bluuebunny/crossref_metadata_2025 huggingface dataset:
Postpartum Contraception Acceptance and Readiness for Long Acting Reversible Contraception [40I]
Authors: Williams Heather , Goad Lindsay , Treloar MacKenzie , Mejia Rachel , Stockdale Colleen , Hardy-Fairbanks Abbey
Published: May 2017

INTRODUCTION:

Determine the optimal time to discuss and formulate a plan for postpartum contraception by using motivational interviewing and stages of change. Determine responses associated with uptake and adherence to long acting reversible postpartum contraception (LARC).

METHODS:

Adult women between gestational ages of 25 0/7 and 35 6/7 weeks seeking prenatal care and plans to delivery at our facility were offered to participate in the study. Subjects completed surveys querying readiness, capability and confidence in discussing and committing to a postpartum contraceptive plan at a single prenatal visit and again during their postpartum hospitalization. Subjects received a phone survey at 4–6 months postpartum.

RESULTS:

243 women recruited from February to July 2015. 63% of patients responded the best time for contraception discussion was the 2nd or 3rd trimester; 90% planned to start contraception after delivery. More women reported prenatally and postpartum that they felt capable to choose LARC (85% v. 87%; P < .0001) compared to other forms of contraception. Additionally more women reported prenatally and postpartum that they felt ready to choose LARC as their postpartum contraception (74% v. 84%; P < .0001) compared again to other forms of contraception. Women who reported being more ready or capable were more likely to choose LARC and to be using that method at 4–6 months postpartum.

CONCLUSION:

Women report higher levels of readiness and capability to choose and discuss contraception postpartum than prenatally, however, high rates were seen throughout. More women choose LARC when they endorse readiness, confidence and capability to choose a contraceptive option.
Impact of Fentanyl Use on Maintenance Therapy During Pregnancy [40O]
Authors: Belcher-Obejero-Paz Alexandra A. , Yarrington Christina , Saia Kelley
Published: May 2017

INTRODUCTION:

Little is known about the impact of fentanyl abuse on pregnancy care. We sought to investigate whether there is a difference in the pattern of opioid maintenance requirement among pregnant women who test positive for fentanyl at their initial titration compared to those who test negative.

METHODS:

We conducted a retrospective cohort review of pregnant patients admitted for initial buprenorphine (STX) or methadone (MTD) maintenance dosing from April 2015 to December 2015. Demographic characteristics and obstetrics outcomes in the fentanyl positive and fentanyl negative cohorts were compared using a student’s t-test or chi square as appropriate. We compared mean MTD or STX dose required among fentanyl positive compared to fentanyl negative patients using a student’s t-test. The small sample size allowed analysis only of crude data.

RESULTS:

Sixteen pregnant patients were admitted for initial STX or MTD maintenance titration. Seven of these patients (43.7%) tested positive for fentanyl on admission. There were no differences in baseline demographics or obstetric outcomes in the two cohorts. There was not a significant differences in dose requirement for fentanyl positive versus fentanyl negative patients (MTD: 45 mg vs 47 mg, p=0.68; 9mg vs 10 mg STX: p=0.12). Average maintenance dos at delivery was higher for fentanyl abusers on MTD maintenance compared to fentanyl non-abusers (90 mg vs 55 mg, p=0.04).

CONCLUSION:

There was no significant difference in MTD or STX requirement at initial titration, but the fentanyl positive cohort maintained on MTD did require a significantly higher dose by delivery.
A Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) Relates to Gestational Diabetes, Glycemic Control [1K]
Authors: VanWinden Kristi , Montoro Martin , Korst Lisa M. , Ouzounian Joseph G.
Published: May 2017

INTRODUCTION:

Current methods of evaluating glycemic control in gestational diabetes (GDM) are difficult to standardize within research protocols. The study objective was to validate the use of the HOMA-IR assessment in pregnancies with and without GDM as an indicator of the degree of insulin resistance and as a potential tool for evaluating the response to interventions for GDM aimed at improving insulin sensitivity.

METHODS:

Prospective cohort study investigating the utility of the HOMA-IR for measuring insulin resistance, beta-cell function, and GDM severity in pregnant women. Each patient had glucose and insulin levels drawn after a minimum 8 hour fast. These values were used to calculate HOMA-IR using published computer models. Measurements were taken between 28 and 34 weeks of gestation in women with diet-controlled gestational diabetes and non-GDM controls, matched for maternal age, gestational age, and body mass index.

RESULTS:

HOMA-IR levels were calculated prospectively in 134 women with diet-controlled gestational diabetes and 23 controls without GDM. HOMA-IR was significantly greater in the GDM group compared with non-GDM controls (mean 2.53+1.01 versus 2.02+0.90, p=0.0216) and in women with GDM who ultimately required medical therapy for glucose control compared with those who remained diet-controlled (1.42+0.952 versus 2.95+2.680, p < 0.0001).

CONCLUSION:

HOMA-IR is a simplified measure of insulin resistance and may predict both which pregnant women are at risk for GDM and which patients with GDM are most likely to require medical therapy. HOMA-IR is a potentially valuable tool in studies of interventions for GDM requiring a marker of insulin resistance.
HPV Vaccination Rates Amongst Academic Based Gynecology Clinics [1E]
Authors: Jackson-Bey Tia , Lambert Tashima , Gamble Charlotte , Patterson Latoya , Jones Monica
Published: May 2017

INTRODUCTION:

The Human Papilloma Virus (HPV) vaccine for prevention of cervical cancer is recommended for all females aged 11-26. Inequities exist in vaccination rates, with lower rates of HPV vaccination among minorities and women living in southern states. Within Duke University Medical center, these statistics are unknown.

METHODS:

This is a retrospective chart review. Data was collected for the month of January 2015 from three Duke based gynecology practices, a resident staffed clinic, and two private Duke affiliated practices. Primary outcome is initiation of HPV vaccination in women aged 11-27. Secondary outcomes include differences in vaccination rates by age, race, ethnicity, practice, and insurance status as well as completion of the vaccination series.

RESULTS:

There were 254 eligible patients. Of those, 15.7% (n=40) were vaccinated. Insurance coverage was high in this population, 94%. Vaccination rates differed by clinic, ranging from 7.6-23% amongst the three practices with vaccination rate in the resident clinic being the lowest. Hispanic and uninsured women were the least likely to be vaccinated.

CONCLUSION:

There is an overall low rate of HPV vaccination within gynecology clinics at Duke University. The majority of this population has medical insurance. Barriers to vaccination include Medicaid criteria for coverage of the vaccination. Interventions should be focused on increasing physician knowledge of the need for this effective vaccine, specifically for racial/ethnic minorities as well as lobbying for greater coverage of the vaccination by Medicaid. The study period has been expanded to 1 year to compare these rates over a longer period of time.
Preoperative Cognitive Performance and Postoperative Delirium Are Independently Associated With Future Dementia in Older People Who Have Undergone Cardiac Surgery: A Longitudinal Cohort Study*
Authors: Lingehall Helena Claesson , Smulter Nina S. , Lindahl Elisabeth , Lindkvist Marie , Engström Karl Gunnar , Gustafson Yngve G. , Olofsson Birgitta
Published: May 2017

Objective:

To investigate if postoperative delirium was associated with the development of dementia within 5 years after cardiac surgery.

Design:

Longitudinal cohort study.

Setting:

Cardiothoracic Division, Umeå University Hospital, Sweden.

Patients:

Patients aged 70 years old or older (n = 114) scheduled for routine cardiac procedures with cardiopulmonary bypass without documented dementia were enrolled in 2009.

Intervention:

Structured assessments were performed preoperatively, 1 and 4 days after extubation, and 1, 3, and 5 years postoperatively.

Measurements and Main Results:

Patients were assessed comprehensively, including cognitive and physical function, coexisting medical conditions, demographic characteristics, and medications. Diagnoses of delirium, depression, and dementia were made according to Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision criteria. During the 5-year period, 30 of 114 participants (26.3%) developed dementia. Postoperative delirium had occurred in 87% of those who later developed dementia. A multivariable logistic regression model showed a lower preoperative Mini-Mental State Examination score (p < 0.001; odds ratio, 0.68; 95% CI, 0.54–0.84) and the occurrence of postoperative delirium (p = 0.002; odds ratio, 7.57; 95% CI, 2.15–26.65) were associated with dementia occurrence.

Conclusions:

Our findings suggest that older patients with reduced preoperative cognitive functions or who develop postoperative delirium are at risk of developing dementia within 5 years after cardiac surgery. Cognitive functions should be screened for preoperatively, those who develop postoperative delirium should be followed up to enable early detection of dementia symptoms, and management should be implemented.
User-Centered Design, Experience, and Usability of an Electronic Consent User Interface to Facilitate Informed Decision-Making in an HIV Clinic
Authors: Ramos S. Raquel
Published: May 2017

Health information exchange is the electronic accessibility and transferability of patient medical records across various healthcare settings and providers. In some states, patients have to formally give consent to allow their medical records to be electronically shared. The purpose of this study was to apply a novel user-centered, multistep, multiframework approach to design and test an electronic consent user interface, so patients with HIV can make more informed decisions about electronically sharing their health information. This study consisted of two steps. Step 1 was a cross-sectional, descriptive, qualitative study that used user-centric design interviews to create the user interface. This informed Step 2. Step 2 consisted of a one group posttest to examine perceptions of usefulness, ease of use, preference, and comprehension of a health information exchange electronic consent user interface. More than half of the study population had college experience, but challenges remained with overall comprehension regarding consent. The user interface was not independently successful, suggesting that in addition to an electronic consent user interface, human interaction may also be necessary to address the complexities associated with consenting to electronically share health information. Comprehension is key factor in the ability to make informed decisions.
Paradoxical Impact of Ileal Pouch-Anal Anastomosis on Male and Female Fertility in Patients With Ulcerative Colitis
Authors: Pachler Frederik R. , Brandsborg Søren B. , Laurberg Søren
Published: May 2017

BACKGROUND:

Birth rates in males with ulcerative colitis and ileal pouch-anal anastomosis have not been studied.

OBJECTIVE:

This study aimed to estimate birth rates in males and females with ulcerative colitis and study the impact of ileal pouch-anal anastomosis.

DESIGN:

This was a retrospective registry-based cohort study that was performed over a 30-year period.

SETTINGS:

Records for parenting a child from the same period were cross-linked with patient records, and birth rates were calculated using 15 through 49 years as age limits. All data were prospectively registered.

PATIENTS:

All patients with ulcerative colitis and ulcerative colitis with ileal pouch-anal anastomosis between 1980 and 2010 were identified in Danish national databases.

MAIN OUTCOME MEASURES:

The primary outcomes measured were birth rates in females and males with ulcerative colitis and ulcerative colitis with ileal pouch-anal anastomosis.

RESULTS:

We included 27,379 patients with ulcerative colitis (12,812 males and 14,567 females); 1544 had ileal pouch-anal anastomosis (792 males and 752 females). Patients with ulcerative colitis have slightly reduced birth rates (males at 40.8 children/1000 years, background population 43.2, females at 46.2 children/1000 years, background population 49.1). After ileal pouch-anal anastomosis, males had increased birth rates at 47.8 children/1000 years in comparison with males with ulcerative colitis without ileal pouch-anal anastomosis (40.5 children/1000 years), whereas females had reduced birth rates at 27.6 children/1000 years in comparison with females with ulcerative colitis without ileal pouch-anal anastomosis (46.8 children/1000 years).

LIMITATIONS:

Only birth rates were investigated and not fecundability. Furthermore, there is a question about misattributed paternity, but this has previously been shown to be less than 5%.

CONCLUSIONS:

Ulcerative colitis per se has little impact on birth rates in both sexes, but ileal pouch-anal anastomosis surgery leads to a reduction in birth rates in females and an increase in birth rates in males. This has clinical impact when counseling patients before ileal pouch-anal anastomosis surgery.
The Evolution of Pelvic Exenteration Practice at a Single Center: Lessons Learned from over 500 Cases
Authors: Koh Cherry E. , Solomon Michael J. , Brown Kilian G. , Austin Kirk , Byrne Christopher M. , Lee Peter , Young Jane M.
Published: May 2017

Considerable progress has been made in the management of patients with locally advanced or recurrent cancers of the pelvis over the past 60 years since the inception of pelvic exenteration. Early progress in pelvic exenteration was marred by the high surgical mortality and morbidity, which drew scepticism from the broader surgical community. Subsequent evolution in the procedure hinged on establishing surgical safety and a better understanding of outcome predictors. Surgical mortality from pelvic exenteration is now comparable to that of elective resection for primary colorectal cancers. The importance of a clear resection margin is also now well established in providing durable local control and predicting long-term survival that, in turn, has driven the development of novel surgical techniques for pelvic side wall resection, en bloc sacrectomy, and pubic bone resection. A tailored surgical approach depending on the location of the tumor with resection of contiguously involved organs, yet preserving uninvolved organs to minimize unnecessary surgical morbidity, is paramount. Despite improved surgical and oncological outcomes, surgical morbidity following pelvic exenteration remains high with reported complication rates ranging between 20% and 80%. Extended antibiotic prophylaxis and preemptive parenteral nutrition in the immediate postoperative period may reduce septic and nutritional complications. A high index of suspicion is needed in the early diagnosis and management of complications that may avoid prolonged duration of hospitalization. An acceptable quality of life has been reported among patients after pelvic exenteration. Further research into novel chemotherapy, immunotherapy, and reconstructive options are currently underway and are needed to further improve outcomes.
Bowel Sounds Are Not Associated With Flatus, Bowel Movement, or Tolerance of Oral Intake in Patients After Major Abdominal Surgery
Authors: Read Thomas E. , Brozovich Marc , Andujar Jose E. , Ricciardi Rocco , Caushaj Philip F.
Published: May 2017

BACKGROUND:

Auscultation for bowel sounds has been advocated by some clinicians as a method to determine the resolution of postoperative ileus.

OBJECTIVE:

Our primary aim was to prospectively evaluate the relationships between bowel sounds and the ability to tolerate oral intake in patients after major abdominal surgery. Secondarily we aimed to evaluate relationships among bowel sounds, flatus and bowel movement, and oral intake.

DESIGN:

This was a prospective, blinded observational study.

SETTINGS:

The study was conducted at Western Pennsylvania Hospital.

PATIENTS:

A total of 124 adult patients undergoing major abdominal surgery were included.

MAIN OUTCOME MEASURES:

Data were collected by medical students blinded to the purpose of the study for 10 days postoperatively or until discharge, including the presence of bowel sounds (auscultation for 1 minute), flatus, bowel movement, and tolerance of oral intake (defined as ingestion of ≥1000 mL/24 h and each subsequent day without vomiting). Associations between paired variables were determined using ϕ coefficient testing.

RESULTS:

The study population consisted of 51 men and 73 women, with a mean age of 64 years (range, 20–92 y). The majority of patients (78/124 (63%)) underwent colorectal resection. The median length of hospital was 6 days. Bowel sounds were not associated with flatus, bowel movement, or tolerance of oral intake throughout the study period. The positive predictive value of bowel sounds in predicting flatus and bowel movement was low in the early postoperative period and remained <25% in predicting tolerance of oral intake throughout the study period. The analysis was repeated, including only those patients undergoing colorectal procedures, and was essentially unchanged. Flatus correlated with bowel movement in the first 6 days postoperation, but neither flatus nor bowel movement was associated with tolerance of oral intake.

LIMITATIONS:

The rate of tolerance of oral intake was relatively modest throughout the study period.

CONCLUSIONS:

Bowel sounds are not associated with flatus, bowel movement, or tolerance of oral intake after major abdominal surgery.
Selected Techniques of Anal Fistula Surgery from Antiquity Through the Early 20th Century Illustrated
Authors: Ortega Adrian E. , Gesek Alan , Linnebur Megan , Cologne Kyle G.
Published: May 2017

This article highlights surgical approaches to the surgical treatment of anal fistula from antiquity to the early 20th century. Primary translations and other authoritative commentaries on the subject are included. Selected surgical techniques have been reconstructed and illustrated in contemporary interpreted images.
Rationale for Therapeutic Drug Monitoring of Biopharmaceuticals in Inflammatory Diseases
Authors: Paintaud Gilles , Passot Christophe , Ternant David , Bertolotto Antonio , Bejan-Angoulvant Theodora , Pascual-Salcedo Dora , Mulleman Denis
Published: May 2017

Biopharmaceuticals bring together a number of specific characteristics as compared with other drugs. However, as it is done for most drugs, an individual adjustment of their dose may be necessary. Similar to “chemical” drugs, biopharmaceuticals used in immunoinflammatory diseases have a rather narrow therapeutic range, lack good early clinical or biological marker of response, have variable pharmacokinetics, and their serum concentrations are most often related with response. Monoclonal antibodies have additional specific sources of pharmacokinetic variability. Low concentrations may increase the risks of immunization, plasmapheresis may increase their elimination, and subcutaneous formulations may be associated with decreased adherence. For all these reasons, pharmacokinetic therapeutic drug monitoring may be useful. However, few randomized controlled therapeutic drug monitoring studies have been published. For monoclonal antibodies, a precise definition of the therapeutic concentrations is challenging because of the interindividual variability in their concentration–effect relationship.
Inflammatory Mediators in Xanthelasma Palpebrarum: Histopathologic and Immunohistochemical Study
Authors: Govorkova Maria S. , Milman Tatyana , Ying Gui-Shuang , Pan Wei , Silkiss Rona Z.
Published: May 2017

Purpose:

To evaluate the expression of inflammatory mediators in xanthelasma palpebrarum.

Methods:

In this retrospective histopathologic case–control study, xanthelasma specimens obtained from the private practice and pathology archives of 1 author (R.Z.S.) were analyzed and compared with the blepharoplasty tissues from age- and sex-matched controls. Paraffin-embedded tissue sections were stained with hematoxylin–eosin and CD3, CD20, CD163, cyclooxygenase-1, inducible nitric oxide synthase, matrix metallopeptidase-9, and myeloperoxidase antibodies. Immunostaining was quantified by light microscopy and with a computerized image analysis system of scanned images.

Results:

Hematoxylin–eosin-stained preparations of xanthelasma specimens demonstrated significantly more intense chronic lymphocytic infiltrate when compared with the control blepharoplasty tissues (p < 0.001). Immunohistochemical studies revealed more intense CD3+ T cell and CD163+ histiocytic infiltrate (11% vs. 5%; p = 0.02 and 28% vs. 5%; p = 0.003, respectively) and increased expression of cyclooxygenase-1 (44% vs. 20% expressing cells; p < 0.001 and 21% vs. 9% strongly expressing cells; p = 0.008) and inducible nitric oxide synthase (43% vs. 26% expressing cells; p = 0.03 and 42% vs. 25% strongly expressing cells; p = 0.02) in xanthelasma specimens compared with control tissues.

Conclusions:

The inflammatory milieu in xanthelasma appears to be analogous to descriptions of the early stages of cardiac atherosclerotic plaque formation. These findings may contribute to the understanding of xanthelasma pathogenesis and to the development of potential targeted therapies.
Transformational Leadership: The Chief Nursing Officer Role in Leading Quality and Patient Safety
Authors: Jones Pam , Polancich Shea , Steaban Robin , Feistritzer Nancye , Poe Terri
Published: May 2017

This department column highlights leadership perspectives of quality and patient safety practice. The purpose of this article is to provide strategic direction for transformational quality and safety leadership as the chief nursing officer (CNO) within the academic medical center environment.
Round Window Application of an Active Middle Ear Implant: A Comparison With Hearing Aid Usage in Japan
Authors: Iwasaki Satoshi , Usami Shin-ichi , Takahashi Haruo , Kanda Yukihiko , Tono Tetsuya , Doi Katsumi , Kumakawa Kozo , Gyo Kiyofumi , Naito Yasushi , Kanzaki Sho , Yamanaka Noboru , Kaga Kimitaka
Published: May 2017

Objective:

To report on the safety and efficacy of an investigational active middle ear implant (AMEI) in Japan, and to compare results to preoperative results with a hearing aid.

Design:

Prospective study conducted in Japan in which 23 Japanese-speaking adults suffering from conductive or mixed hearing loss received a VIBRANT SOUNDBRIDGE with implantation at the round window. Postoperative thresholds, speech perception results (word recognition scores, speech reception thresholds, signal-to-noise ratio [SNR]), and quality of life questionnaires at 20 weeks were compared with preoperative results with all patients receiving the same, best available hearing aid (HA).

Results:

Statistically significant improvements in postoperative AMEI-aided thresholds (1, 2, 4, and 8 kHz) and on the speech reception thresholds and word recognition scores tests, compared with preoperative HA-aided results, were observed. On the SNR, the subjects’ mean values showed statistically significant improvement, with −5.7 dB SNR for the AMEI-aided mean and −2.1 dB SNR for the preoperative HA-assisted mean. The APHAB quality of life questionnaire also showed statistically significant improvement with the AMEI.

Conclusion:

Results with the AMEI applied to the round window exceeded those of the best available hearing aid in speech perception as well as quality of life questionnaires. There were minimal adverse events or changes to patients’ residual hearing.
Psychometric Evaluation of the Chinese Breast Cancer Prevention Trial Symptom Scale
Authors: Tsai Ching-Fen , Tsai Pei-Shan , Liu Chien-Liang , Lin Yen-Kuang , Ling You-Li , Tseng Ing-Jy , Liao Yuan-Mei
Published: May 2017

Background:

Women with breast cancer experience a wide spectrum of symptoms after diagnosis and treatment. Symptoms experienced by this specific population might not be fully assessed using available traditional Chinese-language symptom measures.

Objectives:

The aim of this study was to examine the latent constructs and psychometric properties of the Chinese Breast Cancer Prevention Trial (C-BCPT) Symptom Scale.

Methods:

Two hundred women with breast cancer were recruited in Taiwan. Psychometric properties, including construct validity, internal consistency, and test-retest reliability, of the C-BCPT Symptom Scale were tested after translating the original instrument.

Results:

A 21-item C-BCPT Symptom Scale, with 7 extracted factors accounting for 72.26% of the total variance, resulted from an exploratory factor analysis. Construct validity was confirmed by significant correlations between scores on the C-BCPT Symptom Scale and the Taiwan-version Short Form–36 Health Survey (r = −0.49 to −0.53)/Greene Climacteric Scale (r = 0.81). Reliability coefficients for the overall scale/6 extracted factors (Cronbach's α = 0.72–0.88) and test-retest reliability (intraclass correlation coefficients = 0.77–0.94) of the translated instrument were satisfactory, whereas 1 reliability coefficient for 1 extracted factor was inadequate (Cronbach's α = 0.57).

Conclusion:

An interpretable structure with preliminary acceptable psychometric properties of the C-BCPT Symptom Scale was obtained; the C-BCPT can help traditional Chinese-speaking healthcare professionals perform adequate assessments of the symptoms experienced by women with breast cancer.

Implications for Practice:

The C-BCPT Symptom Scale can be used in clinical practice and research to assess symptoms experienced by this specific population or effects of related interventions.
The Relationship Between Body Image, Gender, Subjective Norms, and the Decision to Undergo Preventive Mastectomy Among Arab and Jewish BRCA Carriers
Authors: Kardosh Majeda , Bar-Tal Yoram , Barnoy Sivia
Published: May 2017

Background:

Carriers for a mutation in BRCA1/2 genes have a high, lifelong risk for developing breast cancer. Preventive mastectomy is considered an effective risk reduction surgery. Many factors might affect the decision to undergo preventive mastectomy, including culture, perceived body image after mastectomy and important others opinion.

Objective:

The aim of this study is to evaluate BRCA mutation carriers’ decision to undergo preventive mastectomy and the relationship between culture, gender, body image, and the decision.

Methods:

The study was a cross-sectional design where Arab and Jewish men and women were requested to imagine that they were/their spouse was a BRCA mutation carrier. The sample consisted of 200 participants, 101 Arab and 99 Jews, included 101 women and 99 men.

Results:

The results show a high intention to undergo preventive mastectomy. Being Arab and having a more positive perception of body image after the surgery were connected to more intention to undergo the surgery. Also, those who intended to choose the surgery considered more the opinions of important others.

Conclusions:

The results point to the importance of partners’ involvement in the decision to undergo preventive mastectomy. Also, important others (relatives, friends, and health caregivers) have an impact on the decision.

Implications for Practice:

Nurses need to consider cultural aspects of patients considering a decision about whether to undergo preventive mastectomy. Understanding the important others who might influence the decision and including them in the decision process are both essential.
Dose Prescription and Delivery in Neonates With Congenital Heart Diseases Treated With Continuous Veno-Venous Hemofiltration
Authors: Ricci Zaccaria , Guzzi Francesco , Tuccinardi Germana , Di Chiara Luca , Clark William , Goldstein Stuart L. , Ronco Claudio
Published: May 2017

Objectives:

Renal replacement therapy may be required for acute kidney injury treatment in neonates with complex cardiac conditions. Continuous veno-venous hemofiltration is applied safely in this population but no published recommendations for dose prescription in neonates currently exist. The aim of our study was to evaluate the effects of a relatively small dialysis dose on critically ill neonates.

Design:

Retrospective analysis of clinical charts.

Setting:

Pediatric Cardiac ICU.

Patients:

Ten critically ill neonates with severe acute kidney injury were analyzed. The primary indication for continuous veno-venous hemofiltration initiation was severe fluid overload with oligoanuria.

Interventions:

None.

Measurements and Main Results:

The median (range) age and weight were 3 days (1–12 d) and 2.6 kg (2.1–4.2 kg), respectively, whereas the median continuous veno-venous hemofiltration duration was 17 days (3–63 d). Median prescribed blood flow rate, replacement fluid rate, and net ultrafiltration rate were 12 mL/min (9–50 mL/min), 100 mL/hr (40–200 mL/hr), and 20 mL/hr (5–45 mL/hr), respectively. The median effluent-based continuous veno-venous hemofiltration dose was 35 mL/kg/hr (11–66 mL/kg/hr), whereas the median delivered daily Kt/V per session (24 hr) was 0.5 (0.01–1.8). However, for treatment sessions lasting less than or equal to 12 versus greater than or equal to 12 hours per session, the median prescribed effluent dose was 41 (11–66) and 32 (17–60) mL/kg/hr, respectively (p = 0.06), whereas the delivered creatinine daily Kt/V values were 0.3 (0.01–0.9) and 0.9 (0.5–1.8), respectively (p < 0.0001). An inverse correlation was found between delivered daily Kt/V and the blood concentration differences of both creatinine (r = –0.3; p = 0.0093) and urea (r = –0.3; p = 0.0028) measured at the end and the beginning of a 24-hour treatment. The decrease of creatinine concentration was significantly greater during 24-hour treatment sessions with a delivered daily Kt/V greater than 0.9 than during those with daily Kt/V less than 0.9.

Conclusions:

Based on these findings, we propose on a provisional basis the use of daily Kt/V as a measure of continuous renal replacement therapy adequacy for critically ill neonates.
Outcome of Pediatric Critical Care Medicine Abstracts Presented at North American Academic National Meetings*
Authors: Basu Sonali , Pollack Murray M.
Published: May 2017

Objectives:

Pediatric critical care medicine abstracts presented at North American national academic meetings have not been followed up to determine their publication outcomes. Our objective was to determine the following: 1) the proportion of these presentations that are published in peer-reviewed journals within 5 years; 2) the impact of trainee status on time to and success of publication; and 3) the quality of the research as reflected in the publishing journal’s impact factor.

Design:

Four years of abstracts (2007–2011) were reviewed from the American Academy of Pediatrics, Pediatric Academic Societies, and Society of Critical Care Medicine national meetings. Pediatric critical care medicine abstracts were delineated by the meeting or identified by keyword search. Data included mode of presentation, trainee status of first author, publication status within 5 years based on a PubMed search, trainee position in the journal of publication authorship list, and the impact factor of journal of publication.

Measurements and Main Results:

We evaluated 267 pediatric critical care medicine abstracts, 85–94 from each meeting. Overall, 41% were published, with the highest rate in Pediatric Academic Societies abstracts (54% Pediatric Academic Societies, 38% Society of Critical Care Medicine, and 33% American Academy of Pediatrics; p = 0.011). Mean time to publication was 22 (± 3) months and did not differ by conference or presentation mode. Journal first authorship was retained in 84%. Journal impact factor was highest in Society of Critical Care Medicine abstracts (3.38 Society of Critical Care Medicine, 2.64 Pediatric Academic Societies, and 1.92 American Academy of Pediatrics; p = 0.006). First author trainee status was not associated with publication rate, time to publication, and impact factor. A total of 100% of trainees but only 79% of nontrainees who published retained first authorship.

Conclusions:

Less than half of pediatric critical care medicine research abstracts presented at North American national academic meetings culminate in articles. Pediatric Academic Societies had the highest publication success rate, and Society of Critical Care Medicine abstracts were published in journals with the highest impact factors. All trainees who were first authors retained that status in the journal publications.
Breast Implant–Associated Anaplastic Large Cell Lymphoma in Australia and New Zealand: High-Surface-Area Textured Implants Are Associated with Increased Risk
Authors: Loch-Wilkinson Anna , Beath Kenneth J. , Knight Robert John William , Wessels William Louis Fick , Magnusson Mark , Papadopoulos Tim , Connell Tony , Lofts Julian , Locke Michelle , Hopper Ingrid , Cooter Rodney , Vickery Karen , Joshi Preeti Avinash , Prince H. Miles , Deva Anand K.
Published: May 2017

Background:

The association between breast implants and breast implant–associated anaplastic large cell lymphoma (ALCL) has been confirmed. Implant-related risk has been difficult to estimate to date due to incomplete datasets.

Methods:

All cases in Australia and New Zealand were identified and analyzed. Textured implants reported in this group were subjected to surface area analysis. Sales data from three leading breast implant manufacturers (i.e., Mentor, Allergan, and Silimed) dating back to 1999 were secured to estimate implant-specific risk.

Results:

Fifty-five cases of breast implant–associated ALCL were diagnosed in Australia and New Zealand between 2007 and 2016. The mean age of patients was 47.1 years and the mean time of implant exposure was 7.46 years. There were four deaths in the series related to mass and/or metastatic presentation. All patients were exposed to textured implants. Surface area analysis confirmed that higher surface area was associated with 64 of the 75 implants used (85.3 percent). Biocell salt loss textured (Allergan, Inamed, and McGhan) implants accounted for 58.7 percent of the implants used in this series. Comparative analysis showed the risk of developing breast implant–associated ALCL to be 14.11 times higher with Biocell textured implants and 10.84 higher with polyurethane (Silimed) textured implants compared with Siltex textured implants.

Conclusions:

This study has calculated implant-specific risk of breast implant–associated ALCL. Higher-surface-area textured implants have been shown to significantly increase the risk of breast implant–associated ALCL in Australia and New Zealand. The authors present a unifying hypothesis to explain these observations.
Dual Infection Contributes to Rapid Disease Progression in Men Who Have Sex With Men in China
Authors: Luan Hong , Han Xiaoxu , Yu Xiaoou , An Minghui , Zhang Hui , Zhao Bin , Xu Junjie , Chu Zhenxing , Shang Hong
Published: May 2017

Background:

Considerable numbers of HIV-1–infected men who have sex with men (MSM) show a relatively rapid disease progression in China; however, the cause remains elusive. HIV-1 dual infection was reported to occur commonly among the MSM population, and its contribution to clinical prognosis remains controversial. We investigated the occurrence and impact on disease progression of dual infection in a prospective MSM cohort in China.

Methods:

Sixty-four HIV-1 early-infected participants were longitudinally followed up for 2 years. Deep sequencing was used as dual-infection screening. CD4+ T-cell counts and HIV-1 viral load were compared between coinfection and single-infection participants and pre- versus post-superinfection.

Results:

Eight coinfected participants and 10 superinfected participants were identified, including 9 participants with intersubtype and 9 with intrasubtype dual infections. The prevalence of coinfection was 13.1%, with a superinfection incidence of 15.6%. Coinfection participants showed lower CD4+ T-cell counts at 120 days after infection (P = 0.042) and a higher viral set point tendency (P = 0.053) as compared with single-infection participants. Kaplan–Meier analysis showed that the time for the viral load to increase to above 4 log10 copies per milliliter was shorter in coinfection participants than in single-infection participants (P < 0.001). After superinfection, the median CD4+ T-cell count decreased from 635 to 481 cells/μL (P = 0.027).

Conclusions:

The occurrence of dual infection among Chinese MSM is relatively high, and HIV-1 dual infection might contribute to rapid disease progression seen in the MSM population.
Addition of Etravirine Does Not Enhance the Initial Decline of HIV-1 RNA in Treatment-Experienced Patients Receiving Raltegravir
Authors: Flandre Philippe , Marcelin Anne-Geneviève , Calvez Vincent ,   on behalf of the ANRS AC11 Resistance Study Group
Published: May 2017

Objective:

The importance of an early reduction of HIV-1 RNA as a marker for positive longer term outcome is still under debate. We investigate whether antiretroviral-experienced patients receiving raltegravir plus etravirine have a higher early reduction of HIV-1 RNA compared with patients receiving raltegravir.

Design:

An observational study of treatment-experienced patients.

Methods:

The objective is to investigate 349 patients included in a raltegravir resistance study. The early outcome is defined as a reduction of HIV-1 RNA at week 8. The crude method defines all measurements below the limit of quantification to be equal to the limit of quantification provides biased estimates. Such a reduction is censored by the limit of quantification and is subject to selection bias in observational studies.

Results:

The crude method showed a significant higher reduction in HIV-1 RNA reduction in patients receiving raltegravir plus etravirine compared with patients receiving raltegravir (mean reduction of 2.1 versus 1.8 log10 copies/mL). However, survival methods adjusted for both censoring, due to the limit of quantification, and confounding factors lead to a nonsignificant difference between the 2 treatment groups (mean reduction of 2.8 versus 2.7 log10 copies/mL).

Conclusion:

Taking into account censoring and confounding factors, our study did not demonstrate a higher early reduction of HIV-1 RNA in patients receiving raltegravir with versus without etravirine.
Distribution of Behavioral Patterns Before Infection Among San Francisco Men Who Have Sex With Men Newly Infected With HIV in 2014
Authors: Chen Yea-Hung , McFarland Willi , Raymond Henry F. , Scott Hyman M. , Vittinghoff Eric , Porco Travis C.
Published: May 2017

Background:

Despite continued reductions in the number of HIV cases reported among San Francisco men who have sex with men (MSM) and the HIV-prevention potential offered by pharmaceutical tools such as pre-exposure prophylaxis (PrEP), there are uncertainties, particularly given reported decreases in consistent condom use. A key uncertainty is what groups of MSM should be targeted. This study estimates the distribution of behavioral patterns before infection among San Francisco MSM newly infected with HIV in 2014.

Methods:

We used a novel modeling approach. The approach uses estimates from the National HIV Behavioral Surveillance System for MSM, the Medical Monitoring Project, 2 trials of PrEP, and a meta-analysis of per-act risks of HIV infection.

Results:

The modeling study suggests that 76% of newly HIV-infected MSM in 2014 were individuals with no discernible strategy in the 6 months before infection: that is, they had condomless receptive anal intercourse with one or more partners not perceived to be HIV uninfected. An estimated 7% of newly infected MSM were serosorters before infection.

Conclusions:

Prevention efforts in San Francisco must reach HIV-uninfected MSM with no discernible behavioral strategy, a group that constitutes 8% of HIV-uninfected MSM in the city. Our study suggests that if all HIV-uninfected, San Francisco MSM with no discernible strategy had been on PrEP in 2014, there would have been 70% fewer HIV infections among San Francisco MSM. Uncertainty analysis suggests that PrEP's impact may be maximized by encouraging PrEP persistence and concomitant reductions in sexual risk behaviors.
Impact of Perinatally Acquired HIV Disease Upon Longitudinal Changes in Memory and Executive Functioning
Authors: Malee Kathleen M. , Chernoff Miriam C. , Sirois Patricia A. , Williams Paige L. , Garvie Patricia A. , Kammerer Betsy L. , Harris Lynnette L. , Nozyce Molly L. , Yildirim Cenk , Nichols Sharon L. ,   for the Memory and Executive Functioning Study of the Pediatric HIV/AIDS Cohort Study
Published: May 2017

Background:

Little is known regarding effects of perinatally acquired HIV infection (PHIV) on longitudinal change in memory and executive functioning (EF) during adolescence despite the importance of these skills for independence in adulthood.

Methods:

PHIV (n = 144) and perinatally HIV-exposed uninfected youth (PHEU, n = 79), ages 12–17, completed standardized tests of memory and EF at baseline and 2 years later. Changes from baseline for each memory and EF outcome were compared between PHEU and PHIV youth with (PHIV/C, n = 39) and without (PHIV/non-C, n = 105) history of CDC class C (AIDS-defining) diagnoses. Among PHIV youth, associations of baseline and past disease severity with memory and EF performance at follow-up were evaluated using adjusted linear regression models.

Results:

Participants were primarily black (79%); 16% were Hispanic; 55% were female. Mean memory and EF scores at follow-up generally fell in the low-average to average range. Pairwise comparison of adjusted mean change from baseline to follow-up revealed significantly greater change for PHIV/non-C compared with PHEU youth in only one verbal recognition task, with a difference in mean changes for PHIV/non-C versus PHEU of −0.99 (95% CI: −1.80 to −0.19; P = 0.02). Among youth with PHIV, better immunologic status at baseline was positively associated with follow-up measures of verbal recall and recognition and cognitive inhibition/flexibility. Past AIDS-defining diagnoses and higher peak viral load were associated with lower performance across multiple EF tasks at follow-up.

Conclusions:

Youth with PHIV demonstrated stable memory and EF during a 2-year period of adolescence, allowing cautious optimism regarding long-term outcomes.
Computed Tomography in the Diagnosis of Classical Trigeminal Neuralgia
Authors: Baliazin Victor A. , Baliazina Elena V. , Aksenov Daniil P.
Published: May 2017

Objective

This study aims to characterize the pathogenesis of neurovascular conflict in trigeminal neuralgia (TN) with the goal of producing a reliable diagnostic method.

Methods

Data were obtained during microvascular decompression surgery. The normal relationship between the superior cerebellar artery (SCA) and the trigeminal nerve root also was characterized in postmortem cases. Furthermore, SCA was imaged with high-resolution computed tomography angiography.

Results

Our results indicate that contact between SCA and the trigeminal nerve root is present in both TN and non-TN cases, but in patients with TN, the apex of SCA loop was always at the bottom of the upper edge of the trigeminal root forming the state of neurovascular conflict. High-resolution angiography supported the intraoperative results.

Conclusions

These findings indicate a clear difference between neurovascular contact and conflict and point to the use of high-resolution computed tomography visualization of the position of SCA loop apex relative to the trigeminal nerve root as a primary diagnostic method.
Application and Indication of Carcinoembryonic Antigen Triggered 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Scanning in the Detection of Relapse of Colorectal Cancer Patients After Curative Therapy
Authors: Yu Xiaozhou , Zhu Lei , Dai Dong , Song Xiuyu , Chen Wei , Zhu Yanjia , Li Xiaofeng , Xu Wengui
Published: May 2017

Objective

This study aimed to explore the characteristics of patients with colorectal cancer (CRC) following curative therapy that may benefit from fluorine-18-2-uoro-2-deoxy-d-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) scanning, evaluate the application of carcinoembryonic antigen (CEA)–triggered 18F-FDG PET/CT scanning, and provide referential indicators.

Methods

This retrospective study included 56 CRC patients who received a PET/CT scan as a primary examination because of rising CEA levels after curative therapy and who had not received any other radiological examinations previously.

Results

The rate of recurrence or metastasis was 75.0% by PET/CT scan but was 69.6% with follow-up treatment. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 94.9%, 70.6%, 87.5%, 88.1%, and 85.7%, respectively. TNM (tumor, node, metastasis) stage, body mass index, and CEA level were significant prognostic factors.

Conclusions

Positron emission tomography/CT can be selectively applied as a primary examination in CRC patients with asymptomatic elevation of CEA. High CEA levels, increased body mass index, and advanced TNM staging are risk factors for relapse.
Vessel-Masked Perfusion Magnetic Resonance Imaging With Histogram Analysis Improves Diagnostic Accuracy for the Grading of Glioma
Authors: Arisawa Atsuko , Watanabe Yoshiyuki , Tanaka Hisashi , Takahashi Hiroto , Matsuo Chisato , Fujiwara Takuya , Fujimoto Yasunori , Yamamoto Kouji , Tomiyama Noriyuki
Published: May 2017

Objective

Dynamic susceptibility contrast magnetic resonance imaging is widely used to assess glioma grade; histogram analyses are used for precise tumor perfusion evaluations. We evaluated the effect of vessel contamination in normalized cerebral blood volume (nCBV) to differentiate high- and low-grade gliomas.

Methods

Thirty-four patients with gliomas underwent dynamic susceptibility contrast magnetic resonance imaging. Both traditional and vessel-masked nCBV maps were constructed. Histogram analyses of whole tumors and statistical comparisons were performed to compare traditional and vessel-masked images.

Results

Mean values of all the histogram metrics were lower in vessel-masked images than in traditional images. Receiver operating characteristic curve analyses for every histogram metric showed a higher area under the curve for vessel-masked images than for traditional images. The integrated discrimination improvement showed that the vessel-masked images were superior to the traditional images significantly for predicting the glioma grading.

Conclusions

Vessel-masked nCBV maps can prevent overestimations of CBV measurements and can improve diagnostic accuracy for glioma grading.