bluuebunny/crossref_metadata_2025 huggingface dataset:
High resistance to reverse transcriptase inhibitors among persons infected with human immunodeficiency virus type 1 subtype circulating recombinant form 02_AG in Ghana and on antiretroviral therapy
Authors: Deletsu Selase D. , Maina Edward K. , Quaye Osbourne , Ampofo William K. , Awandare Gordon A. , Bonney Evelyn Y.
Published: February 2020

This study sought to determine the dominant circulating human immunodeficiency virus type 1 (HIV-1) subtype and associated drug resistance mutations in Ghana.

This cross-sectional study was conducted with archived samples collected from patients who received care at 2 hospitals in Ghana from 2014 to 2016. Blood samples were earlier processed into plasma and peripheral blood mononuclear cells and stored at −80 °C. Ribonucleic acid (RNA) was extracted from the archived plasma. Two HIV-1 genes; protease and reverse transcriptase, were amplified, sequenced using gene-specific primers and analyzed for subtype and drug resistance mutations using the Stanford HIV Database.

Of 16 patient samples successfully sequenced, we identified the predominance of HIV-1 subtypeCRF02_AG(11/16, 68%). SubtypesG(2/16, 13%), dualCRF02_AG/G(2/16, 13%), andCRF01_AE(1/16, 6%) were also observed. Major nucleoside reverse transcriptase inhibitor (NRTI) resistance mutations,M184I/V,D67N,T215F, andK70R/Ewere found. Non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance mutations,K103N,Y181C,V90I,F227L, andV106Awere also prevalent. Additionally, and at a lower level, protease inhibitor (PI)-resistance mutations,M46I,I54 V,V82A,L90 M, andI471 V, were also present in the sequences from antiretroviral therapy (ART)-experienced individuals. Two NRTI-associated drug resistance mutations (DRMs) (D67NandT69N) were present in sequences from 1 ART-naive individual.

HIV-1 subtype CRF02_AG was most frequently detected in this study thus confirming earlier reports of dominance of this subtype in the West-African sub-region and Ghana in particular. The detection of these drug resistance mutations in individuals on first-line regimen composed of NRTI and NNRTI is an indication of prolonged drug exposure without viral load monitoring. Routine viral load monitoring is necessary for early detection of virologic failure and drug resistance testing will inform appropriate choice of regimens for such patients.
Adult rigid flatfoot
Authors: Yang Zongyu , Liu Fei , Cui Liang , Liu Heda , Zuo Junshui , Liu Lin , Li Sentian
Published: February 2020

To analyze the efficacy of arthrodesis combined with osteotomy applied to subtalar, calcaneocuboid, and talonavicular joints for the treatment of adult rigid flatfoot.

This retrospective study included 29 adult patients with rigid flatfoot who underwent triple arthrodesis combined with osteotomy from January 2015 to December 2017. All patients suffered from stage III of adult acquired flatfoot. Patients returned for a clinical and radiologic follow-up evaluation at an average of 19.5 (range, 15–27) months postoperatively. Outcomes were assessed by comparing pre- and postoperative AOFAS scores, VAS pain scores, and Karlsson scores, and the radiographic assessment including Meary, Pitch, and Kite angles.

Twenty six patients returned for final evaluation. Twenty four patients had an excellent or good outcome on patient subjective self-assessment. All the VAS scores, AOFAS scores, and Karlsson scores at final follow-up showed different extents of improvement. The mean Meary angle significantly decreased from 25.8 ± 5.4 degrees preoperatively to 6.9 ± 7.7 degrees at final follow-up, and the mean Pitch angle improved markedly from 12.5 ± 3.7 points preoperatively to 23.2 ± 4.1 points at final follow-up (P < .001).

Arthrodesis combined with osteotomy can effectively correct calcaneal valgus deformity, restore arch structure, and relieve foot pain in adult rigid flatfoot.
Prognostic value of IMP3 immunohistochemical expression in triple negative breast cancer
Authors: Sjekloča Nikoleta , Tomić Snjezana , Mrklić Ivana , Vukmirović Filip , Vučković Ljiljana , Lovasić Ingrid Belas , Maras-Šimunić Marina
Published: February 2020

Triple negative breast cancer (TNBC) account for 12% to 17% of all breast cancers. It is a heterogeneous group of tumors associated with aggressive clinical course. Insulin-like growth factor II mRNA binding protein 3 (IMP3) belongs to a family of insulin-like growth factor type II (IGF2), which plays a key role in the transmission and stabilization of mRNA, cell growth, and migration during embryogenesis. Increased expression of IMP3 is associated with aggressive behavior of different tumor types, advanced clinical stage, distant metastasis, and shorter overall survival (OS).

The study included 118 patients with breast carcinoma diagnosed as TNBC and immunohistochemical staining for estrogen receptors (ER), progesterone receptors (PR), epidermal growth factor receptor 2 (HER2/neu), Ki-67, and IMP3 was performed. Correlations between categorical variables were studied using the chi-square and the Mann–Whitney U test. For survival analysis, the Kaplan–Meier method, log-rank test and the Cox proportional hazard regression model were used.

Positive expression of IMP3 protein was present in 35.6% of TNBC. The presence of basal morphology was observed in 46.6% of TNBC. Positive IMP3 expression was connected with larger size of tumor, higher clinical stage, and basal morphology (P = .039, P = .034, P < .001). Disease-free survival and OS were significantly shorter in IMP3 positive TNBC.

According to results of our study IMP3 expression can be used as negative prognostic factor for triple negative breast carcinomas. Targeting IMP3 molecule could be an effective approach to the management of a triple negative breast cancer with new immunological therapies, which does not yet exist for this group of tumors.
Clinical observation and analysis of thyroid hormone levels in patients with idiopathic membranous nephropathy
Authors: Huang Yu , Feng Luhuai , Li Xian , Huang Shanshan , Deng Ying , Liang Zhong-e , Xia Ning , Yang Zhenhua
Published: February 2020

We sought to investigate the effect of total triiodothyronine (TT3) reduction in the follow-up of patients with idiopathic membranous nephropathy (IMN). A total of 121 patients were enrolled and classified into a low TT3 group or a normal group. Clinical indicators were compared between the groups, and changes in estimated glomerular filtration rate (eGFR), albumin (ALB), thyroid-stimulating hormone, serum creatinine, total protein, total cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C) during follow-up were analysed. In the analysis by TT3 level, ALB was significantly lower in the low TT3 group (P < .05), while TC, TG, LDL-C, fibrinogen, and renal pathological staging were significantly higher in the low TT3 group (P < .05). Analysis of variance for repeated measurement during follow-up showed that there were no significant differences in eGFR and ALB between the groups. TC, TG, and LDL-C levels were significantly higher in the low TT3 group (P 
< .05). Approximately 37% of patients with IMN showed a decrease in TT3, which was accompanied by significantly decreased ALB level, higher pathological stage, and increased serum lipid level compared with patients having a normal TT3 level. The management of TT3, and appropriate intervention, may therefore help to prevent the kidney damage progress in patients with IMN.
Computed tomography texture analysis for assessment of chemotherapy response of Hodgkin lymphoma
Authors: Reinert Christian Philipp , Wanek Larissa , Bösmüller Hans , Federmann Birgit , Fritz Jan , Sökler Martin , Horger Marius
Published: February 2020

The aim of this study was to test the hypothesis that computed tomography texture analysis (CTTA) is accurate for response assessment of Hodgkin lymphoma (HL).

A total of 100 patients with HL were identified. CTTA in baseline and interim staging was performed generating volume of interests in lymphoma tissue from which CTTA features including 1st, 2nd, and higher order textural features were extracted. Baseline and interim 2-deoxy-fluor-glucose positron emission tomography results were used to determine therapy response and compared to CTTA in terms of patient outcome.

At interim, 1st-order features yielded a significant drop (e.g., entropy of heterogeneity, P = .01) or a significant rise (deviation, P < .001), whereas 2nd and higher order features decreased (e.g., entropy of co-occurrence matrix, P < .001). Patients achieving complete remission at end of treatment had a significantly lower entropy of heterogeneity at baseline and interim compared to patients achieving partial remission (P < .05).

CT textural features change in parallel to metabolic therapy response, and are therefore a feasible diagnostic tool for a more accurate response assessment of HL.
Visual function evaluation for low vision patients with advanced glaucoma
Authors: Jeon Soo Ji , Jung Younhea , Jung Chang-Sub , Park Hae-Young Lopilly , Park Chan Kee
Published: February 2020

This study aimed to compare various visual function parameters for evaluating the quality of life (QOL) of patients with advanced glaucoma with low vision.

In total, 44 eyes of advanced glaucoma patients with low vision were included in this cross-sectional study. A moving pattern edge band program was used to assess edge detection ability and the low vision quality-of-life (LVQOL) questionnaire was used for evaluating QOL scores of subjects. Correlation analyses between QOL scores and visual functional parameters including pattern edge band unit, visual acuity (VA), and Mean deviation (MD) of perimetry were performed. The areas under receiver operating characteristic curves (AUROCs) of diverse visual functional parameters were calculated.

VA and pattern edge band unit were related to LVQOL score in all subjects. For patients with a decimal VA lower than 0.1, only the pattern edge band showed a significant correlation with the QOL associated with distant activities (P = .031). However, the MD of perimetry was not related to the QOL score. After sorting subjects into 2 groups according to the LVQOL score, VA and pattern edge band unit were significantly different (P < .01 and P = .029, respectively). The AUROC for edge detection ability using pattern edge band was higher than MD of perimetry.

Assessment of edge detection ability using pattern edge band was meaningful for predicting QOL associated with visual performance in patients with far-advanced glaucoma. For these patients, edge detection could be used as an additional parameter for visual function with traditional VA and perimetry.
Clinical efficacy and safety of imatinib treatment in children and adolescents with chronic myeloid leukemia
Authors: Deng Mengyue , Guan Xianmin , Wen Xianhao , Xiao Jianwen , An Xizhou , Yu Jie
Published: February 2020

Chronic myeloid leukemia (CML) is relatively rare in childhood and few studies have reported the clinical use of imatinib (IM) in pediatric CML. In this study, we evaluated the efficacy and tolerability of IM in children and adolescents with CML.

We investigated 21 patients under 18 years of age with newly diagnosed CML and treated with IM in Children's Hospital of Chongqing Medical University between May 2014 and February 2018. The disease was staged according to the European LeukemiaNet criteria and the IM dose was determined based on the disease stage. Cumulative responses and survival probabilities were estimated according to the Kaplan–Meier method.

The estimated complete hematologic response rate of chronic phase-chronic myeloid leukemia (CML-CP) was 89.5% at 3 months. The complete cytogenetic response rates increased with time, reaching 47.4%, 73.7%, and 80.3% at 6, 12, and 24 months, respectively. The cumulative major molecular response rates were 42.1% and 76.3% at 12 and 24 months, respectively. With a median follow-up time of 33.8 months (range, 3.2–61.7 months), the estimated 2-year overall survival (OS) rate for CML was 95.2% (95% confidence interval [CI], 70.7%–99.3%). None of the CML-CP patients progressed to the accelerated phase or had a blast crisis. The 2-year OS and progression-free survival rates for the CML-CP cohort were both 100%, while the estimated 2-year event-free survival rate was 68% (95% CI, 42.1%–84.2%). None of the patients in this group had treatment-related deaths or IM discontinuation due to drug toxicities, and only 1 patient had a grade III–IV nonhematologic adverse event. Overall, anemia was the most common adverse effect and 42.9% of patients had a decrease in bone mineral density.

IM was effective and the adverse effects were well-tolerated throughout the follow-up period in Chinese CML patients under 18 years of age.
New-onset lone maternal atrial fibrillation
Authors: Janjua Nusrat Batool , Birmani Suhaib Akhtar , McDonagh Thomas , Hameed Abdul , McKernan Matthew
Published: February 2020

Rationale:

Atrial fibrillation (AF) is encountered rarely in pregnancy. Management of maternal AF is challenging as it poses a threat to both maternal and fetal well-being.

Patient concerns:

We report a case of a 35 weeks pregnant woman who presented in emergency with sudden-onset palpitations and mild shortness of breath with no personal/family history of cardiac diseases.

Diagnoses:

Patient's pulse was irregularly irregular with an average rate of 179 beats per minute. The obstetric examination was normal.

Diagnosis:

High-sensitive cardiac troponin T (hs-cTnT) was elevated. The 12 lead electrocardiogram (ECG) confirmed AF. The obstetric ultrasound, electronic fetal heart rate (EFHR) trace, and maternal echocardiography were normal.

Interventions:

The patient was admitted under joint cardiology and obstetric care and monitored with continuous telemetry. She was commenced on a therapeutic dose of low-molecular weight heparin (LMWH) and intravenous fluid. She received a single 200 Joule synchronized direct current (DC) shock under general anesthesia in operation theater, which reverted the rhythm back to normal. EFHR monitoring was normal pre- and post-DC cardioversion. We acknowledge the unwise use of therapeutic dose of LMWH before DC cardioversion (DCCV) because of a potential need for emergency cesarean delivery for maternal and/or fetal compromise.

Outcome:

The patient remained well and in sinus rhythm after cardioversion. She was discharged home the following day on Flecainide (anti-arrhythmic) and therapeutic dose of low molecular weight heparin (LMWH) and followed up in outpatient clinics frequently. She had a baby at term and received prophylactic LMWH for 10 days post-cesarean. She was discharged from cardiology clinic when she was 10 weeks postnatal, and Flecainide was discontinued.

Lessons:

We are reporting this case because of the rarity of the condition and successful use of DCCV for treating maternal AF. High-sensitive cardiac troponin T (hs-cTnT) level is a useful laboratory indicator to gauge the severity of AF in pregnancy. We emphasize to make the arrangements for EFHR monitoring and potential cesarean delivery and advocate cautious use of thromboprophylaxis while planning for electrical cardioversion (ECV) for maternal AF.
Autoimmune polyglandular syndrome type III associated with antineutrophil cytoplasmic autoantibody-mediated crescentic glomerulonephritis
Authors: Tian Shiyuan , Xu Baofeng , Liu Ziwei , Liu Rui
Published: February 2020

Rationale:

Polyglandular autoimmune syndromes (PAS) are a heterogeneous group of rare diseases characterized by the association of at least 2 organ-specific autoimmune disorders, concerning both the endocrine and nonendocrine organs. Type III is defined as the combination of autoimmune thyroid disease and other autoimmune conditions (other than Addison disease), and is divided into 4 subtypes. We describe a patient with Hashimoto thyroiditis, adult-onset Still disease, alopecia, vasculitis, antineutrophil cytoplasmic antibody (ANCA)-mediated crescentic glomerulonephritis, and hyperparathyroidism. Co-occurrence of these 5 diseases allowed us to diagnose PAS type IIIc. The rare combination of these different diseases has not been reported before.

Patient concerns:

A 51-year-old woman was admitted in April, 2019 after the complaint of an enlarged thyroid. She was diagnosed with Hashimoto thyroiditis at the age of 36. At age 40, she was diagnosed with an adult-onset Still disease. Three months before admission, she experienced renal insufficiency. After admission, she was diagnosed with hyperparathyroidism.

Diagnosis:

Renal biopsy revealed renal vasculitis and crescentic nephritis. Antineutrophil cytoplasmic autoantibody showed that human perinuclear ANCA and myeloperoxidase ANCA were positive. Therefore, the patient was diagnosed with vasculitis and ANCA-mediated crescentic glomerulonephritis. After admission, parathyroid single-photon emission computed tomography/computed tomography fusion image demonstrated the presence of hyperparathyroidism.

Interventions:

The patient was treated with high-dose methylprednisolone pulse therapy (0.1 g/d) for vasculitis and ANCA-mediated crescentic glomerulonephritis, calcium and vitamin D3 (600 mg/d elemental calcium [calcium carbonate] and 2.5 μg/d active vitamin D3) for hyperparathyroidism, and levothyroxine sodium (50 ug/d) for Hashimoto thyroiditis.

Outcomes:

Up to now, serum thyroid-stimulating hormone, total triiodothyronine, total thyroxine, free triiodothyronine, and free thyroxine were within the normal ranges. Patient's renal function did not deteriorate.

Lessons:

We report a patient with Hashimoto thyroiditis, adult-onset Still disease, alopecia, vasculitis, ANCA-mediated crescentic glomerulonephritis, and hyperparathyroidism, which is a very rare combination. We present this case as evidence for the coexistence of several different immune-mediated diseases in the clinical context of a PAS IIIc.
How does contrast-enhanced ultrasonography influence Bosniak classification for complex cystic renal mass compared with conventional ultrasonography?
Authors: Qiu Xiaoying , Zhao Qiyu , Ye Zhengdu , Meng Lang , Yan Chunhong , Jiang Tian-An
Published: February 2020

To analyze the degree and pattern of influence of contrast-enhanced ultrasonography (CEUS) on the Bosniak classification system for complex renal cystic mass as compared with conventional ultrasonography (US). One hundred two consecutive patients with complex renal cystic masses were retrospectively analyzed. The diagnostic performance of the Conventional US and CEUS were evaluated separately for malignant and benign lesions. The diagnostic concordance rates were calculated according to pathologic diagnoses. ROC curve analysis determined the confidence in the diagnostic accuracy by calculating the area under each ROC curve. Compared to the Conventional US, septae number, wall and/or septae thickness, solid component and the Bosniak classification changed in 17 (16.7%), 39 (38.2%), 31 (30.4%), and 67 (65.7%) patients as compared with 0 (0.0%), 21 (20.6%), 31 (30.4%), and 37 (36.3%) of the treatment strategy that changed after CEUS respectively. The diagnostic performance of CEUS showed overall higher in terms of sensitivity (100.0 vs 97.2%); specificity (90.9 vs 62.1%); positive predictive value (PPV) (85.7 vs 58.3%); negative predictive value (NPV) (100.0 vs 97.6%); and the concordance with pathology (kappa = 0.876 vs 0.515). CEUS had a higher diagnostic confidence (P < .05) according to the area under the ROC curve (AUC = 0.968 vs 0.799).CEUS performed better than the Conventional US in the diagnosis of complex renal cystic mass, and it might be considered as the first tool to evaluate a complex cystic renal mass, especially for these Bosniak III masses displaying the presence of hemorrhage or infection.
Comparative study of spironolactone and eplerenone in management of ascites in patients of cirrhosis of liver
Authors: Sehgal Rishabh , Singh Harsimranjit , Singh Inder Pal
Published: February 2020

Introduction:

The present study was conducted to compare the efficacy and side effects of Spironolactone and Eplerenone in management of ascites due to liver cirrhosis.

Materials and methods:

105 patients of ascites with liver cirrhosis were randomized into three groups of 35 patients each. Group I was given Spironolactone 100 mg, group II was given Eplerenone 100 mg and group III was given Eplerenone 50 mg. All patients were put on salt-restricted diet (less than or equal to 2 g of sodium) and no loop diuretics were used. Patients were followed after 7 days from the baseline and then biweekly for the period of three months and serial measurements of weight, abdominal girth and incidence of side effects especially gynecomastia, mastalgia, hyperkalemia were recorded. Results were compared. Patients having Child–Turcotte–Pugh score-C, massive ascites, hepatic encephalopathy, Hepatorenal syndrome and ascites due to cardiac, renal, malignant causes were excluded.

Observations:

Difference in mean weight reduction was non significant (P = 0.964) in group I and group II whereas the difference was significant when comparison was made between Group I and III; and Group II and III (P = <0.001, <0.001, respectively). In group I, the incidence of gynecomastia was 14.28% whereas in group II and group III no case of gynecomastia was observed (P <0.001, <0.001). Hyperkalemia was present in one patient (2.8%) in group I whereas no patient developed hyperkalemia in group II and group III (P = >0.05, >0.05).

Conclusion:

Eplerenone and spironolactone are equally effective in management of ascites due to liver cirrhosis but side effect profile of eplerenone scores over Spironolactone.
Expression of hepatitis B surface antigen in liver tissues can serve as a predictor of prognosis for hepatitis B virus-related hepatocellular carcinoma patients after liver resection
Authors: He Ziming , Chen Jinbin , Wang Juncheng , Xu Li , Zhou Zhongguo , Chen Minshan , Zhang Yaojun , Shi Mude
Published: February 2020

Background:

Hepatitis B surface antigen (HBsAg) is a detectable index after hepatitis B virus (HBV) infection, which is a risk factor of hepatocellular carcinoma (HCC). However, few studies have focused on the expression of HBsAg in HCC patients’ liver tissues. This study aimed to explore the potential utility of using HBsAg protein expression in normal liver tissues as a prognostic factor for HCC patients who underwent liver resection.

Study design:

The study enrolled 100 HCC patients with seropositivity for HBsAg. The liver tissues were collected, and tissue microarrays were constructed. The expression of HBsAg in liver tissues were measured by immunohistochemistry (IHC). Relevant clinical data and follow-up records were collected for analysis.

Results:

HBsAg expressions was detected in 29 patients (positive group) and was unable to be detected in the remaining 71 patients (negative group). The patients in the positive group had higher HBV DNA levels (P < 0.05) than the patients in the negative group. The overall survival (OS) rate of the positive group was worse than the OS rate of the negative group (P = 0.013). The OS rates after resection at 1 and 2 years in negative group were 90.1% and 85.7%, respectively, while the value in the positive group were 79.3% and 65.5%, respectively. Multivariate analysis showed that HBsAg expression in liver tissues, ascites and alpha-fetoprotein levels were independent factors influencing OS. Similarly, after propensity score matching (PSM), the OS was worse in the positive group than in the negative group, and HBsAg expression could also serve as a predictor for OS (P = 0.039). The OS rates after resection and PSM at 1 and 2 years were 93.2% and 85.9% in the negative group, while the value in the positive group were 79.3% and 65.5%.

Conclusion:

As determined according to grouping based on immunohistochemistry staining results for HBsAg, this study indicated that HBsAg expression in liver tissues could predict the OS of HBV-related HCC patients after liver resection.
Neutropenia Is an Underrecognized Finding in Pediatric Primary Immunodeficiency Diseases: An Analysis of the United States Immunodeficiency Network Registry
Authors: Michniacki Thomas F. , Connelly James A. , Sturza Julie , Merz Lauren E. , Marsh Rebecca , Dale David , Garabedian Elizabeth , Walkovich Kelly
Published: February 2020

Background:

The frequency of neutropenia in pediatric primary immunodeficiency disorders (PIDDs) is unknown and potentially underappreciated. Our study aimed to determine the overall frequency and severity of neutropenia in children diagnosed with a PIDD entered in the United States Immunodeficiency Network (USIDNET) patient registry.

Procedure:

Neutropenia data and demographic/clinical information from 1145 patients younger than 21 years of age was obtained from the USIDNET registry.

Results:

Neutropenia is more common in PIDD patients entered within the USIDNET registry than previously appreciated. There was a >10% occurrence rate of neutropenia in all broad primary immunodeficiency categories as well as in nearly all individual PIDDs. Neutropenia frequency was greater in African American pediatric PIDD patients than in white or Asian patients. The degree of neutropenia did not associate with mortality in pediatric patients with a PIDD.

Conclusion:

Although our study did not assess the frequency of PIDD in patients presenting with neutropenia, the possibility of a primary immune disorder should be considered in patients with idiopathic neutropenia.
Brief Report: Use of the Consolidated Framework for Implementation Research (CFIR) to Characterize Health Care Workers' Perspectives on Financial Incentives to Increase Pediatric HIV Testing
Authors: Atkins Dana L. , Wagner Anjuli D. , Zhang Junyi , Njuguna Irene N. , Neary Jillian , Omondi Vincent O. , Otieno Verlinda A. , Ondeng'e Kenneth , Wamalwa Dalton C. , John-Stewart Grace , Slyker Jennifer A. , Beima-Sofie Kristin
Published: February 2020

Background:

A prior randomized control trial showed financial incentives increase HIV testing rates for children of unknown HIV status. Translating evidence-based interventions such as these to scale requires an implementation science approach.

Methods:

A qualitative study evaluating health care providers' perceptions of barriers and facilitators of a previously completed financial incentives intervention for pediatric HIV testing was conducted at health care facilities in Kisumu, Kenya. Six focus group discussions with 52 providers explored determinants of acceptability, feasibility, and sustainability of financial incentive scale-up for pediatric HIV testing using the Consolidated Framework for Implementation Research to inform question guides and thematic analysis.

Results:

Providers found the use of financial incentive interventions for pediatric HIV testing to be highly acceptable. First, providers believed financial incentives had a relative advantage over existing strategies, because they overcame cost barriers and provided additional motivation to test; however, concerns about how financial incentives would be implemented influenced perceptions of feasibility and sustainability. Second, providers expressed concern that already overburdened staff and high costs of financial incentive programs would limit sustainability. Third, providers feared that financial incentives may negatively affect further care because of expectations of repeated financial support and program manipulation.

Conclusions:

Providers viewed financial incentives as an acceptable intervention to scale programmatically to increase uptake of pediatric testing. To ensure feasibility and sustainability of financial incentives in pediatric HIV testing programs, it will be important to clearly define target populations, manage expectations of continued financial support, and establish systems to track testing.
Frequency and Duration of Incarceration and Mortality Among US Veterans With and Without HIV
Authors: Hawks Laura C. , McGinnis Kathleen A. , Howell Benjamin A. , Khan Maria R. , Edelman E. Jennifer , Justice Amy C. , Wang Emily A.
Published: February 2020

Background:

Exposure to incarceration is associated with increased risk of mortality, and HIV is cited as a leading cause of death. Yet, few studies have examined the association between incarceration and mortality among people with HIV (PWH), specifically whether and how increasing exposure to incarceration increases risk of mortality. We compared mortality by different incarceration exposures and HIV status.

Methods:

We conducted a prospective cohort study of participants in the Veterans Aging Cohort Study from January 2011 to August 2017 (N = 5367). The primary exposure was incarceration by 3 measures: (1) any (ever/never); (2) frequency; and (3) cumulative duration. Stratifying by HIV status and controlling for age, race, and sex, we used Cox Proportional Hazard models to estimate adjusted hazard ratios (AHRs) and 95% confidence intervals (CIs).

Results:

Incarceration was associated with increased risk of mortality compared with those never incarcerated for PWH (AHR 1.37; 95% CI: 1.13 to 1.66) and those uninfected (AHR 1.24; 95% CI: 0.99 to 1.54), but the association was only statistically significant among PWH. Increasing frequency of incarceration was associated with higher risk of mortality in both groups: for PWH, AHRs 1.13, 1.45, and 1.64 for 1, 2–5; 6+ times, respectively, for uninfected, AHRs 0.98, 1.35, and 1.70 for 1, 2–5, and 6+ times, respectively.

Conclusions:

PWH were at increased risk of mortality after incarceration, and repeated exposure to incarceration was associated with mortality in both groups in a dose–response fashion. This increased risk of mortality may be mitigated by improving transitional health care, especially HIV care, and reducing incarceration.
Medicaid Payer Status, Higher Comorbidity, and Low Income Are Associated With Poorer Outcomes After Total Elbow Arthroplasty
Authors: Singh Jasvinder A. , Cleveland John D.
Published: February 2020

Objective

To assess whether insurance payer, comorbidity, and income are associated with total elbow arthroplasty (TEA) outcomes.

Methods

We used the 1998–2014 US National Inpatient Sample. Multivariable logistic regression adjusted for demographics and underlying diagnosis to estimate odds ratio (OR) and 95% confidence intervals (CI) of insurance payer, comorbidity, and income with TEA outcomes.

Results

The mean age was 60 (SE, 0.29) years, 68% were female, and 62% were white among the 7992 TEA procedures. Compared with private insurance, Medicaid was associated with significantly higher ORs (95% CI) of (1) hospital charges above the median, 1.25 (95% CI, 1.01–1.53); (2) discharge to a rehabilitation facility, 1.64 (95% CI, 1.16–2.31); (3) hospital stay >2 days, 1.63 (95% CI, 1.32–2.00); (4) fracture, 1.71 (95% CI, 1.14–2.56). Medicare payer was associated with higher ORs (95% CI) of (1) discharge to a rehabilitation facility, 1.80 (95% CI, 1.42–2.28); and (2) hospital stay >2 days, 1.29 (95% CI, 1.12–1.50). Compared with Deyo-Charlson score of zero, odds of health care utilization outcomes were higher by 14% to 20% for score of 1 and by 62% to 146% for score of 2 or higher, and by 36% to 257% for transfusion. The lowest income quartile had significantly higher OR of 1.51 (95% CI, 1.31–1.73) of hospital charges above the median versus the highest quartile.

Conclusions

Payer type, comorbidity, and income were associated with higher health care utilization and complications post-TEA. Further investigation into potentially modifiable mediators is needed.
Quality and Safety in Healthcare, Part LXIII
Authors: Harolds Jay A.
Published: February 2020

A lack of well-being, including burnout, is common among residents. Suggestions to combat these issues include promoting a sense of collegiality and camaraderie in the medical community, talking to residents with respect, remedying the reasonable complaints of residents in a reasonable time frame, offering well-being newsletters, having curricula in narrative medicine, encouraging more exercise, and having coaching programs. Suicide prevention programs are also important.
Comparison of 68Ga-PSMA PET/CT and Contrast-Enhanced MRI on Residual Disease Assessment of Juvenile Nasal Angiofibroma
Authors: Thakar Alok , Sakthivel Pirabu , Prashanth Arun , Bhalla Ashu Seith , Sharma Suresh Chandra , Kumar Rakesh
Published: February 2020

Prostate-specific membrane antigen (PSMA) is expressed in the endothelial cells of tumor-associated neovasculature of various nonprostatic benign and malignant neoplasms including juvenile nasopharyngeal angiofibroma (JNA). Positive uptake on PET/CT imaging with 68Ga-labeled PSMA is noted in a patient with residual disease after initial surgery without any abnormal uptake in postoperative fibrosis, in contrast to contrast-enhanced MRI, which was confirmed by biopsy. 68Ga-PSMA PET/CT may be a useful tool clinically for identifying early biochemical recurrences and in specifically differentiating recurrences from surgical site reparative tissue.
Primary Paravertebral Germ Cell Tumor Demonstrated by FDG PET/CT
Authors: Wang Rang , Su Minggang , Tian Rong
Published: February 2020

Extragonadal germ cell tumors are rare. Most of these tumors occur in the anterior mediastinum, retroperitoneum, pineal gland, or suprasellar region. Here, we present a case of a 29-year-old man with a paravertebral mass to the right of the T8 and T9 vertebral bodies on MRI and FDG PET/CT. The lesion exhibited intense FDG uptake and invaded the adjacent rib. Postoperative pathological findings confirmed the diagnosis of a germ cell tumor. This case cautions us that extragonadal germ cell tumors should be in the differential diagnostic spectrum of paravertebral lesions.
A Rare Case of Primary Pleura Myxoid Leiomyosarcoma
Authors: Wang Ling , Ren Yixuan , Ding Xiaofang , Dong Chi , Liu Jiangyan
Published: February 2020

Myxoid leiomyosarcoma is a malignant tumor that originates from the mesenchymal tissue with extensive mucoid degeneration. It usually occurs in the uterus; occurrences from other tissues are extremely rare. Here we report the FDG PET/CT findings and clinicopathological of primary pleura myxoid leiomyosarcoma in a 51-year-old man.
18F-FDG PET/CT Finding of Primary Cardiac Lymphoma
Authors: Kaida Hayato , Kumode Takahiro , Kimura Masatomo , Ishii Kazunari
Published: February 2020

An 80-year-old woman experienced dyspnea. Cardiac enlargement was detected by chest radiography at a local hospital. She was admitted to our hospital, and echocardiography and CT revealed pericardial effusion and multiple tumor lesions in right atrium. 18F-FDG PET/CT demonstrated multiple nodular accumulations in these tumors (SUVmax, 14.5). Cytologic analysis of the pericardial fluid revealed a diffuse large B-cell lymphoma. Primary cardiac lymphoma (PCL) is rare, and there are few reports about the 18F-FDG PET/CT imaging features of PCLs. In high 18F-FDG uptake in multiple tumors in the right atrium and large pericardial effusion, a PCL should be considered.
Suprazygomatic Aponeurotic McLaughlin Myoplasty for Facial Reanimation
Authors: Choudhary Sunil , Khanna Soumya , Mantri Raghav , Arora Prateek
Published: February 2020

Background

Suprazygomatic aponeurotic McLaughlin (SAM) myoplasty technique for facial reanimation is based on the classical McLauglin's lengthening temporalis myoplasty with a series of new modifications. A comprehensive review of previously described other orthodromic temporalis myoplasty techniques is also included to give a succinct comparison.

Methods

Twelve adult patients of facial palsy underwent SAM myoplasty for a period of 4 years. Three had congenital facial palsy, 4 patients had facial palsy secondary to acoustic neuromas, 3 were posttraumatic, and 2 patients had Bell's palsy.

Results

Range of modiolus excursion achieved as measured at 3 months postoperatively on reanimation in our patients was 5 mm to 20 mm with an average of 12.6 mm. With SAM myoplasty technique, we were able to achieve excellent result in 4 patients and good results in 8 patients as evaluated with May and Druker scoring system.

Conclusions

Suprazygomatic aponeurotic McLaughlin myoplasty for facial reanimation demonstrates a successful modification of the classical McLaughlin lengthening temporalis myoplasty, making it more customizable, simple, and predictable by taking the level of transection to the temporalis aponeurosis without the need for zygomatic osteotomy. A new classification of orthodromic temporalis myoplasty based on level of transections is also proposed for the first time. Good to excellent outcomes coupled with high patient satisfaction and low morbidity should make this technique popular among the facial reanimation surgeons.
Cranial Fossa Development in Differing Subtypes of Crouzon Syndrome
Authors: Lu Xiaona , Forte Antonio Jorge , Steinbacher Derek M. , Alperovich Michael , Alonso Nivaldo , Persing John A.
Published: February 2020

Background:

Based on an established classification system of Crouzon syndrome subtypes, detailed regional morphology and volume analysis may be useful, to clarify Crouzon cranial structure characteristics, and the interaction between suture fusion and gene regulated overall growth of the calvarium and basicranium.

Methods:

CT scans of 36 unoperated Crouzon syndrome patients and 56 controls were included and subgrouped as: type I. Bilateral coronal synostosis; type II. Sagittal synostosis; type III. Pansynostosis; type IV. Perpendicular combination synostosis.

Results:

Type I of Crouzon syndrome patients developed a slightly smaller posterior fossa (22%), and increased superior cranial volume (13%), which is the only subtype that develops a greater superior cranial volume. The effect of competing increased and decreased segmental volume is associated with a 24% enlargement of overall cranial volume (P = 0.321). In class III, the anterior fossa volume was increased by 31% (P = 0.007), while the volume of posterior fossa was decreased by 19% (P < 0.001). These resulted in a 7% (P = 0.046) reduction in the overall intracranial volume. Type II and type IV patients developed a trend toward anterior, middle, and posterior fossae, and entire cranial volume reduction.

Conclusions:

Pansynostosis is the most often form of associated craniosynostoses of Crouzon syndrome, however bilateral coronal synostosis may not dominate this form of Crouzon syndrome. The anterior, middle and posterior cranial fossae may have simultaneously reduced volume if the midline suture synostosis is involved. Individualized treatment planning for Crouzon syndrome patient, theoretically should include the patient's age and temporal associated maldevelopment suture sequence.
Clinical Characteristics and Surgical Features of Intracranial Fibrosarcoma
Authors: Kang Peng , Li Pei-Liang , Peng Jia-Yi , Ni Ming , Jia Gui-Jun , Jia Wang
Published: February 2020

Background:

Intracranial fibrosarcoma is an extremely rare neoplasm in the central nervous system. Insofar there were only sporadic case reports describing its features. The purpose of this study is to review the clinical and surgical features of cases who were treated in our department.

Method:

The authors retrospectively reviewed and detailed the clinical and surgical data obtained from 5 patients with fibrosarcoma who underwent treatment at our institute between January 2009 and January 2019.

Results:

There were 3 males and 2 females including 2 juvenile and 3 senior patients. The most frequent sign was intermittent pain and vomiting. The location of the tumor included middle fossa, thalamus and midbrain, sellar and suprasellar region and right parietal-occipital lobe. Surgical observation demonstrated the consistency of the tumor was tenacious with abundant blood supply. Gross total resection was achieved in 2 cases. Pathological analysis showed spindle cells in a herringbone form with positive Vimentin staining in all 5 cases, with the absence of GFAP or S-100. All 5 patients were deceased eventually after a varied period of time after the first surgery.

Conclusion:

Intracranial fibrosarcoma was a highly malignant entity presented in the central nervous system. Surgery still remains the first-line treatment followed by radiotherapy, however, the prognostic outcome was very poor. Future studies should be more focused on accumulation of the relevant information on this disease thus hopefully in assisting to developing more optimized treatment.
Maxillomandibular Advancement for the Treatment of Obstructive Sleep Apnea in Patients With Normal or Class I Malocclusion
Authors: Buller Mitchell , Jodeh Diana S. , Rottgers S. Alex
Published: February 2020

Background:

Maxillomandibular advancement is an effective surgical option for obstructive sleep apnea (OSA) that achieves enlargement of the upper airway by physically expanding the facial skeleton. The authors sought to determine whether an advancement of 10 mm predicts surgical success and if any correlation existed between the magnitude of mandibular/maxillary advancement and improvement in polysomnography metrics using aggregated individual patient data from multiple studies.

Methods:

A search of the PubMed database was performed to identify relevant articles that included preoperative and postoperative polysomnography data and measurements of the advancement of both the maxillary and mandibular portions of the face in patients with normal or class I malocclusion. Each patient was stratified into “Success” or “Failure” groups based on criteria defining a “Success” as a 50% preoperative to post-operative decrease in AHI or RDI and a post-operative AHI or RDI <20.

Results:

A review of the PubMed database yielded 162 articles. Review of these resulted in 9 manuscripts and a total of 109 patients who met the inclusion criteria. There was no statistically significant difference in the amount of anterior advancement of either the mandible (P = 0.96) or the maxilla (P = 0.23) between the “Success” or “Failure” groups.

Conclusions:

While there is a paucity of individual data available, the current data does not support an ideal amount of maxillary or mandibular advancement that is required to obtain a surgical success in the treatment of OSA. Until a multicenter, prospective, randomized trial is performed, surgical planning should be tailored to patient-specific anatomy to achieve the desired result.
Sleep-Disordered Breathing and Airway Assessment Using Polysomnography in Pediatric Patients With Craniofacial Disorders
Authors: Bekisz Jonathan M. , Wang Maxime M. , Rickert Scott M. , Rodriguez Alcibiades J. , Flores Roberto L.
Published: February 2020

Children with cleft and craniofacial conditions commonly present with concurrent airway anomalies, which often manifest as sleep disordered breathing. Craniofacial surgeons and members of the multidisciplinary team involved in the care of these patients should appreciate and understand the scope of airway pathology as well as the proper means of airway assessment. This review article details the prevalence and assessment of sleep disordered breathing in patients with craniofacial anomalies, with emphasis on indications, limitations, and interpretation of polysomnography.
The Development of Chinese Medical Education
Authors: Li Dong , Xu Haisong , Wang Yang , Wei Min
Published: February 2020

This paper mainly introduces the current situation of Chinese medical education, and reviews the development and transformation of Chinese clinical medical education. Overall, Chinese clinical medical education is gradually towards standardization and internationalization. At the same time, scientific research is playing an increasingly important role in Chinese clinical medical education.
HDAC Inhibitor Attenuated NETs Formation Induced by Activated Platelets In Vitro, Partially Through Downregulating Platelet Secretion
Authors: Chen Zhenxing , Liu Chang , Jiang Yu , Liu Hanchi , Shao Lina , Zhang Kaiyuan , Cheng Daye , Zhou Ying , Chong Wei
Published: February 2020

Background:

Accumulating studies in recent years have revealed that platelet activation is an important factor inducing neutrophil extracellular traps (NETs) formation in vivo, while the mechanism of this process is not fully elaborated, restricting its clinical use. Our previous study found that a histone deacetylase inhibitor (HDACi) could attenuate serum H3 elevation in septic mice, which was related to NETs formation, and others found HDAC6 to be involved in platelet activation, indicating that HDACis may attenuate platelet activation and result in reduced NETs formation.

Methods:

Freshly isolated human platelets were activated by TRAP-6 with or without a HDACi, and secretion of α-granules was evaluated by testing PF4 in the supernatant using ELISA. NETs were induced by coincubating neutrophils with preactivated platelets, quantified by fluorescent intensity of Sytox green, monitored by live-cell imaging, and qualitatively analyzed by immunofluorescence.

Main Results:

An in vitro bioreactive system to induce and monitor NETs formation using platelets and neutrophils was established. The PF4 elevation stimulated by TRAP-6 in the supernatant of platelets was attenuated by the HDACi, and NETs formation that was induced by coincubating neutrophils with the preactivated platelets was decreased in the presence of the HDACi.

Conclusion:

The HDACi attenuates NETs formation induced by activated platelets partially by modulating the secretion of platelets.
A Predictive Model for Intracardiac Pressures in Patients Free From Rejection or Allograft Vasculopathy After Pediatric Heart Transplantation
Authors: Mills Marcos F. , Long Jin , Quin Feifei , Collins R. Thomas , Rosenthal David N. , Almond Christopher S. , Hollander Seth A.
Published: February 2020

Background.

Despite the routine use of hemodynamic assessment in pediatric heart transplant (HT) patients, expected intracardiac pressure measurements in patients free of significant complications are incompletely described. A better understanding of the range of intracardiac pressures in these HT patients is important for the clinical interpretation of these indices and consequent management of patients.

Methods.

We conducted a retrospective chart review of pediatric HT recipients who had undergone HT between January 2010 and December 2015 at Lucile Packard Children’s Hospital. We analyzed intracardiac pressures measured in the first 12 mo after HT. We excluded those with rejection, graft coronary artery disease, mechanical support, or hemodialysis. We used a longitudinal general additive model with bootstrapping technique to generate age and donor–recipient size-specific curves to characterize filling pressures through 1-y post-HT.

Results.

Pressure measurements from the right atrium, pulmonary artery, and pulmonary capillary wedge pressure were obtained in 85 patients during a total of 829 catheterizations. All pressure measurements were elevated in the immediate post-HT period and decreased to a stable level by post-HT day 90. Pressure measurements were not affected by age group, donor–recipient size differences, or ischemic time.

Conclusions.

Intracardiac pressures are elevated in the early post-HT period and decrease to levels typical of the native heart by 90 d. Age, donor-to-recipient size differences, and ischemic time do not contribute to differences in expected intracardiac pressures in the first year post-HT.