bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of Pain History and Current Pain With Sagittal Spinal Alignment and Muscle Stiffness and Muscle Mass of the Back Muscles in Middle-aged and Elderly Women
Authors: Masaki Mitsuhiro , Ikezoe Tome , Yanase Ko , Ji Xiang , Umehara Jun , Aoyama Junichi , Minami Seigo , Fukumoto Yoshihiro , Watanabe Yuya , Kimura Misaka , Ichihashi Noriaki
Published: February 2019

Study Design:

A cross-sectional study.

Objective:

To investigate the association of low back pain history (LBPH) and LBP with sagittal spinal alignment, stiffness assessed using ultrasonic shear wave elastography, and mass of the back muscle in community-dwelling middle-aged and elderly women.

Summary of Background Data:

The association of LBPH and LBP with sagittal spinal alignment, stiffness, and mass of the back muscles remains unclear in middle-aged and elderly women.

Participants and Methods:

The study comprised 19 asymptomatic middle-aged and elderly women [control (CTR) group], 16 middle-aged and elderly women with LBPH (LBPH group), and 23 middle-aged and elderly women with LBP (LBP group). Sagittal spinal alignment in the standing and prone positions (kyphosis angle in the thoracic spine, lordosis angle in the lumbar spine, and anterior inclination angle in the sacrum) was measured using a Spinal Mouse. The stiffness of the back muscles (lumbar erector spinae and multifidus) in the prone position was measured using ultrasonic shear wave elastography. The mass of the back muscles (thoracic and lumbar erector spinae, lumbar multifidus, and quadratus lumborum) was also measured.

Results:

Multiple logistic regression analysis with a forward selection method showed that the stiffness of the lumbar multifidus muscle was a significant and independent factor of LBPH. The stiffness of the lumbar multifidus muscle was significantly higher in the LBPH group than in the CTR group. Multiple logistic regression analysis also indicated that lumbar lordosis angle in the standing position was a significant and independent factor of LBP. The lumbar lordosis angle was significantly smaller in the LBP group than in the CTR group.

Conclusions:

Our results suggest that LBPH is associated with increased stiffness of the lumbar multifidus muscle in the prone position, and that LBP is associated with the decreased lumbar lordosis in the standing position in community-dwelling middle-aged and elderly women.
Mini-open Lateral En Bloc Corpectomy
Authors: Turner Jay D. , Zaidi Hasan A. , Godzik Jakub , Albuquerque Felipe C. , Uribe Juan S.
Published: February 2019

Background:

Open approaches to the thoracolumbar spine for en bloc vertebral body tumor resection are associated with significant surgical morbidity. Less invasive surgical techniques may reduce complications.

Objective:

To present our experience with a staged posterior midline and mini-open anterolateral extracoelomic approach to en bloc corpectomy for vertebral body tumor resection in cadaver specimens and patients.

Materials and Methods:

The feasibility and safety of the staged posterior midline and mini-open anterolateral extracoelomic approach were evaluated in 3 cadaveric specimens. The procedure was performed at 3 levels (L1–L3) in each cadaver specimen (9 levels) and then in 1 clinical case. The cadaveric neurovascular structures were evaluated for tissue injury, whereas the operative experience, patient complications, and early surgical and clinical outcomes were reviewed.

Results:

The approach allowed for en bloc corpectomy without any injury to the cadaveric neurovascular structures. The procedure was reproducible in the clinical setting, which showed favorable clinical and radiographic patient outcomes.

Conclusions:

Early clinical experience suggests the staged posterior midline and mini-open anterolateral extracoelomic approach is feasible and safe for en bloc tumor resection compared with open techniques with related morbidity. Long-term studies are needed to understand the strengths and limitations of this technique.
Accuracy in Percutaneous Transpedicular Screws Placement Using Biplane Radioscopy
Authors: Rasmussen Jorge Ariel , Landriel Federico , Hem Santiago , Kornfeld Sebastián , Yampolsky Claudio
Published: February 2019

Study Design:

Systematic review and descriptive data meta-analysis.

Objective:

The objective of this study was to appropriately establish the accuracy in the percutaneous transpedicular screws (PTS) placement using biplane radioscopy (Rx-2D).

Summary of Background Data:

The Rx-2D is a widely-used technique for PTS as it is practical, ubiquitous, and cost-effective. However, the reported “acceptable” accuracy attained by this method is widely variable ranging between 76% and 100%.

Methods:

A systematic review was conducted to screen publications about PTS placement using Rx-2D guidance. PubMed/MEDLINE database was consulted using the search term “percutaneous pedicle screw” from 1977 to 2017. Previous meta-analysis and reference lists of the selected articles were reviewed. Accuracy values were assessed fulfilling the proposed criteria. Observational data meta-analysis was performed. Cochran’s Q test was used to determine heterogeneity among data extracted from the series, which was quantified by I
2 test. P-values≤0.05 were considered statistically significant. The results were depicted by Forest plots. Funnel plots were outlined to visualize a possible bias of publication among the selected articles.

Results:

In total, 27 articles were included in the analysis. Results of the accuracy were as follow, 91.5% (n=7993; 95% CI, 89.3%-93.6%) of the screws were placed purely intrapedicular, and 96.1% (n=8579; 95% CI, 94.0%-98.2%) when deviation from the pedicle was up to 2 mm.

Conclusions:

This meta-analysis is the largest review of PTS placed with Rx-2D guidance reported up to date. We concluded that the procedure is a safe and reproducible technique. The key values obtained in this work set reliable references for both clinical and training outcome assessing.
RNA m6A methyltransferase METTL3 regulates invasiveness of melanoma cells by matrix metallopeptidase 2
Authors: Dahal Ujwal , Le Kang , Gupta Mamta
Published: February 2019

The development of immunotherapy has improved the treatment of melanoma; however, resistance and frequent recurrence persist and remain a major problem. N6-methyladenosine (m6A) is the most abundant epitranscriptomic mark on mRNA and is essential for various physiological processes; however, its role in melanoma is unknown. Utilizing human normal melanocyte and melanoma cell lines, we analyzed the expression of METTL3 by quantitative RT-PCR. We inhibited the METTL3 expression by shRNA and analyzed the effects on melanoma cell proliferation, colony formation ability, and invasion. Finally, we assessed the role of METTL3 by using wild-type and m6A catalytic site mutant METTL3. Melanoma cell lines express higher levels of METTL3, as compared with normal melanocytes. Interestingly, silencing of METTL3 gene expression in melanoma cells resulted in decreased m6A activity, colony formation and invasiveness, while its overexpression led to increased m6A activity, colony formation and invasion. METTL3 overexpression promotes accumulation of MMP2 and N-cadherin in melanoma cells. Strikingly, the overexpression of m6A catalytic site mutant METTL3 was unable to produce a similar increase in MMP2 expression, suggesting that m6A activity of METTL3 is important for melanoma cell invasiveness. Our results for the first time uncover the role of m6A modification in melanoma cell biology. We show that METTL3 is upregulated in human melanoma and plays a role in invasion/migration through MMP2. These findings provide the framework for the development and use of METTL3 inhibitors in melanoma treatment.
Phase II Trial of Eribulin in Patients With Metastatic Hormone Refractory Prostate Cancer
Authors: Stein Mark N. , Chen Yu-Hui , Carducci Michael A. , Hudes Gary R. , Lerma Pauline M. , Tan Winston W. , Dalune Robert , Rowland Kendrith M. , Kuzel Timothy M. , DiPaola Robert S.
Published: February 2019

Background:

Eribulin mesylate, a synthetic analog of halichondrin B, is a novel tubulin-binding agent that inhibits cancer cell proliferation at low-nanomolar levels.

Methods:

In a multicenter ECOG trial, patients with progressive metastatic CRPC, ECOG 0-2 were treated with eribulin 1.4 mg/m2 as an IV bolus over 5 minutes on days 1 and 8 of a 21-day cycle. This noncomparative study stratified points to either a chemonaive (CN), prior-taxane (Tax) only, or 2 prior cytotoxic (TCx) chemotherapy arm. The trial was powered to detect a 50% PSA reduction using Consensus Criteria in at least 40% versus 20% (90% power, one-sided α=0.10) for the CN stratum and 25% versus. 10% (power 87%, one-sided α=0.10) for the Tax and TCx strata.

Results:

In total, 119 pts received treatment of which 116 were eligible for the primary response determination in this study. Median age 70 years (range, 45 to 88); median number of treatment cycles 4 (range, 1 to 20+); ECOG 0-1 90%. Confirmed PSA response rates (50% decline from baseline) were 29% (90% [18.2%, 41.2%]; P=0.20), 10% (90% [5.2%, 27.1%]; P=1.00), and 4% ([0.2%, 18.3%]; P=0.59) in the chemonaive stratum, the prior-taxane stratum, and the 2-prior-chemotherapy stratum, respectively. Median progression-free survival was 3.5 months (95% CI, 2.0, 5.9), 2.3 months (95% CI, 2.0, 2.9) and 3.7 months (95% CI, 2.1, 4.2) for the chemonaive stratum, the prior-taxane stratum and the 2-prior-chemotherapy stratum, respectively. Nonhematological toxicities of any grade (mainly grade 1 and 2) were fatigue (74%), neuropathy (40%), alopecia (39%), nausea (35%), and anorexia (34%). Common hematological toxicities were decreased leukocytes (75%), decreased neutrophils (72%), and decreased hemoglobin (66%). The most common grade ≥ 3 toxicities were decreased neutrophils (55%), decreased leukocytes (42%), sensory neuropathy (13%), and fatigue (11%). Overall, there was a 4% rate of febrile neutropenia.

Conclusions:

In summary, per the prespecified study endpoints, eribulin did not have adequate activity in chemotherapy naïve or chemotherapy pretreated patients with metastatic CRPC to support further study in this setting.
Patient Satisfaction and Patients' Family or Significant Other Perceptions After OnabotulinumtoxinA Treatment: A Prospective Cross-Sectional Study
Authors: Montes José R. , Ubale Ruhi V.
Published: February 2019

BACKGROUND

OnabotulinumtoxinA treatment is associated with improved emotional well-being in patients.

OBJECTIVE

This study aimed to determine satisfaction with onabotulinumtoxinA treatment in patients naive to neurotoxin treatment and patients with previous experience with the procedure and evaluate treatment impact on patients' partners, “significant others,” or close family members.

MATERIALS AND METHODS

Patients' satisfaction and their family's/significant other's perception to treatment outcome were assessed in a prospective, cross-sectional study using standardized questionnaires.

RESULTS

OnabotulinumtoxinA treatment was associated with high patient satisfaction ranging from 80% to 100%. Study patients (61 patients) reported that their faces appeared to be more balanced and symmetrical (mean difference, 1.05) and that they looked much better in photographs (mean difference, 1.43), with their significant others also noting the improvement in appearance. Overall, 98% of patients expressed that they would undergo retreatment, and 100% expressed that they would recommend the procedure to others. The main obstacle for treatment repetition was economic constraints (26%).

CONCLUSION

OnabotulinumtoxinA treatment is one of the most precise and predictable cosmetic treatments available, with high patient satisfaction (97%). A positive outcome of onabotulinumtoxinA treatment, as expressed by patients surveyed using standardized questionnaires, was the appreciation and acceptance by those in close contact with them.
A Retrospective Study of Chinese-Specific Glabellar Contraction Patterns
Authors: Hsieh Daniel Meng-Yen , Zhong Shaomin , Tong Xinyun , Yuan Chen , Yang Li , Yao Anna Yuan , Zhou Cheryl , Wu Yan
Published: February 2019

BACKGROUND

Botulinum toxin has been widely accepted as safe and effective for the treatment of glabellar lines, and previous studies have classified glabellar contraction patterns into 5 categories.

OBJECTIVE

To classify the glabellar contraction patterns among a large-scale Chinese population and provide a reference for injections in Chinese patients.

METHODS

Four hundred eighty-nine Chinese subjects who received botulinum toxin for the treatment of glabellar lines were selected for a retrospective photographic analysis of their glabellar contraction patterns. Using 2 separate previously established classification systems, the patterns were analyzed and classified by a panel of certified Chinese dermatologists.

RESULTS

Two separate classification systems showed different distributions of glabellar contraction patterns among Chinese compared with Caucasians and Koreans. The classifications allowed for identification of the most frequent patterns in Chinese, which were “converging arrows” and “11” pattern, and provided references for identifying the most important muscles.

CONCLUSION

Both classification systems are applicable to the Chinese population with varying distributions. Because the classification system of de Almeida and colleagues focuses more on the muscles involved in the formation of glabellar lines, the authors' subjects classified according to this system displayed a more balanced distribution among the 5 patterns. This provides an easier reference for dermatologists in daily clinical practice and guiding treatment strategies.
Lip and Perioral Enhancement With Hyaluronic Acid Dermal Fillers in Individuals With Skin of Color
Authors: Taylor Susan C. , Downie Jeanine B. , Shamban Ava , Few Julius , Weichman Barry M. , Schumacher Andrew , Gallagher Conor J.
Published: February 2019

BACKGROUND

Individuals with skin of color are underrepresented in studies of lip and perioral enhancement.

OBJECTIVE

To examine the effectiveness and safety of hyaluronic acid (HA) dermal filler treatment for lip and perioral enhancement in subjects with skin of color.

METHODS

Data were pooled from subjects with Fitzpatrick skin phototypes IV, V, or VI in 2 pivotal studies of HA dermal fillers. Photonumeric scales were used to assess lip fullness (5-point scale) and perioral lines and oral commissures severity (each 4-point scales). Safety was assessed by injection site responses recorded in patient diaries and adverse events (AEs).

RESULTS

The cohort comprised 72 subjects (median age: 49.5 years; 95.8% female). Mean lip fullness improved from baseline by 1.1 points at 3 months after treatment; 85.0% of subjects were responders (≥1-point improvement). Of subjects treated for perioral lines (n = 12) and oral commissures (n = 56), 90.9% and 46.4%, respectively, were responders. Injection site responses were generally mild or moderate in severity, resolved within 2 weeks, and were consistent with those expected for HA dermal filler treatment. The most common AEs were injection site mass (19.4%) and bruising (12.5%).

CONCLUSION

Lip and perioral enhancement with HA dermal fillers is effective and safe in subjects with skin of color.
Opioid prescribing after childbirth: overprescribing and chronic use
Authors: Osmundson Sarah S. , Min Jea Young , Grijalva Carlos G.
Published: February 2019

Purpose of review

Overprescribing opioids contributes to the epidemic of drug overdoses and deaths in the United States. Opioids are commonly prescribed after childbirth especially after caesarean, the most common major surgery. This review summarizes recent literature on patterns of opioid overprescribing and consumption after childbirth, the relationship between opioid prescribing and chronic opioid use, and interventions that can help reduce overprescribing.

Recent findings

It is estimated that more than 80% of women fill opioid prescriptions after caesarean birth and about 54% of women after vaginal birth, although these figures vary greatly by geographical location and setting. After opioid prescriptions are filled, the median number of tablets used after caesarean is roughly 10 tablets and the majority of opioids dispensed (median 30 tablets) go unused. The quantity of opioid prescribed influences the quantity of opioid used. The risk of chronic opioid use related to opioid prescribing after birth may seem not high (annual risk: 0.12–0.65%), but the absolute number of women who are exposed to opioids after childbirth and become chronic opioid users every year is very large. Tobacco use, public insurance and depression are associated with chronic opioid use after childbirth. The risk of chronic opioid use among women who underwent caesarean and received opioids after birth is not different from the risk of women who received opioids after vaginal delivery.

Women are commonly exposed to opioids after birth. This exposure leads to an increased risk of chronic opioid use. Physician and providers should judiciously reduce the amount of opioids prescribed after childbirth, although more research is needed to identify the optimal method to reduce opioid exposure without adversely affecting pain management.
Initial Clinical Results of the eyeWatch: a New Adjustable Glaucoma Drainage Device Used in Refractory Glaucoma Surgery
Authors: Roy Sylvain , Villamarin Adan , Stergiopulos Constantinos , Bigler Stéphane , Guidotti Jacopo , Stergiopulos Nikolaos , Kniestedt Christoph , Mermoud André
Published: February 2019

Précis:

In this study, we report clinical results after implantation of an adjustable glaucoma drainage device. The intraocular pressure (IOP) profile was efficiently controlled postoperatively as the resistance to aqueous humor outflow was finely adjusted.

Purpose:

The main purpose of this study was to evaluate the safety and efficacy of the new adjustable glaucoma drainage device eyeWatch used in conjunction with a Baerveldt glaucoma implant in refractory glaucoma.

Patients and Methods:

This was a multicentric, prospective, noncomparative clinical trial. Patients older than 18 years of age suffering from refractory glaucoma after failed surgeries, with IOP of ≥20 mm Hg, in whom a further glaucoma procedure using an aqueous shunt was planned, were enrolled in this study. The primary outcome was the success rate, defined as an IOP≤18 mm Hg and reduction of >20% from baseline, IOP≥6 mm Hg. Secondary outcomes were mean IOP, visual acuity, number of antiglaucoma medications, number, and type of complications.

Results:

Fifteen patients were included. The mean follow-up time was 15.6±3.5 months. The mean baseline IOP decreased from 26.2±6.8 mm Hg before surgery to 11.9±2.8 mm Hg at 12 months (P<0.001). The mean number of glaucoma medications decreased from 3.0±0.7 before surgery to 0.8±0.9 at last visit (P<0.001). The success rate was 40% for complete success and 93% for overall success at last follow-up. Complication rate was 7%.

Conclusions:

The novel glaucoma device allows for perioperative and postoperative noninvasive adjustments of the resistance to aqueous humor outflow. This leads to better management of IOP during the early postoperative period, preventing ocular hypotony and eliminating the need for obstructive elements and reinterventions. The rate of complications was low, IOP was adequately controlled and lowered, with a substantial reduction in the number of antiglaucoma medication.
Posttraumatic Emphysema of the Optic Nerve Sheath
Authors: Rai Ravneet S. , Rowlands Megan A. , Kally Peter M. , Warren Floyd
Published: February 2019

The authors describe the case of a 19-year-old female who suffered posttraumatic emphysema of the optic nerve sheath. She suffered massive head trauma requiring emergent neurosurgery and was incidentally found to have air in her optic nerve sheath on CT scan. At 6 weeks follow up, her visual acuity (20/25 uncorrected) and color perception in the affected eye were excellent. Her examination was notable for an afferent pupillary defect, mild disc pallor, and optic nerve atrophy on optical coherence tomography. This is a case of a patient with posttraumatic optic nerve sheath emphysema who recovered excellent visual function and received follow-up ophthalmic imaging.
Steatocystoma Simplex of the Caruncle: Case Report and Immunohistologic Study
Authors: Charles Norman C. , Jakobiec Frederick A. , Ma Lina , Belinsky Irina
Published: February 2019

A yellow cystic lesion of the caruncle in a 23-year-old woman proved to be a solitary steatocystoma, a rare occurrence in that location. While the histopathologic diagnosis was evident from clusters of sebaceous cells within the cyst wall, a panel of immunohistochemical stains further distinguished the lesion from a keratinous cyst. The most useful stains for differentiating the two conditions were carcinoembryonic antigen, epithelial membrane antigen, cytokeratins 17 and 19, and calretinin. Only three previous cases of caruncular steatocystoma simplex have been reported, none of which included immunohistochemical studies. The current findings support the origin of the cyst from the small duct that connects the unilobular sebaceous gland associated with vellus hairs to the follicular canal.
Evidence-Based Design Has a Sustainable Positive Effect on Patients' Perceptions of Quality of Care in Forensic Psychiatry: A 3-Year Follow-Up Study
Authors: Wijk Helle , Degl' Innocenti Alessio , Kullgren Anette , Alexiou Eirini
Published: February 2019

This prospective longitudinal study aimed to assess the sustainable effect on patients' assessment of ward atmosphere and quality of care at three forensic psychiatric clinics relocated to new facilities built with the latest evidence-based healthcare environment design to support recovery. Baseline data were collected in the old facilities and during three follow-ups after relocation, between 2010 and 2016. Of 74 patients who gave informed consent to participate, 58 patients (100%) answered the questionnaires at baseline, with 25 patients (43%) completing them at Follow-up 1, 11 patients (19%) at Follow-up 2, and seven patients (12%) at Follow-up 3. This study provides evidence that the mean values of patients' perceptions of care quality in these forensic psychiatric facilities increased when moving to new buildings and were stable up to 3 years after relocation, which was statistically significant in the domain of secluded environment (p < 0.05). The sample size at Follow-up 3 was small, and thus the results are limited, which indicates that further research is needed to confirm the findings.
Work and Health Correlates of Sleep Quantity and Quality Among Correctional Nurses
Authors: Zhang Yuan , El Ghaziri Mazen , Dugan Alicia G. , Castro Mary Ellen
Published: February 2019

Background/Objectives

The correctional environment exposes nurses to unique physical and psychosocial work stressors, such as inmate violence and safety concerns. Nurses often experience short and poor sleep; however, the quantity and quality of sleep in this specialty practice group of nurses are underexplored. The study objective was to examine a wide range of work and health correlates of sleep quantity and quality in correctional nurses.

Methods

A Web-based survey was administered to nurses within a Northeastern State Correctional Healthcare System, covering questions on sleep quantity and quality, working conditions, health outcomes, and work outcomes.

Results

Among the 89 correctional nurses who participated, 56.2% reported short sleep duration (≤6 hours/day) and 31.8% reported poor sleep quality. Multivariate Poisson regression modeling suggested that night shift (prevalence ratio [PR] = 1.95, p < 0.05) and single marital status (PR = 2.25, p < 0.05) were significantly associated with increased prevalence of short sleep duration, whereas none of the work and health variables were significantly associated with increased prevalence of poor sleep quality, after adjustment for sociodemographics and other covariates.

Conclusion

Correctional nurses experience a high prevalence of short and poor sleep. Similar to previous studies, we found that short sleep duration was associated with night shift work. Interventions targeting work schedule remodeling (e.g., reduce the number of consecutive night shifts) and shift work coping mechanisms may promote sleep health of correctional nurses.
Use of Supervised Exercise During Recovery Following Sports-Related Concussion
Authors: Popovich Michael , Almeida Andrea , Freeman Jeremiah , Eckner James T. , Alsalaheen Bara , Lorincz Matthew , Sas Andrew
Published: February 2019

Objective:

To assess the safety of supervised exercise (SE) in acute sport-related concussion (SRC) and its influence on recovery.

Design:

Retrospective cohort study.

Setting:

University SRC clinic at a tertiary care center.

Patients:

One hundred ninety-four consecutive new patient charts were reviewed. Patients were included if they were seen within 30 days of sustaining a SRC, and their medical records included all required data elements. One hundred twenty-six patients were included in the analysis.

Interventions:

Symptomatic patients who initiated SE within 16 days of SRC (n = 24) were compared with those who did not undergo SE or initiated SE after postinjury day 16 (n = 84). Age, sex, history of previous concussions, injury severity, relevant comorbidities, and other treatments received were included in the analysis.

Main Outcome Measures:

The association between early SE and clearance for return to sport was determined using a hazard ratio (HR). The number of days from SRC until clearance for return to sport and the number of days symptomatic from concussion were also compared between early SE and nonearly SE cohorts.

Results:

No serious adverse events occurred in the early SE group. Early SE was associated with earlier return to sport (HR = 2.35, P = 0.030). The early SE group had fewer days from SRC until clearance for return to sport (mean 26.5 ± 11.2 days vs 35.1 ± 26.5 days, P = 0.020). There was a trend toward fewer symptomatic days in the early SE group (P = 0.054).

Conclusion:

Early SE performed in the symptomatic stage of SRC was safe and associated with earlier return to sport.
Width of Patulous Eustachian Tube: Comparison of Assessment by Sonotubometry and Tubo-tympano-aerography
Authors: Ikeda Ryoukichi , Kawase Tetsuaki , Takata Iori , Suzuki Yoko , Sato Takeshi , Katori Yukio , Kobayashi Toshimitsu
Published: February 2019

Objective:

To assess the accuracy of tubo-tympano-aerodynamic-graphy (TTAG) in the estimation of morphological severity of patulous Eustachian tube (PET), and to compare the results with that of sonotubometry in clinical cases and in model experiments.

Study Design:

Retrospective chart review and model experiment.

Setting:

Tertiary referral center.

Subjects:

A retrospective survey of medical records in Sen-En Rifu Hospital identified 26 patients (12 men and 14 women subjects aged 14–78 yr, average 49.4 ± 20.9 yr), comprising of 35 ears with PET. A definite diagnosis of PET was made for all patients based on the diagnostic criteria proposed by the Japan Otological Society.

Main Outcome Measures:

Commercial equipment for sonotubometry and TTAG (JK-05A; RION Co., Ltd., Kokubunji, Tokyo, Japan) were used in the following investigations. Model Experiment: The ET model was made using two truncated syringes with silicone barrels and a narrow connecting tube (0.2, 0.4, 0.58, 0.8, 1.00, 2.00, and 3.00 mm). Clinical Investigation: Morphological evaluation of ET patency was performed by a three-dimensional (3-D) CT (3D Accuitomo; Morita MFG. Corp., Kyoto, Japan) and analyzed by software (Integrated Information System i-VIEW; Morita MFG. Corp.).

Results:

The transmitted sound pressure level gradually increased as the tube caliber was widened up to 3 mm diameter. On the other hand, pressure transmission was suddenly elevated and reached a plateau at 0.58 mm in diameter. The cross-sectional area at the narrowest portion of the ET was significantly correlated with the sound attenuation from nostril to external auditory canal (EAC) (Spearman rank correlation test: r = –0.521, p < 0.001). In contrast, the cross-sectional area at the narrowest portion of the ET was not correlated with the pressure changes of TTAG (Spearman rank correlation test: r = 0.317, p = 0.64).

Conclusion:

Sound transmission assessed by sonotubometry could be more useful than pressure transmission assessed by TTAG to predict the morphological severity of PET.
Ilaprazole Compared With Rabeprazole in the Treatment of Duodenal Ulcer
Authors: Fan Li , Xianghong Qin , Ling Wang , Ying Han , Jielai Xia , Haitang Hu
Published: February 2019

Goals:

The main goal of this study was to explore the dose-effect relationship of ilaprazole.

Background:

Ilaprazole is a kind of benzimidazole proton-pump inhibitor, which was confirmed efficacious and safe in treatment of duodenal ulcer (DU). However, the dose-effect relationship of ilaprazole was not clear.

Study:

This was a double-blind, parallel, randomized study. Patients aged above 18 years with at least one endoscopically confirmed active nonmalignant DU were treated with rabeprazole 10 mg or ilaprazole 10 mg/5 mg for 4 weeks. Healing of ulcer was determined by its resolution from active to scarring stage. Symptoms relief was evaluated using a graded score. Safety and tolerability were evaluated on basis of clinical assessments.

Results:

A total of 390 patients completed the study finally. Ulcers were successfully healed in 75.38%, 77.86%, and 83.72% of patients after 4-week treatment with rabeprazole 10 mg, ilaprazole 5 mg, and ilaprazole 10 mg, respectively. The 4-week healing rate difference between rabeprazole 10 mg and ilaprazole 5 mg was 2.48% (95% confidence interval: −7.79% to 12.74%) leading to accept the noninferiority hypothesis. Logistic regression model suggested that ilaprazole 10 mg was superior to ilaprazole 5 mg at week 2 (odds ratio, 1.92; 95% confidence interval: 1.02, 3.59; P=0.04). Most patients (80%) became asymptomatic after treatment. At the dosages administered, the 3 drug groups exhibited similar efficacy and a similar safety profile.

Conclusions:

Ilaprazole 5 mg is not inferior to rabeprazole 10 mg in treating DU, and a dose-effect relationship have been revealed between 5 mg and 10 mg of ilaprazole.
Risk factors for resistance development against lamivudine during long-term treatment of chronic hepatitis B virus infections
Authors: Koukoulioti Eleni , Brodzinski Annika , Mihm Ulrike , Sarrazin Christoph , Jung Maria-Christina , Schott Eckart , Fülöp Balazs , Schlosser Beate , Berg Thomas , van Bömmel Florian
Published: February 2019

Background/aim

The use of lamivudine for the treatment of chronic hepatitis B (CHB) is limited by high rates of lamivudine resistance. However, it is still in use in many regions. Factors associated with lamivudine resistance development have been studied in only a few European cohorts. The aim of our study was to assess the rate and risk factors for lamivudine resistance in a large real-life European cohort.

Patients and methods

We retrospectively analyzed patients with CHB treated in three German University centers over up to 12 years. Lamivudine resistance was defined as virologic breakthrough and presence of genotypic lamivudine resistance. The probability of resistance was estimated by Kaplan–Meier analysis and resistance predictors by Cox regression.

Results

A total of 227 patients were included into the analysis (hepatitis B envelope antigen positive or negative). Rates of lamivudine resistance by years 1–7 were 7, 26, 35, 41, 46, 53, and 55%, respectively. Interestingly, two hepatitis B envelope antigen-negative patients developed resistance during the year 12 of treatment. Independent risk factors for resistance development were hepatitis B virus DNA levels of at least 107 copies/ml before and detectable hepatitis B virus DNA by month 6 of treatment.

Conclusion

Even after long-term response to lamivudine more than 10 years, resistance may still develop. Our findings further discourage the use of lamivudine for the treatment of CHB.
Enhanced processing of von Willebrand factor reflects disease severity and discriminates severe portal hypertension in cirrhosis
Authors: Langholm Lasse L. , Manon-Jensen Tina , Karsdal Morten A. , Bendtsen Flemming , Leeming Diana J. , Møller Søren
Published: February 2019

Objectives

Portal hypertension in cirrhosis is associated with endothelial dysfunction, impaired wound healing, and decreased platelet count. Increased von Willebrand factor (VWF) formation has been suggested as a compensatory mechanism, but the role of VWF processing has not been directly assessed. The aim was to measure the processing of activated VWF (VWF-A) in addition to VWF release (VWF-N) to investigate the association of primary hemostasis with disease activity and portal hypertension in liver cirrhosis.

Participants and methods

Plasma samples from 105 participants undergoing liver vein catheterization and with liver cirrhosis of varying severity were included in the study together with 20 controls without liver disease. Competitive enzyme-linked immunosorbent assay format was used to estimate biomarkers of VWF turnover using neo-epitope-specific monoclonal antibodies.

Results

VWF-N levels and VWF-A levels were significantly elevated in cirrhotic patients compared with controls (P<0.0001), and both markers could discriminate mild from severe cirrhosis (VWF-N, P<0.0001; VWF-A, P<0.05). Both markers correlated well with increasing portal hypertension and could identify patients with clinically significant portal hypertension (VWF-N, area under the curve: 0.78; VWF-A, area under the curve: 0.67). Only VWF-A significantly separated compensated from decompensated patients (P<0.05).

Conclusion

The data indicate that both VWF release and processing of active VWF are increased in cirrhosis, reflecting ongoing wound healing initiation. VWF-N and VWF-A may specifically contain information to assess the presence and severity of PHT as an early indicator of cirrhosis, and for acute damage in decompensated cirrhosis. Whether the increased wound healing affects long-term outcome needs to be addressed in future studies.
Providing Positive Primary Care Experiences for Homeless Veterans Through Tailored Medical Homes
Authors: Jones Audrey L. , Hausmann Leslie R.M. , Kertesz Stefan G. , Suo Ying , Cashy John P. , Mor Maria K. , Pettey Warren B.P. , Schaefer James H. , Gordon Adam J. , Gundlapalli Adi V.
Published: February 2019

Background:

In 2012, select Veterans Health Administration (VHA) facilities implemented a homeless-tailored medical home model, called Homeless Patient Aligned Care Teams (H-PACT), to improve care processes and outcomes for homeless Veterans.

Objective:

The main aim of this study was to determine whether H-PACT offers a better patient experience than standard VHA primary care.

Research Design:

We used multivariable logistic regressions to estimate differences in the probability of reporting positive primary care experiences on a national survey.

Subjects:

Homeless-experienced survey respondents enrolled in H-PACT (n=251) or standard primary care in facilities with H-PACT available (n=1527) and facilities without H-PACT (n=10,079).

Measures:

Patient experiences in 8 domains from the Consumer Assessment of Healthcare Provider and Systems surveys. Domain scores were categorized as positive versus nonpositive.

Results:

H-PACT patients were less likely than standard primary care patients to be female, have 4-year college degrees, or to have served in recent military conflicts; they received more primary care visits and social services. H-PACT patients were more likely than standard primary care patients in the same facilities to report positive experiences with access [adjusted risk difference (RD)=17.4], communication (RD=13.9), office staff (RD=13.1), provider ratings (RD=11.0), and comprehensiveness (RD=9.3). Standard primary care patients in facilities with H-PACT available were more likely than those from facilities without H-PACT to report positive experiences with communication (RD=4.7) and self-management support (RD=4.6).

Conclusions:

Patient-centered medical homes designed to address the social determinants of health offer a better care experience for homeless patients, when compared with standard primary care approaches. The lessons learned from H-PACT can be applied throughout VHA and to other health care settings.
Epilepsy Among Elderly Medicare Beneficiaries
Authors: Moura Lidia M.V.R. , Smith Jason R. , Blacker Deborah , Vogeli Christine , Schwamm Lee H. , Cole Andrew J. , Hernandez-Diaz Sonia , Hsu John
Published: February 2019

Background:

Uncertain validity of epilepsy diagnoses within health insurance claims and other large datasets have hindered efforts to study and monitor care at the population level.

Objectives:

To develop and validate prediction models using longitudinal Medicare administrative data to identify patients with actual epilepsy among those with the diagnosis.

Research Design, Subjects, Measures:

We used linked electronic health records and Medicare administrative data including claims to predict epilepsy status. A neurologist reviewed electronic health record data to assess epilepsy status in a stratified random sample of Medicare beneficiaries aged 65+ years between January 2012 and December 2014. We then reconstructed the full sample using inverse probability sampling weights. We developed prediction models using longitudinal Medicare data, then in a separate sample evaluated the predictive performance of each model, for example, area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity.

Results:

Of 20,945 patients in the reconstructed sample, 2.1% had confirmed epilepsy. The best-performing prediction model to identify prevalent epilepsy required epilepsy diagnoses with multiple claims at least 60 days apart, and epilepsy-specific drug claims: AUROC=0.93 [95% confidence interval (CI), 0.90–0.96], and with an 80% diagnostic threshold, sensitivity=87.8% (95% CI, 80.4%–93.2%), specificity=98.4% (95% CI, 98.2%–98.5%). A similar model also performed well in predicting incident epilepsy (k=0.79; 95% CI, 0.66–0.92).

Conclusions:

Prediction models using longitudinal Medicare data perform well in predicting incident and prevalent epilepsy status accurately.
Physician Participation in Medicare Accountable Care Organizations and Spillovers in Commercial Spending
Authors: Post Brady , Ryan Andrew M. , Moloci Nicholas M. , Li Jun , Dupree James M. , Hollingsworth John M.
Published: February 2019

Importance:

The benefits of public payment policy may extend to private populations through “spillover” effects. If cost-saving efforts in Medicare also reduce costs among commercially insured patients, Medicare payment systems could be a versatile policy tool in future reform efforts.

Objectives:

To determine whether physicians who participated in a Medicare Accountable Care Organization (ACO) reduced spending among their commercial patients.

Design:

This was a retrospective, longitudinal study which was conducted using Blue Cross Blue Shield of Michigan (BCBSM) claims data from 2010 to 2015. We compared patients seen by physicians who participated in a Medicare ACO to patients whose physicians were not part of an ACO. We used a difference-in-differences (DIDs) design to test whether physician participation in an ACO was associated with reduced spending among their commercially insured patients. We also tested for heterogeneous effects: we assessed whether spillovers were larger among patients with clinical conditions (acute myocardial infarction, pneumonia, congestive heart failure) that have previously been targeted by Medicare payment programs.

Setting:

This was a population-based study of commercially insured patients in Michigan.

Participants:

Patients who experienced a significant clinical episode (eg, labor and delivery, acute myocardial infarction) between 2010 and 2015.

Exposure:

Our patient-level exposure is treatment by a Medicare ACO-affiliated physician.

Main Outcomes and Measures:

Medical spending of 0–90 days and 91–365 days after a clinical episode.

Results:

Patients in the exposure group (n=54,750) and in the control group (n=137,883) were similar in demographic characteristics of age, sex, and type of clinical episodes. Adjusted mean 90-day spending in the preexposure period was $21,292 among the exposure group and $21,157 among the comparison group; these means declined to $21,250 and $20,995 in the postperiod, yielding a DIDs estimate of $119 [95% confidence interval (CI), −$170 to $408]. Adjusted means for 91–365 days spending in the preperiod were $4258 among the exposure group and $4251 among the comparison group; these means rose to $4338 and $4421 in the postperiod, yielding a DIDs estimate of −$90 (95% CI, −$312 to $132). We also separately examined patients with conditions that have been targeted by other Medicare payment programs. Among these patients, 90-day spending did not differ between exposure and comparison groups (DIDs, −$223; 95% CI, −$2037 to $1591), although 91–365 days spending decreased among the exposure group with marginal statistical significance (DIDs, −$1160; 95% CI, −$2459 to $140).

Conclusions and Relevance:

Physicians who participated in Medicare ACOs did not reduce spending among most of their commercially insured patients. Medicare policy is unlikely to confer significant spillover benefits to the commercially insured population.
Diagnosis of appendicitis in the paediatric emergency department: an update
Authors: Lawton Ben , Goldstein Henry , Davis Tessa , Tagg Andrew
Published: February 2019

Purpose of review

Concern regarding appendicitis is a common reason for presentation to the paediatric emergency department. We review recent progress in the use of biomarkers, imaging and clinical scoring systems in improving diagnostic accuracy in suspected appendicitis in children.

Recent findings

Use of ultrasound, often performed at the bedside, is becoming more widespread with a parallel reduction in computed tomography (CT) use. Protocols for image acquisition and interpretation have been shown to improve diagnostic accuracy. Novel biomarkers have been explored and clinical diagnostic algorithms refined but none have achieved the level of diagnostic accuracy required.

Appendicitis remains a clinical diagnosis. Point of care ultrasound is increasingly available and offers higher diagnostic accuracy than several routinely performed laboratory investigations. Recent publications provide support for increased use of clinician performed ultrasound, increased use of MRI, less use of CT, less emphasis on basic laboratory investigation and a renewed respect for the value of serial examination, particularly early in the course of illness.
Palm Oil and Beta‐palmitate in Infant Formula
Authors: Bronsky Jiri , Campoy Cristina , Embleton Nicholas , Fewtrell Mary , Mis Nataša Fidler , Gerasimidis Konstantinos , Hojsak Iva , Hulst Jessie , Indrio Flavia , Lapillonne Alexandre , Molgaard Christian , Moltu Sissel Jennifer , Verduci Elvira , Vora Rakesh , Domellöf Magnus ,   ESPGHAN Committee on Nutrition
Published: February 2019

Background:

Palm oil (PO) is used in infant formulas in order to achieve palmitic acid (PA) levels similar to those in human milk. PA in PO is esterified predominantly at the SN‐1,3 position of triacylglycerol (TAG), and infant formulas are now available in which a greater proportion of PA is in the SN‐2 position (typical configuration in human milk). As there are some concerns about the use of PO, we aimed to review literature on health effects of PO and SN‐2‐palmitate in infant formulas.

Methods:

PubMed and Cochrane Database of Systematic Reviews were systematically searched for relevant studies on possible beneficial effects or harms of either PO or SN‐2‐palmitate in infant formula on various health outcomes.

Results:

We identified 12 relevant studies using PO and 21 studies using SN‐2‐palmitate. Published studies have variable methodology, subject characteristics, and some are underpowered for the key outcomes. PO is associated with harder stools and SN‐2‐palmitate use may lead to softer stool consistency. Bone effects seem to be short‐lasting. For some outcomes (infant colic, faecal microbiota, lipid metabolism), the number of studies is very limited and summary evidence inconclusive. Growth of infants is not influenced. There are no studies published on the effect on markers of later diseases.

Conclusions:

There is insufficient evidence to suggest that PO should be avoided as a source of fat in infant formulas for health reasons. Inclusion of high SN‐2‐palmitate fat blend in infant formulas may have short‐term effects on stool consistency but cannot be considered essential.
Free‐breathing Magnetic Resonance Imaging Assessment of Body Composition in Healthy and Overweight Children
Authors: Ly Karrie V. , Armstrong Tess , Yeh Joanna , Ghahremani Shahnaz , Kim Grace H. , Wu Holden H. , Calkins Kara L.
Published: February 2019

Objective:

Conventional, breath‐holding magnetic resonance imaging (MRI) assesses body composition by measuring fat volumes and proton density fat fraction (PDFF). However, breath‐holding MRI is not always feasible in children. This study's objective was to use free‐breathing MRI to quantify visceral and subcutaneous fat volumes and PDFFs and correlate these measurements with hepatic PDFF.

Methods:

This was an observational, hypothesis‐forming study that enrolled 2 groups of children (ages 6–17 years), healthy children and overweight children with presumed nonalcoholic fatty liver disease. Free‐breathing MRI was used to measure visceral and subcutaneous fat volumes and PDFFs, and hepatic PDFF. Imaging biomarkers were compared between groups, and correlations coefficients (r) and coefficients of determination (R2) were calculated.

Results:

When compared with the control group (n = 10), the overweight group (n = 9) had greater mean visceral (1843 vs 329 cm3,P< 0.001) and subcutaneous fat volumes (7663 vs 893 cm3,P< 0.001), as well as greater visceral (80% vs 45%, p < 0.001) and subcutaneous fat PDFFs (89% vs 75%,P= 0.003). Visceral fat volume (r= 0.79,P< 0.001) and PDFF (r= 0.92,P< 0.001) correlated with hepatic PDFF. In overweight subjects, for each unit increase in visceral fat PDFF, hepatic PDFF increased by 2.64%; visceral fat PDFF explained 54% of hepatic PDFF variation (R2= 0.54,P= 0.02).

Conclusions:

In this study, we used free‐breathing MRI to measure body composition in children. Future studies are needed to investigate the possible value of subcutaneous and visceral fat PDFFs, and validate free‐breathing MRI body composition biomarkers.
Hyperammonemia From Ureaplasma Infection in an Immunocompromised Child
Authors: Placone Nicholas , Kao Roy L. , Kempert Pamela , Ruiz Maritza E. , Casillas Jacqueline N. , Okada Maki , Gibson James B. , Maggi Carlos , O’Brien Kevin , Nattiv Roy , Gallant Natalie M. , Abrams Stephanie H.
Published: February 2019

Idiopathic hyperammonemia is a rare, poorly understood, and often lethal condition that has been described in immunocompromised patients. This report describes an immunocompromised patient with acute myelogenous leukemia who developed persistent hyperammonemia up to 705 µmol/L (normal, 0 to 47 µmol/L) refractory to multiple different therapies. However, after beginning azithromycin and then doxycycline therapy for Ureaplasma species infection, the patient showed immediate and sustained clinical improvement and resolution of ammonia levels. Recognizing disseminated Ureaplasma species infection as a potential cause of idiopathic hyperammonemia, an unexplained, often fatal condition in immunocompromised patients, and empirically treating for this infection could potentially be lifesaving.