bluuebunny/crossref_metadata_2025 huggingface dataset:
Anastrozole-induced pulmonary cryptococcosis in a patient with early breast cancer
Authors: Wei Min , Xu Yu-Rong , Liu Kui , Wen Peng
Published: January 2020

Introduction:

Estrogen is a key factor in breast cancer carcinogenesis, and reductions in its synthesis can decrease breast cancer risk. Anastrozole can reduce plasma estrogen levels by inhibiting the enzyme aromatase, and is approved for adjuvant treatment of breast cancer. We report a case of pulmonary cryptococcosis in a patient who was treated with anastrozole for an early-stage tumor. This case is of special interest because the patient achieved a better curative effect after the administration of anastrozole was discontinued.

Patient concerns:

A 61-year-old woman was found to have multiple pulmonary nodules on chest computed tomography (CT) after being treated for 5 months with anastrozole as an adjuvant breast cancer therapy. A biopsy of the largest lesion of the right lung showed cryptococcus fungal bodies with granulomatous inflammation, so the patient was diagnosed with pulmonary cryptococcosis. She was treated with fluconazole (400 mg/day) for 1 month, but a follow-up CT scan of chest showed no improvement.

Diagnosis:

Pulmonary cryptococcosis.

Interventions:

Because the pulmonary cryptococcosis was not improving, the administration of anastrozole was discontinued. Fluconazole was continued.

Outcomes:

The pulmonary lesions diminished in size 2 months after discontinuing anastrozole. The patient continued taking fluconazole for a total of 6 months without re-administration of anastrozole, and the lesions of pulmonary cryptococcosis almost disappeared.

Conclusion:

This case of pulmonary cryptococcosis may have been induced by a decrease in estrogen level caused by the aromatase inhibitor, anastrozole. Treatment of pulmonary cryptococcosis with concurrent anastrozole use may be ineffective, and it may be better to discontinue the aromatase inhibitor.
Transient increase in international normalized ratio (INR) and bleeding risk following Alendronate sodium in elderly patients on warfarin
Authors: Qian Sufeng , Zhou Jia , Bian Pingda , Shi Lingfei
Published: January 2020

Introduction:

Alendronate sodium is used to reduce the risk of bone fracture in aged osteoporosis patients. However, its side effects should be recognized, especially for those aged patients with one or more basic cardiovascular diseases.

Patient concerns:

A 90-year-old and a 75-year-old male patient were admitted to our department. These 2 patients were examined by dual energy X-ray absorptiometry (DXA).

Diagnosis:

Both patients were diagnosed with osteoporosis, they also had history of atrial fibrillation (AF) and had long term use of warfarin.

Interventions:

Alendronate sodium was prescribed to the two patients at 70 mg once a week.

Outcomes:

The 2 patients had experienced dramatic increase of international normalized ratio (INR) to 4.69∼4.86 within 24 hours and gradual decrease in the next 5 days. Both patients experienced spontaneous ecchymoses and petechiae in the skin at the first 72 hours.

Conclusion:

Alendronate sodium can transiently increase the INR over 50%, induce spontaneous ecchymoses and petechiae in the skin of aged male osteoporosis patients with AF who took warfarin. Clinicians should pay enough attention when using alendronate sodium on these kinds of patients and be aware of the consequent potential bleeding risk.
The timing of urinary catheter removal after gynecologic surgery
Authors: Huang Hui , Dong Li , Gu Lan
Published: January 2020

The present study aimed to assess the effect of removing an indwelling urinary catheter at different times on urinary retention and urinary infection in patients undergoing gynecologic surgery.

Electronic databases including PubMed, EMbase, the Cochrane Central Register of Controlled Trials, and Ovid from inception to June 2018 were searched. Relevant randomized controlled trials (RCTs) of removal the indwelling urinary catheter in different time were included.

Eight RCTs were included. Data were analyzed by RevMan 5.3 version. There was significant difference in urinary retention (relative risk [RR] 2.46, 95% confidence intervals [CIs] 1.10–5.53), P = .03) between the ≤6 hours and >6 hours indwelling urinary catheter removal groups, while no significant differences were found in the gynecologic surgery excluded the vaginal surgery group and vaginal surgery group. When compared with >6 hours indwelling urinary catheter removal group, the incidence of urinary infection was significantly reduced at the ≤6 hours removal group (RR = 0.66, 95% CI 0.48–0.89, P = .007). The urinary catheter removal time at ≤6 hours also significantly reduced the incidence of urinary retention (RR = 5.06, 95%CI 1.74–14.69, P = .003), and did not statistically increase the incidence of urinary infection (RR = 0.30, 95%CI 0.08 to 1.20, P = .09), compared with immediate urinary catheter removal after surgery.

Removal time of the urinary catheter at ≤6 hours postoperatively seems to be more beneficial than immediate or >6 hours for patients undergoing gynecologic surgery which excluded the vaginal surgery.
Analysis of the laboratory indexes and risk factors in 189 cases of severe fever with thrombocytopenia syndrome
Authors: Liu Jingwen , Fu Hongmei , Sun Dapeng , Wu Shuzhi , Wang Li , Yao Mingxiao , Yuan Guangying
Published: January 2020

The current study aimed to analyze the clinical characteristics of severe fever with thrombocytopenia syndrome (SFTS) and to explore the risk factors of critical patients. From 2016 to 2018, we collected the hospitalized diagnosed cases with SFTS in Jinan infectious disease hospital of Shandong University and analyzed by the descriptive epidemiological method. According to the prognosis, they were divided into general group and severe group. The epidemiological characteristics, clinical features, and laboratory indexes of these 2 groups of patients were compared and analyzed at the first visit. The risk factors related to the severity of the disease were analyzed by univariate Logistic regression. In total, 189 cases of SFTS were treated during the period and 33 deaths occurred in the severe group, with the fatality rate of 17.46%. The patients’ age (χ2 = 8.864, P < .01), ALT (Z = −2.304, P = .03), AST (Z = −3.361, P < .01), GLU (t = −4.115, P < .01), CK (Z = −3.964, P < .01), CK-MB (Z = −2.225, P = .03), LDH (Z = −3.655, P < .01), α-HBDH (Z = −2.040, P = .04), APTT (t = −3.355, P < .01), BUN (Z = −2.040, P = .04), Cr (Z = −3.071, P = .01), and D-dimer (Z = −2.026, P = .04) in the severe group were higher than that in the normal group, but the blood platelet (PLT) counts were significantly lower (Z = −2.778, P < .01) than that in the normal group. With the neuropsychiatric symptoms (OR = 24.083, 95% CI = 6.064–95.642), skin bleeding point (OR = 30.000, 95% CI = 6.936–129.764), multiple organ dysfunction (OR = 34.048, 95% CI = 7.740–149.782), past medical history (OR = 3.792, 95% CI = 1.284–11.200), and fasting glucose elevation (OR = 1.359, 95% CI = 1.106–1.668) could predict the severity of the SFTS. In summary, the abnormality of the laboratory index, the special clinical manifestations, and the past medical history of SFTS patients were the important basis for judging the patient's serious condition.
Neoadjuvant chemotherapy for lymph node-positive penile cancer: current evidence and knowledge
Authors: Bandini Marco , Pederzoli Filippo , Necchi Andrea
Published: January 2020

Purpose of review

To review the latest in penile cancer treatment focusing on neoadjuvant chemotherapy in patients with regional lymph node involvement.

Recent findings

Patients with regional lymph node involvement from penile cancer still suffer from a poor prognosis, and the chances to achieve cure are primarily dependent on the extent of the disease. Despite multiple lines of research are indicating the need for a multimodal management of the disease upfront, the search for newer effective systemic therapies is ongoing. The available guidelines currently suggest the use of combination chemotherapy regimens including taxanes and cisplatin as induction therapy before lymphadenectomy in patients with locally advanced disease (i.e., fixed or bulky inguinal lymph nodes or pelvic lymph node involvement). Research in the field will aim to provide more effective systemic therapies also in patients with a more limited disease spread to further improve the outcomes. Data from the literature also indicate the possibility to effectively administer postoperative chemotherapy in selected high-risk patients.

We aimed to provide the evidence from the literature and the new avenues that would help delineating the optimal therapeutic pathway for these complex patients, commenting on the new opportunities that may come from the ongoing research.
Burst wave lithotripsy and acoustic manipulation of stones
Authors: Chen Tony T. , Samson Patrick C. , Sorensen Mathew D. , Bailey Michael R.
Published: January 2020

Purpose of review

Burst wave lithotripsy and ultrasonic propulsion of kidney stones are novel, noninvasive emerging technologies to separately or synergistically fragment and reposition stones in an office setting. The purpose of this review is to discuss the latest refinements in technology, to update on testing of safety and efficacy, and to review future applications.

Recent findings

Burst wave lithotripsy produced consistent, small passable fragments through transcutaneous applications in a porcine model, while producing minimal injury and clinical trials are now underway. A more efficient ultrasonic propulsion design that can also deliver burst wave lithotripsy effectively repositioned 95% of stones in 18 human participants (18 of 19 kidneys) and clinical trials continue. Acoustic tractor beam technology is an emerging technology with promising clinical applications through the manipulation of macroscopic objects.

The goal of the reviewed work is an office-based system to image, fragment, and reposition urinary stones to facilitate their natural passage. The review highlights progress in establishing safety, effectiveness, and clinical benefit of these new technologies. The work is also anticipating challenges in clinical trials and developing the next generation of technology to improve on the technology as it is being commercialized today.
Predictors of Outcome of Acute Partial Hospitalization
Authors: Lieberman Paul B. , Gentes Emily , Russell Sheila A.
Published: January 2020

To identify predictors of outcome of acute partial hospital (PH) treatment, patients admitted during a 15-month period were studied. Outcomes were change in the Behavior and Symptom Identification Scale and readmission within 30 days. Predictors were clinical and demographic variables obtained on all patients. Most patients (92%) improved during acute PH treatment, only 5% were readmitted, and average changes were moderate to large. However, many patients still had significant symptoms and behavioral problems at discharge, 56.5% missed at least 1 day, and 16.5% dropped out. Less acute improvement was associated with greater long-term impairment, worse treatment attendance, more previous treatment episodes, and fewer medication changes. Readmission was associated with less acute improvement and its predictors, and with nonattendance. In summary, acute outcome in PH was predicted by functioning more generally. Factors that affect patients' acute PH responses may also affect functioning in other areas. These findings suggest possible modifications of PH practices and programs.
Utility of Postreduction Radiographs After Fluoroscopy-Guided Reduction and Casting of Uncomplicated Pediatric Forearm Fractures
Authors: Chitnis Salil , Giordano Jon , Naraghi Leily , Bonadio William
Published: January 2020

Objective

The aim of the study was to determine efficacy of performing postreduction radiographs in managing uncomplicated pediatric forearm fractures after reduction and casting under fluoroscopic guidance.

Design

This is retrospective analysis of consecutive cases.

Setting

The study was conducted in a large urban hospital pediatric emergency department (ED).

Participants

Pediatric patients presenting to the ED with a forearm fracture between the ages of 0 to 18 years. All received orthopedic manual reduction with fluoroscopic guidance and casting, then followed by performance of a dedicated 2-view radiographic series of postreduction forearm to document proper alignment and cast placement.

Main Outcome(s) and Measure(s)

Of 236 consecutive cases studied, there were only 5 cases (2%) in which the managing orthopedist determined that a further reduction attempt was warranted based on the postreduction radiograph results. All were mid-shaft fractures of both radius and ulna, which were angulated and/or displaced. The remaining 231 patients with an uncomplicated forearm fracture received no further ED clinical orthopedic intervention after performing postreduction radiographs. The mean ED time to ultimate discharge was prolonged an average of 89 minutes per patient after reduction and casting while awaiting performance/orthopedic review of postreduction radiographs. A calculation of postreduction radiograph cost amounted to a total of nearly US $50,000.

Conclusions

Performance of postreduction radiographs in children with uncomplicated pediatric forearm fractures that are reduced and casted under fluoroscopy has little clinical utility and contributes to increased radiation exposure, patient health care cost, and time spent in the ED. Patients with mid-shaft forearm fractures involving both radius and ulna (especially if angulated or displaced) are at risk for unacceptable reduction after casting and may be the target group in which performing post reduction radiographs has potential benefit.
HIV Seroconversion and Types of Relationships Among Men Who Have Sex With Men: A Cohort Study in China
Authors: Sun Xiaoming , Wang Chunyan , Zhao Kun , Zhang Lifen , Li Menglong , Sun Dianqin , Shu Wen , Ruan Yuhua , Zhang Jinyan , Vermund Sten H. , Li Dongliang , Hu Yifei
Published: January 2020

Background:

The role of partner types in modifying HIV seroconversion risk among men who have sex with men (MSM) is complex. We sought to understand the role of regular sexual partners and risky sexual behavior in contributing to incident HIV infection among MSM.

Methods:

From July 2011 to August 2017, we recruited HIV-negative men who reported having anal or oral homosexual encounters in the past 6 months and they were followed up every 3 months for 2 visits. We collected sociodemographic and behavioral characteristics by a self-administrated questionnaire. HIV status was confirmed by a sequential rapid test and confirmatory test. We used multivariable Cox regression to identify risk factors and interaction models to evaluate the relative excess risk between relevant variables.

Results:

Among 1218 participants, the HIV seroconversion rate was 3.66/100 person-years. HIV seroconversion was associated with lower educational attainment [adjusted hazards ratio (aHR)] = 1.73, 95% CI: 1.06 to 2.81), having had penetrative sex with male before age of 18 years (aHR = 2.44, 95% CI: 1.20 to 4.99), not using condoms in the last sexual encounter (aHR = 2.19, 95% CI: 1.29 to 3.71), and having regular but not committed partners (aHR = 3.33, 95% CI: 1.77 to 6.93). Among 890 (73%) of men reported having regular partners, HIV seroconversion was more frequent in men whose stable partners were not committed as boyfriends (aHR = 3.31, 95% CI: 1.73 to 6.36) and in men having unprotected anal sex (aHR = 2.61, 95% CI: 1.42 to 4.80). Interaction between these 2 factors was observed (relative excess risk of interaction = 4.53).

Conclusions:

Incidence among MSM in China was high; unprotected sex with steady but not committed partners was associated with increased seroconversion risk. It is imperative to expand safer sex education and training for MSM to reduce unsafe sexual behaviors, including awareness that casual partners are not the only source of infection.
Prolonged Amenorrhea and Low Hip Bone Mineral Density in Women Living With HIV—A Controlled Cross-sectional Study
Authors: King Elizabeth M. , Nesbitt Ariel , Albert Arianne Y.K. , Pick Neora , Cote Helene C.F. , Maan Evelyn J. , Prior Jerilynn C. , Murray Melanie C.M. ,   the CIHR team on Cellular Aging and HIV Comorbidities in Women and Children (CARMA)
Published: January 2020

Background:

Women living with HIV (WLWH) have higher rates of prolonged secondary amenorrhea (no flow for ≥1 year) than HIV-negative women. Both having amenorrhea and being HIV positive are associated with lower areal bone mineral density (BMD). However, their combined BMD effects remain unclear. Therefore, we investigated prolonged amenorrhea and BMD in WLWH and controls.

Methods:

This cross-sectional study enrolled WLWH and HIV-negative control women aged 19–68 years of similar backgrounds. We assessed BMD (Hologic; as age- and ethnicity-matched Z-scores) in the Children and women: AntiRetrovirals and Markers of Aging cohort. Participants were stratified by amenorrhea history defined as past/present lack of menses for ≥1 year at age 45 and younger and not because of surgery, breastfeeding, pregnancy, or hormonal contraception. Hip and spine Z-scores by amenorrhea/no amenorrhea used linear models with multivariable analysis for relationships within WLWH.

Results:

WLWH (N = 129) were similar to controls (N = 129) in age, body mass index, ethnicity, and substance use. Among WLWH, 21% experienced prolonged amenorrhea vs. 9% in controls. WLWH had significantly lower total hip (mean ± SD: −0.4 ± 0.9 vs. 0.3 ± 1.1; P < 0.001) and spine (−0.5 ± 1.3 vs. 0.2 ± 1.3; P = 0.001) Z-scores than controls. Amenorrhea was independently associated with hip (P = 0.01) but not spine (P = 0.94) BMD by multivariable linear regression. WLWH with amenorrhea had lower hip Z-scores (−0.8 ± 0.9) than those without (−0.3 ± 0.8; P = 0.01). They also had higher rates of substance use, smoking, opioid therapy, hepatitis C coinfection, and lower CD4 nadir.

Conclusions:

WLWH had higher rates of prolonged amenorrhea and lower BMD than controls. WLWH with amenorrhea experienced lower hip BMD Z-scores than those without. Prolonged amenorrhea is an added osteoporosis risk in WLWH.
An Exploratory Study of Correlates of Allostatic Load in Older People Living With HIV
Authors: Fazeli Pariya L. , Waldrop-Valverde Drenna , Yigit Ibrahim , Turan Bulent , Edberg Jeff , Kempf Mirjam , Vance David
Published: January 2020

Background:

Older people living with HIV (PLWH) experience poorer outcomes than seronegative counterparts. Allostatic load (AL) markers have shown utility as indicators of cumulative wear-and-tear of stress on biological systems. However, little is known about correlates of AL in PLWH.

Methods:

Ninety-six PLWH aged 50+ completed a comprehensive neurobehavioral assessment and blood draw. Select AL markers (ie, 10 blood markers) were available for a subset (n = 75) of seronegative controls. AL was operationalized as a sum of markers in the highest risk quartile for: cortisol, DHEA, IL-6, TNF-alpha, C-reactive protein, glucose, total cholesterol, high-density lipoprotein cholesterol, triglycerides, albumin, systolic and diastolic blood pressure, and body mass index.

Results:

PLWH had higher risk levels than seronegatives with small–medium effect sizes for several biomarkers. Among HIV+ African Americans (84% of PLWH), higher AL was associated with lower psychological resilience (rho = −0.27, P = 0.02), less physical activity (rho = −0.29, P < 0.01), poorer neurocognitive functioning (rho = −0.26, P = 0.02), greater basic activity of daily living complaints (P < 0.01), and diabetes (P < 0.01). Multivariable regressions within African American PLWH for significant AL-outcome associations (ie, neurocognitive function, basic activity of daily living complaints, diabetes) showed that associations with AL remained significant when adjusting for relevant covariates. Mediation analysis suggested that the association between socioeconomic status and neurocognitive function was mediated by AL.

Conclusions:

These exploratory findings are consistent with the larger aging literature, suggesting that lower AL may serve as a pathway to better health and functional outcomes, particularly in African American PLWH. Furthermore, resilience and physical activity may reduce AL in this population.
Patient-centered Radiology Reporting for Lung Cancer Screening
Authors: Vitzthum von Eckstaedt Hans , Kitts Andrea B. , Swanson Christina , Hanley Michael , Krishnaraj Arun
Published: January 2020

Medicine is slowly transitioning toward a more patient-centered approach, with patients taking a more central role in their own care. A key part of this movement has involved giving patients increased access to their medical record and imaging results via electronic health portals. However, most patients lack the knowledge to fully understand medical documents, which are generally written above their comprehension level. Radiology reports, in particular, utilize complex terminology due to radiologists’ historic function as consultants to other physicians, with little direct communication to patients. As a result, typical radiology reports lack standardized formatting, and they are often inscrutable to patients. Numerous studies examining patient preference also point to a trend for more accessible radiology reports geared toward patients. Reports designed with an infographic format, combining simple pictures and standardized text, may be an ideal format that radiologists can pursue to provide patient-centered care. Our team, through feedback from patient advisory groups, developed a patient-friendly low-dose computed tomography lung cancer screening report with an infographic format that is both visually attractive and comprehensible to the average patient. The report is designed with sections including a description of low-dose computed tomography, a section on individualized patient results, the meaning of the results, and a list of the next steps in their care. We believe that this form of the report has the potential to serve as a bridge between radiologists and patients, allowing for a better patient understanding of their health and empowering patients to participate in their health and health care.
Secondary Lymphedema Following Radical Prostatectomy
Authors: Cellina Michaela , Martinenghi Carlo , Gibelli Daniele , Menozzi Andrea , Soresina Massimo , Boccanera Dario , Giardini Denisa , Oliva Giancarlo
Published: January 2020

Lymphedema (LE) is a progressive chronic disorder, frequently related to malignancies and their treatment in Western countries. It markedly affected patients' quality of life, and its management is challenging, mainly based on conservative therapy, as bandages and manual lymphatic drainage, with limited results.

Recent advances in imaging technology and microsurgical techniques have changed the approach to this disorder, particularly the recent application of magnetic resonance for the study of LE and the increasingly widespread use of surgical interventions, such as vascularized lymph node transfer. As secondary LE due to radical prostatectomy and/or radiation treatment is a frequent cause of chronic disability in the male population, and few data are available in literature about which imaging technique can be applied to diagnose it and about the surgical modalities to treat this condition, we want to propose an overview on the lymphatic vessels anatomy and function, on the applications of noncontrast magnetic resonance lymphangiography and about the pieces of information this examination can provide, and on the technique of vascularized lymph node transfer and the rationale of this surgical procedure in secondary LE related to prostatic malignancy treatment.
Prepectoral Versus Subpectoral Implant-Based Breast Reconstruction
Authors: Li Yunzhu , Xu Gang , Yu Nanze , Huang Jiuzuo , Long Xiao
Published: January 2020

Background

There is currently no consensus on the ideal plane for implant placement in breast reconstruction. The study compares the clinical efficacy and safety between prepectoral and subpectoral implant-based breast reconstruction.

Methods

PubMed, Web of Sciences, EMBASE, and Cochrane databases were systematically searched following the PRISMA guidelines. Inclusion criteria were articles describing implant-based breast reconstructions with implant placed either prepectorally or subpectorally. Primary outcomes were postoperative complications, pain score, and patients' quality of life.

Results

There were 15 studies including a total of 1868 patients. Overall complication rates were comparable between the prepectoral and subpectoral groups (odds ratio [OR], 0.79; confidence interval [CI], 0.57–1.10). The capsular contracture rate was reduced in the prepectoral group (OR, 0.45; CI, 0.27–0.73), whereas no significant difference was observed in terms of skin necrosis (OR, 0.72; CI, 0.45–1.17), implant loss (OR, 0.85; CI, 0.56–1.30), and patients' quality of life (standardised mean difference, 0.25; CI, −0.51 to 1.00).

Conclusion

The prepectoral implant-based breast reconstruction is a good alternative to subpectoral implant-based breast reconstruction for a certain group of patients, eliminating animation deformity without increasing complications.
Techniques for Patient Positioning During Burn Surgery
Authors: Vrouwe Sebastian Q. , Pham Christopher H. , Gillenwater T. Justin , Yenikomshian Haig A.
Published: January 2020

Introduction

Patient positioning in the operating room remains a challenge for burn surgeons; burn surgery involves critically ill patients who require close monitoring, difficult exposures, and careful handling of grafted areas. Various techniques to optimize intraoperative positioning during burn surgery have been described in the literature. The aim of this review was to outline these positioning techniques and report on their complications.

Methods

A systematic review was performed by 2 independent reviewers using PubMed, Scopus, and OvidSP MEDLINE databases. Articles were included if they described intraoperative techniques to position patients undergoing burn surgery. The primary variable of interest was complications related to positioning during surgery.

Results

The search identified 1855 nonduplicate citations, of which 29 underwent full-text review, and 10 met inclusion criteria. Three studies described overhead suspension techniques, including a hook-and-pulley system, ceiling chains, weighted IV poles, and mounted crossbars; no complications were reported. Six studies described limb fixation techniques, including Steinmann pins, finger traps, wrist/ankle wraps, towel clips through eschar or distal phalanges, and external fixators. Complications included one case of hardware failure of external fixation and several pin site infections. Four studies described table modification techniques, including a modified Stryker frame, a fracture table, the Mayfield headrest, and the recliner position; no complications were reported.

Discussion

Numerous techniques have been described to improve patient positioning during burn surgery. No major complications were identified in this systematic review. Most techniques use standard operating room equipment and can aid in safe and easier operations.
The History of Alloplastic Ear Reconstruction for Microtia
Authors: Kozusko Steven D. , Konofaos Petros , Wallace Robert Doyle
Published: January 2020

Microtia reconstruction is a unique and challenging field in reconstructive surgery. In the early 20th century, many different alloplastic materials have been used in an attempt to recreate the fibrocartilaginous framework of the native ear. These materials include celluloid, tantalum wire cage, nylon mesh, polyethylene, and acrylic. The first standard for alloplastic microtia reconstruction, silicone, is one fraught with complications and failures. This alloplastic material is walled off by the host and prone to scar tissue formation and extrusion. Alloplastic microtia reconstruction largely shifts to porous polyethylene, where the results are markedly superior. This is attributed to the porous structure of porous polyethylene, which allows tissue ingrowth. Moreover, the use of the temporoparietal fascia flap for total coverage of the implant has impressively lowered the risk of implant extrusion. However, there is paucity in the literature regarding the evolution of alloplastic microtia reconstruction, especially characterizing historical mistakes, significant technique evolutions, and drawbacks/advantages of materials. This review serves as a guide both to avoid repeating mistakes and to improve outcomes.
The Chronic Liver Disease Nurse Role in Australia
Authors: Wundke Rachel , McCormick Rosemary , Narayana Sumudu K. , Sorensen Lea , Wigg Alan
Published: January 2020

Cirrhosis of the liver is increasing, with growing patient numbers in hospital outpatient departments, as well as increasing admissions due to decompensated liver disease. Decompensated cirrhosis of the liver is a common and debilitating illness causing disability, readmissions to hospital, and decreased quality of life, and can lead to liver cancer. The advent of the chronic liver disease nurse (CLDN) position in our hospital in 2009 was the first role in Australia dedicated to providing care to patients with cirrhosis. The role incorporates the care of patients with stable compensated disease, case management of patients with complications of decompensated disease, and hepatocellular carcinoma coordination. After a pilot randomized controlled trial and almost 10 years of service, this article describes the role of the CLDN and presents key performance indicators that will assist other centers considering introducing the role or elements of it into their service.
Management of Hepatitis C
Authors: Guss Debra , Sherigar Jagannath , Mohanty Smruti R.
Published: January 2020

Nurses have been at the forefront of the care of patients with hepatitis C since hepatitis C virus was identified in 1989. Treatments of patients with hepatitis C have evolved over the time to the present moment, where there are numerous options available for patients that are efficacious, simple, and well-tolerated. However, many patients with hepatitis C do not know they are infected or have never been treated. Nurses can continue to influence patients' engagement in their care, direct patients toward testing, and support them through their treatment and follow-up. This article discusses the role of the nurse in the management of hepatitis C and offers the most up-to-date information regarding the current standards of care for patients, from identifying patients for testing to managing patients through treatment and follow-up.
Modulation of the HGF/c-Met Axis Impacts Prolonged Hematopoietic Progenitor Mobilization Following Trauma and Chronic Stress
Authors: Loftus Tyler J. , Kannan Kolenkode B. , Mira Juan C. , Brakenridge Scott C. , Efron Philip A. , Mohr Alicia M.
Published: January 2020

Background:

Trauma and hemorrhagic shock trigger mobilization of hematopoietic progenitor cells (HPC) from bone marrow to peripheral blood. Hepatocyte growth factor (HGF), tyrosine-protein kinase Met (c-Met), matrix metallopeptidase 9 (MMP-9), and corticosterone regulate this mobilization process. We hypothesized that beta-blockade with propranolol and sympathetic outflow inhibition with clonidine following trauma and chronic stress would decrease hematopoietic progenitor cell mobilization.

Methods:

Sprague-Dawley rats were randomized to undergo three models of injury and stress: lung contusion, LC plus hemorrhagic shock (LCHS), or LCHS plus chronic restraint stress for 2 h daily (LCHS/CS). Propranolol and clonidine were administered by daily intraperitoneal injection until sacrifice on day seven. Bone marrow HGF, c-Met, and MMP-9 were measured by real-time PCR. Plasma corticosterone was measured by ELISA. Percentage HPC in peripheral blood was measured by flow cytometry.

Results:

Propranolol and clonidine significantly decreased bone marrow MMP-9 expression, plasma corticosterone levels, and HPC mobilization, and significantly increased hemoglobin levels. HPC mobilization was greatest following LCHS/CS (5.4 ± 1.8) and was significantly decreased by propranolol (2.2 ± 0.9, P < 0.001) and clonidine (1.7 ± 0.5, P < 0.001). Hemoglobin (g/dL) was lowest following LCHS/CS (12.3 ± 1.2) and was significantly increased by propranolol (13.7 ± 0.4, P = 0.022) and clonidine (14.1 ± 1.1, P < 0.001).

Conclusions:

Severe injury was associated with increased bone marrow HGF, c-Met, and MMP-9, circulating corticosterone, HPC mobilization, and persistent anemia. Attenuating the neuroendocrine response to injury and stress with propranolol and clonidine reduced MMP-9 expression, corticosterone levels, HPC mobilization, and the degree of anemia.
Robotic-assisted Pancreaticoduodenectomy: Technique Description and Performance Evaluation After 60 Cases
Authors: Marino Marco V. , Podda Mauro , Pisanu Adolfo , di Saverio Salomone , Fleitas Manuel G.
Published: January 2020

Purpose:

Robotic pancreaticoduodenectomy (RPD) remains one of the most challenging abdominal operations. During the implementation of new surgical technologies, safety and efficacy outcomes must be rigorously monitored and the learning curve clearly identified.

Materials and Methods:

The authors investigated their experience during the adoption of RPD, analyzing the outcomes of our first 60 consecutive cases, divided into group A (1 to 30) and group B (31 to 60). The cumulative sum (CUSUM) analysis was used to define the learning curve.

Results:

The authors observed a reduction in operative time (125 min) and estimated blood loss (185 mL) between the firsts 1 to 30 and the latest 30 cases. The overall rate of complications showed the tendency to decrease during the experience (46.7% vs. 23.3%, P=0.02), conversely, severe complications and the rate of clinically relevant postoperative pancreatic fistula did not show a significant reduction in the incidence (P=0.37 and P=0.67, respectively). The mean number of lymph nodes harvested improved significantly after 30 cases (P=0.004).

Conclusion:

Surgical performance improved significantly after the first 30 cases.
Pull back the curtain: External data validation is an essential element of quality improvement benchmark reporting
Authors: Jakubus Jill Lynn , Di Pasquo Shauna L. , Mikhail Judy N. , Cain-Nielsen Anne H. , Jenkins Peter C. , Hemmila Mark R.
Published: January 2020

BACKGROUND

Accurate and reliable data are pivotal to credible risk-adjusted modeling and hospital benchmarking. Evidence assessing the reliability and accuracy of data elements considered as variables in risk-adjustment modeling and measurement of outcomes is lacking. This deficiency holds the potential to compromise benchmarking integrity. We detail the findings of a longitudinal program to evaluate the impact of external data validation on data validity and reliability for variables utilized in benchmarking of trauma centers.

METHODS

A collaborative quality initiative-based study was conducted of 29 trauma centers from March 2010 through December 2018. Case selection criteria were applied to identify high-yield cases that were likely to challenge data abstractors. There were 127,238 total variables validated (i.e., reabstracted, compared, and reported to trauma centers). Study endpoints included data accuracy (agreement between registry data and contemporaneous documentation) and reliability (consistency of accuracy within and between hospitals). Data accuracy was assessed by mean error rate and type (under capture, inaccurate capture, or over capture). Cohen's kappa estimates were calculated to evaluate reliability.

RESULTS

There were 185,120 patients that met the collaborative inclusion criteria. There were 1,243 submissions reabstracted. The initial validation visit demonstrated the highest mean error rate at 6.2% ± 4.7%, and subsequent validation visits demonstrated a statistically significant decrease in error rate compared with the first visit (p < 0.05). The mean hospital error rate within the collaborative steadily improved over time (2010, 8.0%; 2018, 3.2%) compared with the first year (p < 0.05). Reliability of substantial or higher (kappa ≥0.61) was demonstrated in 90% of the 20 comorbid conditions considered in the benchmark risk-adjustment modeling, 39% of these variables exhibited a statistically significant (p < 0.05) interval decrease in error rate from the initial visit.

CONCLUSION

Implementation of an external data validation program is correlated with increased data accuracy and reliability. Improved data reliability both within and between trauma centers improved risk-adjustment model validity and quality improvement program feedback.
Prevalence of Mild Cognitive Impairment in the Elderly Population in Greece: Results From the HELIAD Study
Authors: Vlachos George S. , Kosmidis Mary H. , Yannakoulia Mary , Dardiotis Efthimios , Hadjigeorgiou Georgios , Sakka Paraskevi , Ntanasi Eva , Stefanis Leonidas , Scarmeas Nikolaos
Published: January 2020

Introduction:

Timely recognition of mild cognitive impairment (MCI) is essential in optimizing prevention and treatment for Alzheimer disease. Because of the paucity of data on MCI epidemiology in Greece and the variability of worldwide published results, we investigated the prevalence and determinants of MCI in the elderly population in Greece.

Methods:

As part of the Hellenic Epidemiological Longitudinal Investigation of Aging and Diet (HELIAD), we randomly selected 1960 individuals 65 years and older to undergo full neurological and neuropsychological assessment by a multidisciplinary team. MCI was diagnosed according to the Petersen criteria.

Results:

The age-standardized and gender-standardized prevalence of MCI in people aged 65 years and older in Greece is 13.11%. The amnestic and multidomain MCI subtypes are more common than their nonamnestic and single-domain counterparts, respectively. Almost two thirds of cases are because of suspected Alzheimer disease. Every additional year of age increases the odds of prevalent MCI by 7.4%, every additional year of education decreases the odds of MCI by 6.3%, and apolipoprotein E (APOE-ε4) carriage increases the odds of MCI by 57.9%.

Conclusions:

MCI prevalence in the elderly population in Greece is on par with previously reported rates. Prospective studies with robust methodology will enhance our understanding of the dementia continuum.
Etiology and Clinical Impact of Interictal Periodic Discharges on the Routine Outpatient Scalp EEG
Authors: Carneiro Fábio , Bentes Carla , Peralta Ana Rita
Published: January 2020

Purpose:

Periodic discharges (PDs) are common in acute structural or metabolic brain lesions, but their occurrence during follow-up of epileptic patients in an outpatient setting is rare. Aim of this article was to study whether PDs on the routine outpatient scalp EEG of patients with epilepsy, as compared with nonperiodic epileptiform discharges, are associated with drug refractoriness and the decompensation of epilepsy and particular etiologies.

Methods:

A retrospective case–control study. EEG reports were screened for PDs and their variants. The inclusion criteria were as follows: a diagnosis of epilepsy, epileptogenic lesion on imaging, or a normal 3-T MRI. Inpatient EEGs or EEGs performed in patients with acute cerebral lesions were excluded. Age- and sex-matched controls presenting with other epileptiform EEG abnormalities were selected, and similar selection criteria were applied.

Results:

Forty-one patients with PDs and 82 controls were selected. There were no significant differences between the cases and controls in the rates of epilepsy decompensation at the time of EEG collection or drug refractoriness. Stroke, hippocampal sclerosis, and malformations of cortical development were the most frequent etiologies, without significant differences between the groups.

Conclusions:

By performing a case–control study, the authors have shown that PDs are not a marker of epilepsy decompensation and drug refractoriness and that the finding of PDs is not suggestive of particular epilepsy etiologies, when compared with other epileptiform abnormalities.
Machine-learned patterns suggest that diversification drives economic development
Authors: Brummitt Charles D. , Gómez-Liévano Andrés , Hausmann Ricardo , Bonds Matthew H.
Published: January 2020

We combine a sequence of machine-learning techniques, together called Principal Smooth-Dynamics Analysis (PriSDA), to identify patterns in the dynamics of complex systems. Here, we deploy this method on the task of automating the development of new theory of economic growth. Traditionally, economic growth is modelled with a few aggregate quantities derived from simplified theoretical models. PriSDA, by contrast, identifies important quantities. Applied to 55 years of data on countries’ exports, PriSDA finds that what most distinguishes countries’ export baskets is their diversity, with extra weight assigned to more sophisticated products. The weights are consistent with previous measures of product complexity. The second dimension of variation is proficiency in machinery relative to agriculture. PriSDA then infers the dynamics of these two quantities and of
per capita
income. The inferred model predicts that diversification drives growth in income, that diversified middle-income countries will grow the fastest, and that countries will converge onto intermediate levels of income and specialization. PriSDA is generalizable and may illuminate dynamics of elusive quantities such as diversity and complexity in other natural and social systems.
Raw material optimization and stone tool engineering in the Early Stone Age of Olduvai Gorge (Tanzania)
Authors: Key Alastair , Proffitt Tomos , de la Torre Ignacio
Published: January 2020

For more than 1.8 million years hominins at Olduvai Gorge were faced with a choice: whether to use lavas, quartzite or chert to produce stone tools. All are available locally and all are suitable for stone tool production. Using controlled cutting tests and fracture mechanics theory we examine raw material selection decisions throughout Olduvai's Early Stone Age. We quantify the force, work and material deformation required by each stone type when cutting, before using these data to compare edge sharpness and durability. Significant differences are identified, confirming performance to depend on raw material choice. When combined with artefact data, we demonstrate that Early Stone Age hominins optimized raw material choices based on functional performance characteristics. Doing so flexibly: choosing raw materials dependent on their sharpness and durability, alongside a tool's loading potential and anticipated use-life. In this way, we demonstrate that early lithic artefacts at Olduvai Gorge were engineered to be functionally optimized cutting tools.
Protein aggregate formation permits millennium-old brain preservation
Authors: Petzold Axel , Lu Ching-Hua , Groves Mike , Gobom Johan , Zetterberg Henrik , Shaw Gerry , O’Connor Sonia
Published: January 2020

Human proteins have not been reported to survive in free nature, at ambient temperature, for long periods. Particularly, the human brain rapidly dissolves after death due to auto-proteolysis and putrefaction. The here presented discovery of 2600-year-old brain proteins from a radiocarbon dated human brain provides new evidence for extraordinary long-term stability of non-amyloid protein aggregates. Immunoelectron microscopy confirmed the preservation of neurocytoarchitecture in the ancient brain, which appeared shrunken and compact compared to a modern brain. Resolution of intermediate filaments (IFs) from protein aggregates took 2–12 months. Immunoassays on micro-dissected brain tissue homogenates revealed the preservation of the known protein topography for grey and white matter for type III (glial fibrillary acidic protein, GFAP) and IV (neurofilaments, Nfs) IFs. Mass spectrometry data could be matched to a number of peptide sequences, notably for GFAP and Nfs. Preserved immunogenicity of the prehistoric human brain proteins was demonstrated by antibody generation (GFAP, Nfs, myelin basic protein). Unlike brain proteins, DNA was of poor quality preventing reliable sequencing. These long-term data from a unique ancient human brain demonstrate that aggregate formation permits for the preservation of brain proteins for millennia.
An atypical mating system in a neotropical manakin
Authors: Gaiotti Milene G. , Webster Michael S. , Macedo Regina H.
Published: January 2020

Most of the diversity in the mating systems of birds and other animals comes at higher taxonomic levels, such as across orders. Although divergent selective pressures should lead to animal mating systems that diverge sharply from those of close relatives, opportunities to examine the importance of such processes are scarce. We addressed this issue using the Araripe manakin (
Antilophia bokermanni
), a species endemic to a forest enclave surrounded by xeric shrublands in Brazil. Most manakins exhibit polygynous lekking mating systems that lack territoriality but exhibit strong sexual selection. In sharp contrast, we found that male Araripe manakins defended exclusive territories, and females nested within male territories. However, territoriality and offspring paternity were dissociated: males sired only 7% of nestlings from the nests within their territories and non-territorial males sired numerous nestlings. Moreover, female polyandry was widespread, with most broods exhibiting mixed paternity. Apparently, territories in this species function differently from both lekking arenas and resource-based territories of socially monogamous species. The unexpected territoriality of Araripe manakins and its dissociation from paternity is a unique evolutionary development within the manakin clade. Collectively, our findings underscore how divergences in mating systems might evolve based on selective pressures from novel environmental contexts.
Existence and stability of limit cycles in the model of a planar passive biped walking down a slope
Authors: Makarenkov Oleg
Published: January 2020

We consider the simplest model of a passive biped walking down a slope given by the equations of switched coupled pendula (McGeer T. 1990 Passive dynamic walking.Int. J. Robot. Res.9, 62–82. (doi:10.1177/027836499000900206)). Following the fundamental work by Garcia (Garciaet al. 1998J. Biomech. Eng.120, 281. (doi:10.1115/1.2798313)), we view the slope of the ground as a small parameterγ ≥ 0. Whenγ = 0, the system can be solved in closed form and the existence of a family of cycles (i.e. potential walking cycles) can be computed in closed form. As observed in Garciaet al.(Garciaet al. 1998J. Biomech. Eng.120, 281. (doi:10.1115/1.2798313)), the family of cycles disappears whenγincreases and only isolated asymptotically stable cycles (walking cycles) persist. However, no mathematically complete proofs of the existence and stability of walking cycles have been reported in the literature to date. The present paper proves the existence and stability of a walking cycle (long-period gait cycle, as termed by McGeer) by using the methods of perturbation theory for maps. In particular, we derive a perturbation theorem for the occurrence of stable fixed points from 1-parameter families in two-dimensional maps that can be of independent interest in applied sciences.