bluuebunny/crossref_metadata_2025 huggingface dataset:
Balance and Physical Functioning in Patients After Head and Neck Cancer Post–Neck Dissection Surgery: A Case Series
Authors: Tan Chun Ju , Timon Conrad , Stassen Leo F. A. , Clark Ross A. , Meldrum Dara , Baily-Scanlan Maria , Broderick Julie
Published: September 2020

Background and Purpose:

Rehabilitation research in people with head and neck cancer undergoing neck dissection (ND) surgery has been largely confined to evaluation of shoulder dysfunction. Balance and broader physical functioning variables were evaluated in this patient group.

Case Description:

This case series presents 4 patients scheduled for ND surgery who completed a comprehensive battery of balance and physical functioning assessments preoperatively and 6 weeks postoperatively.

Outcomes:

Post-ND surgery, the majority (n = 3) of patients reported increased upper-quadrant pain, with proprioception and neck range-of-motion measurements showing a decreasing trend. One patient had no neck pain or changes in proprioception. The changes for standing balance and endurance varied across the patients, with no observable trend.

Discussion:

Quality of life, physical activity, and a number of physical functioning measures, including proprioception and physical activity, were lower after ND surgery. This case series identifies the adverse effects of ND surgery performed prior to the start of adjuvant therapy, with many deficits noted potentially amenable to therapeutic intervention. The clinical implication of this study is that physical therapists should assess physical functioning variables after ND surgery and intervene early if deficits are noted.
Modified Subvastus Approach With Improved Exposure During Total Knee Arthroplasty: A Surgical Technique
Authors: Hampton Matthew , Garneti Narendra
Published: September 2020

The subvastus approach for TKA allows for potential benefits in the early post-operative period when compared the conventional medial parapatellar approach. However, there are concerns about potential difficulties with exposure when using the subvastus approach. We describe simple, reproducible modifications of the standard subvastus approach which can be utilised in cases when exposure is found to be challenging.
Management of Incidental High-grade Dedifferentiated Chondrosarcoma by Triple Vertebrectomy and Anterior Reconstruction Using a Posterior-only Approach
Authors: Kalidindi Kalyan K.V. , Sath Sulaiman , Mallepally Abhinandan R. , Sharma Jeevan , Surapaneni Venkata N. , Chhabra Harvinder S.
Published: September 2020

Introduction:

Chondrosarcomas of the spine most commonly present with pain and neurological involvement and surgical resection is the standard of care. However, the involvement of 3 contiguous vertebral bodies is rare and surgical en bloc resection may not be possible in all cases, particularly when there is an extra compartmental spread.

Materials and Methods:

We report a case of incidentally detected biopsy-proven chondrosarcoma who was treated by a triple vertebrectomy through a posterior-only approach.

Results:

Three nerve roots had to be sacrificed on one side and 1 nerve root on the other side. The radicular arteries were freed from the vertebral body and tumor mass. Since the pedicles and lamina were involved and there was an extra compartmental spread to the nearby vital structures, an en bloc resection could not be accomplished. Anterior reconstruction was performed through the posterior approach using a MESH cage. Posterior stabilization using pedicle screws and rods was done 3 levels above and below the vertebrectomy levels. Biopsy suggested a very rare aggressive variant of spinal chondrosarcoma labeled as a dedifferentiated chondrosarcoma. Postoperative Image-guided radiotherapy was given and the patient was doing well at 1-year follow-up.

Discussion:

Primary chondrosarcoma involving 3 or more vertebra has been rarely reported in the literature and no specific guidelines exist on the management of such tumors. The aim of this case report was to emphasize the feasibility of doing a triple vertebrectomy and anterior reconstruction using a posterior-only approach. Posterior-only approach allows for complete tumor removal and circumferential stabilization in a single setting.
Pathophysiologic Signatures of Bloodstream Infection in Critically Ill Adults
Authors: Zimmet Alex N. , Clark Matthew T. , Gadrey Shrirang M. , Bell Taison D. , Zimmet Amanda M. , Moorman J. Randall , Moore Christopher C.
Published: September 2020

Objectives:

Bloodstream infection is associated with high mortality rates in critically ill patients but is difficult to identify clinically. This results in frequent blood culture testing, exposing patients to additional costs as well as the potential harms of unnecessary antibiotics. The purpose of this study was to assess whether the analysis of bedside physiologic monitoring data could accurately describe a pathophysiologic signature of bloodstream infection in patients admitted to the ICU.

Design:

Development of a statistical model using physiologic data from a retrospective observational cohort.

Setting:

University of Virginia Medical Center (Charlottesville, VA), a tertiary-care academic medical center.

Patients:

Critically ill patients consecutively admitted to either the medical or surgical/trauma ICUs with available physiologic monitoring data between February 2011 and June 2015.

Interventions:

None.

Measurements and Main Results:

We analyzed 9,954 ICU admissions with 144 patient-years of vital sign and electrocardiography waveform data, totaling 1.3 million hourly measurements. There were 15,577 blood culture instances, with 1,184 instances of bloodstream infection (8%). The multivariate pathophysiologic signature of bloodstream infection was characterized by abnormalities in 15 different physiologic features. The cross-validated area under the receiver operating characteristic curve was 0.78 (95% CI, 0.69–0.85). We also identified distinct signatures of Gram-negative and fungal bloodstream infections, but not Gram-positive bloodstream infection.

Conclusions:

Signatures of bloodstream infection can be identified in the routine physiologic monitoring data of critically ill adults. This may assist in identifying infected patients, maximizing diagnostic stewardship, and measuring the effect of new therapeutic modalities for sepsis.
A phase II study of the insulin-like growth factor type I receptor inhibitor IMC-A12 in patients with metastatic uveal melanoma
Authors: Mattei Jane , Ballhausen Alexej , Bassett Roland , Shephard Michael , Chattopadhyay Chandrani , Hudgens Courtney , Tetzlaff Michael , Woodman Scott , Sato Takami , Patel Sapna P.
Published: September 2020

Uveal melanoma is a rare and aggressive malignancy and up to half of all patients will develop metastatic disease despite the effective treatment of the primary tumor. Insulin-like growth factors I/II play a fundamental role in the cell migration, proliferation, and apoptosis. IMC-A12, a mAb specifically targets insulin-like growth factor type I receptor, has shown promise in preclinical studies. We performed a multicenter phase II study for patients with metastatic uveal melanoma administered IMC-A12 10 mg/kg IV every two weeks until disease progression or unacceptable toxicity. The primary endpoint was objective response (proportion of patients with complete or partial response), and secondary endpoints were disease control rate, progression-free survival, and overall survival. A total of 18 patients enrolled in this study (10 males and eight females) with a median age. Ten patients (55%) had stable disease, seven patients (38%) had progression as best overall response. No partial response or complete response was observed; however, the disease control rate, defined as complete response + partial response + stable disease ≥3 months, was 50%. Median progression-free survival was 3.1 months, and median overall survival was 13.8 months. Adverse events of any grade occurred in 13 patients (72.2%). Treatment-related grade 3 adverse events were rare, and there were no grade 4 or 5 related adverse events. IMC-A12 was very well tolerated, however, showed limited clinical activity in uveal melanoma as a single agent. Due to its low toxicity profile it could be studied in combination with other pathway-specific agents.
Population-based Assessment of Intermittent Androgen Deprivation Therapy Utilization for Relapsed, Nonmetastatic, Hormone-sensitive Adenocarcinoma of the Prostate
Authors: Janzen Bryan W. , Ong Aldrich , Penner Makoy , Koul Rashmi , Dubey Arbind , Ahmed Shahida , Bashir Bashir , Chowdhury Amitava , Dawe David E. , Nayak Jasmir , Kim Julian O.
Published: September 2020

Objectives:

Androgen deprivation therapy (ADT) is the standard of care for men with nonmetastatic hormone-sensitive prostate cancer (nmHSPC) after treatment failure. Although intermittent ADT (iADT) is noninferior to continuous ADT for prostate cancer outcomes, with superior quality of life and cost-to-benefit ratio, little is known regarding its real-world utilization. The authors aimed to determine the utilization of iADT in a Canadian Provincial Cancer Program for relapsed nmHSPC and identified risk factors associated with the nonreceipt of iADT.

Materials and Methods:

This retrospective population-based cohort study used linked administrative databases to identify all patients with relapsed nmHSPC from 2012 to 2016 and quantified ADT prescription history. Patients were defined as iADT eligible if prostate-specific antigen (PSA) was <4 ng/mL and trending downwards on ≥2 sequential PSAs after ≥6 months of ADT. Univariable and multivariable logistic regression analyses were performed to determine factors associated with nonreceipt of iADT.

Results:

A total of 601 men with relapsed, nmHSPC were included with a median age at relapse of 73 (range, 46 to 96), pre-ADT PSA of 12.2 ng/mL, and a median pre-ADT PSA doubling time of 7.8 months. 80.9% of the cohort were eligible to receive iADT and 74.4% were treated with iADT. On multivariable analysis, patients originally treated with surgery (odds ratio [OR], 0.19; 95% confidence interval [CI], 0.08-0.46) or having a Gleason Score ≥8 (OR, 0.30; 95% CI, 0.12-0.78) had decreased odds of receipt of iADT. Patients with longer PSA doubling times were more likely to receive iADT (OR, 2.71; 95% CI, 1.17-6.31).

Conclusions:

The utilization of iADT was relatively common for men in Manitoba during the study period, however, the uptake of iADT can be improved among identified subgroups.
Effect of Age on Cancer-specific Mortality in Patients With Urothelial Carcinoma of the Urinary Bladder
Authors: Luzzago Stefano , Knipper Sophie , Palumbo Carlotta , Rosiello Giuseppe , Pecoraro Angela , Deuker Marina , Mistretta Francesco A. , Tian Zhe , Musi Gennaro , Montanari Emanuele , Shariat Shahrokh F. , Saad Fred , Briganti Alberto , de Cobelli Ottavio , Karakiewicz Pierre I.
Published: September 2020

Objective:

The objective of the study is to test the effect of age on cancer-specific mortality (CSM) in patients with urothelial carcinoma of the urinary bladder (UCUB), across all disease stages.

Materials and Methods:

Within the Surveillance, Epidemiology, and End Results (SEER) registry (2004-2016), we identified 207,714 patients. Age was categorized as: below 60 versus 60 to 69 versus 70 to 79 versus 80 years and above. Multivariable competing-risks regression (CRR) models were used according to disease stage (low-risk nonmuscle invasive: TaN0M0 low grade, high-risk nonmuscle invasive: Ta high grade or Tis-1N0M0, muscle invasive: T2-3N0M0, regional: T4N0M0/TanyN1-3M0, and metastatic: TanyNanyM1).

Results:

Overall, 33,970 (16.4%) versus 52,173 (25.1%) versus 64,537 (31.1%) versus 57,034 (27.4%) patients were below 60 versus 60 to 69 versus 70 to 79 versus 80 years and above, respectively. In multivariable CRR models that focused on low-risk nonmuscle invasive UCUB, advanced age was associated with higher CSM rates (hazard ratio [HR]: 7.04 in patients aged 80 y and above, relative to below 60 y; P<0.001). Moreover, advanced age was also associated with higher CSM rates in high-risk nonmuscle invasive UCUB (HR: 2.77 in patients aged 80 y and above, relative to below 60 y; P<0.001) and in muscle invasive UCUB patients (HR: 1.38 in patients aged 80 y and above, relative to below 60 y; P<0.001). Conversely, lower CSM rates with advanced age were observed in multivariable CRR that focused on regional (HR: 0.91 for patients aged 80 y and above, relative to below 60 y; P=0.02) or metastatic UCUB (HR: 0.75 for patients aged 80 y and above, relative to below 60 y; P<0.001).

Conclusions:

The direction and the magnitude of the association between advanced age and CSM in UCUB patients changes according to tumor stage. In low-risk nonmuscle invasive, high-risk nonmuscle invasive, and muscle invasive UCUB, more advanced age is associated with higher CSM rates. Conversely, in regional and metastatic UCUB patients, more advanced age is associated with lower CSM rates.
Mucinous Syringometaplasia: Surrounding Acanthosis With Hyperkeratosis Tends to Conceal the Change
Authors: Shimizu Yuri , Hayashi Misa , Ohata Chika
Published: September 2020

A 57-year-old man had a 2-year history of a painful nodule on the right sole. Physical examination revealed an 8 × 8 mm hyperkeratotic plaque with a central fissure. Excisional biopsy disclosed epithelial invagination surrounded by the acanthotic epidermis with parakeratotic hyperkeratosis and focal hypergranulosis. The invaginated epithelium lacked a cornified layer and was composed of a mixture of small basaloid squamous cells and goblet cells showing tubular structures. The patient was diagnosed with mucinous syringometaplasia. Our literature review established that surrounding acanthosis with hyperkeratosis typically tends to conceal mucinous syringometaplastic changes. Because mucinous syringometaplasia often presents as an asymptomatic papule/nodule with no distinct ulcer, fissure, or depressed area, cases may be overlooked.
The Relationship Between Parental Accommodation and Sleep-Related Problems in Children with Anxiety
Authors: Chevalier Lydia L. , O'Connor Erin E. , Holly Lindsay E. , Langer David A. , Pincus Donna B.
Published: September 2020

Objective:

Sleep-related problems, defined as sleep patterns atypical for the child's developmental stage, are common in children with elevated anxiety symptoms and linked to significant mental and physical health consequences. Despite the consequences of sleep-related problems, it remains unclear how these problems are initiated and maintained in children with elevated anxiety symptoms. The current study examines the relationship between sleep-related problems and parental accommodation (e.g., co-sleeping) to determine whether higher levels of accommodation are associated with more frequent sleep-related problems in a sample of children with elevated anxiety symptoms.

Methods:

Participants were 122 children aged 8 to 17 years old (M = 11.97, SD = 2.68; 57% female) and their parents who presented to a university-based anxiety specialty clinic for assessment and treatment. Children completed the Multidimensional Anxiety Scale for Children, and their parents completed the Children's Sleep Habits Questionnaire and Family Accommodation Checklist and Interference Scale. Multiple regression analyses were performed to examine variance in sleep-related problems explained by parental accommodation.

Results:

Parental accommodation accounted for a significant amount of variance in sleep-related problems over and above child anxiety and age for both mother report (19%) and father report (15%). When individual accommodation items were examined, parental sleep accommodations (e.g., slept in my child's bed) and nonsleep accommodations (e.g., came home early) were significant predictors for mother-reported sleep-related problems, but only sleep accommodations (e.g., let my child sleep with the lights on) were significant for father-reported sleep-related problems.

Conclusion:

Parents of children with elevated anxiety symptoms and sleep-related problems engage in accommodation related to their child's sleep (e.g., co-sleeping). Future research elucidating the potential bidirectional and causal links between parental accommodation and sleep-related problems is a necessary step in adapting sleep treatments for this population.
Anticontractile Effect of Perivascular Adipose Tissue But Not of Endothelium Is Enhanced by Hydrogen Sulfide Stimulation in Hypertensive Pregnant Rat Aortae
Authors: Souza-Paula Edileia , Polonio Leticia C. C. , Zochio Gabriela P. , da Silva Katiussia Pinho , Kushima Helio , Dias-Junior Carlos A.
Published: September 2020

Perivascular adipose tissue (PVAT) modulates the vascular tone. Hydrogen sulfide (H2S) is synthetized by cystathionine gamma-lyase (CSE) in brown PVAT. Modulation of vascular contractility by H2S is, in part, adenosine triphosphate (ATP)-sensitive potassium channels dependent. However, the role of PVAT-derived H2S in hypertensive pregnancy (HTN-Preg) is unclear. Therefore, we aimed to examine the involvement of H2S in the anticontractile effect of PVAT in aortae from normotensive and hypertensive pregnant rats. To this end, phenylephrine-induced contractions in the presence and absence of PVAT and endothelium in aortae from normotensive pregnant (Norm-Preg) and HTN-Preg rats were investigated. Maternal blood pressure, fetal-placental parameters, angiogenesis-related biomarkers, and H2S levels were also assessed. We found that circulating H2S is elevated in hypertensive pregnancy associated with angiogenic imbalance, fetal and placental growth restrictions, which revealed that there is H2S pathway activation. Moreover, under stimulated H2S formation PVAT, but not endothelium, reduced phenylephrine-induced contractions in aortae from HTN-Preg rats. Also, H2S synthesis inhibitor abolished anticontractile effects of PVAT and endothelium. Furthermore, anticontractile effect of PVAT, but not of endothelium, was eliminated by ATP-sensitive potassium channels blocker. In accordance, increases in H2S levels in PVAT and placenta, but not in aortae without PVAT, were also observed. In conclusion, anticontractile effect of PVAT is lost, at least in part, in HTN-Preg aortae and PVAT effect is ATP-sensitive potassium channels dependent in normotensive and hypertensive pregnant rat aortae. PVAT but not endothelium is responsive to the H2S stimulation in hypertensive pregnant rat aortae, implying a key role for PVAT-derived H2S under endothelial dysfunction.
Quick Response Codes: An Innovative Approach to Just-in-Time Education
Authors: Hirsch Sonya M. , Bueno Elyse , Tenure Krystal C.
Published: September 2020

BACKGROUND: Many nurses are digital natives who have grown up with advanced technology. Bedside competence is essential, and written policies and procedures guide our practice. Newer learning styles, time constraints, and available personnel may be barriers to historical approaches to information dissemination. METHODS: Quick Response code technology was incorporated to provide just-in-time resources that can be readily accessed at the point of care. RESULTS: Nurses have incorporated Quick Response codes in novel ways to provide quick resources in a dynamic environment. Examples include orientation documents, educational rollouts, infrequently used and high-risk equipment, and leadership updates. IMPLICATIONS: Bedside nurses in our institution have embraced this technology. Benefits include engagement, increased knowledge, and a sense of value among our nursing team.
Deep Venous Thrombosis With Symptomatic Bilateral Pulmonary Embolism After Using an Infrapatellar Strap for Patellofemoral Pain in an Athletic Cardiothoracic Surgeon
Authors: Segers Patrique , Hendriks Babs M. F. , Heuts Samuel
Published: September 2020

Knee braces and patellar straps are frequently prescribed devices for treatment of patellofemoral pain syndrome. In this report, we describe the occurrence of localized deep venous thrombosis (DVT) after use of an infrapatellar strap. Until now, external mechanical compression has not been recognized as a cause of DVT. In young and athletic patients presenting with DVT, after exclusion of the most prominent risk factors, untraditional causes should be considered to mistakenly label a DVT as unprovoked.
Successful Nonsurgical Management of a Posteriorly Displaced Medial Clavicular Physeal Fracture in an Adolescent Athlete: A Case Report
Authors: Wagner Ryan J. , Symanski John S. , Raasch William G. , Young Craig C.
Published: September 2020

Traumatic and sport-related sternoclavicular (SCJ) injuries in adolescent athletes are more commonly physeal fractures rather than true SCJ dislocations. Although rare, posterior displacement of the medial clavicular metaphysis after a physeal fracture necessitates prompt evaluation and treatment. Despite the inherent healing ability of physeal separations, delayed or failed diagnosis has the capacity to cause serious complications or fatality secondary to injury of retrosternal structures. Even with the potential severity, a lack of consensus exists in the literature regarding the most appropriate treatment modality. We report an adolescent football player with a medial clavicular physeal fracture with posterior metaphyseal displacement abutting the left brachiocephalic vein. After nonsurgical management and progression to play, the patient returned to play football. This case not only highlights the diagnostic principles of medial clavicular physeal fractures with posterior metaphyseal displacement but also discusses how these challenging injuries can be managed successfully with conservative treatment.
Telehealth educational interventions in nurse practitioner education: An integrative literature review
Authors: Gartz Jenna , O'Rourke Jennifer
Published: September 2020

Background:

Telehealth is a solution to combat multiple health care problems such as lack of access, provider shortages, increasing health care expenditures, and a growing number of people living with chronic conditions. Nurse practitioner students are not adequately educated in telehealth and may be unprepared to use it in their future careers.

Objective:

To evaluate the efficacy of telehealth educational interventions synthesizing current literature.

Data sources:

Using PubMed and Cumulative Index to Nursing and Allied Health Literature databases, a search was conducted in October 2019 for peer-reviewed articles in English using search terms “telemedicine,” telehealth,” “ehealth,” “mhealth,” and “mobile health,” along with “graduate nursing education” and “nursing education.”

Conclusions:

A total of 15 articles were included for review. Minimal nurse practitioner student education should include didactic content and student projects because of the ease of implementation. When telehealth didactic education is combined with experiential learning such as simulation and clinical experience, the benefit is greater.

Implications for practice:

The identified methods for increasing telehealth education should be implemented to prepare nurse practitioner students because telehealth continues to grow and become a vital part of American health care. Telehealth educational resources should be increased, as telehealth is only as useful as providers are prepared to use it.
Does Calcium Dobesilate Have Therapeutic Effect on Gentamicin-induced Cochlear Nerve Ototoxicity? An Experimental Study
Authors: Çınar Zehra , Edizer Deniz Tuna , Yiğit Özgür , Altunay Zeynep Önerci , Gül Mehmet , Ataş Ahmet
Published: September 2020

Hypothesis:

The ototoxic effects of aminoglycosides are well known. Gentamicin carries a substantial risk of hearing loss. Gentamicin is widely used to combat life-threatening infections, despite its ototoxic effects. Calcium dobesilate is a pharmacologically active agent used to treat many disorders due to its vasoprotective and antioxidant effects. We investigated the therapeutic role of calcium dobesilate against gentamicin-induced cochlear nerve ototoxicity in an animal model.

Methods:

Thirty-two Sprague Dawley rats were divided into four groups: Gentamicin, Gentamicin + Calcium Dobesilate, Calcium Dobesilate, and Control. Preoperative and postoperative hearing thresholds were determined using auditory brainstem response thresholds with click and 16-kHz tone-burst stimuli. Histological analysis of the tympanic bulla specimens was performed under light and transmission electron microscopy. The histological findings were subjected to semiquantitative grading, of which the results were compared between the groups.

Results:

Gentamicin + Calcium Dobesilate group had, on average, 27 dB better click-evoked hearing than Gentamicin group (p < 0.01), whereas the difference was not significant with 16-kHz tone-burst stimuli (p > 0.01). Histologically examining the Control and Calcium Dobesilate groups revealed normal ultrastructural appearances. The Gentamicin group showed the most severe histological alterations including myelin destruction, total axonal degeneration, and edema. The histological evidence of damage was significantly reduced in the Gentamicin + Calcium Dobesilate group compared with the Gentamicin group.

Conclusion:

Adding oral calcium dobesilate to systemic gentamicin was demonstrated to exert beneficial effects on click-evoked hearing thresholds, as supported by the histological findings.
Psychometric Testing of Papanicolaou Testing Barriers and Self-efficacy Scales Among Black Women
Authors: Biederman Erika , Zimet Gregory , Champion Victoria
Published: September 2020

Background

Black women face cervical cancer disparities with higher rates of morbidity and mortality compared with White women. Identifying predictors of Papanicolaou (Pap) testing is a first step to decrease morbidity and mortality from cervical cancer, with barriers and self-efficacy being constructs that should be related to Pap testing adherence. Although barriers and self-efficacy scales have been developed, they have not been validated in Black women for Pap testing.

Objective

The purpose of this study was to modify and psychometrically test barriers and self-efficacy to Pap testing in a Black population.

Intervention/Methods

Data were collected from a minority health fair. Internal consistency reliability testing was conducted using item analysis and Cronbach’s α. Construct validity was assessed by exploratory factor analysis and logistic regression. Papanicolaou testing adherence was regressed on each scale (barriers and self-efficacy) while controlling for antecedents.

Results

Data demonstrated 2 reliable scales: (1) barriers (Cronbach’s α = .79), item-total correlation = 0.479 to 0.628; and (2) self-efficacy (Cronbach’s α = .85), item-total correlation = 0.560 to 0.697. Exploratory factor analysis supported 2 unidimensional scales. The regression models supported a relationship between each scale and Pap testing adherence.

Conclusions

The data suggested barriers and self-efficacy scales were reliable and valid among Black women. Barriers and self-efficacy could be tailored in future interventions to increase Pap testing adherence.

Implications for Practice

Nurses could use responses to these scales for framing discussions about Pap testing.
Treatment of Pyoderma Gangrenosum in Pediatric Inflammatory Bowel Disease
Authors: Vaidy Katherine , Winderman Rebecca , Rabinowitz Simon S. , Schwarz Steven M.
Published: September 2020

Pyoderma gangrenosum (PG) is a rare, necrotizing dermatologic condition associated with neoplastic and immune dysregulatory states, including adult and pediatric inflammatory bowel disease (IBD). Over the last decade, the elucidation of inflammatory mediators in PG has led to a plethora of localized and systemic corticosteroid sparing therapies including antibiotics, antiinflammatory, and immunomodulatory agents. Herein, we describe the case of a 17-year-old female with ulcerative colitis in clinical remission, who presented with a long-standing, large, deep, and painful lower extremity PG lesion. Following failed attempts both at local and at systemic therapies, her PG was successfully treated with the tumor necrosis factor-alpha (TNF-α) monoclonal antibody adalimumab, and the lesion remains in remission after four years of subcutaneous anti-TNF therapy. This case serves as the basis for our presenting a review of the pathogenesis, diagnostic criteria, differential diagnosis, therapies and treatment outcomes for pediatric IBD-associated PG. Our experience adds to earlier reports suggesting anti-TNF-α biologic therapy is most likely to achieve long-term resolution of IBD-associated PG in children and adolescents with severe lesions or who failed other treatments.
Exercise-induced hypoalgesia after acute and regular exercise: experimental and clinical manifestations and possible mechanisms in individuals with and without pain
Authors: Vaegter Henrik Bjarke , Jones Matthew David
Published: September 2020

Exercise and physical activity is recommended treatment for a wide range of chronic pain conditions. In addition to several well-documented effects on physical and mental health, 8 to 12 weeks of exercise therapy can induce clinically relevant reductions in pain. However, exercise can also induce hypoalgesia after as little as 1 session, which is commonly referred to as exercise-induced hypoalgesia (EIH). In this review, we give a brief introduction to the methodology used in the assessment of EIH in humans followed by an overview of the findings from previous experimental studies investigating the pain response after acute and regular exercise in pain-free individuals and in individuals with different chronic pain conditions. Finally, we discuss potential mechanisms underlying the change in pain after exercise in pain-free individuals and in individuals with different chronic pain conditions, and how this may have implications for clinical exercise prescription as well as for future studies on EIH.
The mechanisms of effect of a physiotherapist-delivered integrated psychological and exercise intervention for acute whiplash-associated disorders: secondary mediation analysis of a randomized controlled trial
Authors: Elphinston Rachel A. , Sterling Michele , Kenardy Justin , Smeets Rob , Armfield Nigel R.
Published: September 2020

Introduction:

Integrated psychological and physical treatments can improve recovery for whiplash-associated disorders (WADs). Little is known about how these interventions work.

Objective:

To examine the mechanisms by which a physiotherapist-delivered integrated intervention for acute WAD improves health outcomes.

Methods:

Secondary analysis using structural equation modelling of a randomized controlled trial comparing integrated stress inoculation training and exercise to exercise alone for acute WAD. Outcomes were disability, pain self-efficacy, pain intensity, and health-related quality of life at 12 months. The intended intervention target and primary mediator, stress was tested in parallel with pain-related coping, an additional cognitive behavioral mediator that significantly improved at posttreatment (Model 1). Stress-related constructs that commonly co-occur with stress and pain were also tested as parallel mediators: depression and pain-related coping (Model 2); and posttraumatic stress and pain-related coping (Model 3).

Results:

Reductions in stress mediated the effect of the integrated intervention on disability (β = −0.12, confidence interval [CI] = −0.21 to −0.06), pain self-efficacy (β = 0.09, CI = 0.02–0.18), pain (β = −0.12, CI = −0.21 to −0.06), and health-related quality of life (β = 0.11, CI = 0.04–0.21). There was an additional path to pain self-efficacy through pain-related coping (β = 0.06, CI = 0.01–0.12). Similar patterns were found in Models 2 and 3.

Conclusions:

Improvements in stress and related constructs of depression and posttraumatic stress, and pain-related coping were causal mechanisms of effect in a physiotherapist-delivered integrated intervention. As integrated interventions are growing in popularity, it is important to further personalize interventions for improved benefit.
Brief Report: Accuracy of FIB-4 for Cirrhosis in People Living With HIV and Hepatocellular Carcinoma
Authors: Torgersen Jessie , Kallan Michael J. , Carbonari Dena M. , Park Lesley S. , Mehta Rajni L. , D’Addeo Kathryn , Tate Janet P. , Lim Joseph K. , Goetz Matthew Bidwell , Rodriguez-Barradas Maria C. , Bräu Norbert , Brown Sheldon T. , Taddei Tamar H. , Justice Amy C. , Lo Re Vincent
Published: September 2020

Background:

Hepatocellular carcinoma (HCC) may develop in the absence of cirrhosis in HIV, and determining how often this occurs can provide insights into mechanisms of carcinogenesis. Studies evaluating the prevalence of cirrhosis in the setting of HCC among people living with HIV (PLWH) often rely on noninvasive markers, such as the Fibrosis-4 Index for Hepatic Fibrosis (FIB-4). However, the accuracy of FIB-4 for cirrhosis in the setting of HCC has not been determined among PLWH.

Methods:

We conducted a cross-sectional study among PLWH in the Veterans Aging Cohort Study with VA cancer registry-confirmed HCC diagnosed between 1999 and 2015. FIB-4 was calculated using the age, alanine aminotransferase, aspartate aminotransferase, and platelet count obtained closest to, but within 1 year before, HCC diagnosis. Medical records were reviewed within 1 year before HCC diagnosis to determine the cirrhosis status. We evaluated the area under the receiver-operating characteristic curve and performance characteristics of FIB-4 for confirmed cirrhosis.

Results:

Incident HCC was diagnosed in 302 PLWH. After medical record review, 203 (67.2%, 95% confidence interval: 61.6% to 72.5%) had evidence of cirrhosis. FIB-4 identified patients with cirrhosis with an area under the receiver-operating characteristic curve of 0.67 (95% confidence interval: 0.60 to 0.73). FIB-4 scores >5.0 had a positive predictive value >80% and specificity of >77%, negative predictive value of <41%, and sensitivity of <45%.

Conclusion:

The accuracy of FIB-4 for cirrhosis in the setting of HIV and HCC is modest and may result in misclassification of cirrhosis in this population.
Magnetic Resonance Imaging of Recurrent Adult Granulosa Cell Tumor of the Ovary: A Retrospective Analysis of 11 Cases
Authors: Matsuki Mitsuru , Numoto Isao , Suzuki Ayako , Hamakawa Takefumi , Matsukubo Yuko , Tsurusaki Masakatsu , Ishii Kazunari , Otani Tomoyuki , Matsumura Noriomi
Published: September 2020

Objective

The aim of the study was to characterize magnetic resonance imaging findings in patients with recurrent ovarian adult granulosa cell tumors (AGCTs).

Methods

Clinical and magnetic resonance imaging manifestations of recurrent AGCTs were evaluated in 11 patients.

Results

Initial recurrences of AGCT were diagnosed between 13 months and 30 years (mean, 11.3 years). Recurrent tumors were located in the pelvic peritoneum, the abdominal peritoneum, the retroperitoneum, and bone. The number of recurrent tumors varied from 1 to 5. Tumors varied in morphology and all margins were well circumscribed. The internal structures noted were as follows: multilocular cystic and solid and cystic. Furthermore, internal hemorrhage and sponge-like multicystic components were identified.

Conclusions

Ovarian AGCTs recurred in the pelvic peritoneum, abdominal peritoneum, and the retroperitoneal lymph nodes. Large recurrent AGCTs were commonly well circumscribed, round or lobulated, and multilocular cystic or solid and cystic. Moreover, they frequently included internal hemorrhage and sponge-like multicystic components.
Auricular Pseudocyst
Authors: Whittle Carolina , Castro Alex , Pereira Maria Jose , Cabrera Raul
Published: September 2020

Auricular pseudocyst (AP) is a rare benign condition that corresponds to an intracartilaginous collection resulting in a noninflammatory cystic swelling of the ear.

The objective is to describe ultrasound and clinical presentation of histologically proven AP.

An Institutional Review Board (IRB) approved a 6-year retrospective study. Patients with an auricular pseudocyst were selected. Fifty-nine percent of the cases were referred with clinical suspicion of AP. One hundred percent were men, and in 76% of the cases, AP was located in the scaphoid fossa. The mean age was 35 years (76% from 20 to 50 years).

Unilateral lesion was present in 94% of the cases. A single lesion was found in 88% and multiple lesions in 12%. On high-resolution ultrasound increased thickness of the cartilage was observed in all patients with a cystic lesion inside the cartilage. Fifty-nine percent of the cases were totally anechoic. The other presented echoes or septa inside the cystic lesion.

In conclusion high-resolution ultrasound allows to study the exact anatomic involvement of the cartilage and the surrounding tissues. The auricular pseudocyst presented a characteristic ultrasound finding permitting an adequate early diagnosis and monitoring treatment. Knowledge of this pathology and the sonographic finding is important for a correct diagnosis.
Characteristics of Adults With Hepatitis C Virus
Authors: Williams Sheila A. , Lindley Lisa C.
Published: September 2020

Hepatitis C virus (HCV) infects more than 3 million people in the United States (U.S.). Long-term complications of hepatitis C infection result in increased liver disease and financial burden for the nation. The purpose of this study was to identify characteristics of adults with HCV in the U.S. This secondary, descriptive study analyzed data from the 2011–2012 National Health and Nutrition Examination Survey. The weighted sample included 2,075,749 adults diagnosed with HCV. Descriptive statistics were calculated. The findings revealed that most adults in the U.S. with HCV were insured non-Hispanic, white males, aged 45 to 64 years. Almost half of adults with HCV denied a liver condition. Several participants either were co-infected or had previous infection (82%) with other hepatitis. Substance use (53.5%), alcohol use (96%), and cigarette use (88.6%) among adults with HCV were higher than previously reported. A majority of adults were noncompliant with hepatitis A and B vaccination series completion (67% and 65.1%, respectively). Medication adherence was higher than other reported cases. Adults with HCV have increased mental health symptoms (67.1%) and do not routinely visit a mental health professional (90.2%). HCV-infected adults are likely to use alcohol, cigarettes, and/or other substances. Adults with HCV have significant mental health issues, but rarely access care. Medication adherence was higher than expected for this cohort. The findings provide information for nurses to develop individualized plans of care and identify at-risk individuals for treatment noncompliance.
Supportive Interventions During Treatment of Chronic Hepatitis C
Authors: Bailey Donald E. , Zucker Donna M.
Published: September 2020

There are an estimated 3 million people living with chronic hepatitis C, yet many have limited access to healthcare and treatment due to a variety of behavioral/lifestyle determinants of health. The aim of this literature review was to examine care models and innovations for people successfully treated from 2011 to 2018. We searched PubMed, PsycINFO, and CINAHL to identify care models for people undergoing treatment of chronic hepatitis C. Ten articles met criteria for inclusion and included multiple types of care models, including nurse initiated (n = 2), telemedicine care (n = 3), group visit (n = 1), concurrent treatment (n = 1), community health center care (n = 1), and integrated care (n = 2). Eight of the studies focused on people with mental health challenges and/or substance use disorder. Sustained virological response was the primary outcome of all studies; adherence was a secondary outcome measured in 8 studies.

This search occurred during a period where treatment moved from interferon-based therapy to all-oral direct-acting antiviral medications, representing a paradigm shift in treatment of chronic hepatitis C. As new treatments offer cure for up to 95% of patients, these studies provided strong evidence of benefit for innovative care models for patients with mental health and substance use disorder to complete treatment.
Pediatric adjusted reverse shock index multiplied by Glasgow Coma Scale as a prospective predictor for mortality in pediatric trauma
Authors: Lammers Daniel T. , Marenco Christopher W. , Do Woo S. , Conner Jeff R. , Horton John D. , Martin Matthew J. , Escobar Mauricio A. , Bingham Jason R. , Eckert Matthew J.
Published: September 2020

INTRODUCTION

Shock index and its pediatric adjusted derivative (pediatric age-adjusted shock index [SIPA]) have demonstrated utility as prospective predictors of mortality in adult and pediatric trauma populations. Although basic vital signs provide promise as triage tools, factors such as neurologic status on arrival have profound implications for trauma-related outcomes. Recently, the reverse shock index multiplied by Glasgow Coma Scale (GCS) score (rSIG) has been validated in adult trauma as a tool combining early markers of physiology and neurologic function to predict mortality. This study sought to compare the performance characteristics of rSIG against SIPA as a prospective predictor of mortality in pediatric war zone injuries.

METHODS

Retrospective review of the Department of Defense Trauma Registry, 2008 to 2016, was performed for all patients younger than 18 years with documented vital signs and GCS on initial arrival to the trauma bay. Optimal age-specific cutoff values were derived for rSIG via the Youden index using receiver operating characteristic analyses. Multivariate logistic regression was performed to validate accuracy in predicting early mortality.

RESULTS

A total of 2,007 pediatric patients with a median age range of 7 to 12 years, 79% male, average Injury Severity Score of 11.9, and 62.5% sustaining a penetrating injury were included in the analysis. The overall mortality was 7.1%. A total of 874 (43.5%) and 685 patients (34.1%) had elevated SIPA and pediatric rSIG scores, respectively. After adjusting for demographics, mechanism of injury, initial vital signs, and presenting laboratory values, rSIG (odds ratio, 4.054; p = 0.01) was found to be superior to SIPA (odds ratio, 2.742; p < 0.01) as an independent predictor of early mortality.

CONCLUSION

Reverse shock index multiplied by GCS score more accurately identifies pediatric patients at highest risk of death when compared with SIPA alone, following war zone injuries. These findings may help further refine early risk assessments for patient management and resource allocation in constrained settings. Further validation is necessary to determine applicability to the civilian population.

LEVEL OF EVIDENCE

Prognostic study, level IV.
Evaluation of a population health strategy to reduce distracted driving: Examining all “Es” of injury prevention
Authors: Charyk Stewart Tanya , Edwards Jane , Penney Alyssa , Gilliland Jason , Clark Andrew , Haidar Tania , Batey Brandon , Pfeffer Amanda , Fraser Douglas D. , Merritt Neil H. , Parry Neil G.
Published: September 2020

BACKGROUND

Cell phone use while driving (CPWD) increases the risk of crashing and is a major contributor to injuries and deaths. The objective of this study was to describe the evaluation of a multifaceted, evidence-based population health strategy for the reduction of distracted driving.

METHODS

A multipronged campaign was undertaken from 2014 to 2016 for 16- to 44-year-olds, based on epidemiology, focused on personal stories and consequences, using the “Es” of injury prevention (epidemiology, education, environment, enforcement, and evaluation). Education consisted of distracted driving videos, informational cards, a social media AdTube campaign, and a movie theater trailer, which were evaluated with a questionnaire regarding CPWD attitudes, opinions, and behaviors. Spatial analysis of data within a geographic information system was used to target advertisements. A random sample telephone survey evaluated public awareness of the campaign. Increased CPWD enforcement was undertaken by police services and evaluated by ARIMA time series modeling.

RESULTS

The AdTube campaign had a view rate of >10% (41,101 views), slightly higher for females. The top performing age group was 18- to 24-year-olds (49%). Our survey found 61% of respondents used handheld CPWD (14% all of the time) with 80% reporting our movie trailer made them think twice about future CPWD. A stakeholder survey and spatial analysis targeted our advertisements in areas of close proximity to high schools, universities, near intersections with previous motor vehicle collisions, high traffic volumes, and population density. A telephone survey revealed that 41% of the respondents were aware of our campaign, 17% from our print and movie theater ads and 3% from social media. Police enforcement campaign blitzes resulted in 160 tickets for CPWD. Following campaign implementation, there was a statistically significant mean decrease of 462 distracted driving citations annually (p = 0.001).

CONCLUSION

A multifaceted, evidence-based population health strategy using the Es of injury prevention with interdisciplinary collaboration is a comprehensive method to be used for the reduction of distracted driving.

LEVEL OF EVIDENCE

Therapeutic, level IV.
Cervical Vestibular Evoked Myogenic Potentials in Idiopathic Intracranial Hypertension
Authors: Uyaroğlu Feray G. , Uçar Roza , Şengül Gülgün , Çelebisoy Neşe
Published: September 2020

Purpose:

Idiopathic intracranial hypertension (IIH) is raised intracranial pressure without any identifiable etiology. The inner ear structures are susceptible to cerebrospinal fluid (CSF) pressure changes because of connections between the CSF space and the labyrinth to explain the audiovestibular symptoms, such as pulsatile tinnitus or dizziness, reported in 50% to 60% of these patients. The aim of this study was to investigate the vestibular functions using cervical vestibular evoked myogenic potentials (cVEMPs) in IIH.

Methods:

cVEMPs were recorded in 30 patients with IIH before lumbar puncture. Thirty healthy volunteers constituted the control group. The latencies of peaks p13 and n23 and peak-to-peak amplitude of p13–n23 were measured.

Results:

Responses were gathered bilaterally from all healthy controls. In 30 patients with IIH, 49 responses could be gathered from 60 tests (81.7%). The potential was absent bilaterally in five and unilaterally in one patient. When recorded, the latency and amplitude values of the responses of the patients were not significantly different from the healthy controls (P > 0.005). A correlation between CSF pressure and response persistence could not be determined.

Conclusions:

cVEMPs are affected in patients with IIH and the main finding is the absence of the responses. Increased intracranial pressure causing sound transmission changes within the inner ear can affect the saccular afferents and may end up with absent responses on air-conducted cVEMP recordings. To comment on the correlation between the CSF pressure and cVEMP changes, successive cVEMP recordings with longitudinal CSF pressure monitoring seem necessary.