bluuebunny/crossref_metadata_2025 huggingface dataset:
Identification of Fungal Communities Within the Tar Spot Complex of Corn in Michigan via Next-Generation Sequencing
Authors: McCoy A. G. , Roth M. G. , Shay R. , Noel Z. A. , Jayawardana M. A. , Longley R. W. , Bonito G. , Chilvers M. I.
Published: July 2019

Tar spot is a fungal disease complex of corn that has been destructive and yield limiting in Central and South America for nearly 50 years. Phyllachora maydis, the causal agent of tar spot, is an emerging corn pathogen in the United States, first reported in 2015 from major corn producing regions of the country. The tar spot disease complex putatively includes Monographella maydis (syn. Microdochium maydis), which increases disease damage through the development of necrotic halos surrounding tar spot lesions. These necrotic halos, termed “fish-eye” symptoms, have been identified in the United States, though Monographella maydis has not yet been confirmed. A recent surge in disease severity and loss of yield attributed to tar spot in the United States has led to increased attention and expanded efforts to understand the disease complex and how to manage it. In this study, next-generation sequencing of the internal transcribed spacer 1 (ITS1) ribosomal DNA was used to identify fungal taxa that distinguish tar spot infections with or without fish-eye symptoms. Fungal communities within tar spot only lesions were significantly different from communities having fish-eye symptoms. Two low abundance operational taxonomic units (OTUs) were identified as Microdochium sp., however, neither were associated with fish-eye symptom development. Interestingly, a single OTU was found to be significantly more abundant in fish-eye lesions compared with tar spot lesions and had a 91% ITS1 identity to Neottiosporina paspali. In addition, the occurrence of this OTU was positively associated with Phyllachora maydis fish-eye symptom networks, but not in tar spot symptom networks. Neottiosporina paspali has been reported to cause necrotic lesions on various monocot grasses. Whether the related fungus we detected is part of the tar-spot complex of corn and responsible for fish-eye lesions remains to be tested. Alternatively, many OTUs identified as Phyllachora maydis, suggesting that different isolate genotypes may be capable of causing both tar spot and fish-eye symptoms, independent of other fungi. We conclude that Monographella maydis is not required for fish-eye symptoms in tar spot of corn.
Transversus Abdominis Plane Block
Authors: Tran De Q. , Bravo Daniela , Leurcharusmee Prangmalee , Neal Joseph M.
Published: July 2019

In this narrative review article, the authors discuss the anatomy, nomenclature, history, approaches (posterior vs. lateral vs. subcostal), techniques, pharmacology, indications, and complications of transversus abdominis plane blocks, as well as possible alternative truncal blocks.

Despite the scarcity of evidence and contradictory findings, certain clinical suggestions can nonetheless be made. Overall transversus abdominis plane blocks appear most beneficial in the setting of open appendectomy (posterior or lateral approach). Lateral transversus abdominis plane blocks are not suggested for laparoscopic hysterectomy, laparoscopic appendectomy, or open prostatectomy. However, transversus abdominis plane blocks could serve as an analgesic option for Cesarean delivery (posterior or lateral approach) and open colorectal section (subcostal or lateral approach) if there exist contraindications to intrathecal morphine and thoracic epidural analgesia, respectively.

Future investigation is required to compare posterior and subcostal transversus abdominis plane blocks in clinical settings. Furthermore, posterior transversus abdominis plane blocks should be investigated for surgical interventions in which their lateral counterparts have proven not to be beneficial (e.g., laparoscopic hysterectomy/appendectomy, open prostatectomy). More importantly, because posterior transversus abdominis plane blocks can purportedly provide sympathetic blockade and visceral analgesia, they should be compared with thoracic epidural analgesia for open colorectal surgery. Finally, transversus abdominis plane blocks should be compared with newer truncal blocks (e.g., erector spinae plane and quadratus lumborum blocks) with well-designed and adequately powered trials.
An autophagy-dependent cell death of MDA-MB-231 cells triggered by a novel Rhein derivative 4F
Authors: Liu Yunfeng , Zhong Yanping , Tian Wei , Lan Fu , Kang Jiankang , Pang Huifeng , Hou Huaxin , Li Danrong
Published: July 2019

Triple negative breast cancer (TNBC) has very poor prognosis and no efficacious therapeutic options due to the absence of a validated molecular target. Therefore, novel therapeutic strategies against TNBC are urgently needed. Our team synthesized and screened a series of compounds derived from Rhein, of which 4F was selected for further analysis based on its ability to produce the vacuolated appearance of cells. Using Cell counting kit-8 assay, colony-formation assay, cell apoptosis and cell cycle assay, we compared the antitumor effects of 4F, Rhein and Cisplatin on a TNBC cell line MDA-MB-231 in vitro. The vacuoles in MDA-MB-231 cells were observed and analyzed by hematoxylin–eosin staining and transmission electron microscopy. Autophagy and apoptosis-related proteins including p62, Microtubule Light Chain 3 (LC3), Beclin-1 and Caspase-3 were determined by western blot. The tandem mRFP-GFP-LC3 Lentivirus was used for monitoring the maturation step of autophagosomes. Our data revealed that 4F had lower cytotoxicity to normal breast cell line MCF-10A as compared with positive drug Doxorubicin. Although 4F had better cytotoxicity than Rhein, it had no influence on cells apoptosis in 4F-treated cells. Accumulation of autolysosomes and autophagosomes was observed in 4F-treated MDA-MB-231 cells, accompanied by increased level of Beclin-1 protein. Enhanced autophagic flux was verified by higher ratio of LC3-II/LC3-I, the degradation of p62 protein and alteration in red and green fluorescence puncta. These findings suggested that the process of MDA-MB-231 cell death induced by 4F seemed rely mainly on autophagy rather than apoptosis. 4F may be an alternative drug candidate against TNBC and merits more exploration.
Disruption of the Gut Microbiome Increases the Risk of Periprosthetic Joint Infection in Mice
Authors: Hernandez Christopher J. , Yang Xu , Ji Gang , Niu Yingzhen , Sethuraman Arvinth S. , Koressel Joseph , Shirley Matthew , Fields Michael W. , Chyou Susan , Li Thomas M. , Luna Marysol , Callahan Rowan L. , Ross F. Patrick , Lu Theresa T. , Brito Ilana L. , Carli Alberto V. , Bostrom Mathias P. G.
Published: July 2019

Background

Periprosthetic joint infection (PJI) is one of the most devastating complications of total joint arthroplasty. Given the mortality and morbidity associated with PJI and the challenges in treating it, there has been increased interest in risk factors that can be modified before surgery. In this study, we used a novel mouse model to consider the role of the gut microbiome as a risk factor for PJI.

Questions/purposes

(1) Does the state of the gut microbiota before surgery influence the likelihood of developing an established infection in a mouse model of PJI? (2) How does the state of the gut microbiota before surgery influence the local and systemic response to the presence of an established infection in a mouse model of PJI?

Methods

Male C57Bl/6 mice were divided into two groups: those with modified microbiome ∆microbiome (n = 40) and untreated mice (n = 42). In ∆microbiome mice, the gut flora were modified using oral neomycin and ampicillin from 4 weeks to 16 weeks of age. Mice received a titanium tibial implant to mimic a joint implant and a local inoculation of Staphylococcus aureus in the synovial space (102 colony forming units [CFUs]). The proportion of animals developing an established infection in each group was determined by CFU count. The local and systemic response to established infection was determined using CFU counts in surrounding joint tissues, analysis of gait, radiographs, body weight, serum markers of inflammation, and immune cell profiles and was compared with animals that received the inoculation but resisted infection.

Results

A greater proportion of animals with disrupted gut microbiota had infection (29 of 40 [73%]) than did untreated animals (21 of 42 [50%]; odds ratio, 2.63, 95% CI, 1.04–6.61; p = 0.035). The immune response to established infection in mice with altered microbiota was muted; serum amyloid A, a marker of systemic infection in mice, was greater than in mice with disrupted gut microbiota with infection (689 µg/dL; range, 68–2437 µg/dL, p < 0.05); infection associated increases in monocytes and neutrophils in the spleen and local lymph node in untreated mice but not were not observed in mice with disrupted gut microbiota.

Conclusions

The findings from this in vivo mouse model suggest that the gut microbiota may influence susceptibility to PJI.

Clinical Relevance

These preclinical findings support the idea that the state of the gut microbiome before surgery may influence the development of PJI and justify further preclinical and clinical studies to develop appropriate microbiome-based interventions.
Key Features Defining the Disposition of Bispecific Antibodies and Their Efficacy In Vivo
Authors: Golay Josée , Regazzi Mario
Published: July 2019

Bispecific antibodies (BsAbs) are novel drugs, with only a few approved for clinical use. BsAbs are versatile molecules that come in many different forms and are designed and produced via genetic engineering. Although BsAbs share several pharmacokinetic (PK) and pharmacodynamic (PD) properties with monoclonal antibodies, they have their own unique characteristics based on their overall structure and specificities. BsAbs are generally more complex to investigate and develop than monoclonal antibodies, because they recognize at least 2 different antigens. Understanding their relative affinities to each target is crucial for determining their mechanism of action and efficacy. Moreover, the presence or absence of an Fc region determines, in part, their in vivo stability, distribution, and half-life. This study summarizes several PK and PD aspects that are specific for BsAbs and are important for the success of these new drugs. We emphasize previous PK/PD studies that have been fundamental for the correct prediction of appropriate dosages and schedules of these new drugs in clinical trials or for defining which drugs may take advantage of individualized and standardized drug monitoring for improved efficacy and safety.
Metacarpal Fracture Fixation in a Minor Surgery Setting Versus Main Operating Room: A Cost-minimization Analysis
Authors: Steve Anna K. , Schrag Christaan H. , Kuo Alice , Harrop A. Robertston
Published: July 2019

Background:

The objective of this study was to compare the costs of performing metacarpal fracture fixation in minor surgery (MS) versus the main operating room (OR) at a tertiary care center in Calgary, Alberta, from the institutional perspective.

Methods:

Data were extracted from the Operating Room Information System and the Business Advisory System by a financial analyst. All data were based on actual expenses from the 2016–2017 fiscal year (US$). Direct costs included: staffing, supply, day (outpatient) surgery unit, post-anesthesia care unit (PACU), and anesthesia (anesthesiologist and equipment) costs. Surgeon and hardware costs were deemed neutral and excluded from the analysis.

Results:

The total cost of metacarpal fixation in MS was $250, compared to $2,226 in the OR, after surgeon and hardware costs were excluded. Staffing costs are a major contributing factor to cost by location ($75 in MS versus $233 in OR), largely attributable to 0.5 nursing staff per room in MS compared to 3 nursing staff per room in the OR. Supply costs (minor tray, $94 versus case cart, $247) are also greater for OR cases. The combined costs for DSU ($465), PACU ($435), and anesthesia ($247) totaled $1,147 and are only incurred for OR cases.

Conclusions:

Repair of metacarpal fractures in MS represents a substantial cost-minimization strategy from the institutional perspective. Staffing and supply costs by location and the additional combined costs of DS, PACU, and anesthesia are all contributing factors.
Submandibular Gland Hemangioma
Authors: Sasaki Ryo , Okamoto Toshihiro , Kudo Satoshi , Yamamoto Tomoko , Ando Tomohiro
Published: July 2019

Hemangioma in the submandibular gland or submandibular space is rare. A 31-year-old woman was referred to our department. She became aware of painless swelling in the right submandibular gland at 9 months ago. The right submandibular gland showed swelling with no tenderness, and the palpation was softer than the normal submandibular gland. Magnetic resonance imaging short T1 inversion recovery (STIR) sequence showed a 38 × 29 mm well-circumscribed, lobulated mass with high signal intensity attached with the submandibular gland. Computed tomography showed phlebolith formation. A clinical diagnosis of suspected hemangioma in submandibular gland was made, and submandibular gland excision including mass was performed with submandibular approach without complications. No unusual bleeding during the surgery was observed. Pathological finding indicated that thick walled vessels containing smooth muscle were proliferated with dilatation. Some vascular lumen included phlebolith calcification. Although the boundary with the submandibular gland was mainly clear, some parts were irregularly occupied with a component of hemangioma. The final diagnosis was venous hemangioma in submandibular gland. No postoperative recurrence was recognized in 1-year follow-up. A search of PubMed revealed that only 18 cases associated with hemangioma in the submandibular gland in 12 English articles. Literature review indicated that (1) approximately 70% patients showed painful swelling and (2) x-ray or computed tomography may indicate the phlebolith calcification. It may make an erroneous diagnosis of sialolithiasis. Magnetic resonance imaging finding would be needed for the diagnosis.
The Oxymoron of Financial Illiteracy in a Highly Educated Population: Are We Appropriately Equipping Trainees?
Authors: Adetayo Oluwaseun A. , Ford Rachel S. , Nair Lakshmi , Eliann Reinhardt Myrna
Published: July 2019

Background:

Medical professionals often incur a significant financial burden in pursuit of a medical education. Despite rigorous medical education, financial education appears to be lacking during training. This study intended to explore the financial preparedness and education of 2 cohorts of medical professionals—alumni graduates of a single institution and current plastic surgery residency trainees.

Methods:

An electronic survey of the residency alumni at a single institution across all specialties over a 50-year period was conducted. This was conducted concurrent with a survey to current plastic surgery residency trainees across the country. The survey explored several core financially relevant areas, including financial education at various levels of training, fiscal goals, debt profile, spending and saving habits, investment management, financial and family obligations, estate planning, and retirement preparedness.

Results:

A total of 521 alumni and 84 residents completed the survey from the residency alumni cohort and plastic surgery training programs cohort, respectively. Results from both groups demonstrated that although the large majority considered financial education a priority, this was not prioritized in medical or residency training. Most were introduced to financial education either by a family member or by self-directed learning. Data on investments, savings, finances, and retirement planning are also presented.

Conclusions:

As a very literate group, there is an unacceptably high level of “illiteracy” concerning financial education at an early stage. Practicing physicians and current trainees believe that a more directed approach to financial education should be adopted, rather than the current laissez-faire climate during medical education and residency training.
Monitoring Electromagnetic Radiation Emissions in Buildings and Developing Strategies for Improved Indoor Environmental Quality [RETRACTED]
Authors: Weldu Yemane W. , Mannan Mehzabeen , Al-Ghamdi Sami G.
Published: July 2019

Electronic devices have become ubiquitous in daily life, but they emit electromagnetic radiation, which may have negative health impacts at excessive levels. Little is known regarding the impact of radiation emissions on building occupants or strategies for reducing its intensity. This study applied a novel approach using system analysis to quantify radiation exposure in building spaces, examine building material responses to radiation propagation, and investigate risks to human health in the country of Qatar. Radiation intensity levels varied based on the location and type of building space. Different types of construction materials showed varied responses to electromagnetic field wave propagation. Drywall exhibited the best blocking effect, whereas glass and lumber walls exhibited poor blocking effects. The field strengths quantified in this study are less than the corresponding reference values specified by some jurisdictions, but they are still significantly higher than the safety levels defined in many other countries, which could result in significant health risks. The key strategies for improving indoor environmental quality include the use of shielding materials, spatial design, reduction of exposure time, increased exposure distance, and complete avoidance of exposure in sensitive areas.
IDENTIFICATION AND CLASSIFICATION OF MACULAR MORPHOLOGIC BIOMARKERS RELATED TO VISUAL ACUITY IN RADIATION MACULOPATHY
Authors: Parrozzani Raffaele , Midena Edoardo , Trainiti Sara , Londei Davide , Miglionico Giacomo , Annunziata Tommaso , Frisina Rino , Pilotto Elisabetta , Frizziero Luisa
Published: July 2019

Purpose:

To identify and classify, by a multimodal imaging approach, the most relevant macular morphologic biomarkers related to visual acuity in patients affected by radiation maculopathy secondary to brachytherapy.

Methods:

Fifty-one consecutive patients previously treated with Iodine-125 brachytherapy because of uveal melanoma were enrolled. Each patient underwent full ophthalmologic examination including best-corrected visual acuity and multimodal macular imaging analysis. Macular morphological parameters were processed by a stepwise selection analysis.

Results:

Three macular parameters were identified as the most relevant macular morphologic biomarkers of poor visual acuity: the vertical thickness of the thickest macular cyst (P = 0.0001), the presence of foveal inner segment/outer segment (IS/OS) layer disruption (P = 0.0054), and the presence of foveal retinal pigment epithelium atrophy (0.0884). The intergrader agreement for these morphologic biomarkers was 0.98, 0.92, and 0.92, respectively (interclass correlation coefficient).

Conclusion:

The vertical thickness of the thickest macular cyst, the presence of foveal retinal pigment epithelium atrophy, and IS/OS layer disruption can be used to clinically characterize radiation maculopathy. These parameters allow for separation of the edematous component of radiation maculopathy, which is potentially treatable in early disease stages, from late onset atrophic components, which are theoretically irreversible.
ASYMETRIC GROWTH OF MACULAR ATROPHY ASSOCIATED WITH UNDERLYING MATURE, NONEXUDATIVE CHOROIDAL NEOVASCULARIZATION
Authors: Monés Jordi , Rodríguez-Bocanegra Eduardo , Biarnés Marc
Published: July 2019

Background/Purpose:

To describe a case study that shows a possible association between the slow growth rate of macular atrophy and the presence of underlying mature, nonexudative choroidal neovascularization.

Methods:

Case report.

Patient:

An 82-year-old woman with mixed age-related macular degeneration in both eyes was followed up for 6 years, with the last ranibizumab treatment given in the left eye more than 2 years previously. Evaluations included fluorescein angiography, spectral-domain optical coherence tomography, and optical coherence tomography angiography.

Results:

During follow-up, there was a peculiar growth of macular atrophy, involving mainly the superior nasal sector. No signs of exudation on fluorescein angiography or spectral-domain optical coherence tomography were apparent throughout this period. However, optical coherence tomography angiography showed a mature, nonexudative choroidal neovascularization under the foveal sparing area and surrounding all the boundaries of atrophy except in the superonasal sector. Macular atrophy growth was observed mainly in the region devoid of blood vessels.

Conclusion:

Growth of macular atrophy was more prominent in the region where mature, nonexudative choroidal neovascularization was absent. Nutrients provided by vessels from choroidal neovascularization may provide support to adjacent retinal pigment epithelium cells, slowing down the progression of atrophy.
Aneurysmal bone cyst of the pelvis and extremities: Contemporary management
Authors: Noordin Shahryar , Ahmad Tashfeen , Umer Masood , Allana Salim , Hilal Kiran , Uddin Nasir , Hashmi Pervaiz
Published: July 2019

Aneurysmal bone cysts are tumors of bone occurring predominantly in the metaphyses of long bones and posterior elements of spine in adolescents and young adults. Radiographically, on x-rays they appear as eccentric metaphyseal expansile lytic lesions containing “fluid-fluid” levels. Computed tomographic scan and magnetic resonance imaging clearly define the cysts and fluid-fluid levels; the former delineates cortical expansion and the latter the fibrovascular component clearly. Magnetic resonance imaging is particularly useful in differentiating aneurysmal bone cysts from malignant lesions. Histologically, these cysts are characterized by fibrovascular tissue, multinucleated giant cells, inflammatory cells, fiber-osteoid, “blue bone,” and blood filled lacunae. Chromosomal translocation has been found, implying a neoplastic basis for the development of aneurysmal bone cysts. Malignant transformation has been reported where radiation therapy was used, and in cysts associated with sarcomas. A high ratio of cellular component as compared with osteoid, and a high mitotic index have been reported to be associated with higher recurrence after treatment. Management is aimed at addressing patients’ symptoms and preventing/treating fracture, and can broadly be divided into nonoperative management (drug and radiation therapy), minimally invasive strategies (angiographic embolization, percutaneous injections), and operative management (curettage and bone grafting, en bloc excision). To reduce chances of recurrence, adjuvants such as electrocautery, high speed burr, phenol, cryotherapy, and argon beam laser have been used with variable degrees of success. With contemporary management, a cure rate of 70%–90% is expected.
Suture-Probe Canaloplasty as an Alternative to Canaloplasty Using the iTrack Microcatheter
Authors: Kodomskoi Leonid , Kotliar Konstantin , Schröder Andreas C. , Weiss Michael , Hille Konrad
Published: July 2019

Précis:

Significant intraocular pressure (IOP) reduction was achieved using a novel suture-probe canaloplasty (SPCP) procedure in patients with glaucoma. The effect and low rate of surgical complications were comparable with those of iTrack canaloplasty.

Purpose:

Ab externo canaloplasty using the iTrack microcatheter has been established as a safe surgical procedure to treat open-angle glaucoma. This article, however, describes the results of a novel technique using a cost-efficient suture-probe as an alternative to iTrack canaloplasty and presents 12-month follow-up results.

Patients and Methods:

SPCP was performed on 50 eyes of 50 patients with primary open-angle glaucoma, pseudoexfoliation glaucoma, and steroid-induced glaucoma. The mean±SD preoperative IOP was 21.9±7.0 mm Hg. A suture-probe was used to dilate Schlemm canal and to place a trabecular tensioning suture. Postoperative results were noted and statistically analyzed on the day of discharge from the clinic, and at 1.5, 3, 6, and 12 months of follow-up.

Results:

In all eyes, the mean postoperative IOP 12 months after SPCP was 13.7±3.0 mm Hg. The number of medications decreased from 2.8±0.9 to 0.1±0.4, and visual acuity was 0.3±0.3 logMAR. Postoperative course and complications included: hyphema >1 mm (2%); microhyphema (4%); bleb leakage (2%); bleb suture (2%); laser goniopuncture (18%); laser suture lysis (4%); scleral flap lifting (4%); and iris incarceration following laser goniopuncture (4%).

Conclusions:

SPCP is an inexpensive procedure that can achieve significant IOP reduction in patients with glaucoma. The IOP-lowering effect and low rate of surgical complications were very similar to those of iTrack canaloplasty.
Home Tonometry Assists Glaucoma Drainage Device Management in Childhood Glaucoma
Authors: Go Michelle S. , Barman Navajyoti R. , House Robert J. , Freedman Sharon F.
Published: July 2019

Précis:

Home tonometry is useful in detecting tube-opening and alarming intraocular pressures (IOPs) after Baerveldt glaucoma drainage device (GDD) implantation in childhood glaucoma, allowing for timely physician response and individualized patient care.

Purpose:

The postoperative management of the nonvalved Baerveldt GDD presents challenges in pediatric patients due to widely variable IOP often occurring perioperatively. We evaluated the use of home tonometry in the management of Baerveldt implants for refractory childhood glaucoma.

Materials and Methods:

As part of an ongoing prospective study involving home rebound tonometry, the families of patients receiving Baerveldt implants were trained to use the Icare TA01i rebound tonometer and asked to document IOP, relevant symptoms, and ocular medication changes outside of the clinic setting. Data were analyzed for time to tube-opening, multiple-day fluctuations, and various IOP trends. Clinician response to IOP fluctuations detected by home tonometry was also evaluated.

Results:

Included were 19 patients (mean age: 16.1±9.6 y) having Baerveldt implantation from 2015 to 2018 by 1 attending physician. Home tonometry detected 92.3% (12/13) of spontaneous tube-openings, which occurred at a mean of 6.0±0.5 weeks. By home tonometry, mean IOP decreased 32.7% (24 vs. 15 mm Hg, P<0.01); 5-day IOP fluctuation decreased from 15 mm Hg preoperatively to 8 mm Hg after tube-opening (P<0.05). Preoperative, postimplantation, and post–tube-opening IOP ranged from 10 to 59, 3 to 61, and 1 to 51 mm Hg, respectively. Home tonometry prompted 94 documented medication changes and validated 1 surgical decision among 14 patients.

Conclusions:

Home rebound tonometry accurately detected tube-opening and alarming IOP fluctuations, allowing clinicians to promptly and appropriately respond to these events. Home tonometry-augmented GDD management in childhood glaucoma may improve the care of these challenging patients.
A randomized trial to assess the immediate impact of acupuncture on quantitative sensory testing, pain, and functional status
Authors: Chen Lucy , Deng Hao , Houle Timothy , Zhang Yi , Ahmed Shihab , Zhang Vivian , Sullivan Shelly , Opalaze Arissa , Roth Sarah , Falacova Jen , St Clair Kristan , Vo Tran , Malarick Charline , Kim Hyangin , You Zerong , Shen Shiqian , Mao Jianren
Published: July 2019

In this randomized clinical trial, we examined whether the effect of true acupuncture can be differentiated from sham acupuncture (pain and functionality) by analyzing quantitative sensory testing (QST) profiles in chronic pain participants. We recruited 254 healthy or chronic back and neck pain participants. Healthy subjects were included to control for a possible effect of acupuncture on baseline QST changes. Study participants received 6 sessions (twice weekly) of true acupuncture, sham acupuncture, or no acupuncture treatment (routine care). Quantitative sensory testing profiles, pain scores, and functionality profile were obtained at baseline (visit 1) and after 3 (visit 4) or 6 sessions (visit 7). A total of 204 participants were analyzed. We found no QST profile changes among 3 groups (P = 0.533 and P = 0.549, likelihood ratio tests) in either healthy or chronic pain participants. In chronic back and neck pain participants, true acupuncture reduced pain (visit 4: difference in mean [DIM] = −0.8, 95% confidence interval [CI]: −1.4 to −0.1, adjusted P = 0.168; visit 7: DIM = −1.0, 95% CI: −1.7 to −0.3, adjusted P = 0.021) and improved functional status including physical functioning (DIM = 14.21, 95% CI: 5.84-22.58, adjusted P = 0.003) and energy/fatigue (DIM = 12.28, 95% CI: 3.46-21.11, adjusted P = 0.021) as compared to routine care. Our results indicate that QST was not helpful to differentiate between true acupuncture and sham acupuncture (primary outcome) in this study, although true acupuncture reduced pain and improved functionality (secondary outcomes) when compared with routine care.
Understanding the High Frequency Use of the Emergency Department for Patients With Chronic Pain: A Mixed-Methods Study
Authors: Glynn Brittany A. , Brulé Madeleine , Kenny Samantha L. , Khoo Eve-Ling , Shergill Yaadwinder , Smyth Catherine E. , Poulin Patricia A.
Published: July 2019

Introduction:

Chronic pain (CP) is a common driver of emergency department (ED) visits despite the ED not being the ideal setting for CP because of increased risk of adverse events and high costs.

Purpose:

The purpose of this study is to understand factors contributing to CP-related ED visits, patients' care experiences, and patients' perspectives on alternatives to the ED.

Methods:

We used a mixed-methods design combining semi-structured interviews and questionnaires with 12 patients with CP who had 12 or more ED visits over 1 year. We analyzed test scores using descriptive statistics and interviews using applied thematic analysis.

Results:

Four themes emerged. Factors contributing to ED visits included the following: fear (e.g., pain and its impact); inability to cope with pain; family suggestions to go to the ED; and access to other services and resources. Patients had validating and invalidating experiences in the ED: needs were met or not met; and feeling acknowledged or unacknowledged. Patients' experiences with their family physician included feeling supported or unsupported. Alternatives to the ED included working with an interdisciplinary team, developing personalized care plans, and increased community-based resources.

Conclusions:

Patients with CP and frequent ED use present with complex pain and care experiences, requiring careful attention to management strategies and the patient–provider relationship.
The Effects of Aromatherapy on Postpartum Women: A Systematic Review
Authors: TSAI Shuo-Shin , WANG Hsiu-Hung , CHOU Fan-Hao
Published: July 2019

Background

The postpartum period is the most crucial but also the most fragile stage of most pregnancies. The health benefits of aromatherapy have recently become more widely accepted among medical experts. Although a number of studies have examined these health benefits, no systematic reviews have been conducted to assess the effects of aromatherapy on the psycho-physiological health of postpartum women.

Purpose

This systematic review was conducted to evaluate the effectiveness of aromatherapy interventions on the psycho-physiological health of postpartum women, to determine the methods that were used to measure intervention effectiveness, and to identify the types of interventions that were used.

Methods

We searched for studies that evaluated the effects of aromatherapy on postpartum women published in the Chinese or English languages before March 2018. We used online databases such as the Taiwan Journal Index, Centre for European Policy Studies, Cumulative Index for Nursing and Allied Health Literature, Cochrane Library, PubMed, and Social Sciences Citation Index. The search keywords used were “women,” AND “postpartum,” OR “postnatal” AND “aromatherapy,” OR “aroma,” OR “essential oils.” Only randomized controlled trials including humans as study participants were included. The methodological quality of the trials was assessed using the modified Jadad scale. The quality of the full-text studies was assessed by three reviewers.

Results

The 15 studies that were included in this systematic review were performed in Iran, England, and the United States and included 2,131 participants in total. The numbers of participants in each study ranged between 35 and 635. The review found that the effective duration of aromatherapy varied according to the essential oils that were selected. The visual analog scale was the most frequently used measure of postpartum pain. Most of the studies found that the aromatherapy intervention improved postpartum physiological and psychological health, with positive effects shown on anxiety, depression, distress, fatigue, mood, nipple fissure pain, physical pain, post-cesarean-delivery pain, post-cesarean-delivery nausea, postepisiotomy pain, postepisiotomy recovery, sleep quality, and stress. Most of the studies reported no serious intervention-related side effects.

Conclusions

This systematic review may serve as a reference for healthcare workers in caring for postpartum women. Aromatherapy may be applied as a noninvasive complementary intervention to promote physio-psychological comfort in postpartum women.
Nurse Practitioners' Role in Improving Service for Elderly Trauma Patients
Authors: Bethea Audis , Samanta Damayanti , White Teresa , Payne Nancy , Hardway Jessica
Published: July 2019

Preexisting conditions and decreased physiological reserve in the elderly frequently complicate the provision of health care in this population. A Level 1 trauma center expanded its nurse practitioner (NP) model to facilitate admission of low-acuity patients, including the elderly, to trauma services. This model enabled NPs to initiate admissions and coordinate day-to-day care for low-acuity patients under the supervision of a trauma attending. The complexity of elderly trauma care and the need to evaluate the efficacy of management provided by NPs led to the development of the current study. Accordingly, this study endeavored to compare outcomes in elderly patients whose care was coordinated by trauma NP (TNP) versus nontrauma NP (NTNP) services. Patients under the care of TNPs had a 1.22-day shorter duration of hospitalization compared with that of the NTNP cohort (4.38 ± 3.54 vs. 5.60 ± 3.98, p = .048). Decreased length of stay in the TNP cohort resulted in an average decrease in hospital charges of $13,000 per admission ($38,053 ± $29,640.76 vs. $51,317.79 ± $34,756.83, p = .016). A significantly higher percentage of patients admitted to the TNP service were discharged home (67.1% vs. 36.0%, p = .002), and a significantly lower percentage of patients were discharged to skilled nursing facilities (25.7% vs. 51.9%, p = .040). These clinical and economic outcomes have proven beneficial in substantiating the care provided by TNPs at the study institution. Future research will focus on examining the association of positive outcomes with specific care elements routinely performed by the TNPs in the current practice model.
Hypocalcemia and Massive Blood Transfusions: A Pilot Study in a Level I Trauma Center
Authors: DiFrancesco Nicole R. , Gaffney Thomas P. , Lashley Jenna L. , Hickerson Kirsten A.
Published: July 2019

Trauma is a leading cause of death in the United States, and uncontrolled hemorrhage is often the primary cause of mortality. Massive transfusions provide lifesaving treatment for the bleeding trauma patient; yet, this is not a benign intervention. Calcium levels can be significantly decreased with rapidly transfused blood products due to the citrate preservative that is added. Citrate binds to the patient's endogenous calcium when blood products are administered, rendering calcium inactive. As a result, undesirable physiological effects can occur. Although there is a plethora of evidence reporting the negative effects of hypocalcemia during resuscitation, the research for standardization of calcium monitoring and replacement during a massive transfusion event is less robust. Consequently, monitoring and replacement of this vital electrolyte are often overlooked. Trauma department employees at an urban academic hospital were given a pretest to assess their knowledge of calcium monitoring and replacement during a massive transfusion. On the basis of test results and a need for staff education, a short, animated video was designed and distributed for viewing. Following the educational video, a posttest was administered and yielded higher scores when compared with the pretest (p = .001). Lack of knowledge and national standards may be root causes for hypocalcemia. Educational interventions such as innovative, brief videos can be effective for enhancing staff members' knowledge and improving patient care.
Sarcopenia assessed using bioimpedance analysis is associated independently with significant liver fibrosis in patients with chronic liver diseases
Authors: Hyun Kim Kyung , Kyung Kim Beom , Yong Park Jun , Young Kim Do , Hoon Ahn Sang , Han Kwang-Hyub , Kim Seung Up
Published: July 2019

Aim

Sarcopenia is common in patients with advanced fibrosis or cirrhosis. We investigated the correlation between sarcopenia and other clinical variables, in particular, significant liver fibrosis in patients with chronic liver diseases (CLDs).

Patients and methods

Patients with CLDs who underwent transient elastography (TE) and bioelectrical impedance analysis between 2015 and 2017 were retrospectively recruited. The sarcopenia index (SI) was calculated as follows: SI = total appendicular skeletal muscle mass (kg)/ body mass index (BMI) (kg/m2). Sarcopenia was defined as SI less than 0.789 for men and less than 0.521 for women. Significant liver fibrosis and fatty liver were defined using TE liver stiffness value more than 7 kPa and controlled attenuation parameter more than 250 dB/m, respectively.

Results

Of 2168 patients recruited, 218 (10.1%) had sarcopenia. Age, BMI, diabetes, hypertension, fasting glucose, aspartate aminotransferase, and liver stiffness value were correlated positively with sarcopenia (all P < 0.05), whereas male sex, viral etiology, obesity (BMI > 25 kg/m2), total bilirubin, and serum albumin were correlated negatively with sarcopenia (all P < 0.05). On multivariate analysis, TE-defined significant liver fibrosis was associated independently with sarcopenia (odds ratio = 1.597; 95% confidence interval: 1.174–2.172; P = 0.003), together with age, male sex, viral etiology, and TE-defined fatty liver (all P < 0.05). Among the subgroups with ultrasonography-defined nonalcoholic fatty liver disease (n = 957), sarcopenia was also associated independently with TE-defined significant liver fibrosis (odds ratio = 1.887; 95% confidence interval: 1.261–2.823; P < 0.001).

Conclusion

Sarcopenia is associated independently with significant liver fibrosis in patients with CLDs. Further studies are required to determine whether interventions to improve muscle mass can improve liver fibrosis.
Cost-Effectiveness Analysis of Low-Cost, Domestic Short Peripheral Catheters Versus Higher-Priced, Imported Short Peripheral Catheters
Authors: Dizbay Murat , Ozger Hasan Selcuk , Bilgetekin Irem , Basyurt Rahsan , Yurtal Ozlem , Simsek Hatice , Baran Aksakal Nur
Published: July 2019

This prospective study has been designed with the hypothesis that low unit price does not necessarily mean cost-effectiveness. Low-cost, domestic short peripheral catheters (SPCs) and higher-priced, imported SPCs were compared in 2 different time periods. With the use of the higher-priced, imported SPCs, the rate of successful insertion on first attempt was increased (P < .001), and the development of complications was reduced (P < .001). The study revealed that $345 was saved per 1000 catheters when the catheter with the higher unit price was chosen. Although the domestic SPCs had a low unit price, their use resulted in greater health care expenses.
Coping Strategies for Self-perceived Burden Among Advanced Cancer Patients
Authors: Oeki Miki , Takase Miyuki
Published: July 2019

Background

Self-perceived burden (SPB) causes stress and negatively impacts the quality of life and mental health of patients. It is important to identify effective coping methods to reduce SPB when supporting advanced cancer patients.

Objective

To qualitatively elucidate advanced cancer patients’ strategies for coping with SPB.

Methods

Eleven participants with advanced cancer were recruited from 2 palliative care units. The data were collected through semistructured interviews and analyzed by content analysis.

Results

One of the coping strategies that advanced cancer patients used to reduce their SPB was “making individual efforts to deal with their own circumstances.” This category included subcategories: “making proactive action,” “expressing their gratitude verbally,” “suppressing their feelings,” “searching for positive meanings,” and “avoiding thinking about the burden on their families.” Another coping strategy used was “exploring the solutions with their family,” which consisted of one subcategory and indicated an open dialogue between patients and their families to reach acceptable and mutual decisions about patient care.

Conclusion

Nurses should not only support patients’ efforts to tackle the situation by themselves, but also help the family as a whole to tackle problems together. By facilitating meaningful dialogue between family members, patients’ feelings of SPB can be alleviated.

Implications for Practice

Nurses should facilitate dialogue between patients and their family members in order to help them discover solutions to reduce their SPB and to find positive meanings in the caregiving-receiving situation.
Burden Among Parents of Children With Cancer in Jordan: Prevalence and Predictors
Authors: Al Qadire Mohammad , Aloush Sami , Alkhalaileh Murad , Qandeel Haitham , Al-Sabbah Ashraf
Published: July 2019

Background

A diagnosis of cancer in children affects the children themselves and their entire family. Cancer treatment places parents under continuous stress and increases their life burdens.

Objective

The aim of this study was to assess the burden level and predictors as perceived by Jordanian parents of children with cancer.

Methods

A cross-sectional survey design was used to conduct the study in 2 hospitals. A sample of 264 parents of children with cancer was recruited. Data were collected using 2 instruments: the Zarit Burden Interview and the Hospital Anxiety and Depression Scale.

Results

The mean burden score was 38.1 (SD, 16.6), and 75.4% of parents experienced mild to severe levels of burden. Having a chronic disease, financial constraints, high levels of anxiety and depression, a child with advanced cancer, and a child experiencing pain, nausea, and vomiting predicted higher levels of burden.

Conclusions

Characteristics of both parents and children affect perceived levels of burden, and thus both should be taken into consideration by healthcare providers, and nurses in particular. Various interventions can be suggested to reduce the parents’ burden, including financial support, psychiatric care, and focused management of symptoms.

Implications for Practice

Powered by Editorial Manager and ProduXion Manager from Aries Systems Corporation, assessment of burden and screening for at-risk parents is of high importance and could be conducted briefly at admission and repeated thereafter. Healthcare institutions may need to offer various types of interventions for parents who are at high risk of burden to improve their quality of life and reduce their suffering.
Assessment of Tumor-infiltrating Lymphocytes Predicts the Behavior of Early-stage Oral Tongue Cancer
Authors: Heikkinen Ilkka , Bello Ibrahim O. , Wahab Awais , Hagström Jaana , Haglund Caj , Coletta Ricardo D. , Nieminen Pentti , Mäkitie Antti A. , Salo Tuula , Leivo Ilmo , Almangush Alhadi
Published: July 2019

Tumor-infiltrating lymphocytes (TILs) have shown a promising prognostic value in many epithelial cancers. We sought to assess the prognostic value of TILs in a multicenter cohort of early oral tongue squamous cell carcinoma (OTSCC). The percentage of TILs was assessed on the surgical resection slides stained with hematoxylin and eosin. The assessment of TILs was performed in the stromal compartment and in the intraepithelial compartment (at the invasive front and at the center of the tumor). We followed the method that was described recently by the International Immuno-Oncology Biomarker Working Group for the assessment of TILs. A total of 308 cases from the 5 Finnish university hospitals and from A.C. Camargo Cancer Center, São Paulo, Brazil, were included. We found a promising prognostic value for stromal TILs at the invasive front in the multivariable analysis with a hazard ratio of 2.61 (95% confidence interval [CI], 1.77-3.83; P<0.001) for overall survival, 1.99 (95% CI, 1.07-3.69; P=0.040) for disease-specific survival, and 1.94 (95% CI, 1.14-3.29; P=0.020) for disease-free survival. In conclusion, evaluation of TILs is simple and can aid in identifying the high-risk cases of early OTSCC. The method introduced by the International Immuno-Oncology Biomarker Working Group can be used for standardized determination of TILs in early OTSCC.
Suspected Radial Head Subluxation in Infants
Authors: Hanes Lauren , McLaughlin Robyn , Ornstein Amy E.
Published: July 2019

Radial head subluxation (“pulled elbow” or “nursemaid's elbow”) is a common pediatric condition in children aged 1 to 4 years, although it is an uncommon finding in nonambulatory infants. It is a clinical diagnosis, and further investigations such as x-ray are not routinely done. We present a case series of 2 nonambulatory infants with forearm fractures that were initially diagnosed as radial head subluxation. Current literature supports the use of x-ray in children with atypical or unclear history prior to an attempted pulled elbow reduction. We suggest that this recommendation should be extended to all nonambulatory infants, given the unlikely diagnosis of radial head subluxation, and the necessity for early recognition of injuries that may be indicators of abuse.
Abdominal Tuberculosis in an Infant Presenting With a Small Bowel Obstruction
Authors: Matettore Adela , Rajaprakash Meghna , Bennett Mary , Skarsgard Erik D. , Goldman Ran D.
Published: July 2019

Abdominal tuberculosis (TB) is rare in children and usually spread in the peritoneum or gastrointestinal tract. Symptoms tend to be vague and nonspecific, with no extra-abdominal involvement, presenting a challenge for clinicians and delayed diagnosis. Postnatally acquired abdominal TB is most commonly transmitted through inhalation or ingestion of respiratory droplets with Mycobacterium tuberculosis from the mother.

Abdominal TB in infants is rare. We present a case of a 2-month-old infant presenting with an acute bowel obstruction secondary to abdominal TB acquired through contact with maternal TB mastitis. This unique case emphasizes the importance of considering abdominal TB in the differential for at-risk infants presenting with small bowel obstruction.