bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcomes of Patients Presenting with Mild Acute Respiratory Distress Syndrome
Authors: Pham Tài , Serpa Neto Ary , Pelosi Paolo , Laffey John Gerard , De Haro Candelaria , Lorente Jose Angel , Bellani Giacomo , Fan Eddy , Brochard Laurent Jean , Pesenti Antonio , Schultz Marcus Josephus , Artigas Antonio ,   on behalf of the LUNG SAFE Investigators* and the European Society of Intensive Care Medicine Trials Group
Published: November 2018

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Patients with initial mild acute respiratory distress syndrome are often underrecognized and mistakenly considered to have low disease severity and favorable outcomes. They represent a relatively poorly characterized population that was only classified as having acute respiratory distress syndrome in the most recent definition. Our primary objective was to describe the natural course and the factors associated with worsening and mortality in this population.

Methods

This study analyzed patients from the international prospective Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) who had initial mild acute respiratory distress syndrome in the first day of inclusion. This study defined three groups based on the evolution of severity in the first week: “worsening” if moderate or severe acute respiratory distress syndrome criteria were met, “persisting” if mild acute respiratory distress syndrome criteria were the most severe category, and “improving” if patients did not fulfill acute respiratory distress syndrome criteria any more from day 2.

Results

Among 580 patients with initial mild acute respiratory distress syndrome, 18% (103 of 580) continuously improved, 36% (210 of 580) had persisting mild acute respiratory distress syndrome, and 46% (267 of 580) worsened in the first week after acute respiratory distress syndrome onset. Global in-hospital mortality was 30% (172 of 576; specifically 10% [10 of 101], 30% [63 of 210], and 37% [99 of 265] for patients with improving, persisting, and worsening acute respiratory distress syndrome, respectively), and the median (interquartile range) duration of mechanical ventilation was 7 (4, 14) days (specifically 3 [2, 5], 7 [4, 14], and 11 [6, 18] days for patients with improving, persisting, and worsening acute respiratory distress syndrome, respectively). Admissions for trauma or pneumonia, higher nonpulmonary sequential organ failure assessment score, lower partial pressure of alveolar oxygen/fraction of inspired oxygen, and higher peak inspiratory pressure were independently associated with worsening.

Conclusions

Most patients with initial mild acute respiratory distress syndrome continue to fulfill acute respiratory distress syndrome criteria in the first week, and nearly half worsen in severity. Their mortality is high, particularly in patients with worsening acute respiratory distress syndrome, emphasizing the need for close attention to this patient population.
The Value of Prognostic Nutritional Index in Follicular Lymphoma
Authors: Lee Shing Fung , Ng Ting Ying , Wong Frank Chi Sing
Published: November 2018

Objectives:

Previous studies reported that prognostic nutritional index (PNI), a marker of host inflammatory and nutritional status, is associated with prognoses in a number of cancer types. Thus, we investigated PNI at diagnosis as a prognostic factor in FL.

Methods:

We reviewed FL patients in Tuen Mun Hospital, Hong Kong from 2000 to 2014 (n=88). PNI was calculated by serum albumin (g/L)+5×absolute lymphocyte count (109/L). We determined the best PNI cut-off value using receiver-operating characteristic curves. The extent to which progression-free survival (PFS) and overall survival differed by PNI cut-off was assessed using Kaplan-Meier and log-rank tests. Cox proportional hazards model was utilized to adjust for covariates.

Results:

The best cut-off value for PNI was determined to be 45. Patients with high PNI (>45) had a higher complete response (CR) rate after primary treatment, 46 of 61 (75.4%) patients with high PNI had CR, compared with 10 of 23 (43.5%) for low PNI (2-sample test of proportions P-value=0.006). Further, higher PNI at relapse as a continuous variable was associated with superior postprogression survival with a hazard ratio (HR) 0.88 (95% confidence interval [CI], 0.81-0.96). In multivariate analysis, high PNI at diagnosis had superior PFS (adjusted HR of 0.37; 95% CI, 0.15-0.93).

Conclusions:

PNI was shown to be independent prognostic factor of PFS in FL. It is a cheap and widely available biomarker. Future study is needed to validate its prognostic value and clinical utility in a prospective cohort.
An Educational and Skill-Building Intervention to Improve Symptom Recognition and Interpretation in Women With Acute Coronary Syndrome
Authors: Davis Leslie L. , McCoy Thomas P.
Published: November 2018

Background

The type of symptoms that a woman experiences during an acute coronary syndrome (ACS) event influences symptom recognition and interpretation. Women who experience intense, abrupt symptoms are more likely to correctly attribute symptoms to a cardiac etiology and seek care faster than women with less intense, intermittent symptoms.

Objective

A single-group pretest-posttest design was used to evaluate the feasibility and acceptability of a nurse-delivered education and skill-building intervention designed to improve symptom recognition and interpretation in women with recurrent ACS symptoms.

Methods

Women hospitalized for an ACS event received an individualized education and skill-building intervention that was conceptually framed by the investigator's previous research. Three in-person sessions were followed by 2 telephone sessions for reinforcement. Outcomes and acceptability were evaluated at close-out (approximately 2 months after the index event).

Results

All but 2 women approached agreed to participate. Of the 10 women enrolled, 9 completed all study sessions within an average of 55 days. Mean knowledge scores increased by 7.4% measured by the ACS Response Index. Attitudes toward symptom recognition and help seeking increased by 2.4, whereas beliefs toward expectations and actions increased by 3.2. The women were pleased with the intervention (satisfaction scores averaging 1.4 on a 4-point Likert scale, with 1 as “strongly agree” and 4 as “strongly disagree”). All women who completed the study would recommend it to others.

Conclusion

The nurse-delivered intervention was feasible and acceptable to women in the study. Results support further testing and refinement of the intervention in a longitudinal randomized control study to determine efficacy and sustainability.
System-Wide Improvement for Transitions After Ileostomy Surgery: Can Intensive Monitoring of Protocol Compliance Decrease Readmissions? A Randomized Trial
Authors: Grahn Sarah W. , Lowry Ann C. , Osborne Marc C. , Melton Genevieve B. , Gaertner Wolfgang B. , Vogler Sarah A. , Madoff Robert D. , Kwaan Mary R.
Published: November 2018

BACKGROUND:

Hospital readmission is common after ileostomy formation and frequently associated with dehydration.

OBJECTIVE:

This study was conducted to evaluate a previously published intervention to prevent dehydration and readmission.

DESIGN:

This is a randomized controlled trial.

SETTING:

This study was conducted in 3 hospitals within a single health care system.

PATIENTS:

Patients undergoing elective or nonelective ileostomy as part of their operative procedure were selected.

INTERVENTION:

Surgeons, advanced practice providers, inpatient and outpatient nurses, and wound ostomy continence nurses participated in a robust ileostomy education and monitoring program (Education Program for Prevention of Ileostomy Complications) based on the published intervention. After informed consent, patients were randomly assigned to a postoperative compliance surveillance and prompting strategy that was directed toward the care team, versus usual care.

OUTCOME MEASURES:

Unplanned hospital readmission within 30 days of discharge, readmission for dehydration, acute renal failure, estimated direct costs, and patient satisfaction were the primary outcomes measured.

RESULTS:

One hundred patients with an ileostomy were randomly assigned. The most common indications were rectal cancer (n = 26) and ulcerative colitis (n = 21), and 12 were emergency procedures. Although intervention patients had better postdischarge phone follow-up (90% vs 72%; p = 0.025) and were more likely to receive outpatient intravenous fluids (25% vs 6%; p = 0.008), they had similar overall hospital readmissions (20.4% vs 19.6%; p = 1.0), readmissions for dehydration (8.2% vs 5.9%; p = 0.71), and acute renal failure events (10.2% vs 3.9%; p = 0.26). Multivariable analysis found that weekend discharges to home were significantly associated with readmission (OR, 4.5 (95% CI, 1.2–16.9); p = 0.03). Direct costs and patient satisfaction were similar.

LIMITATIONS:

This study was limited by the heterogeneous patient population and by the potential effect of the intervention on providers taking care of patients randomly assigned to usual care.

CONCLUSIONS:

A surveillance strategy to ensure compliance with an ileostomy education program tracked patients more closely and was cost neutral, but did not result in decreased hospital readmissions compared with usual care. See Video Abstract at http://links.lww.com/DCR/A812.
Role of Yoga in Cardiac Disease and Rehabilitation
Authors: Guddeti Raviteja R. , Dang Geetanjali , Williams Mark A. , Alla Venkata Mahesh
Published: November 2018

Purpose:

Cardiovascular disease continues to be the leading cause of morbidity and mortality around the world. Yoga, a combination of physical postures (asana), breathing exercises (pranayama), and meditation (dhyana), has gained increasing recognition as a form of mind-body exercise. In this narrative review, we intended to review the emerging evidence assessing the physiologic and clinical effects of yoga on the cardiovascular system and the potential role of yoga as a component of comprehensive cardiac rehabilitation.

Methods:

We searched PubMed, Google Scholar, Embase, and Cochrane databases for literature related to cardiovascular effects of yoga from inception up until 2017.

Results:

Yoga has been shown to have favorable effects on systemic inflammation, stress, the cardiac autonomic nervous system, and traditional and emerging cardiovascular risk factors.

Conclusions:

Yoga has shown promise as a useful lifestyle intervention that can be incorporated into cardiovascular disease management algorithms. Although many investigators have reported the clinical benefits of yoga in reducing cardiovascular events, morbidity, and mortality, evidence supporting these conclusions is somewhat limited, thereby emphasizing the need for large, well-designed randomized trials that minimize bias and methodological drawbacks.
New Treatment Options in Advanced Stage Follicular Lymphoma
Authors: Hübel Kai , Salles Gilles , Marcus Robert , Zinzani Pier Luigi , Dreyling Martin
Published: November 2018

Follicular lymphoma is one of the most common non‐Hodgkin's lymphomas with an expected survival of more than 20 years for the majority of patients. This impressive outcome has been achieved with the introduction of immunochemotherapy, as first line treatment with remissions lasting over 8 years, followed by other treatment options at first or subsequent relapse. However, certain groups of patients still have a poor prognosis. In recent years the efficacy of chemotherapy regimens has been augmented by new compounds selectively targeting the cell surface, intracellular pathways, and/or the microenvironment. Some of these are beginning to change the therapeutic landscape. This review summarizes prognostic factors in follicular lymphoma in order to identify patients with greatest medical need for these new treatment options and reviews recent data from prospective clinical studies testing new agents in first‐line and relapsed follicular lymphoma. Finally, we assess the current role of immunochemotherapy and discuss the requirements for future clinical trials.
Performance Validity in Collegiate Football Athletes at Baseline Neurocognitive Testing
Authors: Abeare Christopher , Messa Isabelle , Whitfield Cameron , Zuccato Brandon , Casey Joseph , Rykulski Nicholas , Erdodi Laszlo
Published: November 2018

Objective:

To assess the prevalence of invalid performance on baseline neurocognitive testing using embedded measures within computerized tests and individually administered neuropsychological measures, and to examine the influence of incentive status and performance validity on neuropsychological test scores.

Setting:

Sport-related concussion management program at a regionally accredited university.

Participants:

A total of 83 collegiate football athletes completing their preseason baseline assessment within the University's concussion management program and a control group of 140 nonathlete students.

Design:

Cross-sectional design based on differential incentive status: motivated to do poorly to return to play more quickly after sustaining a concussion (athletes) versus motivated to do well due to incentivizing performance (students).

Main Measures:

Immediate Post-Concussion and Cognitive Testing (ImPACT), performance validity tests, and measures of cognitive ability.

Results:

Half of the athletes failed at least 1 embedded validity indicator within ImPACT (51.8%), and the traditional neuropsychological tests (49.4%), with large effects for performance validity on cognitive test scores (d: 0.62-1.35), incentive status (athletes vs students; d: 0.36-1.15), and the combination of both factors (d: 1.07-2.20) on measures of attention and processing speed.

Conclusion:

Invalid performance on baseline assessment is common (50%), consistent across instruments (ImPACT or neuropsychological tests) and settings (one-on-one or group administration), increases as a function of incentive status (risk ratios: 1.3-4.0) and results in gross underestimates of the athletes' true ability level, complicating the clinical interpretation of the postinjury evaluation and potentially leading to premature return to play.
Management of Type 2 Bubble Formed During Big Bubble Deep Anterior Lamellar Keratoplasty
Authors: Goweida Mohamed Bahgat , Ragab Ahmed Mahmoud , Liu Christopher
Published: November 2018

Purpose:

To review the outcome of 3 techniques for managing type 2 bubbles (between Descemet's membrane [DM] and stroma) formed during big bubble (BB) deep anterior lamellar keratoplasty (DALK) in different corneal pathologies.

Methods:

This is an interventional case series study of patients with type 2 bubbles formed during BB DALK. Three techniques to complete DALK are described: the first is a DM baring technique similar to Anwar's BB technique, the second is the microbubble incision technique to preserve the pre-Descemetic support to DM, and the third is done in eyes with combined type 1 and type 2 BB (mixed bubble), where the type 1 bubble is opened and surgery is completed avoiding the type 2 bubble.

Results:

Thirty-one eyes of 31 patients were included. The DM baring technique has a high rate of conversion to penetrating keratoplasty (12 of 16 eyes). In the other 2 techniques (which did not bare DM), DALK could be completed in all 15 cases with intact DM. Double anterior chamber is a relatively common complication after type 2 BB, even with an intact DM.

Conclusions:

DM baring techniques should be avoided in eyes with type 2 BB. Instead, deep stromal dissection searching for an incomplete type 1 bubble or using one of the manual dissection techniques as a guide to the clear pre-Descemetic stroma is safer and more reliable.
Conjunctival Colloid Milium
Authors: Bhargava Mona , Benurwar Saket , Krishnakumar S.
Published: November 2018

Purpose:

To describe a rare case of conjunctival colloid milium.

Methods:

Case report.

Results:

We report a 45-year-old woman with a history of a slow-growing, painless mass extending from the medial canthal region to the inferior fornix and the inferior bulbar conjunctiva associated with redness. The patient underwent excisional biopsy of the lesion with amniotic membrane transplantation for the resulting conjunctival defect. Biopsy showed homogenous amorphous eosinophilic material with gaps. The stroma did not show any evidence of solar damage, and no refractive material was seen under the polarizer. Congo red stain for amyloid was negative. Based on histopathological findings, a diagnosis of nodular colloid milium was made.

Conclusions:

Adult periocular colloid milium is an unusual presentation of a rare cutaneous deposition disease. The occurrence of conjunctival colloid milium is rare, and we report this case to increase knowledge and management regarding this rare disease and to differentiate it from other diseases such as amyloidosis, lipoid proteinosis, plasmacytoma, and conjunctival lymphoma, which carry a graver prognosis, and have a similar clinical appearance and can be distinguished only on the basis of histopathological characteristics.
Orbital Metastasis From Urothelial Carcinoma: A Comprehensive Literature Review
Authors: Sklar Bonnie A. , Gervasio Kalla A. , Karmazin Konstantin , Wu Albert Y.
Published: November 2018

Purpose:

To review the clinical features of orbital and choroidal metastases from urothelial carcinomas of the urinary tract among cases reported in the literature, and to describe a case of orbital metastasis from bladder cancer presenting as apparent internuclear ophthalmoplegia.

Methods:

Case reports of orbital and choroidal metastases from urothelial carcinomas published in the literature from 1965 to 2018 were reviewed. Data collected included patient demographics, cancer stage and primary site, time to onset of ocular symptoms, length of presenting ocular symptoms, types of primary ocular symptoms, diagnostic imaging, histology, systemic and ocular treatments, and survival time.

Results:

Twenty-eight cases of urothelial carcinoma with metastasis to the orbit or choroid were reviewed. Men were significantly more likely to suffer from this condition than women (p = 0.011). The average age of presentation with orbital symptoms was 63 years, with an average time of 19 months between primary cancer diagnosis and onset of orbital symptoms. Twenty-two patients had metastasis to the orbit and 6 to the choroid. In 4 cases, ocular deficits secondary to orbital and/or choroidal metastases were the initial presenting symptoms in patients with previously undiagnosed urothelial carcinoma. The most commonly noted primary ocular symptoms and signs consisted of decreased visual acuity, decreased ocular motility, proptosis, and diplopia. Average survival from onset of ocular symptoms was 4.67 months.

Conclusions:

Urothelial carcinoma may metastasize to the orbit or choroid; furthermore, its presentation may mimic internuclear ophthalmoplegia. It is recommended that any patient with visual symptoms and known urothelial cancer should undergo expedited workup for metastatic disease.
Heart Failure Symptom Biology in Response to Ventricular Assist Device Implantation
Authors: Lee Christopher S. , Mudd James O. , Lyons Karen S. , Denfeld Quin E. , Jurgens Corrine Y. , Aouizerat Bradley E. , Gelow Jill M. , Chien Christopher V. , Aarons Emily , Grady Kathleen L.
Published: November 2018

Background:

We have a limited understanding of the biological underpinnings of symptoms in heart failure (HF), particularly in response to left ventricular assist device (LVAD) implantation.

Objective:

The aim of this study was to quantify the degree to which symptoms and biomarkers change in parallel from before implantation through the first 6 months after LVAD implantation in advanced HF.

Methods:

This was a prospective cohort study of 101 patients receiving an LVAD for the management of advanced HF. Data on symptoms (dyspnea, early and subtle symptoms [HF Somatic Perception Scale], pain severity [Brief Pain Inventory], wake disturbance [Epworth Sleepiness Scale], depression [Patient Health Questionnaire], and anxiety [Brief Symptom Inventory]) and peripheral biomarkers of myocardial stretch, systemic inflammation, and hypervolumetric mechanical stress were measured before implantation with a commercially available LVAD and again at 30, 90, and 180 days after LVAD implantation. Latent growth curve and parallel process modeling were used to describe changes in symptoms and biomarkers and the degree to which they change in parallel in response to LVAD implantation.

Results:

In response to LVAD implantation, changes in myocardial stretch were closely associated with changes in early and subtle physical symptoms as well as depression, and changes in hypervolumetric stress were closely associated with changes in pain severity and wake disturbances. Changes in systemic inflammation were not closely associated with changes in physical or affective symptoms in response to LVAD implantation.

Conclusions:

These findings provide new insights into the many ways in which symptoms and biomarkers provide concordant or discordant information about LVAD response.
Effects of exercise interventions for specific cognitive domains in old adults with mild cognitive impairment
Authors: Zhou Xiang-Lian , Wang Li-Na , Wang Jie , Shen Xin-Hua , Zhao Xia
Published: November 2018

Background:

Mild cognitive impairment (MCI) is the clinical prognosis that leads to dementia. Early intervention of MCI is critical to protect against dementia. Exercise intervention has gained popularity for the management of MCI. Most current studies have focused only on improvements made by exercise interventions on the global/general cognitive function and/or a specific cognitive function. However, no studies have been performed on a subgroup analysis of the effects of exercise interventions on different cognitive domains of the elderly with MCI. The exploration of this issue will help to clarify the influence and through a preliminary analysis identify the level of influence of exercise interventions on particular cognitive domains, and it will provide the theoretical framework for the construction of precise exercise intervention strategies for MCI patients.

Methods:

A systematic review of electronic databases (MEDLINE, Embase, The Cochrane Library, Web of Science, CNKI, the Wan Fang Database, and CBM), supplemented by expert contact, reference and citation checking, and gray literature searches have been conducted. There is no restriction on language or publication status. Cochrane Handbook for Systematic Reviews of Interventions and add another 3 items according to PEDpro, including “the type of statistical analyses used (true intention-to-treat vs other),” “eligibility criteria,” and “baseline comparability,” are used to assess the risk of bias. Primary outcomes of interest are standardized measurements of executive functions, memory, language, processing speed, and attention. If possible, we conduct a meta-analysis to synthesize the evidence for each outcome.

Results:

This study will provide a high-quality synthesis of current evidence of exercise for MCI patients.

Conclusion:

The conclusion of this systematic review will provide evidence to judge whether exercise is an effective intervention for patient with MCI and preliminary ranking of the effects of exercise on specific cognitive domains.

Prospero registration number:

CRD42018093902
Intracervical Foley catheter balloon versus dinoprostone insert for induction cervical ripening
Authors: Zhu Lixia , Zhang Cong , Cao Fang , Liu Qin , Gu Xing , Xu Jianhao , Li Jianqing
Published: November 2018

Background:

Successful labor induction depends on the cervical status at the time of induction. Currently, both a Foley catheter and a dinoprostone insert are used for effective cervical ripening. This study compared the efficacy and safety of the intracervical Foley catheter and dinoprostone insert for cervical ripening to achieve successful labor induction.

Methods:

PubMed, Embase, and the Cochrane Library were searched from January 2000 to February 2017 for relevant articles. Only published randomized, controlled trials comparing the dinoprostone insert with the Foley catheter were included.

Results:

Eight trials including 1191 women who received the intracervical Foley catheter balloon and 1199 who received the dinoprostone insert were used for this study. There was no significant difference between the 2 groups regarding the induction-to-delivery (I-D) interval in a random effect model (mean difference, 0.71 hours; 95% confidence interval [CI], −2.50 to 3.91; P = .67). The highly significant heterogeneity (I
2 = 97%) could be explained by the subgroup analysis of the type of Foley catheter and balloon volume. There was no significant difference between the 2 methods regarding the cesarean delivery rate (relative risk, 0.91; 95% CI, 0.78–1.07; P = .24), Apgar score, or side effects, including maternal infection rate, postpartum hemorrhage, and hyperstimulation. No obvious publication bias was found.

Conclusions:

According to the cesarean delivery rate, the intracervical Foley catheter balloon was as efficient as the dinoprostone insert. A moderate balloon volume (30 mL) and higher dose of dinoprostone (≥6 mg) were related to shorter I-D intervals. Additionally, there was no significant difference between the two methods regarding maternal or neonatal safety.
Surgical versus nonsurgical treatment for scaphoid waist fracture with slight or no displacement
Authors: Li Hangyu , Guo Wenlai , Guo Shanshan , Zhao Shishun , Li Rui
Published: November 2018

Background:

Surgical or nonsurgical treatment for scaphoid waist fracture with slight or no displacement is still controversial. This study compared the efficacy of the 2 methods through meta-analysis to provide a reference for the choice of clinical treatment options.

Methods:

Two individuals independently searched for relevant RCTs and cohort studies from PubMed (1946–February 2018), Embase (1946–February 2018), and Cochrane library (1997–February 2018). After quality assessment and data extraction, Stata 14 software was used for combining the effect size, testing heterogeneity, and studying bias. GRADEpro was used to rate the level of evidence.

Results:

Ten RCTs and 4 cohort studies with 765 patients were included. No statistical difference in satisfaction, pain, and Disability of the Arm, Shoulder, and Hand score was found after surgical and nonsurgical treatments. Compared with nonsurgical treatment, surgical treatment shortened the time to union (SMD = −5.01, 95% CI: −7.47 to −2.58, P = .000), decreased the convalescence (SMD = −2.09, 95% CI: −3.08 to −1.11, P = .000), and reduced the incidence of nonunion (RR = 0.47, 95% CI: 0.24–0.90), P = .023). Subgroup analyses showed that the percutaneous fixation treatment can shorten the time to union [SMD = −1.82, 95%CI (−2.22 to −1.42), P = = .000] and the convalescence (SMD = −4.26, 95%CI: −6.16 to −2.35, P = = .054), and open reduction fixation treatment can reduce the incidence of nonunion (RR = 0.20, 95%CI: 0.06–0.69, P = = .01).

Conclusion:

For scaphoid waist fractures with slight or no displacement, there was no statistical difference in patient satisfaction, pain, and The Disability of the Arm, Shoulder, and Hand scores between surgical treatment and nonsurgical treatment. Closed surgical treatment can shorten the time to union and convalescence, and open reduction can reduce the incidence of nonunion. On the basis of this conclusion, chief physicians can consider which treatment to use according to the patient's clinical situation and their subjective intention.
Sarcopenia is poor prognostic factor in older patients with locally advanced rectal cancer who received preoperative or postoperative chemoradiotherapy
Authors: Park Song Ee , Hwang In Gyu , Choi Chang Hwan , Kang Hyun , Kim Beom Gyu , Park Byung Kwan , Cha Seong Jae , Jang Joung-Soon , Choi Jin Hwa
Published: November 2018

Sarcopenia is associated with low muscle mass and low physical performance. Here, we performed to evaluate the sarcopenia as prognostic factor and treatment outcomes in older patients with locally advanced rectal cancer (LARC) who received preoperative or postoperative chemoradiotherapy (CRT).

LARC patients aged ≥65 years who received either preoperative or postoperative CRT were analyzed retrospectively. Preoperative or postoperative CRT consisted of 50.4 Gy and fluoropyrimidine. Surgery was performed at 6 weeks after CRT completion. Postoperative CRT was performed at 4 weeks after surgery. One month after surgery or CRT, adjuvant chemotherapy was given. Overall survival (OS) and disease free survival (DFS), local recurrence (LR), and prognostic factor were evaluated.

Thirty patients received preoperative CRT and 35 patients received postoperative CRT. Five-year OS rate, 5-year DFS rate, or 5-year LR rate was not significantly different between preoperative and postoperative CRT groups (69.0%, 58.5%, and 3.4% vs 73.6%, 67.9%, and 6.9%, P = .56, P = .37, and P = .77, respectively). Age, sex, stage, CEA level, or timing of CRT did not affect OS. However, 5-year OS rate of patients with sarcopenia was significantly lower than those without sarcopenia (38.0% vs 92.5%, P < .001). Multivariate analysis showed that sarcopenia was the only independent prognostic factor for overall survival (OS) (hazard ratio [HR]: 6.08, P = .001).

There was no difference in survival between preoperative CRT and postoperative CRT in older patients with LARC. Sarcopenia is a poor prognostic factor in older patients with LARC who received preoperative or postoperative CRT.
Therapeutic effects of sensory input training on motor function rehabilitation after stroke
Authors: Chen Xiaowei , Liu Fuqian , Yan Zhaohong , Cheng Shihuan , Liu Xunchan , Li He , Li Zhenlan
Published: November 2018

Motor dysfunction is a common and severe complication of stroke that affects the quality of life of these patients. Currently, motor function rehabilitation predominantly focuses on active movement training; nevertheless, the role of sensory input is usually overlooked. Sensory input is very important to motor function. Voluntary functional movement necessitates preparation, execution, and monitoring functions of the central nervous system, while the monitoring needs the participation of the sensory system. Sensory signals affect motor functions by inputting external environment information and intrinsic physiological status as well as by guiding initiation of the motor system. Recent studies focusing on sensory input-based rehabilitation training for post-stroke dyskinesia have demonstrated that sensory function has significant effects on voluntary functional movements. In conclusion, sensory input plays a crucial role in motor function rehabilitation, and the combined sensorimotor training modality is more effective than conventional motor-oriented approaches.
An incidental diagnosis of a giant paraovarian cyst in a female teenager
Authors: Mărginean Cristina Oana , Mărginean Claudiu , Meliţ Lorena Elena , Săsăran Vlăduţ Ştefan , Poruţiu Mihai , Mărginean Cristian Dan
Published: November 2018

Rationale:

Paraovarian cysts (PCs) are cystic tumors that can be encountered between the ovarian hilum and the ovarian fimbria located within the mesosalpinx and broad ligament, being usually diagnosed within the 3rd and 4th decade of life.

Patient concerns:

We report the case of a 15-year-old female admitted in our clinic for consciousness loss, who was incidentally diagnosed with a giant pelvic cystic at ultrasound.

Diagnoses:

The magnetic resonance image showed a cystic mass of 170/140/85 mm, suggesting an origin from the left ovary, reaching the subhepatic area.

Interventions and outcomes:

The surgical intervention revealed 3 PCs, a giant one and 2 smaller ones within the large ligament. The cysts were removed by laparoscopic approach, and the histologic examination did not reveal any signs of neoplasia.

Lessons:

In addition to their rarity, giant PCs can be an incidental diagnosis in patients presenting unrelated symptoms resulting in increased difficulties related to the diagnosis. Moreover, the imagistic tools might not establish precisely the origin of these cysts, and therefore, the final diagnosis and treatment approach could be determined sometimes only during the surgical intervention.
LncRNA PCAT-1 in gastrointestinal cancers
Authors: Liu Wanwei , Xu Jiwei
Published: November 2018

Background:

Prostate-cancer-associated ncRNA transcript 1 (PCAT-1), a newly discovered lncRNA, was implicated in the progression of multiple tumors. We conducted a systematic review and meta-analysis to determine its prognostic potential for gastrointestinal cancers.

Methods:

A literature survey was conducted by searching the PubMed, Web of Science, Cochrane Library, Embase together with Wanfang, and China National Knowledge Infrastructure (CNKI) database for articles published as of October 15, 2017. Hazard ratio (HR) or odds ratio (OR) with 95% confidence intervals (95% CIs) were calculated to demonstrate prognostic value of PCAT-1 using Stata 12.0 software.

Results:

A total of 6 studies with 961 cases were pooled in the analysis to evaluate the prognostic value of PCAT-1 in gastrointestinal cancers. Increased PCAT-1 expression was significantly correlated with poor overall survival (OS) (HR = 1.04, 95% CI: 1.02–1.06). Statistical significance was also observed in subgroup meta-analysis stratified by cancer type, histology type, sample size, and analysis type. Additionally, high expression of PCAT-1 was significantly associated with deeper tumor invasion (OR = 4.46, 95% CI: 3.00–6.63), positive lymph node metastasis (OR = 3.76, 95% CI: 1.39–10.16), and advanced clinical stage (OR = 4.09, 95% CI: 1.55–10.82).

Conclusion:

High expression of PCAT-1 was related to poor prognosis and could be a promising biomarker of clinicopathologic features in gastrointestinal cancers. More studies will be necessary to verify and strengthen the clinical value of PCAT-1 in gastrointestinal cancers.
Colombian School Children With Functional Gastrointestinal Disorders Respond Differently to Family Stress Than Healthy Children
Authors: Lu Peter L. , Blom Puck J.J. , Qian Qian , Velasco‐Benítez Carlos A. , Benninga Marc A. , Saps Miguel
Published: November 2018

Our objective is to compare coping methods, stress responses, and resilience in children with and without functional gastrointestinal disorders (FGIDs) in response to common sources of stress. We performed a case‐control study. Children meeting criteria for FGIDs and matched controls completed measures of response to stress (Peer Stress, Family Stress, Academic Problems, and Recurrent Abdominal Pain versions of the Response to Stress Questionnaire) and resilience (Connor‐Davidson Resilience Scale 10). We included 134 children with an FGID (57 with functional constipation and 74 with an abdominal pain‐predominant FGID) and 135 controls. Children with FGIDs were more likely to take action (P < 0.001) and less likely to remain involuntarily engaged (P < 0.001) in response to family stress. Response to peer and academic stress and measures of resilience were similar between groups. Further research is needed to better understand the role that family stress and a child's response play in the pathophysiology of pediatric FGIDs.
Massive Splenic Infarction in a Child With Sickle Cell Disease on Chronic Transfusion Therapy
Authors: Pereda Maria A. , Isaac Jaya , Zhang Yaoping , Jayakumar Rajeswari , Gupta Raavi , Miller Scott T.
Published: November 2018

Massive splenic infarction (MSI) is a rare complication of sickle cell disease, as the spleen generally atrophies within the first few years of life. We report a case of MSI in a 12-year-old boy with homozygous sickle cell anemia (Hb SS) whose chronic transfusion therapy resulted in hypersplenism. The occurrence of a complicated MSI in our patient should perhaps further encourage elective splenectomy in such patients, despite known potential perioperative complications and postsplenectomy risks of infection and thrombosis.
Excellence in Population Health
Authors: Warren Cheryl , Lemieux Amy A. , Phoenix Bittner Nancy
Published: November 2018

Purpose/Objective:

The Community-based Care Transitions Program (CCTP) defined a broad spectrum of interventions and services for elderly patients at high risk of hospital readmission. The purposes for a CCTP as developed by the Centers for Medicare & Medicaid Services are to improve transitions of beneficiaries from the inpatient hospital setting to other care settings, to improve quality of care, to reduce readmissions for high-risk beneficiaries, and to document measurable savings. The goals for this CCTP initiative were as follows: achievement of a 20% reduction in the 30-day all-cause readmission rate across all partner hospitals compared with baseline; reduction in the 30-day all-cause readmission rate among the high-risk cohort served; and achievement of the target volumes for full enrollment.

Primary Practice Settings:

The partnership included acute care institutions and community-based care organizations that have been involved with care transition programs for years and have a long history of working collaboratively to provide services to a largely low-income, underserved, and ethnically and racially diverse target population.

Findings/Conclusions:

The program successfully transitioned to full operation within the first year of inception. To date, the partnership of the acute hospital setting and the community-based organizations has reached and provided services to nearly 8,000 total individuals, surpassing our target enrollment goal. To date, the readmission rate has decreased to 12.5%, which is an 11% decline since inception of the program.

Implications for Case Management Practice:

The collaboration of health care providers, social workers, nurse practitioners, physicians, community pharmacists, and the visiting nurses is integral to a successful transition from hospital to home. Home visits by the transition facilitators allowed for the coordination of a multitude of services in the community, including those previously available to patients in the past that have rarely been accessed. Including a pharmacist on the team provided teaching regarding medication adherence, medication management, and pharmacy services, which added to interventions to decrease future hospitalizations.
Examining the Perceived Effects of an Adult Day Program for Individuals With Dementia and Their Caregivers
Authors: Thompson Karen Helena , Fletcher Paula Christine
Published: November 2018

Background:

Currently 564 000 Canadians are living with dementia, and this number is expected to rise significantly in the next 15 years. Many individuals with dementia use adult day programs; however, contradictory evidence exists as to the effects that adult day programs have on individuals with dementia and their caregivers.

Purpose/Aims:

The purpose of this study was to examine the perceived effects that an adult day program had on individuals with dementia and their caregivers, from the perspective of care providers at an adult day program.

Design:

A qualitative research design was used to guide this study.

Methods:

One-on-one semistructured interviews were completed with all of the adult day program care providers (n = 7). Thematic analysis was used to analyze the data.

Results:

The adult day program care providers identified several benefits of adult day programs for individuals with dementia and their caregivers. Two themes emerged, including (1) the role of care providers and (2) time to breathe.

Conclusions:

Adult day programs have the potential to benefit caregivers and care recipients. Other community support programs may be able to use the knowledge gained from this qualitative study to implement strategies into existing adult day programs to provide support for care recipients and caregivers.
Avoiding Furosemide Ototoxicity Associated With Single-Ventricle Repair in Young Infants*
Authors: Robertson Charlene M. T. , Bork Karin T. , Tawfik Gerda , Bond Gwen Y. , Hendson Leonora , Dinu Irina A. , Khodayari Moez Elham , Rebeyka Ivan M. , Garcia Guerra Gonzalo , Joffe Ari R.
Published: November 2018

Objective:

To reduce bilateral delayed-onset progressive sensory permanent hearing loss using a systems-wide quality improvement project with adherence to best practice for the administration of furosemide.

Design:

Prospective cohort study with regular audiologic follow-up assessment of survivors both before and after a 2007–2008 quality improvement practice change.

Setting:

The referral center in Western Canada for complex cardiac surgery, with comprehensive multidisciplinary follow-up by the Complex Pediatric Therapies Follow-up Program.

Patients:

All consecutive patients having single-ventricle palliative cardiac surgery at age 6 weeks old or younger.

Interventions:

A 2007–2008 quality improvement practice change consisted of a Parenteral Drug Monograph revision indicating slow IV administration of furosemide, an educational program, and an evaluation.

Measurements and Main Results:

The outcome measure was the prevalence of permanent hearing loss by 4 years old. Firth multiple logistic regression compared pre (1996–2008) to post (2008–2012) practice change occurrence of permanent hearing loss, adjusting for confounding variables, including all hospital days, extracorporeal membrane oxygenation, cardiopulmonary bypass time, age at first surgery, dialysis, and sepsis. From 1996 to 2012, 259 infants had single-ventricle palliative surgery at age 6 weeks old or younger, with 173 (64%) surviving to age 4 years. Of survivors, 106 (61%) were male, age at surgery was 11.6 days (9.0 d), and total hospitalization days by age 4 years were 64 (42); 18 (10%) had cardiopulmonary resuscitation and 38 (22%) had sepsis at any time. All 173 (100%) had 4-year follow-up. Pre- to postpractice change permanent hearing loss dropped from 17/100 (17%) to 0/73 (0%) of survivors. On Firth multiple logistic regression, the only variable statistically associated with permanent hearing loss was the pre- to postpractice change time period (odds ratio, 0.03; 95% CI, 0–0.35; p = 0.001).

Conclusions:

A practice change to ensure slow IV administration of furosemide eliminated permanent hearing loss. Centers caring for critically ill infants, particularly those with single-ventricle anatomy or hypoxia, should review their drug administration guidelines and adhere to best practice for administration of IV furosemide.
Microtia in a Chinese Specialty Clinic Population: Clinical Heterogeneity and Associated Congenital Anomalies
Authors: Zhang Ye , Jiang Haiyue , Yang Qinghua , He Leren , Yu Xiaobo , Huang Xueshuang , Wu Rongwei , Yang Meirong , Li Chuan , Pan Bo
Published: November 2018

Background:

Microtia is a congenital anomaly of the external ear that can appear in isolation or in association with other congenital anomalies. In this study, the authors identify the prevalence and phenotypes of associated congenital malformations in patients with microtia in a Chinese specialty clinic population.

Methods:

Data were collected from 672 patients seen between December of 2014 and February of 2016 in the Department of Auricular Reconstruction at the Plastic Surgery Hospital of Peking Union Medical College. All patients were examined by trained clinicians and classified into one of three grades of microtia. Co-occurring congenital anomalies were detected and recorded.

Results:

The majority of study participants were male patients (72 percent), and most participants had unilateral microtia (93 percent, 68 percent of whom had right-side microtia). Two hundred ninety-three patients (44 percent) had one or more associated anomalies. The most commonly occurring comorbid malformations were those of the ear, face, and neck (40 percent of all associated malformations); musculoskeletal system (35 percent); and cardiovascular system (11 percent).

Conclusions:

These data represent the first detailed and thematic study of microtia and associated congenital anomalies in a Chinese clinical population. Substantial clinical heterogeneity was observed, and the prevalence of comorbid congenital malformations was high. Future studies investigating congenital anomalies associated with microtia are needed to improve understanding of its cause.
68Ga–Prostate-Specific Membrane Antigen PET/CT
Authors: Militano Vincenzo , Afaq Asim , Bomanji Jamshed
Published: November 2018

This case highlights that liposarcoma shows 68Ga–prostate-specific membrane antigen avidity and should be included in the differential diagnosis of patients with avid muscle lesions to avoid an incorrect diagnosis of metastasis.
Clinical relevance of single nucleotide polymorphisms in the CXCL1 and CXCL12 genes in patients with major trauma
Authors: Wang Xiao , Zhang An-Qiang , Gu Wei , Wen Da-Lin , Lu Hong-Xiang , Yang Jian-Hua , Wang Xu , Deng Jin , Zhang Hong-Qi , Du Ding-Yuan , Zhang Lian-Yang , Zeng Ling , Jiang Jian-Xin
Published: November 2018

BACKGROUND

Genetic backgrounds have been recognized as significant determinants of susceptibility to sepsis. CXC chemokines play a significant role in innate immunity against infectious diseases. Genetic polymorphisms of CXC chemokine genes have been widely studied in inflammatory and infectious diseases but not in sepsis. Thus, we aimed to investigate the clinical relevance of CXC chemokine gene polymorphisms and susceptibility to sepsis in a traumatically injured population.

METHODS

Thirteen tag single nucleotide polymorphisms were selected from CXC chemokine genes using a multimarker tagging algorithm in the Tagger software. Three independent cohorts of injured patients (n = 1700) were prospectively recruited. Selected single nucleotide polymorphisms were genotyped using an improved multiplex ligation detection reaction method. Cytokine production in lipopolysaccharide-stimulated whole blood was measured using an enzyme-linked immunosorbent assay.

RESULTS

Among the 13 tag single nucleotide polymorphisms, four single nucleotide polymorphisms (rs1429638, rs266087, rs2297630, and rs2839693) were significantly associated with the susceptibility to sepsis, and three (rs3117604, rs1429638, and rs4074) were significantly associated with an increased multiple organ dysfunction score in the derivation cohort. However, only the clinical relevance of rs1429638 and rs266087 was confirmed in the validation cohorts. In addition, rs2297630 was significantly associated with interleukin 6 production.

CONCLUSION

The rs1429638 polymorphism in the CXCL1 gene and the rs2297630 polymorphism in the CXCL12 gene were associated with altered susceptibility to sepsis and might be used as important genetic markers to assess the risks of sepsis in trauma patients.

LEVEL OF EVIDENCE

Prognostic and epidemiologic study, level II.