bluuebunny/crossref_metadata_2025 huggingface dataset:
Nontraditional Academic-Community Partnership: A Survey of Student Knowledge and Competencies
Authors: Sarsfield Eileen , Burkhard Agnes
Published: April 2018

This pilot study examined student perceptions of the acquisition of core knowledge and basic community/public health generalist competencies gained through an innovative, nontraditional clinical partnership with an organization serving a vulnerable population. The Centers for Disease Control and Prevention Workplace Health Model was the conceptual framework. A survey, based on theEssentials of Baccalaureate Nursing Education for Entry Level Community/Public Health Nursing Practice,was completed by 25 BSN nursing students. Students rated the experience as influential/extremely influential in the areas of human diversity, health promotion/risk reduction, and communication. Findings suggest that students can achieve community/public health competencies in nontraditional community settings.
Anxiety of Active and Passive Role Groups in Clinical Simulation: A Pilot Study
Authors: Smith Tedra S. , Hogewood Connie , Etheridge Sherita , Britt Sylvia , Vance David E.
Published: April 2018

Clinical simulation within nursing programs is a hallmark teaching strategy. With faculty challenged to design effective simulations for large groups of students, students are often divided into an active or passive role group. This study examined the anxiety levels experienced by students in the two roles. Results indicated that trait anxiety was similar in both groups before and after the simulation; however, there was a significant decrease in state anxiety ratings in the active role group following the simulation. The finding that students in the active role group experienced reduced state anxiety can theoretically facilitate learning.
Impact of Intravenous Acetaminophen on Perioperative Opioid Utilization and Outcomes in Open Colectomies
Authors: Wasserman Isaac , Poeran Jashvant , Zubizarreta Nicole , Babby Jason , Serban Stelian , Goldberg Andrew T. , Greenstein Alexander J. , Memtsoudis Stavros G. , Mazumdar Madhu , Leibowitz Andrew B.
Published: April 2018

Background

The value of intravenous acetaminophen in postoperative pain management remains debated. The authors tested the hypothesis that intravenous acetaminophen use, in isolation and in comparison to oral, would be associated with decreased opioid utilization (clinically significant reduction defined as 25%) and opioid-related adverse effects in open colectomy patients.

Methods

Using national claims data from open colectomy patients (Premier Healthcare Database, Premier Healthcare Solutions, Inc., USA; 2011 to 2016; n = 181,640; 602 hospitals), we separately categorized oral and intravenous acetaminophen use: 1 (1,000 mg) or more than 1 dose on the day of surgery, postoperative day 1, or later. Multilevel models measured associations between intravenous or oral acetaminophen and (1) opioid utilization and (2) opioid-related adverse effects. Percent change and multiplicity-adjusted 99.5% CI are reported.

Results

Overall, 25.1% of patients received intravenous acetaminophen, of whom 48.0% (n = 21,878) received 1 dose on the day of surgery. In adjusted analyses, particularly more than 1 dose of intravenous acetaminophen (versus nonuse) on postoperative day 1 was associated with a −12.4% (99.5% CI, −15.2 to −9.4%) change in opioid utilization. In comparison, a stronger reduction was seen in those receiving more than 1 oral acetaminophen dose: −22.6% (99.5% CI, −26.2 to −18.9%). Unadjusted group medians were 550 and 490 oral morphine equivalents, respectively. Intravenous versus oral differences were less pronounced among those receiving more than 1 acetaminophen dose on the day of surgery: −8.0% (99.5% CI, −11.0 to −4.9%) median 499 oral morphine equivalents versus −8.7% (99.5% CI, −14.4 to −2.7%) median 445 oral morphine equivalents, respectively; all statistically significant, but none clinically significant. Comparable outcome patterns existed for opioid-related adverse effects.

Conclusions

The demonstrated marginal effects do not support routine use of intravenous acetaminophen given alternative nonopioid analgesic options.
Role of Network Science in the Study of Anesthetic State Transitions
Authors: Lee UnCheol , Mashour George A.
Published: April 2018

The heterogeneity of molecular mechanisms, target neural circuits, and neurophysiologic effects of general anesthetics makes it difficult to develop a reliable and drug-invariant index of general anesthesia. No single brain region or mechanism has been identified as the neural correlate of consciousness, suggesting that consciousness might emerge through complex interactions of spatially and temporally distributed brain functions. The goal of this review article is to introduce the basic concepts of networks and explain why the application of network science to general anesthesia could be a pathway to discover a fundamental mechanism of anesthetic-induced unconsciousness. This article reviews data suggesting that reduced network efficiency, constrained network repertoires, and changes in cortical dynamics create inhospitable conditions for information processing and transfer, which lead to unconsciousness. This review proposes that network science is not just a useful tool but a necessary theoretical framework and method to uncover common principles of anesthetic-induced unconsciousness.
Management of Tibial Bow in Fibular Deficiency
Authors: Westberry David E. , Carpenter Ashley M. , Barrera John , Westberry Alison
Published: April 2018

Background:

Deformity of the tibia, including shortening and angulation, may accompany severe forms of postaxial hypoplasia (fibular deficiency). The current literature reflects varying opinions on the appropriate management for tibial deformity in the setting of fibular deficiency.

Methods:

We performed a retrospective review to determine outcomes of tibial deformity correction in patients with a primary diagnosis of fibular deficiency. Clinical and radiographic outcomes of patients treated with foot ablation were reviewed to establish indications for tibial deformity correction, identify occurrence of additional surgical procedures related to limb alignment or deformity, and characterize difficulties with prosthetic wear potentially related to residual or recurrent tibial deformity.

Results:

From 1989 to 2016, 51 patients (57 extremities) with fibular deficiency were managed with a foot ablation procedure. Twenty-five (44%) had simultaneous correction of the tibial deformity. The initial tibial deformity measured 42.5 degrees, was corrected to 5.6 degrees intraoperatively, and measured 18.6 degrees at follow-up, suggesting recurrent deformity. In follow-up, approximately half of the patients complained of redness and one third complained of a continued prominence along the anterior tibia. Thirty-two extremities had an isolated foot ablation procedure without tibial osteotomy. Radiographic review demonstrated mild tibial bowing at the time of amputation with a mean angular deformity of 15.4 degrees and remained unchanged during the follow-up period (mean, 12.7 degrees). Similar to the osteotomy group, approximately half of the patients complained of redness and erythema over the anterior bow, with one fourth noting prominence, and only 2 reporting significant pain.

Conclusions:

Tibial osteotomies in patients with more significant degrees of angular deformity can be safely performed at the same setting as foot ablative procedures for fibular deficiency. Recurrent deformity with growth may occur. Patients and their caregivers should be aware that rebound deformity may occur, but typically can be managed with prosthetic adjustment and without significant disruption to the child’s daily activities.

Level of Evidence:

Level IV (case series).
The Effect of Booster Seat Use on Pediatric Injuries in Motor Vehicle Frontal Crashes
Authors: Caskey Sean , Hammond Joshua , Peck Jeffrey , Sardelli Matthew , Atkinson Theresa
Published: April 2018

Background:

Motor vehicle crashes are a significant source of pediatric mortality and morbidity. Studies indicate that booster seats significantly improve seat belt fit for children who have not attained a height of 145 cm (4’ 9”). This study examined injuries occurring in booster age children up to age 12, as the majority of children do not attain 145 cm until this age. The purpose of the study was to identify differences in injuries due to the type of restraint used, with attention to musculoskeletal injuries.

Methods:

Vehicle and occupant data were obtained from a publically available statistical sample of tow-away crashes. Frontal crashes over an 8-year period were examined. A data set of cases was created involving children ages 5 to 12 years who were unrestrained, restrained using the vehicle’s lap and shoulder belt, and restrained using a booster seat with the vehicle’s lap and shoulder seat belt. Injury severity, frequency, and patterns of distribution were compared.

Results:

Unrestrained children experienced moderate to severe injuries 3.8 to 19 times more frequently than children using restraints. There were more injuries to the head and face in unrestrained versus restrained children, but the head and face was the most frequently injured region for all groups. There were no serious cervical spine injuries reported for any group. Lower extremity fractures were not observed in booster seat users but occurred at similar rates in both unrestrained and seat belt restrained children. These fractures occurred in older children who were involved in more severe crashes.

Conclusions:

Unrestrained children were more likely to experience moderate and severe injuries than restrained children. The data sample suggests that booster use may reduce the risk of extremity fracture, as there were no extremity fractures in children restrained with booster seats.

Clinical Relevance:

This work provides evidence for the efficacy of booster use for preventing orthopaedic injury in children. This evidence can be used to inform parents and establish recommendations for best practices in transporting children.
Prognostic Significance of Nodal Location and Ratio in Stage IIIC Endometrial Carcinoma Among a Multi-Institutional Academic Collaboration
Authors: Mayadev Jyoti , Elshaikh Mohamed A. , Christie Alana , Nagel Christa , Kennedy Vanessa , Khan Nadia , Lea Jayanthi , Ghanem Ahmad , Miller David , Xie Xian-Jin , Folkert Michael , Albuquerque Kevin
Published: April 2018

Purpose/Objective(s):

Stage IIIC endometrial carcinoma (EC) represents pathologically heterogenous patients with single/multiple pelvic (stage IIIC1) or paraaortic (stage IIIC2) lymph nodes (LNs). There is an increasing trend to offer adjuvant chemotherapy (CT) +/− radiation (RT) uniformly to these patients, regardless of substage. We investigate the prognostic significance of positive LN (pLN) number, ratio (%pLN), location (IIC1 vs. IIC2), and adjuvant treatment on patterns of failure and survival in a large collaborative multi-institutional series.

Materials and Methods:

Clinical data for stage III EC patients such as patient characteristics, surgery/pathologic details, adjuvant therapies (including CT, RT, and chemotherapy and radiation), and outcomes (including pelvic control [PC], disease-free survival [DFS], distant DFS, and overall survival [OS]) were collected from 3 academic institutions. Log-rank analyses, Cox regression univariate and multivariate analyses were performed.

Results:

Of the 264 patients queried for stage III disease, 237 (73%) had pLN, and complete LN sampling for analysis. The mean number of pLN in the combined data were 3.9, with 26.1% of all LN sampled positive; 121 patients (51%) staged IIIC1, and 116 patients (49%) staged IIIC2. There was a significant difference in number of pLN (P=0.0006) and total LN sampled by institution (range, 13 to 35; P=0.0004), without a difference in %pLN (P=0.35). Ninety-seven of 220 (44.1%) have ≥20% pLN. While controlling for substage and institution, a decrease in DFS (hazard ratio [HR], 1.1; P=0.007), and OS (HR, 1.1; P=0.01) was observed with every increase of 10% in the pLN ratio. There was a significant difference in DFS (HR, 1.8; P=0.003), PC (HR, 1.9; P=0.004), and distant DFS (HR, 1.6; P=0.03), as well as a trend for decreased OS (HR, 1.6; P=0.08) for substage IIIC2 versus IIIC1 disease; 5 years DFS 40% versus 45%, OS 50% versus 57%. Patients received no adjuvant therapy (10%), CT alone (27%), RT alone (16%), or chemotherapy and radiation (47%). There was no significant difference in PC, DFS, or OS between the various treatment regimens. On univariate analysis, while pLN was significant, treatment type did not impact DFS or OS. On multivariate analysis for DFS, patient age, race, and IIIC1 versus IIIC2 substage retained significance (HR, 0.56; P=0.01).

Conclusions:

Stage III EC patients with substage IIIC2 disease have a significantly increased risk of local and distant disease recurrence and death from EC. A decrease in DFS and OS was observed with every increase of 10% in the pLN ratio. Stage IIIC2 patients represent a high-risk subpopulation for whom clinical trials, or targeted regimens should be explored to achieve improved oncologic outcomes.
Multi-modal 3D Simulation Makes the Impossible Possible
Authors: Ganske Ingrid M. , Schulz Noah , Livingston Katie , Goobie Susan , Meara John G. , Proctor Mark , Weinstock Peter
Published: April 2018

B.Y. was born full term after a large vertex encephalocele was diagnosed prenatally. The unique challenge to repairing B.Y.’s encephalocele was a microcephalic skull and large proportion of likely functional extracranial brain tissue, which would need to be preserved. At Boston Children’s Hospital, a simulation-based collaborative presurgical planning and rehearsal process, using both digital and 3D printed models, enabled successful technical completion and outcome of an otherwise inoperable case.
Identification of Amino Acid Substitutions Within the VP7 Genes of G2 Rotavirus Strains in Ghana
Authors: Damanka Susan A. , Agbemabiese Chantal A. , Lartey Belinda L. , Dennis Francis E. , Asamoah Frederick K. , Adiku Theophilus K. , Enweronu-Laryea Christabel C. , Sagoe Kwamena W. , Ofori Michael F. , Armah George E.
Published: April 2018

We used the dideoxynucleotide chain termination method to determine the strains of nine non-typeable rotavirus enzyme immunoassay–positive samples, which were identified as G2. We detected nucleotide changes in the primer-binding region and amino acid substitutions within the VP7 protein of the G2 rotavirus strains. Genotyping primers need to be updated regularly.
Social Support Moderates the Relationship Between Perceived Stress and Quality of Life in Patients With a Left Ventricular Assist Device
Authors: Abshire Martha , Russell Stuart D. , Davidson Patricia M. , Budhathoki Chakra , Han Hae-Ra , Grady Kathleen L. , Desai Shashank , Dennison Himmelfarb Cheryl
Published: April 2018

Background:

Living with a left ventricular assist device has significant psychosocial sequelae that affect health-related quality of life (HRQOL).

Objective:

The purpose of this study was to (1) describe psychosocial indicators of stress including perceived stress, depression, fatigue, and coping; (2) examine relationships among stress indicators by level of perceived stress; (3) examine relationships among indicators of stress and clinical outcomes; and (4) test the moderation of social support on the relationship between stress and clinical outcomes.

Methods:

Participants were recruited from 2 outpatient clinics in a cross-sectional study design. Standardized measures were self-administered via survey. Descriptive statistics, correlation, and multiple linear regression analysis were conducted.

Results:

The sample (N = 62) was mostly male (78%), black (47%), and married (66%), with a mean age of 56.5 ± 13 years. The overall sample had a moderate stress profile: moderate perceived stress (mean, 11.7 ± 7), few depressive symptoms (mean, 3.2 ± 3.9), and moderate fatigue (mean, 14.3 ± 9.1). Increased perceived stress was associated with fatigue, depressive symptoms, and maladaptive coping (P < .001). Regression analysis demonstrated that perceived stress and fatigue were significant correlates of overall HRQOL (adj. R
2 = 0.41, P < .0001). Social support moderated the relationship between perceived stress and HRQOL, controlling for fatigue (R
2 = 0.49, P < .001).

Conclusions:

Individuals living with left ventricular assist device with high perceived stress have worse depressive symptoms, fatigue, and coping. The influence of high social support to improve the relationship between stress and HRQOL underscores the importance of a comprehensive plan to address psychosocial factors.
Physical Therapist Student, Nursing Student, and Community Partner Perspectives of Working Together in a Chicago Neighborhood After-School Program
Authors: Healey William E. , Cygan Heide R. , Reed Monique , Huber Gail
Published: April 2018

Background and Purpose.

Racial disparities in health across Chicago have worsened, despite increased attention at federal and local levels. Approaches to addressing health inequity include community-based participatory research (CBPR) and interprofessional education (IPE) experiences. The purpose of this case report is to describe the results of a community-based educational experience in a neighborhood after-school program from the perspectives of health professions students and their community partners.

Case Description.

The Westside Health Authority (WHA), a community-based organization in the Austin neighborhood of Chicago, approached their CBPR partners at Northwestern University and Rush University and asked for assistance to change an after-school program. In response, university faculty designed an IPE experience, which included six physical therapists (PTs) and seven nursing students. In collaboration with WHA Youth Development Center (YDC) staff, PT and nursing students developed and implemented a 10-week physical activity (PA) and nutrition program titled “Kids in Motion (KIM)”. Physical therapy and nursing faculty members provided oversight of KIM.

Outcomes.

Fourteen African American youth (6–12 years old) participated in KIM, which consisted of a PA session led by PT students (on Mondays), a nutrition activity conducted by nursing students (on Thursdays), and an integration of learned activities by YDC staff on other weekdays. Quantitative and qualitative measures were used to assess KIM outcomes.

Discussion and Conclusion.

Focus group findings suggested that the community partners' expectations of the health promotion program for youth were successfully met. In addition, the PT and nursing students indicated increased confidence and preparedness in working with underserved communities to plan programs based on areas of need identified by community stakeholders. Community-based and interprofessional experiences should be considered as sustainable methods to meet both the programming needs identified by community partners and the educational needs of health professions students.
Small Left Ventricular Size Is an Independent Risk Factor for Ventricular Assist Device Thrombosis
Authors: Chivukula Venkat Keshav , Beckman Jennifer A. , Prisco Anthony R. , Lin Shin , Dardas Todd F. , Cheng Richard K. , Farris Stephen D. , Smith Jason W. , Mokadam Nahush A. , Mahr Claudius , Aliseda Alberto
Published: April 2018

The prevalence of ventricular assist device (VAD) therapy has continued to increase due to a stagnant donor supply and growing advanced heart failure (HF) population. We hypothesize that left ventricular (LV) size strongly influences biocompatibility and risk of thrombosis. Unsteady computational fluid dynamics (CFD) was used in conjunction with patient-derived computational modeling and virtual surgery with a standard, apically implanted inflow cannula. A dual-focus approach of evaluating thrombogenicity was employed: platelet-based metrics to characterize the platelet environment and flow-based metrics to investigate hemodynamics. Left ventricular end-diastolic dimensions (LVEDds) ranging from 4.5 to 6.5 cm were studied and ranked according to relative thrombogenic potential. Over 150,000 platelets were individually tracked in each LV model over 15 cardiac cycles. As LV size decreased, platelets experienced markedly increased shear stress histories (SHs), whereas platelet residence time (RT) in the LV increased with size. The complex interplay between increased SH and longer RT has profound implications on thrombogenicity, with a significantly higher proportion of platelets in small LVs having long RT times and being subjected to high SH, contributing to thrombus formation. Our data suggest that small LV size, rather than decreased VAD speed, is the primary pathologic mechanism responsible for the increased incidence of thrombosis observed in VAD patients with small LVs.
Outflow Cannula Systolic Slope in Patients With Left Ventricular Assist Devices: A Novel Marker of Myocardial Contractility
Authors: Grinstein Jonathan , Kruse Eric , Sayer Gabriel , Kim Gene H. , Raikhelkar Jayant , Kalantari Sara , Sarswat Nitasha , Adatya Sirtaz , Ota Takeyoshi , Jeevanandam Valluvan , Mor-Avi Victor , Lang Roberto M. , Uriel Nir
Published: April 2018

Left ventricular (LV) unloading with a LV assist device (LVAD) reverse remodels the heart and may lead to favorable changes in cellular architecture and LV geometry promoting myocardial recovery. Currently, there are no standardized methods for evaluating myocardial recovery. This study assesses the systolic slope of the LVAD outflow cannula as a marker for myocardial contractility. Doppler echocardiography (transthoracic echocardiogram [TTE]) of the LVAD outflow cannula and TTE of the LV cavity were prospectively collected in 57 patients with LVADs. Systolic acceleration of the LVAD outflow cannula was measured in each patient as the peak change of velocity over time (dv/dt) during systole from continuous-wave Doppler signal acquired from the LVAD outflow cannula. Ventricular volumes were concurrently measured by TTE. In a subset of 10 patients, the systolic slope was measured during each stage of a ramp study to study the properties of this parameter across a variety of loading conditions. The systolic slope of the LVAD outflow cannula was successfully measured in 53 of 57 patients (93%). Systolic slope strongly correlated with ejection fraction (EF) (R = 0.92). Analysis of systolic slope stratified by EF (EF >30%, EF 20–30%, EF 10–20%, and EF <10%) revealed systolic slopes that were significantly different between the groups (1,371 cm/s2 ± 324; 983 cm/s2 ± 122; 578 cm/s2 ± 139; and 495 cm/s2 ± 107, respectively; p < 0.001). Systolic slope did not change significantly across variable preload and afterload conditions during a ramp study. Systolic slope of the LVAD outflow cannula strongly correlates with EF and can be used to assess underlying myocardial contractility across a variety of LVAD loading conditions.
Comparison of Totally 3-Dimensional Laparoscopic Pancreaticoduodenectomy and Open Pancreaticoduodenectomy
Authors: Zhang Hang , Guo Xingjun , Xia Jia , Zhu Feng , Shen Ming , Wang Xin , Wang Min , Qin Renyi
Published: April 2018

Objective

The aim of this study was to evaluate the safety, feasibility, and oncologic outcomes of 3-dimensional total laparoscopic pancreaticoduodenectomy (3D-TLPD).

Methods

Data of all patients who underwent 3D-TLPD (n = 202) or open pancreaticoduodenectomy (OPD) (n = 213) at a single institution between October 2014 and December 2016 were reviewed. We evaluated the safety, feasibility, and oncologic outcomes of 3D-TLPD compared with OPD.

Results

The mean operative times in the 3D-TLPD and OPD groups were comparable (P = 0.322). The estimated blood loss and perioperative transfusion rate were similar in both groups, as were the morbidity and mortality rates (P > 0.050). The mean number of analgesic administered and the mean length of hospital and intensive care unit stay were lower (P < 0.001) and shorter (P < 0.001, P = 0.009) in the 3D-TLPD group than in the OPD group, respectively. The surgical resection margins and the number of lymph nodes harvested did not differ between the 2 groups; however, a significant difference was observed in pathological results.

Conclusions

Three-dimensional TLPD had the typical advantages of minimally invasive abdominal procedures, such as shorter hospital stays. It is technically safe and feasible and has comparable operative times and similar oncologic outcomes to those of OPD.
Endoscopic Ultrasound–Based Pancreatic Cancer Screening of High-Risk Individuals
Authors: Gangi Alexandra , Malafa Mokenge , Klapman Jason
Published: April 2018

Objectives

Pancreatic cancer (PC), a common cause of cancer death, is rarely diagnosed at an early stage. Early detection of PC may improve outcomes in affected patients. This study evaluated the utility of screening of high-risk individuals (HRIs) using an endoscopic ultrasound (EUS)-only approach to detect early malignant changes.

Methods

A prospective PC screening program for HRIs was opened in 2007. Fifty-eight patients have enrolled to date. Patients with normal EUS examinations underwent repeat EUS annually for 5 years. Patients with abnormal EUS underwent fine-needle aspiration (FNA) if a mass/cyst 1 cm or longer was found. Those with cysts/mass shorter than 1 cm or benign FNA underwent repeat EUS in 3 months. If unchanged, patients were followed with magnetic resonance imaging.

Results

Thirty-nine patients (67%) had initial normal EUS examinations, and 16 patients completed the 5-year trial. Five patients who initially had a normal EUS developed cysts on subsequent examinations. Of the 24 subjects (41%) with abnormal findings, 3 underwent FNA: 2 consistent with intraductal papillary mucinous neoplasm, 1 with benign cytology. The 21 remaining patients had 1 subcentimeter cyst or more followed by magnetic resonance imaging. No PCs have been detected.

Conclusions

Precancerous cysts are frequently detected with EUS in HRI. Whether screening impacts survival in HRIs remains unclear and requires further evaluation in larger multicenter trials.
Extracorporeal Shock Wave Lithotripsy for Chronic Pancreatitis Patients With Stones After Pancreatic Surgery
Authors: Wang Dan , Ji Jun-Tao , Xin Lei , Bi Ya-Wei , Pan Jun , Liao Zhuan , Du Ting-Ting , Lin Jin-Huan , Zhang Di , Zeng Xiang-Peng , Ye Bo , Zou Wen-Bin , Chen Hui , Xie Ting , Li Bai-Rong , Zheng Zhao-Hong , Li Zhao-Shen , Hu Liang-Hao
Published: April 2018

Objectives

The objective of this study was to evaluate the safety and efficacy of pancreatic extracorporeal shock wave lithotripsy (P-ESWL) in chronic pancreatitis (CP) patients with pancreatic stones after previous pancreatic surgery.

Methods

This is a single-center study prospectively conducted in pained CP patients undergoing P-ESWL. Patients with a pancreatic surgery history (PSH) were included in the PSH group, and patients without a PSH during the same period were assigned to the control group. The primary outcomes included complications associated with P-ESWL and pain relief. Secondary outcomes included stone clearance and improved quality-of-life scores.

Results

From March 2011 to October 2014, P-ESWLs were performed on 1017 patients (50 in the PSH group, 967 in the control group). No significant difference was observed in the frequency of occurrence of P-ESWL complications between the PSH group and control group (14.0% vs 13.2%, P = 0.877). At follow-up (2.6 years; range, 1.0–4.5 years), pain relief was achieved in 36 patients (75.0%), and 37 patients (77.1%) experienced complete stone clearance. No significant differences were observed between these patients and the matched controls.

Conclusions

For CP patients who develop painful stones after pancreatic surgery, P-ESWL safely achieves significant pain relief and stone clearance, preventing the need for a repeat surgery.
Nationwide Multicenter Observational Study of FOLFIRINOX Chemotherapy in 399 Patients With Unresectable or Recurrent Pancreatic Cancer in Japan
Authors: Todaka Akiko , Mizuno Nobumasa , Ozaka Masato , Ueno Hideki , Kobayashi Satoshi , Uesugi Kazuhiro , Kobayashi Noritoshi , Hayashi Hideyuki , Sudo Kentaro , Okano Naohiro , Horita Yosuke , Kamei Keiko , Yukisawa Seigo , Nakamori Shoji , Yachi Yutaka , Henmi Toshiyuki , Kobayashi Marina , Boku Narikazu , Mori Keita , Fukutomi Akira
Published: April 2018

Objectives

FOLFIRINOX (oxaliplatin, irinotecan, 5-fluorouracil, and leucovorin) is the standard therapy worldwide for unresectable pancreatic cancer; however, clinical data for Japanese patients are limited. Therefore, the observational study of FOLFIRINOX for patients with pancreatic cancer was conducted.

Methods

The study included 399 patients with unresectable or recurrent pancreatic cancer, from 27 institutions in Japan, treated with FOLFIRINOX and surveyed until December 2015.

Results

The median age was 63 years; in most patients, the Eastern Cooperative Oncology Group performance status was 1 or lower. The initial dose was reduced in 270 patients (68%). The main grade 3/4 toxicities were neutropenia (64%), anorexia (14%), and febrile neutropenia (13%). Fatal adverse events occurred in 5 patients, 4 of whom did not satisfy the main inclusion criteria of a previous Japanese phase II FOLFIRINOX study. The median overall survival and progression-free survival times were 10.8, and 4.5 months, respectively. The objective response rate was 21%, and the disease control rate was 61%. The median overall survival times were 11.1, 18.5, and 4.9 months in chemotherapy-naïve patients with metastatic, locally advanced, and recurrent disease, respectively.

Conclusion

When carefully managed, FOLFIRINOX is acceptably safe and efficacious in Japanese patients with unresectable pancreatic cancer.
Prediction of Insulin Secretion Ability With Microcirculation Evaluated by Contrast-enhanced Ultrasonography in Pancreas Transplantation
Authors: Aida Naohiro , Kenmochi Takashi , Ito Taihei , Nishikawa Toru , Hiratsuka Izumi , Shibata Megumi , Suzuki Atsushi , Hasegawa Midori , Kawai Akihiro , Kusaka Mamoru , Hoshinaga Kiyotaka , Matsubara Hisahiro
Published: April 2018

Objectives

Contrast-enhanced ultrasonography can evaluate microcirculation. Thus, we used contrast-enhanced ultrasonography in evaluating pancreas graft perfusion and examined the relationship between graft circulation and function.

Methods

Contrast-enhanced ultrasonography was performed in 17 cases within 24 hours and at 1, 3, 5, 7, 14, 21, and 28 days after transplantation (Tx). The time between the time to peak intensity in the parenchyma and that in the vein was defined as delta-Tp(P-V). Graft function was evaluated with oral glucose tolerance test (OGTT) at 1 and 3 months after Tx, and glucagon stimulation test at 1 month after Tx.

Results

Differences in delta-Tp(P-V) between individual cases were more significant early after Tx, and delta-Tp(P-V) within 24 hours (delta-Tp[P-V]24h) was used in the subsequent analysis. Delta-Tp(P-V)24 hours showed a negative correlation with C-peptide increment in the glucagon stimulation test and the area under the curve of insulin level in oral glucose tolerance test. The cases were divided into the following 2 groups: the standard group (delta-Tp[P-V]24h ≤6.10 seconds) and the delayed group (>6.10 seconds). The area under the curve of insulin level increased significantly from 1 to 3 months after Tx in the standard group only.

Conclusions

These results suggest that delta-Tp(P-V)24 hours affects insulin secretion after Tx. Contrast-enhanced ultrasonography is useful in predicting endocrine function of the graft.
Antimicrobial Peptide Human Neutrophil Peptide 1 as a Potential Link Between Chronic Inflammation and Ductal Adenocarcinoma of the Pancreas
Authors: Pausch Thomas , Adolph Sarah , Felix Klaus , Bauer Andrea S. , Bergmann Frank , Werner Jens , Hartwig Werner
Published: April 2018

Objectives

Defensins are antimicrobial peptides playing a role in innate immunity, in epithelial cell regeneration, and in carcinogenesis of inflammation-triggered malignancies. We analyzed this role in pancreatic ductal adenocarcinoma (PDAC) in the context of its association with chronic pancreatitis (CP).

Methods

Human tissue of healthy pancreas, CP, and PDAC was screened for defensins by immunohistochemistry. Defensin α 1 (human neutrophil peptide 1 [HNP-1]) expression was validated using mass spectrometry and microarray analysis. Human neutrophil peptide 1 expression and influences of proinflammatory cytokines (tumor necrosis factor α, interleukin 1β, and interferon γ) were studied in human pancreatic cancer cells (Colo 357, T3M4, PANC-1) and normal human pancreatic duct epithelial cells (HPDE).

Results

Accumulation of HNP-1 in malignant pancreatic ductal epithelia was seen. Spectrometry showed increased expression of HNP-1 in CP and even more in PDAC. At RNA level, no significant regulation was found. In cancer cells, HNP-1 expression was significantly higher than in HPDE. Proinflammatory cytokines significantly led to increased HNP-1 levels in culture supernatants and decreased levels in lysates of cancer cells. In HPDE cytokines significantly decreased HNP-1 levels.

Conclusions

Inflammatory regulation of HNP-1 in PDAC tissue and cells indicates that HNP-1 may be a link between chronic inflammation and malignant transformation in the pancreas.
Encephalocraniocutaneous Lipomatosis
Authors: Bavle Abhishek , Shah Rikin , Gross Naina , Gavula Theresa , Ruiz-Elizalde Alejandro , Wierenga Klaas , McNall-Knapp Rene
Published: April 2018

A 5-year-old boy presented with worsening headaches for 3 months. On examination, he was found to have a hairless fatty tissue nevus of the scalp (nevus psiloliparus), subcutaneous soft tissue masses on the right side of his face, neck, mandible and right buttock and epibulbar dermoid of the right eye (choristoma) (Figs. 1A, B). Magnetic resonance imaging revealed a large suprasellar mass, which was debulked and found to be a pilocytic astrocytoma. Testing was not performed for the BRAF/KIAA1549 fusion or BRAFV600E mutation. Seven years later, he was started on adjuvant chemotherapy for gradual tumor progression. Over the ensuing 3 years, he had further disease progression despite treatment with 3 frontline chemotherapy regimens: vinblastine, carboplatin/vincristine, and irinotecan/bevacizumab. Targeted sequencing of tissue from the right gluteal mass, revealed a mosaic activating FGFR1 c.1966A>G (p.Lys656Glu) mutation, absent in normal left gluteal tissue, confirming the diagnosis of encephalocraniocutaneous lipomatosis (ECCL), belonging to the family of RASopathies (including neurofibromatosis type I, Noonan syndrome, Costello syndrome), with constitutive activation of the mitogen-activated protein kinase (MAPK) pathway, and an increased risk of developing neoplasms. He was started on trametinib, a MEK inhibitor, off-label, targeting the MAPK pathway downstream from FGFR1, with stable tumor size at last follow-up, after 6 months on therapy.
Respiratory Distress and Severe Anemia in a Child With Idiopathic Pulmonary Hemosiderosis
Authors: Temel Münevver T. , Temel Levent , Coskun Mehmet E. , Konduk Bugra T. , Akbayram Sinan , Demiryürek Abdullah T.
Published: April 2018

Idiopathic pulmonary hemosiderosis is an infrequent cause of pulmonary hemorrhage in children. It is classically defined by the triad of recurrent hemoptysis, iron-deficiency anemia, and diffuse parenchymal infiltration without an obvious cause. The pathogenesis remains unexplained, diagnosis may be difficult, and the clinical course exceedingly variable. A 4-year-old girl was admitted to the hospital with complaints of dyspnea, and skin and mucous membrane pallor. The suspicion of idiopathic pulmonary hemosiderosis led to the use of corticosteroid therapy with rapid improvement in clinical condition and discharge from hospital.
Outcomes of Proton Beam Radiation Therapy for Retinoblastoma With Vitreous Seeds
Authors: Jung Eun Hye , Kim Jeong Hun , Kim Joo Young , Jo Dong Hyun , Yu Young Suk
Published: April 2018

Vitreous seeds are the most challenging aspect in the management of retinoblastoma. We report the outcomes of treatment with proton beam radiation therapy (PBRT) for retinoblastoma with vitreous seeds in naive or previously treated eyes. In this retrospective case series, we analyzed data of 4 retinoblastoma patients with vitreous seeds who received PBRT at the Proton Therapy Center, National Cancer Center in Korea between June 2007 and August 2017. All 4 eyes treated by PBRT were classified as group D according to the International Classification of Retinoblastoma (ICRB) criteria, and the vitreous seeds, as class 3 (clouds). The tumor and vitreous seeds regressed in 2 eyes, and globe salvage was achieved in these 2 eyes (50%). The post-PBRT ophthalmologic follow-up time of these 2 preserved eyes was 12 and 50 months, respectively. Visual acuity measurements of the successfully treated patients were 20/40 and 20/600. No radiation-associated malignancies were noted. In conclusion, PBRT successfully treated vitreous seeds classified as clouds in half of the cases, and successfully treated patients who retained useful vision. Therefore, PBRT might be a viable treatment option for vitreous seeds in patients with retinoblastoma.
Successful Management of a Child With Drug-induced Necrotizing Pancreatitis During Acute Lymphoblastic Leukemia Therapy: A Case Report
Authors: Płotka Anna , Wziątek Agnieszka , Wachowiak Jacek , Derwich Katarzyna
Published: April 2018

Acute pancreatitis in children acute lymphoblastic leukemia is commonly caused by drugs, for example, l-Asparaginase, pegapargase, steroids. The incidence of this complication is estimated at 6.7% to 18%. Although the majority of drug-induced acute pancreatitis cases are mild, severe cases can rarely occur. This work presents a case of successful management of a child with drug-induced necrotizing pancreatitis during acute lymphoblastic leukemia therapy. This case illustrates that comprehensive care and immediate intensive treatment can rescue patient despite poor prognosis. Administration of octreotide may serve a role in limiting the severity of the disease.
Hemolytic Uremic Syndrome Associated With Non–Shigatoxin-producing Infectious Agents: Expanding the Shigatoxin Theory
Authors: Keenswijk Werner , Degraeuwe Eva , Dhont Evelyn , Raes Ann , Vande Walle Johan
Published: April 2018

Diarrhea-associated hemolytic uremic syndrome (HUS) is usually associated with shigatoxin-producing Escherichia coli or shigella infections. We report 2 cases of HUS, respectively, caused by salmonella and Campylobacter jejuni infections. None of these bacteria produce shigatoxins, and the underlying mechanism of HUS development remains unknown. In streptococcus pneumoniae–associated HUS, bacterial neuraminidase cleaves neuraminic acid and causes exposure of Thomsen-Friedenreich cryptantigen on the cell surface of, for example, erythrocytes, which induces an inflammatory response caused by binding of preformed IgM. Both campylobacter and salmonella bacteria also produce neuraminidase, and HUS development could be explained by a similar mechanism.
The effect of preoperative exercise on upper extremity recovery following breast cancer surgery: a systematic review
Authors: Yang Ajax , Sokolof Jonas , Gulati Amitabh
Published: April 2018

Prehabilitation benefits among patients undergoing various oncological surgeries have been demonstrated. However, the effects of presurgical exercise and fitness on postoperative ipsilateral upper extremity recovery outcomes in patients with breast cancer surgery are less evident. A systematic review was performed to assess the effects of preoperative exercise and fitness on postmastectomy recovery. Systematic literature search was performed in 12 electronic databases. Study eligibility was accessed using the PICOS (Participants, Interventions, Comparison, Outcome and Study Design) criteria. Six eligible studies were found: three cohort–control and three prospective observational studies. One randomized-controlled trial showed that prehabilitation was beneficial in shoulder range of motion (ROM) and upper extremity functional recovery. One cohort–control study demonstrated that preoperative exercises reduced postoperative pain without increasing the risk of developing a seroma. A prospective cohort study showed that preoperatively active individuals had a significantly better chance of feeling recovered physically at 3 weeks after surgery. Baseline ipsilateral grip strength, shoulder flexion, and abduction ROM were reliable predictors of shoulder flexion and abduction ROM and grip strength improvements at 1 month following breast cancer surgery. One study showed that preoperative conditioning alone without postoperative rehabilitation was insufficient to aid recovery. Implementing exercise program and optimizing preoperative fitness, especially shoulder ROM, before breast cancer surgery in conjunction with individualized rehabilitation program may benefit postmastectomy ipsilateral upper extremity recovery.
Cervical Cancer Screening in Women With Severe Mental Disorders
Authors: Borrull-Guardeño Jessica , Domínguez Alberto , Merizalde-Torres Milton H. , Sánchez-Martínez Vanessa
Published: April 2018

Background

The incidence of invasive cervical cancer and its mortality have been reduced through primary and secondary prevention. Screening rates tend to be lower in vulnerable groups, such as people with severe mental disorders, who have a later detection of cancer and a higher mortality. The access of these women to cervical cancer screening is uncertain in our context.

Objective

The aim of this study was to determine the cervical cancer screening rates in women with severe mental disorders.

Methods

This was a descriptive cross-sectional study. Women 25 to 65 years old who were admitted during 2016 to the psychiatric unit of a public hospital in Spain were included in the study, and it was determined if they had had cervical cancer screening.

Results

A total of 103 eligible women, with a mean age of 45.6 years, were enrolled. Only 28 of the participants (27.2%) had had a cervical cancer screening done in the last 5 years. By age groups, statistically significant differences were found, with women between 35 and 44 years of age having higher rates of cervical cancer screening (41.9%) and the oldest, between 55 and 65 years of age, having the lowest (5%).

Conclusions

Women with severe mental health disorders who were admitted to acute psychiatric care units had much lower cervical cancer screening rates compared with the general population.

Implications for Practice

Mental health nurses could be the optimum professionals to promote cancer primary and secondary prevention in women with mental disorders.
Interprofessional Education
Authors: Nelson-Brantley Heather V. , Warshawsky Nora E.
Published: April 2018

The Institute of Medicine called for all health professionals to be educated in interprofessional teams. Accreditation bodies governing education of health professions responded by creating standards for interprofessional education (IPE) activities. Educators teaching in health professional programs implemented a variety of IPE activities, yet rigorous evaluation of IPE on interprofessional practice and patient outcomes is limited. The authors review the progress of IPE, introduce new trends in IPE, and identify the methods needed to evaluate IPE effectiveness.
Testing a Strategy to Identify Incidence of Nurse Suicide in the United States
Authors: Davidson Judy E. , Stuck Amy R. , Zisook Sidney , Proudfoot James
Published: April 2018

OBJECTIVE

The aim of this study was to test a strategy for quantifying incidence of nurse suicide using San Diego County data as a pilot for national investigation.

BACKGROUND

Worldwide, 1 person dies by suicide every 40 seconds; more than 1 000 000 suicides occur yearly. Suicide rates for nurses in the United States have not been evaluated. This methodological article tested a strategy to identify incidence of nurse suicide compared with those of physicians and the general public.

METHOD

Deidentified San Diego County Medical Examiner data from 2005 to 2015 were analyzed with a descriptive epidemiologic approach.

RESULTS

Overall RN (18.51) and physician (40.72) incidences of suicide per 100 000 person-years were higher than the San Diego general population, excluding nurses (15.81) normalized to 100 000 person-years.

CONCLUSIONS

Establishing incidence of nurse suicide is confounded by variation in reporting mechanisms plus incomplete availability of nurse gender data. Relatively small outcome numbers compared with the general population may underestimate results. Research using a larger sample is indicated. Nurse executives may decrease risk by proactively addressing workplace stressors.
Effects of Progressive Addition Lens Wear on Digital Work in Pre-presbyopes
Authors: Kee Chea-su , Leung Tsz Wing , Kan Ka-hung , Lam Christie Hang-I
Published: April 2018

SIGNIFICANCE

Growing popularity of handheld digital devices imposes significant challenges to our visual system and clinical management. This study aimed to determine the effects of lens design on parameters that may influence the refractive management of pre-presbyopic adult computer users.

PURPOSE

To determine the effects of wearing conventional single-vision lenses (SVL) versus progressive addition lenses (PAL) on the working distance and refractive status.

METHODS

Adult computer users, recruited from two age cohorts (18 to 25 years, n = 19; 30 to 40 years, n = 45), were prescribed SVLs and PALs designed for use with handheld digital devices. For each lens type, the working distance and refractive shift (post-task − pre-task) were measured immediately after lens delivery (T0) and after 1 month of lens wear (T1). Working distances were recorded with an automatic ultrasound device while the participants were playing a video game. Refractive status through the subjects' glasses was measured before (pre-task) and after playing the game (post-task). Questionnaires assessing the frequencies of 10 digital work–related visual symptoms were conducted for both lens types at T1.

RESULTS

Switching from SVL to PAL increased the working distance in both cohorts (mean ± SEM = 1.88 ± 0.60 cm; P = .002) and induced a small but significant positive refractive shift (+0.08 ± 0.04 D, P = .021) in the older cohort at T1. In the younger cohort, the changes in working distance due to the switching lens design were correlated with myopic error (r = +0.66, P = .002). In the older cohort, the changes in refractive shift due to switching lens design were correlated with amplitude of accommodation at both time points (r for T0 and T1 = −0.32 and −0.30, respectively; both P < .05). Progressive addition lens was rated as causing less “increased sensitivity to light” compared with SVL.

CONCLUSIONS

Switching from SVL to PAL increased the working distance and induced a positive refractive shift in the majority of pre-presbyopic adults.