bluuebunny/crossref_metadata_2025 huggingface dataset:
Stumped by the Hump: The Curious Rise and Fall of Norwegian Birthweights, 1991–2007
Authors: Carlsen Ellen Øen , Magnus Maria C. , Omsland Tone K. , Magnus Per M. , Håberg Siri E. , Wilcox Allen J.
Published: May 2020

Background:

There was a distinct rise in mean birthweights in Norway starting in 1991 that plateaued in 1996–2002 and then declined to previous levels. We investigated whether these changes corresponded to trends in neonatal mortality or other birthweight-associated pregnancy outcomes. We also explored known predictors of birthweight and examined whether these could explain the birthweight trends.

Methods:

We calculated mean birthweight for all live births in Norway in each year from 1982 to 2016, together with annual neonatal mortality and proportion of infants born preterm, or with low Apgar score. We stratified mean birthweight over time by factors including parity, gestational age, and Scandinavian versus non-Scandinavian origin of mother, to test robustness of the pattern. In addition, we used multivariable linear regression to obtain adjusted estimates for mean birthweight per year.

Results:

A 50-g rise and fall of mean birthweights during a 25-year period was not accompanied by corresponding changes in neonatal mortality, preterm births, or Apgar scores. The distinct hump pattern was restricted to term births and was not apparent among infants of mothers born outside Scandinavia. We saw a similar pattern for Sweden but not Finland. Known predictors of birthweight (such as parity, mode of onset of delivery, and marital status) did not explain the hump.

Conclusions:

A distinct temporal hump in mean birthweight among Norwegian term births had no obvious explanations. Furthermore, these fluctuations in birthweight were not associated indirectly with adverse outcomes in measures of infant health.
Pharmacogenetic assessment of tafenoquine efficacy in patients with Plasmodium vivax malaria
Authors: St Jean Pamela L. , Koh Gavin C.K.W. , Breton John J. , Espino Fe E.J. , Hien Tran T. , Krudsood Srivicha , Lacerda Marcus V.G. , Llanos-Cuentas Alejandro , Lon Chanthap , Mohammed Rezika , Namaik-larp Chayadol S. , Pereira Dhelio B. , Saunders David L. , Velez Ivan D. , Yilma Daniel , Villegas Maria F. , Duparc Stephan , Green Justin A.
Published: May 2020

Plasmodium vivax has the largest geographic range of human malaria species and is challenging to manage and eradicate due to its ability to establish a dormant liver stage, the hypnozoite, which can reactivate leading to relapse. Until recently, the only treatment approved to kill hypnozoites was the 8-aminoquinoline, primaquine, requiring daily treatment for 14 days. Tafenoquine, an 8-aminoquinoline single-dose treatment with activity against P. vivax hypnozoites, has recently been approved by the US Food and Drug Administration and Australian Therapeutic Goods Administration for the radical cure of P. vivax malaria in patients 16 years and older. We conducted an exploratory pharmacogenetic analysis (GSK Study 208099) to assess the role of host genome-wide variation on tafenoquine efficacy in patients with P. vivax malaria using data from three GSK clinical trials, GATHER and DETECTIVE Part 1 and Part 2. Recurrence-free efficacy at 6 and 4 months and time to recurrence up to 6 months postdosing were analyzed in 438 P. vivax malaria patients treated with tafenoquine. Among the approximately 10.6 million host genetic variants analyzed, two signals reached genome-wide significance (P value ≤ 5 × 10−8). rs62103056, and variants in a chromosome 12 intergenic region, were associated with recurrence-free efficacy at 6 and 4 months, respectively. Neither of the signals has an obvious biological rationale and would need replication in an independent population. This is the first genome-wide association study to evaluate genetic influence on response to tafenoquine in P. vivax malaria.
Harvest of Rib Graft for Rhinoplasty in Breast Implant Patients
Authors: Ors Safvet
Published: May 2020

Combined cosmetic surgeries are advantageous to patients, requiring only 1 anesthesia administration and the loss of fewer working days. There is no previous study reporting on a submuscular implant placement with the simultaneous reconstruction of a nose deformity using a rib graft. Reconstructions of nose deformities through a rib graft, augmentation mammoplasty, and augmentation mastopexy were performed on 4 female patients (who were 19, 23, 24, and 27 years old) between 2006 and 2016. The patients were taken for operations under general anesthesia. First, the rib graft was taken and the breast implant was placed to prevent contamination. An inframammary incision was made, the skin and the subcutaneous layers were passed, and the pectoral muscle fascia was accessed for the rib graft in all 3 patients. After the perichondrium was dissected, an osteochondral graft was harvested at full thickness. The remaining sharp edges were rasped to avoid damaging the silicone. The perichondrium and the periosteum were sutured edge-to-edge, and the donor area was closed. The harvested grafts were used to produce a spreader graft, a nasal valve graft, an onlay graft, and an L-strut graft. In the early period, no seroma, hematoma, or infections were experienced. There were no ruptures, leakages, capsules, or deformities during the 2- to 10-year follow-up. Primary and secondary rhinoplasties requiring a rib graft can be safely performed simultaneously with a breast implant, provided that the rib stumps are closed with a thick protective layer.
Biokinetic Method on Simultaneous Intake of Radionuclides from Multiple Intake Scenarios for Application in Internal Exposures
Authors: Zhang Bin , Sheng Wei , Zhang Yang , Feng Tian-Cheng , Yin Guo-Hui , Lei Jie-Ying , Xu Ming , He Xin-Zhao , Ma Huai-Cheng
Published: May 2020

Biokinetics underlies the basis for assessment of internal exposures. This paper develops a biokinetic method on simultaneous intake of radionuclides from multiple intake scenarios in internal exposures. With numerical techniques that transform the whole biokinetics between the coupled and decoupled representations of the same problem, this method applies to coupled biokinetics with complex structures and has no restrictions of practical importance on the number of intake scenarios, the number of intake parent radionuclides and decay products, and the complexity of decay relationships between parent and progeny nuclides. For illustration, this method is applied to an assumed case of mixed inhalation and ingestion of weapon-grade plutonium material for reference workers that is focused on 241Pu and 241Am. Due to coupled biokinetics between the direct intake and ingrowth parts in different intake pathways, the multiple intake results (the contents of lungs, daily excretions, and cumulative contents) display richer behaviors as compared to single intake cases. This method benefits both the prospective and retrospective assessment of internal exposures for complex intake cases in actual applications.
Orbital Floor Implant Causing Loss of Parasympathetic Lacrimal Gland Innervation
Authors: Madhan Nayasha S. , Cho Raymond I.
Published: May 2020

Many postoperative complications are known to occur as a result of orbital floor fracture repair, but loss of lacrimal gland function has not been reported. The authors present a patient who lost reflex tearing after undergoing orbital floor fracture repair by an outside surgeon. CT scan showed placement of the posterolateral edge of the implant through the inferior orbital fissure, which presumably transected the parasympathetic fibers innervating the lacrimal gland.
Orbital Microscopic Polyangiitis With Secondary Angle Closure Due to Uveal Effusion
Authors: Sheils Catherine R. , Cypen Sanja G. , Bhatter Param , Tao Jeremiah P.
Published: May 2020

A 63 year-old man presented with 3 weeks of worsening, painless left-sided proptosis, ptosis, and diplopia. Examination of the affected eye revealed normal visual acuity, normal intraocular pressure in the presence of a shallow anterior chamber, grade 1 relative afferent pupillary defect, restricted motility in all directions of gaze, and 6 mm of proptosis. Ultrasound biomicroscopy revealed uveal effusions with anterior rotation of the ciliary body causing appositional angle closure. B-scan ultrasonography and MRI demonstrated enhancement of the posterior globe and an infiltrative mass involving the lacrimal gland and multiple extraocular muscles. Laboratory studies revealed positive perinuclear antineutrophil cytoplasmic antibody with elevated myeloperoxidase antibodies, consistent with a diagnosis of microscopic polyangiitis. Biopsy showed nonspecific dacryoadenitis. Intravenous and oral corticosteroids were associated with rapid improvement of all examination findings. The patient was later switched to rituximab steroid-sparing therapy and has shown no recurrence of disease at 3-months follow-up.
Tranexamic Acid
Authors: Yorozuya Lauren I. , Luke Janiene D.
Published: May 2020

A drug is defined in physiology as being a substance that exerts an effect on the body once it has been ingested or otherwise introduced. Drugs are administered in many forms, which include (but are not limited to) a variety of oral and topical preparations. The purpose of this column was to take a closer look at drugs that are used in the field of dermatology. More specifically, this column hopes to bring an understanding to the reader regarding mechanism of action, administration, dosage, adverse effects, contraindications, and viable alternatives to each particular drug being discussed. In this article, tranexamic acid and its use as a dermatologic treatment for melasma, as well as other treatment modalities, will be discussed.
Postmortem Computed Tomography: An Overview for Forensic Nurses Involved in Death Investigation
Authors: Stanley Sophie A. , Rutty Guy N. , Rutty Jane E.
Published: May 2020

The traditional invasive autopsy has been considered the “gold standard” for death investigation worldwide. However, this has now been challenged by a new minimally invasive approach that utilizes cross-sectional radiological imaging to investigate the death. Globally, postmortem computed tomography is the most commonly used modality and is becoming increasingly available throughout the world. Forensic nurses working in association with coroners and medical examiners’ offices, as well as mass fatality incidents, now need to update their knowledge base to understand these innovative techniques, the advantages and disadvantages to their use, and how they impact on medicolegal death investigation and the care of the deceased and bereaved. Using the example of the coroner system of England and Wales, this article provides a comparison between the traditional invasive autopsy and postmortem radiological alternatives and presents the impact postmortem radiology is now having on death investigation.
Early Fluid Accumulation and Intensive Care Unit Mortality in Children Receiving Extracorporeal Membrane Oxygenation
Authors: Anton-Martin Pilar , Quigley Raymond , Dhar Archana , Bhaskar Priya , Modem Vinai
Published: May 2020

Purpose of this study was to evaluate the impact of early fluid accumulation and renal dysfunction on mortality in children receiving extracorporeal membrane oxygenation (ECMO). Retrospective cohort study of neonatal and pediatric patients who received ECMO between January 2010 and December 2012 in a tertiary level multidisciplinary pediatric intensive care unit (ICU). Ninety-six patients were included, and forty-six (48%) of them received continuous renal replacement therapy (CRRT) during ECMO. Overall mortality was 38.5%. Proportion of patients with acute kidney injury (AKI) at ICU admission was 33% and increased to 47% at ECMO initiation. High-risk diagnoses, extracorporeal cardiopulmonary resuscitation (ECPR), and venoarterial (VA)-ECMO were more common among nonsurvivors. Nonsurvivors had significantly higher proportion of AKI at ICU admission (OR: 2.59, p = 0.04) and fluid accumulation on ECMO day 1 (9% vs. 1%, p = 0.05) compared with survivors. Multivariable logistic regression analysis (adjusted for a propensity score based on nonrenal factors associated with increased mortality) demonstrated that fluid accumulation on ECMO day 1 is significantly associated with increased ICU mortality (OR: 1.07, p = 0.04). Fluid accumulation within the first 24 hours after ECMO cannulation is significantly associated with increased ICU mortality in neonatal and pediatric patients. Prospective studies evaluating the impact of conservative fluid management and CRRT during the initial phase of ECMO may help further define this relationship.
A contemporary review of radiation pneumonitis
Authors: Ullah Tofura , Patel Harsh , Pena Grace M. , Shah Rakesh , Fein Alan M.
Published: May 2020

Purpose of review

The current article reviews recent literature and summarizes the current understanding, diagnosis, risk, predictors, and management of radiation pneumonitis.

Recent findings

We discuss the different parameters that contribute to radiation toxicity, the potential biomarkers that predict the risk, and mitigators of radiation pneumonitis.

Radiotherapy aims to provide care and a better quality of life in cancer patients however with complications. Radiation pneumonitis is important to recognize to appropriately plan and care for this population.
Head-up tilt test induces T-wave alternans in long QT syndrome with KCNQ1 gene mutation
Authors: Gu Beiyin , Liu Tingliang , Yang Lei , Zhang Haiyan , Xin Yili , Wang Jian
Published: May 2020

Introduction:

Long QT syndrome (LQTS) is a congenital disorder characterized by a prolongation of the QT interval on electrocardiograms (ECGs) and a propensity to ventricular tachyarrhythmias, which may lead to syncope, cardiac arrest, or sudden death. T-wave alternans (TWA) refers to the periodic beat-to-beat alternation of T-wave shape, polarity and amplitude on surface ECG during regular heart rhythm. In this report, a case of long QT syndrome with KCNQ1 gene mutation induced TWA in the head-up tilt test (HUTT), which has not been reported yet.

Patient concerns:

A 6-year-old boy presented with loss of consciousness twice, 5 months in duration. The boy's ECG showed prolonged QT interval (QTc = 600 ms, QTc = QT/RR1/2). During HUTT test, QT interval was significantly prolonged (QTc = 716 ms) based on macroscopic TWA.

Diagnosis:

The patient was diagnosed with 1. Long QT syndrome type 1(LQT1); 2. Vasovagal syncope (VVS)

Interventions:

Metoprolol 12.5 mg was given orally twice a day. The child was told avoid standing for a long time and strenuous exercises.

Outcomes:

There was no syncope or arrhythmia occurred during hospitalization and follow-up for 1 year.

Conclusions:

VVS may exist in patients with long QT syndrome. Increased sympathetic tone during the early stage of HUTT may induce macroscopic TWA in long QT syndrome with KCNQ1 gene mutation.
Prognostic value of high-sensitivity troponin I after cardiac surgery according to preoperative renal function
Authors: Nam Karam , Shin Kyung Won , Kim Tae Kyong , Kim Kyung Hwan , Kim Ki-Bong , Jeon Yunseok , Cho Youn Joung
Published: May 2020

Cardiac troponin levels can be elevated without myocardial injury in patients with renal impairment. However, the prognostic value of elevated troponin levels after cardiac surgery has not been well evaluated in patients with renal impairment. We evaluated the relationship between postoperative troponin levels and mortality following cardiac surgery according to preoperative renal function.

Among 3661 patients underwent cardiac surgery between March 2005 and December 2015, 1909 patients were analyzed after excluding those with insufficient laboratory data, preoperative myocardial infarction, underwent Cox-Maze or redo surgery, or with a follow-up period <30 days. The primary outcome was risk of 30-day mortality according to elevated postoperative high-sensitivity cardiac troponin I (hs-cTnI) levels in varying degrees of renal function. Secondary outcomes included long-term cardiac-cause and all-cause mortality during the median follow-up of 52 months.

After adjustment for risk factors, elevated peak postoperative hs-cTnI was associated with 30-day mortality [adjusted odds ratio 1.028, 95% confidence interval (CI) 1.013–1.043, P < .001], long-term cardiac-cause [adjusted hazard ratio (HR) 1.013, 95% CI 1.009–1.017, P < .001] and all-cause mortality (adjusted HR 1.013, 95% CI 1.009–1.016, P < .001), in patients with preoperative normal renal function [estimated glomerular filtration rate (eGFR) ≥60 ml/minute/1.73 m2]. However, in patients with renal impairment (eGFR < 60 ml/minute/1.73 m2), hs-cTnI levels were not associated with mortality following cardiac surgery.

Elevated hs-cTnI levels following cardiac surgery did not predict short- and long-term mortality in patients with preoperative renal impairment.
A bibliometric analysis of publications on venous thromboembolism in children from 1988 to 2019
Authors: Tian Lingyun , Zhang Ying , Zeng Jiaqi , Wang Liqian , Gao Huimin , Su Yanan , Li Yinglan
Published: May 2020

Introduction:

Venous thromboembolism (VTE) in children not only imposes a heavy burden on the medical resources and economy of the society, but also seriously affects the growth and development of children, even threaten children's lives. A large number of publications have been performed in this field in recent years. In this bibliometric analysis, publications on VTE in children were examined and analyzed to explain the present research hotspots.

Methods:

Articles related to VTE in children published in the PubMed database from 1988 to June 18, 2019 were selected as the research sample. BICOMB software was used to retrieve the annual publications, journals, journal source countries and the high-frequency major medical subject headings (MeSH) terms on the articles. Then, the co-word matrix was constructed by BICOMB using the selected high-frequency MeSH terms. Next, gCLUTO software was used to analyze the matrix by double clustering and visual analysis in a strategy of hotspot identification. In addition, CiteSpace software was used to perform the knowledge map of co-authors to explore the core authors.

Results:

One thousand seven hundred seventy-nine articles on VTE in children were obtained. Seven hundred ninety academic journals distributed in 58 countries have published articles on VTE in children, and the developed countries and the United States were the major force in the journal source countries. Nowak-Göttl U occupied an important position in this field. We constructed a co-word matrix composing of 37 high-frequency MeSH terms, generated visual matrix and visual hill, and classified the hot-spots into 5 aspects based on 8 categories.

Conclusion:

The results show that the research trend of children's VTE has been increasing gradually, and the sound achievement has been obtained in these hotspots in relation to the area of inherited thrombophilia, prevention and control, treatment, diagnosis, prevalence, risk factors, and complication study. However, there is a lack of communication and cooperation in this field, and the gap of national and regional research results is huge. To sum up, this study provides evidence and guidance for researchers, clinicians, and educators.
Impact of twice- or three-times-weekly maintenance hemodialysis on patient outcomes
Authors: Dai Li , Lu Chan , Liu Jinnv , Li Shanshan , Jin Huanlin , Chen Fadong , Xue Zengqi , Miao Chusheng
Published: May 2020

Aim:

Maintenance hemodialysis (MHD) frequency is associated with survival and complication rates. Achieving the optimal balance between healthcare, quality of life (QOL), and medical costs is challenging. We compared complications, inflammatory status, nutritional status, and QOL between patients with different MHD frequencies.

Material and Methods:

This was a multicenter randomized trial of patients treated between May 2011 and August 2017 at 3 tertiary hospitals in Wenzhou. Patients were grouped according to their treatment schedule over 1 year: twice-weekly or 3-times-weekly. Complications, biochemistry parameters, and QOL (KDQOL-SFTM 1.3 scale) were assessed.

Results:

One hundred forty patients were included aged 29 to 68 years (mean age, 50.9 ± 4.3 years). There were no significant differences in infection, heart failure, or cerebral hemorrhage complications between the 2 groups (P = .664). Pre-dialysis hemoglobin, high-sensitivity C-reactive protein, serum albumin, total cholesterol, triglyceride, calcium, phosphate, parathyroid hormone, and ejection fraction were similar in both groups (P > .05). After 1 year of MHD, both groups exhibited significant improvements in these parameters (all P < .05) with no significant differences between groups. Serum creatinine, blood urea nitrogen (BUN), and weekly standard hemodialysis treatment adequacy did not improve after treatment (all P > .05), although a difference in BUN was observed between the 2 groups (P < .001). QOL was superior in the twice-weekly group than in the 3-times-weekly group (all P < .05), except for social support, which was slightly better in the 3-times-weekly group than in the twice-weekly group.

Conclusions:

Twice- and 3-times-weekly MHD resulted in comparable inflammatory and nutritional clinical outcomes and adverse events. QOL was better for the twice-weekly schedule. Even for patients with economic constraints, twice- or 3-times-weekly MHD should be selected with caution after consideration of BUN levels at baseline.
“Claw hand with a unilateral onset” as a regional variant of Guillain-Barre’ syndrome
Authors: Wang Suhong , Zhao Shuxin , Zhang Zhecheng
Published: May 2020

Rationale:

Although distal nerves located at sites prone to compression are susceptible to autoimmune attack, Guillain-Barre’ syndrome (GBS) with exclusive hand muscle involvement is rarely found in clinics. All reported patients presented with a special variant - finger extensor weakness, especially claw hand caused by predominant ulnar extensor involvement. Similar to typical GBS, these patients showed bilateral symmetric onset with rapid clinical progression.

Patient concerns:

A 62-year-old man with GBS was admitted to our hospital with unilateral onset of claw hand. He showed relatively slow progression and did not develop bilateral symmetric claw hands until 6 weeks later.

Diagnoses:

Eventually the patient was diagnosed as having a regional variant of GBS by neuronal electrophysiology and cerebrospinal fluid examinations.

Interventions:

This patient was treated with intravenous thrombolysis within 4.5 hours of onset. Eventually he was diagnosed as having a regional variant of GBS and was treated with gamma-globulin (400 mg/kg/d) for 5 consecutive days via intravenous infusion.

Outcomes:

The patient had a slow recovery with persistent mild finger extensor weakness.

Lessons:

This patient presented with unilateral onset of claw hand, and the diagnosis of acute ischemic stroke could not be excluded because of a short time window; hence, he was treated with intravenous thrombolysis within 4.5 hours of onset. Eventually he was diagnosed as having a regional variant of GBS. It is important that GBS should also be considered in patients with unilateral hand weakness and unknown aetiology in the early stages of disease.
Dietary inflammatory index and cardiovascular risk and mortality
Authors: Ji Mingxia , Hong Xiaofei , Chen Mengyan , Chen Tiejiang , Wang Jiao , Zhang Ning
Published: May 2020

Background:

The role of dietary inflammatory index (DII) in cardiovascular disease (CVD) risk and mortality is still controversial. This systematic review and meta-analysis of cohort studies aimed to evaluate the effect of DII, indicating a pro-inflammatory diet, on the incidence and mortality of CVD.

Methods:

A comprehensive literature search of articles published through August 2019 was performed in Medline, EMBASE, and Web of Science. The pooled relative risks (RRs) and 95% confidence intervals (CIs) for highest vs lowest DII in relation to CVD risk or mortality were estimated using a DerSimonian and Laird random effects model. The heterogeneity among studies was tested using Cochran's Q test and I
2 statistic.

Results:

A total of 15 cohort studies were finally included in this meta-analysis. The highest DII score was significantly associated with a higher risk of CVD incidence (RR = 1.41, 95% CI 1.12–1.78) or mortality (RR = 1.31, 95% CI 1.19–1.44), compared with the lowest DII score. There was statistically significant heterogeneity among the studies on the association between DII and CVD mortality (P < .001; I
2 = 70.8%). No obvious heterogeneity was observed among the studies on the association between DII and CVD risk (P = .160; I
2 = 37.0%). In the sensitivity analysis, exclusion of any single study did not materially alter the pooled RRs.

Conclusion:

The present systematic review and meta-analysis indicates that a higher DII score is related to a higher risk of CVD. Further well-designed prospective cohort or trials are warranted to validate our preliminary findings.
Molecular regulation and function of FoxO3 in chronic kidney disease
Authors: Lin Fangming
Published: May 2020

Purpose of review

FOXOs are transcription factors that regulate downstream target genes to counteract to cell stress. Here we review the function and regulation of FOXO transcription factors, the mechanism of FOXO3 activation in the kidney, and the role of FOXO3 in delaying the development of chronic kidney disease (CKD).

Recent findings

Progressive renal hypoxia from vascular dropout and metabolic perturbation is a pathogenic factor for the initiation and development of CKD. Hypoxia and low levels of α-ketoglutarate generated from the TCA cycle inhibit prolyl hydroxylase domain (PHD)-mediated prolyl hydroxylation of FoxO3, thus reducing FoxO3 protein degradation via the ubiquitin proteasomal pathway, similar to HIF stabilization under hypoxic conditions. FoxO3 accumulation and nuclear translocation activate two key cellular defense mechanisms, autophagy and antioxidative response in renal tubular cells, to reduce cell injury and promote cell survival. FoxO3 directly activates the expression of Atg proteins, which replenishes core components of the autophagic machinery to allow sustained autophagy in the chronically hypoxic kidney. FoxO3 protects mitochondria by stimulating the expression of superoxide dismutase 2 (SOD2), as tubular deletion of FoxO3 in mice results in reduced SOD2 levels and profound mitochondrial damage.

Knowledge gained from animal studies may help understand the function of stress responsive transcription factors that could be targeted to prevent or treat CKD.
Fixed 30 mCi 131I-iodine therapy without recombinant human thyroid-stimulating hormone stimulation as an attractive therapeutic alternative in nontoxic nodular goiter
Authors: Riguetto Cínthia Minatel , Miguel Vivian Peraro , Pavin EJ , Amorim Bárbara Juarez , Ramos Celso Darío , Zantut-Wittmann Denise Engelbrecht
Published: May 2020

Objective

To analyze outcomes of patients with compressive nontoxic multinodular goiter after 131I-iodine 30 mCi treatment without previous use of recombinant human thyroid-stimulating hormone or methimazole.

Methods

We evaluated fixed-dose radioiodine therapy outcomes in patients with nontoxic multinodular goiter who did not accept thyroidectomy as a therapeutic option. Laboratory thyroid function and thyroid volume estimated by ultrasound were assessed before and one year after radioiodine therapy.

Results

Twenty euthyroid female patients received 30 mCi of 131I-iodine without recombinant human thyroid-stimulating hormone or methimazole pretreatment. Median thyroid volume and Tc-99m sodium pertechnetate thyroid uptake before radioiodine therapy were 68.05 cm3 (31.3–295.3) and 0.5% (0.1%–1.2%), respectively. One year after radioiodine therapy, thyroid volume decreased to 55.4 cm3 (19.8–149.9), and merely 4 patients (20%) developed hypothyroidism. Thyroid volume decreased significantly after radioiodine therapy, presenting a variation of −21.1 cm3 (−161.3 to −0.8) and −30.61% (−73.88 to −1.02), both with P < 0.0001. Thyroid volume variation was positively correlated with thyroid uptake in Spearman’s correlation (r = 0.4730; P = 0.0352). The group satisfied with radioiodine therapy (85%, n = 17) showed a significant reduction in thyroid volume, −25.8 cm3 (−161.3 to −6.2) and −36.74% (−73.88 to −9.95). The dissatisfied group (15%, n = 3) showed −1.0 cm3 (−2.0 to −0.8) and −1.67% (−3.38 to −1.02) in thyroid volume, P = 0.0081. Patients that complained about dysphagia presented a lower percentage of thyroid volume decrease after radioiodine therapy, −21.97% (−70.12 to −1.02, P = 0.0430).

Conclusions

A substantial reduction in thyroid volume associated with a low incidence of hypothyroidism and a high satisfaction rate support the use of conventional radioiodine therapy with a fixed dose of 30 mCi. This therapy is an attractive and cheaper therapeutic alternative in selected patients with nontoxic multinodular goiter.
Utility of DNA Profiling From Main Pancreatic Duct Fluid by Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography to Screen for Malignant Potential
Authors: Simpson Rachel E. , Flick Katelyn F. , Gromski Mark A. , Al-Haddad Mohammad A. , Easler Jeffrey J. , Sherman Stuart , Fogel Evan L. , Schmidt C. Max , DeWitt John M.
Published: May 2020

Objectives

The yield of genetic testing of main pancreatic duct (MPD) fluid collected during endoscopic retrograde cholangiopancreatography (ERCP) versus endoscopic ultrasound-guided fine-needle aspiration is unclear.

Methods

Consecutive MPD fluid samples obtained by endoscopic ultrasound/ERCP with DNA profiling were reviewed, excluding specimens designated “no amplification.” Invasive disease included invasive cancer or malignant cytology.

Results

One hundred ten samples from 109 patients who underwent ERCP (n = 32) or endoscopic ultrasound-guided fine-needle aspiration (n = 78) were analyzed (2007–2018). Leading indications were dilated MPD and suspected intraductal papillary mucinous neoplasm. Elevated DNA quantity, KRAS, loss of heterozygosity (LOH), and GNAS mutations occurred in 61.5%, 25.5%, 16.4%, and 8.7% of samples, respectively. Elevated DNA quantity occurred more frequently in ERCP samples (84.4% vs 51.9%, P = 0.002); other mutation yields were similar (P > 0.05). Invasive pathology (P = 0.032) was associated with LOH in the subset of patients who underwent surgery (n = 44). Adverse events occurred more frequently after ERCP (28.1% vs 9.0%, P = 0.016).

Conclusions

Endoscopic MPD fluid sampling may yield genetic data to improve diagnosis and risk stratification. In our surgical cohort, LOH was the sole predictor of invasive pathology. Endoscopic ultrasound-guided fine-needle aspiration of MPD fluid, when possible, is preferred because of superior safety profile.
Systematic Review and Meta‐analysis
Authors: Verkade Henkjan J. , Thompson Richard J. , Arnell Henrik , Fischler Björn , Gillberg Per‐Göran , Mattsson Jan P. , Torfgård Kristina , Lindström Erik
Published: May 2020

Objectives:

We assessed available data on impact of partial external biliary diversion (PEBD) surgery on clinical outcomes in patients with progressive familial intrahepatic cholestasis (PFIC).

Methods:

We performed a systematic literature review (PubMed) and meta‐analysis to evaluate relationships between liver biochemistry parameters (serum bile acids, bilirubin, and alanine aminotransferase [ALT]) and early response (pruritus improvement) or long‐term outcomes (need for liver transplant) in patients with PFIC who underwent PEBD.

Results:

Searches identified 175 publications before September 2018; 16 met inclusion criteria. Receiver operating characteristic (ROC) analysis examined ability of liver biochemistry parameters to discriminate patients who demonstrated early and long‐term response to PEBD from those who did not. Regarding pruritus improvement in 155 included patients in aggregate, 104 (67%) were responders, 14 (9%) had partial response, and 37 (24%) were nonresponders. In ROC analyses of individual patient data, post‐PEBD serum concentration of bile acids, in particular, could discriminate responders from nonresponders for pruritus improvement (area under the curve, 0.99;P < 0.0001; n = 42); to a lesser extent, this was also true for bilirubin (0.87;P = 0.003; n = 31), whereas ALT could not discriminate responders from nonresponders for pruritus improvement (0.74;P = 0.06; n = 28). Reductions from pre‐PEBD values in serum bile acid concentration (0.89;P = 0.0003; n = 32) and bilirubin (0.98;P = 0.002; n = 18) but not ALT (0.62;P = 0.46; n = 18) significantly discriminated decreased aggregate need for liver transplant.

Conclusion:

Changes in bile acids seem particularly useful in discriminating early and long‐term post‐PEBD outcomes and may be potential biomarkers of response to interruption of enterohepatic circulation in patients with PFIC.
Classic Hodgkin Lymphoma: A Nonclassic Presentation
Authors: Mattes Monica , Steele Amy , Chung Jong , Alvarez Elysia
Published: May 2020

Hodgkin lymphoma classically presents as lymphadenopathy with contiguous spread with or without associated B symptoms including night sweats, weight loss, and fever. With timely diagnosis and treatment, this is a potentially curable disease. This report describes a unique case of Hodgkin lymphoma that presented with localized back pain without overt evidence of lymph node involvement. This nonclassic presentation offers a diagnostic challenge that emphasizes the importance of keeping a broad differential in an adolescent or young adult patient with lytic bone lesions.
Retrospective Evaluation of Relationship Between Iron Overload and Transplantation Complications in Pediatric Patient Who Underwent Allogeneic Stem Cell Transplantation Due to Acute Leukemia and Myelodysplastic Syndrome
Authors: Küpesiz Funda Tayfun , Hazar Volkan , Eker Nursah , Guler Elif , Yesilipek M. Akif , Tuysuz Gulen , Kupesiz Alphan
Published: May 2020

Background:

Hematopoietic stem cell transplantation (HSCT) is a curative therapy option for hematologic malignancies. Iron overload is common in this patient group and can impact short-term and long-term nonrelapse mortality.

Study Design:

Retrospective observational cohort study.

Aims:

To evaluate the effect of iron load on early and late HSCT outcomes in patients with acute leukemia and myelodysplasia to assess the necessity of reducing iron load.

Patients and Methods:

Sixty patients who underwent HSCT in pediatric stem cell transplantation unit between 2000 and 2012 were evaluated retrospectively. The patients were divided into those with pretransplantation serum ferritin levels above and below the median value of 1299 ng/mL.

Results:

Forty-two (70%) of the patients were male, mean ages of the low and high ferritin groups were 85.43±9.42 and 118.56±10.04 months, respectively. Acute graft-versus-host disease (GVHD) within the first 100 days and acute liver GVHD were significantly more common in the high ferritin group (P<0.011 for both). Ferritin level was not associated with rates of engraftment syndrome, veno-occlusive disease, early/late infection, relapse, or overall and disease-free survival.

Conclusions:

In our study, significant result especially in terms of acute liver GVHD, was important to emphasize the need to be more careful in terms of acute liver GVHD risk in early liver pathologies in patients with high levels of ferritin after transplantation. In future large studies may be helpful to explain the relationship between acute liver GVHD and high ferritin levels.
Cannabis and Complex Posttraumatic Stress Disorder
Authors: Dagan Yael , Yager Joel
Published: May 2020

Despite substantial controversies concerning patients' reports of benefits from cannabis for posttraumatic stress disorder (PTSD) and inconsistent research findings regarding its efficacy and adverse risks, some states have already recognized PTSD as a qualifying condition for medical cannabis. Consequently, medical cannabis can also be provided for patients with complex PTSD who experience additional posttraumatic symptoms of affective dysregulation, negative perception of the self, and difficulties in relationships due to a history of repetitive trauma. In this article, we explore cannabis use in relation to benefits versus harms that might occur relative to specific complex PTSD symptoms and comorbidities. Whereas some symptoms related to PTSD per se (e.g., anxiety, insomnia, nightmares) may be benefited, others that are more characteristic of complex PTSD (e.g., dissociation, reckless behavior, and substance abuse associated with dysregulated affect) may be aggravated. Therefore, clinicians treating patients with complex PTSD who use or seek cannabis should carefully assess patients' motivations and the impacts of particular use patterns on specific symptoms. Clinicians and patients should be aware of and fully discuss the significant number of potential adverse effects of cannabis use, several of which might impede patients' participation in beneficial psychotherapeutic, social, and medical interventions.
Diaphragm Atrophy During Pediatric Acute Respiratory Failure Is Associated With Prolonged Noninvasive Ventilation Requirement Following Extubation
Authors: Glau Christie L. , Conlon Thomas W. , Himebauch Adam S. , Yehya Nadir , Weiss Scott L. , Berg Robert A. , Nishisaki Akira
Published: May 2020

Objectives:

Diaphragm atrophy is evident during invasive ventilation for pediatric acute respiratory failure, but with unknown significance. We hypothesized that diaphragm atrophy in pediatric acute respiratory failure is associated with prolonged noninvasive positive pressure ventilation following extubation.

Design:

Prospective observational study.

Setting:

Single-center academic PICU.

Patients:

Invasively ventilated children with acute respiratory failure.

Interventions:

Diaphragm ultrasound was performed within 36 hours after intubation and repeated within 48 hours preceding extubation. Rapid shallow breathing index at 15 and 30 minutes of a spontaneous breathing trial and negative inspiratory force were collected in a subset of patients concurrently with the ultrasound measurements.

Measurements and Main Results:

Diaphragm thickness at end-expiration was measured to assess for diaphragm atrophy during mechanical ventilation. Percentage change in diaphragm thickness at end-expiration was defined as baseline diaphragm thickness at end-expiration minus final, preextubation diaphragm thickness at end-expiration divided by baseline diaphragm thickness at end-expiration. The primary outcome measure was duration of noninvasive positive pressure ventilation following extubation with prolonged use defined as noninvasive positive pressure ventilation use for greater than 24 hours postextubation. Among 56 children, 47 (median age, 15.5 mo; interquartile range, 6–53 mo) had diaphragm thickness at end-expiration measured within 48 hours prior to extubation. Fourteen (30%) had prolonged noninvasive positive pressure ventilation use with median duration 110 hours (interquartile range, 52–130 hr). The median percentage change of diaphragm thickness at end-expiration from baseline among those with and without prolonged noninvasive positive pressure ventilation use was –20% (interquartile range, –32% to –10%) versus –7% (interquartile range, –21% to 0%) (p = 0.04).

Conclusions:

Diaphragm atrophy is associated with prolonged postextubation noninvasive positive pressure ventilation in children with acute respiratory failure. Serial bedside diaphragm ultrasound may identify children at risk for prolonged noninvasive positive pressure ventilation use after extubation.
Do Gender-Based Disparities in Authorship and Editorship Exist in Healthcare Simulation Journals? A Bibliometric Review of the Research
Authors: Lydon Sinéad , Madden Caoimhe , De Bhulbh Áine , Maher Senan , Byrne Dara , O'Connor Paul
Published: May 2020

Summary Statement

Publication in peer-reviewed journals, and serving on editorial boards, is considered an indicator of academic productivity and success, and a means of influencing discourse and practice in a field. This bibliometric review explored gender in authorship, and editorship, across the 3 existing English language, nonspecialty specific healthcare simulation journals. In total, 40.4% of publications had women first authors and 34.4% had women senior authors. There were no differences by journal and no apparent changes over time. Poor participation of women on editorial boards (38.1% of editorial board members were women) was observed. The observed level of representation of women as first and senior authors, and on editorial boards, is comparable with other health sciences domains but nonetheless warrants attention and improvement. Future research examining the profile of those working within simulation or evaluating strategies to improve the participation of women within healthcare simulation research and journals would be of interest.
Definitive Chemoradiotherapy Compared to Neoadjuvant Chemoradiotherapy With Esophagectomy for Locoregional Esophageal Cancer
Authors: Kamarajah Sivesh K. , Phillips Alexander W. , Hanna George B. , Low Donald , Markar Sheraz R.
Published: May 2020

Aim:

Ongoing randomized controlled trials seek to evaluate the potential organ-preservation strategy of definitive chemoradiotherapy as a primary treatment for esophageal cancer. This population-based cohort study aimed to assess survival following definitive chemoradiotherapy (DCR) with or without salvage esophagectomy (SALV) in the treatment of esophageal cancer.

Patients and Methods:

Data from the National Cancer Database (NCDB) from 2004 to 2015, was used to identify patients with nonmetastatic esophageal cancer receiving either DCR (n = 5977) or neoadjuvant chemoradiotherapy with planned esophagectomy (NCRS) (n = 13,555). Propensity score matching and multivariable analyses were used to account for treatment selection bias. Subset analyses compared patients receiving SALV after DCR with NCRS.

Results:

Comparison of baseline demographics of the unmatched cohort revealed that patients receiving NCRS were younger, had a lower burden of medical comorbidities, lower proportion of squamous cell carcinoma (SCC), and more positive lymph nodes. Following matching, NCRS was associated with significantly improved survival compared with DCR [hazard ratio (HR): 0.60, 95% confidence Interval (CI): 0.57–0.63, P < 0.001], which persisted in subset analyses of patients with adenocarcinoma (HR: 0.60, 95% CI: 0.56–0.63, P < 0.001) and SCC (HR: 0.58, 95% CI: 0.53–0.63, P < 0.001). Of 829 receiving SALV after DCR, 823 patients were matched to 1643 NCRS. There was no difference in overall survival between SALV and NCRS (HR: 1.00, 95% CI: 0.90–1.11, P = 1.0).

Conclusions:

Surgery remains an integral component of the management of patients with esophageal cancer. Neoadjuvant therapy followed by planned esophagectomy appears to remain the optimum curative treatment regime in patients with locoregional esophageal cancer.
Transitioning a Surgery Practice to Telehealth During COVID-19
Authors: Grenda Tyler R. , Whang Sung , Evans Nathaniel R.
Published: May 2020

The spread of COVID-19 has challenged practices across the United States to dramatically change inpatient and outpatient practices to focus on containing spread of the virus and accommodate the anticipated increase in volume of acute illness. Despite this transition, practices will need to continue to accommodate evaluation of newly diagnosed malignancies, routine postoperative visits, and acute postoperative issues. Building on an existing telemedicine framework, we aim to describe rapid transition in our outpatient care to a telehealth model in a general thoracic surgery practice during COVID-19.
microRNA-1906 protects cerebral ischemic injury through activating Janus kinase 2/signal transducer and activator of transcription 3 pathway in rats
Authors: Yu Xiunan , Li Xiaohong
Published: May 2020

This study aimed to investigate the effects of miR-1906 on cerebral ischemic injury and its underlying mechanisms. After 24 h of reperfusion, neurological deficit scores, brain water content and infarct volume were measured. Neuronal apoptosis was detected by using terminal dexynucleotidyl transferase-mediated dUTP nick end labeling assay. Hematoxylin–eosin staining was used to evaluate the histopathological damage of neurons. The expression of miR-1906 was detected by qRT-PCR. And the expressions of Bax, Bcl-2, caspase-3, Janus kinase 2 (JAK2), p-JAK2, signal transducer and activator of transcription 3 (STAT3) and p-STAT3 were measured by western blot. Furthermore, the levels of tumor necrosis factor α (TNF-α), interleukin-1β (IL-1β) and IL-6 were measured by ELISA. We found that miR-1906 expression was significantly decreased in the cerebral ischemia injury rats. miR-1906 decreased neurological score, infarct volume, brain water content, neuronal apoptosis and inflammatory factors (TNF-α, IL-6 and IL-1β) expression. In addition, miR-1906 promoted the phosphorylation of JAK2 and STAT3. After treating with JAK2/STAT3 pathway inhibitor AG490, the phosphorylation of JAK2 and STAT3 was inhibited and the effects of miR-1906 on neurological score, infarct volume, brain water content, neuronal apoptosis and inflammatory factors were reversed. miR-1906 could protect cerebral ischemic injury through activating the JAK2/STAT3 pathway in rats.
LncRNA SNHG4 regulates miR-138/c-Met axis to promote the proliferation of glioblastoma cells
Authors: Wang Xiaojiao , Tian Wei , Wu Liang , Wei Zhenqing , Li Weihua , Xu Yousong , Li Yang
Published: May 2020

LncRNA SNHG4 has been reported to be an oncogenic lncRNA in osteosarcoma. Our preliminary analysis of the cancer genome atlas dataset revealed the upregulation of SNHG4 in glioblastoma (GBM). In this study, we confirmed the upregulation of SNHG4 in GBM tissues collected from GBM patients. In addition, lower survival rate of GBM patients was observed in patients with high SNHG4 expression level. SNHG4 can directly interact with miR-138, while SNHG4 expression was no altered after miR-138 overexpression. Interestingly, SNHG4 overexpression led to the upregulation of c-Met, a target of miR-138. Cell counting kit-8 assay showed that miR-138 overexpression resulted in decreased proliferation rate of GBM cells. SNHG4 and c-Met overexpression played opposite roles and reduced the effects of miR-138. Therefore, SNHG4 regulates miR-138/c-Met axis to promote the proliferation of GBM cells.
Using small samples to estimate neutral component size and robustness in the genotype–phenotype map of RNA secondary structure
Authors: Weiß Marcel , Ahnert Sebastian E.
Published: May 2020

In genotype–phenotype (GP) maps, the genotypes that map to the same phenotype are usually not randomly distributed across the space of genotypes, but instead are predominantly connected through one-point mutations, forming network components that are commonly referred to as neutral components (NCs). Because of their impact on evolutionary processes, the characteristics of these NCs, like their size or robustness, have been studied extensively. Here, we introduce a framework that allows the estimation of NC size and robustness in the GP map of RNA secondary structure. The advantage of this framework is that it only requires small samples of genotypes and their local environment, which also allows experimental realizations. We verify our framework by applying it to the exhaustively analysable GP map of RNA sequence length
L
= 15, and benchmark it against an existing method by applying it to longer, naturally occurring functional non-coding RNA sequences. Although it is specific to the RNA secondary structure GP map in the first place, our framework can probably be transferred and adapted to other sequence-to-structure GP maps.