del-Moral Orlando , Lluch-Girbés Enrique , Prieto-Valiente Luis , Falla Deborah
Published: April 2016

Chronic neck pain attributed to a myofascial pain syndrome is characterized by the presence of muscle contractures referred to as myofascial trigger points. In this randomized, parallel-group, blinded, controlled clinical trial, we examined the effectiveness of deep dry needling (DDN) of myofascial trigger points in people with chronic nonspecific neck pain. The study was conducted at a public Primary Health Care Centre in Madrid, Spain, from January 2010 to December 2014. A total of 130 participants with nonspecific neck pain presenting with active myofascial trigger points in their cervical muscles were included. These participants were randomly allocated to receive: DDN plus stretching (n = 65) or stretching only (control group [n = 65]). Four sessions of treatment were applied over 2 weeks with a 6-month follow-up after treatment. Pain intensity, mechanical hyperalgesia, neck active range of motion, neck muscle strength, and perceived neck disability were measured at baseline, after 2 sessions of intervention, after the intervention period, and 15, 30, 90, and 180 days after the intervention. Significant and clinically relevant differences were found in favour of dry needling in all the outcomes (all P < 0.001) at both short and long follow-ups. Deep dry needling and passive stretching is more effective than passive stretching alone in people with nonspecific neck pain. The results support the use of DDN in the management of myofascial pain syndrome in people with chronic nonspecific neck pain.
Pharmacologic attenuation of cross-modal sensory augmentation within the chronic pain insula
Authors: Harte Steven E. , Ichesco Eric , Hampson Johnson P. , Peltier Scott J. , Schmidt-Wilcke Tobias , Clauw Daniel J. , Harris Richard E.
Published: April 2016

Pain can be elicited through all mammalian sensory pathways yet cross-modal sensory integration, and its relationship to clinical pain, is largely unexplored. Centralized chronic pain conditions such as fibromyalgia are often associated with symptoms of multisensory hypersensitivity. In this study, female patients with fibromyalgia demonstrated cross-modal hypersensitivity to visual and pressure stimuli compared with age- and sex-matched healthy controls. Functional magnetic resonance imaging revealed that insular activity evoked by an aversive level of visual stimulation was associated with the intensity of fibromyalgia pain. Moreover, attenuation of this insular activity by the analgesic pregabalin was accompanied by concomitant reductions in clinical pain. A multivariate classification method using support vector machines (SVM) applied to visual-evoked brain activity distinguished patients with fibromyalgia from healthy controls with 82% accuracy. A separate SVM classification of treatment effects on visual-evoked activity reliably identified when patients were administered pregabalin as compared with placebo. Both SVM analyses identified significant weights within the insular cortex during aversive visual stimulation. These data suggest that abnormal integration of multisensory and pain pathways within the insula may represent a pathophysiological mechanism in some chronic pain conditions and that insular response to aversive visual stimulation may have utility as a marker for analgesic drug development.
Denver Spirited Heart
Authors: Hooker Stephanie A. , Ross Kaile , Masters Kevin S. , Park Crystal L. , Hale Amy E. , Allen Larry A. , Bekelman David B.
Published: April 2016

Background:

Increased spiritual well-being is related to quality of life (QOL) in patients with heart failure (HF). However, consistent and deliberate integration of spirituality into HF patient care has received limited attention.

Objective:

The aim of this study was to evaluate the feasibility, acceptability, and preliminary evidence regarding the efficacy of a resource-sparing psychospiritual intervention to improve QOL in HF patients.

Methods:

A 12-week mail-based intervention addressing spirituality, stress, coping, and adjusting to illness was developed and tested using a mixed-methods, 1-group pretest-posttest pilot study design. A convenience sample of patients with HF completed prestudy and poststudy questionnaires, including the Kansas City Cardiomyopathy Questionnaire, Patient Health Questionnaire, Meaning in Life Questionnaire, and Functional Assessment of Chronic Illness Therapy–Spiritual. Research staff conducted semistructured interviews with program completers. Interviews were coded and analyzed using conventional content analysis.

Results:

Participants (N = 33; 82% male; mean age, 61 years) completed 87% of baseline data collection, an average of 9 intervention modules, and 55% of poststudy questionnaires. Participants rated all the modules as at least moderately helpful, and qualitative themes suggested that patients found the intervention acceptable and beneficial. Most participants believed spirituality should continue to be included, although they disagreed on the extent to which religion should remain. Participants who completed the intervention reported evidence suggesting increased QOL (Kansas City Cardiomyopathy Questionnaire; effect size [ES], 0.53), decreased depressive symptoms (Patient Health Questionnaire-9; ES, 0.62), and less searching for meaning (Meaning in Life Questionnaire; ES, 0.52).

Conclusions:

Results indicate that a module-based program integrating spirituality and psychosocial coping strategies was feasible and acceptable and may improve QOL. This preliminary study suggests that clinicians be open to issues of spirituality as they may relate to QOL in patients with HF. Future research will test a revised intervention.
A Young Woman With Severe Chest Pain After Undergoing Endobronchial Ultrasound-guided Transbronchial Needle Aspiration for a Large Mediastinal Mass
Authors: Mogal Rahul , Banerjee Nandini , Yung Bernard , Mukherjee Dipak
Published: April 2016

A 33-year-old woman with chest pain and hemoptysis was found to have a large mediastinal mass. As the radiology imagings were inconclusive, she underwent diagnostic endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA). After the procedure she developed mediastinitis, which required video-assisted thoracoscopic surgery excision and intravenous antibiotics. Bronchogenic cysts are rare congenital anomalies. Traditionally, surgical resection has been recommended as the first-line treatment option for both symptomatic and asymptomatic bronchogenic cysts due to concerns of late complications, including malignant transformation. Recently, there have been a number of case reports of bronchogenic cysts been diagnosed and treated successfully using EBUS-TBNA. We present a case in which EBUS-TBNA was performed for a definitive diagnosis of cystic lesion in the mediastinum.
Distinguishing Bronchoscopic Changes of Mitral Stenosis From Carcinoma In Situ With Narrow Band Imaging
Authors: Fielding David I. , Schuster Daniel D.
Published: April 2016

A 75-year-old woman presented with minor hemoptysis. Past history included atrial fibrillation and rheumatic mitral stenosis. Bronchoscopy revealed a striking abnormality of widespread dilated mucosal and submucosal vessels. Initially the concern was whether there was widespread endobronchial malignancy; however, narrow band imaging (NBI) demonstrated the symmetrical uniform nature of the vessels. In addition, there was a focal area of in situ carcinoma with classic NBI features of malignancy. Following external-beam radiation therapy, NBI features had dramatically changed in the treated area which was now biopsy negative. The case highlights the utility of NBI in identifying endobronchial microvessel appearance even where there are widespread nonmalignant vessel changes in the bronchial mucosa.
Electromagnetic Navigational Bronchoscopy Spares a Drunken Crab From the Surgeon’s Knife
Authors: Parikh Mihir S. , Seeley Eric , Krishna Ganesh
Published: April 2016

Surgical resection is traditionally the preferred treatment for fluorodeoxyglucose-avid peripheral pulmonary nodules that grow over time. However, new technologies, including electromagnetic navigational bronchoscopy (ENB), provide an opportunity to confirm or possibly exclude a cytologic cancer diagnosis, before resection. We present a case of a 56-year-old North American man who presented with a fluorodeoxyglucose-avid pulmonary nodule and sought a second opinion after being recommended thoracotomy with lobectomy. The peripheral nodule was biopsied using ENB and pathologic evaluation of the lesion demonstrated parasitic eggs with features of Paragonimus westermani. No evidence of malignancy was found. The radiographic abnormalities resolved after treatment with praziquantel. Using a minimally invasive procedure with ENB, we successfully diagnosed pulmonary infection with P. westermani, a rare infectious cause of peripheral pulmonary lesions in a patient without travel to an endemic area. Furthermore, an alternative diagnosis to cancer was established, sparing this patient an unnecessary thoracotomy with right middle lobectomy.
Surgical Management and Prognostic Factors of Vulvovaginal Melanoma
Authors: Ditto Antonino , Bogani Giorgio , Martinelli Fabio , Di Donato Violante , Laufer Joel , Scasso Santiago , Chiappa Valentina , Signorelli Mauro , Indini Alice , Lorusso Domenica , Raspagliesi Francesco
Published: April 2016

Objective

The aim of the study was to evaluate the surgical management and the role of different prognostic factors on survival outcomes of women affected by genital (i.e., vulvar and vaginal) melanoma.

Materials and Methods

Data of patients undergoing primary surgical treatment for genital melanoma were evaluated in this retrospective study. Baseline, pathological, and postoperative variables were tested to identify prognostic factors. Five-year disease-free survival (DFS) and overall survival (OS) were analyzed using Kaplan-Meier and Cox proportional hazards models.

Results

Overall, 98 patients met the inclusion criteria. Sixty-seven (68%) and 31 (32%) patients in this study population were diagnosed with vulvar and vaginal melanoma, respectively. Median (range) DFS and OS were 12 (1–70) and 22 (1–70) months, respectively. Considering factors influencing DFS, we observed that at multivariate analysis, only vaginal localization (hazard ratio [HR] = 3.72; 95% CI = 1.05–13.2) and number of mitoses (HR = 1.24; 95% CI = 1.11–1.39) proved to be associated with worse DFS. Nodal status was the only independent factor influencing 5-year OS in patients with vulvar (HR = 1.76; 95% CI = 1.22–2.54; p = .002) and vaginal (HR = 3.65; 95% CI = 1.08–12.3; p = .03) melanoma.

Conclusions

Genital melanomas are characterized by a poor prognosis. Number of mitoses and lymph node status are the main factors influencing survival. Surgery is the mainstay of treatment. A correct and prompt diagnosis is paramount.
Clinical Performance Validation of 4 Point-of-Care Cervical Cancer Screening Tests in HIV-Infected Women in Zambia
Authors: Chibwesha Carla J. , Frett Brigitte , Katundu Katundu , Bateman Allen C. , Shibemba Aaron , Kapambwe Sharon , Mwanahamuntu Mulindi H. , Banda Susan , Hamusimbi Chalwa , Polepole Pascal , Parham Groesbeck P.
Published: April 2016

Objectives

We sought to determine the clinical performance of visual inspection with acetic acid (VIA), digital cervicography (DC), Xpert human papillomavirus (HPV), and OncoE6 for cervical cancer screening in an HIV-infected population.

Materials and Methods

HIV-infected women 18 years or older were included in this cross-sectional validation study conducted in Lusaka, Zambia. The screening tests were compared against a histological gold standard. We calculated sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and odds ratios using cervical intraepithelial neoplasia grade 2 or worse (CIN 2+) and grade 3 or worse (CIN 3+) thresholds.

Results

Between January and June 2015, a total of 200 women were enrolled. Fifteen percent were screen positive by VIA, 20% by DC, 47% by Xpert HPV, and 6% by OncoE6. Using a CIN 2+ threshold, the sensitivity and specificity of VIA were 48% (95% CI = 30%–67%) and 92% (95% CI = 86%–95%), respectively. Similarly, the sensitivity and specificity of DC were 59% (95% CI = 41%–76%) and 88% (95% CI = 82%–93%), respectively. The sensitivity and specificity of Xpert HPV were 88% (95% CI = 71%–97%) and 60% (95% CI = 52%–68%), respectively. Finally, the sensitivity and specificity of OncoE6 were 31% (95% CI = 16%–50%) and 99% (95% CI = 97%–100%), respectively.

Conclusions

VIA and DC displayed moderate sensitivity and high specificity. Xpert HPV performed equivalently to currently approved HPV DNA tests, with high sensitivity and moderate specificity. OncoE6 displayed excellent specificity but low sensitivity. These results confirm an important role for VIA, DC, and Xpert HPV in screen-and-treat cervical cancer prevention in low- and middle-income countries, such as Zambia.
Postpartum Laboratory Follow-up in Women With Hepatitis B in Massachusetts From 2007 to 2012
Authors: Chang Matthew S. , Barton Kerri , Crockett Molly , Tuomala Ruth E. , Rutherford Anna E. , Mutinga Muthoka L. , Andersson Karin L. , Brown Robert S. , Oken Emily , Ukomadu Chinweike
Published: April 2016

Goals:

To determine postpartum hepatitis B virus (HBV) laboratory testing rates and identify factors associated with a lack of follow-up testing in Massachusetts.

Background:

Screening for HBV infection in pregnant women is standard of care. Guidelines recommend that patients with chronic HBV have ongoing care and laboratory testing, but little is known about postpartum maternal HBV care outcomes.

Study:

We conducted a retrospective cohort study using Massachusetts Virtual Epidemiologic Network, an electronic public health surveillance system maintained by the Massachusetts Department of Public Health. We identified women who tested hepatitis B surface antigen positive during their first reported (index) pregnancy in Massachusetts from 2007 to 2012 and measured HBV-related laboratory tests reported to Massachusetts Department of Public Health during and after pregnancy.

Results:

We identified 983 hepatitis B surface antigen positive pregnant women. Half (492/983) did not have evidence of additional postpartum HBV laboratory testing following their index pregnancy. Women who had postpartum laboratory tests reported were younger [mean age (SD): 29 (5.3) vs. 31 (5.5) y, P=0.0001] and more likely to have >1 pregnancy during the study period (41% vs. 1%, P<0.0001). There were no differences in race, ethnicity, and US born status. On multivariable logistic regression, older age predicted a lower likelihood of having postpartum laboratory testing (odds ratio, 0.77; 95% confidence interval, 0.70-0.90).

Conclusions:

Postpartum maternal HBV follow-up laboratory testing occurred in only half of Massachusetts women and did not vary by race, ethnicity, or US born status. Our results were limited to a single state surveillance database, which likely underestimates the number of tests ordered.
A criteria-directed protocol for in-hospital triage of trauma patients
Authors: Granström Anna , Strömmer Lovisa , Schandl Anna , Östlund Anders
Published: April 2016

Objective

To better match hospital resources to patients’ needs of trauma care, a protocol for facilitating in-hospital triage decisions was implemented at a Swedish level I trauma centre. In the protocol, physiological parameters, anatomical injuries and mechanism of injury were documented, and used to activate full or limited trauma team response. The aim of this study was to evaluate the efficacy of the criteria-directed protocol to determine in-hospital trauma triage in an emergency department.

Methods

Level of triage and triage rates were compared before and after implementation of the protocol. Overtriage and undertriage were assessed with injury severity score higher than 15 as the cutoff for defining major trauma. Medical records for undertriaged patients were retrospectively reviewed.

Results

In 2011, 78% of 1408 trauma team activations required full trauma response, with an overtriage rate of 74% and an undertriage rate of 7%. In 2013, after protocol implementation, 58% of 1466 trauma team activations required full trauma response. Overtriage was reduced to 52% and undertriage was increased to 10%. However, there were no preventable deaths in the undertriaged patients.

Conclusion

A criteria-directed protocol for use in the emergency department was efficient in reducing overtriage rates without risking undertriaged patients’ safety.
Selective nonoperative management of penetrating thoracic injury
Authors: Van Waes Oscar J.F. , Halm Jens A. , Van Imhoff Diederik I. , Navsaria Pradeep H. , Nicol Andrew J. , Verhofstad Michael H.J. , Vermeulen Jefrey
Published: April 2016

Background

Thoracic penetrating injury is a cause for up to one-fifth of all non-natural deaths. The aim of this study was to determine the success of selective nonoperative management (SNOM) of patients presenting with a penetrating thoracic injury (PTI).

Methods

This was a prospective study of patients with PTI who presented to a level 1 Trauma Center between April 2012 and August 2012.

Results

A total of 248 patients were included in the study, with 5.7% (n=14) requiring immediate emergency surgery. Overall, five of these 248 patients died, resulting in a mortality rate of 2.0%. Primarily 221 patients (89.1%) were managed with SNOM, of whom 15 (6.8%) failed conservative management. Failure of SNOM was primarily caused by complications of chest tube drainage (n=12) (e.g. retained clot, empyema) and delayed development of cardiac tamponade (n=3). The survival rate in the SNOM group was 100%.

Conclusion

PTI has a low in-hospital mortality rate. Only 16.5% (41/248) of the patients presenting with PTI will need surgical treatment. The other patients are safe to be treated conservatively according to a protocolized SNOM approach for PTI without any additional mortality. Conservative treatment of patients who were selected for this nonoperative treatment strategy with repeated clinical reassessment was successful in 93.2%.
Error in Drugs Consumption Among Older Patients
Authors: Bar-Dayan Yosefa , Shotashvily Thomas , Boaz Mona , Wainstein Julio
Published: April 2016

The cost effectiveness of generic drugs has promoted their use worldwide. However, the large variety of bioequivalent generic and brand-name drugs found in the marketplace increases the complexity and frequency of mistakes in drug consumption. This clinical study investigated the prevalence of various mistakes in drug consumption by patients using a hospital setting. This prospective clinical trial used a hospital setting to identify errors in drug consumption. Six hundred patients who were hospitalized for a minimum of 48 hours in the Internal Medicine Departments were checked at various time points. The medications prescribed by their physician was determined and compared to the medications each patient carried on their person for de facto consumption. Drug consumption errors were found in 13 cases (2.17%), most of which involved duplicate drugs. In 6 of these (46.1%), patients consumed different drugs from the same therapeutic family. In 5 cases (38.5%), patients used chemically similar medications with different names, and in 2 cases (15.4%), patients consumed different drugs from various therapeutic families to treat the same medical condition. Ten of the thirteen cases (76.9%) had the potential to cause serious adverse drug events. More errors were found in female patients (53.8%), elderly patients, and those consuming a large variety of drugs. Variations in names, colors, shapes, and sizes of various drugs cause confusion and errors in drug consumption among patients. Some of these errors have the potential to cause severe, adverse drug effects and can increase morbidity and mortality worldwide.
An Investigation on Self-Rated Health of Adolescent Students and Influencing Factors From Sichuan, China
Authors: Zhang Fengying , Zhao Li , Feng Xianqiong , Hu Xiuying
Published: April 2016

To investigate adolescent students' self-rated health status and to identify the influencing factors that affect students' health status. A stratified cluster sampling method and the Self-assessed General Health Questionnaires were used to enroll 503 adolescent students from Sichuan Province, Southwest part of China. Most adolescent students perceived their self-rated health as “Fair” (29.4%), “Good” (52.1%), or “Very Good” (16.3%). Regarding the sleep quality, most of them rated them as “Fair” (24.9%), “Good” (43.1%), or “Very Good” (19.7%), but 59.7% students reported to sleep less than 8 hours a day, even a few reported to sleep less than 6 hours (4.4%) or more than 9 hours (9.7%). A considerable number of students (41.1%) reported that they “Never” or just “Occasionally” participated in appropriate sports or exercises. As to the dietary habit, a significant number of students (15.7%) reported that they “Never” or “Occasionally” have breakfast. Students from different administrative levels of schools (municipal level, county level, and township level) rated differently (P < 0.05) in terms of their self-rated health, Health Behaviors, Sleeping, Dietary behaviors, Safety Awareness, and Drinking and Smoking behaviors. In general, Chinese teenage students perceived their own health status as fairly good. However, attention needs to be paid to health problems of some of the students, such as lack of sleep and exercise and inadequate dietary habits, etc. More concerns need to be addressed to students from different administrative levels of schools, and strategies should be put forward accordingly.
Reducing Missed Primary Care Appointments in a Learning Health System
Authors: Steiner John F. , Shainline Michael R. , Bishop Mary Christine , Xu Stan
Published: April 2016

Background:

Collaborations between clinical/operational leaders and researchers are advocated to develop “learning health systems,” but few practical examples are reported.

Objectives:

To describe collaborative efforts to reduce missed appointments through an interactive voice response and text message (IVR-T) intervention, and to develop and validate a prediction model to identify individuals at high risk of missing appointments.

Research Subjects and Design:

Random assignment of 8804 adults with primary care appointments to a single IVR-T reminder or no reminder at an index clinic (IC) and 7497 at a replication clinic (RC) in an integrated health system in Denver, CO.

Measures:

Proportion of missed appointments; demographic, clinical, and appointment-specific predictors of missed appointments.

Results:

Patients receiving IVR-T had a lower rate of missed appointments than those receiving no reminder at the IC (6.5% vs. 7.5%, relative risk=0.85, 95% confidence interval, 0.72–1.00) and RC (8.2% vs. 10.5%, relative risk=0.76, 95% confidence interval, 0.65–0.89). A 10-variable prediction model for missed appointments demonstrated excellent discrimination (C-statistic 0.90 at IC, 0.89 at RC) and calibration (P=0.99 for Osius and McCullagh tests). Patients in the 3 lowest-risk quartiles missed 0.4% and 0.4% of appointments at the IC and RC, respectively, whereas patients in the highest-risk quartile missed 24.1% and 28.9% of appointments, respectively.

Conclusions:

A single IVR-T call reduced missed appointments, whereas a locally validated prediction model accurately identified patients at high risk of missing appointments. These rigorous studies promoted dissemination of the intervention and prompted additional research questions from operational leaders.
Role of Tat-interacting protein of 110 kDa and microRNAs in the regulation of hematopoiesis
Authors: Liu Ying , He Johnny J.
Published: April 2016

Purpose of review

Hematopoiesis is regulated by cellular factors including transcription factors, microRNAs, and epigenetic modifiers. Understanding how these factors regulate hematopoiesis is pivotal for manipulating them to achieve their desired potential. In this review, we will focus on HIV-1 Tat-interacting protein of 110 kDa (Tip110) and its regulation of hematopoiesis.

Recent findings

There are several pathways in hematopoiesis that involve Tip110 regulation. Tip110 is expressed in human cord blood CD34+ cells; its expression decreases when CD34+ cells begin to differentiate. Tip110 is also expressed in mouse marrow hematopoietic stem cells (HSC) and hematopoietic progenitor cells (HPC). Tip110 expression increases the number, survival, and cell cycling of HPC. Tip110-mediated regulation of hematopoiesis has been linked to its reciprocal control of proto-oncogene expression. Small noncoding microRNAs (miRs) have been shown to play important roles in regulation of hematopoiesis. miR-124 specifically targets 3′-untranslated region of Tip110 and subsequently regulates Tip110 expression in HSC.

Our recent findings for manipulating expression levels of Tip110 in HSC and HPC could be useful for expanding HSC and HPC and for improving engraftment of cord blood HSC/HPC.
Phosphatidylserine in atherosclerosis
Authors: Darabi Maryam , Kontush Anatol
Published: April 2016

Purpose of review

It is now widely acknowledged that phosphatidylserine is a multifunctional bioactive lipid. In this review, we focus on the function of phosphatidylserine in modulating cholesterol metabolism, influencing inflammatory response and regulating coagulation system, and discuss promising phosphatidylserine-based therapeutic approaches and detection techniques in atherosclerosis.

Recent findings

Phosphatidylserine has been suggested to play important roles in physiological processes, such as apoptosis, inflammation, and coagulation. Recent data demonstrate atheroprotective potential of phosphatidylserine, reflecting its capacity to inhibit inflammation, modulate coagulation, and enhance HDL functionality. Furthermore, modern lipidomic approaches have enabled the investigation of phosphatidylserine properties relevant to the lipid-based drug delivery and development of reconstituted HDL.

Studies of phosphatidylserine in relation to atherosclerosis represent an area of opportunity. Additional research elucidating mechanisms underlying experimentally observed atheroprotective effects of phosphatidylserine is required to fully explore therapeutic potential of this naturally occurring phospholipid in cardiovascular disease.
Does intrauterine exposure to hypercholesterolemia adversely affect familial hypercholesterolemia phenotype?
Authors: Bogsrud Martin P. , Ulven Stine M. , Holven Kirsten B.
Published: April 2016

Purpose of review

There is currently limited information as to whether maternally or paternally inherited familial hypercholesterolemia confers different phenotype risk to offspring. Knowledge about the differences in risk conferred by inheritance could be important with respect to follow-up and more individually targeted treatment of subjects with familial hypercholesterolemia.

Recent findings

Few studies have, with inconsistent results so far, investigated the significance of familial hypercholesterolemia inheritance on cardiovascular risk markers in offspring. Maternal inheritance of familial hypercholesterolemia includes hypercholesterolemic in-utero conditions for the offspring. How this may influence later risk is briefly discussed in the article.

Current data suggest that the dominating factor of the familial hypercholesterolemia (FH) phenotype is the mutation and not the inheritance, however, maternal inheritance of FH has been reported to adversely affect FH phenotype in terms of increased mortality. More knowledge about how intrauterine hypercholesterolemia during pregnancy influences epigenetic modifications and later cardiovascular disease risk in offspring is needed and this may open up new avenues of treatment of pregnant women with familial hypercholesterolemia.