bluuebunny/crossref_metadata_2025 huggingface dataset:
POSTCATARACT ENDOPHTHALMITIS TREATED WITH SMALL GAUGE VITRECTOMY
Authors: Fassbender Janelle M. , Jusufbegovic Denis , Schaal Shlomit
Published: May 2016

Purpose:

To discuss the use of minimally invasive, small gauge vitrectomy for acute postcataract endophthalmitis in patients with better than light-perception vision. Patient: 71-year-old man presented with redness, pain, and decreased vision of his left eye 11 days after cataract extraction. His visual acuity was counting fingers at 1 foot and slit-lamp examination revealed severe conjunctival injection, corneal edema, and hypopyon. The clinical impression was of acute postcataract endophthalmitis.

Methods:

Patient was taken for immediate vitrectomy with simultaneous vitreous tap for culture, PCR, and injection of intravitreal vancomycin and ceftazidime.

Results:

Culture and PCR of vitreous sample were positive for Staphylococcus epidermidis. Vision improved to 20/20 1 month postoperatively with complete resolution of vitreous inflammation and retinal vasculitis.

Conclusion:

In postcataract endophthalmitis with dense vitritis and diffuse retinal vasculitis, immediate, 25-gauge vitrectomy may result in return of baseline visual acuity.
Influence of Apical Clearance on Mini-Scleral Lens Settling, Clinical Performance, and Corneal Thickness Changes
Authors: Esen Fehim , Toker Ebru
Published: May 2016

Purpose:

The purpose of this work was to define the timing and magnitude of scleral contact lens settling, the factors influencing settling, and to examine whether the amount of apical clearance has an impact on clinical performance or is associated with hypoxia-induced corneal changes.

Methods:

Eleven patients (22 eyes) with keratoconus were fitted with a mini-scleral lens (Esclera, Brazil). Three different lenses with successively greater sagittal depths were applied to achieve 3 levels of initial apical clearance: 100 to 200 μm (low), 200 to 300 μm (medium), and greater than 300 μm (high). Corneal apical clearance was measured at 15 min, 1, 2, 4, 6, and 8 hr with optical coherence tomography (OCT). Central corneal thickness was measured with OCT and Pentacam, in the morning and immediately after removal of the contact lens.

Results:

Mean settling was 26.8±18.8 μm (42.7%) at 1 hr, 39.5±26.5 μm (62.9%) at 2 hr, 50.7±31.6 μm (80.8%) at 4 hr, 57.4±34.6 μm (91.4%) at 6 hr, and 62.8±38.4 μm (100%) at 8 hr. Settling rate was significantly lower in low apical clearance group (P=0.01). The smaller diameter lenses settled more (P=0.03). There was a slight statistically significant increase of 1.3% in central corneal thickness measured with OCT (P=0.03). Central corneal thickness measured with Pentacam at three locations increased slightly (P=0.001). Settling showed significant intrasubject and intersubject variations. The amount of corneal swelling and comfort scores did not differ significantly according to apical clearance.

Conclusions:

The average amount of settling was 62.8 μm after 8 hr, 80% of which occurred during the first 4 hr. Slight corneal swelling (1.3%) occurred after 8 hr of wear.
Pain sensitivity profiles in patients with advanced knee osteoarthritis
Authors: Frey-Law Laura A. , Bohr Nicole L. , Sluka Kathleen A. , Herr Keela , Clark Charles R. , Noiseux Nicolas O. , Callaghan John J. , Zimmerman M. Bridget , Rakel Barbara A.
Published: May 2016

The development of patient profiles to subgroup individuals on a variety of variables has gained attention as a potential means to better inform clinical decision making. Patterns of pain sensitivity response specific to quantitative sensory testing (QST) modality have been demonstrated in healthy subjects. It has not been determined whether these patterns persist in a knee osteoarthritis population. In a sample of 218 participants, 19 QST measures along with pain, psychological factors, self-reported function, and quality of life were assessed before total knee arthroplasty. Component analysis was used to identify commonalities across the 19 QST assessments to produce standardized pain sensitivity factors. Cluster analysis then grouped individuals who exhibited similar patterns of standardized pain sensitivity component scores. The QST resulted in 4 pain sensitivity components: heat, punctate, temporal summation, and pressure. Cluster analysis resulted in 5 pain sensitivity profiles: a “low pressure pain” group, an “average pain” group, and 3 “high pain” sensitivity groups who were sensitive to different modalities (punctate, heat, and temporal summation). Pain and function differed between pain sensitivity profiles, along with sex distribution; however, no differences in osteoarthritis grade, medication use, or psychological traits were found. Residualizing QST data by age and sex resulted in similar components and pain sensitivity profiles. Furthermore, these profiles are surprisingly similar to those reported in healthy populations, which suggests that individual differences in pain sensitivity are a robust finding even in an older population with significant disease.
Pediatric-Collaborative Health Outcomes Information Registry (Peds-CHOIR): a learning health system to guide pediatric pain research and treatment
Authors: Bhandari Rashmi P. , Feinstein Amanda B. , Huestis Samantha E. , Krane Elliot J. , Dunn Ashley L. , Cohen Lindsey L. , Kao Ming C. , Darnall Beth D. , Mackey Sean C.
Published: May 2016

The pediatric adaptation of the Collaborative Health Outcomes Information Registry (Peds-CHOIR) is a free, open-source, flexible learning health care system (LHS) that meets the call by the Institute of Medicine for the development of national registries to guide research and precision pain medicine. This report is a technical account of the first application of Peds-CHOIR with 3 aims: (1) to describe the design and implementation process of the LHS; (2) to highlight how the clinical system concurrently cultivates a research platform rich in breadth (eg, clinic characteristics) and depth (eg, unique patient- and caregiver-reporting patterns); and (3) to demonstrate the utility of capturing patient-caregiver dyad data in real time, with dynamic outcomes tracking that informs clinical decisions and delivery of treatments. Technical, financial, and systems-based considerations of Peds-CHOIR are discussed. Cross-sectional retrospective data from patients with chronic pain (N = 352; range, 8-17 years; mean, 13.9 years) and their caregivers are reported, including National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) domains (mobility, pain interference, fatigue, peer relations, anxiety, and depression) and the Pain Catastrophizing Scale. Consistent with the literature, analyses of initial visits revealed impairments across physical, psychological, and social domains. Patients and caregivers evidenced agreement in observable variables (mobility); however, caregivers consistently endorsed greater impairment regarding internal experiences (pain interference, fatigue, peer relations, anxiety, and depression) than patients' self-report. A platform like Peds-CHOIR highlights predictors of chronic pain outcomes on a group level and facilitates individually tailored treatment(s). Challenges of implementation and future directions are discussed.
Improving Operating Room Efficiency: First Case On-Time Start Project
Authors: Phieffer Laura , Hefner Jennifer L. , Rahmanian Armin , Swartz Jason , Ellison Christopher E. , Harter Ronald , Lumbley Joshua , Moffatt-Bruce Susan D.
Published: May 2016

Background:

Operating rooms (ORs) are costly to run, and multiple factors influence efficiency. The first case on-time start (FCOS) of an OR is viewed as a harbinger of efficiency for the daily schedule. Across 26 ORs of a large, academic medical center, only 49% of cases started on time in October 2011.

Methods:

The Perioperative Services Department engaged an interdisciplinary Operating Room Committee to apply Six Sigma tools to this problem. The steps of this project included (1) problem mapping, (2) process improvements to preoperative readiness, (3) informatics support improvements, and (4) continuous measurement and feedback.

Results:

By June 2013, there was a peak of 92% first case on-time starts across service lines, decreasing to 78% through 2014, still significantly above the preintervention level of 49% (p = .000). Delay minutes also significantly decreased through the study period (p = .000). Across 2013, the most common delay owners were the patient, the surgeon, the facility, and the anesthesia department.

Conclusions:

Continuous and sustained improvement of first case on-time starts is attributed to tracking the FCOS metric, establishing embedded process improvement resources and creating transparency of data. This article highlights success factors and barriers to program success and sustainability.
The Use of Claims-Based Data in Inpatient Public Reporting and Pay-for-Performance Programs: Is There Opportunity for Improvement?
Authors: Crews Hazel R. , Chamness Amy R. , Terry Colin L. , Helft Paul R.
Published: May 2016

Purpose:

This study examined whether self-reported, facility-based data validation practices for claims submissions of cases flagged as Patient Safety Indicators (PSIs) match professional and regulatory standards.

Methods:

The National Association of Healthcare Quality members who work in an inpatient setting were invited to complete an anonymous survey to self-report their practices around facility-based data validation of PSI cases.

Results:

The authors found widespread variation in how PSI administrative data are internally validated; inconsistency in the education and training required of staff who participate in this process; and relatively poor compliance with physician query guidelines and documentation amendment standards.

Conclusions:

The self-described wide variation and nonadherence to professional and regulatory standards within the facility-based validation process for PSIs raise concerns about the use of these data to make meaningful judgments about quality and safety. The authors recommend a standardized approach to reporting and validation be implemented for use of PSIs in public reporting and pay-for-performance programs.
Nurses' Perceptions of Barriers and Facilitators Affecting the Shaken Baby Syndrome Education Initiative: An Exploratory Study of a Massachusetts Public Policy
Authors: Rideout Leslie
Published: May 2016

The objective of this study was to assess nurses' perceptions of barriers to and facilitators of implementation of the shaken baby syndrome (SBS)/abusive head trauma (AHT) public policy. A legislative Act providing for the prevention of SBS/AHT was passed in Massachusetts in November 2006. A stipulation of this Act was the provision of a program to educate parents/guardians of newborns about SBS/AHT prevention. A quantitative, cross-sectional research design with a qualitative component was used for this study. Nurses in 13 Massachusetts birthing hospitals were surveyed using a Web-based questionnaire (hosted by Qualtrics, Provo, Utah). Hospital nurses' responses (N = ∼ 922; 155 responded) revealed barriers to and facilitators of SBS/AHT guideline implementation. The disadvantage of Web-based surveys as they relate to the challenges of enlisting cooperation and a lack of direct access to the nurses may have attributed to the low response rate (17%) for this study. The outcomes of logistic regression analyses and themes from the qualitative analysis revealed a lack of SBS/AHT brochures and an inability to provide SBS/AHT education for non-English-speaking parents/guardians as barriers to SBS/AHT education. An atmosphere of supportive leadership facilitated implementation of the SBS/AHT education guidelines by nurses. It is imperative that nurse leadership support be sustained so that nurses have SBS/AHT education resources, an understanding of the SBS/AHT education guidelines, and feedback about the impact of their SBS/AHT education interventions.
Management of Tissue Loss After Agkistrodon Snakebite: Appropriate Use of Crotalidae-Fab Antivenin
Authors: Larson Kenneth W. , Schaefer Keith R. , Austin Cindy , Norton Rhy , Finley Phillip J.
Published: May 2016

Although initially created for the treatment of rattlesnake (genus: Crotalus) bites, Crotalidae-Fab antivenin is used to treat many different pit viper envenomations. However, the efficacy of Crotalidae-Fab in preventing tissue loss from copperhead (Agkistrodon contortrix) or cottonmouth (Agkistrodon piscivorus) snakebites remains unclear. Recent reports show that Agkistrodon-related bites rarely require treatment beyond simple observation and pain control. The purpose of this study was to examine the amount of tissue loss in patients who received Crotalidae-Fab compared with those who did not after an Agkistrodon bite. After institutional review board approval, a retrospective study was completed at a Level 1 trauma center. Between 2009 and 2013, a total of 57 snakebites were identified. Of the 57 bites, the snake species was documented in 36 cases including 31 copperheads, 1 cottonmouth, and 4 rattlesnakes. The other 21 bites were from unknown or nonvenomous species. Of the 32 Agkistrodon-related bites, 15 patients received Crotalidae-Fab (average of 3 vials administered) and 17 did not receive Crotalidae-Fab. None of the 32 patients, regardless of treatment option, had tissue loss or required surgical interventions. Only 1 patient received Crotalidae-Fab and debridement of a vesicle associated with the bite. No clinically significant differences were observed between the groups. These findings support previous literature that failed to show added benefit of Crotalidae-Fab treatment for Agkistrodon bites beyond patient comfort and pain control. Evaluation of current protocols for Agkistrodon envenomations is warranted. Snakebite wound education in trauma physicians and nurses may decrease unnecessary use of antivenom medication.
Pediatric Extracorporeal Life Support Using a Third Generation Diagonal Pump
Authors: Speth Marlene , Münch Frank , Purbojo Ariawan , Glöckler Martin , Toka Okan , Cesnjevar Robert A. , Rüffer André
Published: May 2016

This study reports a single-centre experience of the Medos Deltastream diagonal-pump (DP3) for extracorporeal cardiac, pulmonary, or combined support in a single-center pediatric cohort. Twenty-seven consecutive patients with 28 runs of the DP3 between January 2013 and June 2014 were included for analysis. Median patient age, weight, and duration of support were 278 days (range: 0 days–14.2 years), 7.2 kg (range: 2.5–39 kg), and 8 days (range: 2–69 days). Midline sternotomy (n = 20, 71.4%) or cervical approaches (n = 8, 28.6%) were used for cannulation. The DP3 was employed for either veno-arterial extracorporeal life support (ECLS, n = 16), veno-venous extracorporeal membrane oxygenation (ECMO, n = 5), or ventricular assist devices (right ventricular assist device [RVAD], n = 1; left ventricular assist device [LVAD], n = 1; and univentricular assist device [UNIVAD], n = 5). Three patients initially supported with ECLS were switched to UNIVAD and one patient with UNIVAD was changed to ECLS. Required flow for neonates (n = 8) ranged between 0.2 and 0.75 L/min. Irreversible pump damage occurred in one patient during deairing after air block. Successful weaning, 30 day and hospital survival were 89.3% (n = 25), 85.7% (n = 24), and 71.4% (n = 20). All patients on UNIVAD, who did not require further extracorporeal respiratory assist, survived. In conclusion, the DP3 can be used for individual patient demands and adapted to their most suitable method of support. Meticulous flow adjustments render this pump highly effective for extracorporeal support particularly in pediatric patients.
Postoperative respiratory disorders
Authors: Ball Lorenzo , Battaglini Denise , Pelosi Paolo
Published: May 2016

Purpose of review

Postoperative pulmonary complications (PPC) are a prominent determinant of postoperative morbidity, mortality, and increased use of healthcare resources. Several scores have been developed to identify patients at higher risk of PPC and have been proposed or validated as tools to predict postoperative respiratory disorders, stratify risk among patients requiring surgery, and to plan clinical studies. The aim of this review is to provide an update on the recent progresses in perioperative medicine concerning the risk assessment, prevention, and treatment of PPCs.

Recent findings

Efforts are being made to develop a uniform definition of PPCs; several scores have been developed and some of them externally validated. Their use can help the clinician to identify patients at higher risk, develop tailored strategies to mitigate the risk, and to perform a thoughtful allocation of healthcare resources. Intraoperative protective ventilation, with low tidal volume, low plateau pressure, low driving pressure and positive end expiratory pressure set at low-moderate levels titrated to avoid an increase in driving pressure and to achieve an acceptable gas exchange, can reduce the incidence of PPCs. Noninvasive positive pressure ventilation has an important role in the treatment of early stages of postoperative respiratory impairment, whereas not enough evidence is available concerning the use of routine prophylactic noninvasive continuous positive airway pressure postoperatively.

Several strategies can improve patients’ outcome, including risk assessment, intraoperative protective ventilation and postoperative noninvasive ventilation.
Indocyanine green retention test (ICG-r15) as a noninvasive predictor of portal hypertension in patients with different severity of cirrhosis
Authors: Pind Marie-Louise L. , Bendtsen Flemming , Kallemose Thomas , Møller Søren
Published: May 2016

Background and aims

Portal hypertension is a severe consequence of chronic liver disease, responsible for the main clinical complications of cirrhosis. Measurement of the hepatic venous pressure gradient (HVPG) provides important clinical information, but the procedure is invasive and demands expert skills of the staff.

In the present study, we aimed to investigate the relationship between the constant infusion indocyanine green (ICG) clearance, the calculated ICG retention test after 15 min (ICG-r15), and HVPG in patients with different severity of cirrhosis for validation of ICG-r15 as a noninvasive predictor of portal hypertension.

Methods

A total of 325 patients were studied. During a hemodynamic investigation, the ICG clearance was determined using the constant infusion technique and ICG-r15 was calculated.

Results

Assessment of the diagnostic performance of ICG clearance and ICG-r15 as predictors of HVPG above 10 mmHg was performed by receiver operating characteristic curve analyses.

The ICG clearance and ICG-r15 performed well in all three Child classes, with the most significant results among Child class A patients [area under the receiver operating characteristic (AUROC)=0.832] and less significant results in Child class B (AUROC=0.7448) and Child class C patients (AUROC=0.7392). Only six out of 102 patients in Child class C had HVPG of less than 12 mmHg.

Conclusion

ICG-r15 can be used as an indirect assessment of significant portal hypertension in compensated cirrhotic patients. ICG-r15 may be suitable as a screening tool for the identification of patients for endoscopy and measurement of HVPG.

Further validation of ICG-r15 together with other predictors of portal hypertension and its clinical use is encouraged.
Attitudes and practice related to Helicobacter pylori infection among primary care physicians
Authors: Boltin Doron , Kimchi Nimrod , Dickman Ram , Gingold-Belfer Rachel , Niv Yaron , Birkenfeld Shlomo
Published: May 2016

Objectives

Helicobacter pylori infection is a major public health concern and primary care physicians (PCPs) are at the forefront of H. pylori management. We aimed to assess PCP attitudes related to H. pylori and identify areas where PCP practice deviates from the accepted guidelines.

Methods

A 13-item multiple-choice internet-based questionnaire was distributed to PCPs on a national level. Five questions were related to H. pylori detection, two were related to treatment, three were related to gastric cancer, and three were related to screening. The Maastricht IV/Florence Consensus Report was used as the benchmark for correct responses.

Results

A total of 314 PCP responses were included [140 (52%) men, age 48.2±12.9 years]. Of the total, 292 (93.0%) prescribed clarithromycin-based triple therapy for first-line treatment, 95 (30.3%) prescribed levofloxacin or bismuth-based protocols for second-line treatment, and 137 (43.6%) routinely confirmed eradication. Screening relatives of gastric cancer patients and screening before NSAID treatment was reported by 87 (30.9%) and 39 (14.1%) PCPs, respectively. Of all, 130 (45.0%) believed that the organism is definitely carcinogenic and only 188 (65.0%) agreed that H. pylori eradication reduces the risk of developing gastric cancer. Adherence with guidelines was associated with younger age, central urban clinic location, and a high volume of H. pylori patients.

Conclusion

Overall PCP adherence to H. pylori management guidelines is low. Public health agencies should advance educational initiatives aimed at closing these gaps.
Red blood cell distribution width and globulin, noninvasive indicators of fibrosis and inflammation in chronic hepatitis patients
Authors: Wang Huan , Xu Hongqin , Qu Limei , Wang Xiaomei , Wu Ruihong , Gao Xiuzhu , Jin Qinglong , Niu Junqi
Published: May 2016

Aims

We aimed to develop new simple predictive models for significant fibrosis and inflammation in chronic hepatitis patients using routine laboratory parameters.

Methods

A total of 218 patients who had undergone liver biopsy were enrolled in our study. Among these, 116 had chronic hepatitis B, 65 had primary biliary cirrhosis, and 37 had autoimmune hepatitis. Patients were divided into two groups: absent–mild (S0–S1, G0–G1) and moderate–severe (S2–S4, G2–G4) according to the histologic severity of liver fibrosis and inflammation. All common demographics and routine laboratory parameters were analyzed.

Results

Red blood cell distribution width (RDW) and globulin values increased with progressive liver fibrosis and inflammation. After adjustment for other potent predictors, liver fibrosis was associated independently with RDW and platelet (odds ratio=0.976 and 1.487, respectively), whereas significant inflammation was associated independently with globulin, alanine aminotransferase, red blood cell, and platelet (odds ratio=1.153, 1.017, 0.392, and 1.487, respectively). The sensitivity and specificity of model A were 73.4 and 79.1% for the detection of significant liver fibrosis [area under the receiver-operating characteristic curve (AUROC)=0.81, P<0.001]. The sensitivity and specificity of model B were 75.9 and 88.9% for predicting advanced liver inflammation (AUROC=0.89, P<0.001). Compared with pre-existing indicators, model A achieved the highest AUROC (0.81, P<0.001) for liver fibrosis, whereas model B showed the highest AUROC (0.89, P<0.001) for liver inflammation.

Conclusion

RDW may provide a useful clinical value for predicting liver fibrosis; meanwhile, globulin may provide a useful clinical value for predicting liver inflammation in chronic hepatitis patients with other markers.
Heterogeneity of the bone marrow niche
Authors: Yu Vionnie W.C. , Scadden David T.
Published: May 2016

Purpose of review

The bone marrow niche is increasingly recognized as heterogeneous with specific subtypes of mesenchymal niche cells governing the development or homeostasis of selective parenchymal hematopoietic subsets. The present review outlines recent efforts in dissecting these microniches regulated by unique cell pairings within the bone marrow and provides an overview of how the bone marrow orchestrates multiple facets of hematopoiesis.

Recent findings

Recent advancement in technologies has significantly improved our understanding of the cellular and molecular constituents that contribute to regulation of hematopoiesis and to maintenance of the hematopoietic stem cells (HSCs). Transgenic mouse models that enable endogenous cell deletion or lineage tracing, coupled with advanced intravital microscopy has identified several mesenchymal cell types, including the osteolineage cells, megakaryocytes, macrophages, perivascular cells, and Schwann cells, to be indispensible regulators of hematopoiesis. These niche cells, when perturbed, each caused very specific hematopoietic consequences including impairment in B-cell maturation, T lineage development, erythropoiesis, and impact different aspects of HSC behavior such as quiescence, mobilization, and response to acute stress signals.

The emerging concept is that the bone marrow environment is composed of multiple microniches, each consisting of unique pairing of distinct supportive stromal cells with distinct hematopoietic subtypes to regulate a particular branch of hematopoietic cell process. The bone marrow can be viewed as a carrier with subcompartments tailored to support different hematopoietic activities.
Advances in scar management: prevention and management of hypertrophic scars and keloids
Authors: Del Toro Drew , Dedhia Raj , Tollefson Travis T.
Published: May 2016

Purpose of review

Abnormal scarring remains a poorly understood but functional and aesthetic consequence of surgical and traumatic wounds. The purpose of this review is to describe the current state of the science behind the prevention and management of these scars.

Recent findings

A recent update in the International Clinical Recommendations on Scar Management provides a wealth of information on new and revised treatments for hypertrophic scars and keloids. Silicone-based products continue to be the premier option for prevention and initial treatment of hypertrophic and keloid scars. There is growing evidence demonstrating the efficacy of intralesional corticosteroids and 5-fluorouracil. Laser therapy remains a second-line treatment option, with low-level evidence supporting the use of pulse dye lasers and ablative fractional lasers.

Although there remains no ‘gold standard’ for the prevention and treatment of hypertrophic scars and keloids, silicone gel products and microporous paper tape present the best conservative options. A stepwise algorithm for the treatment of hypertrophic scars or keloids based on the characteristics and responsiveness of the scar presents the best management strategy. Combination therapy (including steroid injections, 5-fluorouracil, and pulse dye laser) proves to be the strongest option for the nonsurgical management of severe hypertrophic scars and keloids.
Estimation of Fat‐free Mass at Discharge in Preterm Infants Fed With Optimized Feeding Regimen
Authors: Larcade Julie , Pradat Pierre , Buffin Rachel , Leick‐Courtois Charline , Jourdes Emilie , Picaud Jean‐Charles
Published: May 2016

Objectives:

The purpose of the present study was to validate a previously calculated equation (E1) that estimates infant fat‐free mass (FFM) at discharge using data from a population of preterm infants receiving an optimized feeding regimen.

Methods:

Preterm infants born before 33 weeks of gestation between April 2014 and November 2015 in the tertiary care unit of Croix‐Rousse Hospital in Lyon, France, were included in the study. At discharge, FFM was assessed by air displacement plethysmography (PEA POD) and was compared with FFM estimated by E1. FFM was estimated using a multiple linear regression model.

Results:

Data on 155 preterm infants were collected. There was a strong correlation between the FFM estimated by E1 and FFM assessed by the PEA POD (r = 0.939). E1, however, underestimated the FFM (average difference: −197 g), and this underestimation increased as FFM increased. A new, more predictive equation is proposed (r = 0.950, average difference: −12 g).

Conclusions:

Although previous estimation methods were useful for estimating FFM at discharge, an equation adapted to present populations of preterm infants with “modern” neonatal care and nutritional practices is required for accuracy.
The inter-rater reliability of the International Classification of Functioning, Disability and Health set for spinal cord injury nursing
Authors: Li Kun , Yan Tiebin , You Liming , Xie Sumei , Li Yun , Tang Jie , Wang Yingmin , Gao Yan
Published: May 2016

The International Classification of Functioning, Disability and Health (ICF) has potential to be used as a clinical assessment instrument directly. However, difficulty in operationalizing the ICF qualifiers has led to unsatisfactory inter-rater reliability of ICF instruments in previous studies. The ICF set for spinal cord injury (SCI) nursing contains a group of categories that can reflect the functioning of SCI patients from the perspective of nurses. The aim of this study was to explore the inter-rater reliability of the ICF set for SCI nursing. Detailed measuring guidelines were prepared for each category of the ICF set. Two trained nurses then used the ICF set to independently rate 40 SCI patients within the first 3 days after their admission. The results showed that the percentage of the observed agreement between the nurses ranged from 42.5 to 100% (median 75%, interquartile range 62.5–87.5%). The weighted κ ranged from −0.03 to 1.00 (median 0.68, interquartile range 0.45–0.84). A total of 50 categories (79.4%) showed weighted κ greater than 0.4 and 39 categories (61.9%) had weighted κ greater than 0.6. The medians of the weighted κ for the body functions, body structures, activity and participation and environmental factors components were 0.6, 0.64, 0.84, and 0.11, respectively. This study indicated that the inter-rater reliability of the ICF set for SCI nursing was acceptable. Establishment of detailed measuring guidelines could help reduce the differences between raters. Simpler and clearer measuring guidelines are recommended and the definitions of some categories need to be clarified in future studies.
The relationship between static posturography measures and specific cognitive domains in individuals with multiple sclerosis
Authors: Kalron Alon
Published: May 2016

There are still limitations as to the understanding of the cognitive–postural control relationship in people with multiple sclerosis (PwMS). The aim of the current study’ was to examine the relationship between cognition with measures of posturography in PwMS. The study was cross-sectional comprising 253 PwMS (162 women) with a mean age of 42.0 (SD=14.0). All participants completed a computerized cognitive test battery designed to evaluate multiple cognitive domains (Mindstreams; NeuroTrax) and static posturography tests (Zebris Medical GmbH). PwMS were divided into four levels of disability on the basis of their Expanded Disability Status Scale (EDSS) score: very mild (EDSS: 0–2.0), mild (EDSS: 2.5–3.5), moderate (EDSS: 4.0–5.5), and severe (EDSS: 6.0–6.5; using a walking aid). Significant correlations were observed between cognitive domains and posturography measures. However, the correlations were different between the disability subgroups. For the mild group, significant correlation scores were observed between the balance measures to the executive function and motor skills cognitive domains (Pearson’s ρ=∼0.3 and ∼0.4, respectively). As for the moderate group, significant correlation scores were observed in memory and verbal function (Pearson’s ρ=∼0.4 and ∼0.4, respectively). Attention was the only cognitive domain correlated significantly with posturography measures in the severe group (Pearson’s ρ=∼0.55). Our study found that posturography measures are related to cognition in PwMS. However, the associations vary in terms of cognitive domains and disability levels.
Clinicopathologic Analysis of Angioimmunoblastic T-cell Lymphoma With or Without RHOA G17V Mutation Using Formalin-fixed Paraffin-embedded Sections
Authors: Nagao Ryoko , Kikuti Yara Yukie , Carreras Joaquim , Kikuchi Tomoki , Miyaoka Masashi , Matsushita Hiromichi , Kojima Minoru , Ando Kiyoshi , Sakata-Yanagimoto Mamiko , Chiba Shigeru , Nakamura Naoya
Published: May 2016

Angioimmunoblastic T-cell lymphoma (AITL) is an infrequent subtype of peripheral T-cell lymphoma derived from follicular helper T cells. Recently, a somatic G17V RHOA gene mutation has been reported. In this article, we examined the RHOA G17V mutation in 18 cases of AITL by 3 different techniques of Sanger sequencing, fully automated SNP genotyping, and deep sequencing, using routine diagnostic formalin-fixed paraffin-embedded tissue. The RHOA G17V mutation was detected in 10 cases (56%). Among the 10 mutated cases, 8 cases were detected by all 3 methods. The status of RHOA mutation was subsequently compared with the clinicopathologic characteristics of AITL. RHOA-mutated AITL (10 cases) was clinically characterized by high serum IL-2R and a poor ECOG performance status. By immunohistochemistry, expression of CD10, PD-1, CXCL13, and CCR4 and a wide distribution of CD21(+) follicular dendritic cells were observed in RHOA-mutated cases. Among these, CCR4 expression and the CD21(+) network in RHOA-mutated AITL cases were more extensive than in the RHOA mutation-negative AITL cases (P<0.05). Thus, RHOA-mutated AITL cases are more characteristic of follicular helper T cells, and the presence of such a mutation is an important marker for AITL.
Radical Prostatectomy Findings in White Hispanic/Latino Men With NCCN Very Low-risk Prostate Cancer Detected by Template Biopsy
Authors: Kryvenko Oleksandr N. , Lyapichev Kirill , Chinea Felix M. , Prakash Nachiketh Soodana , Pollack Alan , Gonzalgo Mark L. , Punnen Sanoj , Jorda Merce
Published: May 2016

Radical prostatectomy (RP) outcomes have been studied in White and Black non-Hispanic men qualifying for Epstein active surveillance criteria (EASC). Herein, we first analyzed such outcomes in White Hispanic men. We studied 70 men with nonpalpable Gleason score 3+3=6 (Grade Group [GG] 1) prostate cancer (PCa) with ≤2 positive cores on biopsy who underwent RP. In 18 men, prostate-specific antigen (PSA) density (PSAD) was >0.15 ng/mL/g. Three of these had insignificant and 15 had significant PCa. The remaining 52 men qualified for EASC. One patient had no PCa identified at RP. Nineteen (37%) had significant PCa defined by volume (n=7), grade (n=7), and volume and grade (n=5). Nine cases were 3+4=7 (GG 2) (5/9 [56%] with pattern 4 <5%), 2 were 3+5=8 (GG 4), and 1 was 4+5=9 (GG 5). Patients with significant PCa more commonly had anterior dominant disease (11/19, 58%) versus patients with insignificant cancer (7/33, 21%) (P=0.01). In 12 cases with higher grade at RP, the dominant tumor nodule was anterior in 6 (50%) and posterior in 6 (median volumes: 1.1 vs. 0.17 cm3, respectively; P=0.01). PSA correlated poorly with tumor volume (r=0.28, P=0.049). Gland weight significantly correlated with PSA (r=0.54, P<0.001). While PSAD and PSA mass density correlated with tumor volume, only PSA mass density distinguished cases with significant disease (median, 0.008 vs. 0.012 μg/g; P=0.03). In summary, a PSAD threshold of 0.15 works well in predicting significant tumor volume in Hispanic men. EASC appear to perform better in White Hispanic men than previously reported outcomes for Black non-Hispanic and worse than in White non-Hispanic men. Significant disease is often Gleason score 3+3=6 (GG 1) PCa >0.5 cm3. Significant PCa is either a larger-volume anterior disease that may be detected by multiparametric magnetic resonance imaging-targeted biopsy or anterior sampling of the prostate or higher-grade smaller-volume posterior disease that in most cases should not pose immediate harm and may be detected by repeat template biopsies.
Cystoisospora belli Infection of the Gallbladder in Immunocompetent Patients
Authors: Lai Keith K. , Goyne Hannah E. , Hernandez-Gonzalo David , Miller Kennon A. , Tuohy Marion , Procop Gary W. , Lamps Laura W. , Patil Deepa T.
Published: May 2016

Cystoisospora belli, previously known as Isospora belli, is an obligate intracellular coccidian parasite that is most often associated with gastrointestinal disease in immunocompromised patients. In this study, we detail the clinicopathologic features of 18 cases of Cystoisospora infection affecting the gallbladder in immunocompetent individuals and compare them with a control group. Each case was reviewed for cholecystitis (none, acute, chronic), epithelial disarray, presence of intraepithelial lymphocytes (none, rare [≤5 per 20 epithelial cells], present [>5 per 20 epithelial cells]), architectural distortion, intramucosal eosinophilia, and mural thickening/serositis. The mean age of patients with Cystoisospora infection was 33 years and the male to female ratio 1:4.3. Cholecystectomy was performed for biliary dyskinesia (n=7), abdominal pain (n=7), suspected cholelithiasis (n=5), and cholecystitis (n=3). In 2 cases, Cystoisospora was found in donor gallbladders resected at the time of liver transplantation. Each case was characterized by eosinophilic, oval or banana-shaped intraepithelial parasites within perinuclear parasitophorous vacuoles. Most cases showed epithelial disarray and minimal intraepithelial lymphocytosis. Of the 11 cases with an average follow-up of 15 months, none had evidence of disease related to Cystoisospora infection within the biliary tract or elsewhere in the gastrointestinal tract. We present the largest series of gallbladder cystoisosporiasis in immunocompetent patients to date. Cystoisospora infection is underrecognized in the gallbladders of immunocompetent patients, in part due to the subtle findings in routine cholecystectomy specimens. On the basis of the clinical follow-up, gallbladder cystoisosporiasis in immunocompetent individuals appears to be a self-limited infection.
Spleen Histologic Appearance in Common Variable Immunodeficiency
Authors: Furudoï Adeline , Gros Audrey , Stanislas Sophie , Hamidou Mohamed , Furudoï Enio , Oksenhendler Éric , Merlio Jean-Philippe , Viallard Jean-François , Parrens Marie
Published: May 2016

Histologic and phenotypic analyses of splenectomy samples from 17 patients with common variable immunodeficiency (CVID) showed the following nonspecific, evocative, white-pulp lesions: white-pulp hyperplasia (WPH) with reactive follicles, giant follicles (GFs), marginal zone hyperplasia, periarteriolar T-zone hyperplasia (PATH) and/or granulomas, which enabled us to discern 2 groups: the first (n=6) composed of WPH with reactive follicles without granulomas, and the second (n=9) characterized by the presence of granulomas with or without WPH. All specimens were Epstein-Barr virus negative by in situ hybridization. Molecular analyses revealed a polyclonal immunoglobulin heavy chain gene (IGH) rearrangement (n=12). WPH-only patients were mostly female individuals and younger at CVID onset, diagnosis, and splenectomy, but their interval between the first symptom and diagnosis was longer; they had more associated infectious events, autoimmune disease, pulmonary complications, and liver regenerative nodular hyperplasia; their IgG, IgA, and IgM concentrations were also higher. Granuloma-group patients were mostly male individuals; were older at CVID onset, diagnosis, and splenectomy; had disseminated granulomatous disease, but infectious events, autoimmune disease, pulmonary complications, and liver regenerative nodular hyperplasia were less common; their immunoglobulin concentrations were lower. Histologic comparisons between the WPH-only and granuloma groups showed more intense WPH and more intense marginal zone hyperplasia and fewer GFs in the former versus more developed PATH and more common GFs in the latter. The results of this novel comparative study of the histologic patterns of 17 CVID patients’ evocative splenic lesions suggested different biological and clinical profiles.
Learning From Experience: Improving Early Tracheal Extubation Success After Congenital Cardiac Surgery*
Authors: Winch Peter D. , Staudt Anna M. , Sebastian Roby , Corridore Marco , Tumin Dmitry , Simsic Janet , Galantowicz Mark , Naguib Aymen , Tobias Joseph D.
Published: May 2016

Objectives:

The many advantages of early tracheal extubation following congenital cardiac surgery in young infants and children are now widely recognized. Benefits include avoiding the morbidity associated with prolonged intubation and the consequences of sedation and positive pressure ventilation in the setting of altered cardiopulmonary physiology. Our practice of tracheal extubation of young infants in the operating room following cardiac surgery has evolved and new challenges in the arena of postoperative sedation and pain management have appeared.

Design:

Review our institutional outcomes associated with early tracheal extubation following congenital cardiac surgery.

Patients:

Inclusion criteria included all children less than 1 year old who underwent congenital cardiac surgery between October 1, 2010, and October 24, 2013.

Measurements and Main Results:

A total of 416 patients less than 1 year old were included. Of the 416 patients, 234 underwent tracheal extubation in the operating room (56%) with 25 requiring reintubation (10.7%), either immediately or following admission to the cardiothoracic ICU. Of the 25 patients extubated in the operating room who required reintubation, 22 failed within 24 hours of cardiothoracic ICU admission; 10 failures were directly related to narcotic doses that resulted in respiratory depression.

Conclusions:

As a result of this review, we have instituted changes in our cardiothoracic ICU postoperative care plans. We have developed a neonatal delirium score, and have adopted the “Kangaroo Care” approach that was first popularized in neonatal ICUs. This provision allows for the early parental holding of infants following admission to the cardiothoracic ICU and allows for appropriately selected parents to sleep in the same beds alongside their postoperative children.
An Unusual Case of YWHAE-NUTM2A/B Endometrial Stromal Sarcoma With Confinement to the Endometrium and Lack of High-Grade Morphology
Authors: Attygalle Ayoma D. , Vroobel Katherine , Wren Dorte , Barton Desmond P. J. , Hazell Stephen J. , Cin Paola Dal , Koelble Konrad , McCluggage W. Glenn
Published: May 2016

Endometrial stromal sarcoma (ESS) characterized by YWHAE-NUTM2A/B genetic fusion is a recently recognized entity that is classified as a high-grade (HG) ESS in the 2014 World Health Organization Classification. These are myoinvasive neoplasms and typically contain a monomorphous HG round-cell cyclinD1-positive component with or without an accompanying low-grade (LG) component that is only focally positive/negative for cyclinD1. We report a case of YWHAE-NUTM2A/B ESS in a 46-yr-old woman that showed a number of unusual histologic features, including being entirely confined to the endometrium with no myoinvasion or lymphovascular space invasion. The initial hysteroscopic biopsy showed a cyclinD1-positive classic LG ESS-like component which merged with a smaller cyclinD1 negative/focally positive fibroblastic component with no HG areas. YWHAE-NUTM2A/B genetic fusion was shown by real-time quantitative polymerase chain reaction and Sanger sequencing. In the subsequent hysterectomy specimen, the tumor was entirely confined to the endometrium and was largely composed of cellular and classic LG ESS-like areas (80%) which were strongly and diffusely positive for cyclinD1 and a focal fibroblastic component (20%) which was largely cyclinD1 negative. Despite the cellular areas showing mild nuclear enlargement, the entire tumor had a very low mitotic and proliferation index and showed strong and diffuse positivity for estrogen and progesterone receptors. The patient remains alive and well with no evidence of disease 14 mo following diagnosis. To our knowledge, this is the first reported case of YWHAE-NUTM2A/B ESS that is confined to the endometrium and which exhibits entirely LG morphology.
Endocervical Polyp With Florid “Epidermal Metaplasia”: Report of a Previously Undescribed Phenomenon
Authors: Angra Seema , McCluggage W. Glenn
Published: May 2016

Endocervical polyps are common benign lesions which rarely result in diagnostic problems, although a variety of alterations occasionally complicate histologic interpretation. We report an unusual, and not previously described, finding of florid “epidermal” metaplasia with keratinization and extensive formation of skin appendages structures (sebaceous and sweat glands and hair follicles) within an endocervical polyp. The features closely resembled an epidermal inclusion cyst. We speculate on the possible pathogenesis of this rare phenomenon and review unusual findings in endocervical polyps.
Mitotically Active Sclerosing Stromal Tumor of the Ovary: Report of a Case Series With Parallels to Mitotically Active Cellular Fibroma
Authors: Goebel Emily A. , McCluggage W. Glenn , Walsh Joanna C.
Published: May 2016

Sclerosing stromal tumor of the ovary is a rare neoplasm that typically occurs in the second and third decades of life. To date, all reported cases have behaved in a benign manner. In their usual form, these neoplasms exhibit scant, if any, mitotic activity. Herein, we report a case series of 6 sclerosing stromal tumors with increased mitotic activity (between 7 and 12 mitoses per 10 high-power fields in the most mitotically active areas). Follow-up is available in 4 of 6 cases (ranging from 3 wk to 68 mo) and 1 tumor recurred within the pelvis. We suggest that the term mitotically active sclerosing stromal tumor is used for such neoplasms and draw parallels with mitotically active cellular fibroma, another benign ovarian stromal neoplasm which occasionally recurs locally, but which does not metastasize.
Primitive “Spindle Cell Variant” (Sarcomatoid Variant) Diffuse Large B-Cell Lymphoma of the Uterine Cervix: Description and Outcome of a Rare Case
Authors: Fratoni Stefano , Abruzzese Elisabetta , Trawinska Malgorzata M. , Niscola Pasquale , de Fabritiis Paolo , Santeusanio Giuseppe
Published: May 2016

A very rare case of primary diffuse large B-cell lymphoma of the uterine cervix characterized by “spindle cell variant” morphology (“sarcomatoid subtype”) is described along with a discussion of the challenging diagnosis due to its rarity and presenting clinical and pathological features.
Immunostaining Study on the Expression of NF-κB, ER, and PR in Ovarian Serous Carcinoma
Authors: Lin Jie , Xi Chenguang , Liu Cuiling , Wang Yuxiang , Liu Yan , Ren Caixia , Liu Congrong
Published: May 2016

In order to explore whether NF-κB activation correlates to the prognosis, chemoresistance, and sex hormone receptors status in ovarian serous carcinoma, we analyzed the expression of NF-κB, ER, and PR by immunohistochemistry in 72 cases of ovarian serous carcinoma, investigated the association among these markers, and evaluated their relations to clinicopathologic factors and prognosis. The positive rates were 88.9% for NF-κB cytoplasmic expression, 45.8% for NF-κB nuclear expression, 41.7% for ER, and 29.2% for PR. NF-κB nuclear expression was positively correlated with the 4th edition WHO grade (P=0.045) and tumor stage (P=0.001). NF-κB cytoplasmic expression was associated with preoperative serum CA125 level (P=0.015) and ascites (P=0.042). Neither cytoplasmic nor nuclear staining of NF-κB showed any association with survival. PR expression was correlated with tumor stage (P=0.023) and omental metastasis (P=0.022). Omental metastasis occurred more frequently in ER−/PR− tumors (P=0.009). No correlation between NF-κB expression and ER, PR expression was observed. In conclusion, in ovarian serous carcinoma, NF-κB nuclear expression correlated with the 4th edition WHO grade and PR was a favorable prognostic factor for ovarian serous carcinoma.