bluuebunny/crossref_metadata_2025 huggingface dataset:
Muscle Dysfunction in Smokers and Patients With Mild COPD
Authors: Fonseca Jéssica , Nellessen Aline Gonçalves , Pitta Fabio
Published: March 2019

Purpose:

To describe and discuss the available evidence in the literature concerning muscle function and the association between smoking and muscle dysfunction in smokers and patients with mild chronic obstructive pulmonary disease (COPD).

Methods:

The literature search involved the following databases: PubMed, Pedro, CINAHL, Cochrane Library, Lilacs, and EMBASE. Studies were included if they investigated muscle strength and/or endurance and/or cross-sectional area (CSA) in smokers and/or patients with COPD classified as Global Initiative for Obstructive Lung Disease (GOLD) I and without lung cancer. Two authors screened and identified the studies for inclusion.

Results:

Eighteen studies were identified. Some studies found lower values in a variety of muscle strength variables in smokers compared with nonsmoking controls, whereas others found similar values between these groups. When comparing patients with COPD classified as GOLD I with smokers, COPD patients showed lower muscle strength. Two studies found no differences in muscle CSA between smokers compared with nonsmoking controls. Some preliminary evidence also shows that patients with COPD classified as GOLD I had lower CSA in comparison with smokers.

Conclusion:

Results concerning muscle dysfunction in smokers are divergent, since some studies have shown worse results in a variety of muscle strength variables in smokers compared with nonsmoking controls, whereas other studies have not. Moreover, there is rather preliminary evidence indicating worse muscle dysfunction and lower CSA in patients with mild COPD in comparison with healthy (or non-COPD) smokers.
Radiation Biology and Its Role in the Canadian Radiation Protection Framework
Authors: Leblanc Julie E. , Burtt Julie J.
Published: March 2019

The linear no-threshold (linear-non-threshold) model is a dose-response model that has long served as the foundation of the international radiation protection framework, which includes the Canadian regulatory framework. Its purpose is to inform the choice of appropriate dose limits and subsequent as low as reasonably achievable requirements, social and economic factors taken into account. The linear no-threshold model assumes that the risk of developing cancer increases proportionately with increasing radiation dose. The linear no-threshold model has historically been applied by extrapolating the risk of cancer at high doses (>1,000 mSv) down to low doses in a linear manner. As the health effects of radiation exposure at low doses remain ambiguous, reducing uncertainties found in cancer risk dose-response models can be achieved through in vitro and animal-based studies. The purpose of this critical review is to analyze whether the linear no-threshold model is still applicable for use by modern nuclear regulators for radiation protection purposes, or if there is sufficient scientific evidence supporting an alternate model from which to derive regulatory dose limits.
PATIENTS PRESENTING EMERGENTLY WITH PROLIFERATIVE DIABETIC RETINOPATHY
Authors: Hinkle John W. , Flynn Harry W. , Banta James T. , Vanner Elizabeth A.
Published: March 2019

Purpose:

To determine the rate of follow-up after emergent encounters for proliferative diabetic retinopathy and to identify patient or visit characteristics associated with follow-up compliance.

Methods:

A retrospective cohort study of patients presenting to an ophthalmic emergency department with active proliferative diabetic retinopathy between May 2014 and December 2016 was conducted. Demographic data and encounter data were gathered for each emergency department visit. Compliance with follow-up was defined as a completed clinic visit as scheduled after the emergency encounter.

Results:

A total of 590 emergency department encounters were included. The overall follow-up rate was 61.9%. Married patients and those with Public Health Trust insurance had increased odds of compliance (odds ratio [OR]: 1.507, P = 0.04; OR: 2.749, P < 0.0001). Patients with Medicaid had reduced odds (OR: 0.543, P = 0.004). Patients with longer emergency department encounters and longer intervals to follow-up had reduced odds (OR: 0.948, P = 0.001; OR of 0.941, P < 0.0001). The other characteristics were not significantly associated with follow-up compliance.

Conclusion:

Patients who present emergently with active proliferative diabetic retinopathy are at high risk of following up noncompliance. Characteristics with significant effects on the odds of follow-up compliance include specific insurance payer, marriage status, length of visit, and interval to follow-up.
Long-term Follow-up of Partial Bleb Excision in Late-onset Bleb-related Complications by a Single Surgeon Using Conjunctival Advancement
Authors: Canut María I. , Cobián Ramón , Fernández-Vega Andrés , Julio Gemma , Barraquer Rafael I.
Published: March 2019

Purpose:

The purpose of this study was to describe the long-term results of partial bleb excision in late-onset bleb-related complications by a single experienced surgeon using the same surgical technique.

Patients and Methods:

This was a retrospective study of 21 eyes of 11 women and 10 men aged 34 to 87 years (mean 64±12.8 y) who underwent first repair of late-onset bleb leaks with or without numerical hypotony (NH) and dysesthesia. The surgical technique consists of removing nonviable conjunctiva until the functional tissue becomes visible, thus adapting to individual conditions, and later conjunctival advancement. Complete success was defined as maintenance of intraocular pressure control without additional bleb revision, surgery, or glaucoma medications. Qualified success met these criteria, but with glaucoma medications.

Results:

The mean follow-up was 5.6±4.4 years (1 to 17 years). Sixty-two percent of the cases were considered complete success, and a moderate number of cases (19%) needed glaucoma medication for achieving qualified success at the end of the follow-up period. Interestingly, bleb leak with NH seems to have long-term outcomes, like the other bleb-related complications (in terms of success and failures), with a significant intraocular pressure increase at 1 month after revision that tended to remain within normal values and lead to visual acuity recovery without recurrent NH.

Conclusions:

Partial bleb excision seems to be a good technique for different late-onset bleb-related complications. Bleb leak with NH showed a good long-term response, like the other bleb revision indications.
Dyslipidemia, Dyslipidemia Treatment, and Open-angle Glaucoma in the Korean National Health and Nutrition Examination Survey
Authors: Shon Kilhwan , Sung Kyung Rim
Published: March 2019

Purpose:

The purpose of this study was to investigate the association between dyslipidemia treatment and open-angle glaucoma (OAG).

Patients and Methods:

We included 16,939 participants aged ≥40 years from the Korea National Health and Nutrition Examination Survey (2008 to 2012) and classified them into 2 groups based on current dyslipidemia treatment. The prevalence of OAG was determined using the modified International Society of Geographical and Epidemiological Ophthalmology criteria. The association between dyslipidemia treatment and OAG was evaluated using logistic mixed-effects model and propensity-score-weighted odds ratios.

Results:

Analyses using the 2 abovementioned models revealed that dyslipidemia treatment was not associated with OAG (odds ratio, 1.08; 95% confidence interval, 0.75-1.56; P=0.838 and 1.03; 0.71-1.48; P=0.882, respectively), presence of optic disc hemorrhage (0.64; 0.15-2.73; P=0.648 and 1.10; 0.39-3.11; P=0.855), high vertical cup-to-disc ratio or asymmetry (1.02; 0.81-1.28; P=0.736 and 0.95; 0.75-1.20; P=0.650), presence of retinal nerve fiber layer defects (0.97; 0.67-1.42; P=0.857 and 1.03; 0.75-1.42; P=0.857), and presence of visual field defects (0.93; 0.55-1.54; P=0.931 and 0.97; 0.81-1.52; P=0.528). Total cholesterol and high-density lipoprotein cholesterol were also not associated with OAG. However, higher serum triglyceride levels were associated with OAG in the treated patients (1.31; 1.02-1.68; P=0.027) but not in the untreated patients (1.03; 0.93-1.14; P=0.079).

Conclusions:

In the Korean population, dyslipidemia treatment was not significantly associated with open-angle glaucoma. However, hypertriglyceridemia was associated with OAG in treated patients.
Establishing the Reliability of a Tool for Assessing Israeli Physical Therapy Students' Clinical Performance
Authors: Schwartz Donny , Jacob Tamar
Published: March 2019

Introduction.

The evaluation of students' abilities in the clinical setting requires the use of a valid and reliable assessment tool. The assessment tool currently used for this purpose in all physical therapy (PT) undergraduate programs in Israel has never been evaluated for these parameters. This study aimed to find an established assessment tool, translate it into Hebrew, and determine the inter-rater reliability of the translated version and whether it could be a viable substitute for the currently used assessment tool.

Review of the Literature.

Revealed that the Assessment of Physiotherapy Practice (APP) is an established, valid, and reliable assessment tool.

Subjects.

Assessors: 21 clinical educators; assessed: 30 undergraduate PT students.

Methods.

The APP was translated into Hebrew using the translation–retranslation method. Clinical educators were briefly trained to use the APP before the study. Following 8 weeks of clinical practice in an assigned outpatient clinic, each student was assessed by 2 clinical educators, each of whom used both the APP and the currently used assessment tool. Intraclass correlation coefficient (ICC) was used to measure the inter-rater reliability of the APP. Cronbach's alpha was used to measure the internal consistency of the sections of the APP. Percentage of agreement between assessors was measured for each item.

Results.

The ICC for the total APP was 0.88 (95% confidence interval: 0.77–0.94). The internal consistency of APP sections ranged from 0.65 to 0.93 Cronbach's alpha. Exact agreement between assessors on 12 of the 20 items was identical in 63% or more occasions.

Discussion and Conclusion.

The ICC for the total score on the Hebrew APP was similar to that of the original APP, and the percentage of agreement among assessors was slightly lower than that of the original version. The latter may be due to the educators' limited experience with this assessment tool. The inter-rater reliability and validity of the Hebrew APP established it as a good substitute for the currently used assessment tool.
Implementation of a Hospital-Based Orthopaedic Physical Therapy Residency Program: A Case Report Describing Clinical Outcomes, Productivity, and Perceived Benefits
Authors: Winslow John , Costello Michael
Published: March 2019

Background and Purpose.

Currently, there are 264 credentialed physical therapy residencies across the United States. Most residency programs take a limited number of residents per year, thus the opportunity for the projected 10,721 physical therapy students graduating in 2019 was relatively small. One of the challenges to developing a new physical therapy residency is convincing the host institution that it will be beneficial in the long-term. The purpose of this case report was to describe the effect of implementing a hospital-based orthopaedic physical therapy residency program on clinical outcomes, productivity, and the perceived benefits of the residency program by staff physical therapists and hospital administrators.

Case Description.

The Patient-Specific Functional Scale (PSFS) was used to assess treatment outcomes for 2 years before the start of the residency program (2007–2008) and for each of the 4 years after the inauguration of the first resident (2009–2012). A total of 3,717 patient outcome scores were used in the analysis. Productivity, measured in “patient visits” and zip code data, representing the service area, was also collected. In addition, staff physical therapists and administrators completed a survey to determine their perceived benefits of the residency program.

Outcomes.

There was a steady improvement in clinical outcomes from 2007 to 2012. In 2007, the average change in the PSFS was 3.81 and in 2012, 4 years after the start of the residency program, the average change in PSFS increased 37% to 5.21. The number of patient visits increased to 60,983 (+17,071), and patients were travelling from outside the service area (41 additional zip codes) to receive treatment at the hospital from staff physical therapists with specialized training. Survey results indicate that both staff physical therapists and hospital administrators had a very positive view of the impact of the residency program on job satisfaction, professional development, staff retention, and success of the department.

Discussion and Conclusion.

The results of this study suggest that hospital-based orthopaedic physical therapy residency programs have the potential to improve clinical outcomes, increase productivity, and create a “culture of excellence.” It provides some justification for hospitals and other physical therapy facilities to invest in residency training.
Text messaging as an intervention for weight loss in emerging adults
Authors: Keating Sharon R. , McCurry Mary
Published: March 2019

Background and purpose:

Rates of overweight and obesity in emerging adults are rapidly increasing and associated with many chronic illnesses, quality of life concerns, and increased health care spending. Effective weight management interventions are needed for this population. The purpose of this study was to examine effects of a text-messaging weight loss intervention on motivation, stage of change for weight loss, and BMI.

Methods:

Overweight and obese emerging adults were enrolled (n = 188) and randomized to control or intervention groups. Weight loss information was delivered via a website to both groups. The intervention group also received daily weight loss–related text messages. Motivation, stage of change, and BMI were assessed online, via self-report at baseline, 4, and 8 weeks.

Conclusions:

Ninety-five participants were included in the final data analysis. There was a significant increase in motivation and stage of change and decrease in BMI over the study duration, with no significant differences between groups.

Implications for practice:

Nurse practitioners are well positioned to provide innovative weight loss interventions in a variety of settings. These results provide important insights for the design of effective weight loss treatment for emerging adults and support the use of web-based and text message–based interventions.
Risk Factors for Gastrointestinal Symptoms Following Successful Eradication of Clostridium difficile by Fecal Microbiota Transplantation (FMT)
Authors: Allegretti Jessica R. , Kassam Zain , Fischer Monika , Kelly Colleen , Chan Walter W.
Published: March 2019

Background:

Fecal microbiota transplantation (FMT) is a promising therapy for recurrent Clostridioides difficile infection (CDI). Many patients report altered bowel habits including constipation, bloating, gas and loose stool post-FMT despite resolution of CDI, and the etiology remains unclear.

Methods:

This was a prospective cohort study of adult patients with recurrent CDI who underwent FMT (1) via colonoscopy with patient-selected donor stool, (2) via colonoscopy from a universal stool bank donor, or (3) via capsules from a universal stool bank. Reassessment occurred 8 weeks post-FMT. Those cured were assessed for gastrointestinal symptoms (bloating, loose stools, constipation). Multivariate logistic regression was performed to assess predictors of post-FMT gastrointestinal symptoms.

Results:

A total of 150 subjects underwent FMT for recurrent CDI, of which 68.7% (103) were female, mean age was 61.5 years±18.1 and 31 patients (20.7%) had preexisting irritable bowel syndrome. Thirty-six had FMT via colonoscopy with a patient-selected donor, 67 via colonoscopy with stool bank donors, and 47 via FMT capsules from stool bank donors. Among those cured, 41 (31.2%) had gastrointestinal symptoms post-FMT. The factors associated with symptoms included younger age (57.2 vs. 64.1 y, P=0.03), a baseline history of irritable bowel syndrome (36.6% vs. 13.3%, P=0.002) and preexisting inflammatory bowel disease (31.7% vs. 10%, P=0.002). Small bowel exposure to donor stool was not related to symptoms (63.4% vs. 62.2%, P=0.89).

Conclusions:

Altered bowel habits are a consequence of CDI and are common after FMT. This study suggests that donor type and FMT delivery modality are not related to the presence of irregular gastrointestinal symptoms after FMT.
Pain and sickle cell disease
Authors: Aich Anupam , Jones Michael K. , Gupta Kalpna
Published: March 2019

Purpose of review

Pain is a major comorbidity of sickle cell disease (SCD). Opioids are the mainstay for pain treatment but remain suboptimal. We discuss mechanism-based treatable targets devoid of opioids to prevent and/or treat SCD pain.

Recent findings

Understanding the pathogenesis of pain is critical to develop targeted therapies. Nevertheless, acute and chronic pain can have independent and/or overlapping mechanisms. The origin of pain involves neurovascular and neuroimmune interactions from the periphery and/or central nervous system. Immunomodulatory components of acute and/or chronic sickle pain for targeting/preventing pain genesis include mast cell and microglial activation, neurogenic inflammation, and leukocyte-derived elastase. Vascular modulators include hypoxia/reperfusion injury, oxidative stress, hemolysis, and adhesion molecules. However, existent pain requires analgesics devoid of an inadvertent effect on sickle pathobiology. Recent analgesic targets include cannabinoid and nociceptin receptors and serotonergic spinothalamic pathway. Complementary approaches (e.g., acupuncture, hypnosis, perception-based therapies) have shown analgesic potential. Owing to heterogeneity in pain development, it remains challenging to combat SCD pain with any one therapy.

SCD pain involves neuroimmune and neurovascular interactions. Such interactions have pronociceptive impacts and impart therapy resistance. Elucidating molecular and cellular entities affecting neuronal interactions in sickle microenvironment may prevent SCD pain and/or provide improved analgesic approaches.
Mixed Lipid, Fish Oil, and Soybean Oil Parenteral Lipids Impact Cholestasis, Hepatic Phytosterol, and Lipid Composition
Authors: Isaac Daniela Migliarese , Alzaben Abeer S. , Mazurak Vera C. , Yap Jason , Wizzard Pamela R. , Nation Patrick N. , Zhao Yuan‐Yuan , Curtis Jonathan M. , Sergi Consolato , Wales Paul W. , Mager Diana R. , Turner Justine M.
Published: March 2019

Objectives:

In parenteral nutrition‐dependent infants and children, intestinal failure (IF)‐associated liver disease (IFALD) remains an important problem. A comparative study was undertaken of parenteral mixed lipid (ML), ω‐3 predominant fish oil (FO), and ω‐6 predominant soybean oil (SO) emulsions in regards to hepatic phytosterol, neutral lipid, fatty acid (FA) content, and the relationship to cholestasis in piglets.

Methods:

Neonatal piglets received parenteral nutrition, varying in lipid dose (5 or 10 g· kg−1 · day−1) and formulation: SO5 (n = 5), SO10 (n = 5), FO5 (n = 5), and ML10 (n = 5). On day 14, liver chemistry, bile flow, histology and neutral lipid staining were assessed. Hepatic triglyceride FA content was determined using thin layer and gas chromatography, and phytosterol content was assessed using gas chromatography‐mass spectrometry.

Results:

SO groups had higher prevalence of biochemical cholestasis (P < 0.04) and lower bile flow (P < 0.0001). Hepatic campesterol, stigmasterol, and β‐sitosterol were highest in SO10 (P < 0.0001). Hepatic FA (P < 0.03) and ω‐6/ω‐3 FA ratio (P < 0.0001) were higher in the SO groups. Neutral lipid accumulation (P = 0.3) and liver histology (P = 0.16) were not different between groups. Univariate predictors of bile flow were: campesterol (r = −0.77, P = 0.001), β‐sitosterol (r = −0.74, P = 0.002), stigmasterol (r = −0.74, P = 0.002), ω‐6 FA (r = −0.72, P = 0.002), and ω‐3 FA (r = 0.59, P = 0.02). Only campesterol independently predicted bile flow.

Conclusions:

ML and FO lipid emulsions reduce cholestasis in association with lowered hepatic phytosterol and lipid content. Lower hepatic phytosterol and ω‐6 FA content, and higher ω‐3 FA content are hepatoprotective. Multivariate analysis suggests reduced phytosterol accumulation may best explain the hepatoprotective effect of fish oil‐containing lipids.
Characterization of Esophageal Motility in Infants With Congenital Diaphragmatic Hernia Using High‐resolution Manometry
Authors: Rayyan Maissa , Omari Taher , Debeer Anne , Decaluwe Herbert , Deprest Jan , Allegaert Karel , Rommel Nathalie
Published: March 2019

Objectives:

The aim of the study was to characterize esophageal motility and esophagogastric junction (EGJ) function in infants who underwent repair of an isolated congenital diaphragmatic hernia (iCDH).

Methods:

High‐resolution manometry with impedance was used to investigate esophageal motility and EGJ function after diaphragmatic repair in 12 infants with iCDH (11 left‐sided; 9 patch repair). They had esophageal motility studies during neonatal admission (n = 12), at 6 months (n = 10) and at 12 months of life (n = 7). Swallows were analyzed using conventional esophageal pressure topography and pressure flow analysis and were compared with 11 healthy preterm born infants at near‐term age.

Results:

Esophageal peristaltic motor patterns in patients with iCDH were comparable to controls. EGJ end‐expiratory pressure was higher in patients with patch repair compared with controls (P = 0.050) and those without patch (P = 0.009). The difference between inspiratory and expiratory pressures at the EGJ was lower in patients with iCDH with patch (P = 0.045) compared to patients without. Patients with iCDH with patch showed increased Pressure Flow Index, resistance of bolus flow at the EGJ, compared with controls (P = 0.043).

Conclusions:

Normal esophageal wave patterns are present in the investigated patients with iCDH. EGJ end‐expiratory pressure seems lower in patients with iCDH without patch suggesting a decreased EGJ barrier function hence increased vulnerability to gastroesophageal reflux. Patch repair appears to increase end‐expiratory pressure at the EGJ above that of controls suggesting that patch surgery tightens the EGJ, thereby increasing flow resistance. This is in line with the increased Pressure Flow Index. In infants with a patch, the inspiration‐expiration pressure difference is lower, reflecting diminished activity of the crural diaphragm.
The effect of low-intensity aerobic training on cognitive functions of severely deconditioned subacute and chronic stroke patients: a randomized, controlled pilot study
Authors: Debreceni-Nagy Adél , Horváth Judit , Bajuszné Kovács Noémi , Fülöp Péter , Jenei Zoltán
Published: March 2019

Our objective was to investigate the impact of low-intensity aerobic training on cognitive functions in severely deconditioned subacute and chronic stroke patients. For this purpose, a randomized, controlled pilot study was designed involving subacute and chronic stroke patients. Thirty-seven eligible patients participated in the 4-week-long randomized, controlled pilot study. Patients were randomized into study group and control group and both groups participated in conventional physiotherapy included occupational therapy. Only the study group’s patients participated in a low-intensity aerobic training by cycle ergometer. Cognitive evaluations (Functional Independence Measure Cognitive part – FIM-cog; Coding and Symbol Search tasks of the Processing Speed index and Digit Span task of Working Memory index of Wechsler Adult Intelligence Scale-Fourth Edition) were performed before and after the programme. In-group analysis showed a significant improvement in study group patients regarding Coding subtest of Processing Speed domain (P = 0.003). Symbol Search subtest of Processing Speed showed significant improvements in both groups by the end of the programme (study group, P = 0.041; control group, P = 0.006). There were no significant changes in the FIM-cog and Digit Span task. The intergroup analysis did not find significant difference between the two groups. It was concluded that even the low-intensity aerobic training may improve special domains of cognitive function after stroke. Further studies are needed to confirm the impact of low-intensity aerobic training on cognitive functions.
Women's Experiences with Tandem Breastfeeding
Authors: O'rourke Molly Patricia , Spatz Diane Lynn
Published: March 2019

Background:

Choosing to breastfeed is a decision with far-reaching benefits; strengthened immune systems, all-encompassing nutrition, and fostering healthy attachment. For these and other reasons, some mothers are reluctant to wean their child due to a subsequent pregnancy. Mothers may breastfeed throughout their second pregnancy, give birth to their second child, and simultaneously breastfeed two children. This practice is known as tandem breastfeeding.

Purpose:

We explore the biological and emotional considerations of tandem breastfeeding and offer practical suggestions for nurses.

Methods:

Three mothers who engaged in tandem breastfeeding were identified and interviewed. Interviews were face-to-face or over the phone. One researcher conducted all interviews using the same questions that served as the foundation and guidance for the discussion-based interview. The interviews lasted 40 to 60 minutes and were audio recorded to minimize recall issues during data analysis.

Results:

Three mothers shared their tandem breastfeeding journeys, challenges faced, and overall perspectives. This was an opportunity for mothers to share feedback on how nurses provided education and care as well as suggestions for nursing care of future mothers who choose to tandem breastfeeding.

Clinical Implications:

Through research and case-series interviews, we developed implications for nursing practice. Nurses must be informed and supportive of mothers' decisions to tandem breastfeed.
Using Lean to Improve Patient Safety and Resource Utilization After Pediatric Adenotonsillectomy
Authors: Gray Mingyang L. , Chen Sida , Kinberg Eliezer , Colley Patrick , Malkin Benjamin D.
Published: March 2019

Objective

The objective of this quality improvement project was to decrease the rate of nonemergent use of emergency department (ED) resources in children undergoing adenotonsillectomy by 50% and/or reach a future state of 5% or less overall ED visits among all postoperative patients within 1 year. A secondary objective was to standardize the preoperative, intraoperative, and postoperative management of these patients.

Methods

The study was a quality improvement project using Lean. The target population was children younger than 18 years undergoing tonsillectomy with or without adenoidectomy. A retrospective review of adenotonsillectomy was performed for a 12-month period. Lean tools including A3 Thinking, Ishikawa “fishbone” diagram, and value stream mapping were used to analyze the problem and identify interventions. Postintervention data were collected for a 10-month period.

Results

Compared with the baseline period, the ED visit rate after adenotonsillectomy decreased from 36.2% to 15.5% (P = 0.0095). The rate of ED visits for nonbleeding complaints decreased from 30.4% to 12.1% (P = 0.01748). There was no significant change in rate of ED visits for bleeding (decreased from 5.8% to 3.5% [P = 0.6873]). There was no significant change in the use of intraoperative dexamethasone and acetaminophen.

Conclusions

Postadenotonsillectomy patients often use emergency resources better reserved for other patients. Addressing this problem with Lean principles significantly decreased postoperative ED visit rates by more than 50%.

Implications for Practice

To our knowledge, this is the first reported use of Lean principles to decrease utilization of emergency resources in the postoperative period. Lean can be applied to other processes in our field to eliminate waste and add value to improve patient outcomes.

Level of Evidence

NA.
A Comparison of Plasma Efavirenz and Tenofovir, Dried Blood Spot Tenofovir-Diphosphate, and Self-Reported Adherence to Predict Virologic Suppression Among South African Women
Authors: Phillips Tamsin K. , Sinxadi Phumla , Abrams Elaine J. , Zerbe Allison , Orrell Catherine , Hu Nai-Chung , Brittain Kirsty , Gomba Yolanda , Norman Jennifer , Wiesner Lubbe , Myer Landon , Maartens Gary
Published: March 2019

Background:

Tenofovir-diphosphate (TFV-DP) in dried blood spots (DBS) is an objective long-term adherence measure, but data are limited on its ability to predict virologic suppression (VS) in people on antiretroviral (ARV) treatment. There are also no data comparing DBS TFV-DP with plasma ARV concentrations as predictors of VS.

Methods:

Women who were on a first-line regimen of tenofovir, emtricitabine, and efavirenz (EFV) were enrolled in a cross-sectional study. Plasma EFV and tenofovir (TFV), DBS TFV-DP assays, and 30-day self-reported adherence were evaluated as predictors of VS (<50 copies/mL) with the area under the curve of receiver operating characteristics and logistic regression.

Results:

We enrolled 137 women; mean age of 33 years; median 4 years on antiretroviral therapy; 88 (64%) had VS. In receiver operating characteristics analyses: DBS TFV-DP [0.926 (95% CI: 0.876 to 0.976)] had a higher area under the curve than plasma TFV [0.864 (0.797 to 0.932); P = 0.006], whereas plasma EFV [0.903 (0.839–0.967)] was not significantly different from DBS TFV-DP (P = 0.138) or plasma TFV (P = 0.140); all ARV assays performed better than self-report. The association of TFV-DP in DBS with VS strengthened with increasing concentrations [reference <350 fmol/punch: 350–699 fmol/punch aOR 37 (8–178); 700–1249 fmol/punch aOR 47 (13–175); ≥1250 fmol/punch aOR 175 (20–1539)]. “White coat adherence” (defined as DBS TFV-DP <350 fmol/punch with detectable plasma TFV) was only detected in 4 women.

Conclusions:

Plasma EFV, TFV, and DBS TFV-DP were all strong predictors of VS. EFV or TFV assays have potential for development as point-of-care assays for use as objective adherence measures in resource-limited settings.
Discrimination, Medical Distrust, Stigma, Depressive Symptoms, Antiretroviral Medication Adherence, Engagement in Care, and Quality of Life Among Women Living With HIV in North Carolina: A Mediated Structural Equation Model
Authors: Relf Michael V. , Pan Wei , Edmonds Andrew , Ramirez Catalina , Amarasekara Sathya , Adimora Adaora A.
Published: March 2019

Background:

Women represent 23% of all Americans living with HIV. By 2020, more than 70% of Americans living with HIV are expected to be 50 years and older.

Setting:

This study was conducted in the Southern United States—a geographic region with the highest number of new HIV infections and deaths.

Objective:

To explore the moderating effect of age on everyday discrimination (EVD); group-based medical (GBM) distrust; enacted, anticipated, internalized HIV stigma; depressive symptoms; HIV disclosure; engagement in care; antiretroviral medication adherence; and quality of life (QOL) among women living with HIV.

Methods:

We used multigroup structural equation modeling to analyze baseline data from 123 participants enrolled at the University of North Carolina at Chapel Hill site of the Women's Interagency HIV Study during October 2013–May 2015.

Results:

Although age did not moderate the pathways hypothesized, age had a direct effect on internalized stigma and QOL. EVD had a direct effect on anticipated stigma and depressive symptoms. GBM distrust had a direct effect on depressive symptoms and a mediated effect through internalized stigma. Internalized stigma was the only form of stigma directly related to disclosure. Depressive symptoms were a significant mediator between GBM, EVD, and internalized stigma reducing antiretroviral therapy medication adherence, engagement in care, and QOL.

Conclusions:

EVD, GBM, and internalized stigma adversely affect depressive symptoms, antiretroviral therapy medication adherence, and engagement in care, which collectively influence the QOL of women living with HIV.
A delicate balancing act: immunity and immunopathology in human H7N9 influenza virus infections
Authors: Karawita Anjana C. , Tong Marcus Z.W. , Short Kirsty R.
Published: March 2019

Purpose of review

A delicate balance exists between a protective and detrimental immune response to an invading viral pathogen. Here, we review the latest advancements in our understanding of immunity and immunopathology during H7N9 influenza A virus (IAV) infections and its relevance to disease management and diagnosis.

Recent findings

Recent studies have highlighted the role of specific leukocytes in the pathogenesis of H7N9 IAV infections and potential diagnostic role that host cytokine profiles can play in forecasting disease severity. Furthermore, alterations in diet have emerged as a possible preventive measure for severe IAV infections.

The recent emergence and continued evolution of H7N9 IAVs have emphasized the threat that these avian viruses pose to human health. Understanding the role of the host immune response in both disease protection and pathogenesis is an essential first step in the creation of novel therapeutic and preventive measures for H7N9 IAV infections.
Single-Center Retrospective Analysis of Breakthrough Allergic-Like Reactions to Gadobutrol
Authors: Walker Daniel , Chakraborty Santanu , Schieda Nicola
Published: March 2019

Objective

The purpose of this study was to assess the rate and severity of breakthrough allergic-like reactions to gadobutrol.

Materials and Methods

Under a waiver from our institutional review board, we performed a key word search of our institutional PACS (Picture Archiving and Communication System) database to identify all allergic-like reactions, which occurred in the setting of gadobutrol administration between December 2009 and August 2018, encompassing approximately 25,000 gadobutrol injections. Patients with an index allergic-like reaction who underwent a subsequent gadobutrol-enhanced magnetic resonance imaging after a standard 13-hour corticosteroid and antihistamine premedication protocol before repeat injection were identified. Patient characteristics, volume of gadobutrol injected, and severity of index and breakthrough reactions were recorded and compared by χ2 test, t test, and Spearman correlation.

Results

The index allergic-like reaction rate to gadobutrol was 0.28% (69/25000). Of the patients who had an index allergic-like reaction, 45% (31/69) had a subsequent magnetic resonance imaging with gadobutrol injection and premedication with a breakthrough reaction rate of 35% (11/31). Most index reactions were mild in severity (91% [63/69]), and most breakthrough reactions were also typically mild (91% [10/11]). One patient escalated from a mild index reaction to a moderate breakthrough reaction despite premedication. There was no correlation between volume of gadobutrol injected (ρ = −0.004, P = 0.98) or association with age (P = 0.74), although female patients had higher breakthrough reaction rates (P = 0.007).

Conclusions

Allergic-like reactions to gadobutrol are rare; however, breakthrough reactions occur with moderate frequency despite premedication, and although generally of mild severity, in our series, one breakthrough reaction escalated in severity.
Splenic Marginal Zone B-Cell Lymphoma With Splenic Infarction in a Patient With Cold Agglutinin Disease
Authors: Nakamoto Ryusuke , Okuyama Chio , Utsumi Takahiko , Yamamoto Yoshihiro
Published: March 2019

We report a case of splenic marginal zone B-cell lymphoma discovered in a 73-year-old man with cold agglutinin disease. PET/CT revealed splenomegaly with focally intense uptake of18F-FDG and diffusely increased bone marrow uptake, which was considered to be secondary to hemolytic anemia. Splenectomy was performed. The histopathology of the spleen showed splenic marginal zone B-cell lymphoma with partial splenic infarction, which correlated with the area of focal intense FDG uptake. Depending on the time since onset, splenic infarctions can present as focal FDG accumulation.
The Prognostic Value of Baseline 18F-FDG PET/CT in Human Papillomavirus–Positive Versus Human Papillomavirus–Negative Patients With Oropharyngeal Cancer
Authors: Gouw Zeno A. R. , La Fontaine Matthew D. , van Kranen Simon , van de Kamer Jeroen B. , Vogel Wouter V. , van Werkhoven Erik , Sonke Jan-Jakob , Al-Mamgani Abrahim
Published: March 2019

Purpose

Oropharynx cancer (OPC) is heterogeneous; human papillomavirus (HPV)–positive and HPV− tumors represent 2 disease entities with a different prognosis. Earlier studies investigating the prognostic value of pretreatment 18F-FDG PET in OPC are small or included patients with unknown HPV status. This study assessed the prognostic value of PET variables, in a large cohort with balanced HPV status.

Methods

Retrospectively, primary tumor SUVmax, SUVpeak, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were extracted from baseline FDG PET/CT of patients with OPC treated with (chemo)radiation. The Pearson correlation between the PET variables was calculated. With linear regression, the correlation between the PET variables and HPV status, age, smoking status, T stage, N stage, and American Joint Committee on Cancer stage was calculated. Univariable and multivariable Cox models analyzed local control, overall survival, and disease-free survival (DFS).

Results

Of 201 patients, 109 were HPV+. Metabolic tumor volume and TLG correlated (r = 0.96), as did SUVpeak and SUVmax (r = 0.97). The PET variables correlated strongest with HPV status and T stage. These two accounted for 40% of the variance of MTV and 33% of TLG. Human papillomavirus–negative tumors had a significantly higher SUVmax, SUVpeak, MTV, and TLG. In univariable analysis, all PET variables were significantly associated with local control, overall survival, and DFS. In multivariable analysis, TLG was significantly associated to DFS in patients with HPV− OPC (hazard ratio, 1.005; 95% confidence interval, 1.001–1.010; P = 0.03). However, we did not observe this in HPV+ patients.

Conclusions

Increased baseline TLG is associated with worse DFS in HPV− OPC and might be used as biomarker for risk stratification in these patients. Interestingly, we could not identify this association in HPV+ patients.
Quality and Safety in Healthcare, Part LIII
Authors: Harolds Jay A.
Published: March 2019

There is overlap between the symptoms of depression and burnout. Many of those with burnout are also depressed. If the depression is significant, the individual should be referred for therapy. However, many articles on therapy for those with burnout are flawed, and the best type of therapy for burnout is controversial. However, cognitive behavior therapy is usually helpful for the emotional exhaustion component of burnout. Counseling and/or coaching may be helpful for those having burnout without significant depression. There are lessons from positive psychology that may be utilized to help counsel those with burnout.
Car Accident With Airbag Deployment Trauma Showed Special Pattern in Bone Scan
Authors: Chuang Tzyy-Ling , Hsu Ta-Wen , Chou Shih-Chin , Wang Yuh-Feng
Published: March 2019

A 72-year-old man had rectal adenocarcinoma with partial obstruction with liver and lung metastases. Bone scan showed special pattern with bony destructions to the lateral aspect of the left first to fourth and right first to 10th ribs (in a row in continuous vertical alignment), the costal end of the left second rib, the left sternoclavicular junction, and sternum. Patient recalled a car traffic accident with airbag deployment trauma to the anterior aspect of the chest about 2 months prior. Chest CT confirmed that the bone lesions were all fractures.
Orbital Paraganglioma
Authors: Zhu Binbin , Yan Jianhua
Published: March 2019

Background:

Paragangliomas are groups of neuroendocrine neoplasms originating from neural crest cells throughout the body, but are rarely observed within the orbit.

Case report:

Two patients, a 4-year-old male and 27-year-old female, presented with a slow-growing proptosis. Well-defined masses were located in the superomedial (male) and temporal (female) portion of the right orbit and involved the entire bodies of either the superior (male) or lateral (female) rectus muscles. B-mode ultrasound scan revealed a homogeneous, well-defined, hypoechoic mass, with rich blood flow signals inside the mass on CDI. CT scans indicated a well-defined, homogeneous mass with moderate enhancement, while MRI showed a well-defined mass with a salt and pepper appearance due to the prominence of blood vessels in the form of flow-void areas. Anterior orbitotomy and total tumor excision were performed on both patients. Subsequent histological and immunohistochemistry assays confirmed the diagnosis of orbital paraganglioma. The male patient is currently at 14 years of follow-up without recurrence or metastasis. The female patient developed recurrence at 3 months post-surgery. After a second surgery and local radiotherapy, there were no signs of the recurrence as assessed at 13 years of follow-up in this female patient.

Conclusion:

Orbital paraganglioma is an extremely rare benign tumor. The salt-and-pepper appearance as observed with MRI scan represents a relatively salient characteristic of this condition. Total excision of the lesion by orbitotomy is the treatment of choice and the possibility of tumor recurrence warrants diligent consideration. Radiotherapy is useful in patients with tumor recurrence or subtotal surgical excision.
Ventriculoperitoneal Shunting in Alobar Holoprosencephaly: Does it Work Even When Patient Has No Sign of Raised Intracranial Pressure?
Authors: Akpinar Elif , Gürbüz Mehmet Sabri , Okutan Mehmet Özerk , Beşkonakli Ethem
Published: March 2019

Holoprosencephaly (HPE) is a developmental anomaly of forebrain characterized by a failure of division of the embryonic forebrain into hemispheres. It is associated with a set of facial anomalies at a rate of 80%. Survival rate, particularly in alobar HPE, is quite low. Alobar HPE is usually associated with a large dorsal cyst which might eventually lead to hydrocephalus and raised intracranial pressure. Placement of ventriculoperitoneal (VP) shunt has been reported to be beneficial in symptomatic hydrocephalus accompanying HPE. Here we report a preterm infant born with alobar HPE and undergoing VP shunt placement although there was no sign of raised intracranial pressure. She is 12 months old now having near-normal developmental progress. This case has revealed that the placement of VP shunt, particularly inserting the catheter tip into dorsal cyst of HPE, might be beneficial and contribute to the survival and further brain development even in the absence of the signs of raised intracranial pressure.
Median Perforating Canal in Human Mandible
Authors: Marzook Hamdy A. , El-Gendy Abeer A. , Darweesh Fawzy R.S.
Published: March 2019

Surgical interventions in the anterior region of the human mandible are associated with many complications. Some anatomical structures like the median perforating canal were discovered in mammals. Such canals may be a cause of concern that needs attention in human mandible. The purpose of the present study was to evaluate the occurrence, location, and course of median perforating canal and its associated extensions in the anterior segment of the human mandible in cone beam computed tomography scans (CBCT). Data were collected from 160 CBCT scans, and evaluated. The incidence was 23.75% for median perforating canal with wide anatomical variations concerning the related lingual and labial extensions. Median perforating canal and their associated lingual and labial foramina are frequently seen in human mandible. A thorough investigation of the symphyseal region using CBCT must be taken into account when targeting surgical intervention in this area.
Extranasopharyngeal Angiofibroma of the Frontal Sinus
Authors: Kim Jong Seung , Kwon Sam Hyun , Kim Jung Soo , Jung Ji Yun , Heo Sung Jae
Published: March 2019

Angiofibroma is a rare tumor that accounts for about 0.05% of all head and neck tumors; it mainly occurs in the region of the nasopharynx. To date, no study originating in the frontal sinus has been reported. The authors report a report of an 18-year-old male complaining of severe pain in the right periocular area, forehead, and temporal area for 1 week. Endoscopic sinus surgery in combination with trephination was used to remove the tumor and the tumor was diagnosed as angiofibroma from histopathologic examination. It is hard to consider a tumor as being angiofibroma when it is not located in the nasopharynx. In particular, although extranasopharyngeal angiofibroma can occur in all head and neck regions, a tumor which has developed in the frontal sinus is more difficult to diagnose as angiofibroma because no patients have been reported until now. With this study, surgeons now need to be aware of the possibility of occurrence of angiofibroma in the frontal sinus.
Bone Morphogenetic Protein-9–Stimulated Adipocyte-Derived Mesenchymal Progenitors Entrapped in a Thermoresponsive Nanocomposite Scaffold Facilitate Cranial Defect Repair
Authors: Lee Cody S. , Bishop Elliot S. , Dumanian Zari , Zhao Chen , Song Dongzhe , Zhang Fugui , Zhu Yunxiao , Ameer Guillermo A. , He Tong-Chuan , Reid Russell R.
Published: March 2019

Due to availability and ease of harvest, adipose tissue is a favorable source of progenitor cells in regenerative medicine, but has yet to be optimized for osteogenic differentiation. The purpose of this study was to test cranial bone healing in a surgical defect model utilizing bone morphogenetic protein-9 (BMP-9) transduced immortalized murine adipocyte (iMAD) progenitor cells in a citrate-based, phase-changing, poly(polyethylene glycol citrate-co-N-isopropylacrylamide) (PPCN)-gelatin scaffold. Mesenchymal progenitor iMAD cells were transduced with adenovirus expressing either BMP-9 or green fluorescent protein control. Twelve mice underwent craniectomy to achieve a critical-sized cranial defect. The iMAD cells were mixed with the PPCN-gelatin scaffold and injected into the defects. MicroCT imaging was performed in 2-week intervals for 12 weeks to track defect healing. Histologic analysis was performed on skull sections harvested after the final imaging at 12 weeks to assess quality and maturity of newly formed bone. Both the BMP-9 group and control group had similar initial defect sizes (P = 0.21). At each time point, the BMP-9 group demonstrated smaller defect size, higher percentage defect healed, and larger percentage defect change over time. At the end of the 12-week period, the BMP-9 group demonstrated mean defect closure of 27.39%, while the control group showed only a 9.89% defect closure (P < 0.05). The BMP-9-transduced iMADs combined with a PPCN-gelatin scaffold promote in vivo osteogenesis and exhibited significantly greater osteogenesis compared to control. Adipose-derived iMADs are a promising source of mesenchymal stem cells for further studies in regenerative medicine, specifically bone engineering with the aim of potential craniofacial applications.