bluuebunny/crossref_metadata_2025 huggingface dataset:
Ratchet-Rasquache Activism: Aesthetic and Discursive Frames within Chicago-Based Women-of-Color Activism
Authors: Gonzales Teresa Irene
Published: June 2020

Extending the rich literature about women-of-color activism, this article analyzes the ways Chicago-based Chicanas and Black women maintain, build, and expand low-income residents’ access to and ownership of the city. I draw on 30 months of community-engaged, ethnographic fieldwork within high-poverty Mexican- and African-American neighborhoods and on interviews with 22 women-of-color activists across Chicago. Combining the cultural signifiers “ratchet” and “rasquache,” I highlight the strategic use of discursive and aesthetic frames to disrupt negative narratives of these women’s activism and their often-vilified communities. As a framework, ratchet-rasquache activism counters urban development practices that marginalize Black and Chicana/o/x communities. Emerging from African-American communities, “ratchet” connotes unruliness and low-class behavior. In Mexican communities, “rasquache” similarly connotes negative or low-class behavior but also means making the most with the tools one has. Both concepts, rooted in working-class sensibilities, can subvert narratives of racial uplift and reject normative whiteness as the standard for both activism and community development. Deploying “ratchet” and “rasquache” as positive attributes, Chicago-based women-of-color activists used nonhierarchical community-organizing tactics to operate as neighborhood strategists. Acknowledging the strength and expertise within marginalized, impoverished communities, they embraced a working-class, asset-based, ratchet and rasquache strategy, while striving to build something from something.
A telephone-based guided imagery tobacco cessation intervention: results of a randomized feasibility trial
Authors: Gordon Judith S , Bell Melanie L , Armin Julie S , Giacobbi Peter R , Nair Uma S
Published: June 2020

Background

Evidence supports the use of guided imagery for smoking cessation; however, scalable delivery methods are needed to make it a viable approach. Telephone-based tobacco quitlines are a standard of care, but reach is limited. Adding guided imagery to quitline services might increase reach by offering an alternative approach.

Purpose

To develop and test the feasibility and potential impact of a guided imagery-based tobacco cessation intervention delivered using a quitline model.

Methods

Participants for this randomized feasibility trial were recruited statewide through a quitline or community-based methods. Participants were randomized to guided imagery Intervention Condition (IC) or active behavioral Control Condition (CC). After withdrawals, there were 105 participants (IC = 56; CC = 49). The IC consisted of six sessions in which participants created guided imagery audio files. The CC used a standard six-session behavioral protocol. Feasibility measures included recruitment rate, retention, and adherence to treatment. We also assessed 6-month quit rates and consumer satisfaction.

Results

Both the IC and CC protocols were feasible to deliver. We finalized protocols and materials for participants, coaches and study staff, and delivered the protocols with fidelity. We developed successful recruitment methods, and experienced high retention (6 months = 81.9%) and adherence (all sessions = 66.7%). Long-term quit rates (IC = 27.9%; CC = 38.1%) compared favorably to those of quitlines, and program satisfaction was high, suggesting that the protocols are acceptable to smokers and may contribute to smoking abstinence.

Conclusions

The guided imagery intervention is feasible and promising, suggesting that a fully powered RCT to test the efficacy of the intervention is warranted.

Trial registration number

NCT02968381.
New Burmese amber fossils clarify the evolution of bethylid wasps (Hymenoptera: Chrysidoidea)
Authors: Jouault Corentin , Ngô-Muller Valérie , Pouillon Jean-Marc , Nel André
Published: June 2020

Two new bethylid wasps from Cenomanian Burmese amber, one tentatively placed in †Protopristocerinae: Cretapristocera longiscapa gen. & sp. nov. and one in †Holopsenellinae: Megalopsenella pouilloni gen. & sp. nov., are described and illustrated here. They provide new data on the Cretaceous diversity of the family and extend the Cenomanian Burmese amber records to six species. We discuss their systematic placements and provide identification keys to species of †Holopsenellinae and †Protopristocerinae to assist future taxonomic studies. We phylogenetically analyse Bethylidae, adding several fossil taxa to a recent study, suggesting a new hypothesis for the relationships between the different subfamilies. We also address the distribution and underestimated diversity of the family during the Cretaceous and the evolution of the venation of their wings. Finally, we discuss the possible misplacement of the families Plumariidae and †Falsiformicidae.
Original Research: How Magnet Hospital Status Affects Nurses, Patients, and Organizations: A Systematic Review
Authors: Rodríguez-García Ma Carmen , Márquez-Hernández Verónica V. , Belmonte-García Teresa , Gutiérrez-Puertas Lorena , Granados-Gámez Genoveva
Published: June 2020

Objective:

As the number of Magnet hospitals continues to rise in the United States and abroad, the body of literature regarding various outcomes at Magnet hospitals is increasing also. A systematic review examining and compiling the most recent evidence would be invaluable to those seeking to pursue Magnet recognition for their facility. We conducted this systematic review to investigate how Magnet hospital status affects outcomes for nursing professionals, patients, and health care organizations.

Methods:

In January 2018, the databases CINAHL, ProQuest, PubMed, and La Biblioteca Cochrane Plus were searched for relevant studies. The reference lists of selected articles were also examined to identify additional studies. The PRISMA statement was followed, and established methods for systematic review were used to produce a narrative summary. The quality of the reviewed studies was assessed according to the 22-item Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for observational studies.

Results:

Of the 163 studies identified, 21 met the eligibility criteria and are included in this review. On the whole, lower rates of nursing shortages, burnout, job dissatisfaction, and turnover were observed at Magnet hospitals compared with non-Magnet hospitals. The rates of patient mortality, falls, hospital-acquired infections, and pressure ulcers were also lower. Nursing work environments were found to be safer and were associated with a higher quality of care in Magnet hospitals than in non-Magnet hospitals, and Magnet hospitals were found to provide more cost-effective care.

Conclusion:

This review provides nursing managers and administrators with the most recent evidence demonstrating that Magnet hospitals have better nursing work environments and are associated with better outcomes for nurses, patients, and organizations than non-Magnet hospitals. This evidence should inform future decision-making with regard to pursuing Magnet designation.
Immunity to Hepatitis B is Undetectable in the Majority of Adolescents and Young Adults Seeking Outpatient Medication Treatment for Opioid Use Disorder
Authors: Stull Samuel W. , McKnight Erin R. , Matson Steven C. , Bonny Andrea E.
Published: June 2020

Objective:

To assess prevalence and predictors of hepatitis B immune status among adolescents and young adults (AYA) seeking outpatient medication treatment for opioid use disorder (MOUD).

Study Design:

A retrospective medical chart review was conducted of AYA seeking MOUD between January 1, 2013 through December 31, 2015. Inclusion criteria included: diagnosis of opioid use disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; received hepatitis serologic testing; and no evidence of prior or current hepatitis B infection. Hepatitis B immunization initiation was defined as a record of at least 1 hepatitis B vaccination; while receipt of at least 3 vaccinations indicated immunization completion. The presence of hepatitis B surface antibody (anti-HBs) was the primary outcome measure.

Results:

Of the 193 patients that met eligibility criteria, the presence of anti-HBs was evident in 62 (32.1%). Hepatitis B immunization initiation and completion before presenting for MOUD was documented in 102 (52.9%) and 84 (43.5%). In multivariable logistic regression modeling, hepatitis B immunization initiation after infancy was associated with increased odds of having protective anti-HBs relative to immunization series initiation in infancy (OR 8.96, 95% CI 1.57–51.05). Completion of hepatitis B immunization series after infancy as compared to completion in infancy also increased the odds of protective anti-HBs (OR, 6.68, 95% CI 2.10–21.24).

Conclusions:

Rates of immunity to hepatitis B were low in AYA seeking MOUD. It is important to immunize patients seeking MOUD for hepatitis B and follow up with checks for seroconversion.
Photoprotection With Mineral-Based Sunscreens
Authors: Solish Nowell , Humphrey Shannon , Waller Brittany , Vanderveen Sherri
Published: June 2020

BACKGROUND

Although chemical sunscreens have traditionally been at the forefront of sun protection, safety concerns and increasing awareness of the environmental impact of personal-care products have led to greater interest in the use of mineral blockers as photoprotective agents.

OBJECTIVE

To examine the safety and efficacy of mineral-based sunscreens to allow patients to make informed choices about ultraviolet (UV) protection.

MATERIALS AND METHODS

A review of the literature was performed using the PubMed database.

RESULTS

This article provides an overview of physical blockers and focuses on the efficacy of mineral sunscreens in offering broad-spectrum UV protection and safety concerns, including the controversy surrounding the use of nanoparticles. Practical tips for application are also reviewed.

CONCLUSION

Mineral sunscreens are an attractive, efficacious option for consumers who prefer alternative choices in sun protection.
The Last 200 Surgeon-Loaded Descemet Membrane Endothelial Keratoplasty Tissue Versus the First 200 Preloaded Descemet Membrane Endothelial Keratoplasty Tissue
Authors: Potts Luke B. , Bauer Alex J. , Xu David N. , Chen Shin-Yi , Alqudah Asem A. , Sanchez Philip J. , Straiko Michael D. , Terry Mark A.
Published: June 2020

Purpose:

The purpose of this study was to compare the clinical outcomes from using eye bank–prepared, endothelium-out preloaded Descemet membrane endothelial keratoplasty (DMEK) tissue with those obtained with endothelium-out surgeon-loaded DMEK tissue using the same surgical technique at 1 site.

Methods:

This study retrospectively reviewed 400 consecutive cases of DMEK from March 2016 to April 2018. The last 200 cases using surgeon-loaded tissue were compared with the first 200 cases using preloaded tissue. Statistical analysis was performed using the Wilcoxon signed-rank test, binomial logistic regression, Kruskal–Wallis 1-way analysis of variance, Student t test, or Pearson χ2 tests.

Results:

Comparing surgeon-loaded versus preloaded DMEK tissue, respectively, no statistical difference was found in the mean 6-month postoperative values for endothelial cell loss (32.9% ± 18.5% vs. 29.9% ± 16.4%, P = 0.31), best corrected visual acuity (20/26 vs. 20/25, P = 0.54), or change in central corneal thickness (−14.4% ± 8.9% vs. −15.6% ± 11.7%, P = 0.43). The mean 1-year endothelial cell loss was also not significantly different (37.6% ± 17.2% vs. 33.2% ± 14.8%, P = 0.07). Overall, the rebubble rate for surgeon-loaded tissue was 17.5% and 12.5% for preloaded tissue, a statistically nonsignificant difference. Operative outcomes for mean tissue scroll tightness (1–4) and tissue unscroll time (minutes) for surgeon-loaded and preloaded tissue were similar between groups (2.4 vs. 2.2, P = 0.12 and 3.5 vs. 3.3 minutes, P = 0.50).

Conclusions:

Tissue that is trephinated, stained, and loaded into an injector by the eye bank and then shipped to the surgeon had no difference in clinical outcomes compared with tissue where the surgeon performs these steps. The safety and speed of using preloaded tissue should be considered by DMEK surgeons.
Aberrometric outcome of customized toric IOL in cataract with very high corneal astigmatism due to pellucid marginal degeneration
Authors: Paryani Mukesh , Deshpande Madan
Published: June 2020

A case of pellucid marginal degeneration (PMD) with cataract where a customized high-power toric IOL was implanted is reported. The patient had preoperative corneal astigmatism of 13.96 diopters (D), and a customized toric IOL of 19 D toricity was implanted; postoperative visual acuity was 6/9 on Snellen chart. The visual quality and aberrometric outcome were assessed with a ray-tracing aberrometer. The toric IOL gave not only a better uncorrected visual acuity but also better quality of vision in this patient with corneal astigmatism due to PMD.
Presurgical risk model for chronic postsurgical pain based on 6 clinical predictors: a prospective external validation
Authors: Montes Antonio , Roca Gisela , Cantillo Jordi , Sabate Sergi ,   for the GENDOLCAT Study Group
Published: June 2020

No externally validated presurgical risk score for chronic postsurgical pain (CPSP) is currently available. We tested the generalizability of a six-factor risk model for CPSP developed from a prospective cohort of 2929 patients in 4 surgical settings. Seventeen centers enrolled 1225 patients scheduled for inguinal hernia repair, hysterectomy (vaginal or abdominal), or thoracotomy. The 6 clinical predictors were surgical procedure, younger age, physical health (Short Form Health Survey-12), mental health (Short Form Health Survey-12), preoperative pain in the surgical field, and preoperative pain in another area. Chronic postsurgical pain was confirmed by physical examination at 4 months. The model's discrimination (c-statistic), calibration, and diagnostic accuracy (sensitivity, specificity, and positive and negative likelihood ratios) were calculated to assess geographic and temporal transportability in the full cohort and 2 subsamples (historical and new centers). The full data set after exclusions and losses included 1088 patients; 20.6% had developed CPSP at 4 months. The c-statistics (95% confidence interval) were similar in the full validation sample and the 2 subsamples: 0.69 (0.65-0.73), 0.69 (0.63-0.74), and 0.68 (0.63-0.74), respectively. Calibration was good (slope b and intercept close to 1 and 0, respectively, and nonsignificance in the Hosmer–Lemeshow goodness-of-fit test). The validated model based on 6 clinical factors reliably identifies risk for CPSP risk in about 70% of patients undergoing the surgeries studied, allowing surgeons and anesthesiologists to plan and initiate risk-reduction strategies in routine practice and researchers to screen for risk when randomizing patients in trials.
A modulator of the low-voltage-activated T-type calcium channel that reverses HIV glycoprotein 120-, paclitaxel-, and spinal nerve ligation-induced peripheral neuropathies
Authors: Cai Song , Tuohy Peter , Ma Chunlong , Kitamura Naoya , Gomez Kimberly , Zhou Yuan , Ran Dongzhi , Bellampalli Shreya Sai , Yu Jie , Luo Shizhen , Dorame Angie , Yen Ngan Pham Nancy , Molnar Gabriella , Streicher John M. , Patek Marcel , Perez-Miller Samantha , Moutal Aubin , Wang Jun , Khanna Rajesh
Published: June 2020

The voltage-gated calcium channels CaV3.1–3.3 constitute the T-type subfamily, whose dysfunctions are associated with epilepsy, psychiatric disorders, and chronic pain. The unique properties of low-voltage-activation, faster inactivation, and slower deactivation of these channels support their role in modulation of cellular excitability and low-threshold firing. Thus, selective T-type calcium channel antagonists are highly sought after. Here, we explored Ugi-azide multicomponent reaction products to identify compounds targeting T-type calcium channel. Of the 46 compounds tested, an analog of benzimidazolonepiperidine—5bk (1-{1-[(R)-{1-[(1S)-1-phenylethyl]-1H-1,2,3,4-tetrazol-5-yl}(thiophen-3-yl)methyl]piperidin-4-yl}-2,3-dihydro-1H-1,3-benzodiazol-2-one) modulated depolarization-induced calcium influx in rat sensory neurons. Modulation of T-type calcium channels by 5bk was further confirmed in whole-cell patch clamp assays in dorsal root ganglion (DRG) neurons, where pharmacological isolation of T-type currents led to a time- and concentration-dependent regulation with a low micromolar IC50. Lack of an acute effect of 5bk argues against a direct action on T-type channels. Genetic knockdown revealed CaV3.2 to be the isoform preferentially modulated by 5bk. High voltage-gated calcium, as well as tetrodotoxin-sensitive and -resistant sodium, channels were unaffected by 5bk. 5bk inhibited spontaneous excitatory postsynaptic currents and depolarization-evoked release of calcitonin gene-related peptide from lumbar spinal cord slices. Notably, 5bk did not bind human mu, delta, or kappa opioid receptors. 5bk reversed mechanical allodynia in rat models of HIV-associated neuropathy, chemotherapy-induced peripheral neuropathy, and spinal nerve ligation-induced neuropathy, without effects on locomotion or anxiety. Thus, 5bk represents a novel T-type modulator that could be used to develop nonaddictive pain therapeutics.
Effectiveness of Liver-Directed Therapy for the Management of Intractable Hypoglycemia in Metastatic Insulinoma
Authors: Habibollahi Peiman , Bai Harrison X. , Sanampudi Sreeja , Soulen Michael C. , Dagli Mandeep
Published: June 2020

Objective

The aim of the study was to evaluate efficacy of chemoembolization and radioembolization in treating patients with recurrent hypoglycemia secondary to metastatic insulinoma.

Methods

A retrospective review was performed of all patients with metastatic insulinoma treated with liver-directed therapy (LDT) at a large academic medical center from January 1998 to August 2017. Primary outcomes included blood glucose levels, occurrence of symptomatic hypoglycemic episodes, and tumor imaging response rates.

Results

Seven patients were identified (4 male patients). The mean age at the first LDT was 60.9 (standard deviation [SD], 9.2) years. The median follow-up was 1.8 years. Thirty-three sessions of LDT were performed including 30 sessions of chemoembolization and 3 sessions of radioembolization. Technical success rate was 97% (32/33 procedures) with an initial clinical success rate of 100%, defined as absence of recurrent symptomatic hypoglycemia within 1 month after first cycle of LDT and overall clinical success rate of 85%. Random daytime glucose levels increased from 75.0 (SD, 26) mg/dL to 152.8 (SD, 52.4) mg/dL after LDT. The mean time to recurrence of intractable hypoglycemia was 21 (SD, 9) months. No severe complications were reported.

Conclusions

Liver-directed therapy with chemoembolization or radioembolization is effective for treatment of symptomatic hypoglycemia secondary to malignant insulinoma metastatic to liver.
Patients With Acinar Cell Carcinoma of the Pancreas After 2005
Authors: Zong Yuan , Qi Changsong , Peng Zhi , Shen Lin , Zhou Jun
Published: June 2020

Objectives

Acinar cell carcinoma of the pancreas is a rare tumor with limited data. We aim to evaluate the characteristics, treatments, and outcomes of pancreatic acinar cell carcinoma after 2005.

Methods

We retrospectively reviewed patients with pancreatic acinar cell carcinoma treated in Peking University Cancer Hospital and Institute (2005–2018) and identified cases from Surveillance, Epidemiology, and End Results database (2005–2015).

Results

A total of 306 cases in our institute (n = 11) and Surveillance, Epidemiology, and End Results database (n = 295) were identified. The median age was 67 years, and 73.5% were male. The 5-year survival was 36.8% for all patients (median, 27 months). About 37% underwent surgical resection. The 5-year survival was 65.6% for resected patients as compared with 16.9% for unresected ones (P < 0.0001). Among locoregional and metastatic diseases, surgery significantly prolonged survival as well (P = 0.0003). Stage IV patients who received chemotherapy had a better survival than those without it (median, 16 vs 3 months; P = 0.0019). Aging, stage IV, and no surgery were independent predictors of poor overall survival.

Conclusions

For pancreatic acinar cell carcinoma, surgery is a potentially curative treatment contributing to long-term survival and suggested even in advanced diseases. Chemotherapy improved survival for metastatic patients.
Interactions Between Neutrophils and Platelets in the Progression of Acute Pancreatitis
Authors: Tokoro Tomokazu , Makino Isamu , Harada Shinichi , Okamoto Koichi , Nakanuma Shinichi , Sakai Seisho , Kinoshita Jun , Nakamura Keishi , Miyashita Tomoharu , Tajima Hidehiro , Ninomiya Itasu , Fushida Sachio , Ohta Tetsuo
Published: June 2020

Objective

Severe acute pancreatitis is a serious disease, but its detailed mechanism has not yet been elucidated. We aimed to clarify the interaction between neutrophils and platelets in the pathogenesis of acute pancreatitis.

Methods

We induced acute pancreatitis in rats by injection of sodium taurocholate into the biliopancreatic duct and killed them over time. We observed the histological changes in pancreatic tissue with special attention to the dynamics of neutrophils and platelets. We also measured the concentrations of neutrophil- and platelet-derived factors in pancreatic tissue and blood samples.

Results

Neutrophils and platelets in the pancreatic tissue showed a similar pattern of migration. They initially spread in the interlobular connective tissue and finally into the lobules. The concentration of myeloperoxidase gradually increased in the inflamed pancreas until 24 hours and the concentration of thromboxane B2, plasminogen activator inhibitor 1, and CD41 also increased with time. Finally, the concentration of serum myeloperoxidase, citrullinated histone H3, and high-mobility group box 1 increased over time.

Conclusions

The interaction between neutrophils and platelets in pancreatic tissue plays an important role in the mechanism of advancing severity in acute pancreatitis. Circulating damage-associated molecular patterns induced by excessive local inflammation may lead to other organ injuries.
Dose Verification Errors in Hospitals
Authors: Hunt Sevgin , Chakraborty Joyram
Published: June 2020

Background:

The effectiveness of the dose verification features of the electronic medication administration record (eMAR) and complementary systems in the hospital setting is not well understood.

Purpose:

The authors completed a narrative synthesis of literature findings on the effectiveness of eMAR-based systems in the hospital setting.

Methods:

A literature review was carried out across 5 bibliographic databases to evaluate the safety features of current eMAR-based systems in preventing dosing errors and design issues that impede their usability.

Results:

While eMAR-based systems are beneficial to reducing order and drug cross-checking errors, safe dose verification features are sporadically available for targeted tasks. Overall, the eMAR had little impact on preventing low to moderate dosing errors. Dosing errors may occur because of error-prone activities that result from system design and work process issues during medication administration.
Nurses' Knowledge, Perception, and Practice of Discharge Planning in Acute Care Settings
Authors: Hayajneh Audai A. , Hweidi Issa M. , Abu Dieh Milian W.
Published: June 2020

Background:

Unsuccessful discharge planning (DP) may lead to undesirable health consequences among patients after discharge from the hospital.

Purpose:

The aims of this study were to assess nurses' knowledge, perception, and practice of DP in acute care settings and identify significant predictors for nurses' practice toward DP.

Methods:

The study had a descriptive correlational cross-sectional design. Three questionnaires about knowledge, perception, and nurses' activities toward DP were used. Nurses (n = 117) were recruited from 3 Jordanian hospitals.

Results:

The level of nurses' knowledge toward DP was very low to low. Slightly more than half (52.1%) of nurses had a negative perception toward DP and about 50% had poor practices related to DP. Nurse-to-patient ratio and perception of nurses were significant predictors for nurses' practice toward DP.

Conclusion:

The reinforcement of a positive perception toward DP among nurses working in acute care settings may lead to better health outcomes among patients after discharge from hospital.
Improving Staff Experience With Vaccine Data Entry With 2D Barcode Scanning
Authors: Evanson Heather V. , Reed Jenica Huddleston , Cox Regina , Clinthorne Ashley Daily , Williams Warren W. , Vallero Judi , Rodgers Loren , Greene Michael , Koeppl Patrick , Gerlach Ken
Published: June 2020

Background:

Small fonts on vaccine labels make manually recording vaccine data in patient records time-consuming and challenging. Vaccine 2-dimensional (2D) barcode scanning is a promising alternative to manually recording these data.

Problem:

While vaccine 2D barcode scanning assists in data entry, adoption of scanning technology is still low.

Approach:

Pilot sites (n = 27) within a health system scanned 2D barcodes to record vaccine data for 6 months. The time to record through scanning and nonscanning methods was measured for 13 vaccinators at 9 sites. A survey was administered to participants across all sites about their experience.

Outcomes:

On average, 22 seconds were saved per vaccine scanned versus entered manually (7 vs 29 seconds, respectively). Participants reported preference for scanning over other vaccine entry options and identified benefits of scanning.

Conclusion:

Expanded use of 2D barcode scanning can meaningfully improve clinical practices by improving efficiency and staff satisfaction during vaccine data entry.
Explainable AI (xAI) for Anatomic Pathology
Authors: Tosun Akif B. , Pullara Filippo , Becich Michael J. , Taylor D. Lansing , Fine Jeffrey L. , Chennubhotla S. Chakra
Published: June 2020

Pathologists are adopting whole slide images (WSIs) for diagnosis, thanks to recent FDA approval of WSI systems as class II medical devices. In response to new market forces and recent technology advances outside of pathology, a new field of computational pathology has emerged that applies artificial intelligence (AI) and machine learning algorithms to WSIs. Computational pathology has great potential for augmenting pathologists’ accuracy and efficiency, but there are important concerns regarding trust of AI due to the opaque, black-box nature of most AI algorithms. In addition, there is a lack of consensus on how pathologists should incorporate computational pathology systems into their workflow. To address these concerns, building computational pathology systems with explainable AI (xAI) mechanisms is a powerful and transparent alternative to black-box AI models. xAI can reveal underlying causes for its decisions; this is intended to promote safety and reliability of AI for critical tasks such as pathology diagnosis. This article outlines xAI enabled applications in anatomic pathology workflow that improves efficiency and accuracy of the practice. In addition, we describe HistoMapr-Breast, an initial xAI enabled software application for breast core biopsies. HistoMapr-Breast automatically previews breast core WSIs and recognizes the regions of interest to rapidly present the key diagnostic areas in an interactive and explainable manner. We anticipate xAI will ultimately serve pathologists as an interactive computational guide for computer-assisted primary diagnosis.
Making Magnets More Attractive
Authors: Brunnquell Christina L. , Hoff Michael N. , Balu Niranjan , Nguyen Xuan V. , Oztek Murat Alp , Haynor David R.
Published: June 2020

Patient comfort is an important factor of a successful magnetic resonance (MR) examination, and improvements in the patient's MR scanning experience can contribute to improved image quality, diagnostic accuracy, and efficiency in the radiology department, and therefore reduced cost. Magnet designs that are more open and accessible, reduced auditory noise of MR examinations, light and flexible radiofrequency (RF) coils, and faster motion-insensitive imaging techniques can all significantly improve the patient experience in MR imaging. In this work, we review the design, development, and implementation of these physics and engineering approaches to improve patient comfort.
Endoscopic Endonasal Transclival Approach to Spontaneous Hypertensive Brainstem Hemorrhage
Authors: Liu Bolin , Zheng Tao , Mao Yanjun , Bian Ka , He Shiming , Lv Wenhai
Published: June 2020

Surgical management of spontaneous hypertensive brainstem hemorrhage remains a challenge for neurosurgeons, especially when the hemorrhage is located the ventral brainstem. Recently endoscopic endonasal approach has been applied for resection of ventral brainstem lesions, though no published literature has explored its utility in treating brainstem hemorrhage. Here we reported a successful evacuation of severe hypertensive brainstem hemorrhage through endoscopic endonasal transclival approach. A 37 years-old male with a 5-year history of uncontrolled hypertension was brought to the Emergency Department with sudden vomiting, limb convulsions, and loss of consciousness for 2 hours. Computed tomography demonstrated a hemorrhage measuring 2.5 × 2.2 cm in the ventral midbrain and pontine. He presented with a Glasgow coma scale (GCS) score of 3 and disrupted vitals, and was intubated in the Emergency Department. Considering the ventral location of the hemorrhage and the need for emergent surgical decompression, an endoscopic endonasal approach was applied. Evacuation of the brainstem hemorrhage was achieved and his spontaneous respiration improved immediately after surgery. He was weaned off the ventilator and extubated on postoperative day 1, along with an improved GCS score of 5 (E2V1M2). At 1 month postoperatively his GCS score improved to 11 (E4V2M5) and he is currently under rehabilitation. Endoscopic endonasal approach is a feasible alternative for emergent surgery of ventrally located brainstem hemorrhage in carefully selected cases by providing direct visualization of the area and a good working angle, which facilitate evacuation of the hemorrhage with minimal damage to the brainstem.
Direct Oral Feeding After a Minimally Invasive Esophagectomy
Authors: Fransen Laura F. C. , Janssen Thijs H. J. B. , Aarnoudse Martijn , Nieuwenhuijzen Grard A. P. , Luyer Misha D. P.
Published: June 2020

Objective:

The aim of this single-center cohort study was to compare direct oral feeding (DOF) to standard of care after a minimally invasive esophagectomy (MIE) performed in a center with a stable and acceptable postoperative complication rate.

Background:

A recent multicenter, international randomized controlled trial showed that DOF following a MIE is comparable to standard of care (nil-by-mouth). However, the effect of DOF was potentially influenced by postoperative complications.

Methods:

Patients in this single-center prospective cohort study received either DOF (intervention) or nil-by-mouth for 5 days postoperative and tube feeding (standard of care, control group) following a MIE with intrathoracic anastomosis. Primary outcome was time to functional recovery and length of hospital stay. Secondary outcomes included anastomotic leakage, pneumonia, and other surgical complications.

Results:

Baseline characteristics were similar in the intervention (n = 85) and control (n = 111) group. Median time to functional recovery was 7 and 9 days in the intervention and control group (P < 0.001), respectively. Length of hospital stay was 8 versus 10 days (P < 0.001), respectively. Thirty-day postoperative complication rate was significantly reduced in the intervention group (57.6% vs 73.0%, P = 0.024). Chyle leakage only occurred in the control group (18.9%, P < 0.001). Anastomotic leakage, pneumonia, and other postoperative complications did not differ between groups.

Conclusion:

Direct oral feeding following a MIE results in a faster time to functional recovery and lower 30-day postoperative complication rate compared to patients that were orally fasted.
The Largest Single Center Report on Pediatric Liver Transplantation
Authors: Nikeghbalian Saman , Malekhosseini Seyed Ali , Kazemi Kourosh , Arasteh Peyman , Eghlimi Hesameddin , Shamsaeefar Alireza , Nikoupour Hamed , Gholami Siavash , Dehghani Masood , Dehghani Seyed Mohsen , Bahador Ali , Salahi Heshmatollah
Published: June 2020

Objective:

We described our experiences on pediatric liver transplantation (LT) from the largest LT center in the world termed the Shiraz Transplant Center.

Background:

After the first successful pediatric LT in 1967, pediatric LT has become the routine treatment for children with liver failure worldwide.

Methods:

Data on a total of 1141 pediatric cases of LT were collected. Specifics on baseline and anthropometric characteristics, clinicopathology, prognosis of recipients of LT, and donor characteristics are reported.

Results:

Mean age of patients was 7.83 ± 5.55 years old. Most common etiologies for LT were biliary atresia (15.9%), progressive familial intrahepatic cholestasis (13.4%), and Wilson's disease (13.3%), respectively.

Whole organs, living donor grafts, and split grafts were used in 47.9%, 41%, and 11.1% of patients, respectively. In-hospital complications were seen among 34.7% of patients and the most common complications were infections (26.8%), bleeding (23.4%), and vascular complications (18%).

Median (interquartile range) model for end stage liver disease score was 20 (15, 25). Main causes of death among patients were sepsis (35.2%), followed by post-transplantation lymphoproliferative diseases (10.5%), and primary nonfunction of liver (9%).

Patient survival showed improvement over the years (1-year survival of 73.1%, 83.4%, and 84.4%, 2-year survival of 65.2%, 77.1%, and 78.7%, 5-year survival of 58.2%, 72%, and 77.8% for 1997–2007, 2007–2013, and 2013–2019, respectively; P < 0.001).

Conclusions:

This is the largest single-center report on pediatric LT in literature which provides valuable experiences in pediatric LT.
A Modern Assessment of Cancer Risk in Adrenal Incidentalomas
Authors: Kahramangil Bora , Kose Emin , Remer Erick M. , Reynolds Jordan P. , Stein Robert , Rini Brian , Siperstein Allan , Berber Eren
Published: June 2020

Objective:

The aim of this study was to analyze the incidence of and risk factors for adrenocortical carcinoma (ACC) in adrenal incidentaloma (AI).

Summary of Background Data:

AI guidelines are based on data obtained with old-generation imaging and predominantly use tumor size to stratify risk for ACC. There is a need to analyze the incidence and risk factors from a contemporary series.

Methods:

This is a retrospective review of 2219 AIs that were either surgically removed or nonoperatively monitored for ≥12 months between 2000 and 2017. Multivariate logistic regression was performed to define risk factors. ROC curves constructed to determine optimal size and attenuation cut-offs for ACC.

Results:

16.8% of AIs underwent upfront surgery and rest initial nonoperative management. Of conservatively managed patients, an additional 7.7% subsequently required adrenalectomy. Overall, ACC incidence in AI was 1.7%. ACC rates by size were 0.1%, 2.4%, and 19.5% for AIs of <4, 4 to 6, and >6 cm, respectively. The optimal size cut-off for ACC in AI was 4.6 cm. ACC risks by Hounsfield density were 0%, 0.5%, and 6.3% for lesions of <10, 10 to 20, and >20 HU, with an optimal cut-off of 20 HU to diagnose ACC. 15.5% of all AIs and 19.2% of ACCs were hormonally active. Male sex, large tumor size, high Hounsfield density, and >0.6 cm/year growth were independent risk factors for ACC.

Conclusion:

This contemporary analysis demonstrates that ACC risk per size in AI is less than previously reported. Given these findings, modern management of AIs should not be based just on size, but a combination of thorough hormonal evaluation and imaging characteristics.
Evaluation of Recurrence Risk After Curative Resection for Patients With Stage I to III Colorectal Cancer Using the Hazard Function
Authors: Kudose Yozo , Shida Dai , Ahiko Yuka , Nakamura Yuya , Sakamoto Ryohei , Moritani Konosuke , Tsukamoto Shunsuke , Kanemitsu Yukihide
Published: June 2020

Objective:

This study aimed to investigate transitions of recurrence hazard and peak recurrence time in patients with nonmetastatic CRC using the hazard function.

Summary of Background Data:

A postoperative surveillance period of 5 years is consistent across major guidelines for patients with nonmetastatic CRC, but surveillance intervals differ. Estimates of instantaneous conditional recurrence rate can help set appropriate intervals.

Methods:

The study population consisted of 4330 patients with stage I to III CRC who underwent curative resection at the National Cancer Center Hospital between January 2000 and December 2013. Hazard rates of recurrence were calculated using the hazard function.

Results:

Recurrence rates in patients with stage I, II, and III CRC were 4% (50/1432), 11% (136/1231), and 25% (424/1667), respectively. The hazard curve for stage I was relatively flat and hazard rates were consistently low (<0.0015) for 5 years after surgery. The hazard curve for stage II had a peak hazard rate of 0.0046 at 13.7 months, after which the curve had a long hem to the right. The hazard curve for stage III had an earlier and higher peak than that of stage II (0.0105 at 11.6 months), with a long hem to the right.

Conclusions:

Changes in recurrence hazard for CRC patients varied considerably by stage. Our findings suggest that short-interval surveillance might be unnecessary for stage I patients for the first 3 years after surgery, whereas short-interval surveillance for the first 3 years should be considered for stage III patients.
Tertiary Hyperparathyroidism
Authors: Dream Sophie , Chen Herbert , Lindeman Brenessa
Published: June 2020

Objective:

To evaluate the reason for delay of surgical referral in tertiary hyperparathyroidism (THPT) and its impact on renal allograft function.

Background:

Persistent hyperparathyroidism after renal transplant has been shown to negatively impact allograft function, yet referral for definitive treatment of THPT is often delayed.

Methods:

A retrospective review was performed of patients undergoing parathyroidectomy for THPT (n = 38) at a single institution from May 2016 to June 2018. The first elevated serum calcium after transplant and time to referral for parathyroid surgery were recorded. Baseline creatinine post-transplant and the most recent creatinine level were used to assess allograft function.

Results:

Thirty-eight patients were included, with mean age 53 ± 2 years and 66% male. Mean preoperative calcium and parathyroid hormone were 10.8 ± 0.1 mg/dL and 328 ± 48 pg/mL, respectively. THPT after renal transplant was diagnosed at a median of 15 days (range of 1–4892 days). Median time to parathyroidectomy referral was 320 days (range 16–6281 days). In over 50% of patients, the cited reason for referral to an endocrine surgeon was difficulty with cinacalcet – either cost, poor calcium control, and poor compliance or tolerance. In comparing renal function between patients referred early (<278 days, n = 19) versus later (>278 days, n = 19) for parathyroidectomy, those referred early had an improvement in creatinine (27.6% vs −5%, P = 0.007).

Conclusions:

Patients with THPT wait approximately a year, on average, before referral to an endocrine surgeon for curative parathyroidectomy; earlier referral was associated with improvement in serum creatinine.
Electrocautery, Diathermy, and Surgical Energy Devices
Authors: Zakka Kimberley , Erridge Simon , Chidambaram Swathikan , Beatty Jasmine Winter , Kynoch Michael , Kinross James , Purkayastha Sanjay
Published: June 2020

Objective:

The aim of the study was to provide a rapid synthesis of available data to identify the risk posed by utilizing surgical energy devices intraoperatively due to the generation of surgical smoke, an aerosol. Secondarily it aims to summarize methods to minimize potential risk to operating room staff.

Summary Background Data:

Continuing operative practice during the coronavirus disease-19 (COVID-19) pandemic places the health of operating theatre staff at potential risk. SARS-CoV2 is transmitted through inhaled droplets and aerosol particles, thus posing an inhalation threat even at considerable distance. Surgical energy devices generate an aerosol of biological particular matter during use. The risk to healthcare staff through use of surgical energy devices is unknown.

Methods:

This review was conducted utilizing a rapid review methodology to enable efficient generation and dissemination of information useful for concurrent clinical practice.

Results:

There are conflicting stances on the use of energy devices and laparoscopy by different surgical governing bodies and societies. There is no definitive evidence that aerosol generated by energy devices may carry active SARS-CoV2 virus. However, investigations of other viruses have demonstrated aerosolization through energy devise use. Measures to reduce potential transmission include appropriate personal protective equipment, evacuation and filtration of surgical plume, limiting energy device use if appropriate, and adjusting endoscopic and laparoscopic practice (low CO2 pressures, evacuation through ultrafiltration systems).

Conclusions:

The risk of transmission of SARS-CoV2 through aerosolized surgical smoke associated with energy device use is not fully understood, however transmission is biologically plausible. Caution and appropriate measures to reduce risk to healthcare staff should be implemented when considering intraoperative use of energy devices.
Therapeutic Suggestion in Postoperative Pain Control: A Randomized Controlled Trial
Authors: Shah Nemi M. , Andriani Leslie A. , Mofidi Jessica L. , Ingraham Caitlin F. , Tefera Eshetu A. , Iglesia Cheryl B.
Published: June 2020

Objectives

There is conflicting research on the effect of therapeutic suggestion in the perioperative period. This study systematically compared subjective and objective measures of postoperative pain, nausea and vomiting, urinary and bowel function, and global perception of symptomatic improvement between participants receiving perioperative therapeutic suggestion versus routine perioperative care during minimally invasive pelvic reconstructive surgery.

Methods

This was a single-blinded, randomized controlled trial of participants undergoing vaginal hysterectomy with minimally invasive sacrocolpopexy and concomitant prolapse repairs. The intervention group received perioperative therapeutic suggestion, whereas the control group did not. Primary outcomes included postoperative pain scores and analgesic use. Secondary outcomes included a postoperative nausea and vomiting scale, the Pelvic Floor Distress Inventory Questionnaire—Short Form 20, the Patient Global Impression of Improvement scale, and time to return of bowel and bladder function.

Results

Sixteen participants were randomized to each group. Final analysis included 15 intervention and 14 control participants. Overall measures of postoperative pain and analgesic use were low across all participants without a significant difference between intervention and control groups (opioid: 52.5; interquartile range [IQR], 25.5–58.9 vs 66 IQR, 7.3–125.8; morphine milligram equivalents; P = 0.64; acetaminophen: 2225 mg; IQR, 500–2600 mg vs 2800 mg; IQR, 650–4775 mg; P = 0.38). There were no statistically significant differences in secondary outcomes of urinary symptoms, bowel function, and subjective improvement of prolapse symptoms.

Conclusions

No differences in postoperative pain, analgesic use, return of bowel and bladder function, or pelvic organ prolapse symptoms were noted in participants receiving perioperative therapeutic suggestion versus routine perioperative care.
Interactive Web Application for Plotting Personalized Prognosis Prediction Curves in Allogeneic Hematopoietic Cell Transplantation Using Machine Learning
Authors: Okamura Hiroshi , Nakamae Mika , Koh Shiro , Nanno Satoru , Nakashima Yasuhiro , Koh Hideo , Nakane Takahiko , Hirose Asao , Hino Masayuki , Nakamae Hirohisa
Published: June 2020

Background.

Allogeneic hematopoietic cell transplantation (allo-HCT) is a curative treatment option for malignant hematological disorders. Transplant clinicians estimate patient-specific prognosis empirically in clinical practice based on previous studies on similar patients. However, this approach does not provide objective data. The present study primarily aimed to develop a tool capable of providing accurate personalized prognosis prediction after allo-HCT in an objective manner.

Methods.

We developed an interactive web application tool with a graphical user interface capable of plotting the personalized survival and cumulative incidence prediction curves after allo-HCT adjusted by 8 patient-specific factors, which are known as prognostic predictors, and assessed their predictive performances. A random survival forest model using the data of patients who underwent allo-HCT at our institution was applied to develop this application.

Results.

We succeeded in showing the personalized prognosis prediction curves of 1-year overall survival, progression-free survival, relapse/progression, and nonrelapse mortality (NRM) interactively using our web application (https://predicted-os-after-transplantation.shinyapps.io/RSF_model/). To assess its predictive performance, the entire cohort (363 cases) was split into a training cohort (70%) and a test cohort (30%) time-sequentially based on the patients’ transplant dates. The areas under the receiver-operating characteristic curves for 1-year overall survival, progression-free survival, relapse/progression, and nonrelapse mortality in test cohort were 0.70, 0.72, 0.73, and 0.77, respectively.

Conclusions.

The new web application could allow transplant clinicians to inform a new allo-HCT candidate of the objective personalized prognosis prediction and facilitate decision-making.
Clostridium ramosum rapidly identified by MALDI-TOF MS. A rare gram-variable agent of bacteraemia.
Authors: Legaria M.C. , García S.D. , Tudanca V. , Barberis C. , Cipolla L. , Cornet L. , Famiglietti A.M.R. , Stecher D. , Vay C.A.
Published: June 2020

Clostridium ramosum

is an enteric anaerobic, endospore-forming, gram-positive rod with a low GC content that is rarely associated with disease in humans. We present a case of

C. ramosum

bacteraemia. To the best of our knowledge, this is the second case of

C. ramosum

bacteraemia in an elderly patient presenting with fever, abdominal pain and bilious emesis. We highlight the Gram stain variability, the lack of visualization of spores and the atypical morphology of the colonies that showed

C. ramosum

in a polymicrobial presentation that initially appeared to show monomicrobial bacteraemia. The microorganism was rapidly identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). We present a comprehensive literature review of 32 cases of clinical infections by

C. ramosum

in which we describe, if available, sex, age, clinical symptoms, predisposing conditions, other organisms present in the blood culture, other samples with

C. ramosum

, identification methodology, treatment and outcome.