bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinico-Pathological Study of 4 Cases of Pseudoherpetic Grover Disease: The Same as Vesicular Grover Disease
Authors: Capusan Tania M. , Herrero-Moyano María , Fraga Javier , Llamas-Velasco Mar
Published: December 2017

Introduction:

Grover disease (GD) was described with 4 histopathological patterns, but later wide histopathological studies found additional ones including vesicular GD. From 2014, 2 new patterns, GD with epidermolytic hyperkeratosis and pseudoherpetic GD, have been proposed.

Objectives:

The authors present 4 cases of pseudoherpetic GD and review the 6 previously published cases to better characterize this variant clinically and histopathologically.

Results:

Half of the patients were men. Mean age at diagnosis was 70, 25 years old. All the patients were immunosuppressed, and 75% of them were treated with chemotherapy. Lesions were asymptomatic or itchy papules sometimes crusted and intermingled with isolated vesicles or pustules mostly in the trunk. Skin biopsies showed intraepidermal vesicles filled with plasma (50%) with floating grouped acantholytic cells. No viral inclusions were found, and immunostaining for herpes virus and varicella zoster was negative.

Discussion:

Vesicular pattern in GD is described exclusively from a histopathological point of view, and it is defined as the presence of an intraepidermal vesicle filled with plasma and with dyskeratotic cells in the upper part of the vesicle. After reviewing all the described cases, pseudoherpetic GD presents the same histopathological features than vesicular GD, but authors paid attention to the presence of grouped acantholytic cells mimicking multinucleated cells of herpes infection. The authors consider that the so-called pseudoherpetic GD is a vesicular GD, where clinical suspicion of varicella raises this differential diagnosis and leads us to check viral nuclear cytopathic changes, and the authors favor the use of vesicular GD in the dermatopathologist report.
Langerhans Cell Histiocytosis Associated With Underlying Hematolymphoid Disorders in Adults: Report of 2 Cases and Review of the Literature
Authors: Kiavash Katrin , Malone Janine C.
Published: December 2017

Langerhans cell histiocytosis (LCH) is an uncommon disorder characterized by proliferation of abnormal LCs usually affecting children and adolescents. LCH in adults first presenting in the skin is rare. Although LCH and even LCH with a second malignancy may be more common in children, cutaneous LCH with a second hematologic malignancy has been more commonly identified in adults. The authors report 2 new cases of LCH in adult patients with underlying myelodysplasia and follicular lymphoma. The specimens were examined by routine microscopy and immunohistochemical stains for S100 protein and CD1a. Patients were elderly men with established diagnoses of follicular lymphoma and myelodysplasia, presented with follicular lesions and erythematous plaques involving intertriginous areas. Histologic examination revealed collections of mononuclear cells in upper dermis, which demonstrated strong positivity for S100 and CD1a, confirming their identity as LCs. BRAF analysis returned negative for detection of BRAF V600E mutation in both patients. The authors have recently encountered 2 cases of adult patients with skin-limited LCH predated by other lymphoproliferative disorders. The association between LCH and hematopoietic disorders may be explained by a common bone marrow precursor that is differentiating along different cell lines. Cutaneous LCH may be associated with underlying lymphoproliferative disorders and should be considered in the differential diagnosis of cutaneous eruptions in patients with hematopoietic disorders. Clinical follow-up evaluation of patients diagnosed with LCH for peripheral blood abnormalities and lymphadenopathy or “B symptoms” may be prudent in patients not already carrying a diagnosis of an underlying hematologic disorder.
Development and history of morcellators
Authors: Nezhat Ceana , Zurawin Robert K.
Published: December 2017

Purpose of review

Controversy exists surrounding extraction of tissue in gynecologic surgery using morcellators following cases of disseminated uterine cancers discovered after the use of electromechanical morcellators. This chapter traces the history of tissue extraction in gynecology and reviews the evolving scientific data and opinions regarding the future of morcellation.

Recent findings

Since the initial Food and Drug Administration warning about morcellation in 2014, subsequent studies do not support the Food and Drug Administration's high incidence of occult uterine cancer. Current research continues, focusing on methods of contained tissue morcellation, both laparoscopically and vaginally.

Minimally invasive surgical techniques have revolutionized gynecology, drastically reducing the need for open procedures. To maximize patient safety while preserving the rapid recovery and low morbidity of laparoscopic and vaginal approaches, optimal methods of tissue extraction need to be developed and promulgated.
THEORETICAL GAS CONCENTRATIONS ACHIEVING 100% FILL OF THE VITREOUS CAVITY IN THE POSTOPERATIVE PERIOD
Authors: Williamson Tom H. , Guillemaut Jean-Yves. , Hall Sheldon K. , Hutter Joseph C. , Goddard Tony
Published: December 2017

Purpose:

To determine the concentrations of different gas tamponades in air to achieve 100% fill of the vitreous cavity postoperatively and to examine the influence of eye volume on these concentrations.

Methods:

A mathematical model of the mass transfer dynamics of tamponade and blood gases (O2, N2, and CO2) when injected into the eye was used. Mass transfer surface areas were calculated from published anatomical data. The model has been calibrated from published volumetric decay and composition results for three gases sulphahexafluoride (SF6), hexafluoroethane (C2F6), or perfluoropropane (C3F8). The concentrations of these gases (in air) required to achieve 100% fill of the vitreous cavity postoperatively without an intraocular pressure rise were determined. The concentrations were calculated for three volumes of the vitreous cavity to test whether ocular size influenced the results.

Results:

A table of gas concentrations was produced. In a simulation of pars plana vitrectomy operations in which an 80% to 85% fill of the vitreous cavity with gas was achieved at surgery, the concentrations of the 3 gases in air to achieve 100% fill postoperatively were 10% to 13% for C3F8, 12% to 15% for C2F6, and 19% to 25% for SF6. These were similar to the so-called “nonexpansive” concentrations used in the clinical setting. The calculations were repeated for three different sizes of eye. Aiming for an 80% fill at surgery and 100% postoperatively, an eye with a 4-mL vitreous cavity required 24% SF6, 15% C2F6, or 13% C3F8; 7.2 mL required 25% SF6, 15% C2F6, or 13% C3F8; and 10 mL required 25% SF6, 16% C2F6, or 13% C3F8. When using 100% gas (e.g., used in pneumatic retinopexy), to achieve 100% fill postoperatively, the minimum vitreous cavity fill at surgery was 43% for SF6, 29% for C2F6, and 25% for C3F8 and was only minimally changed by variation in the size of the eye.

Conclusion:

A table has been produced, which could be used for surgical innovation in gas usage in the vitreous cavity. It provides concentrations for different percentage fills, which will achieve a moment postoperatively with a full fill of the cavity without a pressure rise. Variation in axial length and size of the eye does not seem to alter the values in the table significantly. Those using pneumatic retinopexy need to increase the volume of gas injected with increased size of the eye to match the percentage fill of the vitreous cavity recommended for a given tamponade agent.
ENDOGENOUS KLEBSIELLA PNEUMONIAE ENDOPHTHALMITIS IN NORTHERN CALIFORNIA
Authors: Shields Ryan A. , Smith Stephen J. , Pan Carolyn K. , Do Diana V.
Published: December 2017

Purpose:

To report the clinical features, treatment modalities, and visual outcomes in 12 eyes with endogenous Klebsiella pneumoniae endophthalmitis (EKPE).

Methods:

The medical records of all patients diagnosed with EKPE at Stanford Hospital (Palo Alto, CA) and Santa Clara Valley County Hospital (Santa Clara, CA) from January 2000 to March 2017 were retrospectively reviewed.

Results:

A total of 10 patients (12 eyes) were diagnosed with EKPE. The median age at presentation was 56, 80% were male, and 30% were non-Asian. Presenting visual acuities ranged from 20/20 to no light perception. Of the 12 eyes 10 received a tap and injection (range, 1–33 injections per eye), 2 eyes underwent primary enucleation or evisceration, and 1 patient underwent pars plana vitrectomy after tap and injection. Final visual acuities ranged from no light perception (six eyes) to 20/300 or better (five eyes). Five patients eventually underwent evisceration or enucleation. All cases were associated with positive blood and/or vitreous cultures and had concurrent systemic infection.

Conclusion:

Endogenous Klebsiella pneumoniae endophthalmitis is a rare, but devastating, ocular infection. Most cases in this series resulted in light perception vision or worse, and almost half required enucleation or evisceration. In light of the virulence of EKPE, early diagnosis and treatment should be initiated in all suspected cases.
OUTCOMES OF REPEAT PARS PLANA VITRECTOMY AFTER FAILED SURGERY FOR PROLIFERATIVE VITREORETINOPATHY
Authors: Narala Ramsudha , Nassiri Nariman , Kim Chaesik , Mehregan Christian , Padidam Sneha , Abrams Gary W.
Published: December 2017

Purpose:

To evaluate outcomes of repeat pars plana vitrectomy for proliferative vitreoretinopathy after previous failed pars plana vitrectomy.

Methods:

This is a retrospective case series including 51 eyes of 50 patients who underwent repeat surgery after failed previous pars plana vitrectomy for proliferative vitreoretinopathy from 2000 to 2015 at the Kresge Eye Institute, Detroit, MI. Patients were classified into successful and unsuccessful groups. Success was defined as retinal reattachment, silicone oil removed, and best-corrected visual acuity (BCVA) ≥5/200 at the final follow-up visit.

Results:

Forty-three eyes (84.3%) were successfully reattached at the last follow-up. Seventeen (33.3%) eyes were deemed successful and 34 (66.7%) eyes unsuccessful according to our criteria. Compared with the successful group, eyes in the unsuccessful group had more eyes with preoperative BCVA <5/200 (P < 0.001), preoperative BCVA of hand motion or worse (P = 0.002), preoperative flare ≥Grade 2+ (P = 0.03), preoperative posterior breaks (P = 0.02), previous retinectomy (P = 0.04), and final postoperative hypotony (intraocular pressure ≤ 5 mmHg) (P = 0.005). Eyes with silicone oil removed were more likely to have BCVA ≥5/200 (P < 0.001) at the final follow-up visit. Location of patients >100 miles (P = 0.04) from Detroit and preoperative BCVA of hand motion or worse (P = 0.01) were significantly associated with failure in the logistic regression analysis.

Conclusion:

Success after repeat surgery for proliferative vitreoretinopathy should include ambulatory vision, retinal reattachment, and silicone oil removal. We identified several preoperative and perioperative factors that were associated with success in the bivariate and logistic analyses. The decision to perform surgical reoperation in these patients should be based on multiple factors, most importantly preoperative BCVA.
INTRAVITREAL ZIV-AFLIBERCEPT FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
Authors: de Oliveira Dias João R. , Costa de Andrade Gabriel , Kniggendorf Vinicius F. , Novais Eduardo A. , Takahashi Vítor K. L. , Maia André , Meyer Carsten , Watanabe Sung E. S. , Farah Michel E. , Rodrigues Eduardo B.
Published: December 2017

Purpose:

To evaluate the 52-week safety and efficacy of intravitreal ziv-aflibercept in patients with neovascular age-related macular degeneration.

Methods:

All patients received three monthly intravitreal injections of 0.05 mL of ziv-aflibercept (1.25 mg) followed by a pro re nata regimen. The best-corrected visual acuity and spectral domain optical coherence tomography were obtained at baseline and monthly. Full-field and multifocal electroretinograms were obtained at baseline and 4, 13, 26, and 52 weeks. For some full-field electroretinography parameters, we calculated the differences between baseline and 52 weeks and then compared those differences between treated and untreated fellow eyes.

Results:

Fifteen patients were included and 14 completed the 52-week follow-up. The mean best-corrected visual acuity improved from 0.95 ± 0.41 (20/200) at baseline to 0.75 ± 0.51 (20/125) logarithm of the minimum angle of resolution at 52 weeks (P = 0.0066). The baseline central retinal thickness decreased from 478.21 ± 153.48 μm to 304.43 ± 98.59 μm (P = 0.0004) at 52 weeks. Full-field electroretinography parameters used to assess retinal toxicity after intravitreal injections (rod response and oscillatory potentials) remained unchanged during follow-up. The average multifocal electroretinography macular response in 5° showed increased N1-P1 amplitude and decreased P1 implicit time (P < 0.05). One patient presented with intraocular inflammation after the seventh intravitreal procedure.

Conclusion:

The results suggested that intravitreal ziv-aflibercept might be safe and effective for treating neovascular age-related macular degeneration. More patients and a longer follow-up are needed to confirm the long-term outcomes of intravitreal ziv-aflibercept.
Research progression of blood and fecal metabolites in colorectal cancer
Authors: Kong Cheng , Gao Renyuan , Yan Xuebing , Qin Huanlong
Published: December 2017

The development of colorectal cancer (CRC) is correlated with metabolic changes, suggesting great potential of metabolites to be diagnostic and prognostic biomarkers for clinical management. A large variety of metabolites have recently been identified due to their oncogenic role and clinical significance. Although the results may vary within studies due to their diversity and complexity, these biomarkers profoundly reflecting intestinal homeostasis and disease status can be further developed as noninvasive diagnostic tools in complementary to traditional approaches such as colonoscopy, particularly for early population-based screening. This review focuses on the potential clinical utilities of metabolites as novel biomarkers in CRC, and discusses the metabolites-directed strategy for early diagnosis.
Use of a New Expanded Polytetrafluoroethylene Multichordal Mitral Apparatus (Mitrapatch) to Repair Complex Mitral Valve Lesions
Authors: Chawla Surendra K. , Padala Muralidhar , Chitwood W. Randolph , Frater Robert W.M.
Published: December 2017

Objective

We report a new expanded polytetrafluoroethylene multichordal mitral apparatus (MitraPatch) to simplify mitral repairs involving multiple cusps and sought to describe the surgical technique and demonstrate the efficacy of the device.

Methods

MitraPatch was laser cut from a single sheet of expanded polytetrafluoroethylene and mounted on a custom-designed handle. Surgical technique to deploy the apparatus on the native mitral valve was developed in ex vivo porcine hearts. Hemodynamic efficacy of repairing mitral prolapse and regurgitation was assessed in ex vivo hearts and in five 30-day chronic swine, with histopathology in an additional swine at 120 days after implantation.

Results

In ex vivo heart studies, leaflet coaptation was restored from 0 mm at the posterior prolapsing segment to 8.1 ± 2.2 mm after repair with the MitraPatch ( P < 0.05) and to 10.2 ± 1.3 mm after the repair of the anterior leaflet ( P < 0.05). In in vivo studies, valve function at 30 days was considered good, with none to trace regurgitation. Device was flexible, without tissue overgrowth or dehiscence. At 120 days, complete endothelialization was observed.

Conclusions

The multichordal MitraPatch can potentially simplify complex mitral valve repairs involving multiple leaflet cusps, possibly enabling an optimal mitral repair even by surgeons without the focused high-volume experience.
Morbid Obesity does not Increase Morbidity or Mortality in Robotic Cardiac Surgery
Authors: Kitahara Hiroto , Patel Brooke , McCrorey Mackenzie , Nisivaco Sarah , Balkhy Husam H.
Published: December 2017

Objective

Morbid obesity (body mass index S 35 kg/m2)usually confers a higher perioperative risk in cardiac surgery. Robotic cardiac surgery may have many advantages for these high-risk patients.

Methods

We retrospectively reviewed patients undergoing robotic cardiac surgery from July 2013 to April 2017 at our institution. We compared the outcomes of morbidly obese patients versus nonobese patients.

Results

A total of 486 patients underwent robotic cardiac surgery (322 men, median age = 65 years). The robotic procedures were the following: totally endoscopic beating heart coronary artery bypass (n = 263), mitral valve surgery (n = 138), arrhythmia surgery (n = 33), adult congenital surgery (n = 16), pericardiectomy (n = 11), and others (n = 25). The cohorts were divided into the following: normal weight (body mass index < 25, n = 123), overweight (body mass index = 25 to < 30, n = 182), obesity (body mass index = 30 to < 35, n = 105), and morbid obesity (body mass index S 35, n = 76). Morbidly obese patients had a higher rate of hypertension, dyslipidemia, and diabetes mellitus compared with normal or overweight patients. There were no significant differences in morbidity, mean length of intensive care unit stay (2.10 ± 4.27 days), and hospital stay (4.48 ± 5.61 days) among the groups. In-hospital mortality was 1.4% (7/486) with nonsignificant difference.

Conclusions

Outcomes of robotic heart surgery in morbidly obese patients in our center were acceptable. Over a broad range of cardiac surgical procedures, morbid obesity was not associated with increased morbidity or mortality when these procedures were performed using a robotic approach. These findings can be beneficial in managing this challenging group of patients.
The Diuretic Potential of Sacubitril/Valsartan: A Tale of 2 Patients
Authors: Hormann Sabrina M. , Davis Lindsay E. , Pogge Elizabeth K.
Published: December 2017

Background:

Heart failure prevalence continues to rise in the United States causing significant morbidity and mortality and costing billions in healthcare expenditures. Consensus guidelines updated in 2016 recommend an angiotensin receptor–neprilysin inhibitor (ARNi) as a therapeutic option in lieu of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker for the management of stage C heart failure with reduced ejection fraction (HFrEF). For chronic HFrEF patients with New York Heart Association class II or III symptoms tolerating an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, a change in therapy to an ARNi is recommended to further reduce morbidity and mortality.

Purpose:

We present a brief case series of 2 patients initiated on ARNi therapy for treatment of HFrEF and evaluate their fluid status and diuretic needs before and after ARNi dose optimization.

Conclusions:

After titration to target-dose ARNi therapy, both patients demonstrated improved fluid and electrolyte balance, as well as a reduction in diuretic therapy requirements, suggesting a mechanism of diuresis attributable to ARNi therapy.

Clinical Implications:

Angiotensin receptor–neprilysin inhibitor therapy seems to promote a clinically relevant diuresis in heart failure patients because of increased levels of functioning natriuretic peptides. Awareness of this diuretic potential may allow for optimization of heart failure regimens with pharmacologic agents demonstrated to improve morbidity and mortality, while preventing adverse effects that may occur with overdiuresis.
Comparison of Paliperidone Palmitate and Risperidone Long-Acting Injection in Schizophrenic Patients
Authors: Limosin Frédéric , Belhadi Drifa , Comet Denis , Pacou Maud , Bouju Sophie , Van Impe Kristel , Guillon Pascal
Published: December 2017

Purpose/Background

The study objective was to compare the impact of being treated by paliperidone palmitate (PP) or risperidone long-acting injection (RLAI) on the length of stay on initial hospitalization, rehospitalization risk, and treatment duration in schizophrenic patients.

Methods

We conducted an observational retrospective cohort study in 43 centers in France, including schizophrenic patients who initiated a treatment by PP or RLAI during initial hospitalization. The follow-up periods started in September 2012 for the RLAI group (median follow-up duration, 233 days) and in June 2013 for the PP group (259 days). Statistical analyses were based on Cox regression models, with propensity score weighting to account for differences in patients’ characteristics.

Findings/Results

The analysis included 347 patients: 197 in the PP treatment group and 150 in the RLAI group. Compared with patients on RLAI, patients on PP were significantly more likely to have nonpsychiatric comorbidities, to have been on previous antipsychotic therapy, or to have been hospitalized for psychiatric care in the previous year. With regard to length of stay on initial hospitalization, there was no statistically significant difference between both groups (hazard ratio, 1.13 [0.97; 1.31]). Being on PP was associated with similar times to first rehospitalization compared with RLAI (hazard ratio, 0.92 [0.65; 1.30]).

Implications/Conclusions

We observed nonsignificant differences in initial hospitalization duration and time to rehospitalization between PP and RLAI, potentially due to lack of statistical power. A trend was observed in favor of PP with regard to time to treatment discontinuation, although this result was compromised by patients who switched between RLAI and PP.
Exposure to Dihydroxyacetone in Sunless Tanning Products
Authors: Gallagher Mary
Published: December 2017

The public has been warned for years about the dangers of ultraviolet exposure from natural sunlight and tanning beds due to the associated risk for skin cancer development. An alternative to obtaining the sun-kissed look without ultraviolet exposure has been self-tanning products, which are applied directly to the skin via lotions, sprays, foams, and wipes. However, recent research has indicated that the chemical dihydroxyacetone (DHA), which is the active agent in most sunless tanning lotions, may cause cell damage via free radical reactions. Changes in pigmented lesion appearance during dermoscopic examinations after use of products containing DHA have been documented, and these findings will be analyzed. This integrative research review will examine evidence-based research regarding the risks of using DHA-containing products. Nola Pender’s health promotion model is recommended to identify strategies that healthcare providers can use when developing anticipatory guidance to address factors leading to barriers in health promoting behaviors. This model is focused on improvement of well-being while preventing diseases.
Practices, attitudes, and knowledge about Crohn’s disease and smoking cessation among gastroenterologists
Authors: Nulsen Benjamin , Sands Bruce E. , Shah Brijen J. , Ungaro Ryan C.
Published: December 2017

Objective

Cigarette smoking is one of the most important, modifiable environmental factors in Crohn’s disease (CD) and screening for tobacco use is an official recommendation and quality measure in the care of CD patients. The objective of this study was to learn more about gastroenterologists’ practices, opinions, and knowledge in this area.

Patients and methods

A 15 question survey was sent through email to two national gastroenterology distribution lists. Questions were written in multiple choice formats and were designed to collect information about gastroenterologists’ practices, attitudes, and knowledge regarding smoking cessation in CD patients. Responses were stratified by practice setting, experience, and inflammatory bowel disease-focus. Responses were anonymous and were collected in a secure, online database.

Results

A total of 141 respondents completed the survey. Overall, 89% of participants screened their CD patients for smoking more than 75% of the time. In all, 62% provided smoking cessation counseling more than 75% of the time. Overall, 94% of respondents felt comfortable discussing the benefits of smoking cessation with their patients. In all, 56% felt comfortable discussing smoking cessation strategies with their patients. Overall, 88% of respondents agreed that gastroenterologists should provide smoking cessation counseling; however, 43 and 11% agreed that the gastroenterologist should be the primary counselor and primary prescriber of cessation-related pharmacotherapy, respectively.

Conclusion

Surveyed gastroenterologists agree that smoking cessation is an important part of the care of CD patients and this is reflected in their screening practices. Counseling occurs irregularly and many gastroenterologists do not feel comfortable discussing cessation strategies. Future guidelines should provide further guidance on the gastroenterologist’s role in smoking cessation counseling for CD patients.
Levocarnitine for the Treatment of Valproic Acid–Induced Hyperammonemic Encephalopathy in Children: The Experience of a Large, Tertiary Care Pediatric Hospital and a Poison Center
Authors: Glatstein Miguel , Bonifacio Rino Pedro , de Pinho Silvina , Scolnik Dennis , Pivko-Levi Dikla , Hoyte Christopher
Published: December 2017

Background:

Although rare, symptomatic hyperammonemia is sometimes associated with valproic acid (VPA), especially in children. l-carnitine (levocarnitine), sometimes classified as an essential amino acid, is vital to mitochondrial utilization of fatty acids and can be helpful in treating this condition. The data supporting this, however, are limited.

Study Question:

The aim of the study was to illustrate the role of l-carnitine in the treatment of patients with VPA–induced hyperammonemic encephalopathy (VPE) at 2 different institutions.

Methods:

Medical records of affected patients were reviewed; data collected included exposure history, clinical manifestations, physical examination, and laboratory values.

Results:

There were 13 cases of VPE; 12 were associated with therapeutic dosing and 1 with an overdose. The maximum ammonia concentration was 557 μmol/L, and blood concentrations of VPA ranged from 68 to 600 μg/mL (therapeutic range 50–100 μg/mL). In all cases, liver function tests were normal or only mildly increased. In this study, 12 patients received a daily dose of l-carnitine 100 mg/kg, and 1 received 200 mg/kg (intravenous infusion over 30 minutes) divided every 8 hours until clinical improvement. All patients made a full recovery. None developed adverse effects or reactions, and no cases of toxicity were reported.

Conclusion:

Our series suggests that intravenous l-carnitine, at a dose of 100 mg·kg−1·d−1 in 3 divided doses each over 30 minutes until clinical improvement occurs, is a safe and effective treatment in the management of VPE in children.
Care Management to Reduce Disparities and Control Hypertension in Primary Care
Authors: Hong Jonathan C. , Padula William V. , Hollin Ilene L. , Hussain Tanvir , Dietz Katherine B. , Halbert Jennifer P. , Marsteller Jill A. , Cooper Lisa A.
Published: December 2017

Background:

Project ReD CHiP (reducing disparities and controlling hypertension in primary care) care management was a clinic-based intervention that aimed to improve blood pressure control through improved care coordination and provide self-management support to patients from racially and socioeconomically.

Objective:

To evaluate the cost-effectiveness of ReD CHiP care management versus standard care to treat hypertension in diverse communities.

Research Design:

Microsimulation model from a health care sector perspective over 15 years. We used the published literature to inform our model including the ReD CHiP trial and the age-specific and race-specific cardiovascular disease risk equations. Deterministic and probabilistic sensitivity analyses were conducted to assess the uncertainty.

Subjects:

Primary prevention in a racially diverse setting.

Measures:

Costs per quality-adjusted life years (QALYs) to produce an incremental cost-effectiveness ratio (ICER).

Results:

ReD CHiP had an increase of $2114 and 0.04 QALYs. The ICER was $52,850/QALY. Predominately African American (ICER: $48,250/QALY) and elderly populations (ie, age 65+) derived value from ReD CHiP (ICER: $39,525/QALY). The value of ReD CHiP varied with changes in the reduction in systolic blood pressure (5 mm Hg reduction, ICER: $133,300/QALY; 15 mm Hg reduction, ICER: $18,767/QALY). Probabilistic sensitivity analysis indicated that ReD CHiP CM was cost-effective in over 90% of simulations, based on a willingness-to-pay of $100,000/QALY.

Conclusions:

ReD CHiP care management is cost-effective to prevent negative consequences of hypertension. African American and elderly patients have more favorable ICERs, recommending targeted interventions to improve health equity among vulnerable patient populations.
Prevalence of Hypertension (HTN) and Cardiovascular Risk Factors in a Hospitalized Pediatric Hemophilia Population
Authors: Alperstein Warren , Corrales-Medina Fernando F. , Tamariz Leonardo , Palacio Ana M. , Davis Joanna A.
Published: December 2017

Improved life expectancy in hemophilia has led to a greater interest in age-related disorders. Hypertension (HTN) as well as cardiovascular disease have been increasingly reported in hemophilic adults but there is currently very limited data in the pediatric population. We conducted a cross-sectional study using data from the 2012 National Health Cost and Utilization Project database to determine the prevalence of HTN and associated cardiovascular risk factors in a hospitalized pediatric hemophilia population, between the ages of 0 to 21 years, in comparison with the general pediatric population. The prevalence of HTN was significantly higher in children with hemophilia (CWH) in comparison with the general pediatric population (1.71% vs. 1.02%, P-value=0.005). When adjusting the analysis for sex, the prevalence of HTN in the hemophilia cohort remained higher, although not statistically significant (1.52% vs. 1.22%, P-value=0.2568). When examining the concomitant presence of ≥1 cardiovascular risk factors in the hypertensive subgroups, CWH had a higher prevalence of obesity (2.64% vs. 1.32%, P-value <0.0001). Interestingly, diabetes mellitus was more prevalent in nonhemophilic children (1.47% vs. 0.56%, P-value=0.0015). These data suggest that cardiovascular risk factors need to be closely monitored in CWH, and a better preventive strategy is likely needed to identify those hemophilic patients at higher risk of developing cardiovascular disease in adulthood.
Solid Pseudopapillary Neoplasm of the Pancreas in Children and Adults: A National Study of 369 Patients
Authors: Leraas Harold J. , Kim Jina , Sun Zhifei , Ezekian Brian , Gulack Brian C. , Reed Christopher R. , Tracy Elisabeth T.
Published: December 2017

Background:

Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare tumor in children, with current evidence limited to single-center studies. We examined treatment and clinical outcomes for pediatric and adult SPN with a national data set.

Methods:

The 2004 to 2013 National Cancer Data Base was queried to identify all patients diagnosed with SPN. The cohort was stratified by age (pediatric and adult) defined as below 18 years and 18 years and above, respectively. Baseline characteristics and unadjusted outcomes were compared.

Results:

We identified 21 pediatric and 348 adult patients with SPN. Both groups displayed similar demographic composition. Patients were commonly female (90.5% [pediatric] vs. 85.9% [adult], P=0.56) and white (66.7% vs. 68.3%, P=0.74). Tumor location was similar between adults and children. Median tumor size was similar between children and adults (5.9 vs. 4.9 cm, P=0.41). Treatment strategies did not vary between groups. Partial pancreatectomy was the most common resection strategy (71.4% vs. 53.1%, P=0.80). Both groups experienced low mortality (0.0% vs. 0.7% at 5 y, P=0.31).

Conclusions:

This study provides the largest comparison of pediatric and adult SPN to date. Children with SPN have similar disease severity at presentation, receive similar treatments, and demonstrate equivalent postoperative outcomes compared with their adult counterparts.
Satisfaction and Barriers of Surgical Safety Checklist Implementation in a Nonmandatory Adoption Resource-Limited Country
Authors: Kasatpibal Nongyao , Sirakamon Somjai , Punjasawadwong Yodying , Chitreecheur Jittaporn , Chotirosniramit Narain , Pakvipas Parichat , Whitney JoAnne D.
Published: December 2017

Objectives

A surgical safety checklist has been a globally implemented and mandated adoption in several countries. However, its use is not mandatory in Thailand. This study aimed to evaluate the perceptions of surgical personnel on surgical complications and safety and to examine the satisfaction and barriers of surgical safety checklist implementation.

Methods

A survey study was performed between November 2013 and February 2015 in 61 Thai hospitals. A questionnaire capturing demographics, perceptions related to surgical complications and safety, and the satisfaction and barriers of surgical safety checklist implementation was distributed to surgical personnel.

Results

A total of 2024 surgical personnel were recruited. Nearly all of them reported experience or knowledge of an adverse surgical event (99.6%). Most thought that it could be preventable (98.2%) and quality care improvement could help reduce the occurrence of adverse events (97.7%). Overall, respondents reported a high level of satisfaction with the checklist (mean [SD] = 3.79 [0.71]). The three areas of highest satisfaction were benefit to the patient (mean [SD] = 4.11 [0.69]), benefit to the organization (mean [SD] = 4.05 [0.68]), and reduction in adverse events (mean [SD] = 4.02 [0.69]). Overall, the barrier for implementation of the checklist was rated as moderate (mean [SD] = 2.52 [0.99]). However, the means of barriers in each period, sign in, time out, and sign out, were rated as low (means [SD] = 2.41 [1.07], 2.50 [1.03], and 2.34 [1.01], respectively).

Conclusions

The data document that the satisfaction with the checklist are fairly high. However, some barriers were identified. Efforts to increase understanding through more rigorous policy enforcement and strategic support may lead to improving the checklist implementation.
Isoniazid Preventive Therapy for People With HIV Who Are Heavy Alcohol Drinkers in High TB-/HIV-Burden Countries: A Risk–Benefit Analysis
Authors: Freiman J. Morgan , Jacobson Karen R. , Muyindike Winnie R. , Horsburgh C. Robert , Ellner Jerrold J. , Hahn Judith A. , Linas Benjamin P.
Published: December 2017

Background:

Isoniazid preventive therapy (IPT) reduces mortality among people living with HIV (PLHIV) and is recommended for those without active tuberculosis (TB) symptoms. Heavy alcohol use, however, is contraindicated for liver toxicity concerns. We evaluated the risks and benefits of IPT at antiretroviral therapy (ART) initiation to ART alone for PLHIV who are heavy drinkers in 3 high TB-/HIV-burden countries.

Methods:

We developed a Markov simulation model to compare ART alone to ART with either 6 or 36 months of IPT for heavy drinking PLHIV enrolling in care in Brazil, India, and Uganda. Outcomes included nonfatal toxicity, fatal toxicity, life expectancy, TB cases, and TB death.

Results:

In this simulation, 6 months of IPT + ART (IPT6) extended life expectancy over both ART alone and 36 months of IPT + ART (IPT36) in India and Uganda, but ART alone dominated in Brazil in 51.5% of simulations. Toxicity occurred in 160/1000 persons on IPT6 and 415/1000 persons on IPT36, with fatal toxicity in 8/1000 on IPT6 and 21/1000 on IPT36. Sensitivity analyses favored IPT6 in India and Uganda with high toxicity thresholds.

Conclusions:

The benefits of IPT for heavy drinkers outweighed its risks in India and Uganda when given for a 6-month course. The toxicity/efficacy trade-off was less in Brazil where TB incidence is lower. IPT6 resulted in fatal toxicity in 8/1000 people, whereas even higher toxicities of IPT36 negated its benefits in all countries. Data to better characterize IPT toxicity among HIV-infected drinkers are needed to improve guidance.
Prediction of Posthepatectomy Liver Failure Proposed by the International Study Group of Liver Surgery
Authors: Mizutani Yoichi , Hirai Toshinori , Nagamachi Shigeki , Nanashima Atsushi , Yano Koichi , Kondo Kazuhiro , Hiyoshi Masahide , Imamura Naoya , Terada Tamasa
Published: December 2017

Purpose

The International Study Group of Liver Surgery (ISGLS) proposed a definition and grading system for posthepatectomy liver failure (PHLF). We evaluated the usefulness of residual liver function estimation using 99mTc-galactosyl human serum albumin (99mTc-GSA) for the prediction of PHLF.

Methods

Patients with liver tumors (n = 136) and scheduled for hepatectomy underwent 99mTc-GSA scintigraphy. Based on their imaging data, the maximal GSA removal rate (GSA-Rmax)was calculated using multicompartment analysis. We also calculated GSA-Rmax in the predicted residual liver (GSA-RL) whose volume was determined on computed tomography (CT) scans. We compared the age, sex, 15-minute indocyanine green retention rate; albumin, bilirubin, hyaluronic acid, and type 4 collagen levels; the Child-Pugh classification; residual liver volume; residual liver percentage; GSA-Rmax; and GSA-RL in patients with and without PHLF. Univariate and multivariate logistic analyses were used for statistical assessments.

Results

Of 136 patients, 17 (12.5%) met the ISGLS criteria for PHLF (ISGLS-PHLF). There was a statistically significant difference in the age, albumin level, Child-Pugh classification, residual liver volume, residual liver percentage, GSA-Rmax, and GSA-RL between patients with and without PHLF. Based on multivariate analysis, GSA-RL and the residual liver volume were significant independent predictors of ISGLS-PHLF (P = 0.004 and P = 0.038, respectively). The odds ratio was 149423 for GSA-RL and 1.003 for the residual liver volume.

Conclusions

GSA-RL calculated using 99mTc-GSA scintigraphy was the most useful independent predictor for ISGLS-PHLF.
Artifactual Hepatic Metastasis on FDG PET/CT Secondary to Cryoablation for Adrenal Metastasis
Authors: Frankl Joseph , Eshghi Naghmehossadat , Lundeen Tamara F. , Kuo Phillip H.
Published: December 2017

A 65-year-old woman with metastatic lung cancer was referred for CT-guided cryoablation of a right adrenal metastasis. For cryoablation, probes were placed into the adrenal region. FDG PET/CT 3 months later showed new activity in hepatic segment 6 initially suspected to be metastasis. Proximity of the hepatic lesion to the adrenal metastasis was a strange coincidence and prompted review of imaging from the cryoablation. CT showed the probe entered the liver, and postablation image demonstrated injury to the liver adjacent to the adrenal metastasis. Careful review of treatment history and imaging from ablation procedures are important to avoid this pitfall.
Postoperative Mortality After Nonelective Surgery for Inflammatory Bowel Disease Patients in the Era of Biologics
Authors: Justiniano Carla F. , Aquina Christopher T. , Becerra Adan Z. , Xu Zhaomin , Boodry Courtney I. , Swanger Alex A. , Monson John R. T. , Fleming Fergal J.
Published: December 2017

Objective:

The aim of the study was to analyze recent trends in the rate of nonelective surgery and corresponding mortality for inflammatory bowel disease (IBD) patients since the rise of biologic use.

Background:

Modern biologic therapy has improved outcomes for IBD, but little is known about the impact on mortality rates after nonelective surgery.

Methods:

New York's Statewide Planning & Research Cooperative System was queried for hospital admissions for ulcerative colitis (UC) with concurrent colectomy and Crohn disease (CD) with concurrent small bowel resection or colectomy from 2000 to 2013. Mixed-effects analyses assessed patient, surgeon, and hospital-level factors and hospital-level variation associated with 30-day mortality after nonelective surgery.

Results:

Between 2000 to 2006 and 2007 to 2013, the number of unscheduled IBD-related admissions increased by 50% for UC and 41% for CD, but no change in the proportion of nonelective surgery cases was observed (UC=38% vs 38%; CD=45% vs 42%) among 15,837 intestinal resections (UC=5,297; CD=10,540). Nonelective surgery mortality rates between 2000 to 2006 and 2007 to 2013 were high and increased for UC (10.2% vs 15%) but decreased for CD (3.3% vs 2.2%). Nonelective surgery in 2007 to 2013 was associated with an 82% increased risk of 30-day mortality in UC cases (odds ratio: 1.82; confidence interval: 1.19–2.62). After controlling for patient-level factors, large hospital-level variation was observed with 23-fold difference in mortality for both UC and CD.

Conclusions:

Although nonelective IBD surgery rates have remained stable, associated 30-day mortality for UC has doubled in recent years despite advances in medical management. Current clinical decision-making and care pathways must be further evaluated to improve outcomes in this high-risk population.
On three-dimensional Gerstner-like equatorial water waves
Authors: Henry D.
Published: December 2017

This paper reviews some recent mathematical research activity in the field of nonlinear geophysical water waves. In particular, we survey a number of exact Gerstner-like solutions which have been derived to model various geophysical oceanic waves, and wave–current interactions, in the equatorial region. These solutions are nonlinear, three-dimensional and explicit in terms of Lagrangian variables.

This article is part of the theme issue ‘Nonlinear water waves’.
The dynamic pressure in deep-water extreme Stokes waves
Authors: Lyons Tony
Published: December 2017

In this paper, we consider the dynamic pressure in a deep-water extreme Stokes wave. While the presence of stagnation points introduces a number of mathematical complications, maximum principles are applied to analyse the dynamic pressure in the fluid body by means of an excision process. It is shown that the dynamic pressure attains its maximum value beneath the wave crest and its minimum beneath the wave trough, while it decreases in moving away from the crest line along any streamline.

This article is part of the theme issue ‘Nonlinear water waves’.
On periodic geophysical water flows with discontinuous vorticity in the equatorial
f
-plane approximation
Authors: Martin Calin Iulian
Published: December 2017

We are concerned here with geophysical water waves arising as the free surface of water flows governed by the
f
-plane approximation. Allowing for an arbitrary bounded discontinuous vorticity, we prove the existence of steady periodic two-dimensional waves of small amplitude. We illustrate the local bifurcation result by means of an analysis of the dispersion relation for a two-layered fluid consisting of a layer of constant non-zero vorticity
γ
1
adjacent to the surface situated above another layer of constant non-zero vorticity
γ
2
≠
γ
1
adjacent to the bed. For certain vorticities
γ
1
,
γ
2
, we also provide estimates for the wave speed
c
in terms of the speed at the surface of the bifurcation inducing laminar flows.

This article is part of the theme issue ‘Nonlinear water waves’.
Capturing the flow beneath water waves
Authors: Nachbin A. , Ribeiro-Junior R.
Published: December 2017

Recently, the authors presented two numerical studies for capturing the flow structure beneath water waves (Nachbin and Ribeiro-Junior 2014Disc. Cont. Dyn. Syst. A34, 3135–3153 (doi:10.3934/dcds.2014.34.3135); Ribeiro-Junioret al.2017J. Fluid Mech.812, 792–814 (doi:10.1017/jfm.2016.820)). Closed orbits for irrotational waves with an opposing current and stagnation points for rotational waves were some of the issues addressed. This paper summarizes the numerical strategies adopted for capturing the flow beneath irrotational and rotational water waves. It also presents new preliminary results for particle trajectories, due to irrotational waves, in the presence of a bottom topography.

This article is part of the theme issue ‘Nonlinear water waves’.
Dynamic-pressure distributions under Stokes waves with and without a current
Authors: Umeyama Motohiko
Published: December 2017

To investigate changes in the instability of Stokes waves prior to wave breaking in shallow water, pressure data were recorded vertically over the entire water depth, except in the near-surface layer (from 0 cm to −3 cm), in a recirculating channel. In addition, we checked the pressure asymmetry under several conditions. The phase-averaged dynamic-pressure values for the wave–current motion appear to increase compared with those for the wave-alone motion; however, they scatter in the experimental range. The measured vertical distributions of the dynamic pressure were plotted over one wave cycle and compared to the corresponding predictions on the basis of third-order Stokes wave theory. The dynamic-pressure pattern was not the same during the acceleration and deceleration periods. Spatially, the dynamic pressure varies according to the faces of the wave, i.e. the pressure on the front face is lower than that on the rear face. The direction of wave propagation with respect to the current directly influences the essential features of the resulting dynamic pressure. The results demonstrate that interactions between travelling waves and a current lead more quickly to asymmetry.

This article is part of the theme issue ‘Nonlinear water waves’.
Nonlinear water waves: introduction and overview
Authors: Constantin A.
Published: December 2017

For more than two centuries progress in the study of water waves proved to be interdependent with innovative and deep developments in theoretical and experimental directions of investigation. In recent years, considerable progress has been achieved towards the understanding of waves of large amplitude. Within this setting one cannot rely on linear theory as nonlinearity becomes an essential feature. Various analytic methods have been developed and adapted to come to terms with the challenges encountered in settings where approximations (such as those provided by linear or weakly nonlinear theory) are ineffective. Without relying on simpler models, progress becomes contingent upon the discovery of structural properties, the exploitation of which requires a combination of creative ideas and state-of-the-art technical tools. The successful quest for structure often reveals unexpected patterns and confers aesthetic value on some of these studies. The topics covered in this issue are both multi-disciplinary and interdisciplinary: there is a strong interplay between mathematical analysis, numerical computation and experimental/field data, interacting with each other via mutual stimulation and feedback. This theme issue reflects some of the new important developments that were discussed during the programme ‘Nonlinear water waves’ that took place at the Isaac Newton Institute for Mathematical Sciences (Cambridge, UK) from 31st July to 25th August 2017. A cross-section of the experts in the study of water waves who participated in the programme authored the collected papers. These papers illustrate the diversity, intensity and interconnectivity of the current research activity in this area. They offer new insight, present emerging theoretical methodologies and computational approaches, and describe sophisticated experimental results.

This article is part of the theme issue ‘Nonlinear water waves’.