bluuebunny/crossref_metadata_2025 huggingface dataset:
Is combined extra-hepatic bile-duct resection justified for advanced gallbladder carcinoma?
Authors: Wang Jun-Ke , Ma Wen-Jie , Wu Zhen-Ru , Yang Qin , Hu Hai-Jie , Liu Fei , Li Fu-Yu
Published: April 2019

Background

Whether the extra-hepatic bile duct (EHBD) should be routinely resected for gallbladder carcinoma (GBC) remains controversial. The current study aimed to determine the clinical impact of combined EHBD resection during curative surgery for advanced GBC.

Methods

In total, 213 patients who underwent curative surgery for T2, T3 or T4 GBC were enrolled. The clinicopathological features were compared between the patients treated with EHBD resection and those without EHBD resection. Meanwhile, univariable and multivariable Cox-proportional hazards regression models were used to identify risk factors for overall survival (OS).

Results

Among the 213 patients identified, 87 (40.8%) underwent combined EHBD resection. Compared with patients without EHBD resection, patients with EHBD resection suffered more post-operative complications (33.3% vs. 21.4%, P = 0.046). However, the median OS of the EHBD resection group was longer than that of the non-EHBD resection group (25 vs. 11 months, P = 0.008). Subgroup analyses were also performed according to tumor (T) category and lymph-node metastasis. The median OS was significantly longer in the EHBD resection group than in the non-EHBD resection group for patients with T3 lesion (15 vs. 7 months, P = 0.002), T4 lesion (11 vs. 6 months, P = 0.021) or lymph-node metastasis (12 vs. 7 months, P < 0.001). No survival benefit of EHBD resection was observed in GBC patients with T2 lesion or without lymph-node metastasis. T category, lymph-node metastasis, margin status, pre-operative CA19-9 level and EHBD resection were identified as independent prognostic factors for OS of patients with advanced GBC (all P values <0.05).

Conclusions EHBD resection can independently affect the OS in advanced GBC. For GBC patients with T3 lesion, T4 lesion and lymph-node metastasis, combined EHBD resection is justified and may improve OS.
Resistance of Soybean Plant Introductions to Three Colonies of Soybean Aphid (Hemiptera: Aphididae) Biotype 4
Authors: Conzemius Sophia R , Hesler Louis S , Varenhorst Adam J , Tilmon Kelley J
Published: April 2019

Soybean aphid, Aphis glycines Matsumura (Hemiptera: Aphididae), infestations of soybean, Glycine max (L.) Merr. (Fabales: Fabaceae), and the associated yield loss have led to a large dependence on insecticidal management in soybean throughout the Midwestern United States. However, several populations of pyrethroid-resistant soybean aphids have recently been found in Iowa, Minnesota, North Dakota and South Dakota, which highlights the importance of alternative management approaches. One such alternative method is host-plant resistance, which uses naturally occurring plant defenses in crop cultivars to reduce the potential for yield loss from a pest population. Current soybean aphid-resistant cultivars do not protect against all soybean aphids due to the presence of virulent biotypes. In particular, soybean aphid biotype 4 is virulent to Rag1 and Rag2 resistance genes both individually and in combination. However, we hypothesized that resistance to biotype 4 may exist in previously identified, but uncharacterized resistant soybean plant introductions (PIs). To test this, we evaluated 51 previously identified but uncharacterized soybean aphid-resistant PIs for their resistance to colonies of soybean aphid biotype 4 collected in separate site-years (Lomira, WI 2013; Volga, SD 2015, 2016). Free-choice tests identified 14 PIs with putative resistance to ‘Lomira13’, two to ‘Volga15’, and eight to ‘Volga16’ soybean aphid colonies. Follow-up, no-choice tests corroborated two to three resistant PIs per colony, and PI 437696, which was resistant to each of the three colonies and could aid in breeding efforts and an integrated approach to soybean aphid management.
Pervasive Resistance to Pyrethroids in German Cockroaches (Blattodea: Ectobiidae) Related to Lack of Efficacy of Total Release Foggers
Authors: DeVries Zachary C , Santangelo Richard G , Crissman Jonathan , Suazo Alonso , Kakumanu Madhavi L , Schal Coby
Published: April 2019

Despite limited efficacy data, do-it-yourself (DIY) insecticide products often promise low-cost alternatives to professional pest control. Total release foggers (TRFs, ‘bug bombs’), which are prominent DIY products, were recently shown to be ineffective at reducing German cockroach (Blattella germanica L.) infestations, in contrast to highly effective baits. However, the reason(s) for TRF failure remain unknown. Therefore, we investigated insecticide resistance of apartment-collected cockroaches from homes where TRFs failed. In topical (direct) application assays, resistance to cypermethrin (a common active ingredient in TRFs) was 202 ± 33 times that of a laboratory insecticide-susceptible population (based on LD50 ratios), while resistance to fipronil, a common bait active ingredient, was considerably lower at 14 ± 2 times that of the laboratory insecticide-susceptible population. The addition of PBO, a P450 inhibitor that synergizes pyrethroids, enhanced the efficacy of cypermethrin, but only at high doses of cypermethrin. Additionally, >96% of screened cockroaches possessed at least one copy of the L993F mutation in the voltage-gated sodium channel, known to confer resistance to pyrethroids (knockdown resistance, kdr). Because TRF treatments killed insecticide-susceptible sentinel cockroaches but failed to kill apartment-collected cockroaches, these results suggest that pyrethroid resistance is a major factor contributing to the failure of TRFs. Multiple mechanisms of resistance, including metabolic detoxification of the pyrethroids and kdr mutations that confer target-site insensitivity, suggest that TRFs would lack efficacy against German cockroaches in residential settings, where high levels of pyrethroid resistance have been documented globally.
Jasmonate signalling in carnivorous plants: copycat of plant defence mechanisms
Authors: Pavlovič Andrej , Mithöfer Axel
Published: April 2019

The lipid-derived jasmonate phytohormones (JAs) regulate a wide spectrum of physiological processes in plants such as growth, development, tolerance to abiotic stresses, and defence against pathogen infection and insect attack. Recently, a new role for JAs has been revealed in carnivorous plants. In these specialized plants, JAs can induce the formation of digestive cavities and regulate enzyme production in response to different stimuli from caught prey. Appearing to be a new function for JAs in plants, a closer look reveals that the signalling pathways involved resemble known signalling pathways from plant defence mechanisms. Moreover, the digestion-related secretome of carnivorous plants is composed of many pathogenesis-related (PR) proteins and low molecular weight compounds, indicating that the plant carnivory syndrome is related to and has evolved from plant defence mechanisms. This review describes the similarities between defence and carnivory. It further describes how, after recognition of caught insects, JAs enable the carnivorous plants to digest and benefit from the prey. In addition, a causal connection between electrical and jasmonate signalling is discussed.
Weltpolitik
Authors: Murray Michelle
Published: April 2019

This chapter considers the rise of Imperial Germany to world power status at the turn of the twentieth century. It argues that Germany’s bid for world power status—Weltpolitik—embodied the recognitive practices constitutive of world power status and was designed to secure recognition from Britain, the system’s preeminent world power. Specifically, in building a powerful fleet of battleships stationed in the North Sea, German leaders reasoned they could alter the political relationship with Britain by creating a display of military force so great that Britain would recognize Germany’s position among the world powers. At the same time, these recognitive practices insulted Germany from the social uncertainty associated with intersubjective identity formation by creating the illusion that its world power status was self-evident rather than dependent on British recognition. The precariousness of its social status was revealed during the First Moroccan Crisis, when in response to acts of misrecognition Germany initiated a serious international crisis that risked war, rousing suspicions among the European great powers that Germany was a revisionist power.
Inequality: an assessment
Authors: Mayhew Ken , Wills Samuel
Published: April 2019

Concern about inequality, particularly inequality of income and wealth, has become prominent in public discourse around the world. This article first discusses issues of measurement and goes on to ask why we should care, emphasizing fairness and the market distortions and negative externalities found in unequal societies. It documents that the decline in global inequality in recent decades has been due to falling inequality between, rather than within, countries. The popular picture of rising inequality in OECD countries is more varied and complex than often perceived. Its drivers include aspects of globalization and of technological change as well as changes in the distribution of market power, in financial markets, public policy, and monetary policy. There are two over-arching questions about how governments can address inequality. The first is what should be tackled at the international level and what should be the preserve of national policy. The second is what should be the balance between pre- and post-market interventions. Both have a role but generally the balance has been too skewed towards the latter.
Progress and Obstacles in Culturing ‘Candidatus Liberibacter asiaticus’, the Bacterium Associated with Huanglongbing
Authors: Merfa Marcus V. , Pérez-López Edel , Naranjo Eber , Jain Mukesh , Gabriel Dean W. , De La Fuente Leonardo
Published: April 2019

In recent decades, ‘Candidatus Liberibacter spp.’ have emerged as a versatile group of psyllid-vectored plant pathogens and endophytes capable of infecting a wide range of economically important plant hosts. The most notable example is ‘Candidatus Liberibacter asiaticus’ (CLas) associated with Huanglongbing (HLB) in several major citrus-producing areas of the world. CLas is a phloem-limited α-proteobacterium that is primarily vectored and transmitted among citrus species by the Asian citrus psyllid (ACP) Diaphorina citri. HLB was first detected in North America in Florida (USA) in 2005, following introduction of the ACP to the State in 1998. HLB rapidly spread to all citrus growing regions of Florida within three years, with severe economic consequences to growers and considerable expense to taxpayers of the state and nation. Inability to establish CLas in culture (except transiently) remains a significant scientific challenge toward effective HLB management. Lack of axenic cultures has restricted functional genomic analyses, transfer of CLas to either insect or plant hosts for fulfillment of Koch’s postulates, characterization of host-pathogen interactions and effective screening of antibacterial compounds. In the last decade, substantial progress has been made toward CLas culturing: (i) three reports of transient CLas cultures were published, (ii) a new species of Liberibacter was identified and axenically cultured from diseased mountain papaya (Liberibacter crescens strain BT-1), (iii) psyllid hemolymph and citrus phloem sap were biochemically characterized, (iv) CLas phages were identified and lytic genes possibly affecting CLas growth were described, and (v) genomic sequences of 15 CLas strains were made available. In addition, development of L. crescens as a surrogate host for functional analyses of CLas genes, has provided valuable insights into CLas pathogenesis and its physiological dependence on the host cell. In this review we summarize the conclusions from these important studies.
Evaluation of a Medical Student Research and Career Development Program to Increase Diversity in Academic Medicine
Authors: Fernandez Alicia , Chen Victoria , Quan Judy , Martinez Alma , Flowers Loma , Aronson Louise
Published: April 2019

Purpose

To describe and evaluate an innovative research program supported by the National Institutes of Health, “Promoting Research Opportunities Fully—Prospective Academics Transforming Health” (PROF-PATH), designed to support medical students from groups underrepresented-in-medicine (URM) interested in pursuing academic careers.

Method

Based on social cognitive career theory (SCCT), PROF-PATH supplemented a traditional research program (TRP) by providing additional mentorship and a curriculum focused on “assumed knowledge” of academic culture, guidance with research challenges, and emotional competence. The four-year evaluation (2013–2016) consisted of pre- and postprogram surveys of PROF-PATH and TRP students, plus focus groups and individual structured interviews with PROF-PATH students. Survey questions queried students’ self-confidence in research- and career-related skills and abilities. The authors mapped themes elicited in focus groups and interviews onto SCCT domains.

Results

Of 454 medical students, 343 (75.6%) completed the surveys. According to preprogram surveys, PROF-PATH students (n = 85) were less confident in their ability to find or manage mentor relationships than TRP students (n = 258) and less likely to report having a mentor who provided strong support for their research interests. At program’s end, PROF-PATH students showed greater increases in confidence than TRP students in multiple ability domains. Qualitative analysis of themes indicated that PROF-PATH influenced students through seven SCCT domains and increased student academic career self-efficacy.

Conclusions

An innovative program for URM medical students participating in mentored research was successful in supporting academic career interest and academic self-efficacy. Schools motivated to increase diversity in academic medicine should consider adapting PROF-PATH.
Automated Ambulatory Blood Pressure Measurements and Intraoperative Hypotension in Patients Having Noncardiac Surgery with General Anesthesia
Authors: Saugel Bernd , Reese Philip C. , Sessler Daniel I. , Burfeindt Christian , Nicklas Julia Y. , Pinnschmidt Hans O. , Reuter Daniel A. , Südfeld Stefan
Published: April 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Normal blood pressure varies among individuals and over the circadian cycle. Preinduction blood pressure may not be representative of a patient’s normal blood pressure profile and cannot give an indication of a patient’s usual range of blood pressures. This study therefore aimed to determine the relationship between ambulatory mean arterial pressure and preinduction, postinduction, and intraoperative mean arterial pressures.

Methods

Ambulatory (automated oscillometric measurements at 30-min intervals) and preinduction, postinduction, and intraoperative mean arterial pressures (1-min intervals) were prospectively measured and compared in 370 American Society of Anesthesiology physical status classification I or II patients aged 40 to 65 yr having elective noncardiac surgery with general anesthesia.

Results

There was only a weak correlation between the first preinduction and mean daytime mean arterial pressure (r = 0.429, P < 0.001). The difference between the first preinduction and mean daytime mean arterial pressure varied considerably among individuals. In about two thirds of the patients, the lowest postinduction and intraoperative mean arterial pressures were lower than the lowest nighttime mean arterial pressure. The difference between the lowest nighttime mean arterial pressure and a mean arterial pressure of 65 mmHg varied considerably among individuals. The lowest nighttime mean arterial pressure was higher than 65 mmHg in 263 patients (71%).

Conclusions

Preinduction mean arterial pressure cannot be used as a surrogate for the normal daytime mean arterial pressure. The lowest postinduction and intraoperative mean arterial pressures are lower than the lowest nighttime mean arterial pressure in most patients.
Capsulotomy in Unstable Slipped Capital Femoral Epiphysis and the Odds of AVN: A Meta-analysis of Retrospective Studies
Authors: Kaushal Neil , Chen Cynthia , Agarwal Kunal N. , Schrader Tim , Kelly Derek , Dodwell Emily R.
Published: April 2019

Background:

Unstable slipped capital femoral epiphysis (SCFE) may lead to avascular necrosis (AVN) in up to 60% of patients. The aim of this study was to assess the best clinical evidence to determine the effect of capsular decompression (CD) on odds of AVN in unstable SCFE.

Methods:

Medline, Embase, and Cochrane databases were systematically searched for comparative studies investigating AVN rates in unstable SCFE treated with or without CD (aspiration, percutaneous, or open). Quality was evaluated by the Newcastle Ottawa Scale. A comparative analysis with pooled effect estimates using random-effects modeling was calculated. Secondary analysis pooled AVN rates from both comparative studies and case series.

Results:

Comparative analysis included 17 retrospective studies with 453 hips (201 with CD, 252 without CD). Thirty-four of 201 (17%) hips with CD developed AVN, while 67 of 252 (27%) hips without CD developed AVN. The odds of AVN for patients treated with or without CD [odds ratio=0.80, 95% confidence interval (CI): 0.48-1.35] was not statistically different. Subanalysis on patients treated with in situ pinning or positional reduction and pinning showed no difference in AVN rates with or without CD (odds ratio=0.97, 95% CI: 0.44-2.10). In the secondary analysis of 17 comparative studies and 23 case series, the average rate of AVN was 17%, 0.17 (95% CI: 0.13-0.23) for patients treated with CD (60/447 hips) and 28%, 0.28 (95% CI: 0.22-0.35) for patients treated without CD (129/464 hips).

Conclusions:

There was no statistically significant decrease in odds of AVN with CD. However, studies were limited by their retrospective nature and inadequate documentation of CD techniques; the majority lacked femoral head blood flow monitoring to demonstrate adequate decompression. Future prospective studies with carefully documented complete decompression may help to elucidate the effect of CD on AVN risk. Although there was no statistically different odds of AVN with or without CD, even this large meta-analysis was underpowered, and one cannot conclude that there was truly no difference in odds of AVN without an appropriately powered study. Therefore, we recommend routine CD for all unstable SCFEs pending additional research, as CD adds little to the surgical procedure and may minimize the risk of a devastating insult to the femoral head.
Vitamin D Trends in the Pediatric Orthopaedic Population: A Survey
Authors: Williams Kevin , Hughes Daniel , Horan Michael
Published: April 2019

Background:

Within the last decade, multiple studies have demonstrated the potential health benefits of vitamin D supplementation including improved bone health, reduced fracture risk, protection from autoimmune disease, and decreased cancer risk. Because of the prevalence of vitamin D deficiency in pediatric populations and despite recent evidence of increased vitamin D supplementation in the United States, our goal is to assess the knowledge of current vitamin D recommendations among pediatric orthopaedists and fellows within the Pediatric Society of North America (POSNA). It is our purpose to use the data to increase awareness and understanding of vitamin D among all pediatric providers.

Methods:

Our survey was distributed to 1316 POSNA members via a series of 2 email requests to participate in the survey on the SurveyMonkey website. They agreed to participate by responding positively on the first page of the survey. The data was depersonalized and analyzed via χ2 and the Fisher exact testing.

Results:

A total of 395 responses were recorded. Overall, 69% of participants rated their vitamin D knowledge as fair to good. In total, 68% of participants have been in practice over 10 years and represented most US geographic regions fairly equally. Most estimate that over 25% of their practice is vitamin D deficient with about a 50% compliance rate of supplementation. Over 30% of participants feel vitamin D management is mostly the role of the pediatrician; however, 64% of participants discuss or check vitamin D levels in their practice for patients with repeat fractures, medical comorbidities, or nonunions most commonly.

Conclusions:

Survey participants demonstrated a wide variety of responses indicating their understanding of vitamin D testing and supplementation. Although providers estimate a high deficiency rate, many do not routinely check vitamin D. When they do check, there is no standard indication for testing or supplementation and many believe this to be the role of the pediatrician or endocrinologist. More studies are needed to provide a standardized protocol for vitamin D testing and supplementation in the pediatric orthopaedic literature.

Clinical Relevance:

POSNA survey.
Circulating Endothelial Cells From Septic Shock Patients Convert to Fibroblasts Are Associated With the Resuscitation Fluid Dose and Are Biomarkers for Survival Prediction
Authors: Tapia Pablo , Gatica Sebastian , Cortés-Rivera Cristian , Otero Carolina , Becerra Alvaro , Riedel Claudia A. , Cabello-Verrugio Claudio , Kalergis Alexis M. , Simon Felipe
Published: April 2019

Objectives:

To determine whether circulating endothelial cells from septic shock patients and from nonseptic shock patients are transformed in activated fibroblast by changing the expression level of endothelial and fibrotic proteins, whether the level of the protein expression change is associated with the amount of administered resuscitation fluid, and whether this circulating endothelial cell protein expression change is a biomarker to predict sepsis survival.

Design:

Prospective study.

Setting:

Medical-surgical ICUs in a tertiary care hospital.

Patients:

Forty-three patients admitted in ICU and 22 healthy volunteers.

Interventions:

None.

Measurements and Main Results:

Circulating mature endothelial cells and circulating endothelial progenitor cells from septic shock and nonseptic shock patients showed evidence of endothelial fibrosis by changing the endothelial protein expression pattern. The endothelial proteins were downregulated, whereas fibroblast-specific markers were increased. The magnitude of the expression change in endothelial and fibrotic proteins was higher in the septic shock nonsurvivors patients but not in nonseptic shock. Interestingly, the decrease in the endothelial protein expression was correlated with the administered resuscitation fluid better than the Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores in the septic shock nonsurvivors patients but not in nonseptic shock. Notably, the significant difference between endothelial and fibrotic protein expression indicated a nonsurvival outcome in septic shock but not in nonseptic shock patients. Remarkably, area under the receiver operating characteristic curve analysis showed that endothelial protein expression levels predicted the survival outcome better than the Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores in septic shock but not in nonseptic shock patients.

Conclusions:

Circulating endothelial cells from septic shock patients are acutely converted into fibroblasts. Endothelial and fibrotic protein expression level are associated with resuscitation fluid administration magnitude and can be used as biomarkers for an early survival diagnosis of sepsis.
Anti-Müllerian Hormone and Its Predictive Utility in Assisted Reproductive Technologies Outcomes
Authors: GRANGER EMILY , TAL RESHEF
Published: April 2019

Anti-Müllerian hormone (AMH) has become one of the most informative biochemical markers of the ovary and is considered the earliest and most sensitive marker of reproductive aging. The accuracy of AMH in predicting ovarian response to controlled ovarian stimulation has led to AMH-based prognostication counseling and individualization of assisted reproductive technology (ART) stimulation protocols to optimize ovarian response and minimize hyperstimulation risks. Although AMH is considered a good predictor of quantitative ART outcomes, its correlation with qualitative ART outcomes is still controversial. The aim of this review is to provide an updated overview of the clinical utility of AMH in predicting ART outcomes.
Contemporary Management of Polycystic Ovarian Syndrome
Authors: ZIMMERMAN LILLI D. , SETTON ROBERT , PEREIRA NIGEL , ROSENWAKS ZEV
Published: April 2019

PCOS remains one of the most intriguing endocrine disorders that physicians encounter even though it was first described over 80 years ago. Although the diagnostic criteria, nomenclature, and ideal therapeutic strategies are areas of active and ongoing debate, there is no doubt that we have made tremendous progress in improving the quality of life and reproductive outcomes of women who suffer from this wide-ranging disorder.
Treatment and Prevention of Pneumococcal Infection
Authors: MOUMNE OLIVIA , DUFF PATRICK
Published: April 2019

Streptococcus pneumoniae, a gram-positive diplococcus, is the most common cause of bacterial pneumonia. The diagnosis of pneumococcal pneumonia is usually confirmed by chest x-ray and gram stain. The most appropriate antibiotics for treatment pneumococcal infection are macrolides, beta-lactams, and quinolones. Two vaccines, PPSV23 and PCV13, are highly effective in preventing infection.
Cancer-Related Symptoms and Cognitive Intervention Adherence Among Breast Cancer Survivors: A Mixed-Methods Study
Authors: Bail Jennifer R. , Ivankova Nataliya , Heaton Karen , Vance David E. , Triebel Kristen , Meneses Karen
Published: April 2019

Background

Breast cancer survivors (BCSs) experience long-term symptoms of cancer and treatment, which may exacerbate cognitive function and ability to adhere to interventions aimed at improving cognition.

Objective

The intent of this study was to explore the relationship between selected cancer-related symptoms and adherence to the Speed of Processing in Middle Aged and Older BreAst Cancer SuRvivors (SOAR) cognitive training (CT) intervention among BCSs residing in Alabama.

Methods

A sequential quantitative to qualitative (Quan→Qual) mixed-methods design was used. First, the relationship between selected cancer-related symptoms and adherence to SOAR among BCSs (n = 30) was examined using self-reported questionnaire data. Follow-up semistructured interviews with 15 purposefully selected participants (adherent and nonadherent) were conducted to explore how symptoms contributed to/explained differences in adherence to SOAR. Data were analyzed using RStudio and NVivo software.

Results

Spearman’s ρ correlation suggested relationships between adherence and perceived cognitive impairment, depressive symptoms, and sleep quality. Inductive thematic analysis yielded 4 themes: (1) experiences of cancer-related symptoms, (2) influences of CT, (3) adherence to CT, and (4) environment for CT. Integration of quantitative and qualitative results revealed that experiences of and responses to CT and cancer-related symptoms differently shape adherence to CT among BCSs.

Conclusions

To aid in cognitive intervention adherence among BCSs, future studies may consider applying a comprehensive approach aimed at addressing concurrent cancer-related symptoms.

Implications for Practice

Clinicians can routinely assess cognition and provide education and resources for management of cancer-related symptoms.
Impact of Kamishibai Card Process on Compliance With the Central Venous Line Maintenance Bundle
Authors: Frith Julia , Hampton Debbie , Pendleton Michelle , Montgomery Vicki L. , Isaacs Pam
Published: April 2019

Background:

The Kamishibai Card (K-Card) process is a storytelling methodology designed to help identify barriers and remove or redesign them.

Purpose:

The purpose of this study was to evaluate the effectiveness of the K-Card process for central venous line (CVL) maintenance bundle compliance in a pediatric intensive care unit.

Methods:

A retrospective evaluation of the implementation of the K-Card process was performed using a pretest and posttest design.

Results:

A total of 1003 central venous catheter maintenance observations were completed during the study period. A statistically significant change was noted in one element of the CVL maintenance bundle, tubing timed and dated. The most frequent cause for noncompliance with the CVL maintenance bundle was incomplete communication during handoff, followed by device associated factors (failure of device, use of device, and availability of device).

Conclusions:

The K-Card process had a positive impact on CVL maintenance bundle compliance in the study setting.
Diagnostic Significance of HRAS Mutations in Epithelial-Myoepithelial Carcinomas Exhibiting a Broad Histopathologic Spectrum
Authors: Urano Makoto , Nakaguro Masato , Yamamoto Yoshinari , Hirai Hideaki , Tanigawa Maki , Saigusa Natsuki , Shimizu Akira , Tsukahara Kiyoaki , Tada Yuichiro , Sakurai Kouhei , Isomura Madoka , Okumura Yuki , Yamaguchi Hiroshi , Matsubayashi Jun , Nagao Toshitaka
Published: April 2019

Epithelial-myoepithelial carcinoma (EMC) is a rare salivary gland tumor that is histologically characterized by biphasic tubular structures composed of inner ductal and outer clear myoepithelial cells. Because of its histologic variety, it is sometimes challenging to make an accurate diagnosis, and useful ancillary tests are essential for this purpose. We investigated 87 cases of EMC arising in the major and minor salivary glands and seromucinous glands in the nasal cavity or bronchus to describe the histologic features and mutation status of selected key oncogenes. Classic EMC accounted for 40.2% of all cases. Other cases showed various growth patterns and cytologic features in addition to the typical histology; cribriform patterns, a basaloid appearance, and sebaceous differentiation were relatively common (17.2% to 18.4%), whereas oncocytic/apocrine, papillary-cystic, double-clear, squamous, psammomatous, Verocay-like, and high-grade transformation were rare. HRAS mutations were found in 82.7% of EMCs and were concentrated in codon 61. There was no significant correlation between the HRAS mutation status and the histology. No EMC ex pleomorphic adenoma cases had HRAS mutations. PIK3CA and/or AKT1 mutations were the second most frequent mutations (20.7%, 6.5%, respectively) and almost always cooccurred with HRAS mutations. It is noteworthy that the HRAS mutation was not identified in any salivary gland tumor entities manifesting EMC-like features, including adenoid cystic carcinoma, pleomorphic adenoma, basal cell adenoma/adenocarcinoma, and myoepithelial carcinoma. We conclude that HRAS mutations are a frequent tumorigenic gene alteration in EMC, despite its histologic diversity. This study provides further insight into strategies for diagnosing EMC and discriminating it from its mimics.
A Paper-Based Car Seat Safety Educational Intervention in the Pediatric Emergency Department
Authors: Cooper-Sood Jonathan Bryan , Chan Cristal , Cho Christine S.
Published: April 2019

Objective

Motor vehicle crashes are a leading source of pediatric morbidity and mortality in children younger than 13 years. Proper car seat safety device (CSD) markedly reduces mortality, but the majority of families misuse them. Emergency department (ED)–based educational interventions can improve knowledge patient regarding proper CSD use but historically have been resource intensive. Our study evaluated the utility of a novel educational intervention in improving patient knowledge of proper CSD use and in evaluating for proper CSD installation.

Methods

Parents of children younger than 14 years presenting to the ED were given a paper-based quiz followed by a CSD-educational handout. Improvement in patient knowledge and evaluation for proper CSD installation were evaluated by repeat quiz and a phone-based survey 2 to 4 weeks later.

Results

Parents exhibited an 18% improvement in quiz answers evaluating knowledge of proper CSD use (P value < 0.0001). Eighty-two percent and 72% of families felt that the intervention improved their understanding of proper CSD use and increased their awareness of their importance, respectively, but only 18% had their CSD checked by a professional.

Conclusions

A paper-based educational intervention in the pediatric ED is well received by parents, may improve patient knowledge surrounding proper CSD use, and encourages some families to get their CSDs checked for proper installation.
Outcomes of Acute Inpatient Rehabilitation of Patients With Left Ventricular Assist Devices and Subsequent Stroke
Authors: Mathews Amy , Goodman Daniel A. , Rydberg Leslie
Published: April 2019

Objective

The aim of the study was to examine the functional outcomes and medical complications of patients with left ventricular assist device implantation and subsequent stroke during comprehensive inpatient rehabilitation.

Design

Retrospective cohort study of 21 patients admitted to an inpatient rehabilitation facility between 2009 and 2015. Main outcome measurements include admission and discharge Functional Independence Measure, length of stay, and Functional Independence Measure efficiency.

Results

The study included 17 male and 4 female patients aged 32–75 yrs. Eleven patients (52%) required transfer to an acute care hospital for evaluation. Fifteen patients completed inpatient rehabilitation with median [interquartile range] length of stay 26 [13.5–34] days (range = 7–59 days), median [interquartile range] Functional Independence Measure gain of 18 [12.5–32], and median [interquartile range] Functional Independence Measure efficiency of 1.0 [0.6–1.44]. Patients who required transfer to acute care during their course but ultimately completed inpatient rehabilitation (n = 5) demonstrated larger median [interquartile range] Functional Independence Measure gain (40 [23–42]) and longer median [interquartile range] length of stay (35 [35–42]) compared with patients who completed inpatient rehabilitation without transfer (Functional Independence Measure gain = 15 [9.25–26.5]; length of stay = 14.5 [11.5–26.25]).

Conclusions

Patients with left ventricular assist device implantation and subsequent stroke demonstrate functional gains during acute inpatient rehabilitation programs. A large percent of patients required transfer to acute care.
Where Do We Look? Assessing Gaze Patterns in Cosmetic Face-Lift Surgery with Eye Tracking Technology
Authors: Cai Lawrence Z. , Kwong Jeffrey W. , Azad Amee D. , Kahn David , Lee Gordon K. , Nazerali Rahim S.
Published: April 2019

Background:

Aesthetics plays a central role in determining success in plastic surgery. Understanding perceptions of favorable aesthetics is critical to ensure patient satisfaction. Eye-tracking technology offers an objective way of evaluating attention and understanding how viewers direct their focus on patients who undergo cosmetic face-lift procedures.

Methods:

Thirty-six subjects ranging from layperson to attending plastic surgeon viewed 15 sets of photographs before and after patients underwent an elective face-lift procedure. They were instructed to evaluate the aesthetic quality on a Likert scale while eye-tracking equipment tracked their gaze and analyzed their distribution of attention.

Results:

Postoperative images showed a Likert score improvement of 0.51 ± 0.26, with the greatest difference in attending cosmetic plastic surgeons (1.36 ± 0.22; p < 0.05). The nose was the most common first fixation location (31 percent of first fixations) and the most viewed area (16 ± 3 percent of fixation time) for all subjects. Experienced subjects spent less time in nonrelevant areas (30 ± 11 percent for attending cosmetic plastic surgeons and 37 ± 10 percent for attending noncosmetic plastic surgeons) compared with less experienced subjects (50 ± 15 percent for laypersons).

Conclusions:

This study demonstrates that viewers with greater experience in cosmetic surgery focus quickly on the cheeks, chin, and neck and have evenly distributed gaze across the entire face. These results suggest that a layperson’s gaze is drawn to the center of the face (because of both unfamiliarity with the face-lift procedure and the natural tendency to look at the central face), whereas attending plastic surgeons exhibit holistic gaze patterns and are more aware of the impact of the procedure.
Framework for the Creation of Ethical and Professional Social Media Content
Authors: Schoenbrunner Anna , Gosman Amanda , Bajaj Anureet K.
Published: April 2019

Background:

Social media are powerful tools that allow users to communicate directly with an online community. Plastic surgeons were early adopters of social media, recognizing their educational and marketing potential. With the use of social media comes ethical and legal concerns. The lack of professional society policies on social media use has led to calls for the American Society of Plastic Surgeons to establish guidelines regarding the use of social media in medical practice. The authors propose a framework for the creation of ethical and professional social media content.

Methods:

The authors reviewed the updated American Society of Plastic Surgeons Code of Ethics, current professional organization codes of ethics and social media guidelines, recently published articles, and legal documents pertaining to social media use in medical practice.

Results:

The updated American Society of Plastic Surgeons Code of Ethics provides adequate guidance for the professional use of social media in plastic surgery practice. The authors drew on the American Society of Plastic Surgeons Code of Ethics along with existing professional society guidelines to develop a framework for the professional and ethical creation of social media content. The authors also propose a sample informed consent form for social media use.

Conclusions:

Social media are powerful tools that will continue to transform the practice of plastic surgery and medicine at large. Plastic surgeons must uphold values of professionalism and ethics when using social media to protect patients and maintain the high professional standards of the specialty.
The Effect of Bimaxillary Surgery on the Airway Morphology in Class III Patients: Taking Into Account the Head Posture During Walking
Authors: Kiliç Banu , Amuk Nisa Gül , Hacioğlu Zeynep , Demirbaş Ahmet Emin
Published: April 2019

Objectives:

To assess changes in head and neck posture, airway, hyoid, tongue, and soft palate in skeletal class III individuals whose cephalograms were taken using dynamic natural head positioning method with an inclinometer.

Materials and Methods:

This study was conducted on 20 class III patients operated with double jaw surgery. Natural head positions were determined before and 6 months after the surgery. Craniocervical, pharyngeal airway, tongue, and hyoid positions were measured. In the analysis of the data, paired t test, independent sample t test and correlation tests were used.

Results:

There was a statistically significant change in the craniocervical measurements with the operation and the head position was further extended (P < 0.05). Significant changes were observed in the soft palate angles upon surgery (P < 0.026) and the increase in oropharyngeal airway area was statistically significant (P < 0.001). There was a statistically significant increase in tongue length (TL) and distance from vertical reference plane to tongue tip (TTi/VRP) measurements (P < 0.001 and P < 0.012, respectively). There was a statistically significant decrease in distance from horizontal reference plane to tongue tip (TTi/HRP) and tongue dorsum (TD/HRP) measurements (P < 0.033 and P < 0.003, respectively). The only significant change among the hyoid bone position-related measurements was distance between hyoidale and epiglottis (P < 0.013).

Conclusions:

Hyoid bone location, tongue measurements, and posterior pharyngeal airway were found to be related to each other and they have been found to be effective on the head and neck posture. Head position will be affected by possible surgical alternatives.
LPS-Induced Hypotension in Pregnancy: The Effect of Progesterone Supplementation
Authors: Zöllner Julia , Howe Laura G. , Edey Lydia F. , O’Dea Kieran P. , Takata Masao , Leiper James , Johnson Mark R.
Published: April 2019

Our previous work has shown that pregnancy exacerbates the hypotensive response to both infection and lipopolysaccharide (LPS). The high levels of progesterone (P4) associated with pregnancy have been suggested to be responsible for the pregnancy-induced changes in the cardiovascular response to infection. Here, we test the hypothesis that P4 supplementation exacerbates the hypotensive response of the maternal cardiovascular to LPS.

Female CD1 mice had radiotelemetry probes implanted to measure hemodynamic function noninvasively and were time-mated. From day 14 of pregnancy, mice received either 10 mg of P4 or vehicle alone per day and on day 16, intraperitoneal LPS (10 μg of serotype 0111:B4) was injected. In two identically treated cohorts of mice, tissue and serum (for RNA, protein studies) were collected at 6 and 12 h.

Administration of LPS resulted in a fall in blood pressure in vehicle treated, but not P4 supplemented mice. This occurred with similar changes in the circulating levels of cytokines, vasoactive factors and in both circulating and tissue inflammatory cell numbers, but with reduced left ventricular expression of cytokines in P4-supplemented mice. However, left ventricular expression of markers of cardiac dysfunction and apoptosis were similar.

This study demonstrates that P4 supplementation prevented LPS-induced hypotension in pregnant mice in association with reduced myocardial inflammatory cytokine gene expression. These observations suggest that rather than being detrimental, P4 supplementation has a protective effect on the maternal cardiovascular response to sepsis.
Norepinephrine vs Vasopressin: Which Vasopressor Should Be Discontinued First in Septic Shock? A Meta-Analysis
Authors: Wu Zongsheng , Zhang Shi , Xu Jingyuan , Xie Jianfeng , Huang Lili , Huang Yingzi , Yang Yi , Qiu Haibo
Published: April 2019

Background:

Patients with septic shock in whom norepinephrine (NE) infusion alone is insufficient to raise blood pressure require the concomitant administration of vasopressin (VP). However, current guidelines do not advise clinicians as to which vasoactive agent to discontinue first once the patient's septic shock begins to resolve. Moreover, there is controversial data guiding clinicians on how to discontinue vasopressors for septic shock patients who are receiving a combination therapy of NE and VP.

Methods:

The PubMed, EMBASE, and Cochrane Central Register databases were searched from the database inception until October 18, 2018. Studies were limited to adult patients with septic shock who received concomitant NE and VP treatment, that included different orders of vasopressor discontinuation. The primary outcome was the incidence of hypotension. Overall mortality, ICU mortality, and length of stay (LOS) in the ICU were secondary outcomes. Sensitivity and subgroup analyses as well as trial sequential analysis were performed.

Results:

One prospective randomized controlled trial and seven retrospective cohort studies were included in present meta-analysis. Compared with discontinuing VP first, the incidence of hypotension was significantly lower when NE was discontinued first (odds ratio, OR 0.3, 95% confidence interval, CI 0.10 to 0.86, P = 0.02; I
2 = 91%). No significant difference was detected in either overall mortality (OR 1.28, 95% CI 0.77 to 2.10, P = 0.34) or ICU mortality (OR 0.99, 95% CI 0.74 to 1.34, P = 0.96) between these two groups. Furthermore, ICU LOS was also evaluated in five studies, and no statistical significance was observed between the two groups with different orders in weaning vasopressors (mean difference 1.35, 95% CI −2.05 to 4.74, P = 0.44). The subgroup analyses suggested a significant association between hypotension and the practice of discontinuing VP first specifically in patients with a low usage rate of corticosteroids (odds ratio, OR 0.18, 95% confidence interval, CI 0.04 to 0.78, P = 0.02). The trial sequential analysis indicated a lack of sufficient evidence to draw conclusions from the current results (required information size  = 11 821).

Conclusions:

In adults with septic shock treated with concomitant VP and NE therapy, discontinuing VP first may lead to a higher incidence of hypotension but is not associated with mortality or ICU LOS. Further prospective studies with larger sample sizes are warranted.
The Prognostic Value of Prehospital Blood Lactate Levels to Predict Early Mortality in Acute Cardiovascular Disease
Authors: Martín-Rodríguez Francisco , López-Izquierdo Raúl , Castro Villamor Miguel A. , del Pozo Vegas Carlos , Delgado Benito María del Pilar , Martínez Caballero Carmen M. , Priego Martínez Vicente , Martín Conty José Luis , Mayo-Iscar Agustín , Sánchez-Soberón Irene , Baez Gemma Pastor
Published: April 2019

Introduction:

The knowledge of the prognostic value of prehospital lactate (PLA) is limited. Our objective was to evaluate the predictive capacity of PLA to predict early mortality (within 48 h) from the index event in acute cardiovascular disease (ACVD).

Methods:

Prospective, longitudinal, multicenter, observational study in patients, attended by advanced life support units, transferred to the emergency department of their reference hospital and diagnosed with ACVD. We collected demographic, physiological, clinical, analytical variables, main cardiological diagnosis, and data on hospital admission and early mortality. The main outcome variable was mortality from any cause within 2 days.

Results:

Between March 1, 2018 and January 31, 2019, a total of 492 patients were included in our study. Early mortality after the index event within the first 48 h affected 27 patients (5.5%). The most frequent cause of care demand was chest pain with 223 cases (45.3%). The predictive power of PLA to discriminate mortality at 2 days obtained an area under the curve of 0.911 (95% confidence interval [CI]: 0.83–0.98, P < 0.001). A value equal or superior to 4.3 mmol/L globally attained a sensitivity of 92.6% (95% CI, 76.6–97.9) with a specificity of 82.8% (95% CI, 79.1–86.0), with a positive predictive value of 23.8 (16.7–32.8) and a negative predictive value of 99.5 (98.1–99.9).

Conclusion:

PLA represents a prognostic biomarker with excellent predictive capacity for ACVD. Prehospital Emergency Services (PhEMS) should incorporate this test routinely in their usual procedures.