bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of decompression range on decompression limit of cervical laminoplasty
Authors: Diao Yin-Ze , Yu Miao , Zhang Feng-Shan , Sun Yu , Wang Shao-Bo , Zhang Li , Pan Sheng-Fa , Liu Zhong-Jun , Li Wei-Shi
Published: March 2020

Backgrounds

Cervical posterior decompression surgery is used to relieve ventral compression indirectly by incorporating a backward shift of the spinal cord, and this indirect decompression is bound to be limited. This study aimed to determine the decompression limit of posterior surgery and the effect of the decompression range.

Methods

We retrospectively reviewed the data of 129 patients who underwent cervical open-door laminoplasty through 2008 to 2012 and were grouped as follows: C4–C7 (n = 11), C3–C6 (n = 61), C3–C7 (n = 32), and C2–C7 (n = 25). According to the relative location of spinal levels within a decompression range, the type of decompression at a given level was categorized as external decompression (ED; achieved at the levels located immediately external to the decompression range margin), internal decompression (ID; achieved at the levels located immediately internal to the decompression range margin), and central decompression (CD; achieved at the levels located in the center, far from the decompression range margin). The vertebral–cord distance (VCD) was used to evaluate the decompression limit. The C2–C7 angle and VCD on post-operative magnetic resonance images were analyzed and compared between groups. The relationship between VCD and decompression type was analyzed. Moreover, the relationship between the magnitude of the ventral compressive factor and the probability of post-operative residual compression at each level for different decompression ranges was studied.

Results

There was no significant kyphosis in cervical curvature (> −5°), and there was no significant difference among the groups (F = 2.091, P = 0.105). The VCD of a specific level depended on the decompression type of the level and followed this pattern: ED < ID < CD (P < 0.05). The decompression type of a level was sometimes affected by the decompression range. For a given magnitude of the ventral compressive factor, the probability of residual compression was lower for the group with the larger VCD at this level.

Conclusions

Our study suggests that the decompression range affected the decompression limit by changing the decompression type of a particular level. For a given cervical spinal level, the decompression limit significantly varied with decompression type as follows: ED < ID < CD. CD provided maximal decompression limit for a given level. A reasonable range of decompression could be determined based on the relationship between the magnitude of the ventral compressive factor and the decompression limits achieved by different decompression ranges.
Advances in the role of helper T cells in autoimmune diseases
Authors: Zhang Xiao-Mei , Liu Chun-Yan , Shao Zong-Hong
Published: March 2020

Autoimmune diseases are primary immune diseases in which autoreactive antibodies or sensitized lymphocytes destroy and damage tissue and cellular components, resulting in tissue damage and organ dysfunction. Helper T cells may be involved in the pathogenesis of autoimmune diseases under certain conditions. This review summarizes recent research on the role of helper T cells in autoimmune diseases from two aspects, helper T cell-mediated production of autoantibodies by B cells and helper T cell-induced activation of abnormal lymphocytes, and provides ideas for the treatment of autoimmune diseases. The abnormal expression of helper T cells promotes the differentiation of B cells that produce autoantibodies, which leads to the development of different diseases. Among them, abnormal expression of Th2 cells and T follicular helper cells is more likely to cause antibody-mediated autoimmune diseases. In addition, abnormal activation of helper T cells also mediates autoimmune diseases through the production of abnormal cytokines and chemokines. Helper T cells play an essential role in the pathogenesis of autoimmune diseases, and a full understanding of their role in autoimmune diseases is helpful for providing ideas for the treatment of autoimmune diseases.
Glucose-6-phosphate isomerase is associated with disease activity and declines in response to infliximab treatment in rheumatoid arthritis
Authors: Xu Jing , Zhang Xiao-Ying , Li Ru , Liu Jing , Ye Hua , Zhang Xue-Wu , Li Zhan-Guo
Published: March 2020

Background

Rheumatoid arthritis (RA), a systemic autoimmune disease characterized by synovial inflammation, can cause cartilage and bone damage as well as disability. The aim of this study was to explore whether serum glucose-6-phosphate isomerase (GPI) is correlated with disease activity and the value of GPI in the evaluation of infliximab treatment in patients with RA.

Methods

Sixty-two patients with RA who had an inadequate response to methotrexate (MTX) were enrolled in Peking University People's Hospital from July 1, 2016 to July 31, 2018. Infliximab (3 mg/kg, intravenous at weeks 0, 2, and 6 and then every 8 weeks) was administered to patients with stable background MTX therapy. Serum samples were obtained at baseline and week 18. Serum GPI levels were determined using enzyme-linked immunosorbent assay. The associations between serum GPI levels and clinical features were analyzed.

Results

Serum GPI was positively correlated with Disease Activity Score in 28 joints (DAS28), swollen joint count, tender joint count and C-reactive protein level (P < 0.001,P < 0.001,P < 0.001, andP = 0.033, respectively). The change of DAS28 in GPI-positive patients was greater than that in GPI-negative patients (P < 0.001). Compared with those for patients receiving MTX monotherapy at baseline, the GPI levels were significantly declined when MTX was combined with infliximab (P < 0.001).

Conclusion

Serum GPI is related to disease activity and clinical response to infliximab treatment.
Involvement of long non-coding RNAs in the pathogenesis of rheumatoid arthritis
Authors: Lao Min-Xi , Xu Han-Shi
Published: March 2020

Long non-coding RNA (lncRNA) plays a contributory role in rheumatoid arthritis (RA). In this review, we summarized the current findings of lncRNAs in RA, including cellular function and the potential mechanisms. Serum lncRNA levels are associated with serum proinflammatory cytokines and disease activity. LncRNAs regulate proliferation, migration, invasion and apoptosis of RA fibroblast-like synoviocytes (FLSs), modulate the differentiation of T lymphocytes and macrophages, and affect bone formation-destruction balance of chondrocytes. Besides, lncRNAs are involved in inflammation and cell motivation signaling pathways. In-depth research on lncRNAs may help elucidate the pathogenesis of RA and provides clues for novel treatment targets.
New Classification Schemata of Hypersensitivity Adverse Effects After Hyaluronic Acid Injections: Pathophysiology, Treatment Algorithm, and Prevention
Authors: Mikkilineni Radha , Wipf Angela , Farah Ronda , Sadick Neil
Published: March 2020

BACKGROUND

Side effects during hyaluronic acid (HA) injection are considered mild and reversible; however, an alarming trend of increased hypersensitivity reactions has recently been reported.

OBJECTIVE

The goal of this article is to review the hypersensitivity reactions reported in the literature and, in combination with the authors' experience, to create a classification system to sort the timing and clinical manifestations of these reactions, as well as a treatment schema to manage their clinical course.

METHODS

A literature search using PubMed, Ovid MEDLINE, and Embase databases was performed with no date restrictions. Search terms included “hyaluronic acid and hypersensitivity” and “hyaluronic acid and nodules.” Data analyzed included study type, number of subjects, HA filler type, injection location, adverse reaction, timing, treatment, and outcomes.

RESULTS

Thirty-six studies were identified, documenting hypersensitivity reactions to HA treatment. Twelve cases described events occurring within a week, 6 within a month, and 31 after a month of treatment. Combined with the authors' experience, a new classification system and management of hypersensitivity reactions to HA fillers is proposed of early (up to a week), intermediate (a week to a month), and late (over a month) hypersensitivity reactions.

CONCLUSION

The classification system proposed provides objective measurements and management options that can be helpful for physicians to navigate these hypersensitivity reactions and design treatment protocols that provide the best clinical outcomes for their patients.
Executive function after risk-reducing salpingo-oophorectomy in BRCA1 and BRCA2 mutation carriers: does current mood and early life adversity matter?
Authors: Shanmugan Sheila , Sammel Mary D. , Loughead James , Ruparel Kosha , Gur Ruben C. , Brown Thomas E. , Faust Jessica , Domchek Susan , Epperson C. Neill
Published: March 2020

Objective:

Despite the fact that negative mood and executive dysfunction are common after risk-reducing salpingo-oophorectomy (RRSO), occurring in up to a third of women, little is known about risk factors predicting these negative outcomes. Adverse childhood experiences (ACE) predict poorer health in adulthood and may be a risk factor for negative outcomes after RRSO. Given the complex relationship between early life stress, affective disorders, and cognitive dysfunction, we hypothesized that ACE would be associated with poorer executive function and that mood symptoms would partially mediate this relationship.

Methods:

Women who had undergone RRSO were included in the study (N = 552; age 30-73 y). We measured executive function (continuous performance task, letter n-back task, and Brown Attention Deficit Disorder Scale Score), exposure to early life stress (ACE questionnaire), and mood symptoms (Hospital Anxiety and Depression Scale). Generalized estimating equations were used to evaluate the association between ACE and executive dysfunction and the role of mood symptoms as a mediator in this relationship.

Results:

ACE was associated with greater severity of subjective executive dysfunction (adjusted mean difference [aMD] = 7.1, P = 0.0005) and worse performance on both cognitive tasks (continuous performance task: aMD = –0.1, P = 0.03; n-back: aMD = –0.17, P = 0.007). Mood symptoms partially mediated ACE associations with sustained attention (21.3% mediated; 95% CI: 9.3%-100%) and subjective report of executive dysfunction (62.8% mediated; 95% CI: 42.3%-100%).

Conclusions:

The relationship between childhood adversity and executive dysfunction is partially mediated by mood symptoms. These data indicate that assessing history of childhood adversity and current anxiety and depression symptoms may play a role in treating women who report cognitive complaints after RRSO.

Video Summary:

http://links.lww.com/MENO/A571.
Impact of Routine Rotavirus Vaccination in Germany
Authors: Marquis Adine , Koch Judith
Published: March 2020

Background:

Routine rotavirus (RV)-vaccination is recommended in Germany since August 2013. Five years later, we evaluated the recommendation by examining vaccine uptake and the impact on RV-gastroenteritis (RVGE) burden in all age groups and on intussusceptions in infants.

Methods:

We estimated RV-vaccine uptake in the 2014–2018 birth cohorts using statutory health insurance prescription data. For impact assessment, we analyzed RVGE-surveillance data of the German infectious diseases notification system. We compared age-specific RVGE-incidences of different severity between pre-vaccination (2005/06–2007/08) and routine vaccination period (2013/14–2017/18) calculating incidence rate ratios (IRR) using Poisson regression. To determine the effect on intussusception, we used hospital discharge data (2006–2017) and compared incidences between pre-vaccination and routine vaccination period using Poisson regression.

Results:

Vaccination coverage increased from 59% (2014) to 80% (2018). Incidences of RVGE-outpatient cases, RVGE-hospitalization and nosocomial RVGE among <5-year-olds decreased by 74% (IRR = 0.26; 95% CI: 0.26–0.27), 70% (IRR = 0.30; 95% CI: 0.30–0.31) and 70% (IRR = 0.30; 95% CI: 0.30–0.31), respectively. Incidence of RVGE-outpatient cases in age groups ineligible for RV-vaccination decreased by 38% (IRR 0.62; 95% CI: 0.61–0.63). Compared with the pre-vaccination period, incidence of intussusception in the first year of life decreased by 28% (IRR = 0.73; 95% CI: 0.68–0.79) while at age of the first vaccine-dose (7th–12th week of age) increase in incidence of intussusception was non-significant (IRR = 1.29; 95% CI: 0.93–1.78).

Conclusions:

Routine RV-vaccination is well accepted in Germany. Since implementation of routine RV-vaccination, RVGE significantly decreased in <5-year-olds and in non-vaccinated older age groups through herd protection. The decline of intussusceptions in the first life year suggests a potential vaccination-associated protection against gastrointestinal infections that might trigger intussusceptions. These encouraging results should be communicated to doctors and parents for further improvement of vaccine uptake and protection of more infants.
Transition Home
Authors: Bordelon Curry , Wood Tara , Johnson Margaret , Fogger Susanne
Published: March 2020

Background and Purpose

Opioid use disorder is an ever-expanding health epidemic affecting populations across the lifespan. Infants diagnosed with neonatal abstinence syndrome (NAS) often require additional resources while inpatient and after discharge to support ongoing NAS symptoms and improve outcomes. The purpose of this article is to highlight the need for a “safe plan of care” for infants with a history of NAS and provide evidence-based recommendations for providers.

Review of Current Practice

In response to the opioid crisis, legislative efforts were passed to enhance access to care and provide valuable resources for families and clinical providers. These efforts require the development of comprehensive plans of care that include assessment of the home environment along with specialized care and services. Despite active legislation, infants and families continue to lack adequate access to resources such as therapy, specialized nutritional support, developmental specialists, and financial support.

Evidence-Based Recommendations

An effective safe plan of care ensures that infants with a history of NAS are discharged to caregivers who are prepared, devoted, and responsive to the infants' needs. These essential components include responsive caregiving, safe and secure environments, appropriate nutrition, and health-promoting behaviors.

Conclusion and Implications

A review of current practice and evidence-based recommendations reveals essential components of a safe plan of care for infants with a history of NAS. By embracing the need for a comprehensive plan, providers can empathize with family needs and activate resources to promote healthy families and improve long-term outcomes of these infants.
Morning blood pressure surge and diastolic dysfunction in patients with masked hypertension
Authors: Yilmaz Samet , Nar Gökay , Til Aysen , Kaftan Asuman
Published: March 2020

Objectives

In this study, we evaluated the association between morning blood pressure surge (MBPS) levels and diastolic function parameters in patients with masked hypertension (MH).

Methods

A total of 92 patients with diagnosis of MH were enrolled in the study. Patients were divided into three groups according to their MBPS levels. Cardiac dimensions, left atrial volume and ejection fraction were determined by transthoracic echocardiography. A two-dimensional Doppler echocardiogram was performed to evaluate diastolic function parameters including transmitral E-wave and A-wave velocity, mitral annular E′ and A′ velocity, E wave deceleration time and isovolumic relaxation time.

Results

Mean MBPS value of the total study population was 25.1 ± 6.4 mmHg. When going from the lowest MBPS group to the higher MBPS groups; E velocity [0.75 (0.74–0.77) vs. 0.71 (0.69–0.73) vs. 0.68 (0.66–0.69) cm/s, respectively] E/A ratio [1.44 (1.40–1.48) vs. 1.35 (1.32–1.39) vs. 1.26 (1.23–1.29), respectively] and E′ velocity [0.114 (0.111–0.117) vs. 0.102 (0.100–0.105) vs. 0.093 (0.089–0.096) cm/s, respectively] were significantly decreased. E/E’ ratio [7.3 (6.9–7.7) vs. 6.6 (6.4–7.9), P = 0.002] and left atrial volume index [27.24 (25.5–28.9) vs. 21.90 (21.0–22.7) ml/m2, P < 0.001] were significantly higher in the highest MBPS tertile than the lowest tertile. There was a positive correlation between E/E’ ratio and MBPS values (r = 0.306, P = 0.003).

Conclusion

Increased MBPS levels were found to be related with deterioration of diastolic function parameters in patients with MH.
Validation of the BIOS BD240 home blood pressure monitor in a multi-racial, multi-morbid Canadian population according to the International Standards Organization 2018 Protocol
Authors: Ringrose Jennifer S. , Wood Peter W. , Diaz-Carvallo Fabiola , Wirzba Mira , Padwal Raj
Published: March 2020

Objective:

Assess the accuracy of the BIOS BD240 home blood pressure (BP) monitor and wide-range cuff according to the International Organization for Standardization (ISO) 2018 standard.

Methods:

Eighty-five subjects (aged ≥18 y) with arm circumferences between 24 and 43 cm were studied. Blinded, two-observer, mercury-based auscultation performed using a two-piece cuff chosen for upper arm size was used for reference measurements. Accuracy criteria 1 and 2 of the ISO standard were determined and Bland–Altman plots generated.

Results:

Sixty percent of the study sample was female and 42% had hypertension. Mean device-to-reference standard differences in SBP/DBP were 0.0 ± 6.2/−0.2 ± 6.3 for criterion 1 and 0.0 ± 4.8/−0.2 ± 5.8 for criterion 2.

Conclusion:

The BIOS BD240 passed the requirements of the American National Standards Institute/Association for the Advancement of Medical Instrumentation/ISO standard for both SBP and DBP and can be recommended for use.
State Policies for Prescription Drug Monitoring Programs and Adverse Opioid-related Hospital Events
Authors: Wen Katherine , Johnson Phyllis , Jeng Philip J. , Schackman Bruce R. , Bao Yuhua
Published: March 2020

Background:

State policies to optimize prescriber use of Prescription Drug Monitoring Programs (PDMPs) have proliferated in recent years. Prominent policies include comprehensive mandates for prescriber use of PDMP, laws allowing delegation of PDMP access to office staff, and interstate PDMP data sharing. Evidence is limited regarding the effects of these policies on adverse opioid-related hospital events.

Objective:

The objective of this study was to assess the effects of 3 PDMP policies on adverse opioid-related hospital events among patients with prescription opioid use.

Research Design:

We examined 2011–2015 data from a large national commercial insurance database of privately insured and Medicare Advantage patients from 28 states with fully operating PDMPs by the end of 2010. We used a difference-in-differences framework to assess the probabilities of opioid-related hospital events and association with the implementation of PDMP policies. The analysis was conducted for adult patients with any prescription opioid use, a subsample of patients with long-term prescription opioid use, and stratified by older (65+) versus younger patients.

Results:

Comprehensive use mandates were associated with a relative reduction in the probability of opioid-related hospital events by 28% among patients with any opioid and 21% among patients with long-term opioid use. Such reduction was greater (in relative terms) among older patients despite the lower rate of these events among older than younger patients. Delegate laws and interstate data sharing were associated with limited change in the outcome.

Conclusion:

Comprehensive PDMP use mandates were associated with meaningful reductions in opioid-related hospital events among privately insured and Medicare Advantage adults with prescription opioid use.
Biliary Atresia Patients With Successful Kasai Portoenterostomy Can Present With Features of Obliterative Portal Venopathy
Authors: Patel Kalyani R. , Harpavat Sanjiv , Khan Zahida , Dhingra Sadhna , Quintanilla Norma , Firan Mihail , Goss John
Published: March 2020

Objective:

Study of liver explants of biliary atresia (BA) patients with successful Kasai portoenterostomy (KP).

Methods:

Pathology and medical records of BA liver explants from January 2009 to June 2018 with successful KP were reviewed along with appropriate controls.

Results:

Fourteen out of 68 (20.6%) BA patients with LT had a successful KP. Median age at BA diagnosis, KP and LT was 60.5 days, 61 days, and 10 years, respectively, with conjugated bilirubin (c‐bil) normalizing at 12.5 weeks after KP. Advanced fibrosis was diffuse in 2/14 (14.3%) explants, limited to periphery in 11/14 (78.6%) and absent in 1. Hilar partial nodular transformation (PNT) was seen in 11 explants (78.6%) and diffuse nodular regenerative hyperplasia (NRH) in 2 (14.3%). Areas of PNT and NRH showed diffuse portal sclerosis (100%), complete and incomplete portal vein (PV) stenosis (100%), PV herniation (100%), hypervascular portal tracts (20%), periportal abnormal vessels (100%), abundant lymphatic collaterals (100%), mild medial hepatic arterial hypertrophy (100%), and delicate fibrous septae (100%). Extrahepatic PVs showed variable luminal occlusion with mean PV intima to full thickness ratio of 0.6 +/− 0.11; significantly higher than age‐matched noncirrhotic (n = 27, 0.08 +/− 0.09; P < 0.0001) and cirrhotic controls (n = 19, 0.34 +/− 0.2; P = 0.0015); and comparable to BA patients with failed KP (P = 0.82) and without KP (P = 0.04).

Conclusions:

BA patients with successful KP can present with obliterative portal venopathy (OPV). In the context of optimal bile drainage, portal hypertension may not be because of advanced parenchymal fibrosis but possibly because of OPV. Vascular abnormalities of the PV system should be investigated in BA patients.
Quality of Life and Severity of Symptom Differences Between Post Open Colectomy and Laparoscopic Colectomy in Colorectal Cancer Patients
Authors: Niu Shu-Fen , Cheng Sue-Yueh , Chin Chia-Hui
Published: March 2020

Background

Worldwide, colorectal cancer is the third most common cancer in men and the second in women. The main surgical methods for colorectal cancer patients include a conventional open colectomy and laparoscopic-assisted colectomy. Laparoscopic-assisted colectomy is associated with less blood loss, faster recovery of bowel function, and shorter hospital stays.

Objective

The aim of this study was to compare the quality of life and symptom severity in patients with colorectal cancer 1 month after conventional open colectomy or laparoscopic-assisted colectomy.

Methods

A comparative cross-sectional study design was conducted from September 2015 to May 2016. Participants were recruited through convenience sampling from the surgical outpatient department of a medical center in Northern Taiwan; 33 patients underwent each type of surgery.

Results

The laparoscopic-assisted colectomy group scored 9.39 points higher in quality of life and lower in symptom severity by 14.88 points than the conventional open colectomy group (P = .03 and P = .05, respectively). Both groups reported low symptom severity; “changes in bowel habits” was the symptom with the highest severity. The conventional open colectomy group had higher insomnia and worried about their future more than did the laparoscopic-assisted colectomy group.

Conclusions

Patients who received the laparoscopic-assisted colectomy procedure reported a better quality of life and lower symptom severity than those who received the conventional open colectomy surgical method.

Implications for Practice

Patients who will have a conventional open colectomy will likely need enhanced management of symptoms and attention to their quality of life.
Exercise Effects on Chemotherapy-Induced Peripheral Neuropathy
Authors: Kanzawa-Lee Grace A. , Larson Janet L. , Resnicow Kenneth , Smith Ellen Marie Lavoie
Published: March 2020

Background

No effective cures for chemotherapy-induced peripheral neuropathy (CIPN) are known; however, exercise may be beneficial.

Objective

The purpose of this review was to synthesize high-quality research publications reporting the effects of exercise on CIPN and related outcomes among people of all age groups who received neurotoxic chemotherapy.

Methods

PubMed, CINAHL, Scopus, PsycINFO, and SPORTDiscus databases were searched first between May and November 2016 and then again in April 2019 for all clinical trials and meta-analyses. Subsequent hand-searching continued through April 2019. Potential scientific bias was rigorously evaluated, using the CONSORT (Consolidated Standards of Reporting Trials) guidelines.

Results

Thirteen studies (7 randomized controlled trials, 6 quasi-experiments) were found that reported exercise effects in various adult CIPN populations (ie, mixed cancer types and stages, chemotherapy regimens and status, and CIPN presence and severity). No studies provided high-quality evidence; 2 studies provided moderate-quality evidence. Most studies (76.3%) evaluated combined aerobic, strength, and balance training interventions of varying dosages. The most commonly improved outcomes were CIPN, balance, and fitness. All 7 studies with an aerobic exercise component led to significant—most studies showing moderate to large—CIPN benefits.

Conclusions

Few studies—none of high quality or in child/adolescent populations—have evaluated exercise effects on CIPN. The exercise interventions, dosages, and settings have been too heterogeneous to identify the most beneficial intervention for other CIPN-related outcomes. However, aerobic exercise may be a key component of exercise interventions for CIPN.

Implications for Practice

Although promising, the empirical evidence is insufficient to definitively conclude that exercise interventions ameliorate CIPN.
Innovative Frontline Nurse Leader Professional Development Program
Authors: McGarity Tammy , Reed Charles , Monahan Laura , Zhao Meng
Published: March 2020

Frontline nurse leaders direct staff and unit systems while ensuring that quality, safe patient care is provided. It is unknown if frontline nurse leaders oriented with only on-the-job-training are competent and if a professional development program will improve their competencies. This project’s purpose was to measure self-assessed competencies, using the Nurse Manager Inventory Tool, of 38 frontline nurse leaders. This project used a quasi-experimental design and utilized pre- and postsurvey for evaluation purposes of a leadership development curriculum.
Using Simulation to Evaluate Nurse Competencies
Authors: Vanderzwan Kathryn J. , Schwind Julie , Obrecht Jennifer , O’Rourke Jennifer , Johnson Alexia Hieber
Published: March 2020

A multimodal nursing pedagogy utilizing simulation was incorporated into annual nurse competencies at a 465-bed academic medical center to translate into practice the required surveillance of a potentially septic patient and the necessary clinical decision-making. Pretest/posttest was used to determine knowledge retention from simulation. Nurses’ sepsis knowledge following simulation was improved. Simulation can provide long-term knowledge retention of sepsis for application into clinical practice and be a viable option for competency assessment for professional nurses.
Trends in Reported Sexual Behavior and Y-Chromosomal DNA Detection Among Female Sex Workers in the Senegal Preexposure Prophylaxis Demonstration Project
Authors: Roberts D. Allen , Hawes Stephen E. , Bousso Bao Mame D. , Ndiaye Anna Julienne , Gueye Daouda , Raugi Dana N. , Mane Moustapha , Mboup Aminata , Diouf Ousmane , Jones Fatima , Kane Coumba Toure , Sarr Moussa , Mboup Souleymane , Gottlieb Geoffrey S.
Published: March 2020

Background

Preexposure prophylaxis (PrEP) can reduce HIV acquisition among female sex workers (FSWs). However, changes in condomless sex frequency after PrEP initiation could reduce PrEP effectiveness when PrEP adherence is suboptimal as well as increase the risk of acquiring other sexually transmitted infections. Objective measures of condomless sex may be more accurate for determining changes in sexual behavior than self-reported measures.

Methods

We longitudinally measured self-reported condom use, number of clients, and presence of Y-chromosomal DNA (Yc-DNA) in vaginal swabs among 267 FSWs accessing PrEP at 4 clinics in Senegal between 2015 and 2016. We assessed trends in sexual behavior over time since PrEP initiation using generalized estimating equations and evaluated predictors of Yc-DNA detection.

Results

We found no increase in self-reported condomless sex with clients (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.89–1.00), main partners (OR, 0.99; 95% CI, 0.96–1.02), or Yc-DNA detection (OR, 0.99; 95% CI, 0.90–1.08) over time since initiation. Y-chromosomal DNA was detected in 34 (22%) of 154 swabs tested and in 15 (26%) of 58 swabs from FSW reporting consistent condom use among both clients and main partners. Self-reported condom use with clients or main partners did not predict Yc-DNA detection.

Conclusions

In a FSW PrEP demonstration project in Senegal, we found no evidence of risk compensation among FSWs on PrEP as measured by self-reported behavior or through Yc-DNA detection. Y-chromosomal DNA detection was frequently detected among FSWs reporting consistent condom use, highlighting limitations of self-reported sexual behavioral measures.
Automated Quantitation of CD8-positive T Cells Predicts Prognosis in Colonic Adenocarcinoma With Mucinous, Signet Ring Cell, or Medullary Differentiation Independent of Mismatch Repair Protein Status
Authors: Hartman Douglas J. , Frank Madison , Seigh Lindsey , Choudry Haroon , Pingpank James , Holtzman Matthew , Bartlett David , Bahary Nathan , Pantanowitz Liron , Pai Reetesh K.
Published: March 2020

Despite their association with DNA mismatch repair (MMR) protein deficiency, colonic adenocarcinomas with mucinous, signet ring cell, or medullary differentiation have not been associated with improved survival compared with conventional adenocarcinomas in most studies. Recent studies indicate that increased T-cell infiltration in the tumor microenvironment has a favorable prognostic effect in colonic adenocarcinoma. However, the prognostic effect of tumor-associated T cells has not been evaluated in histologic subtypes of colonic adenocarcinoma. We evaluated CD8-positive T-cell density in 259 patients with colonic adenocarcinoma, including 113 patients with tumors demonstrating mucinous, signet ring cell, or medullary differentiation, using a validated automated quantitative digital image analysis platform and correlated CD8-positive T-cell density with histopathologic variables, MMR status, molecular alterations, and survival. CD8-positive T-cell densities were significantly higher for MMR protein-deficient tumors (P<0.001), BRAF V600E mutant tumors (P=0.004), and tumors with medullary differentiation (P<0.001) but did not correlate with mucinous or signet ring cell histology (P>0.05 for both). In the multivariable model of factors predicting disease-free survival, increased CD8-positive T-cell density was associated with improved survival both in the entire cohort (hazard ratio=0.34, 95% confidence interval, 0.15-0.75, P=0.008) and in an analysis of patients with tumors with mucinous, signet ring cell, or medullary differentiation (hazard ratio=0.06, 95% confidence interval, 0.01-0.54, P=0.01). The prognostic effect of CD8-positive T-cell density was independent of tumor stage, MMR status, KRAS mutation, and BRAF mutation. Venous invasion was the only other variable independently associated with survival in both the entire cohort and in patients with tumors with mucinous, signet ring cell, or medullary differentiation. In summary, our results indicate that the prognostic value of MMR protein deficiency is most likely attributed to increased tumor-associated CD8-positive T cells and that automated quantitative CD8 T-cell analysis is a better biomarker of patient survival, particularly in patients with tumors demonstrating mucinous, signet ring cell, or medullary differentiation.
HEG1 Is a Highly Specific and Sensitive Marker of Epithelioid Malignant Mesothelioma
Authors: Naso Julia R. , Tsuji Shoutaro , Churg Andrew
Published: March 2020

Malignant mesothelioma can be difficult to distinguish from other malignancies, particularly non–small cell lung carcinomas (NSCLCs), without immunohistochemistry. However, conventional markers of mesothelial lineage all have variable degrees of cross-reactivity with other neoplasms, including NSCLCs, necessitating the use of multiple mesothelioma and carcinoma markers in every case for accurate diagnosis. A recently described monoclonal HEG homolog 1 (HEG1) antibody was proposed to be a specific marker for mesothelioma. Here we performed a large scale assessment of the SKM9-2 HEG1 antibody using tissue microarrays containing 69 epithelioid mesotheliomas, 32 sarcomatoid mesotheliomas, 167 NSCLCs, and 17 ovarian high-grade serous carcinomas. Strong membrane staining, usually diffuse, for HEG1 was seen in 65/69 (94%) epithelioid mesotheliomas, 0/60 pulmonary squamous cell carcinomas, 0/73 pulmonary adenocarcinomas, and 0/13 pulmonary large cell carcinomas. HEG1 showed staining in 14/32 (44%) sarcomatoid mesotheliomas compared with 0/21 sarcomatoid pulmonary carcinomas. Three of 17 (18%) high-grade serous carcinomas demonstrated membrane staining. Ten B3 thymoma whole sections were negative. On the microarrays, the conventional mesothelial markers calretinin, WT1, D2-40, and CK5/6 had sensitivities for epithelioid mesothelioma of 94%, 90%, 96%, and 91%, respectively. We conclude that HEG1 SKM9-2 antibody offers sensitivity comparable to conventional markers for epithelioid mesotheliomas, but provides considerably better specificity, such that the diagnosis of epithelioid mesothelioma versus NSCLC potentially could be confirmed with a combination of HEG1 and a suitable broad spectrum carcinoma marker such as claudin-4. HEG1 is specific but insensitive for separating sarcomatoid mesotheliomas from sarcomatoid lung carcinomas.
Glucocorticoid-Associated Demise of a Patient With Duchenne Muscular Dystrophy
Authors: Brahmsteadt Alexander E. , Bach John R. , Pishdad Reza , Cespedes Lissette , Pierucci Paola
Published: March 2020

We describe the clinical deterioration of a 26-yr-old man with Duchenne muscular dystrophy on oral daily high-dose deflazacort. Although this daily regimen was targeted to benefit ambulation and respiration, it resulted in premature death with lethal sequelae from liver failure, decubiti, diabetes mellitus, and morbid obesity. This case illustrates the need for further research weighing risk versus benefit of daily glucocorticoid therapy, specifically deflazacort, in Duchenne muscular dystrophy patients. Thus, curtailment of daily dosing to eliminate dire sequelae in patients living longer into adulthood than ever before is recommended.
Three-Dimensional Measurement of the Lateral Lip Element Sacrificed in Primary Repair of a Unilateral Cleft Lip
Authors: Fujimoto Hiroki , Morioka Daichi , Akamine Syuryo , Takagi Shinsuke , Tosa Yasuyoshi , Kadomatsu Koichi , Ohkubo Fumio
Published: March 2020

Background

In most children with a unilateral cleft lip (UCL), because lateral lip tissue on the cleft side is congenitally short, the lateral lip element should be appropriately excised during primary cheiloplasty so that symmetric nasolabial features are obtained after surgery. The purpose of this study was to measure how much of the lateral lip element is removed during primary cheiloplasty and compare the amount of sacrifice between different incision designs.

Methods

Preoperative 3-dimensional images of 50 infants with UCL were randomly selected. The incision designs of 3 representative techniques (Millard, Onizuka, and Fisher) were drawn on the images that were obtained before the primary repair. The lateral lip tissue excised by each technique was estimated as a percentage of the surface area of the sacrificed lateral lip to the entire lateral lip of the cleft side.

Results

In the case of incomplete UCL, the median values (range) were 3.2% (1.1%–5.9%), 11.6% (8.3%–20.1%), and 27.2% (15.1%–42.3%) for the Millard, Onizuka, and Fisher repairs, respectively. In cases of complete UCL, no sacrifice was needed for the Millard repair, whereas the median values (range) were 10.6% (5.2%–28.9%) and 22.5% (11.5%–48.6%) for the Onizuka and Fisher repairs, respectively. In Millard repair, the median values (range) of the lateral lip element that was resected before skin closure according to the “cut-as-you-go” policy were 5.8% (2.2%–11.8%) in cases with an incomplete UCL and 4.9% (2.7%–9.1%) in cases with a complete UCL.

Conclusions

Our study demonstrated that sacrifice of the lateral lip element was minimal in the Millard repair, whereas it could exceed 20% in the Fisher repair. However, additional sacrifice of the advancement flap was needed in the Millard-type repair. The ratio of the lateral lip sacrifice varied between patients. Although UCL repair techniques should not be evaluated with the sacrifice ratio, excessive sacrifice of the lateral lip tissue can complicate the secondary lip correction. We recommend that surgeons estimate preoperatively how much lateral lip element will be sacrificed with each incision design using a 3-dimensional image for each child with a UCL.
MiR-433 Regulates Myocardial Ischemia Reperfusion Injury by Targeting NDRG4 Via the PI3K/Akt Pathway
Authors: Cheng Hua , Yan Wei
Published: March 2020

Background and purpose:

Myocardial ischemia reperfusion (IR) injury is a serious issue in the treatment of myocardial infarction. MiR-433 is upregulated in myocardial IR injury, but its specific effects remain unclear. In this study, we explored the effect and mechanism of miR-433 in myocardial IR injury.

Methods:

The expression of miR-433 was measured by qRT-PCR. H9c2 cells were transfected with miR-433 mimic and inhibitor after exposure to HR, respectively. Cell viability was detected by MTT. Cell apoptosis was measured by flow cytometry. Protein expression was assessed by western blot. Dual-luciferase reporter assay was performed to assess the target reaction between miR-433 and NDRG4. In vivo rat model of IR was used, and antagomiR-433 was injected to IR rats.

Results:

The qRT-PCR results showed that miR-433 expression increased in H9c2 cardiomyocytes after exposure to HR. Transfection with miR-433 inhibitor significantly increased cell viability, reduced LDH and apoptosis, downregulated Bax level, and upregulated Bcl-2 level. In contrast, the miR-433 mimic significantly augmented the HR-induced effects. Dual-luciferase reporter assay and western blot analysis suggested that miR-433 directly targeted NDRG4. NDRG4 silencing abrogated the protection of miR-433 inhibition on HR injury in H9c2 cells. It also reversed PI3K/Akt pathway activation that was induced by miR-433 inhibition. MiR-433 inhibition significantly decreased CK-MB and LDH serum level in IR rats. And NDRG4, p-PI3K, and p-Akt protein expression was elevated by antagomiR-433 injection in vivo.

Conclusion:

MiR-433 regulated myocardial IR injury by targeting NDRG4 and modulating PI3K/Akt signal pathway.
PINK1 Activation and Translocation to Mitochondria-Associated Membranes Mediates Mitophagy and Protects Against Hepatic Ischemia/Reperfusion Injury
Authors: Gu Jian , Zhang Tao , Guo Jianrong , Chen Ke , Li Huili , Wang Jiliang
Published: March 2020

Hepatic ischemia/reperfusion (I/R) injury is a major concern in liver surgery settings. Mitochondria are critical targets or the origin of tissue injury, particularly I/R injury. Mitophagy, a selective form of autophagy, is a fundamental process that removes damaged or unwanted mitochondria for mitochondrial quality control, but its role in hepatic I/R remains unclear. In the present study, we investigated the role of mitophagy in hepatic I/R by focusing on PTEN-induced putative kinase 1 (PINK1). Livers from 10-week-old mice and primary hepatocytes were subjected to in vivo hepatic I/R and in vitro hypoxia-reoxygenation (H/R), respectively. Analyses of oxidative stress, immunoblotting, and ATP generation showed that hepatic I/R leads to mitochondrial damage. Dysfunctional mitochondria promoted reactive oxygen species (ROS) production and apoptosis. Hepatic I/R led to decreases in the mitochondrial proteins COX4 and TOM20 and mitochondrial DNA and increases in the autophagy-related indicators LC3 and P62, which indicates that hepatic I/R promotes mitophagy. We found that I/R also leads to endoplasmic reticulum stress, which has frequent signal communication with mitochondria through the mitochondria-associated membranes (MAMs). We showed that the mitophagy-related proteins Parkin, Beclin, optineurin were enhanced in hepatic I/R. No significant change is in PINK1 but it translocated to MAMs region to initiate mitophagy. The silencing PINK1 by shRNA in cultured primary hepatocytes reduced the level of H/R-induced mitophagy, leading to the accumulation of dysfunctional mitochondria during H/R, increased production of ROS, mitochondria-induced apoptosis, and eventually hepatocyte death. Taken together, these findings indicate that PINK1-mediated mitophagy plays a key role in mitochondrial quality control and liver cell survival during I/R.
The Effect of Washing of Stored Red Blood Cell Transfusion Units on Post Transfusion Recovery and Outcome in a Pneumosepsis Animal Model
Authors: van Manen Lisa , Maas Adrie , Roelofs Joris J.T.H. , Vlaar Alexander P.J. , van Bruggen Robin , Juffermans Nicole P.
Published: March 2020

Background:

Septic patients are often anemic, requiring red blood cell (RBC) transfusions. However, RBC transfusions are associated with organ injury. The mechanisms of RBC-induced organ injury are unknown, but increased clearance of donor RBCs from the circulation with trapping in the organs could play a role. We hypothesized that washing of RBCs prior to transfusion may reduce clearance and trapping of donor cells and thereby reduce organ injury.

Methods:

Sprague-Dawley rats were inoculated intratracheally with 107 colony-forming units (CFU) of Streptococcus pneumoniae or vehicle as a control and transfused with either a washed or standard (non-washed) biotinylated RBC transfusion from syngeneic rats. Controls received saline. Blood samples were taken directly after transfusion and at 24 h to calculate the 24 h post transfusion recovery (PTR). After sacrifice, flow cytometry was used to detect donor RBCs in organs and blood. The organs were histologically scored by a pathologist and CFUs in the lung and blood were counted.

Results:

The 24h-PTR was similar between healthy and pneumoseptic rats after a standard transfusion. In healthy rats, a washed transfusion resulted in a higher PTR and less accumulation of donor RBCs in the organs compared with a standard transfusion. However, during pneumonia, this effect of washing was not seen. Transfusion did not further augment lung injury induced by pneumonia, but washing decreased bacterial outgrowth in the lungs associated with reduced lung injury.

Conclusion:

In healthy recipients, washing increased 24h-PTR of donor RBCs and decreased trapping in organs. In pneumoseptic rats, washing reduced bacterial outgrowth and lung injury, but did not improve PTR.
Preoperative Opioid Use and Readmissions Following Surgery
Authors: Tang Ruiqi , Santosa Katherine B. , Vu Joceline V. , Lin Lewei A. , Lai Yen-Ling , Englesbe Michael J. , Brummett Chad M. , Waljee Jennifer F.
Published: March 2020

Objective:

To assess the association between preoperative opioid exposure and readmissions following common surgery.

Summary Background Data:

Preoperative opioid use is common, but its effect on opioid-related, pain-related, respiratory-related, and all-cause readmissions following surgery is unknown.

Methods:

We analyzed claims data from a 20% national Medicare sample of patients ages ≥ 65 with Medicare Part D claims undergoing surgery between January 1, 2009 and November 30, 2016. We grouped patients by the dose, duration, recency, and continuity of preoperative opioid prescription fills. We used logistic regression to examine the association between prior opioid exposure and 30-day readmissions, adjusted for patient risk factors and procedure type.

Results:

Of 373,991 patients, 168,579 (45%) filled a preoperative opioid prescription within 12 months of surgery, ranging from minimal to chronic high use. Preoperative opioid exposure was associated with higher rate of opioid-related readmissions, compared with naive patients [low: aOR=1.63, 95% CI=1.26–2.12; high: aOR=3.70, 95% CI=2.71–5.04]. Preoperative opioid exposure was also associated with higher risk of pain-related readmissions [low: aOR=1.27, 95% CI=1.23–1.32; high: aOR=1.62, 95% CI=1.53–1.71] and respiratory-related readmissions [low: aOR=1.10, 95% CI=1.05–1.16; high: aOR=1.44, 95% CI=1.34–1.55]. Low, moderate, and high chronic preoperative opioid exposures were predictive of all-cause readmissions (low: OR 1.09, 95% CI: 1.06–1.12); high: OR 1.23, 95% CI: 1.18–1.29).

Conclusions:

Higher levels of preoperative opioid exposure are associated with increased risk of readmissions after surgery. These findings emphasize the importance of screening patients for preoperative opioid exposure and creating risk mitigation strategies for patients.
Lymphovascular Infiltration, Not Depth of Invasion, is the Critical Risk Factor of Metastases in Early Colorectal Cancer
Authors: Rönnow Carl-Fredrik , Arthursson Victoria , Toth Ervin , Krarup Peter-Martin , Syk Ingvar , Thorlacius Henrik
Published: March 2020

Objective:

To identify clinical and histopathological risk factors of LNM in T1 CRC.

Summary of Background Data:

The requisite of additional surgery after locally resected T1 CRC is dependent on the risk of LNM. Depth of submucosal invasion is used as a key predictor of lymphatic metastases although data are conflicting on its actual impact.

Methods:

Retrospective population-based cohort study on prospectively collected data on all patients with T1 CRC undergoing surgical resection in Sweden, 2009–2017 and Denmark 2016–2018. The Danish cohort was used for validation. Potential risk factors of LNM investigated were; age, sex, tumor location, submucosal invasion, grade of differentiation, mucinous subtype, lymphovascular, and perineural invasion.

Results:

One hundred fifty out of the 1439 included patients (10%) had LNM. LVI (P < 0.001), perineural invasion (P < 0.001), mucinous subtype (P = 0.006), and age <60 years (P < 0.001) were identified as independent risk factors whereas deep submucosal invasion was only a dependent (P = 0.025) risk factor and not significant in multivariate analysis (P = 0.075). The incidence of LNM was 51/882 (6%) in absence of the independent risk factors. The Danish validation cohort, confirmed our findings regarding the role of submucosal invasion, LVI, and age.

Conclusions:

This is a large study on LNM in T1 CRC, including validation, showing that LVI and perineural invasion, mucinous subtype, and low age constitute independent risk factors, whereas depth of submucosal invasion is not an independent risk factor of LNM. Thus, our findings provide a useful basis for management of patients after local excision of early CRC.