bluuebunny/crossref_metadata_2025 huggingface dataset:
Incident injury is strongly associated with subsequent incident temporomandibular disorder: results from the OPPERA study
Authors: Sharma Sonia , Wactawski-Wende Jean , LaMonte Michael J. , Zhao Jiwei , Slade Gary D. , Bair Eric , Greenspan Joel D. , Fillingim Roger B. , Maixner William , Ohrbach Richard
Published: March 2019

Cross-sectional studies confirm, as expected, a positive association between jaw injury and painful temporomandibular disorders (TMDs), but prospective evaluations are lacking. We prospectively assessed incident jaw injury, injury type, and development of TMD in adults aged 18 to 44 years. Data were collected from 3258 individuals from communities surrounding 4 US academic institutes between 2006 and 2008. At enrollment, participants reported no TMD history and no facial injuries in the previous 6 months. Quarterly, follow-up questionnaires assessed incident jaw injury, which was classified as intrinsic (attributed to yawning or prolonged mouth opening) or extrinsic (attributed to other causes). Examiners classified incident TMD during a median follow-up period of 2.8 years (range 0.2-5.2 years). Cox regression models used jaw injury as a time-dependent covariate to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association with incident TMD. Among 1729 participants with complete data, 175 developed TMD. Eighty percent of injuries were intrinsic. Temporomandibular disorder annual incidence was nearly twice as high in those experiencing jaw injury (5.37%) compared with those who did not (3.44%). In the Cox model that accounted for timing of injury, the corresponding HR was 3.94 (95% CI = 2.82-5.50) after adjusting for study site, age, race, and sex. Hazard ratios did not differ (P = 0.91) for extrinsic injuries (HR = 4.03, 95% CI = 2.00-8.12) and intrinsic injuries (HR = 3.85, 95% CI = 2.70-5.49). Jaw injury was strongly associated with incident TMD. If surveillance and intervention after jaw injury is to be effective in preventing TMD, they should focus on both intrinsic and extrinsic injuries.
Effectiveness of Implementing a Predischarge Order to Discharge Patients Before 11 a.m.
Authors: Mallipudi Rajiv M. , Khan Qamar , Mbolu George U. , Alquran Lance , Mehta Bijal , Allusson Valerie
Published: March 2019

Barriers to early discharges include poor communication among the healthcare team and families, pending laboratory test results, delays in discharge orders, medical reconciliation list, and patient transport. The baseline data at our hospital in October 2017 (N = 1,021) showed that 5% of patients were discharged before 11 a.m., with the mean discharge processing time being 145 minutes. The goal of this study was to assess the effectiveness of using an electronic predischarge order to discharge more than 40% of patients before 11 a.m. A predischarge order set was created in the electronic record, which notified the nurses, pharmacists, and case and social workers to complete all tasks related to discharge (medication reconciliation, complete laboratory test results and imaging, and arrange transport with family and nursing homes). The resident teaching service group (N = 381) from November 2017 to September 2018 discharged 22% of their patients before 11 a.m. (baseline: 5%, p value = 3.38638E-22), and the mean total discharge time was 77 minutes (baseline: 145 minutes; p value = 1.12013E-19). Our inability to discharge more than 40% of patients from the resident teaching service group before 11 a.m. was attributed to 3 limitations. We propose three viable recommendations to meet our goal in a future intervention.
Mental and Physical Quality of Life by Age Groups in People Living With HIV
Authors: Jang Hannah J. , Satre Derek D. , Leyden Wendy , Leibowitz Amy , Silverberg Michael J.
Published: March 2019

Quality of life (QoL) is relevant to people living with HIV (PLWH) with increased life expectancy because of antiretroviral therapy. Our cross-sectional study examined associations between sociodemographic, HIV-related and psychological variables, and QoL, overall and by age. PLWH (n = 614) completed questionnaires at enrollment in an alcohol treatment study. QoL was assessed by the 12-item Short Form Survey, which includes physical and mental domains. Linear regression models evaluated the association of age and other factors with mental and physical QoL. PLWH younger than 50 years (n = 310) reported poorer mental QoL but better physical QoL compared to older PLWH (n = 304). Poorer mental QoL was associated with substance use, depression, and anxiety. Poorer physical QoL was associated with depression and history of injection drug use. We identified age-group differences in QoL for this primary care-based sample. Health care providers can use our findings to guide patient-centered care.
Symptom Profile and Technology Use of Persons Living With HIV Who Access Services at a Community-Based Organization in the Deep South
Authors: Schnall Rebecca , Musgrove Karen , Batey D. Scott
Published: March 2019

Currently, the Southern United States has the highest rates of new HIV diagnoses with the largest percentage of people living with HIV (PLWH), and the most Americans dying from the disease. Given the increase of the HIV epidemic in the Deep South and the availability of evidence-based self-management tools for PLWH, we conducted an in-person survey in Birmingham, Alabama, to understand the symptom profile and the use of technology by PLWH. Muscle aches or joint pain was the most frequently (67%) reported symptom followed by fatigue, sleep difficulties, neuropathy, and depressive symptoms. We also assessed mobile technology use and ownership and found that 83.7% of persons own a smartphone, with most of these (79.9%) being Android users. Given these findings, there is strong scientific premise to support the feasibility of a mobile-delivered symptom self-management tool in the Deep South for improving health outcomes for PLWH.
AMSSM Position Statement Update: Blood-Borne Pathogens in the Context of Sports Participation
Authors: McGrew Christopher , MacCallum Daisy-Scarlett , Narducci Dustymarie , Nuti Rathna , Calabrese Leonard , Dimeff Robert , Paul Stephen , Poddar Sourav K. , Rao Ashwin , McKeag Douglas
Published: March 2019

This AMSSM position statement update is directed toward health care providers of patients involved in sport and exercise. There have been significant advances in clinical and scientific research in the understanding of blood-borne pathogens (BBPs), and this update incorporates these advancements. This document is intended as a general guide to clinical practice based on the current state of evidence, while acknowledging the need for modification as new knowledge becomes available. Confirmed transmission of BBPs during sport is exceedingly rare. There are no well-documented reports of HIV, hepatitis C virus, or hepatitis D virus transmission during sport. There is also no evidence for universal testing for BBPs as a specific requirement for participation in sports. Competitive athletes and nonathletes should follow appropriate general public health agency recommendations for screening for BBPs, considering their individual risk factors and exposures. Standard (universal) precautions must be followed by those providing care to athletes. Exercise and athletic participation can help promote a healthy lifestyle for persons living with BBPs. Those with acute symptomatic BBP infection should limit exercise intensity based on their current health status. Education is the key tool for preventing BBP transmission. Research gaps include evaluation of the prevalence of BBP infections in competitive athletes, the effects of long-term, intense training on infected athletes, and the effects of BBP treatment therapies on performance.
Enhancing Pediatric Education for Physical Therapy Students Through the Development of Community Partnerships to Facilitate Experiential Learning: A Case Report
Authors: Wolden Mitch , Anderson Brittany
Published: March 2019

Background and Purpose.

Doctoral physical therapy (DPT) programs are expected to provide students with educational experiences in classroom and in clinical settings and with all age demographics, including pediatrics. There is significant discrepancy in the delivery and assessment of pediatric content in DPT programs. One effective and evidence-based strategy to address this discrepancy and deliver pediatric content is experiential learning (EL). Our case report illustrates how EL with a symbiotic community partner can enable DPT programs to effectively address the current limitations in direct contact hours and clinical experiences in pediatrics.

Case Description.

We formed a structured and formal partnership with a local community fitness and gymnastics facility to provide our students with pediatric EL opportunities outside of the classroom and traditional clinic settings. Each student is required to engage in structured and focused play-based interactions with typically and atypically developing children 1 hour per week for two 8-week EL periods under direct supervision of a certified pediatric clinical specialist.

Outcomes.

Students demonstrated appropriate professional behaviors, increased self-efficacy, achievement of the pediatric course learning objectives, and attainment of 3 Academy of Pediatric Physical Therapy essential core competencies. With our community partner, 87% of the children demonstrated improvement in their gross motor skills.

Discussion and Conclusion.

Our case report details an innovative approach to use EL to increase the number of direct contact hours with the pediatric population through a symbiotic community partnerships that positions our students to reach entry-level competency with the pediatric population upon graduation.
Adjusting to the transition into assisted living: Opportunities for nurse practitioners
Authors: Scott Judith M. , Mayo Ann M.
Published: March 2019

Background and purpose:

Transition from an independent living residence to assisted living (AL) is challenging. The study purpose was to understand such a transition from the perspective of older women.

Methods:

A hermeneutic phenomenological approach was used to explore how 17 older women living in a Continuing Care Retirement Community, many of whom were recently widowed, experienced this transition.

Conclusions:

Three major themes emerged from the interviews: preplanning, executing, and adjusting to the transition. Even with facility, family and staff assistance, the transition was challenging, and adjustment was affected when participants had physical or sensory impairments.

Implications for practice:

Older adult women transitioning to AL settings should be assessed for adjustment to the new setting. Those with sensory, cognitive, emotional, or physical problems will need additional supportive strategies to help with adjustment. With a rapidly expanding population, AL settings offer new opportunities for nurse practitioners to promote the health and well-being of older adults.
CD101 Topical Compared With Oral Fluconazole for Acute Vulvovaginal Candidiasis: A Randomized Controlled Trial
Authors: Nyirjesy Paul , Alessio Cynthia , Jandourek Alena , Lee Jon D. , Sandison Taylor , Sobel Jack D.
Published: March 2019

Objectives

Vulvovaginal candidiasis (VVC) is an infection of the vagina's mucous membranes, caused by Candida albicans in more than 90% of acute VVC. Several topical and oral azole agents are available in a variety of formulations, and all seem to have similar effectiveness. Azoles are fungistatic, meaning that the fungi are inhibited from growth or replication but are not eradicated. Recurrent infection and developing azole resistance demonstrate a significant need for alternative treatments.

Materials and Methods

One hundred twenty-six women were randomized to 1 of the following 3 treatment cohorts: CD101 3% gel (n = 50) applied intravaginally on days 1 and 2, CD101 6% ointment (n = 50) applied intravaginally on day 1, or oral fluconazole 150 mg (n = 26) on day 1. Primary outcomes of clinical and mycological cure, as demonstrated by changes in the vaginal scores and mycological culture, were assessed on day 7 (±2 days), day 14 (±2 days), and day 28 (±7 days). Safety assessments included treatment-emergent adverse events.

Results

Ninety-nine women with positive Candida culture remained in the modified intent-to-treat population with 40 in each CD101 arm and 19 in the fluconazole arm. In the CD101 gel, CD101 ointment, and oral fluconazole groups, 35%, 30%, and 52.6% demonstrated clinical cure and 45%, 40%, and 57.9% had mycological cure at day 28, respectively.

Conclusions

CD101 3% gel and CD101 6% ointment were well tolerated and produced similar rates of clinical and mycological cure in patients with an acute, moderate-to-severe episode of VVC. However, cure rates for these 2 formulations and regimens of CD101 were lower than those in patients treated with fluconazole.
Risk of Stroke in Liver Cirrhosis
Authors: Zheng Kexin , Yoshida Eric M. , Tacke Frank , Li Yingying , Guo Xiaozhong , Qi Xingshun
Published: March 2019

Background and Aims:

Liver cirrhosis can lead to abnormal coagulation, rendering patients at risk for bleeding but also thrombotic complications. We conducted a systematic review and meta-analysis to explore the epidemiology of stroke in liver cirrhosis and the potential association between them.

Materials and Methods:

Studies were searched through the PubMed, EMBASE, and Cochrane Library databases. Incidence and prevalence of unspecific stroke, hemorrhagic stroke, intracranial hemorrhage, subarachnoid hemorrhage, and ischemic stroke were pooled by using a random-effect model. Meta-regression analyses were employed to explore the sources of heterogeneity. As for the cohort studies, hazard ratios (HRs) with 95% CIs were pooled to evaluate the association between liver cirrhosis and stroke.

Results:

Twenty-seven studies with 93,191 cirrhotic patients were included, of which 23 explored the incidence and 10 explored the prevalence. The pooled incidence of unspecific stroke, hemorrhagic stroke, intracranial hemorrhage, and ischemic stroke was 4.1%, 1.3%, 2.0%, and 3.7%, respectively. The pooled prevalence of unspecific and ischemic stroke was 9.0% and 2.6%, respectively. Heterogeneity among studies was significant in most of meta-analyses. Meta-regression analyses indicated that the sample size might explain the potential source of heterogeneity (P=0.018). Liver cirrhosis significantly increased the risk of subarachnoid (HR=2.36; 95% CI, 1.80-3.09; P=0.000) and intracranial hemorrhage (HR=1.48; 95% CI, 1.06-2.05; P=0.020), but not unspecific (HR=1.02; 95% CI, 0.49-2.14; P=0.960), ischemic (HR=0.79; 95% CI, 0.46-1.35; P=0.380), or hemorrhagic stroke (HR=1.88; 95% CI, 0.52-6.81; P=0.335).

Conclusions:

Stroke is uncommon in cirrhotic patients. However, considering a positive relationship of liver cirrhosis with subarachnoid and intracranial hemorrhage, the prophylactic strategy may be selectively adopted in cirrhotic patients.
Serum steroid profiling by mass spectrometry in adrenocortical tumors: diagnostic implications
Authors: Fanelli Flaminia , Di Dalmazi Guido
Published: March 2019

Purpose of review

Liquid chromatography–tandem mass spectrometry (LC–MS/MS), allowing the reliable measurement of large panels of steroids, opened a new era in the characterization of adrenal diseases. This review summarizes the most recent findings on serum steroid profile in benign adrenocortical tumors and provides a focus on the most promising analytical developments.

Recent findings

Recently developed LC–MS/MS assays included challenging compounds, providing new knowledge on adrenal steroid secretion. Pioneering studies highlighted the potential of incoming technologies in increasing measurement selectivity and implementing the steroidomic approach. In primary aldosteronism, several studies highlighted the signature of aldosterone-producing adenomas, mainly characterized by secretion of hybrid steroids. The combination of steroid panel and radiological data reached an agreement with adrenal vein sampling-based classification in more than 80% of the cases. The serum steroid profiling in patients with Cushing's syndrome, mainly characterized by reduced androgens and increased 11-dexoycorticosterone in adrenal hypercortisolism, showed a good discriminant power for patients’ subtyping (90% correct classification rate). Finally, a selected panel of steroids, including 11-deoxycortisol as the main discriminant compound, was able to achieve a good separation of patients with and without adrenocortical carcinomas.

The constantly evolving serum steroid profiling by MS may improve the diagnosis of different types of adrenocortical tumors.
Clinical impact of serum α-fetoprotein and its relation on changes in liver fibrosis in hepatitis C virus patients receiving direct-acting antivirals
Authors: Fouad Rabab , Elsharkawy Aisha , Abdel Alem Shereen , El Kassas Mohamed , Alboraie Mohamed , Sweedy Ahmad , Afify Shimaa , Abdellatif Zeinab , Khairy Marwa , Esmat Gamal
Published: March 2019

Background

α-Fetoprotein (AFP) is used widely as a serological marker for hepatocellular carcinoma. However, the AFP value is elevated in chronic hepatitis C virus (HCV) patients without hepatocellular carcinoma. Yet, data on the impact of direct-acting antiviral agents (DAAs) therapy on AFP levels after viral eradication are still lacking.

Aim

The aim of this study was to elucidate the changes in the serum AFP level in chronic hepatitis C patients treated with DAA-based therapy and their relation to response and liver fibrosis parameters.

Patients and methods

A total of 456 chronic HCV patients who received different DAAs-based treatment regimens were enrolled. Laboratory data including serum AFP, transient elastography values, and fibrosis scores were recorded at baseline and sustained virological response at 24 weeks after treatment (SVR24). The outcome was the changes in the AFP level from baseline to SVR24 and its relation to changes in liver fibrosis parameters at SVR24 using Spearman’s rank correlation test.

Results

Overall, 96.9% of enrolled patients were responders. A statistically significant improvement in serum transaminases, albumin, transient elastography values, and fibrosis scores at SVR24 was reported. The AFP level was significantly decreased from a median (interquartile range) of 6 (3.2–10.8) ng/ml before DAAs to 4 (2.3–6) ng/ml at SVR24 (P < 0.0001). Only 22.6% of patients showed an increase in the AFP level after treatment. On multivariate analysis, the only independent baseline variable associated with an increase in the AFP level after treatment was baseline AFP (odds ratio: 0.95, 95% confidence interval: 0.91–0.99, P = 0.02). There is a significant correlation between changes in AFP and liver fibrosis parameters at SVR24.

Conclusion

DAAs-based regimens are a highly efficient antiviral therapy for chronic hepatitis C patients that resulted in improvements in the serum AFP level.
Peroral cholangioscopy with cholangioscopy-directed biopsies in the diagnosis of biliary malignancies: a systemic review and meta-analysis
Authors: Badshah Maaz B. , Vanar Vishwas , Kandula Manasa , Kalva Nikhil , Badshah Mashood B. , Revenur Vakya , Bechtold Matthew L. , Forcione David G. , Donthireddy Kavitha , Puli Srinivas R.
Published: March 2019

Background and aim

Accurate diagnosis is essential in the appropriate management of biliary strictures. Our aim is to evaluate the efficacy of cholangioscopy-directed biopsies in differentiating biliary intraductal malignancies from benign lesions.

Materials and methods

Articles were searched in Medline, PubMed, and Ovid journals. Pooling was performed by both fixed-effects and random-effects models. Only studies from which a 2×2 table could be constructed for true-positive, false-negative, false-positive, and true-negative values were included.

Results

Initial search identified 2110 reference articles for peroral cholangioscopy; of these, 160 relevant articles were selected and reviewed. Data were extracted from 15 studies (N=539) that fulfilled the inclusion criteria. Pooled sensitivity of cholangioscopy-directed biopsies in diagnosing malignancy was 71.9% [95% confidence interval (CI): 66.1–77.1] and pooled specificity was 99.1% (95% CI: 96.9–99.9). The positive likelihood ratio of cholangioscopy-directed biopsies was 18.1 (95% CI: 9.1–35.8), whereas the negative likelihood ratio was 0.3 (95% CI: 0.2–0.4). The pooled diagnostic odds ratio was 71.6 (95% CI: 32.8–156.4). All the pooled estimates calculated by fixed-effects and random-effect models were similar. Summary receiver operating characteristic curves showed an area under the curve of 0.98. Theχ2heterogeneity for all the pooled accuracy estimates was 5.62 (P=0.96).

Conclusion

Peroral cholangioscopy with cholangioscopy-directed biopsies has a high specificity in differentiating intraductal malignancies from benign lesions. Cholangioscopy-directed biopsies should be strongly considered for biliary stricture evaluation.
Increased Human Growth Hormone After Oral Consumption of an Amino Acid Supplement: Results of a Randomized, Placebo-Controlled, Double-Blind, Crossover Study in Healthy Subjects
Authors: Tam Charmaine S. , Johnson William D. , Rood Jennifer , Heaton Amy L. , Greenway Frank L.
Published: March 2019

Background:

Human growth hormone (hGH) is best known for influencing bone and muscle growth, as well as body composition, but the use of recombinant hGH is controversial. Amino acids are a potentially safer alternative; however, preliminary investigations of the effects of oral amino acids on hGH release have been inconclusive. Therefore, we tested the effects of a novel blend of amino acids optimized to increase hGH release.

Study Question:

Does an investigational amino acid supplement affect hGH release?

Study Design:

This was a randomized, placebo-controlled, double-blind, crossover study that included 16 (12 men, 4 women; age 32 ± 14 years; body mass index 26.4 ± 5.0 kg/m2) healthy participants. All participants received both placebo and the amino acid supplement after an overnight fast and completed all study visits. Treatment order was randomized, and each treatment was separated by a 1-week washout period.

Measures and Outcomes:

The primary outcomes were the percent change in hGH from baseline to 120 minutes and the area under the curve of hGH over baseline. Serum hGH was measured using enzyme-linked immunosorbent assay at baseline and 15, 30, 60, 90, and 120 minutes.

Results:

At 120 minutes, hGH levels increased by 682% (8-fold) from baseline and were significantly higher than placebo (P = 0.01). In addition, a significantly higher mean area under the curve was observed for the amino acid supplement compared with the placebo [20.4 (95% confidence interval, 19.9–21.0 ng/mL) vs. 19.7 (95% confidence interval, 18.7–20.6 ng/mL); P = 0.04].

Conclusions:

These results show that a single dose of the oral amino acid supplement was sufficient to significantly increase hGH levels in healthy adult men and women.

Clinical Trial Registry:

clinicaltrials.gov NCT01540773.
US Physicians’ Work Motivation and Their Occupational Health
Authors: Moller Arlen C. , Jager Andrew J. , Williams Geoffrey C. , Kao Audiey C.
Published: March 2019

Background:

Poor occupational health among physicians poses a serious risk both to physicians themselves and the patients under their care. Prior research has found that occupational health among nonphysicians is associated with both degree and type of work motivation.

Objective:

The main purpose of this article was to assess the association between physician work motivation and their occupational health.

Research Design:

This study was a national survey of practicing physicians. A split-sample method was used to validate a measure of work motivation adapted for physicians.

Subjects:

In total, 3589 physicians were selected from the American Medical Association Physician Masterfile among whom 2247 physicians completed a survey (response rate of 62.6%).

Measures:

Eight-item measure adapted from the Work Extrinsic and Intrinsic Motivation Scale. Grounded in self-determination theory, this measure includes 2 superordinate subscales of autonomous and controlled work motivation (characterized by feeling free and volitional versus pressured or compelled, respectively). Indicators of physicians' occupational health included single-item measures of general health, burnout, job satisfaction, intention to leave their practice, and intention to leave medicine, and a 2-item measure of depression risk.

Results:

Confirmatory factor analyses found that an 8-item, 2 superordinate (4 subordinate subscale) measure had good factor structure [χ2
(14, n=500)=35.62, P<0.001; χ2
(14, n=1747)=108.85, P<0.001]. Autonomous work motivation was found to be positively related to all 6 indicators of physicians’ occupational health. Controlled work motivation was negatively related to 3 of 6 occupational health indicators.

Conclusions:

Physicians who are more autonomously motivated at work reported having better occupational health. Fostering a health care work environment that supports autonomous motivation may benefit the well-being of physicians and their patients.
Magnetic Resonance Imaging
Authors: Barnekow Kris , Shyken Paige , Ito Joy , Deng Jie , Mohammad Saeed , Fishbein Mark
Published: March 2019

Objectives:

To assess information retention by parents/caretakers regarding nonalcoholic fatty liver disease (NAFLD) utilizing the actual image of their child's affected liver.

Methods:

In this pilot study, parents/caretakers of children with newly diagnosed NAFLD were presented with an magnetic resonance (MR) image of their child's fatty liver. An adjacent image of a normal‐appearing liver was used to highlight the degree of fat accumulation present in their child's liver. The appearance of the fatty liver was used as an adjunct to patient education as provided by a nurse clinician. The efficacy of this approach was determined by a set of image‐ and disease‐specific queries. Health literacy was assessed concurrently by the Newest Vital Sign (NVS) instrument. The image‐ and disease‐specific queries were then repeated by telephone follow‐up 2 to 4 weeks after initial clinic visit.

Results:

Parents/caretakers initially gave 100% correct responses regarding the variation of appearance of normal liver (pink) and their child's fatty liver (yellow). They also all correctly stated the fat content initially. At follow‐up, their recall was 95% for the appearance of normal liver and 81% for fatty liver; recall was only 52% for fat content at follow‐up. Nonvisualized elements of nonalcoholic steatohepatitis (NASH) and cirrhosis were not identified or recalled as well. Results may have been influenced by parent/caretaker health literacy competence.

Conclusions:

Personalized images of fatty liver were effective visualization tools for parents/caretakers to comprehend NAFLD and comprehension was not compromised by health literacy. Clear visual instruments may improve parent/caretaker comprehension of these conditions and may help to address deficiencies in health literacy.
Normal Liver Stiffness Values in Children
Authors: Mjelle Anders B. , Mulabecirovic Anesa , Havre Roald F. , Rosendahl Karen , Juliusson Petur B. , Olafsdottir Edda , Gilja Odd H. , Vesterhus Mette
Published: March 2019

Objectives:

Noninvasive tests for the evaluation of liver fibrosis are particularly helpful in children to avoid general anesthesia and potential complications of invasive tests. We aimed to establish reference values for 2 different elastography methods in a head‐to‐head comparison for children and adolescents 4 to 17 years, using transient elastography as common reference in a subset.

Methods:

A total of 243 healthy participants aged 4 to 17 years were examined by a single observer with a full liver B‐mode scan before elastography, following a minimum of 3 hours fasting. Liver stiffness measurements (LSMs) using 2‐dimensional shear wave elastography (2D‐SWE, GE Logiq E9) and point shear wave elastography (pSWE, Samsung RS80A with Prestige) were performed in all participants, and compared to transient elastography (TE, FibroScan) in a subset (n = 87). Interobserver agreement was evaluated in 50 children aged 4 to 17 years.

Results:

Valid measurements were obtained in 242 of 243 (99.6%) subjects for 2D‐SWE, 238 of 243 (97.9%) for pSWE, and in 83 of 87 (95.4%) for TE. Median liver stiffness overall was 3.3 (interquartile range [IQR] 2.7–4.3), 4.1 (IQR 3.6–4.7), and 4.1 kPa (IQR 3.5–4.6) for 2D‐SWE, pSWE, and TE, respectively. Intraclass correlation coefficients between observers were 0.84 and 0.83 for 2D‐SWE and pSWE, respectively. LSM values were significantly lower for 2D‐SWE compared to pSWE and TE, and increased with advancing age. Higher LSM values in males were observed in adolescents.

Conclusions:

All methods showed excellent feasibility. 2D‐SWE showed significantly lower LSM values than pSWE and TE, and lower failure rate compared to TE. Our results further indicate an age and sex effect on LSM values.
Sub‐10‐minute High‐quality Diagnostic Colonoscopy With Terminal Ileum Intubation in Children Is Feasible and Safe
Authors: Thomson Mike , Eltumi Muftha , Singh Chaaya , Eyles Miranda , Shah Neil , Vadamalayan Babu , Chong Sonny , Thapar Nikhil , D'Ambrosio Angelo , Isoldi Sara
Published: March 2019

Objectives:

To critically appraise ileocolonoscopy (IC) practice in a large tertiary center, where IC is exclusively performed by experienced pediatric colonoscopists, particularly focusing on indications for the procedure; bowel preparation efficacy; IC completion rates and timings; diagnostic yield; and complications.

Patients and Methods:

We prospectively evaluated all patients referred to our clinic between July 2015 and June 2016. Data on age, height and weight, sex, surgical history, indications for colonoscopy, bowel preparation given, and bowel cleansing efficacy were collected. The following were calculated: percentage of terminal ileal (TI) intubation; time to terminal ileum; total duration of each procedure. In addition, we evaluated the number and the type of complications encountered and the number of patients readmitted within 30 days from the elective procedure. Endoscopic diagnostic yield, stratified for indication, was calculated.

Results:

A total of 1392 patients were referred; 181 required an endoscopic evaluation of the lower gastrointestinal (GI) tract (Outpatient Department conversion rate: 13%). Main indications for IC were: recurrent abdominal pain 38.1%; unexplained chronic diarrhea 16%; suspected inflammatory bowel disease (IBD) 24.9%; isolated rectal bleeding 13.2%; occult GI bleeding 1.6%; unexplained faltering growth 1.6%; IBD restaging 2.6%; and miscellaneous 1.6%. Terminal ileum was reached in all the patients (TI intubation rate = 100%). Median time to TI was 9.8 minutes (1–50 minutes). Time to TI was lower in younger patients compared to older ones (P = 0.005). Bowel cleansing was judged as grade 1 in 49.2%; grade 2 in 33.7%; grade 3 in 13.3%; and grade 4 in 3.9%. A significant statistical correlation was recorded between bowel cleansing and time to TI. The positive diagnostic yield was: 11.6% in patients with abdominal pain; 37.9% in patients with chronic diarrhea; 51.1% in patients with suspected IBD; 29.2% in patients with isolated rectal bleeding; 33.3% in patients with occult GI bleeding; 0% in patients with faltering growth; and 33% in the miscellaneous group.

Conclusions:

In conclusion, appropriately targeted IC in the management of children with GI symptoms is a safe, fast, and useful investigation. TI intubation rates of 100% are achievable and desirable and can be conducted quickly. Poor bowel preparation impacts negatively on this and IC duration may be faster in younger children. High diagnostic yields have been recorded in patients with a clinical suspicion of IBD. Diagnostic yield in isolated recurrent abdominal pain is low. Training to excellence in pediatric IC should be a persistent goal.
A Randomized Controlled Trial to Assess the Effectiveness of Muscle Strengthening and Balancing Exercises on Chemotherapy-Induced Peripheral Neuropathic Pain and Quality of Life Among Cancer Patients
Authors: Dhawan Shelly , Andrews Rachel , Kumar Lalit , Wadhwa Sanjay , Shukla Garima
Published: March 2019

Background

Chemotherapy-induced peripheral neuropathy (CIPN) is the presence of tingling, burning, itching, and unpleasant sensations in hands and feet due to nerve damage by chemotherapy. Exercise rehabilitation has potential to prevent or alleviate CIPN.

Objective

The aim of this study was to assess the effectiveness of muscle strengthening and balancing exercises on CIPN pain and quality of life (QOL) among cancer patients.

Methods

The randomized controlled trial included 45 cancer patients from a tertiary care hospital in India receiving chemotherapeutic drugs paclitaxel and carboplatin and found to have CIPN. Subjects were randomly allocated to exercise (n1 = 22) and usual care (n2 = 23) groups. The exercise group received home-based muscle strengthening and balancing exercise for 10 weeks. Data regarding demographic, clinical characteristics, CIPN, neuropathic pain, and QOL were collected by structured questionnaires Chemotherapy-Induced Peripheral Neuropathy Assessment Tool, nerve conduction velocity, Leeds Assessment of Neuropathic Symptoms and Signs pain scale, and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire.

Results

The 2 groups were homogenous regarding demographic variables. In clinical characteristics, the exercise group had larger body surface area and received a higher dose of paclitaxel. Significant reduction in neuropathic pain scores (P < .0001) and improvement in Functional QOL (P = .0002), Symptom QOL (P = .0003), Global Health Status QOL (P = .004) scores were observed after intervention in the exercise group than the usual-care group.

Conclusion

Muscle strengthening and balancing exercises are effective in reducing CIPN pain and improving QOL among cancer patients.

Implications for Practice

Muscle strengthening and balancing exercises can be used as a complementary therapy for effective management of CIPN.
What Are the Experiences of Men Affected by Prostate Cancer Participating in an Ecological Momentary Assessment Study?
Authors: Paterson Catherine , Primeau Charlotte , Lauder William
Published: March 2019

Background

Within the cluster of self-report methodologies, ecological momentary assessment (EMA) is a method used in health services research whereby a participant repeatedly reports on affect, behaviors, symptoms, and cognitions as they occur in real time in the participant’s natural environment. However, little is known about the impact of participating in an EMA study on individuals’ experiences who are affected by prostate cancer.

Objectives

The aims of this study were to explore the lived experiences of men affected by prostate participating in an EMA study and assess whether their participation in EMA alters their representation of their condition.

Methods

Participants (n = 12) were purposively recruited from 2 university teaching hospitals in Scotland. Semistructured interviews were conducted with men affected by prostate cancer following the completion of EMA data collection. Data were analyzed using thematic analysis.

Results

The lived experience of prostate cancer included 6 superordinate themes: isolation in the healthcare system, lack of shared care plans, informational support, coping with prostate cancer, fear of death and dying, and vocational rehabilitation. The organizing theme electronic diary as an intervention included 4 superordinate themes: changing self-management behaviors, habitual experience, changing perceptions, and diary in daily life.

Conclusion

We observed that men participating in the EMA study described several methodological complexities, which need to be addressed through future research.

Implications for Practice

Importantly, there is a need for the health system to prioritize research and develop a more holistic approach to prostate cancer care in line with men’s preferences and needs in the future.
Gene Expression Profiling Revealed 2 Types of Bronchial Basal Cell Hyperplasia and Squamous Metaplasia With Different Progression Potentials
Authors: Denisov Evgeny V. , Schegoleva Anastasia A. , Gerashchenko Tatiana S. , Skryabin Nikolay A. , Sleptcov Alexey A. , Yakushina Valentina D. , Lyapunova Liliya S. , Tuzikov Sergey A. , Pankova Olga V. , Perelmuter Vladimir M.
Published: March 2019

The premalignant process preceding squamous cell lung cancer is not inevitable; it can stop at any of the bronchial lesions: basal cell hyperplasia (BCH), squamous metaplasia (SM), and dysplasia and then progress or regress. At present, the mechanisms underlying the progression of the bronchial lesions remain undefined. Previously, we hypothesized that bronchial lesions that presented individually or combined with each other in the bronchi of lung cancer patients mirror the different “scenarios” of the premalignant process: individual BCH—the stoppage at the stage of hyperplasia, BCH plus SM—the progression of hyperplasia to metaplasia, and SM plus dysplasia—the progression of metaplasia to dysplasia. In this study, we analyzed gene expression profiles of BCH, SM, and dysplasia depending on their cooccurrence in the bronchi of lung cancer patients. The immune response gene expression was found to be a key difference between the individual BCH and BCH combined with SM lesions and a potential mechanism that determines the progression of hyperplasia to metaplasia. Upregulation of the cell cycle and downregulation of the cilium assembly genes mainly distinguished SM that copresented with dysplasia from SM that copresented with BCH and is a probable mechanism of the progression of metaplasia to dysplasia. Dysplasia showed mainly overexpression of the cell division genes and underexpression of the inflammation genes. Thus, this study demonstrates the significant gene expression differences between the premalignant lesions depending on their cooccurrence in the bronchi and sheds light on the mechanisms of the precancerous process preceding squamous cell lung cancer.
Evaluation of the Efficacy and Safety of 3 Different Management Protocols in Pediatric Diabetic Ketoacidosis
Authors: Akcan Nese , Uysalol Metin , Kandemir Ibrahim , Soydemir Didem , Abali Zehra Yavas , Poyrazoglu Sukran , Bas Firdevs , Bundak Ruveyde , Darendeliler Feyza
Published: March 2019

Objective

Management protocols for pediatric diabetic ketoacidosis (DKA) vary considerably among medical centers. The aim of this study was to investigate the efficacy and safety of 3 different fluid protocols in the management of DKA.

Methods

Fluid management protocols with sodium contents of 75, 100, and 154 mEq/L NaCl were compared. In all groups, after the initial rehydration, the protocols differed from each other in terms of the maintenance fluid, which had different rates of infusion and sodium contents. Clinical status and blood glucose levels were checked every hour during the first 12 hours. Biochemical tests were repeated at 2, 6, 12, 24, and 36 hours.

Results

The medical records of 144 patients were evaluated. Cerebral edema developed in 18% of the patients. The incidence of cerebral edema was lowest in the group that received fluid therapy with a sodium content of 154 mEq/L NaCl at least 4 to 6 hours and had a constant rate of infusion for 48 hours. The patients with cerebral edema had lower initial pH and HCO3 and severe dehydration with higher initial plasma osmolality. There was no significant difference between the groups in terms of the recovery times of blood glucose, pH, HCO3, and the time of transition to subcutaneous insulin therapy.

Conclusions

Severity of acidosis and dehydration are associated with the development of cerebral edema. It can be concluded that fluid therapy with higher Na content and a constant maintenance rate may present less risk for the patient with DKA.
The Girl With the Bleeding Earlobe Mass
Authors: Nistel Mason , Lee Sang Hoon , Born Hayley , Greinwald John H. , Abdaljaleel Maram , Sobolewski Brad
Published: March 2019

Pilomatrixomas, also known as epithelioma calcificans, are benign tumors of hair follicle matrix cells that are often mistaken for other lesions, especially cutaneous abscesses. We report an illustrative case in which a teenage girl developed a red, swollen earlobe that required multiple care visits and interventions until definitive diagnosis and treatment were provided. Although the lesion was initially treated as an abscess, it continued to progress in size and discomfort. The correct diagnosis was established after imaging and complete excision with pathologic examination. Ultimately, our patient was subjected to avoidable procedures that carried the risk of potentially negative cosmetic sequelae before the proper intervention. Although abscesses are common, it is important for clinicians to avoid incision and drainage of lesions, unless the diagnosis is certain.
Dedifferentiated Carcinoma of the Endometrium Associated With Low-grade Müllerian Adenosarcoma: A Clinicopathologic Case Report Including the Immunohistochemical and Molecular Profile
Authors: Bai Shi , Hutchinson Lloyd M. , Meng Xiuling , Bai Hongwei , Cosar Ediz F. , Khan Ashraf , Cornejo Kristine
Published: March 2019

Dedifferentiated carcinoma is defined as undifferentiated carcinoma coexisting with a second component of FIGO grade 1 or 2 endometrioid carcinoma. It is a rare entity with highly aggressive behavior. Dedifferentiated carcinoma combined with another primary uterine tumor is even rarer. We describe a case containing 3 different morphologies comprised of a dedifferentiated carcinoma associated with a low-grade endometrioid carcinoma coexisting with a low-grade Müllerian adenosarcoma. We also used targeted genomic analysis to show all 3 components arise from the same founding clone and identify novel mutations that drive tumor progression.
Associations Between Lifetime Traumatic Experiences and HIV-Risk Behaviors Among Young Men Living in Informal Settlements in South Africa: A Cross-Sectional Analysis and Structural Equation Model
Authors: Gibbs Andrew , Hatcher Abigail , Jewkes Rachel , Sikweyiya Yandisa , Washington Laura , Dunkle Kristin , Magni Sarah , Peacock Dean , Khumalo Mzwakhe , Christofides Nicola
Published: March 2019

Background:

Qualitative research emphasizes men's experiences of trauma increase HIV risk. We seek to understand associations between experience of traumatic events and HIV-risk behaviors among heterosexual men in 2 trials in urban informal settlements in South Africa.

Methods:

Cross-sectional surveys among men in Johannesburg and Durban, South Africa, enrolled in intervention trials. Adjusted logistic regression and structural equation modeling assessed associations between men's experiences of poverty and traumatic events, and HIV-risk behaviors (inconsistent condom use, transactional sex, and number of sex partners). We explored mediated pathways from trauma to HIV risk through mental health and alcohol, and gender attitudes.

Results:

Among 2394 men, in adjusted logistic regression, transactional sex and 4 or more sex partners were associated with witnessing the murder of a family member, witnessing a murder of a stranger, experiencing excessive pain, been kidnapped, and witnessing a rape. More consistent condom use was associated with witnessing the murder of a family member, being kidnapped, and witnessing a rape. In 3 separate structural equation modeling pathways were consistent, trauma directly increased transactional sex, and past year sexual partners, and increased consistent condom use. Risk was increased through mental health pathways, and gender inequitable attitudes and practices.

Conclusion:

Men's HIV-risk behaviors in this population emerge at the confluence of poverty, traumatic experiences, and gender inequalities. Effective HIV-prevention interventions needs to reduce men's experiences of poverty and trauma, transform gender norms, and reduce the mental health impact of trauma.
Evaluation of PR3-ANCA Status After Rituximab for ANCA-Associated Vasculitis
Authors: McClure Mark E. , Wason James , Gopaluni Seerapani , Tieu Joanna , Smith Rona M. , Jayne David R. , Jones Rachel B.
Published: March 2019

Introduction

The value of antineutrophil cytoplasmic antibody (ANCA) measurements among patients with an established diagnosis of ANCA-associated vasculitis (AAV) to assess disease activity or predict relapse remains controversial, but recent evidence suggests a possible role for rituximab-treated patients.

Patients and Methods

All patients with active vasculitis and positive proteinase 3 (PR3)–ANCA who were starting a 2-year treatment course of rituximab for induction of remission at Addenbrooke's Hospital between January 2011 and January 2016 were included in this study. Common department practice consists of 6 g of rituximab given over 2 years, concomitant corticosteroids (0.5–1.0 mg/kg) with rapid taper over 3 months, and cessation of oral maintenance immunosuppressive agents at time of first rituximab dose. Clinical and laboratory data were collected retrospectively using electronic patient records.

Results

Fifty-seven patients with current PR3-ANCA positivity were included in the analysis. Median follow-up was 59 months. PR3-ANCA negativity was achieved in 25 patients (44%) with a median time of 14 months. Clinical remission was achieved in 53 patients (93%) with a median time of 3 months. Among the 53 patients who achieved remission during follow-up, 24 (45%) relapsed with a median time to relapse of 36 months from remission. Both PR3-ANCA–negative status and 50% reduction in PR3-ANCA from baseline (as time-varying covariates) were significantly associated with a longer time to relapse (PR3-ANCA–negative status: hazards ratio, 0.08 [95% confidence interval, 0.01–0.63, p = 0.016]; 50% reduction in PR3-ANCA: hazards ratio, 0.25 [95% confidence interval, 0.18–0.99, p = 0.046]).

Conclusions

Achieving and maintaining PR3-ANCA negativity after rituximab was associated with longer-lasting remission.
Diagnostic and Prognostic Value of Using 18F-FDG PET/CT for the Evaluation of Bone Marrow Involvement in Peripheral T-Cell Lymphoma
Authors: Abe Yoshiaki , Kitadate Akihiro , Usui Yoshiaki , Narita Kentaro , Kobayashi Hiroki , Miura Daisuke , Takeuchi Masami , O'uchi Eri , O'uchi Toshihiro , Matsue Kosei
Published: March 2019

Purpose

No study has analyzed a sizeable cohort that comprised solely peripheral T-cell lymphoma (PTCL) patients for the diagnostic and prognostic performance of 18F-FDG PET/CT for bone marrow (BM) involvement. This study aimed to investigate the utility of PET/CT for the identification of BM involvement and to explore its prognostic relevance in patients with PTCL.

Methods

Eighty-three consecutive patients with newly diagnosed PTCL were enrolled in this retrospective study. The diagnosis of BM involvement was confirmed on the basis of positive BM histology or disappearance of marrow abnormalities on follow-up PET/CT concurrently with a successful treatment response.

Results

Of 28 patients with confirmed BM involvement, BM biopsy (BMB) and PET/CT detected an involvement in 17 and 25 patients. Among 66 patients with negative BM histology, 11 patients had BM involvement detected by PET/CT and furthermore showed significantly shorter progression-free and overall survival than patients without BM involvement. We recategorized the International Prognostic Index (IPI) risk groups based on the presence of BM involvement using the combined assessment of iliac crest marrow biopsy histology and PET/CT (PET/BMB-based IPI). PET/BMB-based IPI tended to perform better than conventional BMB-based IPI.

Conclusions

This study included the largest population of PTCL patients for PET/CT evaluation of BM involvement so far. PET/CT exhibited a higher sensitivity for BM involvement than BMB. Furthermore, BM assessment using PET/CT identified patients at high risk of disease progression and mortality among those with negative BM histology, suggesting that PET/CT may have a potential to improve existing prognostic strategies in PTCL.