bluuebunny/crossref_metadata_2025 huggingface dataset:
Optimization of intravenous immune globulin use at a comprehensive cancer center
Authors: Figgins Bradley S , Aitken Samuel L , Whited Laura K
Published: October 2019

Purpose

Intravenous immune globulin (IVIG) is a high-cost medication used in a diverse range of settings. At many institutions, IVIG is dosed using total body weight (TBW). Recent evidence suggests that alternative dosing weights reduce waste without compromising clinical outcomes. The objective of this study was to quantify the waste reduction potential generated through the use of alternative IVIG dosing weights.

Methods

We performed a retrospective analysis of all IVIG doses administered from January 2011 through January 2016 to adults (≥18 years). TBW and height at the time of administration were used to calculate prescribed dose (g/kg), ideal body weight (IBW), and adjusted body weight (AdjBW). Three dosing methods were analyzed, as follows: use of AdjBW if TBW is >120% IBW (method 1), AdjBW for all doses (method 2), and IBW for all doses (method 3). Outcomes included potential IVIG use averted, direct drug cost savings, and reductions in outpatient infusion times for each method.

Results

A total of 9,918 doses were administered to 2,564 patients over 5 years, representing an average usage of 75,994 g/year. If dosing methods 1, 2, and 3 had been used, the annual use of IVIG would have decreased by 21.9% (16,658 g/year, p < 0.001), 24.2% (18,371 g/year, p < 0.001), and 35.9% (27,252 g/year, p < 0.001), respectively. This translates into average annual cost differences of $2.37 million, $2.62 million, and $3.89 million and average annual outpatient infusion time savings of 841 hours, 920 hours, and 1,366 hours, respectively.

Conclusion

IVIG dosing optimization through use of alternative dosing weights represents a significant source of waste reduction and cost reduction.
Proliferation, apoptosis, and number of Sertoli cells in the Syrian hamster during recrudescence after exposure to short photoperiod†‡
Authors: Martínez-Hernández Jesús , Seco-Rovira Vicente , Beltrán-Frutos Ester , Ferrer Concepción , Serrano-Sánchez María Isabel , Pastor Luis Miguel
Published: October 2019

The Sertoli cell (Sc) has been described as a quiescent cell once the animal has reached sexual maturity. Syrian hamster is an animal that displays testicular regression due to short photoperiod, during which process germ cells and Sc are removed through apoptosis. The aim of this work was to investigate histochemically whether the spontaneous testicular recrudescence processes after exposure to a short photoperiod lead to an increase in Sc proliferative activity in order to restore the normal population. Three spontaneous recrudescence groups were established: initial (IR), advanced (AR), and total (TR) recrudescence, which were compared with animal undergoing the regression process (mild: MRg, strong: SRg, and total: TRg) and animals in long photoperiod (Controls). Histological sections were submitted to histochemical techniques for detecting apoptotic and proliferative Sc with bright-field and fluorescence microscopy. For each group, the proliferative Sc index (PScI) and apoptotic Sc index (AScI), and the total number of Sc were obtained. The results revealed the existence of Vimentin+/TUNEL+ as well as Vimentin+/PCNA+ cells. The PScI was significantly higher in TRg and IR than in the other groups. The AScI was only significantly higher in MRg and SRg with respect to the other groups. The total number of Sc increased among TRg, IR, and AR, reaching values similar to those of the Controls. In conclusion, the increase in Sc proliferation from final regression and recrudescence, accompanied by a similar rate of apoptosis to the Control group, is the cause of the restoration of the Sc population during spontaneous recrudescence.
Intraovarianism. Local mechanisms that affect follicle and luteal dynamics in heifers and women†
Authors: Ginther O J
Published: October 2019

Intraovarianism is represented by greater follicle activity in right ovary (RO) than left ovary (LO) during the two or three follicular waves per interovulatory interval in heifers and the ovulatory wave in women. In each species, selection between the dominant follicle (DF or F1) and future largest subordinate follicle (F2) is manifested by diameter deviation. The RO has more ≥6 mm predeviation follicles in heifers, more 2–10 mm predeviation follicles in women, and greater frequency of ovulation in each species. The RO propensity for ovulation likely develops before birth or at least before sexual maturity as indicated by (1) heavier RO with more follicles in recently born calves and heavier right fetal gonad with more DNA content in humans and (2) greater RO frequency for largest follicle of a wave in sexually immature heifers and for first ovulation of puberty. In heifers, intraovarianism is also expressed by (1) two-way enhancement effect between DF and CL when in same ovary, (2) regression of predeviation follicles when adjacent to the regressing CL, (3) more frequent location of F2 during predeviation in ovary that contains F1, (4) greater diameter increase during recovery of subordinate follicles when in RO with the future DF, and (5) effect of an intraovarian pattern on the pattern in the next wave. The nature of these forms of intraovarianism is not known but may be physical rather than from local passage of factors between structures. Intraovarianism should be considered when studying systemic hormonal effects on ovarian dynamics.
Networked Decisions: Decision-Making Thresholds in Child Protection
Authors: Keddell Emily , Hyslop Ian
Published: October 2019

Families are significantly affected by decisions made in the child protection context, yet decision outcomes differ even when cases are similar. Understanding the concepts, practices and processes of differentiation that push some cases over the threshold of key decision points, but not other similar cases, is crucial. Drawing on interviews and focus groups with child protection social workers from three site offices in Aotearoa New Zealand (interviews, n = 26; focus groups, n = 25) and using thematic analysis, this study identified the case, internal organisational, inter-site organisational and external elements that contributed to threshold decisions. Case factors such as children’s age, abuse type and chronicity recorded family history and perceptions of family compliance interacted with internal organisational processes and practices, social negotiations and hierarchical power differences to produce decision outcomes. Inter-site differences in decision thresholds resulted from differences in site managers’ perceptions of acceptable case type, site workloads, resources, size and cultural commitment to family preservation. External demographic inequalities were perceived as causing differing levels of site workload. This ‘networked decision-making’ process is theorised drawing on an extended version of the decision-making ecology (DME), by using qualitative methods to examine interactions between the DME elements and their relationship with risk regimes.
Secrecy, spies and the global South: intelligence studies beyond the ‘Five Eyes’ alliance
Authors: Shiraz Zakia , Aldrich Richard J.
Published: October 2019

The study of secrecy and spies remain subjects dominated by Anglo-American experiences. In recent years there has been some effort to refocus the lens of research upon ‘intelligence elsewhere’, including the global South. This is partly because of intense interest in the Arab Spring and ‘managed democracy’, placing a wider range of secret services under the spotlight. However, the approach to research is still dominated by concepts and methods derived from studying the English-speaking states of the ‘Five Eyes’ alliance and their European outriders. This article calls for a re-examination of research strategies for Intelligence Studies and for those theorizing surveillance, suggesting that both fields have much to learn from area studies and development studies, especially in the realm of research practice and ethics. If the growing number of academics specializing in intelligence genuinely wish to move forward and examine the global South they will need to rethink their tool-kit and learn from other disciplines. We suggest there is a rich tradition to draw upon.
The ACS National Surgical Quality Improvement Program—Inflammatory Bowel Disease Collaborative: Design, Implementation, and Validation of a Disease-specific Module
Authors: Eisenstein Samuel , Holubar Stefan D , Hilbert Nicholas , Bordeianou Liliana , Crawford Lynne A , Hall Bruce , Hull Tracy , Hyman Neil , Keenan Megan , Kunitake Hiroko , Lee Edward C , Lewis William D , Maron David , Messaris Evangelos , Miller Reba , Mutch Matthew , Ortenzi Gail , Ramamoorthy Sonia , Smith Radhika , Steinhagen Randolph M , Wexner Steven D
Published: October 2019

Background

Surgery for inflammatory bowel disease (IBD) involves a complex interplay between disease, surgery, and medications, exposing patients to increased risk of postoperative complications. Surgical best practices have been largely based on single-institution results and meta-analyses, with multicenter clinical data lacking. The American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) has revolutionized the way in which large-volume surgical outcomes data have been collected. Our aim was to employ the ACS-NSQIP to collect disease-specific variables relevant to surgical outcomes in IBD.

Study Design

A collaborative of 13 high-volume IBD surgery centers was convened to collect 5 IBD-specific variables in NSQIP. Variables included biologic and immunomodulator medications usage, ileostomy utilization, ileal pouch anastomotic technique, and colonic dysplasia/neoplasia. A sample of the Surgical Clinical Reviewer collected data was validated by a colorectal surgeon at each institution, and kappa's agreement statistics generated.

Results

Over 1 year, data were collected on a total of 956 cases. Overall, 41.4% of patients had taken a biologic agent in the 60 days before surgery. The 2 most commonly performed procedures were laparoscopic ileocolic resections (159 cases) and subtotal colectomies (151 cases). Overall, 56.8% of cases employed an ileostomy, and 134 ileal pouches were constructed, of which 92.4% used stapled technique. A sample of 214 (22.4%) consecutive cases was validated from 8 institutions. All 5 novel variables were shown to be reliably collected, with excellent agreement for 4 variables (kappa ≥ 0.70) and very good agreement for the presence of colonic dysplasia (kappa = 0.68).

Conclusion

We report the results of the initial year of implementation of the first disease-specific collaborative within NSQIP. The selected variables were demonstrated to be reliably collected, and this collaborative will facilitate high-quality, large case–volume research specific to the IBD patient population.
A Pilot Trial of Online Training for Family Well-Being and Veteran Treatment Initiation for PTSD
Authors: Erbes Christopher R , Kuhn Eric , Polusny Melissa A , Ruzek Josef I , Spoont Michele , Meis Laura A , Gifford Elizabeth , Weingardt Kenneth R , Campbell Emily Hagel , Oleson Heather , Taylor Brent C
Published: October 2019

Introduction

Family members are important supports for veterans with Posttrauamtic Stress Disroder (PTSD), but they often struggle with their own distress and challenges. The Veterans Affairs—Community Reinforcement and Family Training (VA-CRAFT) website was designed to teach family members of veterans with PTSD effective ways to interact with their veterans to encourage initiation of mental health services as well as to care for themselves and improve their relationships. This article presents a pilot investigation of VA-CRAFT.

Materials and Method

Spouse/partners of veterans who had screened positive for PTSD but were not in mental health treatment were randomized to either use the VA-CRAFT website (n = 22) or to a waitlist control condition (n = 19) for 3 months. Veteran mental health service initiation was assessed posttreatment. Spouse/partner distress, caregiver burden, quality of life, and relationship quality were assessed pre and posttreatment. The study was approved by the Minneapolis VA Health Care System Institutional Review Board (IRB).

Results

Differences between groups on veteran treatment initiation were small (Phi = 0.17) and not statistically significant. VA-CRAFT participants reported large and statistically significantly greater decreases in overall caregiver burden (η2 = 0.10) and objective caregiver burden (η2 = 0.14) than control participants. Effects were larger for those with greater initial distress. Effects sizes for other partner outcomes were negligible (η2 = 0.01) to medium (η2 = 0.09) and not statistically significant. Postintervention interviews suggested that only 33% of the VA-CRAFT participants talked with their veterans about starting treatment for PTSD during the trial.

Conclusion

Results from this pilot trial suggest that VA-CRAFT holds initial promise in reducing caregiver burden and as such it could be a useful resource for family members of veterans with PTSD. However, VA-CRAFT does not enhance veteran treatment initiation. It may benefit from enhancements to increase effectiveness and caregiver engagement.
Abdominal Insufflation Is Associated With Increase of Intracranial Pressure in Patients With Normal Pressure Hydrocephalus
Authors: Bunevicius Adomas , Vernon Ashley , Golby Alexandra
Published: October 2019

BACKGROUND

Ventriculoperitoneal shunting (VPS) is effective for the treatment of normal-pressure hydrocephalus (NPH) and sometimes requires laparoscopic assistance with abdominal insufflation.

OBJECTIVE

To evaluate the association of abdominal insufflation with opening pressure (OP) in NPH patients undergoing VPS implantation.

METHODS

Between March 2016 and April 2019, 52 consecutive patients who underwent first-time VPS implantation surgery were retrospectively identified by reviewing electronic health records. OP during the large volume lumbar tap test (OPLP) and VPS implantation surgery (OPSURGERY) were measured in 29 patients.

RESULTS

Laparoscopic assistance with abdominal insufflation was used in 20 (69%) cases. There were no differences in patient age (P = .589), gender (P = .822), body mass index (P = .289), weight (P = .789), height (P = .542), and OPLP (P = .476) in patients operated with and without laparoscopic assistance. When compared to patients operated without laparoscopic assistance, laparoscopic assistance was associated with a greater rate of OP increase during surgery relative to OPLP (40% vs 100%, P = .002), a greater increase in OPSURGERY relative to OPLP (−0.40 ± 5.38 vs 10.17 ± 5.53 cm H2O, P < .001), and a greater proportion of patients with OPSURGERY of ≥25 cm H2O during the VPS surgery (0% vs 78%, P < .001).

CONCLUSION

Abdominal insufflation is associated with an increase in intracranial pressure with OPs often exceeding 25 cm H2O. This should be considered when selecting optimal VPS pressure settings.
Equity Price Discovery with Informed Private Debt
Authors: Addoum Jawad M , Murfin Justin R
Published: October 2019

Equity markets fail to account for the value-relevant nonpublic information enjoyed by syndicated loan participants and reflected in publicly posted loan prices. A long-short strategy that buys (sells) the equities of firms with recently appreciated (depreciated) loans earns large risk-adjusted returns, suggesting a surprising and economically important level of segmentation across the same firm’s capital structure. The information lag captured by trading strategy returns is not affected by drivers of firm-specific attention, including the publication of loan returns in the Wall Street Journal. Instead, returns to the strategy are eliminated among equities held by mutual funds also trading in syndicated loans.

Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
A Novel Association of Martorell Ulcer With Liddle Syndrome
Authors: Malphrus Elizabeth , Couch Kara , Chao Jerry W.
Published: October 2019

Pseudohyperaldosteronism, or Liddle syndrome, is a rare, autosomal dominant condition characterized by early-onset hypertension, often associated with hypokalemia and metabolic alkalosis. Martorell hypertensive ischemic leg ulcer is a rare, underdiagnosed ulcer characterized by subcutaneous arteriolosclerosis, classically appearing over the dorsolateral lower extremity or Achilles tendon in patients with hypertension and diabetes. It presents an important diagnostic challenge because it can appear grossly similar to other entities such as pyoderma gangrenosum or venous stasis ulcers, but requires surgical intervention. This article presents a case study of surgical management of a Martorell ulcer in a 69-year-old woman with Liddle syndrome. To the authors’ knowledge, this is the first case reported in the literature of this rare ulcer occurring secondary to this rare cause of hypertension.
Continuity With Patients, Preceptors, and Peers Improves Primary Care Training: A Randomized Medical Education Trial
Authors: Henschen Bruce L. , Liss David T. , Golden Blair P. , Cameron Kenzie A. , Bierman Jennifer A. , Ryan Elizabeth R. , Gard Lauren A. , Neilson Eric G. , Wayne Diane B. , Evans Daniel B.
Published: October 2019

Purpose

Infusing continuity of care into medical student clerkships may accelerate professional development, preserve patient-centered attitudes, and improve primary care training. However, prospective, randomized studies of longitudinal curricula are lacking.

Method

All entering Northwestern University Feinberg School of Medicine students in 2015 and 2016 were randomized to the Education Centered Medical Home (ECMH), a 4-year, team-based primary care clerkship; or a mentored individual preceptorship (IP) for 2 years followed by a traditional 4-week primary care clerkship. Students were surveyed 4 times (baseline, M1, M2, and M3 year [through 2018]); surveys included the Maslach Burnout Inventory (MBI); the Communication, Curriculum, and Culture (C3) survey assessing the hidden curriculum; and the Attitudes Toward Health Care Teams (ATHCT) scale. The authors analyzed results using an intent-to-treat approach.

Results

Three hundred twenty-nine students were randomized; 316 (96%) participated in surveys. Seventy percent of all respondents would recommend the ECMH to incoming first-year students. ECMH students reported a more positive learning environment (overall quality, 4.4 ECMH vs 4.0 IP, P < .001), greater team-centered attitudes (ATHCT scale, 3.2 vs 3.0, P = .007), less exposure to negative aspects of the hidden curriculum (C3 scale, 4.6 vs 4.3, P < .001), and comparable medical knowledge acquisition. ECMH students established more continuity relationships with patients (2.2 vs 0.3, P < .001) and reported significantly higher professional efficacy (MBI-PE, 4.1 vs 3.9, P = .02).

Conclusions

In this randomized medical education trial, the ECMH provided superior primary care training across multiple outcomes compared with a traditional clerkship-based model, including improved professional efficacy.
An Investigation of the Relationship Between COMLEX-USA Licensure Examination Performance and State Licensing Board Disciplinary Actions
Authors: Roberts William L. , Gross Gretta A. , Gimpel John R. , Smith Larissa L. , Arnhart Katie , Pei Xiaomei , Young Aaron
Published: October 2019

Purpose

Passing the Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) serves as a licensing requirement, yet there is limited understanding between this high-stakes exam and performance outcomes. This study examined the relationship between COMLEX-USA scores and disciplinary actions received by osteopathic physicians.

Method

Data for osteopathic physicians (N = 26,383) who graduated from medical school between 2004 and 2013 were analyzed using multinomial logistic regression to assess the relationship between COMLEX-USA scores and placement into one of 3 disciplinary action categories relative to no action received, controlling for years in practice and gender.

Results

Less than 1% of physicians in this study (n = 187) had a disciplinary action(s). Controlling for all COMLEX-USA levels, years in practice, and gender, higher Level 3 scores were associated with significant decreased odds for all action categories: revoked licensed (odds ratio [OR] = 0.51, 95% confidence interval [CI] 0.36, 0.72; P < .001), imposed limitations to practice (OR = 0.59, 95% CI 0.41, 0.84; P < .01), and other action imposed (OR = 0.48, 95% CI 0.33, 0.69; P < .001), relative to not receiving an action. In these same models, higher Level 2 Performance Evaluation Biomedical/Biomechanical Domain scores decreased the odds for an action that revoked a license (OR = 0.75, 95% CI 0.58, 0.98; P < .05) and imposed limitations to practice (OR = 0.64, 95% CI 0.49, 0.84; P < .001).

Conclusions

These findings provide evidence that the COMLEX-USA delivers useful information regarding the likelihood of a practitioner receiving state board disciplinary actions.
Minimally Invasive Transforaminal Lumbar Interbody Fusion (TLIF)
Authors: Badlani Neil , Yu Elizabeth , Kreitz Tyler , Khan Safdar , Kurd Mark F.
Published: October 2019

Degenerative spondylolisthesis with or without spondylolysis, multiply recurrent disk herniation, and degenerative disk disease commonly presents as back and leg pain, weakness and paresthesias. Surgical intervention, to include lumbar decompression with instrumented fusion with or without interbody fusion, is recommended to patients who are refractory to at least six weeks of nonoperative treatment, or patients with severe or progressive neurological deficits. This paper reviews the pre- and post-operative considerations, as well as the surgical technique, for a minimally invasive transforaminal lumbar interbody fusion for the above conditions.
Genome-wide study on uveal melanoma patients finds association to DNA repair gene TDP1
Authors: Thomsen Hauke , Chattopadhyay Subhayan , Hoffmann Per , Nöthen Markus M. , Kalirai Helen , Coupland Sarah E. , Jonas Jost B. , Hemminki Kari , Försti Asta
Published: October 2019

Uveal melanoma is a life-threatening disease for which data on germline predisposition are essentially limited to mutations in the BAP1 gene. Many risk factors are shared between uveal melanoma and cutaneous melanoma, and these include fair skin color and light eye color. We carried out a genome-wide association study on 590 uveal melanoma patients and 5199 controls. Using a P-value limit of 10−5 we identified 11 loci with related odds ratios for the risk alleles ranging from 1.32 to 1.78. The smallest P-value in the overall analysis reached 1.07 × 10−7 for rs3759710 at 14q32.11, which is intronic to TDP1 (tyrosyl-DNA phosphodiesterase 1). This locus emerged as a genome-wide significant association for uveal melanoma clinical subtypes with any chromosomal aberrations (P = 10−10) and presence of epithelioid cells (P = 10−9). TDP1 is a DNA repair enzyme capable of repairing many types of DNA damage, including oxidative DNA lesions which may be relevant for uveal melanoma. We additionally wanted to replicate the previous candidate locus for uveal melanoma at chromosome 5p15.33 intronic to the CLPTM1L gene. Our analysis gave an odds ratio of 1.23 (95% confidence interval: 1.09–1.38; P = 0.0008) for the C allele of rs421284 and 1.21 (95% confidence interval: 1.07–1.36; P = 0.002) for the C allele of rs452932. Our data thus replicated the association of uveal melanoma with the CLPTM1L locus. Our data on TDP1 offer an attractive model positing that oxidative damage in pigmented tissue may be an initiation event in uveal melanoma and the level of damage may be regulated by the degree and type of iris pigmentation.
Effects of linalool on extinction of mouse operant behaviour
Authors: Shaw David , Norwood Kelly , Kennedy Paul J. , Leslie Julian C.
Published: October 2019

Linalool is an enanitomer monoterpene compound identified as the pharmacologically active constituent in a number of essential oils and has been reported to display anxiolytic properties in humans and in animal models and to exert both GABAergic and glutamatergic effects. In Experiment 1 linalool (100, 200, and 300, i.p.) had no significant effects compared with saline in an activity tracker with C57BL/6j mice. Experiment 2 assessed the effects on operant extinction with mice of chlordiazepoxide at a dose (15 mg/kg, i.p.) previously shown to facilitate extinction, and the same doses of linalool, compared with saline. Linalool had a dose-related facilitatory effect on extinction. While the effects of the highest dose of linalool most closely resembled the effects of chlordiazepoxide, the pattern of results suggested that linalool may affect both the acquisition of extinction learning, which is influenced by glutamatergic processes, and the expression of extinction, known to be affected by GABAergic agents such as chlordiazepoxide.
Diagnosis and Treatment of a Benign Pediatric Mandible Tumor
Authors: Joy Matthew T. , Liao Christopher D. , Magdycz William P. , Parulis Albert W. , Thompson James T.
Published: October 2019

Pediatric mandible tumors are rare and generally benign but can be locally aggressive. Diagnosis and treatment involve tumor identification, excision, and subsequent reconstruction. Successful reconstruction should address form and function of the mandible while minimizing morbidity. The authors review the diagnosis and treatment of a benign pediatric mandible tumor and the use of nonvascularized rib graft for mandible reconstruction. The subject of interest is an 8-year-old boy who presented with progressive left-sided facial swelling and examination findings concerning for a mandibular neoplasm. A large bony tumor of the left mandibular ramus and condyle was identified on computed tomography scan. Needle aspiration was performed but was nondiagnostic. The patient underwent en bloc resection and immediate reconstruction utilizing nonvascularized rib graft. Pathologic analysis demonstrated a benign fibro-osseous lesion consistent with fibrous dysplasia, ossifying fibroma, or aneurysmal bone cyst. The patient had excellent recovery of jaw function and resumption of solid diet 5 weeks after reconstruction. Mandibular defects >6 cm in length often require free vascularized bone flaps for reconstruction; however, these procedures can have greater morbidity in the skeletally immature patient. Nonvascularized rib graft is a viable alternative that also allows for reconstruction of the mandibular condyle using the costocartilagenous cap of the harvested rib. The authors present this case as an example of a rare pediatric head and neck tumor and review of the approach to diagnosis and treatment, including special considerations for complex pediatric mandibular reconstruction.
Breast Implant Surfaces and Their Impact on Current Practices: Where We Are Now and Where Are We Going?
Authors: Munhoz Alexandre Mendonça , Clemens Mark W. , Nahabedian Maurice Y.
Published: October 2019

Most commercially available breast implants feature some degree of elastomer surface modifications to increase surface roughness, in part because several clinical series have demonstrated positive outcomes from texturizing. However, the literature shows that textured implants support higher rates of bacterial growth, and there is a clear association between increased bacterial contamination and host response in vivo, such as capsular contracture. Furthermore, the infectious theory related to bacterial contamination has recently been described as a potential cause in the etiology of anaplastic large-cell lymphoma. Recent research has focused on the physiology of breast implant surfaces advances and how they interact with the body, creating new surface technologies which have the potential to affect all aspects of breast surgery. Understanding how surface properties affect inflammatory cell response will be essential in designing implants that can provide an esthetic solution while also minimizing long-term clinical complications. This special topic highlights the current knowledge on silicone implant surfaces, as well as innovations that have shaped and will continue to change the silicone breast implant industry in the future. It also provides an overview of the principal surfaces that exist and may find clinical applications in esthetic and reconstructive breast surgery. As additional advances emerge, objective tools will be required to evaluate the different surfaces available on the market, along with the long-term efficacy of new technologies.
Prevalence of Chronic Multisymptom Illness/Gulf War Illness Over Time Among Millennium Cohort Participants, 2001 to 2016
Authors: Porter Ben , Long Kyna , Rull Rudolph P. , Dursa Erin K.
Published: October 2019

Objective:

Chronic multisymptom illness/Gulf War illness (CMI/GWI) is the defining illness of the 1990 to 1991 Gulf War. However, few studies have examined changes over time in CMI/GWI prevalence.

Methods:

Prevalence of CMI/GWI over time was compared between three groups of military personnel (9110 Gulf War veterans, 36,019 era personnel, 31,446 non-era personnel) enrolled in the Millennium Cohort Study. Post hoc analyses were conducted among participants with no reported mental and physical health conditions (N = 30,093).

Results:

CMI/GWI prevalence increased substantially over the study period among all groups. Gulf War veterans had the highest prevalence of CMI/GWI across the study period. This finding persisted after excluding participants with mental and physical health conditions.

Conclusions:

Gulf War veterans’ increased risk of CMI/GWI persisted across the study period, highlighting the continued importance of screening and improving treatment options among this population.
Periodically rotated overlapping parallel lines with enhanced reconstruction acquisition to improve motion-induced artifacts in bladder cancer imaging
Authors: Nguyen Huyen Thanh , Shah Zarine Ketul , Mortazavi Amir , Pohar Kamal S. , Wei Lai , Zynger Debra Lyn , Knopp Michael Vinzenz
Published: October 2019

Motion-induced artifacts have been a major drawback in bladder cancer imaging. This study is to evaluate the clinical utility of periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) acquisition in improving motion-induced artifacts in T2-weighted (T2W) magnetic resonance imaging (MRI) of bladder cancer at 3T.

Sixteen patient MRI exams were included. Using a Likert scale, 2 radiologists independently scored T2W data without and with PROPELLER in terms of artifact severity and tumor visualization. Statistical analysis was done to assess the image quality improvement by PROPELLER and inter-observer variability.

Without PROPELLER, the median scores of artifact severity and tumor visualization were 1.5 and 1.5 for reviewer 1, and 2.0 and 2.0 for reviewer 2. With PROPELLER, the scores increased to 3 and 3.5 for reviewer 1, and 3.5 and 3.5 for reviewer 2. Despite the inter-observer variability (κ scores < 0.2), both reviewers found significant improvement in artifacts and visualization (all P < .001).

PROPELLER acquisition significantly improved the image quality of T2W-MRI. These initial findings indicate that this technique should be utilized in clinical MRI of the bladder.
Poststroke depression and risk of recurrent stroke
Authors: Wu Quan-e , Zhou Ai-min , Han Yun-peng , Liu Yan-ming , Yang Yang , Wang Xiao-meng , Shi Xin
Published: October 2019

Background:

Conflicting results have been reported on the association of poststroke depression with recurrent stroke events. This meta-analysis of prospective studies aims to evaluate whether poststroke depression is an independent predictor of stroke recurrence among stroke patients.

Methods:

A systematic search of articles in PubMed and Embase databases from their inception to October 2018 was conducted. Prospective studies reporting risk estimates of stroke recurrence by depression status in stroke patients were included and pooled risk ratio (RR) with 95% confidence intervals (CIs) of stroke recurrence was calculated for patients with or without poststroke depression.

Results:

Six studies with 4648 stroke patients were finally included, and the prevalence of poststroke depression was found to from 15.9% to 40.5%. The pooled adjusted RR for stroke recurrence in patients suffering from poststroke depression was 1.48 (1.22–1.79) in a fixed-effect model. Subgroup analyses indicated that poststroke depression significantly increased stroke recurrence (RR 1.64; 95% CI, 1.28–2.10) among ischemic stroke patients but not in total stroke patients (RR 1.28; 95% CI, 0.96–1.73).

Conclusions:

This meta-analysis suggests that poststroke depression may be an independent predictor of stroke recurrence among ischemic stroke patients. Further studies are required to investigate whether treatment of poststroke depression can reduce the risk of stroke recurrence.
Effects of acupuncture on rates of ovulation and pregnancy in women with unruptured follicular luteinization syndrome
Authors: Xi Ting , Liu Yanfeng , Bao Xiaoxia , Mi Shuqi
Published: October 2019

Background

As a fabulous part of Oriental Medcine, acupuncture and moxibustion possesses the advantage of high safety, convenience and less adverse effects. Unruptured follicular luteinization syndrome is a common cause of infertility in women of reproductive age, which seriously affects the physical and mental health of patients. Certain studies have reported that acupuncture can improve the rate of pregnancy in women with unruptured follicular luteinization syndrome. In this protocol, the effects of acupuncture on rates of ovulation and pregnancy among women with unruptured follicular luteinization syndrome will be further explored.

Methods

Electronic bibliographic databases such as: MEDLINE, EMBASE, PsycINFO, Global Health, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Methodology Register), Health Technology Assessment Database, and Web of Science (Science and Social Science Citation Index), PubMed, Chinese Biomedical Databaseare, Chinese VIP Information, Chinese National Knowledge Infrastructure (CNKI), all helpful to identify relevant randomized controlled trials (RCTs) of effects of acupuncture on rates of ovulation and pregnancy among women with unruptured follicular luteinization syndrome. The pooled odds ratio of achieving a clinical pregnancy, ongoing pregnancy, or live birth were used as the main outcome and the secondary outcome includes the changes of ovarian artery dynamics before and after treatment, so as to the adverse reactions of treatment. We will use RevMan 5.3 software to help us to analyze all data and use the Cochrane evaluation manual 5.1.0 to help us to assess the methodological quality for incorporated RCTs.

Result

This systematic review will provide evidence for assessing the effects of acupuncture on rates of ovulation and pregnancy in women with unruptured follicular luteinization syndrome.

Conclusion

The results of this study will be a useful reference for clinical treatment with acupuncture to improve rates of ovulation and pregnancy among women with unruptured follicular luteinization syndrome.
Efficiency and safety of autologous chimeric antigen receptor T-cells therapy used for patients with lymphoma
Authors: Cao Genmao , Lei Lijian , Zhu Xiaolin
Published: October 2019

Background:

Chimeric antigen receptor (CAR) T-cell therapy has produced promising response rates in patients with B cell malignancies. However, previous meta-analyses have demonstrated that CAR T-cell efficacy is unsatisfactory in patients with lymphoma unlike in patient with other hematological malignancies, but these studies included insufficient numbers of studies and patients with lymphoma. Furthermore, clinicians are interested in the effects of infusion dose, CAR structure, interleukin-2 (IL-2), and conditioning therapy regimen.

Methods:

All clinical trials administering autologous CAR T-cell therapy in lymphoma patients were searched in medical databases. A traditional meta-analysis was performed to assess the safety and efficacy of CAR T-cells in lymphoma treatment. Subgroup analysis was performed to determine the relationships between potential factors and efficacy. The best overall response rate (ORR), 6 month ORR (6m ORR), and severe cytokine release syndrome (sCRS) rate were calculated by Stata 14.0.

Results:

A total of 411 patients across all the studies were included. Our analysis showed a best ORR of 0.71, a 6m ORR of 0.63, and an overall CRS (grade ≥ 3) rate of 0.18. The subgroup analysis showed that increased response rates and reduced CRS (grade ≥ 3) rates were associated with a low dose of CAR T-cells. No IL-2 administration and the use of a fludarabine-containing lymphodepletion regimen led to improved efficacy, while anti-CD19 CAR T cells led to a more successful outcome than anti-CD20 CAR T cells. In addition, 2nd- and 3rd-generation CAR T cells exhibited increased effectiveness in clinical studies, and no significant effect diversity was found between the 2nd- and 3rd-generation CAR T cells. sCRS was associated with a high dose of infused CAR T cells when IL-2 and fludarabine were excluded from the positive factors for sCRS.

Conclusion:

CAR T cells are promising in the treatment of relapsed or refractory lymphoma. Doses lower than 108/m2, no IL-2 administration, fludarabine administration, and anti-CD19 CAR T cells were related to improved efficacy and safety.
Histogram analysis of absolute cerebral blood volume map can distinguish glioblastoma from solitary brain metastasis
Authors: Qin Jianhua , Li Ying , Liang Donghai , Zhang Yuanna , Yao Weicheng
Published: October 2019

Glioblastoma multiforme (GBM) is difficult to be separated from solitary brain metastasis (sBM) in clinical practice. This study aimed to distinguish two entities by the histogram analysis of absolute cerebral blood volume (CBV) map.

From March 2016 to June 2018, 24 patients with GBM and 18 patients with sBM were included in this retrospective study. The enhancing area was first segmented on the post-contrast T1WI, then the segmentation was copied to the absolute CBV map and histogram analysis was finally performed. Unpaired t test was used to select the features that could separate two entities and receiving operating curve was used to test the diagnostic performance. Finally, a machine learning method was used to test the diagnostic performance combing all the selected features.

Six of 19 features were feasible to distinguish GBM from sBM (all P < .001), among which energy had the highest diagnostic performance (area under curve, 0.84; accuracy, 88%), while a machine learning method could improve the diagnostic performance (area under curve, 0.94; accuracy, 95%).

Histogram analysis of the absolute CBV in the enhancing area could help us distinguish GBM from sBM, in addition, a machine learning method with combined features is preferable. It is quite helpful in the condition that the biological nature of peritumoral edema could not separate these two entities.
Efficacy of microsurgery for patients with cerebral hemorrhage secondary to gestational hypertension
Authors: Wang An-bang , Zhang Hua
Published: October 2019

Background:

Microsurgery is widely utilized for patients with cerebral hemorrhage (CH). The purpose of this study is to assess the efficacy and safety of microsurgery for the treatment of patients with CH secondary to gestational hypertension (GH).

Methods:

Relevant randomized controlled trials in eight electronic databases of Cochrane Library, PUBMED, EMBASE, Web of Science, VIP, WANFANG, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure will be included. All electronic databases will be searched from inceptions to the present without language restriction. RevMan 5.3 software will be applied for statistical analysis.

Results:

This study will summarize a high-quality synthesis of maternal mortality, severe maternal complications, maternal quality of life, limbs function, muscle strength, and muscle tone to evaluate the efficacy and safety of microsurgery for patients with CH secondary to GH.

Conclusions:

This study will provide evidence that microsurgery is an effective intervention in patients with CH secondary to GH.

PROSPERO registration number:

PROSPERO CRD42019145750.
Acupuncture for patients with myasthenia gravis
Authors: Shi Shuai , Ji Xinyu , Wang Yanping , Liu Bin , Zhang Huamin , Lu Cheng
Published: October 2019

Background:

The objective of this systematic review protocol is to provide the methods for evaluating the effectiveness and safety of acupuncture on the treatment of myasthenia gravis (MG).

Methods and analysis:

We will search randomized controlled trials (RCTs) on this subject in 8 electronic databases and they are Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PubMed, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), the Wan-Fang Database, and Chinese Scientific Journal Database (VIP database). Other relevant literatures will be manually searched as a complement. Only RCTs related to acupuncture for MG will be included, without Language restrictions and limitation of publication types. The risk of bias and trial quality will be assessed by the Cochrane collaboration tool. The study inclusion, data extraction and quality assessment will be conducted independently by 2 reviewers. All data from the studies included will be analyzed by RevMan V.5.3 statistical software.

Results:

This study will provide a high-quality synthesis of RCTs on the efficacy and safety of acupuncture as an adjuvant therapy in the treatment of MG.

Conclusion:

This systemic review will provide high quality evidence to evaluate acupuncture as adjuvant therapy in patients with MG.

Prospero registration number:

PROSPERO CRD42019133577.
Incidence of hydrocephalus in traumatic brain injury
Authors: Chen Kai-Hua , Lee Chuan-Pin , Yang Yao-Hsu , Yang Yun-Hsuan , Chen Chien-Min , Lu Mong-Liang , Lee Yi-Chen , Chen Vincent Chin-Hung
Published: October 2019

Background:

The aim of this study was to investigate the risk and peak time of post-traumatic hydrocephalus (PTH) in traumatic brain injury (TBI) patients with traumatic subarachnoid hemorrhage (SAH), compared to TBI patients without traumatic SAH.

Methods:

In this retrospective population-based cohort study, the data was extracted from Longitudinal Health Insurance Database from 2000 to 2010 in Taiwan. A total of 23,775 TBI patients who had a first event TBI during 2000 to 2010 were included and divided into TBI with SAH (TBI-S) group and TBI without SAH (TBI-NS) group. We focused on analyzing the PTH in both groups within 2 years after brain injury. Competing risk regression models were performed to assess the risk of developing PTH in the TBI-S group compared to the TBI-NS group.

Results:

Comparing to the TBI-NS group, there was a significantly higher cumulative incidence of PTH in the TBI-S group during the 2-year follow-up period. The adjusted hazard ratio (HR) of PTH in TBI-S group within 2 years was between 2.90–3.47, and the highest estimates were obtained within 6 months after injury (HR = 3.47, 95% CI: 2.43–4.94). The occurrence percentage of PTH was highest during 0–3rd month follow-up periods (1.95% in TBI-S group; 0.48% in TBI-NS group).

Conclusions:

The peak time of PTH occurrence was noted during 0–3rd month post brain injury. Traumatic SAH patients had an approximate 3-fold risk of developing PTH, comparing to TBI patients without traumatic SAH.
Prognostic factors associated with mortality in mechanically ventilated patients in the intensive care unit
Authors: Liang Jianfeng , Li Zhiyong , Dong Haishan , Xu Chang
Published: October 2019

Data on outcomes of patients receiving mechanical ventilation (MV) in China are scarce.

To investigate factors associated with the prognosis of patients given MV in the intensive care unit (ICU).

A 12-year (January 1, 2006–December 31, 2017) retrospective cohort study.

ICU of Beijing Geriatric Hospital, China.

A total of 905 patients aged ≥16 years given MV during the study period.

None.

Among 905 patients included (610 men; median age, 78 years; Acute Physiology and Chronic Health Evaluation [APACHE]-II score, 27.3 ± 8.9), 585 survived (388 men; median age, 77 years; average APACHE-II score, 25.6 ± 8.4), and 320 died in the ICU (222 men; median age, 78 years; APACHE-II score, 30.6 ± 8.9). All-cause ICU mortality was 35.4%. In patients aged <65 years, factors associated with ICU mortality were APACHE-II score (odds ratio [OR], 1.108; 95% confidence interval [95% CI], 1.021–1.202; P = .014), nosocomial infection (OR, 6.618; 95% CI, 1.065–41.113; P = .043), acute kidney injury (OR, 17.302; 95% CI, 2.728–109.735; P = .002), invasive hemodynamic monitoring (OR, 10.051; 95% CI, 1.362–74.191; P = .024), MV for cardiopulmonary resuscitation (OR, 0.122; 95% CI, 0.016–0.924; P = .042), duration of MV (OR, 0.993; 95% CI, 0.988–0.998; P = .008), successful weaning from MV (OR, 0.012; 95% CI, 0.002–0.066; P < .001), and renal replacement therapy (OR, 0.039; 95% CI, 0.005–0.324; P = .003). In patients aged ≥65 years, factors associated with mortality were APACHE-II score (OR, 1.062; 95% CI, 1.030–1.096; P < .001), nosocomial infection (OR, 2.427; 95% CI, 1.359–4.334; P = .003), septic shock (OR, 2.017; 95% CI, 1.153–3.529; P = .014), blood transfusion (OR, 1.939; 95% CI, 1.174–3.202; P = .010), duration of MV (OR, 0.999; 95% CI, 0.999–1.000; P = .043), and successful weaning from MV (OR, 0.027; 95% CI, 0.015–0.047; P < .001).

APACHE-II score, successful weaning, and nosocomial infection in the ICU are independently associated with the prognosis of patients given MV in the ICU.
Relationship between the optimal cut-off values of anthropometric indices for predicting metabolic syndrome and carotid intima-medial thickness in a Korean population
Authors: Yang Yu Jin , Park Ho-Jong , Won Ki-Bum , Chang Hyuk-Jae , Park Gyung-Min , Kim Yong-Giun , Ann Soe Hee , Park Eun Ji , Kim Shin-Jae , Lee Sang-Gon
Published: October 2019

Anthropometric measurements are simple and useful methods for predicting metabolic syndrome (MetS) because obesity is a predominant feature of MetS. Although carotid intima-medial thickness (IMT) is generally used to evaluate subclinical atherosclerosis, the relationship between the optimal cut-off anthropometric values for predicting MetS and carotid IMT has not been analyzed in a Korean population.

Anthropometric measurements including waist circumference (WC), waist hip ratio (WHR), waist height ratio (WHtR), body mass index (BMI), and carotid IMT were assessed in 2560 Korean subjects without previous history of cardiovascular disease, cerebrovascular disease, neurological abnormalities, or malignancy who participated in baseline health examinations in a self-referral setting in the Seoul area between April 2010 and November 2012. MetS was defined using the National Cholesterol Education Program–Adult Treatment Panel III criteria.

In both men and women, the levels of all anthropometric indices were significantly higher in subjects with MetS than in those without MetS. According to the receiver operating characteristic curve, the values of 80.8 cm for WC, 0.87 for WHR, 0.52 for WHtR, and 24.6 kg/m2 for BMI were the optimal cut-offs for predicting MetS in women. The values of 89.3 cm for WC, 0.90 for WHR, 0.52 for WHtR, and 25.1 kg/m2 for BMI were the optimal cut-offs for predicting MetS in men. After adjusting for confounding factors, the WC optimal cut-off values for predicting MetS were independently associated with carotid IMT in both women and men (women: β = 0.016, P = .008; men: β = 0.033, P = .009). The optimal BMI cut-off value was independently associated with carotid IMT in men only (β = 0.027, P = .032).

Among anthropometric indices including WC, WHR, WHtR, and BMI, the WC optimal cut-off values for MetS were independently associated with an increased carotid IMT in both women and men in a Korean population.