bluuebunny/crossref_metadata_2025 huggingface dataset:
Pharmacological depletion of serotonin and norepinephrine with para-chlorophenylalanine and alpha-methyl-p-tyrosine reverses the antidepressant-like effects of adolescent caffeine exposure in the male rat
Authors: Turgeon Sarah M. , Abdulzahir Alifayaz , Hwang Kaylin , Sanford Jordan
Published: September 2020

Adolescent exposure to caffeine has been shown to decrease immobility in the forced swim test, suggesting and antidepressant-like effect of caffeine; however, studies have produced different results with regard to caffeine-induced active behaviors. The present study attempted to clarify the possible neurochemical mechanisms of caffeine’s action by selectively depleting norepinephrine with alpha-methyl-p-tyrosine or serotonin with para-chlorophenylalanine in two separate experiments and assessing the ability for caffeine to alter anxiety-like and depressive-like behavior. Caffeine-treated adolescent male rats were exposed to caffeine (0.25 g/L) in their drinking water beginning on P28. A-methyl-p-tyrosine, para-chlorophenylalanine, or saline were administered prior to light-dark, open field, and forced swim testing beginning on P45. Caffeine-induced reductions in immobility and increases in swimming in the forced swim test were reversed by both a-methyl-p-tyrosine and para-chlorophenylalanine. Caffeine-induced increases in crosses and rears were reversed by para-chlorophenylalanine but not alpha-methyl-p-tyrosine, whereas caffeine-induced increases in transitions in the LD test were reversed by alpha-methyl-p-tyrosine but not para-chlorophenylalanine. Taken together, these results suggest that caffeine-induced decreases in immobility in male rats requires both norepinephrine and serotonin as depletion of either prevents the induction of immobility by chronic caffeine.
Protocol for development of a core outcome set for menopausal symptoms (COMMA)
Authors: Kim Bobae V. , Iliodromiti Stamatina , Christmas Monica , Bell Robin , Lensen Sarah , Hickey Martha
Published: September 2020

Objective:

Menopause is the natural cessation of menstruation and may be accompanied by troublesome symptoms including hot flushes and night sweats (vasomotor symptoms) and genitourinary symptoms. Randomized trials evaluating the safety and effectiveness of interventions for these symptoms have reported a wide range of outcomes and used inconsistent measures. This variation precludes comparing and combining data from different trials. To overcome this limitation, we will develop a Core Outcome Set for Menopausal Symptoms.

Methods:

We will systematically review the literature to identify the outcomes reported in the interventional trials for vasomotor and genitourinary symptoms. This list will be entered into a two-round modified Delphi survey to be completed by clinicians, researchers, and consumers (women who have experienced menopause). Participants will score outcomes on a nine-point scale from “not important” to “critically important.” Representatives from each stakeholder group will then meet to discuss the results and finalize the Core Outcome Set. Ethics approval was not required as this was considered service evaluation and development. The study is registered with the Core Outcome Measures in Effectiveness Trials Initiative (http://www.comet-initiative.org/studies/details/917).

Results:

An agreed upon set of minimum outcomes and outcome measures will facilitate combining and comparing findings from future trials of treatments for menopausal symptoms.

Conclusions:

This Core Outcome Set will better enable women and clinicians to select effective treatments, improve the quality of trial reporting, reduce research wastage, and improve care for women with troublesome menopausal symptoms.

Video Summary:

http://links.lww.com/MENO/A633.
Acupuncture ameliorated vasomotor symptoms during menopausal transition: single-blind, placebo-controlled, randomized trial to test treatment efficacy
Authors: Soares Jose M. , Branco-de-Luca Alexandre C. , da Fonseca Angela M. , Carvalho-Lopes Ceci M. , Arruda-Veiga Eduardo C. , Roa Cristiane L. , Bagnoli Vicente R. , Baracat Edmund C.
Published: September 2020

Objectives:

This study aimed to evaluate the effects of acupuncture on women with vasomotor symptoms during the menopausal transition with the aid of the Kupperman-Blatt Menopausal Index.

Method:

Crossover, single-blind, sham-controlled trial with 100 women randomly divided into two groups of 50 participants each: G1 and G2. During the first 24 weeks of treatment, the G1 women received acupuncture and the G2 women were given sham acupuncture. The crossover was then applied: the G1 participants were given sham acupuncture, and the G2 participants received acupuncture for 24 more weeks.

Results:

The mean score of hot flashes of the group who first experienced acupuncture (G1) was statistically higher than that of the group that started with sham acupuncture (G2, P = 0.020). Also, both groups had similar mean scores in the middle of the study (both were receiving acupuncture). During the last 6 months of the study, after crossover, the values of G2 (acupuncture) were lower than those of G1 (sham acupuncture).

Conclusions:

Acupuncture treatment may mitigate hot flashes and other climacteric symptoms during the menopausal transition.

Video Summary:
http://links.lww.com/MENO/A641.
Unnecessary bilateral salpingo-oophorectomy at the time of hysterectomy and potential for ovarian preservation
Authors: Wong Jellena , Murji Ally , Sunderji Zahra , Chow Ovina , Shapiro Jodi , Wolfman Wendy , Shirreff Lindsay
Published: September 2020

Objective:

To evaluate predictors of bilateral salpingo-oophorectomy at hysterectomy and determine rate of unnecessary bilateral salpingo-oophorectomy.

Methods:

Retrospective review of hysterectomies at six Ontario, Canada hospitals from July 2016 to June 2018. Data was extracted from health records coding and electronic medical records. Of patients with concurrent bilateral salpingo-oophorectomy, age, preoperative diagnoses, surgical factors (presence of endometriosis/adhesions), and surgeon training (fellowship/no fellowship) were recorded. Chi-square tests compared indicated and nonindicated bilateral salpingo-oophorectomy cases based on preoperative diagnosis. Criteria for unnecessary bilateral salpingo-oophorectomy were: age under 51 years, benign preoperative diagnosis, and absence of intraoperative endometriosis and adhesions.

Results:

Concurrent bilateral salpingo-oophorectomy occurred in 749/2,656 (28%) cases with 509/749 (68%) indicated based on preoperative diagnosis. There was interhospital variation in rate of indicated bilateral salpingo-oophorectomy based on preoperative diagnosis (45.3%–76.9%, χ2
P < 0.001). Concurrent bilateral salpingo-oophorectomy at academic centers was more likely to have preoperative indications versus those at community hospitals (70% vs 63%, OR 1.42, 95% CI 1.02–1.97, P = 0.04). BSO performed by fellowship-trained surgeons were more likely to be indicated than those performed by generalists (75% vs 63%, OR 1.76, 95% CI 1.26–2.44, P = 0.001). Of patients without preoperative indications for bilateral salpingo-oophorectomy, 105/239 (44%) were under 51 years of age, of which 59 (58%) had no intraoperative endometriosis/adhesions. Ovarian preservation may have been reasonable in 8% (59/749).

Conclusions:

Concurrent bilateral salpingo-oophorectomy performed by generalists and at community hospitals was less likely to have preoperative indications. Ovarian preservation was potentially possible for 8%.
Age at menarche and cardiovascular health: results from the NHANES 1999-2016
Authors: Zheng Yi , Wen Tony S. , Shen Yun , Hu Hui
Published: September 2020

Objective:

Cardiovascular disease is the leading cause of death among women. Early menarche has been associated with many cardiovascular disease risk factors, but little is known about its associations with cardiovascular health (CVH) as defined by Life's Simple 7 (LS7). We aim to examine the associations between age at menarche and CVH.

Methods:

Data were obtained from the 1999-2016 National Health and Nutrition Examinations Survey (NHANES). CVH was assessed according to LS7 (ideal CVH: > 4 ideal CVH metrics, CVH score: ranging from 0 to 14). Weighted logistic regression was used after adjusting for sociodemographic factors. The interaction between age at menarche and age was also examined.

Results:

Among the 20,447 women included, 2,292 (11.2%) had ideal CVH. After adjusting for age, race/ethnicity, education, poverty income ratio, marital status, and birth year, significantly worse CVH was observed among women with early menarche (OR: 0.70, 95% CI: 0.60-0.82), and higher odds of ideal CVH were observed among those with late menarche (OR: 1.40, 95% CI: 1.21-1.62). Consistent results were observed for CVH score. Age significantly modifies the associations between age at menarche and CVH. Late menarche was significantly associated with ideal CVH among those aged 25-34 (OR: 1.64, 95% CI: 1.27-2.11) or 35-44 (OR: 1.73, 95% CI: 1.31-2.30), while the associations for early menarche were observed only among those aged 25-34 years (OR: 0.72, 95% CI: 0.53-0.97).

Conclusions:

Our findings suggested that early menarche is associated with worse CVH, especially among young women. Further efforts are warranted to confirm these findings.

Video Summary:

http://links.lww.com/MENO/A643.
A Solution for Iterative Determination of Patient Release Instructions for Fractionated Radionuclide Therapy
Authors: Otis Garrett
Published: September 2020

Introduction

For fractionated radionuclide therapy protocols that involve large activities administered within short periods of time, there is a lack of guidance concerning how patient release calculations should be performed.

Objectives

Present a solution for estimating the effective dose of individuals exposed to a patient undergoing fractionated radionuclide therapy; this is intended to be used for iterative determination of patient release instructions.

Methods

The effective dose of an individual in the vicinity of a patient is described by a piecewise function that is integrated over periods of time that are defined by several variables relevant to clinical planning of fractionated radionuclide therapy protocols. This solution is compared to a simpler calculation that treats all administrations as identical events.

Results

For the two compared methodologies, their equivalence for estimating effective dose depends on several variables. However, for protocols where the elimination time of the radionuclide is far smaller than the time between administrations, both methodologies produce essentially equal results.

Conclusion

The author recommends using the presented solution for iterative determination of patient release instructions if a simpler approach generates release instructions that are overly restrictive. Doing so will allow for less strict release instructions because the dose mitigation from repeated adherence to release instructions after each fraction, in addition to potential inpatient time after each fraction, will be taken into account. Lastly, a spreadsheet that incorporates the presented solution has been made freely available for download.
Clinical Detection and Recovery of Vestibular and Oculomotor Impairments Among Amateur Athletes Following Sport-Related Concussion: A Prospective, Matched-Cohort Study
Authors: Büttner Fionn , Howell David R. , Doherty Cailbhe , Blake Catherine , Ryan John , Delahunt Eamonn
Published: September 2020

Objective:

To (1) quantify the diagnostic accuracy of the vestibular/oculomotor screening (VOMS), and (2) determine the recovery of vestibular and oculomotor impairments exhibited by concussed athletes compared with nonconcussed athletes using the VOMS.

Setting:

Clinical assessment laboratory.

Participants:

Amateur athletes who were diagnosed with sport-related concussion by emergency department physicians, and non-concussed, control athletes.

Design:

Prospective, longitudinal study.

Main Measures:

Participants were assessed 1 week following sport-related concussion, upon clearance to return-to-sporting activity, and 2 weeks following return-to-sporting activity by a study investigator who administered the VOMS. We calculated test sensitivity, specificity, and positive and negative predictive values to estimate the diagnostic accuracy of the VOMS. We performed a mixed-design analysis of variance to assess differences in VOMS symptom scores reported by concussed athletes compared with control athletes.

Results:

Fifty concussion participants and 50 control participants completed the study. The VOMS demonstrated sensitivity and specificity of 96% and 46%, respectively, and produced positive and negative predictive values of 64% and 92%, respectively. The concussion group exhibited a significantly greater symptom provocation change score from baseline than the control group for all test domains of the VOMS only in the first week following concussion.

Conclusion:

The VOMS may be most useful as a clinical screening tool to rule out, rather than confirm, the presence of sport-related concussion. The VOMS may be appropriate to inform the recovery of vestibular and oculomotor impairments exhibited by concussed individuals over time.
Clinical Utility of the Patient Health Questionnaire–Adolescent in Adolescents With Traumatic Brain Injury
Authors: Zachar-Tirado Rachel , Chen Ziqi , Donders Jacobus
Published: September 2020

Objective:

To determine the clinical utility of the Patient Health Questionnaire–Adolescent (PHQ-A) in screening for depressive disorders in adolescents following traumatic brain injury (TBI).

Design:

Retrospective analysis of data collected as a part of routine clinical care over a period of 4 years.

Setting:

Regional rehabilitation facility.

Participants:

Adolescents (n = 101) with mild to moderate-severe TBI who were referred for an outpatient neuropsychological evaluation within 1 to 12 months postinjury.

Main Outcome Measures:

PHQ-A, PHQ-A_2 (2-item version), and Processing Speed Index (PSI) from the Wechsler scales of intelligence.

Results:

Both premorbid depressive disorder and PHQ-A scores predicted a postinjury diagnosis of depressive disorder, with a combined sensitivity of 0.91 and specificity of 0.59. PHQ-A_2 did not reach acceptable levels of sensitivity in predicting suicidal thoughts. PHQ-A scores did not add significantly to the prediction of PSI results after accounting for TBI severity.

Conclusions:

PHQ-A has clinical utility as a screening instrument for depressive disorders in outpatient adolescents with TBI when the cutoff for clinically significant concern is set at more than 4 and premorbid psychiatric history is also taken into account.
An update on the diagnosis and management of ocular sarcoidosis
Authors: Hwang De-Kuang , Sheu Shwu-Jiuan
Published: September 2020

Purpose of review

Ocular sarcoidosis is one of the most common causes of uveitis worldwide. The diagnosis and treatment of patients with ocular sarcoidosis remains challenging in some cases. It is important for clinicians to keep up to date with new diagnostic and treatment tools for this disease.

Recent findings

The International Workshop on Ocular Sarcoidosis diagnostic criteria were first proposed in 2009 and revised in 2017. The new criteria contained two parts: ocular presentation and systemic investigation. The diagnostic value of liver enzymes was reduced in the new criteria, whereas the value placed of lymphopenia and the CD4/CD8 ratio in bronchoalveolar lavage fluid were increased. Despite not being included in the criteria, recent studies have also highlighted the diagnostic value of serum soluble interleukin-2 receptors. Recent ophthalmologic imaging also provides useful insights for the differential diagnosis.

Many new treatments for ocular sarcoidosis have been developed in recent years. The introduction of biological immunomodulatory agents for uveitis treatment represents a big improvement. Antitumor necrosis factor-alpha antibodies, including adalimumab, have been proven to be effective for treating ocular sarcoidosis. Many studies have also suggested that other biological agents could be effective and well tolerated. Newer intravitreal dexamethasone and fluocinolone implants have been developed. Patients treated with these implants have experienced good and sustained control of their intraocular inflammation.

Diagnosis and treatment options for ocular sarcoidosis have changed over time. However, challenges still exist in some difficult patients. Future studies should focus on finding more sensitive biomarkers and developing more effective immunomodulatory treatments with longer efficacy and less side effects.
Streptococcus pneumoniae Peritonitis and Enterocolitis in a Previously Healthy Female
Authors: Krause Amanda J. , Angarone Michael P.
Published: September 2020

Streptococcus pneumoniae rarely causes peritonitis; however, it has been associated with peritonitis in 3 major populations: in those with immunocompromising conditions, in association with gastrointestinal disease or surgery, and in previously healthy adult women from a genitourinary source. We present a case of a previously healthy 40-year-old woman who presented with symptoms of gastroenteritis. Initial workup revealed multiple dilated, thick walled, and fluid-filled loops of small bowel and S. pneumoniae bacteremia. She rapidly developed multiloculated ascites, significant peritonitis, enterocolitis, and a pelvic abscess. Polymerase chain reaction of her pelvic abscess identified S. pneumoniae. The patient was treated with multiple paracenteses, abscess drain placement, and antibacterial therapy. This case is noteworthy given the rarity of S. pneumoniae peritonitis and the severity of the patient's presentation. It is important for clinicians to be aware of the virulence of S. pneumoniae and consider this disease in a previously healthy female patient with peritonitis.
Real-World Experience Using Cefpodoxime and Cefuroxime Axetil for Urinary Tract Infections at a Large Academic Medical Center
Authors: Bao Hongkai , Jen Shin-Pung , Chen Xian Jie (Cindy) , Siegfried Justin , Pham Vinh P. , Papadopoulos John , Dubrovskaya Yanina
Published: September 2020

Background

Cefpodoxime (CPD) and cefuroxime (CFX) are both oral cephalosporins indicated for urinary tract infection (UTI) treatment. Despite having lower renal excretion and higher risk of collateral damage compared with CFX, CPD is a third-generation cephalosporin (3GC) with broader gram-negative activity than CFX. The objective of this study was to assess the efficacy and safety of these 2 agents for UTI treatment in a real-world clinical setting.

Methods

A retrospective evaluation was conducted among adult patients who received CPD or oral CFX for UTI treatment between January 2013 and July 2018. The primary outcome was clinical cure. Secondary outcomes included rate of subsequent UTI, Clostridioides difficile infection, and detection of isolates resistant to 3GC within 90 days after treatment.

Results

A total of 747 patients were assessed for study inclusion, of which 295 patients met eligibility criteria (CPD n = 165, CFX n = 130). Clinical cure was 100% versus 98% for CPD versus CFX, P = 0.084. The rate of subsequent UTI for CPD versus CFX was 18% versus 16%, P = 0.647. There were no differences in development of Clostridioides difficile infection or 3GC resistance. After adjusting for multiple factors in multivariate analysis, chronic kidney disease and history of UTI within 180 days, but not the choice of oral cephalosporin, were independent predictors of subsequent UTI.

Conclusions

Cefpodoxime and CFX are both favorable treatment options for UTIs, with high rates of clinical cure and limited adverse effects.
Pasteurella multocida Mycotic Aortic Aneurysm in a Man After a Healed Canine Bite
Authors: Perez-Lopez Carlos Juan , Gompf Sandra G. , Cannella Anthony P. , Vega Vivian R.
Published: September 2020

Pasteurella multocida is most commonly associated with cat bites leading to skin and soft tissue infections, including joint and bone infections, with or without concomitant bacteremia. Mycotic aneurysm secondary to P. multocida bacteremia is a rare complication. However, because of its high morbidity and mortality, as well as the bacterium's high virulence and predilection for endothelium, this is an entity clinicians should be aware of. Because of limited data and very few reported cases in the literature, little is known regarding risk factors, clinical presentation, and treatment. All those cases presented insidiously and with nonspecific symptoms; therefore, a high degree of clinical suspicion is necessary to make the diagnosis. We present a case of an immunocompetent patient that presented with P. multocida bacteremia complicated by mycotic aneurysm of a native vessel. A review of the literature on the topic is also discussed.
Intraventricular Catheter-Associated Rothia mucilaginosa Bacteremia in a Neutropenic Patient
Authors: Li Monica , Lin Doris
Published: September 2020

Rothia mucilaginosa is a pleomorphic gram-positive coccobacilli found commensally in the nose and throat. Over the past several decades, it has been recognized as a rare cause of severely invasive disease in the immunocompromised. We present an uncommon case of neutropenic fever caused by R. mucilaginosa bacteremia with a recently placed Ommaya reservoir intraventricular catheter system as a potential nidus. The patient recovered after antibiotic and tbo-filgrastim therapy, as well as removal of the catheter.
Pulmonary Nocardiosis and Cryptococcosis Co-Infection in First Diagnosis of HIV Infection
Authors: Ungthammakhun Chutchawan , Nasomsong Worapong , Chueansuwan Worawong , Traipattanakul Junthima , Changpradub Dhitiwat , Wongchansom Kittisak
Published: September 2020

Pulmonary infections among patients with acquired immunodeficiency syndrome (AIDS) may be caused by more than 1 organism. Pulmonary nocardiosis co-infection with cryptococcosis among patients with AIDS was extremely rare and has never been reported. Here, we report a case of pulmonary co-infection with nocardiosis and cryptococcosis in a 54-year-old HIV-positive man presenting productive cough and constitutional symptoms. Bronchoalveolar lavage and lung biopsy culture were positive for Nocardia species and Cryptococcus neoformans. The patient was treated with cotrimoxazole plus ceftriaxone for Nocardia species and fluconazole for C. neoformans. Etiology of pulmonary infections among patients with AIDS may be caused by multiple organisms. Among patients with AIDS having chest radiographic abnormality, an aggressive diagnostic approach should be warranted to accurately diagnose and appropriately manage.
Boosting Perceived Customer Orientation as a Driver of Patient Satisfaction
Authors: Verleye Katrien , De Keyser Arne , Vandepitte Sophie , Trybou Jeroen
Published: September 2020

Objective:

Several hospitals have embraced customer orientation as a strategy to better meet patients' needs, desires, and wishes. This study therefore investigates how hospitals can boost the extent to which patients feel treated in a customer-oriented way by staff (hereafter, “perceived customer orientation”) and its implications for their satisfaction with the hospital.

Design:

A cross-sectional study of hospital staff's interpersonal skills (interpersonal quality) and the atmosphere and physical features of the hospital (environmental quality) as drivers of perceived customer orientation and its satisfaction implications.

Participants and Setting:

Two hundred eighty-nine patients in seven surgery wards and two day-surgery departments of a Belgian hospital.

Main Outcome Measures:

Perceived customer orientation and patient satisfaction.

Results:

Our results show that interpersonal and environmental qualities have a positive impact on perceived customer orientation, with the interpersonal skills of nursing staff having a greater effect than those of physicians. Perceived customer orientation, however, matters most for patient satisfaction when the nature of the service involves high-contact frequency.

Conclusions:

Interpersonal and environmental qualities may help to ensure that patients feel treated in a customer-oriented way, which improves patient satisfaction with the hospital.
A Refugee Child With Lead Poisoning
Authors: Rivers Lexis
Published: September 2020

A case study is presented of a refugee family and children presenting to the refugee clinic, with a positive result for lead toxicity. Clinical presentation and management of pediatric lead toxicity is discussed, and a literature review of refugee screening procedures for the state of California is examined, emphasizing the importance of continuity of care, case management, community resource utilization, and trauma-informed care.
Designing an Active Valvulated Outflow Conduit for a Continuous-Flow Left Ventricular Assist Device to Increase Pulsatility: A Simulation Study
Authors: Cusimano Valerio , Di Molfetta Arianna , Ferrari Gianfranco
Published: September 2020

The purpose of this work was to investigate, using a lumped parameter model, the feasibility of increasing the pulsatility of a continuous-flow ventricular assist device (VAD) by implanting an active valvulated outflow cannula. A lumped parameter model was adopted for this study. VAD was modeled, starting from its pressure-flow characteristics. The valvulated outflow conduit was modeled as an active resistance described by a square function. Starting from pathologic condition, the following simulations were performed: VAD, VAD and valvulated outflow conduit in copulsation and counterpulsation with different ratios between the VAD valve opening rate and the heart rate, and asynchrony work with the heart with different VAD valve opening intervals. The copulsation 1:1 configuration and the asynchrony 0.3s-close–0.7s-open configurations permit to maximize the hemodynamic benefits provided by the presence of the active VAD outflow valvulated conduit providing an increase of arterial pulsatility from 1.86% to 14.98% without the presence of left ventricular output. The presence of the active VAD valve in the outflow conduit causes a decrement of the left ventricular unloading and of VAD flow and, that can be counteracted by increasing the VAD speed without affecting arterial pulsatility. The valvulated outflow tube provides an increase in arterial pulsatility; it can be driven in different working modality and can be potentially applicable to all types of VADs. However, the valvulated outflow conduit causes a decrement of left ventricular unloading and of the VAD flow that can be counteracted, increasing the VAD speed.
Severe hyperphosphatasemia and severe acute respiratory syndrome coronavirus 2 infection in children
Authors: Tchidjou Hyppolite Kuekou , Caron Fiorella , Ferec Adeline , Braun Karine , Hery Loic , Castelain Sandrine , Romeo Bernard
Published: September 2020

It is now known that SARS-CoV-2 infection because of coronavirus is highly contagious and caused varying degrees of illness throughout the world. Hepatic dysfunction and the slight elevation of liver enzymes have been reported in cases of COVID-19 infection. Transient hyperphosphatasemia is a benign condition characterized by the elevation of serum alkaline phosphatase and the return to normal levels within weeks or months of first observation. We reported the first infant case of severe hyperphosphatasemia because of SARS-CoV-2 infection, in a 9-month-old child admitted to the Pediatric Covid-19 Unit of Amiens University Hospital. Given the hepatic tropism and COVID-19-related hyperinflammatory reactions, our case suggests that, an isolated severe hyperphosphatasemia in children with SARS-CoV-2 infection should increase the possibility of transient hyperphosphatasemia, even if is also demonstrated a classic natural history of the transient hyperphosphatasemia during viral infection, especially in SARS-CoV-2 infection.
Ultrathin biodegradable polymer sirolimus-eluting stent versus contemporary durable polymer everolimus-eluting stent for percutaneous coronary intervention: a meta-analysis of randomized trials
Authors: Sethi Ankur , Kodumuri Vamsi , Prasad Vinoy , Kassotis John
Published: September 2020

Introduction

Improvements in coronary drug-eluting stent technology has focused on reducing the long-term complications associated with the effects of the residual footprint on the vessel wall. Although many of the newer stents have exhibited noninferiority to the durable polymer everolimus-eluting stent (DP-EES), they have yet to exhibit clear superiority. We compared the performance of the latest ultrathin strut biodegradable polymer sirolimus-eluting stents (BP-SES) to DP-EES.

Methods

We searched the electronic databases for randomized controlled trials comparing BP-SES to DP-EES. A random effect meta-analysis was performed using the Poisson regression model. The primary end point was target lesion failure (TLF), a composite of target vessel myocardial infarction (TVMI), cardiac death and target lesion revascularization (TLR).

Results

There was no difference between the stents in stent thrombosis [incidence rate ratio (IRR) = 0.79, 95% confidence interval (CI) 0.58–1.06), TLR (IRR = 0.88, 95% CI 0.57–1.38), TVMI (IRR = 0.79, 95% CI 0.61–1.01), cardiac death (IRR = 0.99, 95% CI 0.76–1.29) and target vessel failure (IRR = 0.82, 95% CI 0.64–1.06). In addition, there was no difference in TLF (IRR = 0.82, 95% CI 0.64–1.06). There was evidence of reduced TLF in small vessels with BP-SES based on definition used (defined as ≤2.75 mm; IRR 0.64, 95% CI 0.46–0.91 versus ≤3 mm; IRR 1.11, 95% CI 0.90–1.36).

Conclusion

In our study, the performance of the latest generation BP-SES was comparable to DP-EES but failed to show superiority. The possible benefit in patients with small vessels should be explored future trials.
SMAD4-Expressing Pancreatic Ductal Adenocarcinomas Have Better Response to Neoadjuvant Therapy and Significantly Lower Lymph Node Metastasis Rates
Authors: Kassardjian Ari , Wang Hanlin L.
Published: September 2020

Objective

For many patients whose pancreatic ductal adenocarcinoma (PDAC) is locally advanced, neoadjuvant therapy has been proposed as a way to decrease tumor burden. Pancreatic ductal adenocarcinoma is generally thought to be resistant to chemotherapy and radiation, however, response to neoadjuvant therapy in PDAC has been described in a subset of patients. The SMAD4 status is considered to be an important molecular feature which distinguishes two subsets of PDAC, SMAD4-positive and -negative tumors. The objective of this study was to evaluate the neoadjuvant treatment response rate as well as compare the different clinicopathologic variables between SMAD4-positive and -negative tumors.

Methods

We analyzed the data of patients who underwent surgical resection for PDAC from 2009–2019. Our cohort from a single institution included 233 patients.

Results

Of the 233 cases, 143 (61.4%) were SMAD4-negative and 90 (38.6%) were SMAD4-positive. Overall, SMAD4-positive tumors with neoadjuvant therapy had better treatment response and better tumor regression scores. In addition, SMAD4-positive tumors had a significantly lower lymph node metastasis rate in both the neoadjuvant and nonneoadjuvant setting.

Conclusions

Further characterization of the role of SMAD4 within the context of neoadjuvant therapy will lead to improved personalized therapeutic strategies.
Inflammatory Bowel Diseases Elevate the Risk of Developing Acute Pancreatitis
Authors: Tél Bálint , Stubnya Bence , Gede Noémi , Varjú Péter , Kiss Zoltán , Márta Katalin , Hegyi Péter Jenő , Garami András , Hegyi Eszter , Szakács Zsolt , Hegyi Péter , Veres Gábor
Published: September 2020

Objectives

Increasing data suggest that acute pancreatitis (AP) occurs more frequently among patients with inflammatory bowel diseases (IBDs) than in the non-IBD population; however, currently no comprehensive meta-analysis is available.

Methods

Systematic literature search was conducted in 4 major databases. We included observational studies sampling from the general population. Basic study characteristics and crude incidences of AP were extracted. Pooled odds ratios (ORs) with 95% confidence interval (CIs) were calculated using the random-effects model. Subgroups were set up by Crohn disease and ulcerative colitis. Heterogeneity was tested with I
2 statistics.

Results

Eight studies were eligible for the analysis. The odds of AP were 3 times higher in IBD (OR, 3.11; 95% CI, 2.93–3.30; I
2, 0.0%), significantly higher in Crohn disease than in ulcerative colitis (P < 0.001; OR, 4.12 vs OR, 2.61; I
2, 0.0%). The pooled annual incidence of AP in IBD was 210/100,000 person-years (95% CI, 84–392/100,000 person-years; I
2, 98.66%).

Conclusions

We confirmed that IBD elevates the risk of AP and of 100,000 IBD patients 210 AP cases are to be expected annually. Therefore, it is important to include pancreatic enzyme level measurements and radiological investigations in the workup of IBD patients with acute abdominal pain.
Real-world Evidence of Diffusion-weighted Imaging Combined With Magnetic Resonance Cholangiopancreatography for Pancreatic Tumor Screening
Authors: Fukuba Nobuhiko , Ishitobi Hitomi , Takahashi Yoshiko , Nagaoka Makoto , Fukuhara Hiroyuki , Yuki Mika , Komazawa Yoshinori , Kuroda Hiroyuki , Sato Shuichi , Shizuku Toshihiro
Published: September 2020

Objectives

The aim was to clarify the sensitivity and specificity of diffusion-weighted imaging, as well as of that in combination with magnetic resonance cholangiopancreatography for pancreatic tumor diagnosis in real-world clinical setting.

Methods

Subjects were 217 consecutive patients who underwent both magnetic resonance imaging and contrast-enhanced ultrasound sonography. Cases positive for a pancreatic tumor were confirmed based on pathological diagnosis, whereas negative cases were defined when no solid pancreatic tumor was detected by contrast-enhanced ultrasound sonography or a solid mass was detected but the diagnosis was ultimately denied based on pathological results. Diffusion-weighted imaging-positive was defined as a case with high signals and magnetic resonance cholangiopancreatography-positive when localized main pancreatic duct stenosis with caudal dilation was detected.

We calculated sensitivity and specificity of each modality and those in combination based on sequential use for pancreatic tumor diagnosis.

Results

Diffusion-weighted imaging showed a sensitivity of 94.4% and specificity of 94.5%, whereas those values for magnetic resonance cholangiopancreatography alone were 83.3% and 99.0%, respectively, and for the modalities in combination were 100% and 94.5%, respectively.

Conclusions

Diffusion-weighted imaging was more sensitive than magnetic resonance cholangiopancreatography, whereas those used in combination resulted in increased sensitivity.
Efficacy and Safety of Early Systemic Anticoagulation for Preventing Splanchnic Thrombosis in Acute Necrotizing Pancreatitis
Authors: Zhou Jing , Zhang He , Mao Wenjian , Ke Lu , Li Gang , Ye Bo , Zhang Jingzhu , Lin Jiajia , Gao Lin , Tong Zhihui , Li Weiqin
Published: September 2020

Objectives

Splanchnic venous thrombosis (SVT) is a relevant complication in patients with acute necrotizing pancreatitis. So far, no specific treatment for preventing development of SVT exists, and the effect of systemic anticoagulation (SAC) is unclear.

Methods

Patients with acute necrotizing pancreatitis admitted to our center within 7 days from onset of abdominal pain were screened. In the historic group, during which period, most patients received no SAC. Patients in the study group received SAC therapy considering the risk of deep vein thrombosis and SVT. The primary outcome measure was the incidence of SVT.

Results

Splenic vein was involved in 71% of all 84 SVT patients. Compared with the historic cohort, patients who received SAC experienced lower incidence of SVT (P < 0.001), especially for splenic venous thrombosis (P = 0.002). Patients in the study group also showed lower mortality (P = 0.04) and incidence of new-onset organ failure (P = 0.03). The incidence of bleeding shows no statistical significance between 2 groups.

Conclusions

Application of SAC seems to reduce the incidence of SVT and improve clinical outcomes without increasing the risk of bleeding. Randomized clinical trials are needed to confirm our findings.
Adipose Tissue From Type 1 Diabetes Mellitus Patients Can Be Used to Generate Insulin-Producing Cells
Authors: Ikemoto Tetsuya , Tokuda Kazunori , Wada Yuma , Gao Luping , Miyazaki Katsuki , Yamada Shinichiro , Saito Yu , Imura Satoru , Morine Yuji , Shimada Mitsuo
Published: September 2020

Objectives

We aimed to determine whether responsive insulin-producing cells (IPCs) could be generated from adipose-derived stem cells (ADSCs) isolated from patients with type 1 diabetes mellitus (T1DM).

Methods

We isolated ADSCs from adipose tissue of 4 patients (one patient with T1DM and 3 nondiabetic patients), who underwent surgery and differentiated them into IPCs with using a 2-step xeno-antigen free, 3-dimensional culture method. Characteristics of isolated ADSCs, in vitro cell quality, programmed cell death ligand-1 (PDL-1) expression, and transplantation into streptozotocin induced diabetic nude mice were investigated.

Results

Adipose-derived stem cells from T1DM patients and commercially obtained ADSCs showed the same surface markers; CD31−CD34−CD45−CD90+CD105+CD146−. Moreover, the generated IPCs at day 21 demonstrated appropriate autonomous insulin secretion (stimulation index, 3.5; standard deviation, 0.8). Nonfasting blood glucose concentrations of IPC-transplanted mice were normal at 30 days. The normalized rate of IPC-transplanted mice was significantly higher than that of the sham-operated group (P < 0.05). Insulin-producing cells generated from T1DM adipose tissue expressed high levels of PDL-1.

Conclusions

Insulin-producing cells obtained from adipose tissue of T1DM patients are capable of secreting insulin long-term and achieve normoglycemia after transplantation. Expression of PDL-1 suggests the potential for immune circumvention.
Acute Phase Response and Postprocedural Evaluation of Open and Laparoscopic Cryoablation Procedures in Porcine Pancreases
Authors: Imai Shunichi , Kitago Minoru , Matsuda Sachiko , Nakamura Yuki , Shinoda Masahiro , Yagi Hiroshi , Abe Yuta , Fujita Yusuke , Nakano Yutaka , Iwata Kansei , Nakatsuka Seishi , Kitagawa Yuko
Published: September 2020

Objectives

Cryoablation is a potentially less invasive locoregional ablation modality. Although cryoablation has been used to treat malignancy in various organs, a limited application of this modality in the pancreas has been reported.

Methods

Acute phase response assessments and postprocedural course evaluations of 2 experimental locoregional ablation methods were conducted. In one method, open and laparoscopic cryoablation of a porcine pancreas using an argon-helium gas–based cryoablation system and monitoring of tissue temperature during the procedure were performed. In the other method, open cryoablation of a porcine pancreas using liquid nitrogen was performed. The animals were evaluated postoperatively.

Results

The size of the cryolesion was larger in the second treatment than in the first. Laparoscopic cryoablation was associated with the formation of an iceball, which possibly affected the surrounding structures. The ablated region was adequately cooled with 10 minutes of freeze/repeat cycles. The area cooled to a temperature of less than −40°C was approximately half the size of the cryolesion in diameter. The swine used for the evaluation of the postprocedural course survived 3 weeks after the procedure with a temporal elevation of the serum lipase level.

Conclusions

Cryoablation of the pancreas was experimentally practicable without severe complications under direct or laparoscopic vision.
Surveillance of Lung Cancer and Mesothelioma Patients With Noncurative Treatment Intent
Authors: Fraser Anne , McNeill Rob
Published: September 2020

Background

Lung cancer patients with advanced disease and no active treatment options currently face frequent follow-up visits to outpatient clinics, associated with significant anxiety, time commitment, and costs. Visits also place considerable strain on the health system. Evidence from other cancers and chronic health conditions suggests virtual or remote follow-up can lead to higher patient satisfaction without negatively impacting health outcomes such as survival time.

Objective

The aim of this review was to identify patient preferences for, and any evidence of relative effectiveness of, different surveillance protocols for patients who have noncurative treatment intent for lung cancer or mesothelioma.

Interventions/Methods

MEDLINE, PubMed, and CINAHL Plus databases were searched for articles published between 1998 and June 2018. The search was restricted to English-language publications and included all original research.

Results

Nine studies met the inclusion criteria, with most studies being retrospective. Findings identified the need for reassurance and hope as part of surveillance, the importance of trust and relationship, and the lack of consistency and evidence around frequency and method of surveillance models.

Conclusions

Current surveillance is based on expert opinion with little consideration of patient preferences, quality of life, impact on anxiety, and impact on survival outcomes.

Implications for Practice

Nurses play a key role in managing surveillance programs for noncurative lung cancer patients. Programs should be built using codesign approaches to ensure best outcomes. Further research needs to be conducted, ensuring directed surveillance models that meet the holistic needs of patients.
Feeding a Person With Advanced Alzheimer’s Disease
Authors: Clifton Margaret , Johnstone William Miller , Kolasa Kathryn M.
Published: September 2020

We update our 2011 discussion of feeding the person with late-stage or advanced Alzheimer’s disease (advanced AD). We present a case of a 92-year-old woman diagnosed with AD, from our family medicine practice who was brought to the emergency department with fever and a change in mental status. Previously, neither she nor her family had received counseling about the typical trajectory of AD, nor had she made end-of-life plans. We present a discussion of the typical trajectory of AD, involuntary weight loss, advance care planning related to nutrition, and hydration and alternatives to tube feeding. We added a note describing the initial impact of COVID-19 on care.
Adenomatoid Tumor of the Uterus: A Report of 6 Unusual Cases With Prominent Cysts Including 4 With Diffuse Myometrial Involvement, 4 With Uterine Serosal Involvement, and 2 Presenting in Curettage Specimens
Authors: Lerias Sofia , Ariyasriwatana Chai , Agaimy Abbas , Erber Ramona , Young Robert H. , Oliva Esther
Published: September 2020

We evaluated the clinicopathologic features of 6 adenomatoid tumors of the uterus with unusual features. All the tumors differed grossly from the usual adenomatoid tumor, typically being ill-defined and occupying >50% of the myometrium, essentially replacing it in 4. The neoplasm extended to the endometrium in 2 cases and in one of these it formed an intracavitary mass; in both the tumor was first diagnosed in a curettage. In the other 4 cases, the adenomatoid tumor was discovered in a hysterectomy specimen performed for irregular vaginal bleeding (3 patients), and the finding of a pelvic mass on a computed tomography scan in a patient with right lower quadrant pain. The tumors extended to the uterine serosa in the form of small grape-like vesicles or cysts in 4 cases. All tumors contained the typical small often irregularly shaped spaces but also had prominent cysts. When cysts involved the serosa, the microscopic appearance mimicked that of peritoneal inclusion cysts. In one case with serosal involvement, a prominent papillary pattern was also present. The cysts were typically closely packed with minimal intervening stroma but were occasionally separated by conspicuous smooth muscle bundles. The stroma in one case was extensively hyalinized. Two tumors were focally infarcted. A striking, but minor, solid growth in which the tumor cells were arranged in tightly packed nests or interanastomosing cords and trabeculae was seen in 2 tumors. The unusual gross and microscopic features of these tumors can cause significant diagnostic difficulty and bring into the differential diagnosis entities that are usually not realistic considerations. The presentation of 2 tumors in a curettage specimen represents an unusual clinical aspect.
Ovarian Extravascular Papillary Endothelial Hyperplasia (Masson Tumor) Mimicking a Primary Gynecologic Malignancy
Authors: Sherring Kate , Foot Oliver , Barton Desmond P. , Vroobel Katherine M.
Published: September 2020

Papillary endothelial hyperplasia or Masson tumor most commonly occurs within the extremities and head and neck. It is usually of intravascular type, associated with thrombus formation and organization within a preexisting vessel or vascular malformation, but rarely can be extravascular. We describe the first 2 cases of this extravascular type to occur within the ovary, one of which mimicked malignancy radiologically. This condition is thought to represent a reactive phenomenon with reparative response secondary to thrombosis although with an unclear underlying pathogenesis. The prognosis is generally good, with complete surgical resection usually representing adequate treatment.
Impact of COVID–19-Related Stress and Lockdown on Mental Health Among People Living With HIV in Argentina
Authors: Ballivian Jamile , Alcaide Maria L. , Cecchini Diego , Jones Deborah L. , Abbamonte John M. , Cassetti Isabel
Published: September 2020

Background:

The spread of severe acute respiratory syndrome coronavirus 2, causative agent of the coronavirus disease 2019 (COVID-19), has necessitated widespread lockdown to mitigate the pandemic. This study examines the influence of resilience on the impact of COVID-related stress and enforced lockdown on mental health, drug use, and treatment adherence among people living with HIV (PLWH) in Argentina.

Setting:

PLWH residing predominantly in Buenos Aires Metropolitan Area and urban regions of Argentina were identified from a private clinic electronic database.

Methods:

Participants completed an anonymous online survey to evaluate the impact of COVID-19 on economic disruption, resilience, mental health outcomes (depression, anxiety, stress, and loneliness), adherence to HIV treatment, and substance use. We performed ordinary least squares and logistic regressions to test whether resilient coping buffered the impact of economic disruption on mental health and drug use during quarantine.

Results:

A total of 1336 PLWH aged 18–82 were enrolled. The impact of economic disruption on mental health ΔF(1,1321) = 8.86,P= 0.003 and loneliness ΔF(1,1326) = 5.77,P= 0.016 was buffered by resilience. A 3-way interaction between resilient buffering, stress, and sex was significant ΔF(1,1325) = 4.76,P= 0.029. Participants reported less than excellent adherence to medication (33%), disruption to mental health services (11%), and disruption to substance abuse treatment (1.3%) during lockdown.

Discussion:

The impact of COVID-stress and lockdown on emotional distress seemed mitigated by resilience coping strategies, and the buffering impact of resilience on perceived stress was greater among women. Results highlight PLWH's capacity to adhere to treatment in challenging circumstances and the importance of developing resilience skills for better coping with stress and adversity.