bluuebunny/crossref_metadata_2025 huggingface dataset:
Gender differences for theory-based determinants of muscle-strengthening physical activity in college-aged students: a moderation analysis
Authors: Fairchild Saidi Grace , Branscum Paul
Published: April 2019

Researchers and practitioners have primarily focused on understanding and promoting aerobic forms of physical activity (PA), while leaving muscle-strengthening forms of PA less understood. There are also stark gender disparities for muscle-strengthening PA but not aerobic PA. The purpose of this study was to apply the reasoned action approach (RAA) toward understanding theory-based determinants of muscle-strengthening PA and to explore gender differences. Female (n = 272) and male (n = 120) college students completed a valid and reliable survey evaluating their participation in muscle-strengthening PA and the constructs of the RAA (intentions, attitudes, perceived norms, and perceived behavioral control [PBC]). Results showed that attitudes, perceived norms, and PBC explained a substantial amount of the variance of intentions for both female (53.8%) and male (54.7%) participants; however, when predicting participation in muscle-strengthening PA, PBC moderated the relationship between intentions and muscle-strengthening PA participation for female participants but not for male participants. Results from this study showed that for women, implementational processes are likely needed for public health interventions to promote muscle-strengthening PA to build capability, skills, and self-efficacy, while for men, motivational interventions are warranted to create favorable attitudes.
BCG-induced discitis and osteomyelitis in a patient with a history of bladder cancer
Authors: Heck Cheryl L. , Schwartzbauer Gary T.
Published: April 2019

This article describes the diagnosis and treatment of a patient with lumbar discitis and osteomyelitis caused by Bacillus Calmette-Guérin instillation therapy for treatment of superficial bladder cancer. Treatment of this rare condition consists of antituberculosis microbial therapy and one or more IV antibiotics to cover multidrug-resistant bacteria in the bone.
The need for greater diversity in the PA profession
Authors: Coplan Bettie , Fleming Shani
Published: April 2019

Leading organizations committed to improving health and healthcare in the United States agree that a more diverse healthcare workforce is needed to combat widespread disparities affecting underrepresented minority and underserved populations. Until the 1990s, a higher proportion of underrepresented minorities entered PA programs than other healthcare professions programs, such as medical school. However, in recent years, the PA profession has struggled to increase diversity among its ranks. This article reviews the rationale for greater diversity in the PA workforce, discusses the obstacles that underrepresented minority students and PA educators face, and makes recommendations to address diversity. The PA profession's rapid growth presents an opportunity to expedite change through community outreach, sustained commitment to diversity, research, and policy change.
The Unwavering Courage of Nurses
Authors: Kennedy Maureen Shawn
Published: April 2019

Courage can take many forms.
Mechanical vs. Manual Chest Compressions for Cardiac Arrest
Authors: Porritt Kylie
Published: April 2019

Editor's note: This is a summary of a nursing care–related systematic review from the Cochrane Library. For more information, see http://nursingcare.cochrane.org.
New Drugs for Preventing Migraines
Authors: Aschenbrenner Diane S.
Published: April 2019

The Food and Drug Administration has approved three drugs from a new drug class designed to prevent migraine headaches. The drugs target calcitonin gene–related peptide, a substance involved in the excessive cerebral vasodilation that leads to migraine headaches.

The three new products are administered subcutaneously once per month.
FDA Warns of Hidden Prescription Drugs in Dietary Supplements
Authors: Aschenbrenner Diane S.
Published: April 2019

The Food and Drug Administration has issued a warning that many products sold as dietary supplements for weight loss, sexual enhancement, or body building contain prescription drugs or other chemicals.

Nurses and NPs should assess patients for use of these products and help them recognize those that are potentially tainted.
Leading the Effort to Promote Bleeding Control in Our Communities
Authors: Reed LTC (Ret.) James R. , Carman Margaret
Published: April 2019

Nurses can prepare the public to save lives following a mass casualty event.
Ensuring a Successful Preceptorship
Authors: Loughran Mary Catherine , Koharchik Linda
Published: April 2019

This article is one in a series on the roles of adjunct clinical faculty and preceptors, who teach nursing students and new graduates to apply knowledge in clinical settings. One of the first steps to becoming a preceptor is learning about the resources and support available within one's organization. This article offers tips to help preceptors prepare for and navigate the precepting experience.
Bag-Mask Ventilation Benefits Critically Ill Adults Undergoing Tracheal Intubation
Authors: Rosenberg Karen
Published: April 2019

According to this study:

Among critically ill adults undergoing tracheal intubation in the ICU, patients who received bag-mask ventilation in between the administration of medication and laryngoscopy had higher oxygen saturation rates and lower rates of severe hypoxemia compared with those who received no ventilation.
A Nurse in the House
Authors: Collins Amy M.
Published: April 2019

Freshman congresswoman Lauren Underwood brings nursing and health care policy experience to the table.
Deprescribing
Authors: Diggins Kristene
Published: April 2019

In today's clinical landscape, the simultaneous use of multiple drugs to treat a single condition has become a major patient safety issue. Recent evidence suggests a need to identify deprescribing opportunities in the management of polypharmacy. NPs, as clinical gatekeepers, are in a key position to spearhead deprescribing best practices, specifically as they relate to older adults with multiple medication regimens.
Neural Indices of Vowel Discrimination in Monolingual and Bilingual Infants and Children
Authors: Yu Yan H. , Tessel Carol , Han Henry , Campanelli Luca , Vidal Nancy , Gerometta Jennifer , Garrido-Nag Karen , Datta Hia , Shafer Valerie L.
Published: April 2019

Objectives:

To examine maturation of neural discriminative responses to an English vowel contrast from infancy to 4 years of age and to determine how biological factors (age and sex) and an experiential factor (amount of Spanish versus English input) modulate neural discrimination of speech.

Design:

Event-related potential (ERP) mismatch responses (MMRs) were used as indices of discrimination of the American English vowels [ε] versus [I] in infants and children between 3 months and 47 months of age. A total of 168 longitudinal and cross-sectional data sets were collected from 98 children (Bilingual Spanish–English: 47 male and 31 female sessions; Monolingual English: 48 male and 42 female sessions). Language exposure and other language measures were collected. ERP responses were examined in an early time window (160 to 360 msec, early MMR [eMMR]) and late time window (400 to 600 msec, late MMR).

Results:

The eMMR became more negative with increasing age. Language experience and sex also influenced the amplitude of the eMMR. Specifically, bilingual children, especially bilingual females, showed more negative eMMR compared with monolingual children and with males. However, the subset of bilingual children with more exposure to English than Spanish compared with those with more exposure to Spanish than English (as reported by caretakers) showed similar amplitude of the eMMR to their monolingual peers. Age was the only factor that influenced the amplitude of the late MMR. More negative late MMR was observed in older children with no difference found between bilingual and monolingual groups.

Conclusions:

Consistent with previous studies, our findings revealed that biological factors (age and sex) and language experience modulated the amplitude of the eMMR in young children. The early negative MMR is likely to be the mismatch negativity found in older children and adults. In contrast, the late MMR amplitude was influenced only by age and may be equivalent to the Nc in infants and to the late negativity observed in some auditory passive oddball designs.
Persistent Use of Extended Fractionation Palliative Radiotherapy for Medicare Beneficiaries With Metastatic Breast Cancer, 2011 to 2014
Authors: Yu James B. , Pollack Craig E. , Herrin Jeph , Zhu Weiwei , Soulos Pamela R. , Xu Xiao , Gross Cary P.
Published: April 2019

Introduction:

With no evidence to support extended radiation courses for the palliation of bone metastases, multiple guidelines were issued discouraging its use. We assessed contemporary use and cost of prolonged palliative radiotherapy in Medicare beneficiaries with bone metastases from breast cancer.

Methods:

We conducted a retrospective, longitudinal study of palliative radiotherapy use among fee-for-service Medicare beneficiaries with bone metastasis from breast cancer who underwent palliative radiotherapy during 2011 to 2014. Patients were categorized according to the number of days (fractions) on which they received palliative radiotherapy: 1, 2 to 10, 11 to 19, or 20 to 30. We examined the association of clinical, demographic, and provider characteristics with the use of extended (≥11 fractions) or very extended (≥20 fractions) fractionation with logistic regression models. We also compared the cost of different fractionation schemes from the payer perspective.

Results:

Of the 7547 patients in the sample (mean age, 71 y), 3084 (40.8%) received extended fractionation. The proportion of patients receiving 11 to 19 (34.7% in 2011 and 28.1% in 2014, trend P<0.001) and 20 to 30 treatments (10.3% in 2011 to 9.0% in 2014, trend P=0.07) decreased modestly over time. Patients with comorbidities were less likely to undergo extended fractionation (34.4% for ≥3 comorbidities vs. 44.9% for 0 comorbidities; adjusted odds ratio 0.67 [95% confidence interval, 0.58-0.76]). Patients treated at free-standing practices were more likely to undergo extended fractionation (47.9%) compared with those treated at hospital-based practices (37.3%, P<0.001; adjusted odds ratio, 1.49 [95% confidence interval, 1.35-1.65]). The mean cost of treatment varied from $633 (SD $240) for single-fraction treatment, to $3566 (SD $1349) for 11 to 19 fractions, to $6597 (SD $2893) for 20 to 30 fractions.

Conclusion:

The use of prolonged courses of palliative radiotherapy among Medicare beneficiaries with breast cancer remained high in 2011 to 2014. The association between free-standing facility status and use of extended fractionation suggests that provider financial incentives may impact choice of treatment.
Nonsurgical Treatments for Infraorbital Rejuvenation: A Review
Authors: Lipp Michael , Weiss Eduardo
Published: April 2019

BACKGROUND

Tear trough and infraorbital region changes are one of the first signs recognizable aging. This is a common consultation for cosmetic dermatologists and there are many treatment options available.

OBJECTIVE

This article provides a review of the anatomy and changes that occur in the infraorbital region as we age. We also suggest the use of the osseous, color, underlying anatomy, laxity, adipose, rhytides (OCULAR) mnemonic to evaluate these changes and review the literature for treatments options.

MATERIALS AND METHODS

A literature search was performed through PubMed, using search terms “Tear trough,” “Infra-orbital,” “Dark-circles,” “Lower-Eyelid,” and “Midface.”

RESULTS

Fillers, lasers, radiofrequency devices, chemical peels, various topicals, and botulinum toxin are available non-surgical treatment options discussed in the literature found to significantly improve and rejuvenate the infraorbital region.

CONCLUSION

A complete understanding of the anatomy and changes that occur with aging are of most importance when assessing the infraorbital region. Organizing these changes into the OCULAR mnemonic is one way to assess the infraorbital region and achieve optimal rejuvenation.
Far-lateral Vascularized Rib Graft for Cervical and Lumbar Spinal Arthrodesis: Cadaveric Technique Description
Authors: Bohl Michael A. , Hlubek Randall J. , Turner Jay D. , Kakarla U. Kumar , Preul Mark C. , Reece Edward M.
Published: April 2019

Background:

Rotational vascularized autografts are ideal for achieving spinal arthrodesis because they maintain bony vascularization while avoiding the morbidity and challenges of free-tissue transfer. Although proximal ribs are ideal candidates for vascularized bone grafts, their use is restricted to the thoracic spine. This study describes a novel technique for harvesting lateral rib grafts on an intercostal pedicle for use in cervical and lumbar posterolateral arthrodesis.

Methods:

Six cadaveric dissections were performed (2 included upper and all 6 included lower rib dissections). Measurements included graft width and thickness, distance reached from harvest level to the top of the graft, and ipsilateral and contralateral spine levels reached by the graft.

Results:

Overall, 60 lateral rib grafts were harvested. Intercostal vessel pedicles were torn during harvest in 4/48 (8.3%) of the lower rib and 5/12 (41.7%) of the upper rib grafts. Mean measurements of successful upper rib grafts were 1.4 ± 0.12 cm × 0.5 ± 0.15 cm (width × thickness), 14.1 ± 2.79 cm (distance) reached, and C2 (occiput–C4) reached ipsilaterally and C3 (occiput–C5) reached contralaterally. Mean lower rib graft measurements were 1.4 ± 0.26 cm × 0.4 ± 0.15 cm (width × thickness), 18.0 ± 6.19 cm (distance), S1 (L1–S2) reached ipsilaterally, and L4 (L1–S1) reached contralaterally.

Conclusions:

It is technically feasible to rotate a far-lateral rib graft on an intercostal pedicle into the posterolateral cervical or lumbar spine for the augmentation of arthrodesis. Upper ribs seem to be more difficult to harvest and rotate while keeping the intercostal pedicle intact than lower ribs.
Role of Radiofrequency (Votiva, InMode) in Pelvic Floor Restoration
Authors: Dayan Erez , Ramirez Henry , Westfall Lacy , Theodorou Spero
Published: April 2019

Background:

Postpartum pelvic floor disorders are estimated to impact 24% of women in the United States. This study describes the use of a radiofrequency device (Votiva, InMode) for postpartum pelvic floor restoration using an electrostimulator to objectively measure treatment effect.

Methods:

A retrospective evaluation was conducted between April 2017 and May 2018 of consecutive patients undergoing vaginal radiofrequency treatment. Inclusion criteria were patients at least 6 weeks postvaginal delivery with symptoms of pelvic floor dysfunction. Resting pelvic floor muscle tone and maximal pelvic floor contraction were measured.

Results:

Fifty women were included in the study with an average age of 32 (29–40) years old, average of 2.6 pregnancies, and 1.8 vaginal deliveries. Two patients were lost to follow-up and excluded. Three complete radiofrequency treatments were performed in 31/50 patients, whereas 19 patients received 1–2 treatments. There were no adverse events from the radiofrequency treatment. No changes were found in resting pelvic muscle tone after Votiva treatment [Wilks’ lambda = 0.98, F (1, 45) = 0.86, P = 0.36]. The quantity of treatments seemed to impact mean values of maximal pelvic floor contraction [F (1, 45) = 105.14, P < 0.001]. On the patient questionnaire, patients felt subjective improvement correlated to number of treatments.

Conclusions:

Radiofrequency is safe for the treatment of pelvic floor dysfunction. This study showed no changes in resting pelvic muscle tone but an improvement in maximal pelvic floor contraction. A prospective randomized study is being conducted to further evaluate the efficacy of this technology.
AXL Inhibition Extinguishes Primitive JAK2 Mutated Myeloproliferative Neoplasm Progenitor Cells
Authors: Pearson Stella , Blance Rognvald , Somervaille Tim C.P. , Whetton Anthony D. , Pierce Andrew
Published: April 2019

Supplemental Digital Content is available in the text
A Novel Medial Canthal Reconstruction Technique in Children With Blepharophimosis Syndrome
Authors: Parvizi Sahar , Ong Juling , Abou Rayyah Yassir , Dunaway David
Published: April 2019

Purpose:

There are different techniques for medial canthoplasty in blepharophimosis syndrome where individuals have epicanthus inversus and telecanthus leading to typical facial appearances. These methods have potential problems with scarring, epistaxis, and extrusion of metal plates.

Methods:

The authors describe a novel technique of medial canthal reconstruction using titanium microplates with microscrew fixation to the anterior lacrimal crest, with effective, safe, and reproducible results.

Results:

Seven children with blepharophimosis syndrome underwent medial canthus reconstruction surgery at a single center with the collaboration of a pediatric oculoplastic surgeon and craniofacial plastic surgeon to improve eye opening through correction of the lid contours and telecanthus.

Conclusions:

This is a safe, effective, and reproducible technique, with minimal morbidity and rapid postoperative recovery in children. It produces cosmetically acceptable scars and a strong stable reconstruction of the medial canthal insertion.
Safety and Efficacy of Resident-Performed Functional Upper Eyelid Blepharoplasty
Authors: Hellman Justin B. , Mahmood Bilawal , Lin Lily Koo
Published: April 2019

Resident-performed functional upper eyelid blepharoplasty under the direct supervision of an attending is a safe and effective procedure with similar complication rate, number of revision procedures, and patient satisfaction to attending-performed functional upper eyelid blepharoplasty.

Purpose:

To determine the safety and efficacy of resident-performed functional upper eyelid blepharoplasty.

Methods:

The authors retrospectively looked at functional upper eyelid blepharoplasty surgery performed on 836 eyes of 448 patients under the supervision of one oculoplastic surgery attending at the University of California Davis Eye Center from January 1, 2013, to December 31, 2017. The primary surgeon was a resident on 427 eyes and was an attending on 409 eyes. Patients (73.5%) were female, and the mean age was 66.0 ± 10.0. All patients had at least 2 postoperative visits, and eyes that underwent other concurrent upper eyelid or brow procedures were excluded. The authors looked at major and minor complications, percentage of initially dissatisfied patients, and percentage of cases that required a revision procedure within 6 months. Chi-square tests were used for statistical analysis.

Results:

There were no major complications in either group. There was no difference in the rate of minor complications (10.8% vs. 7.6%, p = 0.11), percentage of patients who were initially dissatisfied with the procedure (3.5% vs. 2.0%, p = 0.17), or percentage of patients requiring a revision procedure (5.2% vs. 3.2%, p = 0.15). The most common minor complications were inclusion cysts (45, 5.4%), wound dehiscence (9, 1.1%), and hypertrophic scars (9, 1.1%), and the most common revision procedures were removal of inclusion cyst(s) (17, 2.0%) and suturing or placement of topical skin adhesive for wound dehiscence (9, 1.1%).

Conclusions:

Ophthalmology residents can perform functional upper eyelid blepharoplasty safely and effectively under the supervision of an attending physician.
Factors Affecting Self-care Maintenance and Management in Patients With Heart Failure
Authors: Chuang Hui-Wan , Kao Chi-Wen , Lin Wei-Shiang , Chang Yue-Cune
Published: April 2019

Background:

Self-care is indispensable for health maintenance and well-being. This naturalistic decision-making process involves behavioral choices to maintain physiological stability (self-care maintenance) and response to occurring symptoms (self-care management). However, several factors affect self-care, but some have contradictory results.

Objective:

We aimed to examine how depressive symptoms, social support, eHealth literacy, and heart failure (HF) knowledge directly and indirectly affect self-care maintenance and management and to identify the mediating role of self-care confidence in self-care maintenance and management.

Methods:

The study included a total of 141 patients with HF (average age, 65.2 years; male, 55.3%). We analyzed their data, including demographic and clinical characteristics, obtained from the Patient Health Questionnaire-9, Multidimensional Scale of Perceived Social Support, eHealth Literacy Scale, Dutch Heart Failure Knowledge Scale, and Self-Care of Heart Failure Index. Furthermore, path analysis was conducted to examine the effects of the study variables on self-care maintenance and management.

Results:

Self-care confidence significantly and directly affected self-care maintenance and management and mediated the relationships between factor variables (depressive symptoms, social support, and HF knowledge) and outcome variables (self-care maintenance and management). Specifically, depressive symptoms had a negative and direct effect on self-care maintenance, whereas eHealth literacy had significant and direct effects on self-care management and HF knowledge.

Conclusion:

Self-care confidence decreases the negative effects of depressive symptoms on self-care. This study underscores the need for interventions targeting patients' self-care confidence to maximize self-care among patients with HF.
Optimization of Intraoperative Imaging Protocol to Confirm Placement of Cochlear Implant Electrodes
Authors: Cooper Timothy , Hildrew Douglas , McAfee Jacob S. , Piatt Brian K. , Branstetter Barton , McCall Andrew A. , Hirsch Barry E.
Published: April 2019

Objectives:

The need to intraoperatively confirm correct placement of the active electrode of a cochlear implant may occur in various clinical settings. These include a malformed cochlea, difficulty with insertion, or suboptimal or abnormal electrical responses (impedance or evoked action potentials) obtained during intraoperative testing. Frustration with inconsistent images using portable x-ray machines prompted this study to determine the technique needed to reliably image the electrode within the cochlea. Our objective was to establish a radiology protocol that would be reproducible and reliable across institutions.

Methods:

Prospective cadaveric imaging study. Access to the round window via the facial recess was established using cadaver heads. Electrodes provided by three cochlear implant manufacturers were inserted into the cochlea. The position of the head, angle of the x-ray tube, and beam settings were varied. A compendium of electrode images was obtained and analyzed by neurotologists and a head and neck radiologist to reach a consensus on an optimal imaging protocol.

Results:

The optimal position for intraoperative x-ray confirmation of cochlear implant electrode placement is obtained by turning the head 45 degrees toward the contralateral ear. The portable digital x-ray machine and central ray was angled 15 degrees (aiming cephalic) from vertical with exposure settings of 32 mAs at 70 kVp and the digital radiography image receptor was positioned under the mattress of the operating table.

Conclusion:

A protocol for patient and beam source positioning and exposure using a portable digital x-ray unit can provide reliable imaging for intraoperative confirmation of cochlear implant electrode positioning.
Electrical Impedance as a Biomarker for Inner Ear Pathology Following Lateral Wall and Peri-modiolar Cochlear Implantation
Authors: Shaul Chanan , Bester Christofer W. , Weder Stefan , Choi June , Eastwood Hayden , Padmavathi K.V. , Collins Aaron , O’Leary Stephen J.
Published: April 2019

Objectives/Hypothesis:

Spikes in cochlear implant impedance are associated with inner ear pathology after implantation. Here, we correlate these spikes with episodes of hearing loss and/or vertigo, with a comparison between lateral wall and peri-modiolar electrode arrays.

Methods:

Seven hundred seventy recipients of Cochlear's slim-straight, lateral wall electrode (CI422), or peri-modiolar (CI512) electrode were investigated for impedance spikes. Impedance fluctuations were defined as a median rise of ≥ 4 kΩ across all intracochlear electrodes from baseline measurements taken 2 weeks after switch-on. Medical records were analyzed from 189 of the 770 patients.

Results:

The slim straight, lateral wall electrode was found to spike in impedance at a significantly higher rate than the peri-modiolar array (17% vs 12%). The peri-modiolar electrode tended to spike in impedance earlier than the slim-straight electrode. Impedance spikes were found to significantly correlate with medical events (hearing loss, vertigo, or tinnitus). Overall, in the “spike” group, 42 of 75 patients (56%) demonstrated a clinical event during the impedance spike, whereas 26 of 114 patients (22%) of the “non-spike” group had a clinical event. This significant difference existed with both implant types.

Conclusion:

These results demonstrate a small, but significant increase in impedance spikes in lateral wall electrodes, and support the relationship between spikes in cochlear implant impedances and postoperative inner-ear events, including the loss of residual hearing and vertigo. Monitoring cochlear implant impedance may be a method for early detection, and so the prevention, of these events in the future.
Characteristics of Mid-Frequency Sensorineural Hearing Loss Progression
Authors: Birkenbeuel Jack , Abouzari Mehdi , Goshtasbi Khodayar , Moshtaghi Omid , Sahyouni Ronald , Moshtaghi Afsheen , Cheung Dillon , Gelnett Donna , Lin Harrison W. , Djalilian Hamid R.
Published: April 2019

Objectives:

To characterize the progression of mid-frequency sensorineural hearing loss (MFSNHL) over time.

Methods:

A retrospective chart review spanning 2012 to 2017 was performed at a tertiary care audiology and neurotology center. Our cohort included 37 patients met the criteria for MFSNHL also known as “cookie bite hearing loss.” It was defined as having a 1, 2, and 4 kHz average pure tone audiometry greater than 10 dB in intensity compared with the average threshold at 500 Hz and 8 kHz.

Results:

Average age at initial presentation was 11.8 years (range, 8 mo to 70 yr). Across all individuals, the average mid-frequency threshold was 47 dB, compared with 27 dB at 500 Hz and 8 kHz. Twenty-three patients (62%) had multiple audiograms with 4-year median follow up time. Average values across all frequencies (0.5, 1, 2, 4, 8 kHz) in the initial audiogram was 37 dB, compared with an average of 39 dB demonstrated on final audiogram. Of those with serial audiograms, only five patients demonstrated threshold changes of 10 dB or more. Of these five patients, only one was found to have clinical worsening of MFSNHL.

Conclusions:

MFSNHL is an uncommon audiometric finding with unspecified long-term outcomes. We demonstrated that most patients (96%) with MFSNHL do not experience clinical worsening of their hearing threshold over almost 4 years of follow up. Future prospective studies aimed at collecting longer-term data are warranted to further elucidate the long-term trajectory of MFSNHL patients.
Systematic Review of Hearing Loss Genes in the African American Population
Authors: Worden Cameron P. , Jeyakumar Anita
Published: April 2019

Objective:

Literature review of the genetic etiology of hearing loss (HL) in the African American (AA) population.

Data Sources:

PubMed, EBSCO, and CINAHL were accessed from 1966 to 2018.

Review Methods:

PRISMA guidelines were followed. Search terms included permutations of “hearing loss,” “African American,” “black,” and “genetic”; “African American” was then cross-referenced against documented HL genes. AA subjects included in multiethnic cohorts of genetic HL testing were identified by searching the key terms “hearing loss” and “ethnic cohort” and “genetic.” The Q-Genie tool was used in the quality assessment of included studies. An allele frequency meta-analysis of pathogenic GJB2 variants in the AA population was performed and stratified by hearing status.

Results:

Four hundred seventeen articles were reviewed, and 26 met our inclusion criteria. Ten studies were included in the GJB2 meta-analysis. In the general AA population, pathogenic GJB2 variants are rare, including the 35delG allele, which displayed a carrier frequency of 0.05%. Pathogenic variants were discovered in seven nonsyndromic HL genes (GJB2, MYO3A, TECTA, STRC, OTOF, MYH14, TMC1), eight syndromic HL genes, and one mitochondrial HL gene. Recent comprehensive genetic testing using custom genetic HL testing platforms has yielded only a 26% molecular diagnosis rate for HL etiologies in the AA population.

Conclusions:

Investigators should be encouraged to provide an ethnic breakdown of results. Sparse literature and poor diagnosis rates indicate that genes involved in HL in the AA population have yet to be identified. Future explorative investigations using next-generation sequencing technologies, such as whole-exome sequencing, into the AA population are warranted.
Drug Repositioning in Oncology
Authors: Serafin Marissa B. , Bottega Angelita , da Rosa Taciéli F. , Machado Catrine S. , Foletto Vitória S. , Coelho Silvana S. , da Mota Augusto D. , Hörner Rosmari
Published: April 2019

Background:

The worldwide increase in the occurrence of cancer associated with the limitations of immunotherapy and the emergence of resistance have impaired the prognosis of cancer patients, which leads to the search for alternative treatment methods. Drug repositioning, a well-established process approved by regulatory agencies, is considered an alternative strategy for the fast identification of drugs, because it is relatively less costly and represents lower risks for patients.

Areas of Uncertainty:

We report the most relevant studies about drug repositioning in oncology, emphasizing that its implementation faces financial and regulatory obstacles, making the creation of incentives necessary to stimulate the involvement of the pharmaceutical industry.

Data Sources:

We present 63 studies in which 52 non-anticancer drugs with anticancer activity against a number of malignancies are described.

Therapeutic Innovations:

Some have already been the target of phase III studies, such as the Add-Aspirin trial for nonmetastatic solid tumors, as well as 9 other drugs (aprepitant, artesunate, auranofin, captopril, celecoxib, disulfiram, itraconazole, ritonavir, and sertraline) in the CUSP9* clinical trial for the treatment of recurrent glioblastoma. Others have already been successful in repositioning such as thalidomide, zoledronic acid, celecoxib, methotrexate, and gemcitabine.

Conclusions:

Therefore, drug repositioning represents a promising alternative for the treatment of oncological disorders; however, the support from funding agencies and from the government is still needed, the latter regarding regulatory issues.
Normal and leukemic stem cell niche interactions
Authors: Oh Il-Hoan , Jeong Seon-Yeong , Kim Jin-A
Published: April 2019

Purpose of review

Normal hematopoietic stem cells (HSCs) and leukemic stem cells (LSCs) interact with the stem cell niche bone marrow in different ways. Understanding the potentially unique microenvironmental regulation of LSCs is key to understanding in-vivo leukemogenic mechanisms and developing novel antileukemic therapies.

Recent findings

When leukemic cells are engrafted in the stem cell niche, the cellular nature of the niche – including mesenchymal stromal cells – is reprogramed. Altered mesenchymal cells selectively support leukemic cells and reinforce the pro-leukemic environment. As the niche plays an active role in leukemogenesis, its remodeling may significantly influence the leukemogenic pattern, and cause differences in clinical prognosis. Notably, niche cells could be stimulated to revert to a pronormal/antileukemic state, creating potential for niche-based antileukemic therapy.

Bone marrow microenvironments are under dynamic regulation for normal and leukemic cells, and there is bi-directional control of leukemic cells in the niche. Leukemic cells are both protected by stroma and able to reprogram stromal cells to transform the niche to a state, which reinforces leukemogenesis. Because of its dynamic nature, the niche could be converted to an environment with antileukemic properties, making it an attractive target for therapy.
Defining the functions of adenosine-to-inosine RNA editing through hematology
Authors: Heraud-Farlow Jacki E. , Chalk Alistair M. , Walkley Carl R.
Published: April 2019

Purpose of review

The direct modification of RNA is now understood to be widespread, evolutionarily conserved and of consequence to cellular and organismal homeostasis. adenosine-to-inosine (A-to-I) RNA editing is one of the most common mammalian RNA modifications. Transcriptome-wide maps of the A-to-I editing exist, yet functions for the majority of editing sites remain opaque. Herein we discuss how hematology has been applied to determine physiological and malignant functions of A-to-I editing.

Recent findings

Functional studies have established that A-to-I editing and ADAR1, responsible for the majority of editing in blood cells, are essential for normal blood cell homeostasis. ADAR1 edits endogenous RNA and reshapes its secondary structure, preventing MDA5 from perceiving the cells own RNA as pathogenic. Roles for ADAR1 in human leukaemia, and most recently, cancer cell intrinsic and extrinsic functions of ADAR1 have been identified that highlight ADAR1 as a therapeutic target in cancer.

The studies reviewed have identified the key physiological function of ADAR1 and mechanistic basis for A-to-I editing in normal physiology and have now been extended to cancer. As our understanding of the biology and consequences of A-to-I editing evolve, it may be possible to target ADAR1 function advantageously in a number of settings.
A primary care pediatrician's guide to assessing problematic interactive media use
Authors: Nereim Cameron , Bickham David , Rich Michael
Published: April 2019

Purpose of review

To review the literature and provide a guide to assessing patients with problematic interactive media use (PIMU).

Recent findings

0.3–1.0% of the world population meets criteria for internet gaming disorder (IGD). 26.8–83.3% of adolescents meeting criteria for internet addiction have comorbid attention-deficit/hyperactivity disorder. IGD is associated with increased anxiety and social anxiety/phobias. Group counseling, cognitive behavioral therapy, and sports intervention are associated with significant reductions in internet addiction.

With the Diagnostic and Statistical Manual of Mental Disorders-5 inclusion of IGD under ‘Conditions for Further Study’ and the addition of gaming disorder to International Classification of Diseases (ICD)-11, the idea that PIMU is a mental health disorder gained traction. Although certain populations may be at increased risk, all children and adolescents should be screened for PIMU given now-normal heavy media usage rates. Effective treatment of PIMU starts with identification and management of comorbid mental and behavioral health problems. Depending on their degree of functional impairment, patients may benefit from various forms of psychotherapy with coordinated outpatient management or may warrant higher level of care in one of several established residential treatment programs. Few studies have evaluated pharmacologic approaches to treating PIMU, but some medications targeting comorbid mental and behavioral health conditions improve PIMU-related behaviors.
Ovary-sparing surgery for benign pediatric ovarian masses
Authors: Lawrence Amy E. , Minneci Peter C. , Deans Katherine J.
Published: April 2019

Purpose of review

This review highlights progress in the management of pediatric ovarian neoplasms. Recent research has identified disparities in the management of patients with benign ovarian neoplasms based on a variety of factors. However, the long-term effects of unilateral oophorectomy have prompted an emphasis on ovary-sparing surgery (OSS) for benign masses. One of the challenges still facing providers is the preoperative differentiation between benign and malignant masses.

Recent findings

Recent studies highlight the variability in practice patterns surrounding the management of benign ovarian neoplasms. Progress continues to be made in identifying reliable factors that can be used to inform preoperative risk stratification of patients who present with ovarian neoplasms. These factors include imaging characteristics, symptoms and tumor markers. In addition, the safety of OSS with regard to recurrence and upstaging in appropriate settings continues to be demonstrated.

This review highlights the importance of multidisciplinary collaboration in the treatment of ovarian neoplasms given the varied surgical approach by specialty. Multiple retrospective studies have identified factors that can be used for preoperative risk stratification and selection of patients for OSS. Prospective studies evaluating the accuracy of these factors for preoperative risk stratification are needed.
A Rare Case of Activated Phosphoinositide 3-Kinase Delta Syndrome (APDS) Presenting With Hemophagocytosis Complicated With Hodgkin Lymphoma
Authors: Cansever Murat , Zietara Natalia , Chiang Samuel C.C. , Ozcan Alper , Yilmaz Ebru , Karakukcu Musa , Rohlfs Meino , Somekh Ido , Canoz Ozlem , Abdulrezzak Ummuhan , Bryceson Yenan , Klein Christoph , Unal Ekrem , Patiroglu Turkan
Published: April 2019

Gain of function mutations in the p110δ catalytic subunit of the phosphatidylinositol-3-OH kinase (PIK3CD) classified as activated phosphoinositide 3-kinase delta syndrome (APDS) are the cause of a primary immunodeficiency characterized by recurrent sinopulmonary infections, and lymphoproliferation. Previously, autoimmunity and Epstein-Barr virus–related B-cell lymphoma have been documented for patients with APDS; here, we present a case that extends the picture, as the patient shows the full diagnostic criteria of hemophagocytic lymphohistiocytosis at 6 months of age. He experienced Hodgkin lymphoma as a 2.5-year-old baby. Next-generation sequencing returned a de novo heterozygous missense variant in PIK3CD (LRG_191t1: c.3061G>A; p.Glu1021Lys), confirming the primary immunodeficiency. After 2 courses of ifosfamide, cisplatin, and etoposide combined with brentuximab, the patient successfully underwent allogeneic hematopoietic stem cell transplantation from his HLA full matched sister, and he has been well for 18 months after that. The hematologist treating Hodgkin lymphoma and/or hemophagocytic lymphohistiocytosis should be vigilant about the possible underlying immune deficiency, and they should consider APDS in their differential diagnosis.
Infusion of Hematopoietic Stem Cell Products Using Pump Mechanism: An Approach Worth Consideration?
Authors: Kissoon Trisha , Godder Kamar , Fort John
Published: April 2019

Hematopoietic stem cell transplantation using progenitor cells is a potentially curative treatment option for patients with high-risk malignancies and nonmalignant hematologic, immunologic, and genetic conditions. There is a need for evidence regarding safe practices and controlled infusion processes. Syringe and intravenous infusion pumps are not commonly used to deliver hematopoietic stem cell products (HPCs) due to a paradigm of thought that suggests that the pressure from the pump might damage the HPCs. Here, we describe a retrospective analysis of 114 patients who received HPC infusions using either a syringe or intravenous pump, providing support for this method along with successful engraftment data. This method may be a viable option to obtain reliable and consistent infusion rates, especially in pediatrics. To the best of our knowledge, this is the only study to date demonstrating safely using syringe and intravenous pump mechanisms in the setting of autologous and allogeneic pediatric stem cell transplantation.
Connecting the Dots From Fever of Unknown Origin to Myelodysplastic Syndrome: GATA2 Haploinsufficiency
Authors: Montiel-Esparza Raúl , Reys Brian , Rogers Zora R. , Evans Amanda S. , Wysocki Christian A. , Timmons Charles , Dickerson Kathryn E.
Published: April 2019

Leukemia-predisposing conditions, such as GATA2 haploinsufficiency, are known for their high penetrance and expressivity profiles. These disorders pose a difficult diagnostic challenge to even the most experienced clinician when they first present. We describe the case of a 17-year-old male presenting with features of nontuberculous mycobacterial infection, pulmonary fibrinoid granulomatous vasculitis, and myelodysplasia in the setting of a pathogenic GATA2 frameshift mutation confirmed by next-generation sequencing. The broad differential for GATA2 haploinsufficiency requires prompt recognition of key clinical features and laboratory abnormalities towards directing diagnosis and guiding appropriate and perhaps life-saving therapy.
Chinese American Women's Experiences with Postpartum Depressive Symptoms and Mental Health Help-Seeking Behaviors
Authors: Ta Park Van M. , Goyal Deepika , Suen Joyce , Win Nolee , Tsoh Janice Y.
Published: April 2019

Purpose:

The objective of this study was to explore the perspectives of postpartum depression (PPD) and mental health help-seeking behaviors among Chinese American women.

Study Design and Methods:

Using a qualitative design, Chinese American women, who had given birth in the past year, participated in a semistructured interview (English or Mandarin). Depressive symptoms and mental health services questionnaires were also conducted.

Results:

All 15 participants were married and between 29 and 39 years of age. Content analysis revealed two main themes including culture-specific postpartum traditions and mental health help-seeking. Nine reported sadness or PPD symptoms, including three who scored above the cutoff of the Edinburgh Postnatal Depression Scale (EPDS score ≥9) for risk of PPD and others who disclosed such information during the interview. Many women shared that they experienced postpartum depressive symptoms, but some did not believe depression was applicable to Chinese women.

Clinical Implications:

Healthcare professionals working with Chinese American women must be aware of culture-specific childbearing traditions to promote maternal–infant well-being outcomes.
Bifocal treatment for peri-articular femoral nonunions
Authors: Grewal Ishvinder S. , Giotakis Nikos , Narayan Badri , Nayagam Selvadurai
Published: April 2019

Aim:

This is a retrospective review of complex periarticular femoral nonunions where bone loss from comminution at original fracture, subsequent infection or lysis was identified and treated by radical excision, internal fixation, and concurrent femoral lengthening from a different level.

Material and Method:

Sixteen patients with a mean age of 41 years were treated. There were 6 infected nonunions. Ten nonunions were located in the distal femur and the remaining proximal. Case notes and radiograph review were used to determine fracture union, lengthening achieved, and complications. Patient outcome was assessed using the SF-12, Tegner–Lysholm Knee Score, and Oxford Hip Score.

Results:

Fracture union was achieved in all patients. The mean lengthening performed was 51 mm (range 30–80) with a fixator time averaging 39 weeks (range 17–80). The bone healing index was 1.9 months/cm. All but 2 patients were restored to within 5 mm of opposite leg length; 1 patient subsequently underwent contralateral limb shortening. The SF-12 had a mean Physical Health Composite Score of 40.0 (22.4–52.9) and a mean Mental Health Composite Score of 49 (30.7–62.0). The Oxford Hip Score was scored at a mean of 39 (21–47) and the Tegner–Lysholm score had a mean of 71 (36–94). There were 3 cases of fracture/deformity from the lengthened bone column (regenerate) and 2 patients required a quadricepsplasty for knee stiffness that was present prior to the treatment for the nonunion.

Conclusion:

Bifocal treatment of complex periarticular femoral nonunions offers a single solution for dealing with bone loss, nonunion, and instability. The method is safe and reliable but has, as with all methods involving distraction osteogenesis, a significant complication rate. Despite this caution, the patients’ outcomes were satisfactory.
Heterosexual Men Anticipate Risk Compensatory Behaviors With Future Preexposure Prophylaxis Initiation: Findings From an Exploratory Cross-Sectional Study
Authors: Roth Alexis M. , Tran Nguyen , Felsher Marisa , Szep Zsofia , Krakower Douglas
Published: April 2019

Among 146 urban heterosexuals screening negative for human immunodeficiency virus, one third anticipated increased sexual risk taking with human immunodeficiency virus preexposure prophylaxis. Men (vs. women) and black (vs. white) participants had increased odds for anticipating decreased condom use. Men and persons reporting transactional sex expected to increase sexual partnerships. Risk compensation could affect reproductive health and disease control.
Biomarkers of Cerebral Damage in Fatal Hypothermia
Authors: Morleo Bastien , Teresinski Gregor , Rousseau Guillaume , Tse Rexson , Tettamanti Camilla , Augsburger Marc , Palmiere Cristian
Published: April 2019

The identification of hypothermia as the cause of death remains challenging in forensic pathology because of unspecific radiological, morphological, and biochemical results. Hyperemia, edema, and petechial hemorrhages within the cerebral parenchyma were described in cases of death by hypothermia. On the other hand, the effect of low temperatures in the brain has been speculated to cause local injuries on a cellular level with potential occurrences of necrosis and inflammation. In the study herein described, endocan, alkaline phosphatase, neuron-specific enolase, S100 protein subunit B, glial fibrillary acidic protein, and C-reactive protein were measured in postmortem serum from femoral blood and cerebrospinal fluid in a series of hypothermia fatalities and control cases. The combination of data collected failed to identify a specific biochemical profile for death by hypothermia in postmortem serum and/or the cerebrospinal fluid, thus suggesting that an alternative panel of brain damage biomarkers indicative of diffuse hypoxic brain injury needs to be defined in hypothermia fatalities.
Incidence and Significance of GATA3 Positivity in Pancreatic Ductal Adenocarcinoma and Cholangiocarcinoma
Authors: Agostini-Vulaj Diana , Bratton Laura E. , Dunne Richard F. , Cates Justin M. M. , Zhou Zhongren , Findeis-Hosey Jennifer J. , Yang Qi , Ramesh Mira K. , Gonzalez Raul S.
Published: April 2019

GATA3 is a transcription factor involved in the development and differentiation of lymphocytes, breast, and hair follicles. The protein is a useful immunohistochemical (IHC) marker for supporting diagnoses of breast or urothelial carcinoma. This can be especially helpful in metastatic neoplasms to help delineate site of origin. GATA3 is also reportedly positive in a percentage of pancreatic ductal adenocarcinomas (PDACs) and cholangiocarcinomas (CCs), but no study has closely evaluated this relationship with respect to clininopathologic features or patient outcome. Using tissue microarrays, we analyzed 240 PDACs and 60 CCs with GATA3 IHC and compared expression to various clinical and pathologic parameters. Overall, GATA3 positivity was seen in 16% of PDACs and 5% of CCs. GATA3 positivity in PDAC cases was more common in male patients (P=0.013). GATA3-positive PDACs trended toward worse survival on multivariate analysis (P=0.074). The only 3 GATA3-positive CCs were poorly differentiated (P=0.069); low case number precluded multivariate survival analysis for CCs. GATA3 positivity can occur in carcinomas of the pancreatobiliary system, which should be considered during IHC workup of neoplasms of unclear origin. This positivity seems to have minimal relevance to patient outcome.