bluuebunny/crossref_metadata_2025 huggingface dataset:
Nasal Glioma: A Rare Cause of Congenital Inner Canthal Swelling
Authors: Charles Norman C. , Lisman Richard D. , Patel Payal , Callahan Alison B.
Published: March 2018

Nasal glioma, encephalocele, and ectopic brain are rare congenital anomalies. The terminology applied to these entities has been historically confusing. In many cases, the terms overlap and may be employed synonymously although some authors emphasize their differences. The authors describe herein a child with an inner canthal mass of brain-like tissue that they interpret as nasal glioma, a variety of encephalocele that has lost its connection to the intracranial contents. This research was conducted in conformity with the Helsinki Declaration and Health Insurance Portability and Accountability Act regulations.
Measurement of Medial Wall Bowing and Clinical Associations in Thyroid Eye Disease
Authors: Bokman Christine L. , Ugradar Shoaib , Rootman Daniel B.
Published: March 2018

Purpose:

To propose and validate a measure of medial wall bowing in thyroid eye disease (TED) and to assess the clinical correlates of bowing in TED.

Methods:

In this cross-sectional cohort study, all patients affected with TED seen by a single specialist over a 2-year period were screened for study entry. Eligible participants were adults with clinical evidence of TED and either CT or MRI of the orbits. Exclusion criteria included prior history of decompression surgery and/or medical or other ophthalmic conditions that could alter the orbital anatomy. The primary outcome measure was prevalence of medial wall bowing. Secondary outcomes included the associations between medial wall bowing and exophthalmometry, diplopia, rectus muscle restriction, dysthyroid optic neuropathy (DON), strabismus, and quality of life. Medial wall bowing was defined as medial divergence of the medial wall from a straight line drawn between the anterior lacrimal crest and the middle of the optic canal and measured radiographically using axial images of the orbits. Volumetric analysis of bowing was performed on a sample of orbits with and without bowing. Volumetric and axial single slice measurements were compared. Bivariate statistics were performed.

Results:

The final sample included 112 orbital images from 56 patients with TED. Medial wall bowing was found to be evident in 11.6% (n = 13/112) of orbits. Medial wall bowing was significantly associated with greater Hertel measurements, horizontal and vertical muscle restriction, ocular surface symptoms and Clinical Activity Score, as well as lower quality of life scores. Patients with demonstrable medial wall bowing were more likely to be affected by optic neuropathy, diplopia (Gorman score ≥ 1), strabismus, or horizontal muscle restriction. Analysis of the volume for medial wall bowing demonstrated that the height of the arc at the peak of bowing on an axial image of a 2-dimensional CT scan correlated highly with the total volume of bowing (r = 0.90, p < 0.001).

Conclusions:

The identification of medial wall bowing on CT or MRI is associated with clinical measures of disease severity, including diplopia and DON.
Prevalence and Correlates of Substance Use in Homeless Youth and Young Adults
Authors: Santa Maria Diane M. , Narendorf Sarah C. , Cross Matthew B.
Published: March 2018

Substance use is higher among homeless youth than among the general population. Although substance use has been well studied, little is known about the risk factors associated with specific substances used by homeless youth, particularly in the Houston, Texas, area. Therefore, we conducted this study to examine the rates of lifetime and past-month substance use in a sample of homeless youth in Harris County, Texas, and examine the relations between substance type and race/ethnicity, age, gender identity, sexual orientation, shelter status, stress, and trauma history. Participants were recruited during October and November 2014 as part of the study YouthCount 2.0! and completed a survey to assess demographics, stress, abuse, substance use, and risk behaviors. The sample (N = 416) was predominantly young adult (13–17 years old: 55 and 18–24 years old: 361), African American (54.5%), and male (55.9%). Nearly one quarter identified as lesbian, gay, bisexual, or questioning (n = 102). Over a third of youth had used alcohol (38%) or marijuana (36%) in the past month, and 36% had ever used synthetic marijuana. Bivariate analyses showed that substance use was significantly associated with race/ethnicity, age, gender identity, sexual orientation, shelter status, stress, and trauma scores. Youth in this study had lower rates of alcohol and some substance use than other samples of homeless youth, although use still exceeded national rates for housed youth. Substance use prevention interventions for homeless youth should be trauma informed and include housing navigation and stress management strategies. The most at-risk subgroups included street-dwelling and lesbian, gay, bisexual, or questioning youth.
Relational Health and Recovery
Authors: Vandermause Roxanne , Fougere Merry , Liu Yi-Hsiu , Odom-Maryon Tamara
Published: March 2018

Adolescent substance use (SU) endures as a priority concern to communities. The increasing risk of SU in young women has been a rising concern, and the needs of young women may be unique. The importance of relationships and “connectedness” as aberrant behavior protective factors has been validated extensively in the literature of several disciplines over the past decade. Less well described are the components and qualities of relational engagement among adolescents involved in SU treatment. This multimethod study was a broad analysis of the nature of relational health in adolescent girls, so as to determine whether understanding components of relational health could inform SU treatment options. The survey tool, the Relational Health Indices (Liang et al., 2002), was used to measure dimensions and domains of relational health in adolescent girls and informed qualitative methods in the study. It is clear from this research that adolescent girls in SU treatment care deeply about but are confused regarding their relationships with others, particularly their romantic partners and their mothers. They have a desire to help others, specifically their siblings and others struggling with addiction. This article describes the multimethod study and implications for treatment, research, and education.
The Relationship Between Emotional Intelligence and Internet Addiction Among Youth and Adults
Authors: Saraiva Jorge , Esgalhado Graça , Pereira Henrique , Monteiro Samuel , Afonso Rosa Marina , Loureiro Manuel
Published: March 2018

This study aimed to compare emotional intelligence (EI) levels and Internet addiction (IA) by gender and age groups and to assess the predictive relationship between EI and IA. One thousand four hundred thirteen young people and adults participated in the study. Participants were between 17 and 81 years old (M = 38.70 years old, SD = 13.72 years old); 42.2% were male, whereas 57.5% were female. We used a sociodemographic questionnaire, the Schutte Emotional Intelligence Scale (Schutte, Malouff, & Bhullar, 2009), and the Internet Addiction Test (Young, 1998) as data collection instruments. Results showed that there is a weak, but statistically significant, negative relationship between EI and IA. We found higher levels of EI in older people and in women than in the youngest participants and in men. No relevant prevalence of IA was found in the participants of this study.
Bariatric Outcomes: Self-Management for Sustained Surgical Success
Authors: Anderson Laura M. , Chacko Thomas P.
Published: March 2018

Binge eating disorder, food addiction, and dysregulated overeating are common among people with severe obesity and prevalent among bariatric surgery populations. These problematic eating habits share commonalities with other addictions. Effective, holistic self-management is needed to promote long-term weight loss and psychosocial adjustment among patients who are severely obese who undergo surgery, especially those with clinically remarkable levels of binge eating, food addiction, or dysregulated overeating.

This article aims to briefly review binge eating disorder, food addiction, and obesity—as well as issues surrounding surgery for individuals who are severely obese—and introduce the Bariatric Outcomes: Self-management for Sustained Surgical Success (BOSSSS) program. The BOSSSS program is holistic, skill based, and designed to promote weight loss, prevent weight regain, and improve well-being in patients with severe obesity with a history of bariatric surgery.

Preliminary survey data suggest that bariatric surgery patients report a lack of skill-based emotional and behavioral support designed to help them over the long term. The BOSSSS program is rooted in self-determination theory, integrating mobile health technology across program components. Self-determination theory-based interventions are personalized and encourage autonomy, competence, and social support among participating patients and providers. The behavioral self-regulation training within BOSSSS is energy balance self-monitoring and titration. Emotional self-regulation is addressed via a specialized version of dialectical behavior skills therapy, emphasizing promotion of coping skills and use of adaptive, healthy substances in immediate environments. The BOSSSS program has been well received by patients and could be implemented by nurses and other health professionals with minimal support.
Evaluation of a School-Based Program for Internet Addiction of Adolescents in Turkey
Authors: Uysal Gulzade , Balci Serap
Published: March 2018

This study aimed to evaluate a school-based program for Internet addiction, the Healthy Internet Use Program, with adolescents in Turkey. Forty-one students were included in the intervention group, and the control group was composed of 43 students. All students were from two primary schools. Students in the intervention group participated in the Healthy Internet Use Program, which was developed in accordance with the literature. The intervention group was given eight training sessions over a 3-month period, and their parents were given two training and consultancy sessions. Data were collected using a data collection form and the Internet Addiction Scale. The third evaluation of the Internet Addiction Scale scores showed a significant difference between the intervention group and the control group (p < .05). The fourth evaluation of the Internet Addiction Scale points showed a highly significant difference between the two groups (p < .001). The findings suggest that use of the Healthy Internet Use Program decreases the rate of Internet addiction among adolescents.
Opiate Dependence or Addiction?
Authors: Dobbs Gina C. , Fogger Susanne A.
Published: March 2018

In the wake of epidemic of opioid overdoses in the United States, patients who are receiving treatment for chronic pain with opioid have come under increasing scrutiny. The Centers for Disease Control and Prevention issued a guideline for managing chronic pain in 2016, which makes recommendations for opioids based on current evidence. This review will highlight key components of the guideline including differentiating addiction from dependence to assist nurses to better inform patient care in managing chronic pain.
Brazilian Public Policies on Drugs
Authors: de Souza Jacqueline , Fiorati Regina C. , Macedo Maraiza M. , de Macedo Jaqueline Queiroz
Published: March 2018

Since 2004, Brazilian policy makers have been making some changes in the drug policies. It has prioritized a harm reduction perspective instead of a prohibitionist one. Nevertheless, this latter perspective also persists in some parts of the policies and strategies used to deal with this phenomenon in Brazil. This study aims to analyze the structure of the drug policies in Brazil. It is a documental search of Brazilian mental health legislation (laws, decrees, and ordinances) regarding alcohol and other drugs since 2001. The analysis focused on prevention, assistance, and supply control axes. There was a predominance of assistance, which focuses on development of treatment services. Documents have focused more on crack cocaine than on other drugs which have more impact on public health. Scientific evidence competes with partisan political issues and values and the opinions of different actors. The results suggest that it is necessary to have a solid scientific foundation, clearer technical operational aspects, and an evaluation strategy for mental health services to systematize and analyze the implemented policies.
Racialized Mass Incarceration and the War on Drugs
Authors: Fornili Katherine Smith
Published: March 2018

The purpose of this column is to summarize important aspects of the racialized War on Drugs, including (a) the school-to-prison pipeline, (b) the for-profit prison system (“prison industrial complex”), (c) racialized mass incarceration, and (d) the disproportionately negative impact of the War on Drugs on families and communities of color. Analysis of critical race theory (CRT), the study of the relationships between race, racism, and power, will provide a cohesive framework for examining these four aspects. CRT maintains that American laws, including antidiscrimination laws, are structured to maintain White privilege (Alexander, 2010; Capers, 2014; Delgado & Stefancic, 2017; Nyika & Murray-Orr, 2017). Proponents of CRT are committed to progressive race consciousness and view CRT as a mechanism for analyzing and addressing racial inequity (Capers, 2014). We cannot incarcerate our way out of the drug epidemic. The War on Drugs is a war on individuals who experience a treatable medical condition and on the communities in which they reside. It should more properly be called “The War on Our Own People.” The failed War on Drugs and the current administration’s efforts to revive and strengthen it provide examples of how the dominant society allows, and perhaps even actively promotes, the destruction of minority communities. Addictions nurses object to the conditions that perpetuate the War on Drugs and racialized mass incarceration. We view it our ethical responsibility to advocate for social justice and healthy sociopolitical environments for all members of society, regardless of race, class, or creed.
Placebo Effects Across Self-Report, Clinician Rating, and Objective Performance Tasks Among Women With Post-Traumatic Stress Disorder
Authors: Hodgins Gabrielle E. , Blommel Jared G. , Dunlop Boadie W. , Iosifescu Dan , Mathew Sanjay J. , Neylan Thomas C. , Mayberg Helen S. , Harvey Philip D.
Published: March 2018

Purpose/Background

For a drug to acquire Food and Drug Administration approval, it must significantly outperform placebo treatment. In recent years, the placebo effect seems to be increasing in neuropsychiatric conditions. Here, we examine placebo effects across self-reported, clinically rated, and performance-based data from a trial using a corticotropin-releasing hormone receptor type 1 (CRHR1) antagonist for treatment of post-traumatic stress disorder (PTSD).

Methods/Procedures

Women with chronic PTSD were randomized to treatment with either GSK561679, a CRHR1 antagonist, or placebo. Before randomization, participants completed self-report scales, clinician-rated measures of PTSD and depression symptoms, and objective tests of cognition and functioning. Differences in change scores on measures were compared between GSK561679 and placebo-treated participants.

Findings/Results

GSK561679 failed to produce any significant improvement in the participants. A substantial placebo effect was observed in both self-report and clinical rating scales, with effect sizes up to 1.5 SD. No single variable predicted placebo-related changes. Notably, there was an improvement on objective performance measures of cognition that exceeded previous standards for practice effects.

Implications/Conclusions

Participants in this trial manifested retest effects on performance-based measures of cognition. Notably, they had minimal prior experience with performance-based assessments. Experiencing the structure and support of a clinical trial may have contributed to significant reductions in subject-reported and clinician-rated PTSD symptom levels. The improvement seen across all assessment domains was consistent with that seen in previous studies where the active treatments separated from placebo. Investigators conducting clinical trials treating PTSD patients should expect placebo effects and design studies accordingly.
α7 Nicotinic Acetylcholine Receptor
Authors: Jones Candace
Published: March 2018

Purpose

The aim of this article is to review the recent trials of α7 nicotinic acetylcholine receptor (α7 nAChR) agonists and positive allosteric modulators (PAMs) on the treatment of cognitive decline in schizophrenia. α7 Nicotinic acetylcholine receptor abnormalities in schizophrenia and clinical implications of α7 nAChR agonists and PAMs are also discussed.

Procedures

Studies were searched on PubMed with keywords “nicotinic,” “alpha7,” and “schizophrenia” over a 2-year period: January 1, 2016, to December 1, 2017. Cognition was not included in key terms in order to broaden the results. Inclusion criteria included (1) article categorization as a clinical study, review, or journal article; (2) schizophrenia diagnosis based on Diagnostic and Statistical Manual of Mental Disorders criteria; (3) article in English; (4) objective measure of cognition from effects of α7 nAChR agonists/PAMs; and (5) article currently published.

Findings

A total of 76 studies were found over the past 2 years. Fifteen of these studies were included in this review. Human studies were limited. Cognitive-related improvements in rodent models were found across the 6 cognitive constructs: perception, executive functioning, social and affective processes, working memory, and long-term memory.

Implications

These results support the potential of nAChR agonists and PAMs to improve cognitive decline in patients with schizophrenia as an adjunct treatment to antipsychotics. However, these results were found primarily in rodent models of schizophrenia, and further primate/human studies are necessary to support this conclusion in humans.
Development of an Epilepsy Nursing Communication Tool: Improving the Quality of Interactions Between Nurses and Patients With Seizures
Authors: Buelow Janice , Miller Wendy , Fishman Jesse
Published: March 2018

Background: Nurses have become increasingly involved in overseeing the management of patients with complex medical conditions, including those with epilepsy. Nurses who are not specialists in epilepsy can play a central role in providing optimal care, education, and support to their patients with epilepsy, given the proper tools. Objective: Our objective was to create a tool that can be used by nurses in the clinic setting to help facilitate discussion of topics relevant to enhancing medical care and management of patients with epilepsy. To address this need, a panel of epilepsy nursing experts used a patient-centered care approach to develop an Epilepsy Nursing Communication Tool (ENCT). Methods: An initial set of topics and questions was created based on findings from a literature review. Eight nurse experts reviewed and revised the ENCT using focus groups and discussion forums. The revised ENCT was provided to nurses who care for patients with epilepsy but had not been involved in ENCT development. Nurses were asked to rate the usability and feasibility on a 5-point scale to assess whether the tool captured important topics and was easy to use. Results: Ten nurses provided usability and feasibility assessments. Results indicated strong tool utility, with median scores of 4.5, 4, and 4 for usefulness, ease of use, and acceptability, respectively. Conclusions: The preliminary ENCT shows promise in providing a tool that nurses can use in their interactions with patients with epilepsy to help address the complexity of disease management, which may help improve overall patient care.
Prediction of Liver Steatosis Applying a New Score in Subjects from the Brazilian Longitudinal Study of Adult Health
Authors: Perazzo Hugo , Benseñor Isabela , Mill José Geraldo , Pacheco Antônio G. , da Fonseca Maria de Jesus Mendes , Griep Rosane Härter , Lotufo Paulo , Chor Dora
Published: March 2018

Goals:

To develop a noninvasive algorithm for diagnosis of liver steatosis and to compare its diagnostic value with available predictive models.

Background:

Liver steatosis represents the most frequent liver disease worldwide.

Study:

This cross-sectional study analyzed data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Patients were randomly divided into training (n=6571) and validation (n=3286) cohort. Abdominal ultrasound (US), used to grade steatosis, and overnight fasting blood tests were performed at the same day. Fatty Liver Index (FLI), Hepatic Steatosis Index, and Nonalcoholic Fatty Liver Disease-Liver Fat Score were calculated. A backward stepwise multivariate logistic regression analysis was used to develop the new predictive model, Steato-ELSA.

Results:

In total, 9857 subjects [58% female, age=51 (interquartile range, 45 to 58) years, body mass index=26.4 (23.9 to 29.6) Kg/m2] were included. Body mass index, waist circumference, homeostasis model of assessment of insulin resistance, transaminases, and triglycerides were independently associated with steatosis in the multivariate model (Hosmer-Lemeshow P=0.279). In the validation cohort, the area under the receiver-operator characteristics (95% confidence interval) for prediction of mild and moderate steatosis were: (i) 0.768 (0.751-0.784) and 0.829 (0.810-0.848) for Steato-ELSA; (ii) 0.762 (0.745-0.779) and 0.819 (0.799-0.838) for Fatty Liver Index; (iii) 0.743 (0.727-0.761) and 0.800 (0.779-0.822) for Hepatic Steatosis Index; and (iv) 0.719 (0.701-0.737) and 0.769 (0.747-0.791) for Nonalcoholic Fatty Liver Disease-Liver Fat Score. Steato-ELSA performed significantly better than other models and yielded sensitivity (Se)/specificity (Sp) (95% confidence interval): (i) for mild steatosis (score ≥0.386): Se=65.6% (63.0-68.3) and Sp=73.7% (71.8-75.6); (ii) for moderate steatosis (score ≥0.403): Se=83.5% (80.0-86.9) and Sp=68.7% (67.0-70.4).

Conclusions:

Steato-ELSA is an accurate and inexpensive tool that uses simple parameters to identify individuals at high risk of liver steatosis.
Water Exchange Produces Significantly Higher Adenoma Detection Rate Than Water Immersion
Authors: Leung Felix W. , Koo Malcolm , Cadoni Sergio , Falt Premysl , Hsieh Yu-Hsi , Amato Arnaldo , Erriu Matteo , Fojtik Petr , Gallittu Paolo , Hu Chi-Tan , Leung Joseph W. , Liggi Mauro , Paggi Silvia , Radaelli Franco , Rondonotti Emanuele , Smajstrla Vit , Tseng Chih-Wei , Urban Ondrej
Published: March 2018

Goals:

To test the hypothesis that water exchange (WE) significantly increases adenoma detection rates (ADR) compared with water immersion (WI).

Background:

Low ADR was linked to increased risk for interval colorectal cancers and related deaths. Two recent randomized controlled trials of head-to-head comparison of WE, WI, and traditional air insufflation (AI) each showed that WE achieved significantly higher ADR than AI, but not WI. The data were pooled from these 2 studies to test the above hypothesis.

Study:

Two trials (5 sites, 14 colonoscopists) that randomized 1875 patients 1:1:1 to AI, WI, or WE were pooled and analyzed with ADR as the primary outcome.

Results:

The ADR of AI (39.5%) and WI (42.4%) were comparable, significantly lower than that of WE (49.6%) (vs. AI P=0.001; vs. WI P=0.033). WE insertion time was 3 minutes longer than that of AI (P<0.001). WE showed significantly higher detection rate (vs. AI) of the >10 mm advanced adenomas. Right colon combined advanced and sessile serrated ADR of AI (3.4%) and WI (5%) were comparable and were significantly lower than that of WE (8.5%) (vs. AI P<0.001; vs. WI P=0.039).

Conclusions:

Compared with AI and WI, the superior ADR of WE offsets the drawback of a significantly longer insertion time. For quality improvement focused on increasing adenoma detection, WE is preferred over WI. The hypothesis that WE could lower the risk of interval colorectal cancers and related deaths should be tested.
Dietary Factors and Mucosal Immune Response in Celiac Disease Patients Having Persistent Symptoms Despite a Gluten-free Diet
Authors: Laurikka Pilvi , Lindfors Katri , Oittinen Mikko , Huhtala Heini , Salmi Teea , Lähdeaho Marja-Leena , Ilus Tuire , Mäki Markku , Kaukinen Katri , Kurppa Kalle
Published: March 2018

Goals:

The aim of this study was to investigate the role of dietary factors, distinct small-bowel mucosal immune cell types, and epithelial integrity in the perpetuation of gastrointestinal symptoms in treated celiac disease patients.

Background:

For unexplained reasons, many celiac disease patients suffer from persistent symptoms, despite a strict gluten-free diet (GFD) and recovered intestinal mucosa.

Study:

We compared clinical and serological data and mucosal recovery in 22 asymptomatic and 25 symptomatic celiac patients on a long-term GFD. The density of CD3+ and γδ+ intraepithelial lymphocytes (IELs), CD25+ and FOXP3+ regulatory T cells, and CD117+ mast cells, and the expression of tight junction proteins claudin-3 and occludin, heat shock protein 60, interleukin 15, and Toll-like receptor 2 and 4 were evaluated in duodenal biopsies.

Results:

All subjects kept a strict GFD and had negative celiac autoantibodies and recovered mucosal morphology. The asymptomatic patients had higher mean fiber intake (20.2 vs. 15.2 g/d, P=0.028) and density of CD3+ IELs (59.3 vs. 45.0 cell/mm, P=0.045) than those with persistent symptoms. There was a similar but nonsignificant trend in γδ+ IELs (17.9 vs. 13.5, P=0.149). There were no differences between the groups in other parameters measured.

Conclusions:

Low fiber intake may predispose patients to persistent symptoms in celiac disease. There were no differences between the groups in the markers of innate immunity, epithelial stress or epithelial integrity. A higher number of IELs in asymptomatic subjects may indicate that the association between symptoms and mucosal inflammation is more complicated than previously thought.
Unilateral Versus Bilateral Lung Transplantation
Authors: Tangaroonsanti Anupong , Lee Augustine S. , Vela Marcelo F. , Crowell Michael D. , Erasmus David , Keller Cesar , Mallea Jorge , Alvarez Francisco , Almansa Cristina , DeVault Kenneth R. , Houghton Lesley A.
Published: March 2018

Goals:

To assess the effect of unilateral versus bilateral lung transplantation (LTx) on esophageal motility and gastroesophageal reflux, and the association with the development of obstructive chronic lung allograft dysfunction (o-CLAD).

Background:

We have shown that esophagogastric junction outflow obstruction, incomplete bolus transit, and proximal reflux are all independent risk factors for the development of chronic allograft failure. However, it remains unclear whether these factors are influenced by the type of surgery and how this relates to allograft failure.

Study:

Patients post-LTx (n=48, 24 female; aged 20 to 73 y) completed high-resolution impedance manometry and 24-hour pH/impedance.

Results:

Patients who had undergone unilateral LTx were more likely to exhibit esophagogastric junction outflow obstruction (47% vs. 18%; P=0.046) and less likely to exhibit hypocontractility (0% vs. 21%; P=0.058) than those who had undergone bilateral LTx. Although the proportion of patients exhibiting gastroesophageal reflux was no different between groups (33% vs. 39%; P=0.505), those undergoing bilateral LTx were more likely to exhibit proximal reflux (8% vs. 37%; P=0.067). Univariate Cox proportion hazards regression analysis did not show a difference between unilateral versus bilateral LTx in the development of o-CLAD (hazard ratio=1.17; 95% confidence interval, 0.48-2.85; P=0.723).

Conclusion:

The type of LTx performed seems to lead to different risk factors for the development of o-CLAD. Physicians should be aware of these differences, as they may need to be taken into account when managing patient’s post-LTx.
De-novo nonalcoholic steatohepatitis is associated with long-term increased mortality in liver transplant recipients
Authors: Gitto Stefano , de Maria Nicola , di Benedetto Fabrizio , Tarantino Giuseppe , Serra Valentina , Maroni Lorenzo , Cescon Matteo , Pinna Antonio D. , Schepis Filippo , Andreone Pietro , Villa Erica
Published: March 2018

Objective

Patients who have undergone transplantation often develop metabolic syndrome (MetS) and de-novo nonalcoholic fatty liver disease (NAFLD). Our aim was to evaluate the impact of metabolic disease on cardiovascular and neoplastic risk and survival.

Patients and methods

Data from patients who underwent transplantation between 2000 and 2005 in two Italian transplant centers were analyzed. Cox regression analysis was carried out for predictors of de-novo NAFLD and nonalcoholic steatohepatitis (NASH), cardiovascular events, de-novo extrahepatic cancers, and survival. Survival analysis was completed using the Kaplan–Meier method. A P value less than 0.05 was considered significant for all tests.

Results

De-novo NAFLD was found in one-fifth of 194 patients. Patients with de-novo NAFLD fulfilled the criteria of MetS in 74.4% of cases, while patients without de-novo NAFLD in 29.8% (P=0.000). On multivariate analysis, MetS correlated independently with de-novo NAFLD and this emerged as an independent predictor of cardiovascular events and as a relevant risk factor for solid extrahepatic cancer. Data on smoking habits, which represent a consolidated risk factor for cardiovascular events and cancer in both the general population and patients who have undergone transplantation, are not available. In the subset of histologically proven NASH, it was the strongest predictor of long-term survival (hazard ratio=4.133, 95% confidence interval: 1.385–12.331, P=0.011).

Conclusion

Post-transplant NAFLD represented a strong risk factor for cardiovascular atherosclerotic disease and solid extrahepatic cancer, whereas de novo histologically proven NASH was an independent predictor of long-term mortality.
Transparent cap-assisted endoscopic sclerotherapy in esophageal varices: a randomized-controlled trial
Authors: Ma Lili , Huang Xiaoquan , Lian Jingjing , Wang Jian , Chen Shiyao
Published: March 2018

Background and aim

Endoscopic treatment is widely accepted as the first-line therapy selection for esophageal variceal bleeding. Nevertheless, endoscopic injection sclerotherapy requires experienced endoscopists and is associated with a high risk of bleeding. Our study evaluates the feasibility and efficacy of transparent cap-assisted endoscopic sclerotherapy in the management of esophageal varices.

Patients and methods

A randomized-controlled trial was conducted in a tertiary referral center from April 2015 to May 2016. Patients who received endoscopic sclerotherapy were randomized in a blinded manner into two groups: the transparent cap-assisted group (n=59) and the control group (n=61).

Results

The average injection sites were reduced in the transparent cap-assisted group compared with the control group (1.2±0.4 vs. 1.4±0.05, P=0.000), whereas no difference was observed in the dosage of lauromacrogol (16.97±4.91 vs. 16.85±4.57, P=0.662) and the hemorrhage that occurred during injection made no difference (50.8 vs. 61.0%, P=0.276); yet, salvage hemostasis methods were used in only nine patients in the transparent cap-assisted group compared with 17 patients in the control group (25.0 vs. 38.7%, P=0.0936). The cost of each procedure in the cap-assisted group was ¥2578 (1878–4202), whereas it was ¥3691 for the control group (2506–5791) (P=0.023). Moreover, in both groups, no esophageal constriction was observed during the 6-month follow-up period, whereas the rebleeding rate between two groups showed no statistical significance in 6 months (89.8 vs. 93.4%, P=0.563).

Conclusion

Transparent cap-assisted sclerotherapy provided a clear field of vision and helped to fix the targeted veins, thus significantly reducing the use of the salvage hemostasis method during sclerotherapy injection hemorrhage. It is also associated with reduced injection sites and endoscopic therapy cost.
Retrospective analysis of children with α-1 antitrypsin deficiency
Authors: Comba Atakan , Demirbaş Fatma , Çaltepe Gönül , Eren Esra , Kalayci Ayhan G.
Published: March 2018

Background

α-1 Antitrypsin (AAT) deficiency is the most frequently occurring genetic liver disorder. The association among classical α-1 antitrypsin deficiency (AATD), chronic liver disease, and cirrhosis is common in adult patients but rare in children.

Aim

To assess the clinical characteristics of children with AATD and to compare symptoms between homozygous and heterozygous children.

Materials and methods

The study included 20 children who were found to have mutant Pi alleles. AAT phenotyping was conducted on patients with a low serum AAT level. The exclusion criteria included infectious, anatomic, and metabolic conditions. Symptoms on presentation, physical examination findings, laboratory values, liver biopsy results, and follow-up periods were recorded for each patient.

Results

The patients included six (30%) girls and 14 (70%) boys, with a mean age of 6.3±5.1 (1–16) years. The PiZZ phenotype was present in eight (40%) and PiMZ in 12 (60%) patients. The most frequent symptom was elevated liver function test results. Three patients were referred with neonatal cholestasis and one with compensated cirrhosis. Eight patients underwent liver biopsy; all patients except one had periodic acid-Schiff-positive diastase-resistant globules in the hepatocytes. The mean follow-up period was 34±33 (12–101) months. At the end of follow-up, all patients with PiZZ were found to have chronic hepatitis, and one with cirrhosis. On the contrary, two patients with PiMZ were found to have chronic hepatitis.

Conclusion

Children with classical AATD commonly have chronic liver disease. In heterozygous (PiMZ) children with AATD, enzyme levels can normalize with occasional fluctuations, sometimes causing delayed diagnosis.
Homocysteine: a new diagnostic marker in spontaneous bacterial peritonitis
Authors: Abdel-Razik Ahmed , Eldars Waleed , Elhelaly Rania , Eldeeb Ahmed A. , Abdelsalam Mostafa , El-Wakeel Niveen , Aboulmagd Alsaid
Published: March 2018

Background and aims

The diagnosis of spontaneous bacterial peritonitis (SBP) depends primarily on a polymorphonuclear leukocyte cell count more than 250/mm3. This method is invasive, and not diagnostic in all variants of SBP; we aimed to assess serum homocysteine as a precise indicative marker for the diagnosis of all variants of SBP.

Patients and methods

A total 323 consecutive ascitic patients were registered in this prospective work. Serum and ascitic fluid of homocysteine were evaluated utilizing an enzyme-linked immunosorbent assay.

Results

Participants were classified into a non-SBP group, including 262 participants and 61 patients with SBP. Serum and ascitic homocysteine were considerably elevated in the SBP group than in the non-SBP group (17.94±7.57 vs. 11.75±5.68 μmol/l; P<0.001 and 14.70±5.45 vs. 9.75±4.55 μmol/l; P<0.001). At a cutoff value of 17.79 μmol/l, serum homocysteine had 89.3% specificity and 95.1% sensitivity for distinguishing SBP (area under the curve: 0.932) and, at a cutoff value of 16.1 μmol/l, ascitic homocysteine had 84.4% specificity and 92.7% sensitivity for distinguishing SBP (area under the curve: 0.901). Both were positively correlated with the polymorphonuclear count, C-reactive protein, Child–Pugh score, and Model For End-Stage Liver Disease score as well as negatively correlated with the protein content in the ascitic fluid and estimated glomerular filtration rate. After SBP therapy, there was a marked reduction in serum and ascitic homocysteine levels.

Conclusion

This study demonstrates that serum and ascitic homocysteine are considerably higher in SBP participants versus non-SBP patients. Serum homocysteine may provide a reliable and noninvasive diagnostic marker for all variants of SBP.
Clozapine Rechallenge After Major Adverse Effects: Clinical Guidelines Based on 259 Cases
Authors: Manu Peter , Lapitskaya Yevgeniya , Shaikh Atef , Nielsen Jimmi
Published: March 2018

Background:

Clozapine is widely prescribed for treatment-refractory schizophrenia, but its use is limited by many potentially life-threatening adverse effects. The risk of rechallenge after these complications has never been comprehensively assessed in controlled studies. Thus, clinical guidelines must rely on the published case reports. The number of such reports is likely to increase over time, and updated analyses of larger samples are needed, as they may lead to changes in clinical guidelines.

Study Questions:

How safe is the clozapine rechallenge after life-threatening adverse effects?

Study Design:

The published case reports of clozapine rechallenge were identified in a MEDLINE search. We added 121 cases reported from 2012 through 2017 to the 138 cases reported from 1972 through 2011 analyzed by us in a previous publication. The 95% confidence intervals (CIs) of the successful rechallenge rate were calculated for each adverse effect with at least 5 published case reports. The rechallenge was considered a valid clinical option when the lower end of the CI range was at least 50%.

Results:

A successful outcome was documented in 128/203 patients rechallenged after neutropenia (63.0%, CI, 56.0%–69.6%), 3/17 after agranulocytosis (17.7%, CI, 4.7%–44.2%), 11/17 after myocarditis (64.7%, CI, 38.6%–84.7%), and 7/7 after neuroleptic malignant syndrome (100%, CI, 56.1%–100%). Among the 15 patients with other clozapine-induced adverse effects, the rechallenge was successful in those with eosinophilia, cardiac complications other than myocarditis (QTc prolongation, pericarditis, cardiomyopathy, and atrial flutter), and gastrointestinal hypomotility. The rechallenge failed in patients who had developed pancreatitis or renal insufficiency.

Conclusion:

Clozapine rechallenge is a reasonable clinical option after return to baseline for patients who had developed neutropenia and neuroleptic malignant syndrome, but not after agranulocytosis or myocarditis. Data are insufficient to formulate rechallenge guidelines for any other clozapine-related adverse effects.
Molecular Classification of Grade 3 Endometrioid Endometrial Cancers Identifies Distinct Prognostic Subgroups
Authors: Bosse Tjalling , Nout Remi A. , McAlpine Jessica N. , McConechy Melissa K. , Britton Heidi , Hussein Yaser R. , Gonzalez Carlene , Ganesan Raji , Steele Jane C. , Harrison Beth T. , Oliva Esther , Vidal August , Matias-Guiu Xavier , Abu-Rustum Nadeem R. , Levine Douglas A. , Gilks C. Blake , Soslow Robert A.
Published: March 2018

Our aim was to investigate whether molecular classification can be used to refine prognosis in grade 3 endometrial endometrioid carcinomas (EECs). Grade 3 EECs were classified into 4 subgroups: p53 abnormal, based on mutant-like immunostaining (p53abn); MMR deficient, based on loss of mismatch repair protein expression (MMRd); presence of POLE exonuclease domain hotspot mutation (POLE); no specific molecular profile (NSMP), in which none of these aberrations were present. Overall survival (OS) and recurrence-free survival (RFS) rates were compared using the Kaplan-Meier method (Log-rank test) and univariable and multivariable Cox proportional hazard models. In total, 381 patients were included. The median age was 66 years (range, 33 to 96 y). Federation Internationale de Gynecologie et d'Obstetrique stages (2009) were as follows: IA, 171 (44.9%); IB, 120 (31.5%); II, 24 (6.3%); III, 50 (13.1%); IV, 11 (2.9%). There were 49 (12.9%) POLE, 79 (20.7%) p53abn, 115 (30.2%) NSMP, and 138 (36.2%) MMRd tumors. Median follow-up of patients was 6.1 years (range, 0.2 to 17.0 y). Compared to patients with NSMP, patients with POLE mutant grade 3 EEC (OS: hazard ratio [HR], 0.36 [95% confidence interval, 0.18-0.70]; P=0.003; RFS: HR, 0.17 [0.05-0.54]; P=0.003) had a significantly better prognosis; patients with p53abn tumors had a significantly worse RFS (HR, 1.73 [1.09-2.74]; P=0.021); patients with MMRd tumors showed a trend toward better RFS. Estimated 5-year OS rates were as follows: POLE 89%, MMRd 75%, NSMP 69%, p53abn 55% (Log rank P=0.001). Five-year RFS rates were as follows: POLE 96%, MMRd 77%, NSMP 64%, p53abn 47% (P=0.000001), respectively. In a multivariable Cox model that included age and Federation Internationale de Gynecologie et d'Obstetrique stage, POLE and MMRd status remained independent prognostic factors for better RFS; p53 status was an independent prognostic factor for worse RFS. Molecular classification of grade 3 EECs reveals that these tumors are a mixture of molecular subtypes of endometrial carcinoma, rather than a homogeneous group. The addition of molecular markers identifies prognostic subgroups, with potential therapeutic implications.
Next-generation Sequencing Reveals Recurrent Somatic Mutations in Small Cell Neuroendocrine Carcinoma of the Uterine Cervix
Authors: Xing Deyin , Zheng Gang , Schoolmeester John Kenneth , Li Zaibo , Pallavajjala Aparna , Haley Lisa , Conner Michael G. , Vang Russell , Hung Chien-Fu , Wu Tzyy-Choou , Ronnett Brigitte M.
Published: March 2018

Small cell neuroendocrine carcinoma (SCNEC) of the uterine cervix is a rare but extremely aggressive tumor. While high-risk human papillomavirus (HPV) is involved at an early stage of oncogenesis in many tumors, additional driving events have been postulated to facilitate the progression of SCNECs. Identification of oncogenic drivers could guide targeted therapy of this neoplasm. Clinicopathologic features of 10 cervical SCNECs are reported. Analyses included immunohistochemical evaluation of p16, p53, synaptophysin, and chromogranin expression; in situ hybridizations and polymerase chain reaction for high-risk HPV and/or HPV 18; and next-generation sequencing based on a 637-gene panel. The patients ranged in age from 28 to 68 years (mean, 45.6 y; median, 40.5 y). All tumors had diffuse p16 and synaptophysin expression. All but 1 tumor was positive for chromogranin (extent of staining ranged from focal to diffuse). HPV 18 was detected in 6 tumors and HPV 35 in 1 tumor. At least 1 driver mutation was detected in 8 tumors. Four cases harbored TP53 somatic mutations, 3 of which correlated with an aberrant p53 staining pattern. Four PIK3CA mutations (p.G106A, p.N345T, p.E545K, and p.E545D) were detected in 3 tumors, 2 of which also harbored TP53 mutations. Oncogenic driver mutations involving KRAS, Erbb2, c-Myc, NOTCH1, BCL6, or NCOA3 were detected in 4 tumors. Mutations in caretaker tumor suppressors PTEN, RB1, BRCA1, BRCA2, and ARID1B were also identified in 4 tumors that commonly coharbored activating oncogenic mutations. Targeted next-generation gene sequencing identified genetic alterations involving the MAPK, PI3K/AKT/mTOR, and TP53/BRCA pathways in SCNECs. The presence of genetic alterations that are amenable to targeted therapy in SCNECs offers the potential for individualized management strategies for treatment of this aggressive tumor.
Histopathologic Features of Postablation Tubal Sterilization Syndrome
Authors: Butnor Kelly J. , Bartlett Jamen R.
Published: March 2018

Postablation tubal sterilization syndrome (PATSS) is an uncommon complication of endometrial ablation in patients with antecedent tubal ligation characterized by cyclic pelvic pain. Recurrent tubal distention resulting from retrograde menstruation into occluded proximal fallopian tube segments by residual/regenerated cornual endometrial tissue is postulated to be the cause. Reports of PATSS have largely focused on the clinicoradiologic and operative findings. Detailed descriptions of the gross pathologic findings of PATSS are sparse and rarer still are examples in which the histologic manifestations are discussed. Three patients with a history of tubal ligation and subsequent endometrial ablation who underwent hysterectomy and bilateral salpingo-oophorectomy for pelvic pain were identified. A clinical suspicion of PATSS was conveyed to the pathologist at the time of initial pathologic examination in only 2 of the 3 cases. Pathologic findings in all 3 cases were similar and included hematosalpinx of the proximal fallopian tubes, intraluminal hemosiderotic material, mural hemosiderosis, and pseudoxanthomatous salpingitis featuring plical and mural lipofuscin-laden macrophages, along with inactive to attenuated endometrium with variable submucosal myometrial hyalinization/scarring compatible with postablative changes. The pathologic features, in conjunction with the appropriate clinicoradiologic findings, were interpreted as consistent with PATSS. PATSS complicates an estimated 5% to 10% of endometrial ablations, but is likely underreported due to a lack of awareness. Pathologists should consider PATSS in hysterectomy specimens that show postablative endometrial changes accompanied by hematosalpinx and pseudoxanthomatous salpingitis of the proximal segments of ligated fallopian tubes. To our knowledge, this is the first study to depict the histopathologic features of PATSS.
Inflammatory Myofibroblastic Tumor Associated With the Placenta
Authors: Ladwig Nicholas R. , Schoolmeester J. Kenneth , Weil Laura , Chapman Jocelyn S. , Zaloudek Charles , Umetsu Sarah E.
Published: March 2018

Inflammatory myofibroblastic tumor (IMT) is a neoplasm of intermediate malignant potential that only rarely involves the gynecologic tract. Several cases of IMT arising in various locations including the lung, bladder, trachea, and breast in association with pregnancy have been reported in the literature, and 3 cases involving the placenta have been previously described. We report 2 cases of IMT identified in association with pregnancy; the first was an intrauterine mass delivered entirely separate from the placenta and fetus, and the second was an incidental mass identified within the placental parenchyma following delivery. Short tandem repeat genotyping was used to compare tissue from the tumor and the placenta for both cases. Both tumors were determined to be of maternal origin, confirming that uterine IMTs may present within the placenta or as a separate mass following delivery. This demonstrates the utility of short tandem repeat genotyping in determining the origin of tumors presenting in association with the placenta.