bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictability modulates the anticipation and perception of pain in both self and others
Authors: Peng Weiwei , Huang Xiaoxuan , Liu Yang , Cui Fang
Published: June 2019

Predictability has been suggested to modulate both the anticipation and perception of self-pain. Considering the overlapping neural circuits between self-pain and other-pain perceptions, the present study investigated how the predictability of forthcoming pain modulates the anticipation and perception of self-pain and other-pain. We used a balanced, within-participant experimental design in which a visual cue indicating the recipient, intensity and predictability of an upcoming painful electrical stimulation was presented before its delivery. Subjective ratings and electroencephalography activities to the anticipation and perception of self-pain and other-pain were recorded and compared between certain and uncertain conditions. Results showed that predictability affected the perception of self-pain and other-pain in a similar manner such that the differences in behavioral ratings and event-related potentials to high-intensity and low-intensity pain were significantly reduced when the intensity was uncertain. The strengths of predictability-induced modulation of self-pain and other-pain perceptions were positively correlated with each other. Furthermore, predictability also modulated the anticipation of both self-pain and other-pain such that pre-stimulus high-frequency α-oscillation power at sensorimotor electrodes contralateral to the stimulation side was maximally suppressed when anticipating certain high-intensity pain. These findings demonstrate that predictability-induced modulation on pain anticipation and perception was similarly applied to both self-pain and other-pain.
Real-time Monitoring of Cerebral Blood Flow and Cerebral Oxygenation During Rapid Ventricular Pacing in Neurovascular Surgery: A Pilot Study
Authors: Saldien Vera , Schepens Tom , Vanlinthout Luc , Wildemeersch Davina , Wouters Kristien , Vercauteren Marcel , Menovsky Tomas
Published: June 2019

Background:

Rapid ventricular pacing (RVP) can be used to produce short periods of flow arrest during dissection or rupture of a cerebral aneurysm but carries the risk of inducing cerebral ischemia. This study evaluates the intraoperative effect of RVP on local cerebral blood flow (CBF) and cerebral oxygenation during neurovascular surgery.

Materials and Methods:

Five patients undergoing elective cerebrovascular surgery were included in a single-center prospective study. RVP was applied in pacing periods of 40 seconds with 30% and 100% FiO2. Regional cerebral oxygenation was monitored using a Foresight near-infrared spectroscopy sensor. A Clark-type electrode and a thermal diffusion microprobe located in the white matter were used to monitor brain tissue pO2 and CBF, respectively.

Results:

CBF response to RVP closely followed the blood pressure pattern and resulted in a low-flow state. Unlike CBF, brain tissue pO2 and regional cerebral oxygenation showed a delayed response to RVP, decreasing beyond the pacing period and slowly recovering after RVP cessation. We found a correlation between brain tissue pO2 and regional cerebral oxygenation. Increasing the inspired oxygen concentration had a positive impact on absolute regional cerebral oxygenation and brain tissue pO2 values, but the pattern resulting from applying RVP remained unaltered.

Conclusions:

RVP reduces CBF and cerebral oxygenation. Brain tissue pO2 and regional cerebral oxygenation are correlated but unlike CBF respond to RVP in a delayed manner. Further research is required to evaluate the impact of longer RVP bursts on brain oxygenation.
Symptomatic Iliosacral Screw Removal After Pelvic Trauma—Incidence and Clinical Impact
Authors: Quade Jonathan , Busel Gennadiy , Beebe Michael , Auston Darryl , Shah Anjan R. , Infante Anthony , Maxson Benjamin , Watson David , Sanders Roy W. , Mir Hassan R.
Published: June 2019

Objective:

To calculate the incidence of symptomatic iliosacral (SI) screw removal following pelvic trauma and to determine the clinical impact of the secondary intervention.

Design:

Retrospective chart review.

Setting:

Level 1 and Level 2 trauma centers.

Patients:

Four hundred seventy-one consecutive patients undergoing percutaneous posterior pelvic fixation over 10 years, with 7 excluded for spinopelvic fixation,and 7 excluded due to age <16 year old.

Intervention:

Implant removal.

Main Outcome Measurement:

Secondary intervention.

Results:

A total of 25/457 patients underwent screw removal (5.4%). Two patients were lost to follow-up, leaving 23 for analysis. There were 13 male patients and 10 female patients. There were 13 SI and 10 trans-sacral screws removed. Four screws were loose before removal (17%). Average time to screw removal was 10.7 months (4–26 minutes). Fifteen (83.3%) patients had subjective improvement, and 3 (16.7%) had no notable improvement.

Conclusion:

The incidence of symptomatic SI screws necessitating removal is low (5.4%). When removed, there is a high likelihood (83%) that the secondary intervention will result in subjective symptomatic improvement. Routine screw removal is unnecessary because most patients tolerate the implants without symptoms necessitating subsequent surgery.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Contained-Delivery Route and the Administration of Postoperative Steroids Following Anterior Cervical Spinal Fusion With Low-dose rhBMP-2 Reduces the Magnitude of Respiratory Compromise
Authors: Maza Noor M. , Ferrer Christopher E. , Qureshi Sheeraz A. , Cho Samuel K. , Chaudhary Saad B. , Hecht Andrew C.
Published: June 2019

Study Design:

Retrospective chart review of patients who underwent anterior cervical discectomy and fusion (ACDF) using low-dose recombinant human bone morphogenic protein (rhBMP)-2.

Objective:

Determine whether severity and incidence of respiratory complications after ACDF surgery are decreased when using a low-dose BMP-infused sponge within a constrained carrier and postoperative IV and oral steroids.

Summary of Background Data:

Many physicians avoid using BMP in anterior cervical spine fusions because of concern for an increased incidence of dysphagia, significant prevertebral swelling, and airway edema compromise. Pilot studies have shown that the local application of steroids may decrease the incidence of postoperative airway edema and dysphagia. We performed a retrospective study to evaluate the safety of immediate postoperative tapered steroid use following low-dose rhBMP-2 completely contained inside either an allograft or PEEK cage in reducing the severity and incidence of respiratory complications following ACDF.

Materials and Methods:

Forty-seven patients between 33 and 74 years of age, undergoing 1-, 2-, 3-, or 4-level ACDFs augmented with a fraction of a small sponge of rhBMP-2 (0.525 mg/level) within an allograft or PEEK cage and prescribed IV and oral postoperative steroids between January 1, 2008 and November 1, 2016. The incidence of complications such as dyspnea, dysphagia, airway issues, edema ectopic bone osteolysis, radiculitis, and nonunion were collected using medical charts. Additional data regarding length of hospital stay and readmissions were also recorded.

Results:

No life-threatening respiratory events, such as prolonged intubation, re-intubation, or readmission for labored breathing, were observed. No complications referable to steroids such as delayed healing, uncontrollable blood sugar, or diabetes were encountered in this series.

Conclusions:

This study provides evidence that a tapered dose of steroids and a contained delivery route significantly decreases postoperative respiratory compromise incidence and magnitude following anterior cervical spine fusion using low-dose rhBMP-2.
Sagittal Balance in Adolescent Idiopathic Scoliosis Managed With Intraoperative Skull Femoral Traction
Authors: Peiro-Garcia Alejandro , Brown Garielle E. , Earp Madalene A. , Parsons David , Ferri-de-Barros Fabio
Published: June 2019

Study Design:

This is a retrospective cohort, single-center quality improvement study.

Objectives:

To evaluate the effect of the intraoperative skull femoral traction (IOSFT) on sagittal balance in posterior spinal instrumentation (PSI) to manage scoliosis.

Summary of Background Data:

IOSFT has been used routinely as an adjunct technique for facilitating PSI to manage scoliosis in our institution since 2010. Previous studies have raised concerns regarding the negative effect of IOSFT on lumbar lordosis.

Materials and Methods:

The medical records and radiographs of 113 patients with adolescent idiopathic scoliosis managed with single stage PSI were reviewed. Eighty-five patients were operated with IOSFT (traction group) and 28 patients were operated without traction (nontraction group). Patients who had double (anterior-posterior) approaches or nonidiopathic scoliosis were excluded. Sagittal balance and pelvic parameters at 2 years of postoperative follow-up were the primary outcome measures. Statistical analysis was done with R for statistical computing. Median values and interquartile range were compared between groups using Wilcoxon rank sum, Fischer exact, and Welch t tests. P-values of <0.05 were considered statistically significant.

Results:

No significant differences were found comparing postoperative lumbar lordosis in the nontraction group (54 degrees) with the traction group (53 degrees) (P=0.4953). No significant differences were found in postoperative sagittal vertical axis medians comparing both groups, with 17 mm in the nontraction group and 18 mm in the traction group (P=0.3994). No significant differences were found in postoperative pelvic parameters. The median pelvic incidence was 52 degrees in the nontraction group and 50 degrees in the traction group (P=0.2711).

Conclusions:

According to our results, the use of IOSFT as an adjunct to facilitate PSI for managing adolescent idiopathic scoliosis had no measurable negative impact on sagittal balance in our IOSFT cohort.
Metastatic Mixed Adenoneuroendocrine Carcinoma of the Colon with Response to Immunotherapy with Pembrolizumab: A Case Report
Authors: Stueger Amelie , Winder Thomas , Tinguely Marianne , Petrausch Ulf , Helbling Daniel
Published: June 2019

Mixed adenoneuroendocrine carcinoma (MANEC) is a rare, aggressive tumor arising from different localizations along the gastrointestinal tract with generally poor prognosis. We present the case of a 51-year-old female patient with histopathologically confirmed diagnosis of a MANEC of the descending colon. At presentation, the tumor had already spread to the liver causing extensive hepatic metastases. Immunohistochemical examination showed 5%–10% of tumor cells to express the programmed cell death receptor ligand 1 and FoundationOne testing revealed a high mutational tumor burden with 149 Muts/Mb. The patient responded very well clinically and radiologically to anti-programmed death 1 receptor monoclonal antibody pembrolizumab therapy after having undergone 3 previous systemic treatment regimens as well as selective internal radiation therapy of her hepatic metastases. Clinical improvement was evident after the first infusion already and is ongoing for 10 months so far with very little side effects including initial and short lived skin irritation as well as muscle pain. To our knowledge, this is the first published case where a MANEC was successfully treated with immunotherapy targeting the programmed death 1 receptor.
Primary Sternal Osteomyelitis: A Case Report and Review
Authors: Lopez Christopher D. , Hill J. Bradford , Stavropoulos Christos , Lerman Oren Z.
Published: June 2019

Primary sternal osteomyelitis (PSO) remains a rare but morbid and challenging condition. Due to the limited reports of PSO in the literature, management of this disease continues to lack consensus. We present a case report highlighting how PSO remained, in our experience, refractory to medical management, and how operative intervention provided resolution, and a review of the literature.
A Meta-analysis and Systematic Review of Emotion-Regulation Strategies in Borderline Personality Disorder
Authors: Daros Alexander R. , Williams Gregory E.
Published: June 2019

Emotion dysregulation is often considered a core characteristic of individuals with borderline personality disorder (BPD). With the development and strength of a contemporary affective-science model that encompasses both healthy emotion regulation (ER) and emotion dysregulation, this model has increasingly been used to understand the affective experiences of people with BPD. In this meta-analysis and review, we systematically review six of the most commonly studied ER strategies and determine their relative endorsement in individuals with elevated symptoms of BPD compared to individuals with low symptoms of BPD and healthy controls, as well as to individuals with other mental disorders. Results from 93 unique studies and 213 different effect-size estimates indicated that symptoms of BPD were associated with less frequent use of ER strategies that would be considered more effective at reducing negative affect (i.e., cognitive reappraisal, problem solving, and acceptance) and more frequent use of ER strategies considered less effective at reducing negative affect (i.e., suppression, rumination, and avoidance). When compared to individuals with other mental disorders, people with BPD endorsed higher rates of rumination and avoidance, and lower rates of problem solving and acceptance. We also review important contributions from studies of ER in BPD that we were unable to incorporate into our meta-analysis. We conclude by discussing how the pattern of using ER strategies in BPD contributes to emotion dysregulation and also the potential reasons for this pattern, integrating both Gross’s extended process model of ER and Linehan’s updated theoretical account on the development of emotion dysregulation.
Otitis Media-associated Bacterial Meningitis in Children in a Low-income Country
Authors: Lempinen Laura , Karppinen Mariia , Pelkonen Tuula , Laulajainen-Hongisto Anu , Aarnisalo Antti A. , Sinkkonen Saku T. , Bernardino Luis , Peltola Heikki , Pitkäranta Anne , Jero Jussi
Published: June 2019

Background:

Otitis media (OM) is a common childhood infection that may result in bacterial meningitis (BM). However, OM-associated BM remains poorly characterized. We aimed to study the occurrence, clinical presentation and outcome of this type of childhood BM in Luanda, Angola.

Methods:

Five hundred twelve children from our previous clinical BM trial, with the ear meticulously examined, were analyzed whether they had or not OM, and according to their age, ≤12 month old and >12 month old. Prospectively collected clinical data, laboratory test results and outcome for these groups were assessed.

Results:

Sixty-two children (12%) had OM-associated BM, of whom 39 had otorrhea. Ear discharge was more common in older children (median age 45 months old vs. 12 months old;P< 0.001). Children with OM often showed an additional infectious focus (n = 20, 32% vs. n = 82, 18%;P= 0.016), were dehydrated (n = 16, 26% vs. n = 66, 15%;P= 0.04), and showed higher odds of complicated clinical course or death (odds ratios 2.27, 95% CI: 1.004–5.15,P= 0.049) compared with children without OM. The >12-month-old children with OM often arrived in poor clinical condition with coma and/or ptosis. Otorrhea was associated with HIV positivity. Infants with otorrhea frequently lived under poor socioeconomic conditions.

Conclusions:

Children with OM-associated BM were prone to many problems, such as being especially ill at presentation, undergoing a difficult clinical course and showing a higher risk of complicated or fatal outcome. HIV infection and malnutrition were common in children with otorrhea, which was also associated with low socioeconomic status.
Pneumococcal-related Hemolytic Uremic Syndrome in the United Kingdom
Authors: Makwana Ashley , Sheppard Carmen , Fry Norman K. , Ladhani Shamez N.
Published: June 2019

Background:

children <5 years of age since the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in 2006 and its replacement with the 13-valent pneumococcal conjugate vaccine (PCV13) in 2010 in the United Kingdom.

Methods:

Public Health England conducts enhanced national surveillance of invasive pneumococcal disease in England. Confirmed invasive pneumococcal disease cases diagnosed between September 1, 2006, and March 31, 2016, with hemolytic uremic syndrome reported as a complication were included in the analysis.

Results:

There were 54 cases of pHUS during the surveillance period, with a median age of 17 months. The incidence of pHUS was 0.25/100,000 during the PCV7 period and 0.08/100,000 during the PCV13 period (incidence rate ratio: 0.31; 95% confidence interval: 0.16–0.57; P < 0.0001). Twelve children (22%) had an underlying comorbidity before disease onset. Overall, 31 (57%) presented with lower respiratory tract infection, 14 (25%) with meningitis, 8 (15%) with bacteremia and 1 (2%) with septic arthritis. An empyema was reported in 26/31 children (84%) with lower respiratory tract infection and cerebral abscess in 5/14 children (36%) with meningitis. The main responsible serotypes were 19A (n = 20), 3 (n = 6), 7F (n = 5) and 33F (n = 4). Eight children (15%) died, including 6 with meningitis.

Conclusions:

pHUS continues to be associated with significant morbidity and mortality. The incidence of pHUS was significantly lower after PCV13 replaced PCV7 in the childhood immunization program. Currently, most cases are due to non-PCV13 serotypes.
Validation of the British Thoracic Society Severity Criteria for Pediatric Community-acquired Pneumonia
Authors: Ambroggio Lilliam , Brokamp Cole , Mantyla Rachel , DePaoli Bradley , Ruddy Richard M. , Shah Samir S. , Florin Todd A.
Published: June 2019

Background:

The British Thoracic Society (BTS) guideline for pediatric community-acquired pneumonia (CAP) outlines severity criteria to guide clinical decision-making. Our objective was to examine the predictive performance of the criteria on the need for hospitalization (NFH) and disposition.

Methods:

This was a retrospective cohort study of children 3 months–18 years of age diagnosed with CAP in an urban, pediatric emergency department (ED) in the United States from September 2014 to August 2015. Children with chronic medical conditions, recent ED visits, and ED transfers were excluded. The main outcomes were interventions or diagnoses that necessitate hospitalization (ie, NFH) and disposition (eg, admit vs. discharge). Test characteristics, stratified by age, were calculated for each outcome.

Results:

Of 518 eligible children, 56.6% (n = 293) were discharged from the ED with 372 children meeting at least 1 BTS criterion. Overall BTS criteria were specific but not sensitive for NFH nor for disposition. For children <1 year of age sensitive criteria included not feeding and temperature for NFH and tachycardia, cyanosis and not feeding for disposition. For children ≥1 year of age, tachycardia had a sensitivity of >0.60 for both outcomes. The areas under the receiver operator characteristic curves for predicting any BTS criteria was 0.57 for NFH and 0.84 for disposition.

Conclusions:

The BTS CAP severity criteria had fair to excellent ability to predict NFH and disposition, respectively. Although specific, the low sensitivity and poor discriminatory ability for NFH of these criteria suggest a need for improved prognostic tools for children with CAP.
Antimicrobial Use in a Swedish Pediatric Hospital
Authors: Luthander Joachim , Bennet Rutger , Nilsson Anna , Eriksson Margareta
Published: June 2019

Background:

Antimicrobial resistance is increasing, and data on antimicrobial use in Swedish children are limited. We evaluated trends in antimicrobial use and attempted to identify targets for improving the quality of antimicrobial prescribing in a tertiary care center.

Methods:

One-day hospital-wide point prevalence surveys were conducted 8 times during 2003–2017 at Astrid Lindgren Children’s Hospital. Children <17 years old were included. Medical records were evaluated for risk factors, indications for treatment, and antibiotic agents used.

Results:

Among 946 admitted patients, 36% (336/946) received antimicrobial treatment. The total number of prescriptions increased (P = 0.031), but the proportion of patients treated remained unchanged. The proportion of patients receiving prophylactic treatment increased from 11% to 43% (P = 0.005). The rate of hospital-acquired infections remained unchanged. The primary indication for antimicrobial therapy was sepsis, fever of unknown origin, or fever in neutropenia, followed by intra-abdominal infections and pneumonia. The most frequently used antibiotics were cephalosporins, but consumption decreased, and in 2017 piperacillin-tazobactam was the most frequently used. Antimicrobial use was generally appropriate, although guidelines were often missing. The number of pediatric hospital beds decreased, and the bed occupancy was 71% (101/142) in 2003 and 121% (110/91) in 2017. The patient mix changed toward more patients with underlying risk factors for infectious diseases.

Conclusions:

Antimicrobial use changed during the study period, mainly due to increased prophylactic use in at-risk patients. Antimicrobial stewardship programs including infection control interventions and increasing the availability of guidelines may reduce and improve antimicrobial therapy.
Demographics, Complications and Resource Utilization for Patients Hospitalized for Measles Across Us Children’s Hospitals
Authors: Hester Gabrielle Z. , Nickel Amanda J. , Stinchfield Patricia A. , Spaulding Alicen B.
Published: June 2019

Our objective was to retrospectively describe measles hospitalizations in 52 US children’s hospitals. We identified 136 patients hospitalized for measles in 2004–2018; 17% (23/136) had complex chronic conditions, 2 of whom died or were in hospice. Among noncomplex patients only 39% received vitamin A, median length of stay was 3 days and median adjusted estimated costs were $5896.
The Economic Burden of Pediatric Postconcussive Syndrome
Authors: Corwin Daniel J. , Master Christina L. , Grady Matthew F. , Zonfrillo Mark R.
Published: June 2019

Objective:

To estimate the direct costs of pediatric postconcussive syndrome (PCS).

Design:

Retrospective cohort study.

Setting:

Subspecialty sports medicine clinics of a large pediatric tertiary care network in the United States.

Patients:

One hundred fifty-four patients aged 5 to 18 years with PCS, evaluated between 2010 and 2011.

Assessment of Independent Variables:

Direct costs included visits to sports medicine clinic, visio-vestibular therapy, homebound education, subspecialist referral, and prescription-only medications (amantadine and amitriptyline), all measured beginning at 28 days after injury.

Main Outcome Measures:

Postconcussive syndrome was defined as persistence beyond 28 days from injury.

Results:

The cost incurred by each PCS patient for sports medicine visits was $1575, for visio-vestibular therapy was $985, for homebound tutoring was $55, for prescription medications was $22, and for subspecialist referral was $120, totaling $3557 per patient, with a 95% confidence interval range of $2886 to $4257.

Conclusions:

Given the high economic costs of PCS determined in this study, therapies that mitigate this syndrome may have the potential to be cost-effective and even cost saving.
Non-HDL cholesterol should not generally replace LDL cholesterol in the management of hyperlipidaemia
Authors: Soran Handrean , Ho Jan H. , Adam Safwaan , Durrington Paul N.
Published: June 2019

Purpose of review

Non-HDL cholesterol was originally conceived as a therapeutic target for statin treatment in hypertriglyceridaemia when apolipoprotein B100 assays were not widely available. Recently non-HDL cholesterol has been recommended to replace LDL cholesterol in the clinical management of dyslipidaemia routinely in general medical practice. This is misguided.

Recent findings

Non-HDL cholesterol is heterogeneous, constituting a mixture of triglyceride-rich VLDL, intermediate density lipoprotein and LDL in which small dense LDL is poorly represented and to which VLDL cholesterol contributes increasingly as triglyceride levels rise. This makes it unsuitable as a goal of lipid-lowering treatment or as an arbiter of who should receive such treatment. Results of trials designed to lower LDL cholesterol are not easily translated to non-HDL cholesterol. Fasting is no longer thought essential for screening the general population for raised LDL cholesterol. ApoB100 measurement also does not require fasting even in rarer more extreme lipoprotein disorders encountered in the Lipid Clinic, provides greater precision and specificity and overcomes the problems posed by LDL and non-HDL cholesterol. It is more easily interpreted both in diagnosis and as a therapeutic goal and it includes SD-LDL.

If we are to discourage use of LDL cholesterol, it should be in favour of apoB100 not non-HDL cholesterol.
Bone Marrow Necrosis in a Patient Following Blinatumomab Therapy
Authors: Yarali Nese , Isik Melek , Arman-Bilir Ozlem , Guzelkucuk Zeliha , Oguz-Erdogan Ayse Selcen
Published: June 2019

Bone marrow necrosis (BMN) is an extremely rare condition characterized by necrosis of the myeloid tissue and medullary stroma leaving an amorphous eosinophilic background and ill-defined necrotic cells in the hematopoietic bone marrow. Several conditions are associated with BMN, including sickle cell disease, metastatic carcinoma, and hematologic malignancies. It is also associated with the use of antineoplastic drugs, such as fludarabine, interferon alpha, and imatinib. Blinatumomab is a CD19/CD3 bispecific T-cell engager antibody which redirects autologous CD3-positive T cells to CD19-positive lymphoblasts creating a cytolytic synapse leading to blastic cells. Cytokine release syndrome, cerebral nervous system toxicities, and febrile neutropenia are the most frequent adverse effects of blinatumomab. Here, we report an adolescent boy with relapse/resistant acute lymphoblastic leukemia developing BMN following blinatumomab therapy. To our knowledge, this is the first case report on BMN following blinatumomab treatment.
Trajectories of functional performance and muscle strength recovery differ after total knee and total hip replacement: a performance-based, longitudinal study
Authors: Judd Dana L. , Wolfe Pamela , LeDoux Cherie V. , Hogan Craig , Dayton Michael R. , Stevens-Lapsley Jennifer E.
Published: June 2019

Total joint replacement is indicated to alleviate pain and disability associated with hip and knee osteoarthritis. Arthroplasty outcomes are typically reported together, or anecdotal comparisons are made between total knee arthroplasty (TKA) and total hip arthroplasty (THA) recovery. Limited data quantifies differences in recovery trajectories, especially with respect to performance-based outcomes. Seventy-nine people undergoing total knee or THA were followed over 6 months. Functional performance was measured using the stair climb test, timed-up-and-go test, and 6-min walk test. Surgical limb isometric strength was also measured. All outcomes significantly declined 1 month after surgery. Participants in the TKA group showed a greater decline in climbing stairs (P < 0.001), timed-up-and-go (P = 0.01), and 6-min walk distance (P < 0.01). Further, the TKA group lost more strength (P < 0.001) and were weaker than those after THA (P < 0.001). Differences in postoperative outcomes between groups at 3 and 6 months were also observed. The TKA group experiences a greater decline in measured outcomes than the THA group, and muscle strength and functional recovery occurred differently in each group. These findings should be considered in rehabilitation priorities after arthroplasty surgery.
Is the UICC/AJCC pT2 Staging Category for Clear Cell Renal Cell Carcinoma Meaningful?
Authors: Delahunt Brett , Dagher Julien , Egevad Lars , Yaxley John , Varma Murali , Samaratunga Hemamali
Published: June 2019

This study was undertaken to determine the association between extrarenal tumor spread and size in a series of well-sampled clear cell renal cell carcinoma (ccRCC). In a series of 917 cases of ccRCC, 178 were >7 cm in maximum extent. Assessment of tumors >7 cm in size showed 72 (40.4%) to have renal sinus infiltration, the tumor infiltrating perirenal fat in 7 (3.9%) cases, and both in 96 (53.9%) cases. In the remaining 3 (1.7%) cases, no extrarenal extension of the tumor was seen. These 3 cases with organ-confined ccRCC were all cystic tumors. Two showed extensive infarction with associated hemorrhage and the presence of a thick investing pseudocapsule, while the third was a cystic ccRCC arising in the upper pole of the kidney. For the ccRCCs in the series that were ≤7 cm in maximum extent, division of cases according to tumor size and pT staging category showed an increase in the proportion of tumors showing extrarenal spread with increasing size, ranging from 0% for tumors <1 cm in diameter to 84.7% for tumors >6 to 7 cm. The study has shown that for ccRCC, the extrarenal spread of tumor is strongly associated with the size of the primary tumor. The study has also shown that renal sinus invasion and/or perirenal fat infiltration by tumor is commonplace in tumors >7 cm in maximum extent and that tumors of this dimension are rarely organ-confined. These findings provide evidence that the defining features of pT1, pT2, and pT3a staging categories for ccRCC require revision.
Emergency Management of Acute Late-Presenting Congenital Diaphragmatic Hernia in Infants and Children
Authors: Yuan Miao , Li Fei , Xu Chang , Fan Xia , Yang Gang , Xiang Bo , Huang Lugang
Published: June 2019

Objectives

Acute late-presenting congenital diaphragmatic hernia (CDH) might result in mediastinal shift away from the lesion and even sudden cardiopulmonary arrest. This study aimed to discuss the prompt and effective emergency management of acute late-presenting CDH.

Methods

A retrospective review of acute late-presenting CDH cases in West China Hospital of Sichuan University and Guizhou Provincial People's Hospital from October 2010 to June 2016 was conducted.

Results

A total of 22 patients were included in this study. All the patients presented with respiratory symptoms. Chest x-ray revealed swollen stomach and mediastinal shift. After nasogastric tube placement, fluid infusion, and nasal oxygen breathing, the symptoms in 8 patients ameliorated, and 14 patients had no signs of obvious relief. Three patients underwent the bedside percutaneous puncture of distensible stomach, and 1 patient died in the process of emergent management for critical condition. The remaining 21 patients underwent emergency surgery. Five thoracotomies and 16 thoracoscopies were performed. Five thoracoscopies that were converted to thoracotomies were required for the difficult reduction of herniated stomach. At follow-up, all patients improved their condition.

Conclusions

Acute late-presenting CDH is a clinical emergency that can be fatal. The sudden and progressive expansion of the stomach is mainly responsible for this emergent condition. The prompt and effective management is key to decrease the mortality and achieve favorable prognosis.
Stretching and Progressive Resistance Exercise in Children With Cerebral Palsy: A Randomized Controlled Trial
Authors: Fosdahl Merete Aarsland , Jahnsen Reidun , Kvalheim Kristin , Holm Inger
Published: June 2019

Purpose:

To evaluate the effect of stretching and progressive resistance exercise on range of motion and muscle strength in children with cerebral palsy.

Methods:

Thirty-seven children with spastic bilateral cerebral palsy and Gross Motor Function Classification System levels I to III were randomized to an intervention and a comparison group. The intervention included stretching of hamstrings and progressive resistance exercise, targeting the lower extremities for 16 weeks, followed by a 16-week maintenance program. Passive and active popliteal angle and muscle strength were evaluated at 0, 16, and 32 weeks.

Results:

After 16 weeks nonsignificant improvements were found in passive, active popliteal angle and quadriceps and hamstrings strength.

Conclusion:

A 16-week stretching and progressive resistance exercise program followed by a 16-week maintenance program showed nonsignificant improvements in passive, active popliteal angle and muscle strength for the intervention group.
Distance-Based Throwing Programs for Baseball Players From Little League to High School
Authors: Cisco Steven , Miller Semon Megan , Moraski Paul , Smith Joseph , Thorndike Cheryl
Published: June 2019

An estimated 2.4 million children play baseball in 80 countries. The majority of these children have experienced pain with throwing. A key component to a successful rehabilitation after an upper extremity injury for a baseball player is an interval throwing program, which allows a youth athlete to increase the demands of throwing in a progressive and controlled manner. Numerous interval throwing programs are designed for baseball players of high school age and older, but few exist for the baseball player who is skeletally immature. Our interval throwing programs take into consideration various field dimensions, injury types, and position requirements for youth. Our goal is to create a guide for rehabilitation specialists and players to return to throwing as quickly and safely as possible.
A Meta-analysis Assessing Diarrhea and Pneumonia in HIV-Exposed Uninfected Compared With HIV-Unexposed Uninfected Infants and Children
Authors: Brennan Alana T. , Bonawitz Rachael , Gill Christopher J. , Thea Donald M. , Kleinman Mary , Long Lawrence , McCallum Caitryn , Fox Matthew P.
Published: June 2019

Objective:

Previous studies have demonstrated that HIV-exposed uninfected (HEU) infants and children experience morbidity and mortality at rates exceeding those of their HIV-unexposed uninfected (HUU) counterparts. We sought to summarize the association between HEU vs. HUU infants and children for the outcomes of diarrhea and pneumonia.

Design:

Meta-analysis.

Methods:

We reviewed studies comparing infants and children in the 2 groups for these infectious disease outcomes, in any setting, from 1993 to 2018 from 6 databases.

Results:

We included 12 studies, and 17,955 subjects total [n = 5074 (28.3%) HEU and n = 12,881 (71.7%) HUU]. Random-effects models showed HEU infants and children had a 20% increase in the relative risk of acute diarrhea and a 30% increase in the relative risk of pneumonia when compared with their HUU counterparts. When stratifying by time since birth, we showed that HEU vs. HUU children had a 50% and 70% increased risk of diarrhea and pneumonia, respectively, in the first 6 months of life.

Conclusions:

We show an increased risk of diarrhea and pneumonia for HEU vs. HUU infants and children. Although we acknowledge, and commend, the immense public health success of prevention of mother-to-child transmission, we now have an enlarging population of children that seem to be vulnerable to not only death, but increased morbidity. We need to turn our attention to understanding the underlying mechanism and designing effective public health solutions. Further longitudinal research is needed to elucidate possible underlying immunological and/or sociological mechanisms that explain these differences in morbidity.
The Impact of a Group-Based Multidisciplinary Rehabilitation Program on the Quality of Life in Patients With Fibromyalgia
Authors: Jacobs Herlinde , Bockaert Martine , Bonte Jan , D'Haese Mark , Degrande Jan , Descamps Line , Detaeye Ulrike , Goethals Willem , Janssens Jo , Matthys Koen , Muller Lieve , Van de Walle Hilde , Viane Ilse , Vlieghe Barbara , Grillet Michiel , Asher Rachael , Grillet Bernard , De Bacquer Dirk
Published: June 2019

Background and Objective

Patients with fibromyalgia (FM) have a substantially reduced health-related quality of life (HRQoL). Their management should preferably focus on multidisciplinary nonpharmacological interventions. However, the long-term impact of such multicomponent therapies is not fully established. Waiting lists for patients seeking medical treatment are long, making individual-based approaches often unfeasible. The aim of our pragmatic study was to evaluate long-term HRQoL benefits of a comprehensive 8-week group-based multidisciplinary rehabilitation program focusing on patients' coping ability and self-care.

Methods

A total of 94 patients with clinically confirmed FM agreed to participate in this study. Before entering the program based on group-based cognitive behavioral therapy and graded activity training, patients completed questionnaires to screen for comorbidities. Health-related quality of life was assessed at the start, at 8 weeks, 6 months, and 1 year using the 36-Item Short-Form Health Survey instrument. Changes in HRQoL scores were analyzed according to linear mixed regression modeling.

Results

Baseline findings confirmed the substantially low physical and mental HRQoL in FM patients as well as high levels of depression, anxiety, and burnout. Only 2 patients left the program prematurely; 89% participated in the 1-year assessment. By the end of the program, HRQoL was significantly improved in all domains. This effect was maintained at 6 months and 1 year for all subscales. Changes at 1 year were greater in younger patients and those with depressive feelings before the start of treatment.

Conclusions

Our group-based program offered to FM patients proved successful with significant improvements in their HRQoL both in the short and long term.
Diverse Behavior in 18F-Fluorocholine PET/CT of Brain Tumors in Patients With Neurofibromatosis Type 1
Authors: Pena Pardo Francisco José , Moreno José María Borrás , Jiménez Aragón Fátima , González García Jesús , García Vicente Ana María
Published: June 2019

Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder that causes CNS tumors in around 20% of patients, being pilocytic astrocytomas (PA), and particularly optic pathway gliomas (OPG), the most common. We present three cases of NF1 patients referred for 18F-fluorocholine PET/CT because of suspected glioma in the setting of ongoing FUMEGA (Functional and Metabolic Glioma Analysis) trial. One case turned out to be a WHO grade I ganglioglioma; the second was a high grade glioma; and the last one (negative in PET) a probable low-grade glioma.
Specific connectivity with Operculum 3 (OP3) brain region in acoustic trauma tinnitus: a seed-based resting state fMRI study
Authors: Job Agnès , Kavounoudias Anne , Jaroszynski Chloé , Jaillard Assia , Delon-Martin Chantal
Published: June 2019

Tinnitus mechanisms remain poorly understood. Our previous functional MRI (fMRI) studies demonstrated an abnormal hyperactivity in the right parietal operculum 3 (OP3) in acoustic trauma tinnitus and during provoked phantom sound perceptions without hearing loss, which lead us to propose a new model of tinnitus. This new model is not directly linked with hearing loss and primary auditory cortex abnormalities, but with a proprioceptive disturbance related to middle-ear muscles. In the present study, a seed-based resting-state functional MRI method was used to explore the potential abnormal connectivity of this opercular region between an acoustic trauma tinnitus group presenting slight to mild tinnitus and a control group. Primary auditory cortex seeds were also explored because they were thought to be directly involved in tinnitus in most current models. In such a model, hearing loss and tinnitus handicap were confounding factors and were therefore regressed in our analysis. Between-groups comparisons showed a significant specific connectivity between the right OP3 seeds and the potential human homologue of the premotor ear-eye field (H-PEEF) bilaterally and the inferior parietal lobule (IPL) in the tinnitus group. Our findings suggest the existence of a simultaneous premotor ear-eye disturbance in tinnitus that could lift the veil on unexplained subclinical abnormalities in oculomotor tests found in tinnitus patients with normal vestibular responses. The present work confirms the involvement of the OP3 subregion in acoustic trauma tinnitus and provides some new clues to explain its putative mechanisms.
Persistent trajectory-modulated hippocampal neurons support memory-guided navigation
Authors: Kinsky Nathaniel R. , Mau William , Sullivan David W. , Levy Samuel J. , Ruesch Evan A. , Hasselmo Michael E.
Published: June 2019

Trajectory-dependent splitter neurons in the hippocampus encode information about a rodent’s prior trajectory during performance of a continuous alternation task. As such, they provide valuable information for supporting memory-guided behavior. Here, we employed single-photon calcium imaging in freely moving mice to investigate the emergence and fate of trajectory-dependent activity through learning and mastery of a continuous spatial alternation task. We found that the quality of trajectory-dependent information in hippocampal neurons correlated with task performance. We thus hypothesized that, due to their utility, splitter neurons would exhibit heightened stability. We found that splitter neurons were more likely to remain active and retained more consistent spatial information across multiple days than did place cells. Furthermore, we found that both splitter neurons and place cells emerged rapidly and maintained stable trajectory-dependent/spatial activity thereafter. Our results suggest that neurons with useful functional coding properties exhibit heightened stability to support memory guided behavior.
Motility induced fracture reveals a ductile to brittle crossover in the epithelial tissues of a simple animal
Authors: Prakash Vivek N. , Bull Matthew S. , Prakash Manu
Published: June 2019

Animals are characterized by their movement, and their tissues are continuously subjected to dynamic force loading while they crawl, walk, run or swim1. Tissue mechanics fundamentally determine the ecological niches that can be endured by a living organism2. While epithelial tissues provide an important barrier function in animals, they are subjected to extreme strains during day to day physiological activities, such as breathing1, feeding3, and defense response4. How-ever, failure or inability to withstand to these extreme strains can result in epithelial fractures5, 6 and associated diseases7, 8. From a materials science perspective, how properties of living cells and their interactions prescribe larger scale tissue rheology and adaptive response in dynamic force landscapes remains an important frontier9. Motivated by pushing tissues to the limits of their integrity, we carry out a multi-modal study of a simple yet highly dynamic organism, the Trichoplax Adhaerens10–12, across four orders of magnitude in length (1 µm to 10 mm), and six orders in time (0.1 sec to 10 hours). We report the discovery of abrupt, bulk epithelial tissue fractures (∼10 sec) induced by the organism’s own motility. Coupled with rapid healing (∼10 min), this discovery accounts for dramatic shape change and physiological asexual division in this early-divergent metazoan. We generalize our understanding of this phenomena by codifying it in a heuristic model, highlighting the fundamental questions underlying the debonding/bonding criterion in a soft-active-living material by evoking the concept of an ‘epithelial alloy’. Using a suite of quantitative experimental and numerical techniques, we demonstrate a force-driven ductile to brittle material transition governing the morphodynamics of tissues pushed to the edge of rupture. This work contributes to an important discussion at the core of developmental biology13–17, with important applications to an emerging paradigm in materials and tissue engineering5, 18–20, wound healing and medicine8, 21, 22.
Rituximab treatment for IgA vasculitis: A systematic review
Authors: Carbonell Cristina , Mirón-Canelo Jose-A , Diez-Ruiz Sandra , Marcos M Miguel , Chamorro Antonio-J
Published: June 2019

Objetives

Immunoglobulin A vasculitis (IgAV) is an inflammatory disease with a controversial treatment based in corticosteroids as first line. To review cases of patients with IgA vasculitis (IgAV) treated with rituximab (RTX) and assess disease characteristics, treatment efficacy and safety.

Methods

We conducted a systematic literature review according to PRISMA guidelines. We searched Pubmed, Web of Science, Embase and Scopus, selecting articles with information on IgAV and RTX treatment up to February 2019, with no language limitations. We extracted data on patient characteristics, disease evolution, treatment safety and efficacy. We created a database and analyzed it using statistical software package SPSS v 22.0.

Results

We extracted clinical data for 43 IgAV patients treated with RTX. Distribution by sex was similar, and the median age at diagnosis was 16 (range 2 months to 70 years). The majority of patients were diagnosed at a pediatric age (24 patients under 18, 55.81%). The time of disease evolution until RTX administration greatly varied. An important number of patients suffered renal complications (86%) before RTX treatment. The frequency of adverse effects from RTX was low (7%, hypersensitivity with no treatment interruption). In terms of disease evolution, 41 patients (95.3%) presented clinical improvement, 15 patients had recurrence after initial remission (34.9%) and 34 patients (79.1%) achieved full remission after completing treatment. None of the patients treated with RTX and included in our systematic review died.

Conclusions

RTX is efficacious in patients with IgAV. A high percentage of patients achieved complete remission with a favorable safety profile.