bluuebunny/crossref_metadata_2025 huggingface dataset:
Intrauterine Device Use and Ovarian Cancer Risk
Authors: Wheeler Lindsay J. , Desanto Kristen , Teal Stephanie B. , Sheeder Jeanelle , Guntupalli Saketh R.
Published: September 2019

OBJECTIVE:

To explore the relationship between intrauterine device (IUD) use and risk of ovarian cancer through systematic review of the literature and meta-analysis.

DATA SOURCES:

We searched MEDLINE, EMBASE, Cochrane Library, Web of Science Core Collection from inception to June 2018. For the MEDLINE search, we included the MeSH terms “intrauterine devices” AND “ovarian neoplasms,” however also searching “intrauter*,” “ovar*” and “fallopian tube,” as well as “cancer” and “carcinoma” as keywords to include all possible variations. Similar search terms were used in the other databases. We also searched ClinicalTrials.gov.

METHODS OF STUDY SELECTION:

Case–control and cohort studies that collected individual level data on IUD use and ovarian cancer diagnosis were critically reviewed and data extracted. Review of abstracts from 399 articles through systematic database review and an additional 200 articles through Google Scholar identified a total of 15 studies with individual level data regarding IUD use and incident ovarian cancer. On critical review, 11 of these studies were used for meta-analysis. All case reports and reviews were excluded.

TABULATION, INTEGRATION, AND RESULTS:

The data were harmonized and weighted and summary odds ratios (ORs) were calculated. Covariates were identified evaluated separately. A random-effects meta-analysis was performed to confirm minimal bias. Harmonization and weighting of the data revealed an OR association between ever use of an IUD and incident ovarian cancer to be 0.68 (95% CI 0.62–0.75). There were no significant differences found between covariates. Heterogeneity among all studies was found to be I2=68%.

CONCLUSION:

Intrauterine device use is associated with a reduced incidence of ovarian cancer based on a review of existing retrospective data. Unfortunately, prospective investigation into the role of IUDs in ovarian cancer prevention is limited.
Predictive Value of the Signs and Symptoms Preceding Eclampsia
Authors: Hastie Roxanne , Brownfoot Fiona C. , Cluver Catherine A. , Walker Susan P. , Hesselman Susanne , Tong Stephen , Bergman Lina
Published: September 2019

OBJECTIVE:

To estimate the predictive value of signs and symptoms that occur before onset of eclampsia among pregnant women.

DATA SOURCES:

Electronic databases, including MEDLINE, EMBASE, Cochrane, and ClinicalTrials.gov were searched from inception to 2018. Search terms included eclampsia, predict, likelihood ratio, predictive value, and risk.

METHODS OF STUDY SELECTION:

Abstracts and later full texts were selected for review if a diagnosis of eclampsia was made, a comparator arm included (women without a diagnosis of eclampsia), and predictors of imminent eclampsia reported. Of 2,791 retrieved records, 11 were selected. Significant heterogeneity existed between studies, with differing designs, settings, participants, and signs or symptoms. In total, 28 signs or symptoms were reported, with visual disturbances and epigastric pain most common (six studies), followed by headache (five studies), and any edema (four studies).

TABULATION, INTEGRATION, AND RESULTS:

Data on study characteristics and predictive value of signs or symptoms were extracted, and, where appropriate, bivariate mixed-effect meta-analysis was applied to raw data. None of the pooled estimates were able to accurately predict eclampsia nor rule out eclampsia in their absence, with moderate specificity (83–94%) and poor sensitivity (29–56%).

CONCLUSION:

There is a dearth of high-quality studies investigating the predictive value of imminent signs and symptoms of eclampsia. Owing to the small number of studies, heterogeneity, and inconsistent reporting, it is difficult to provide accurate estimates of the predictive value of prodromal symptoms of eclampsia. Of the most commonly reported symptoms—visual disturbances, epigastric pain, and headache—none were able to accurately predict, nor rule out, imminent eclampsia.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO, CRD42018095076.
Association Between First-Trimester Subchorionic Hematomas and Adverse Pregnancy Outcomes After 20 Weeks of Gestation in Singleton Pregnancies
Authors: Naert Mackenzie N. , Muniz Rodriguez Alberto , Khadraoui Hanaa , Naqvi Mariam , Fox Nathan S.
Published: September 2019

OBJECTIVE:

To assess the association of first-trimester subchorionic hematomas with pregnancy outcomes after 20 weeks of gestation in women with singleton pregnancies.

METHODS:

We conducted a retrospective cohort study of all women with singleton pregnancies presenting for prenatal care before 14 weeks of gestation over a 3-year period at a single obstetric practice. All patients underwent routine first-trimester ultrasound examinations. We compared rates of adverse pregnancy outcomes at more than 20 weeks of gestation in women with and without a subchorionic hematoma on the initial ultrasound examination, excluding women with pregnancy loss before 20 weeks of gestation.

RESULTS:

From January 2015 to December 2017, a total of 2,172 women met the inclusion criteria for the study, 389 (17.9%) of whom had a subchorionic hematoma (mean largest diameter 2.1±1.4 cm). Women with subchorionic hematomas had their first ultrasound examination at earlier gestational ages (8 5/7 vs 9 6/7 weeks, P<.001) and were more likely to have vaginal bleeding at the time of the ultrasound examination (31.9% vs 7.9%, P<.001). Maternal age, race, use of in vitro fertilization, body mass index, and medical comorbidities did not differ between the groups. On univariable analysis, subchorionic hematoma was not associated with any pregnancy outcomes at more than 20 weeks of gestation, including gestational age at delivery, preterm birth, birth weight, birth weight less than the 10th percentile for gestational age, gestational hypertension, preeclampsia, placental abruption, intrauterine fetal death at more than 20 weeks of gestation, cesarean delivery, blood transfusion, and antepartum admissions. On regression analysis including subchorionic hematoma, vaginal bleeding, and gestational age at ultrasound examination, vaginal bleeding was independently associated with preterm birth at less than 37 weeks of gestation and birth weight less than the 10th percentile. Subchorionic hematoma was not independently associated with pregnancy outcomes. This study had 80% power to detect a 5% absolute difference in the frequency of preterm birth; that is, from 10% to 15%.

CONCLUSION:

In singleton pregnancies, a first-trimester subchorionic hematoma is not associated with adverse pregnancy outcomes at more than 20 weeks of gestation.
U.S. Food and Drug Administration Statements About Transvaginal Mesh and Changes in Apical Prolapse Surgery
Authors: Winkelman William D. , Modest Anna M. , Richardson Monica L.
Published: September 2019

OBJECTIVE:

To assess the effects of the U.S. Food and Drug Administration (FDA) safety communication and the reclassification of transvaginal mesh to a class III device on national trends in the treatment of apical prolapse.

METHODS:

A retrospective cohort study of surgical cases from 2008 to 2017 from the American College of Surgeons National Surgical Quality Improvement Program was conducted. Patients were included if they underwent apical prolapse repair, as identified by Current Procedural Terminology codes.

RESULTS:

We identified 36,523 eligible surgical cases. There were no clinically meaningful differences in postoperative complications when stratified by surgical approach. The use of transvaginal mesh decreased from 35.0% to 11.0% from 2008 to 2017. In the year immediately after the first FDA safety communication in 2011, there was a decrease in the proportion of apical procedures using transvaginal mesh of 4.4% per quarter (P<.001), and the proportion of intraperitoneal, extraperitoneal, and abdominal colpopexy all increased. The greatest increase was seen for abdominal colpopexy procedures, which rose by 2.6% per quarter (P<.001). In the year after the FDA reclassification of transvaginal mesh in 2016, there was no significant change in the proportion of apical procedures using transvaginal mesh (P=.56).

CONCLUSION:

The first FDA safety communication in 2011 was associated with a significant decline in the use of transvaginal mesh and a concurrent rise in abdominal colpopexy procedures using transabdominal mesh. We speculate that the 2019 FDA ban of transvaginal mesh will result in an even more substantial shift toward abdominal colpopexy procedures.
Detailed Fetal Anatomic Ultrasound Examination Duration and Association With Body Mass Index
Authors: Gupta Vivek K. , Adams Jacquelyn H. , Heiser Timothy , Iruretagoyena J. Igor , Hoppe Kara K. , Antony Kathleen M.
Published: September 2019

OBJECTIVE:

To evaluate the association of the duration of the detailed fetal anatomic ultrasound examination with maternal body mass.

METHODS:

This was a retrospective chart review of patients presenting to our clinic for detailed fetal anatomic examinations between January 1, 2010, and June 30, 2017. After excluding multifetal pregnancies and other examinations expected to have a longer duration, a total of 6,522 examinations were performed between 18 0/7 and 22 0/7 weeks of gestation. Results were analyzed using analysis of variance and Student's t-test.

RESULTS:

Mean (SD) body mass index (BMI) was 29.3 (±7.7), and mean examination time was 51.5 (±10.4) minutes. We found that mean examination time was 48.8 (±9.6) minutes for patients with normal BMIs, 50.6 (±10.0) minutes for overweight patients, 52.2 (±10.4) minutes for patients with class I obesity, 54.6 (±10.3) minutes for patients with class II obesity, and 57.7 (±10.3) minutes for patients with class III obesity (P<.001). The duration of the detailed fetal anatomic ultrasound examination increased continuously with BMI (r=0.285, P<.001).

CONCLUSION:

We found that the duration of detailed fetal anatomic examinations increased with BMI. Examinations for gravid patients with class III obesity lasted 8.9 minutes longer than those for gravid patients with normal BMIs; examinations for gravid patients with BMIs of 50 or higher lasted 13.5 minutes longer. This information may be useful for fetal ultrasound examination scheduling.
Hoverboard injuries in children and adolescents: results of a multicenter study
Authors: Hosseinzadeh Pooya , Devries Clarabelle , Saldana Roger E. , Scherl Susan A. , Andras Lindsay M. , Schur Mathew , Shuler Franklin D. , Mignemi Megan , Minaie Arya , Chu Alice , Fornari Eric D. , Frick Steven L. , Caird Michelle S. , Riccio Anthony I. , Pierz Kristen , Plakas Christos , Herman Martin J.
Published: September 2019

With the increasing popularity of hoverboards in recent years, multiple centers have noted associated orthopaedic injuries of riders. We report the results of a multi-center study regarding hoverboard injuries in children and adolescents. who presented with extremity fractures while riding hoverboards to 12 paediatric orthopaedic centers during a 2-month period were included in the study. Circumstances of the injury, location, severity, associated injuries, and the required treatment were recorded and analysed using descriptive analysis to report the most common injuries. Between-group differences in injury location were examined using chi-squared statistics among (1) children versus adolescents and (2) males versus females. Seventy-eight patients (M/F ratio: 1.8) with average age of 11 ± 2.4 years were included in the study. Of the 78 documented injuries, upper extremity fractures were the most common (84.6%) and the most frequent fracture location overall was at the distal radius and ulna (52.6%), while ankle fractures comprised most of the lower extremity fractures (66.6%). Majority of the distal radius fractures (58.3%) and ankle fractures (62.5%) were treated with immobilization only. Seventeen displaced distal radius fractures and three displaced ankle fractures were treated with closed reduction in the majority of cases (94.1% versus 66.7%, respectively). The distal radius and ulna are the most common fracture location. Use of appropriate protective gear such as wrist guards, as well as adult supervision, may help mitigate the injuries associated with the use of this device; however, further studies are necessary to demonstrate the real effectiveness of these preventions.
Unsuspected tarsal coalitions in equinus and varus foot deformities
Authors: Van Rysselberghe Noelle L. , Souder Christopher D. , Mubarak Scott J.
Published: September 2019

Tarsal coalitions have been reported in the setting of equinovarus foot deformities, but only as rare isolated findings. Failure to recognize this diagnosis may inhibit successful equinovarus correction. Here, we review a series of tarsal coalitions seen in congenital and neuropathic equinovarus deformity at two institutions, to report the breakdown of types of coalitions encountered, and to suggest methodology to facilitate earlier diagnosis. The records of all patients treated by two of the authors for bilateral equinovarus deformities and found to have either a unilateral or bilateral tarsal coalition between 2006 and 2016 were reviewed. Nine feet with tarsal coalition (calcaneonavicular n = 7 and talocalcaneal n = 2) were reviewed. Five of these cases occurred in patients with idiopathic equinovarus and four cases in patients with equinovarus related to a neurologic disease. All patients were definitively diagnosed by computed tomography scans with 3D reconstruction. In 56% of cases, the patient had previously undergone at least one open procedure before the coalition was recognized. The mean age at diagnosis of the coalition was 11.4 years. Our experience suggests that tarsal coalitions, particularly calcaneonavicular coalitions, may occur more frequently in equinovarus deformities than previously reported. Upon recognition and removal of these coalitions, we were able to achieve improved correction of the equinovarus deformities and improved range of motion. We recommend that surgeons maintain an awareness of this potential concomitant problem in all equinovarus foot deformities and consider advanced imaging in cases which fail to respond to traditional treatment.
Long non-coding RNA H19 confers resistance to gefitinib via miR-148b-3p/DDAH1 axis in lung adenocarcinoma
Authors: Huang Zekai , Ma Yuanyuan , Zhang Panpan , Si Jiahui , Xiong Ying , Yang Yue
Published: September 2019

Epidermal growth factor receptor tyrosine kinase inhibitors therapy, such as gefitinib, have proven to be effective for lung adenocarcinoma with epidermal growth factor receptor-sensitive mutations. However, drug resistance remains inevitable and the underlying mechanisms are still elusive and poorly understood. In order to explore the mechanisms underlying tyrosine kinase inhibitors resistance, we used long non-coding RNA microarray analysis and found that long non-coding RNA H19 was highly expressed in gefitinib-resistant cell lines. In addition, knockdown of long non-coding RNA H19 was found to be able to decrease cell proliferation, half maximal inhibitory concentration (IC50) of gefitinib, migration and invasion. Mechanistically, we demonstrated that long non-coding RNA H19 positively regulated dimethylarginine dimethylaminohydrolase-1 expression via sponging miR-148b-3p. Furthermore, overexpression or inactivation of miR-148b-3p could enhance or reverse the inhibitory effect of long non-coding RNA H19 inhibition in lung adenocarcinoma cells, respectively. High expression of either long non-coding RNA H19 or dimethylarginine dimethylaminohydrolase-1 was associated with poorer overall survival in patients with lung adenocarcinoma, while high expression of miR-148b was associated with better overall survival. Overall, our data revealed that long non-coding RNA H19 confers resistance to gefitinib via miR-148b/dimethylarginine dimethylaminohydrolase-1 axis in lung adenocarcinoma, which offers a new insight into the epidermal growth factor receptor tyrosine kinase inhibitors therapy resistance.
Practical Heart Sparing Breast Cancer Radiation Therapy Using Continuous Positive Airway Pressure (CPAP) in Resource-Limited Radiation Oncology Clinics
Authors: Kil Whoon Jong , Lee Ik Jae , Pham Tabitha , Cho In Hye
Published: September 2019

Purpose:

The purpose of this study was to report experiences of practical heart sparing breast radiation therapy (RT) using continuous positive airway pressure (CPAP) in resource-limited radiation oncology clinics.

Patients and Methods:

Twelve patients underwent computed tomography-simulations with both free-breathing (FB) and CPAP under the individual maximum tolerable air pressure. For each patient, left-sided breast RT plans (9 with breast only, 3 with breast and regional nodal stations) with FB and CPAP were created using 3-dimensional conformal RT (supine tangential or wide tangential RT fields) according to RTOG 1304. For daily RT, patients started CPAP in the patients waiting area for 15 minutes before entering the treatment room and continued CPAP during RT. Treatment setup times between breast RT with and without CPAP were compared.

Results:

All patients tolerated CPAP well with 8 to 15 cm H2O of air pressure. Compared with FB, CPAP inflated the thorax and increased total lung volume by 35±16% (CPAP: 3136±751 vs. FB: 2354±657 cm3, P<0.01); caudally displaced the heart by 1.8 cm (P<0.01); and decreased heart volume within tangential RT fields on computed tomography–simulation scans by 96±4% (1.4±2.5 vs. 21±17 cm3, P=0.02) in all patients. Planning target volume coverage was acceptable in all RT plans. CPAP lowered mean dose (D
mean) to heart by 47±22% (2.5±1.5 vs. 5.4±3.3 Gy, P<0.01); heart volume receiving ≥25 Gy (V25) by 82±18% (2.2±2.6 vs. 9.1±7.1%, P<0.01); D
mean to left anterior descending coronary artery by 68±8% (4.7±1.9 vs. 14.8±3.3 Gy, P<0.01). CPAP decreased radiation dose to ipsilateral lung compared with FB: 9.1±5.8 versus 11.2±8 Gy (20% reduction, P=0.03) of D
mean; 15.7±12.5 vs. 20.5±17.5% (25% reduction, P=0.03) of V20. RT with CPAP did not increase treatment setup time compared with FB (week 1: 362±63 vs. 352±77 s; week 2 to 5: 217±13 vs. 201±14 s, all P>0.25).

Conclusion:

Novel use of CPAP allowed efficient and practical heart sparing breast RT without increasing infrastructural requirements in resource-limited radiation oncology clinics.
Cerebral Hemorrhage after Cosmetic Facial Injection
Authors: Wang Chenyu , Wang Xiaojun
Published: September 2019

Cosmetic facial injection is a mini-invasive surgical procedure and is widely used at present. Meanwhile, it may also cause severe complications like cerebrovascular infarction occasionally. A 49-year-old female patient presented to a local hospital with dysphoria, left eye and head ache, unconsciousness, orthocolosis, right upper extremity hemiplegic paralysis, and emesia after receiving facial injection of hyaluronic acid into the glabella. Low molecular weight heparin and clopidogrel were used to treat the patient, but there was no relief of symptoms. The patient gradually developed coma and was transferred to our hospital. Brain computed tomography showed mixed density in left temporal lobe, multiple high density in left frontal temporal parietal lobe and sulcus, and subarachnoid hemorrhage and high density in brainstem. The patient was diagnosed with cerebral hematoma and hernia, who gradually developed respiratory and circulatory failure and eventually died.
Thirty-day Emergency Department Utilization after Distal Radius Fracture Treatment: Identifying Predictors and Variation
Authors: Nasser Jacob S. , Chou Ching-Han , Chung Kevin C.
Published: September 2019

Background:

Unplanned hospital visits are costly and may indicate reduced care quality. In this analysis, we aim to investigate the emergency department (ED) utilization for patients 30 days after treatment for a distal radius fracture (DRF) with an emphasis on DRF-related diagnoses of complications and examine nationwide variation in returns to the ED after treatment.

Methods:

In this population-based analysis, we used the Truven MarketScan database to identify adult patients who underwent treatment for their DRF. We examined primary diagnoses upon ED visits to assess for relation to treatment. Multivariable logistic regression was performed to evaluate the risk of DRF-related ED visits and pain-related diagnoses.

Results:

Of the patients who underwent treatment for a DRF, 2% of surgical patients and 4% of nonsurgical patients visited the ED within 30 days after treatment with a DRF-related diagnosis. The most common diagnoses for all patients were pain-related diagnoses. Patients receiving internal fixation were less likely to experience a DRF-related visit compared with patients receiving other surgical treatments most likely because of no exposed hardware. In addition, patients receiving surgical in the South were more likely to visit the ED with a pain-related diagnosis compared with any other region.

Conclusions:

Policy makers should include ED visits after treatment for outpatient hand conditions as indicators of care quality. Given the geographic differences in the ED utilization for this patient population, collaborative initiatives and institutional-level policy may help reduce variation in care for patients after treatment for their fracture care.
Improvement in Sleep Architecture is associated with the Indication of Surgery in Syndromic Craniosynostosis
Authors: de Goederen Robbin , Joosten Koen F.M. , den Ottelander Bianca K. , van der Oest Mark J.W. , Bröker-Schenk Els M.M. , van Veelen Marie-Lise C. , Wolvius Eppo B. , Versnel Sarah L. , Tasker Robert C. , Mathijssen Irene M.J.
Published: September 2019

Background:

Children with syndromic craniosynostosis (sCS) often suffer from obstructive sleep apnea (OSA) and intracranial hypertension (ICH). Both OSA and ICH might disrupt sleep architecture. However, it is unclear how surgically treating OSA or ICH affects sleep architecture. The aim of this study was twofold: to explore the usefulness of sleep architecture analysis in detecting disturbed sleep and to determine whether surgical treatment can improve it.

Methods:

Eighty-three children with sCS and 35 control subjects, who had undergone a polysomnography (PSG), were included. Linear-mixed models showed the effects of OSA and ICH on sleep architecture parameters. In a subset of 19 patients, linear regression models illustrated the effects of OSA-indicated and ICH-indicated surgery on pre-to-postoperative changes.

Results:

An increase in obstructive-apnea/hypopnea index (oAHI) was significantly associated with an increase in N2-sleep, arousal index, and respiratory-arousal index and a decrease in REM-sleep, N3-sleep, sleep efficiency, and sleep quality. ICH and having sCS were not related to any change in sleep architecture. OSA-indicated surgery significantly increased the total sleep time and sleep efficiency and decreased the arousal index and respiratory-arousal index. ICH-indicated surgery significantly decreased REM-sleep, N1-sleep, sleep efficiency, and sleep quality.

Conclusions:

For routine detection of disturbed sleep in individual subjects, PSG-assessed sleep architecture is currently not useful. OSA does disrupt sleep architecture, but ICH does not. OSA-indicated surgery improves sleep architecture, which stresses the importance of treating OSA to assure adequate sleep. ICH-indicated surgery affects sleep architecture, although it is not clear whether this is a positive or negative effect.
Accuracy of fully automated oscillometric central aortic blood pressure measurement techniques
Authors: Gotzmann Michael , Hogeweg Maximilian , Seibert Felix S. , Rohn Benjamin Johannes , Bergbauer Martin , Babel Nina , Bauer Frederic , Mügge Andreas , Westhoff Timm H.
Published: September 2019

Background:

Central aortic blood pressure (cBP) is a valuable predictor of cardiovascular risk. The lack of fully automated measurement devices impeded an implementation in daily clinical practice so far. The present study compares two novel automated oscillometric devices with invasively measured cBP.

Methods:

From March 2017 to March 2018, we enrolled consecutive patients undergoing elective coronary angiography to this cross-sectional study. Noninvasive assessment of cBP was performed by the SphygmoCor XCEL device and the Mobil-O-Graph NG device simultaneously to invasive measurement.

Results:

Our study included 502 patients (228 women, 274 men) with a mean age of 67.9 ± 11.6 years. The noninvasive measurement of cBP was successful in 498 patients (99%) with SphygmoCor XCEL device and in 441 patients (88%) with Mobil-O-Graph NG device (P = 0.451). Measurements of both devices revealed a high correlation to invasively measured systolic (SphygmoCor R
2 0.864, P < 0.001; Mobil-O-Graph R
2 0.763, P < 0.001) and diastolic (SphygmoCor R
2 0.772, P < 0.001; Mobil-O-Graph R
2 0.618, P < 0.001) cBP. Both devices slightly underestimated systolic and overestimated diastolic central blood pressure: biases were −5.0 ± 7.7/0.5 ± 6.2 mmHg with SphygmoCor XCEL and −6.0 ± 10.4/3.6 ± 8.3 mmHg with Mobil-O-Graph NG device. Correlations (R
2) were higher and biases were lower with the SphygmoCor device (P < 0.001 each).

Conclusion:

The present study is the largest validation study of noninvasive cBP measurement techniques so far and shows that two current automated oscillometric monitors are able to assess cBP with acceptable accuracy. Automated oscillometric devices may facilitate the implementation of cBP in daily clinical practice.
Epithelial Inclusion Cyst of the Bulbar Conjunctiva Secondary to Scleral Lens Impingement Managed With a MicroVault
Authors: Sherman Suzanne W. , Cherny Christina , Suh Leejee H.
Published: September 2019

Acquired epithelial inclusion conjunctival bulbar cyst is a reported complication of scleral contact lens impingement commonly corrected with a diameter change or notch of the scleral contact lens. This case discusses an acquired epithelial inclusion conjunctival bulbar cyst due to microtrauma caused by prolonged scleral contact lens wear and corrected with a MicroVault.
Minimizing Time to Plasma Administration and Fresh Frozen Plasma Waste: A Multimodal Approach to Improve Massive Transfusion at a Level 1 Trauma Center
Authors: Hyatt Wendy , Yon James R. , Haley-Andrews Stephanie
Published: September 2019

Massive transfusion protocols are part of damage control resuscitation for hemorrhaging trauma patients with the goal of returning the patient to hemodynamic stability. It is essential that patients receive blood products immediately and in the proper ratios. At our metropolitan Level 1 trauma center, we identified several challenges to deploying massive transfusion rapidly and within the recommended ratio guidelines. In 2016, we implemented a quality improvement project addressing 4 opportunities: fresh frozen plasma (FFP) bag breakage, plasma options, blood bank equipment, and multidisciplinary policy revision. Implementing packaging and shipping improvements, utilization of new products, and updating protocols have resulted in a 50% decrease in FFP bag breakage rates, a dramatic decrease in time for patients receiving massive transfusion to receive plasma products (mean time 3.5 min), and patients being administered the recommended ratio of blood products.
Neonatal and pediatric platelet transfusions: current concepts and controversies
Authors: Patel Ravi Mangal , Josephson Cassandra
Published: September 2019

Purpose of review

In this review, we focus on three specific concepts related to platelet transfusion in the neonatal and pediatric population: choice of transfusion threshold; use of ABO-mismatched platelets; transfusion of pathogen-reduced or inactivated platelets.

Recent findings

Recent trials support the use of lower platelet transfusion thresholds (25 000/μl) in preterm neonates, although data is limited to guide transfusion among more mature neonates. In children, there is low-level evidence as to what the prophylactic platelet transfusion threshold should be in many situations of thrombocytopenia, revealing major variability in platelet transfusion practices. Most pediatric guidelines are extrapolated from adult studies with the most evidence in treatment-associated hypoproliferative thrombocytopenia varying between a platelet transfusion threshold of 10 000/μl to 20 000/μl. Although pathogen-reduced platelets may lower the risks of transfusion-transmitted infection, the effects on platelet refractoriness and transfusion burden in this population warrant additional study.

Our review highlights recent advances in neonatal and pediatric platelet transfusion and also emphasizes the urgent need for better evidence to guide practice given recent studies showing the potential harms of platelet transfusion, particularly with liberal use.
Using minimal (measurable) residual disease assessments to guide decision-making for timing of allogeneic transplantation in acute myeloid leukemia
Authors: Fasan Omotayo
Published: September 2019

Purpose of review

The current review aims to highlight recent and important developments in the detection and value of minimal (measurable) residual disease (MRD) testing in patients with acute myeloid leukemia (AML) and the impact on the timing of allogeneic hematopoietic cell transplantation.

Recent findings

The European LeukemiaNet MRD Working Party recently published guidelines to help standardize testing, utilizing flow cytometry and molecular techniques. The timing of MRD assessments, choice of assay and cutoff of for reporting positive results are all important. Patients known to be MRD-positive pretransplantation have a poor prognosis and consideration should be given to selecting a myeloablative regimen over a reduced intensity regimen (if appropriate) and offering posttransplantation maintenance therapy.

It may be best to think of MRD as a dynamic variable, where a rising MRD result is more specific and highly predictive of relapse. It is unclear how MRD results should impact the timing of allogeneic hematopoietic cell transplantation, if at all. There are currently no published randomized studies to help guide the practitioner in this situation, hence decision-making should be individualized.
Survey of Impediments to Prevention of Mother‐to‐infant Transmission of Hepatitis B Virus by International Societies
Authors: Chang Mei‐Hwei , Fischler Bjorn , Blauvelt Barri , Ciocca Mirta , Dhawan Anil , Ekong Udeme , Ni Yen‐Hsuan , Porta Gilda , Sibal Anupam , DAgostino Daniel , Wirth Stefan , Morhan Neelam , Schwarz Kathleen B.
Published: September 2019

Objective:

Mother‐to‐infant transmission (MIT) is the leading cause of hepatitis B virus (HBV) infections globally. The aim of this international study was to assess the impediments to prevention of (MIT) of HBV.

Methods:

A cross‐sectional survey was developed by the Federation of the International Societies for Pediatric Gastroenterology, Hepatology and Nutrition. (FISPGHAN) The survey was sent to HBV experts of the 5‐member societies of FISPGHAN, and 63 of 91 countries/regions responded. Main outcome measures include percentage of countries having vaccine programs, timing of the first dose of HBV vaccine, availability of HBV vaccine for outborn neonates, payment of HBV vaccine and hepatitis B immune globulin, screening HBV markers during pregnancy, and antivirals to highly infectious pregnant mothers.

Results:

Among the participating countries/regions, 11% did not implement infant HBV immunization programs. The first dose of vaccine was given >24 hours in 36% of the total countries and 100% of African countries. The recommended birth dose was unavailable for outborn neonates in 45% of the total countries, including 92% of African and 50% of Latin American countries/regions. During pregnancy, 44% countries do not screen maternal viral markers, and 46% do not provide third trimester antiviral therapy for highly viremic pregnant mothers.

Conclusions:

Our study demonstrated multiple obstacles to achieving the goal of preventing MIT of HBV. Comprehensive public health programs to enhance vaccine coverage rate, supply HBV vaccine for out‐born neonates, screening maternal HBV markers, treating highly viremic pregnant mothers are proposed to overcome these obstacles and achieve the goal of preventing MIT of HBV.
Internet Addiction Among Lebanese Adolescents
Authors: Obeid Sahar , Saade Sylvia , Haddad Chadia , Sacre Hala , Khansa Wael , Al Hajj Roula , Kheir Nelly , Hallit Souheil
Published: September 2019

The study objective was to evaluate the association between depression, anxiety, social anxiety and fear, impulsivity, and aggression and Internet addiction (IA) among Lebanese adolescents. This cross-sectional study, conducted between October 2017 and April 2018, enrolled 1103 young adolescents aged between 13 and 17 years. The Internet Addiction Test (IAT) was used to screen for IA. The results also showed that 56.4% of the participants were average Internet users (IAT score ≤49), 40.0% had occasional/frequent problems (IAT scores between 50 and 79), and 3.6% had significant problems (IAT scores ≥80) because of Internet use. The results of a stepwise regression showed that higher levels of aggression (β = 0.185), depression (Multiscore Depression Inventory for Children) (β = 0.219), impulsivity (β = 0.344), and social fear (β = 0.084) were associated with higher IA, whereas an increased number of siblings (β = −0.779) and a higher socioeconomic status (β = −1.707) were associated with lower IA. Uncontrolled use of the Internet can be associated with addiction and other psychological comorbidities.
Metacognitive Interpersonal Mindfulness-Based Training for Worry About Interpersonal Events
Authors: Ottavi Paolo , Passarella Tiziana , Pasinetti Manuela , MacBeth Angus , Velotti Patrizia , Velotti Anna , Bandiera Aldea , Popolo Raffaele , Salvatore Giampaolo , Dimaggio Giancarlo
Published: September 2019

Individuals with personality disorders experience worry and repetitive thoughts regarding interpersonal scenarios. Mainstream mindfulness-based approaches may be insufficient to soothe these individual's distress due to difficulties in letting thoughts go and refocusing attention to the present moment. For this reason, we devised an adapted form of mindfulness-based program called Metacognitive Interpersonal Mindfulness-Based Training (MIMBT) for personality disorders. In this pilot study, 28 individuals attended nine weekly sessions to evaluate the feasibility and acceptability, and to establish preliminary outcomes. All individuals completed the program. Attendance was very high (96%). Significant changes were observed on the primary outcome of reduction in repetitive thinking, measured using the Metacognition Questionnaire-30. We also observed a decrease in depression severity. Despite important limitations, this pilot study suggests that MIMBT has the potential to be a viable and well-accepted option for increasing positive outcomes in the treatment of personality disorders. Clinical considerations and directions for future research are discussed.
Effectiveness of Cerebellar Circuitry Modulation in Schizophrenia
Authors: Escelsior Andrea , Belvederi Murri Martino , Calcagno Pietro , Cervetti Alice , Caruso Rosangela , Croce Enrico , Grassi Luigi , Amore Mario
Published: September 2019

Structural and functional abnormalities of the cerebellum have been observed in schizophrenia since the first neuroimaging studies. More recently, the functions of the cerebellum have been extended beyond sensorimotor control to include participation in higher-level cognition and affective regulation. Consistently, the “cognitive dysmetria” theory posits that dysfunctions of cortical-subcortical-cerebellar circuitry may be crucial for the pathogenesis of different clinical features of schizophrenia. This conceptual framework offers a set of testable hypotheses, now that various tools to exert direct modulation of cerebellar activity are available. We conducted a systematic review of studies examining the effects of cerebellar modulation in schizophrenia. Two independent authors conducted a search within PubMed for articles published up to April 2019 and identified 10 studies (three randomized controlled trials, two open-label studies, two case reports, one preclinical study) describing the effects of cerebellar circuitry modulation in patients with schizophrenia or animal models. The majority of interventions were uncontrolled and used stimulation of the cerebellar vermis, using transcranial magnetic stimulation or transcranial direct-current stimulation. Most studies detected improvements after cerebellar modulation. Clinical changes mostly pertained the domains of negative symptoms, depressive symptoms and cognitive functions. In conclusion, few studies examined the effects of cerebellar modulation in schizophrenia but yielded promising results. This approach may hold therapeutic potential, pending further methodologically robust replication.
Artifactual Displacement of Ductal Carcinoma In Situ (ADDCIS) (Toothpaste Effect)
Authors: Shabihkhani Maryam , Simpson Jean F. , White Marissa J. , Cimino-Mathews Ashley , Argani Pedram
Published: September 2019

Needle tract displacement is a recognized mimicker of invasive ductal carcinoma (IDC). Artifactual displacement of ductal carcinoma in situ (ADDCIS) unassociated with needle tracts may occur secondary to mechanical compression of breast specimens but has not been systematically studied. We identified 16 cases of ADDCIS unassociated with needle tract changes; the majority (75%) were internal referrals to the breast pathology service to rule out IDC, 19% were received as external diagnostic consultations to rule out IDC, and 6% were routine second review cases originally diagnosed as IDC at an outside hospital. The majority (62.5%) of ADDCIS occurred in lumpectomies, whereas 25% occurred in mastectomies and 12.5% in core biopsies. ADDCIS foci ranged from <1 to 5 mm; however, all ADDCIS spanning >4 mm demonstrated a linear pattern of displacement. In all cases, ADDCIS involved mammary stroma in a nonlobular distribution; in half, ADDCIS extended between benign lobules. Immunohistochemistry revealed no myoepithelial cells around the ADDCIS (n=7), adding to the concern for IDC. However, in contrast to most IDC, ADDCIS lacked stromal reaction and showed degenerative, smudged chromatin. None of the 9 patients with significant follow-up (mean, 7 y) developed metastasis. All received further local therapy for DCIS (5 radiation, 4 completion mastectomy); 1 received adjuvant systemic therapy (hormone therapy for contralateral IDC). In conclusion, ADDCIS mimics IDC, particularly given its permeative pattern and absence of myoepithelial cells. ADDCIS is most common in lumpectomies but can occur in mastectomies or core biopsies. Diagnostic clues include smudged nuclear chromatin, lack of stromal response, and linear pattern of displacement in larger lesions. The benign follow-up without systemic therapy supports our view that ADDCIS does not represent true IDC.
Clinical Experience With the C-MAC and GlideScope in a Pediatric Emergency Department Over a 10-Year Period
Authors: Pacheco Garrett S. , Patanwala Asad E. , Mendelson Jenny S. , Sakles John C.
Published: September 2019

Objective

There is little literature describing the performance of video laryngoscopes for the intubation of pediatric patients in the emergency department (ED). The purpose of this study is to report our experience with direct laryngoscopy (DL), the C-MAC (CMAC), and the GlideScope (GVL) over a 10-year period in an urban academic pediatric ED.

Methods

This was an analysis of pediatric intubations prospectively recorded into a Continuous Quality Improvement database in an academic pediatric ED over a 10-year period. Between July 1, 2007, and June 30, 2017, emergency physicians recorded all consecutive intubations performed in the pediatric ED. The database included patient demographics and detailed information on each intubation such as age of the patient, reason for intubation, device(s) used, method of intubation, difficult airway characteristics, adverse events, number of intubation attempts, and outcome of each attempt. All patients younger than 18 years who underwent intubation by an emergency medicine resident using a DL or videolaryngoscope (CMAC or GVL) were included in the study. The primary outcome measure was first-pass success without adverse events (FPS-AE), which was defined as successful tracheal intubation on a single laryngoscope insertion without the occurrence of any adverse events during the peri-intubation period. A multivariate regression analysis was performed to control for potential confounders and included difficult airway characteristic, operator level of training, method of intubation, and patient age.

Results

During the study period, 530 intubations were performed in pediatric patients. Of these, 493 intubations met the inclusion criteria and were analyzed (218 DL, 187 CMAC, 88 GVL). The FPS-AE with each device is as follows: DL, 54.1% (n = 118/218); CMAC, 64.0% (n = 119/187); and GVL, 52.3% (n = 46/88). In the logistic regression analysis, compared with DL, the CMAC was associated with a higher FPS-AE (odds ratio, 1.6 [95% confidence interval, 1.03–2.45]), whereas the GVL was not associated with an increased FPS-AE (odds ratio, 0.62 [95% confidence interval, 0.35–1.10]).

Conclusions

In this study of pediatric patients intubated in the ED, compared with DL, the CMAC was associated with an increased FPS-AE, but the GVL was not.
Image Artifact Management for Clinical Magnetic Resonance Imaging on a 7 T Scanner Using Single-Channel Radiofrequency Transmit Mode
Authors: Fagan Andrew J. , Welker Kirk M. , Amrami Kimberly K. , Frick Matthew A. , Watson Robert E. , Kollasch Peter , Chebrolu Venkata , Felmlee Joel P.
Published: September 2019

Objectives

The aim of this work was to devise mitigation strategies for addressing a range of image artifacts on a clinical 7 T magnetic resonance imaging scanner using the regulatory-approved single-channel radiofrequency transmit mode and vendor-supplied radiofrequency coils to facilitate clinical scanning within reasonable scan times.

Materials and Methods

Optimized imaging sequence protocols were developed for routine musculoskeletal knee and neurological imaging. Sources of severe image nonuniformities were identified, and mitigation strategies were devised. A range of custom-made high permittivity dielectric pads were used to compensate for B1
+ and B1
− inhomogeneities, and also for magnetic susceptibility-induced signal dropouts particularly in the basal regions of the temporal lobes and in the cerebellum.

Results

Significant improvements in image uniformity were obtained using dielectric pads in the knee and brain. A combination of small voxels, reduced field of view B0 shimming, and high in-plane parallel imaging factors helped to minimize signal loss in areas of high susceptibility-induced field distortions. The high inherent signal-to-noise ratio at 7 T allowed for high receiver bandwidths and thin slices to minimize chemical shift artifacts. Intermittent artifacts due to radiofrequency inversion pulse limitations (power, bandwidth) were minimized with dielectric pads. A patient with 2 implanted metallic cranial fixation devices located within the radiofrequency transmit field was successfully imaged, with minimal image geometric distortions.

Conclusions

Challenges relating to severe image artifacts at 7 T using single-channel radiofrequency transmit functionality in the knee and brain were overcome using the approaches described in this article. The resultant high diagnostic image quality paves the way for incorporation of this technology into the routine clinical workflow. Further developmental efforts are required to expand the range of applications to other anatomical areas, and to expand the evidence- and knowledge-base relating to the safety of scanning patients with implanted metallic devices.
The Keystone Island Perforator Flap in Reconstruction of Large Myelomeningocele Defects
Authors: Hifny Mahmoud A. , Hamdan Ali R.
Published: September 2019

Background

Reconstruction of the skin defect after myelomeningocele repair is a crucial step that influences the quality of the surgical outcome. Keystone perforator flap is an islanded fasciocutaneous flap based on random regional perforators, which is advanced to adjacent defects. It has become a reliable method of locoregional reconstruction in various body parts with minimum morbidity. The aim of this study was to evaluate our clinical experiences in using keystone perforator flaps as an alternative surgical method for closure of large myelomeningocele defects.

Methods

In this study, the keystone island perforator flap was used for reconstruction of large myelomeningocele defect in 7 patients (5 males and 2 females) aged between 7 days and 4.5 months. The defect size was 5.9 cm × 6.5 cm on average (range, 4.5 × 5 cm to 7 × 9 cm). The localization of the lesions was lumbosacral in 6 patients and thoracolumbar in 1 patient.

Results

In all patients, tension-free closure was obtained and healing was successful without any complications, except 1 infection, which resolved with conservative wound management. There was no patient with late breakdown of the wound or associated cerebrospinal fluids fistula formation for a mean of 13 months (range, 4 months to 2 years).

Conclusions

The keystone perforator flap technique is an effective, reliable, and durable reconstructive option which enables the reconstructive surgeon to attain a tension-free closure of sizable meningomyeleocele defects with no late wound breakdown or associated cerebrospinal fluids fistula formation and negligible donor site morbidity.
Early Pediatric Nasal Reconstruction Utilizing the Tagliacozzi Flap
Authors: Benkler Michal , Pressler Mark P. , Hallac Rami R. , Patel Shitel , Seaward James R. , Kane Alex A.
Published: September 2019

The Tagliacozzi cross arm flap has been historically described for repair of large nasal defects. The authors report what we believe is the youngest case in modern literature of nasal reconstruction with a Tagliacozzi flap, in a 6-year-old girl. Due to her poor face and scalp skin quality, the more modern reconstructive options of a forehead flap or free tissue transfer were not deemed suitable. Two delay procedures and a complex splint were required to position the medial arm fasciocutaneous flap over the nasal construct. The arm was immobilized for 3 weeks to allow for vascularization of the recipient bed. The child successfully tolerated the splint. She has improved breathing and nasal contour.
Spontaneous Idiopathic Cerebrospinal Fluid Rhinorrhea
Authors: Mikayilli Mushfig , Hasanov Teyyub , Otluoglu Gulden Demirci , Nacitarhan Dicle Ece , Erdoğan Raziye Banu Atalay , Demir Necdet , Toktas Zafer Orkun , Colak Ahmet
Published: September 2019

Cerebrospinal fluid rhinorrhea is described as cerebrospinal fluid flow through the nose due to the abnormal connection of the subarachnoid space and sinonasal cavity. Spontaneous idiopathic rhinorrhea is a rarely seen disease. Besides the patient's clinical presentation detailed radiological evaluation and other invasive procedures must be carried out to confirm the diagnosis. Its treatment is compelling due to high recurrence rates. In the treatment algorithm when conservative treatment modalities had been proven inadequate, surgical repair must follow in order. In this paper the authors present the details of 2 cases of spontaneous rhinorrhoea patients.