bluuebunny/crossref_metadata_2025 huggingface dataset:
Thoracoscopic surgery for lung cancer is associated with improved survival and shortened admission length: a nationwide propensity-matched study
Authors: Valo Johanna Katariina , Kytö Ville , Sipilä Jussi , Rautava Päivi , Sihvo Eero , Gunn Jarmo
Published: June 2019

OBJECTIVES

Population-based studies comparing long-term survival after minimally invasive and open surgery for lung cancer are lacking. The aim of this study was to compare long-term survival rates between minimally invasive [video-assisted thoracoscopic surgery (VATS)] and open surgery for lung cancer in an unselected nationwide setting.

METHODS

Patients undergoing minimally invasive (n = 710) or open (n = 2814) lung resection for lung cancer between 2004 and 2014 were identified from nationwide complete registries in Finland. Propensity score matching resulted in groups of 632 patients who had VATS and 632 who had a thoracotomy. The primary outcome was the 1-year survival rate. Secondary outcomes were 30-day, 90-day and 5-year survival rates and the length of surgical admission. Cox models were adjusted for sex, age, comorbidity, centre size, year of surgery, histological diagnosis, stage and adjuvant therapy.

RESULTS

In the propensity-matched cohort, the 1-year survival rate was 90.8% [confidence interval (CI) 88.3–92.8%] after VATS and 87.1% (CI 84.3–89.6%) after open surgery. The 5-year survival rate in the propensity-matched cohort was 59.6% (CI 54.9–63.9%) after VATS and 53.3% (CI 48.6–57.7%) after open surgery. The 30-day mortality rates showed no differences between approaches, but the 90-day mortality rate was better after VATS when adjusted for patient-, tumour- and operation-specific features (hazard ratio 0.56, 95% CI 0.30–0.92; P = 0.024).

CONCLUSIONS

According to this population-based nationwide study from Finland, minimally invasive surgery for lung cancer is associated with improved long- and short-term survival rates, supporting the use of VATS as a primary surgical method for treating lung cancer. Due to the complexity of confounding factors in this study, one should, however, interpret the results critically. Additional studies are needed.
Performance Surface Analysis Identifies Consistent Functional Patterns across 10 Morphologically Divergent Terrestrial Turtle Lineages
Authors: Stayton C Tristan
Published: June 2019

Newly-developed methods for utilizing performance surfaces—multivariate representations of the relationship between phenotype and functional performance—allow researchers to test hypotheses about adaptive landscapes and evolutionary diversification with explicit attention to functional factors. Here, information from performance surfaces of three turtle shell functions—shell strength, hydrodynamics, and self-righting—is used to test the hypothesis that turtle lineages transitioning from aquatic to terrestrial habitats show patterns of shell shape evolution consistent with decreased importance of hydrodynamic performance. Turtle shells are excellent model systems for evolutionary functional analysis. The evolution of terrestriality is an interesting test case for the efficacy of these methods because terrestrial turtles do not show a straightforward pattern of morphological convergence in shell shape: many terrestrial lineages show increased shell height, typically assumed to decrease hydrodynamic performance, but there are also several lineages where the evolution of terrestriality was accompanied by shell flattening. Performance surface analyses allow exploration of these complex patterns and explicit quantitative analysis of the functional implications of changes in shell shape. Ten lineages were examined. Nearly all terrestrial lineages, including those which experienced decreased shell height, are associated with morphological changes consistent with a decrease in the importance of shell hydrodynamics. This implies a common selective pattern across lineages showing divergent morphological patterns. Performance studies such as these hold great potential for integrating adaptive and performance data in macroevolutionary studies.
Potential relationship between dietary long-chain saturated fatty acids and hypothalamic dysfunction in obesity
Authors: Sergi Domenico , Williams Lynda M
Published: June 2019

Diet-induced hypothalamic inflammation, which leads to hypothalamic dysfunction and a loss of regulation of energy balance, is emerging as a potential driver of obesity. Excessive intake of long-chain saturated fatty acids is held to be the causative dietary component in hypothalamic inflammation. This review summarizes current evidence on the role of long-chain saturated fatty acids in promoting hypothalamic inflammation and the related induction of central insulin and leptin insensitivity. Particularly, the present review focuses on the molecular mechanisms linking long-chain saturated fatty acids and hypothalamic inflammation, emphasizing the metabolic fate of fatty acids and the resulting lipotoxicity, which is a key driver of hypothalamic dysfunction. In conclusion, long-chain saturated fatty acids are key nutrients that promote hypothalamic inflammation and dysfunction by fostering the build-up of lipotoxic lipid species, such as ceramide. Furthermore, when long-chain saturated fatty acids are consumed in combination with high levels of refined carbohydrates, the proinflammatory effects are exacerbated via a mechanism that relies on the formation of advanced glycation end products.
Practical Oomph: A Case for Subjectivism
Authors: Bedke Matthew
Published: June 2019

This paper examines the empirical and armchair evidence concerning the practical profiles of normative judgments. It then argues that the theory of normative judgment that best explains these practical profiles is a version of cognitivism: subjectivism. The preferred version says, roughly, i) each normative predicate is conventionally associated with a certain conative attitude, and ii) for S to judge that x has normative status N is for S to judge that x has a property picked out by the conative attitude associated with N. In short, having a normative judgment about x semantically necessitates having a conative attitude toward x's properties, to be contrasted with conceptual necessitation, metaphysical necessitation, rational necessitation, etiological necessitation, and other flavors of necessitation.
Introducing a dispensing power in English succession law
Authors: Hedlund Richard
Published: June 2019

Executing a will is one of the most important legal acts that a person will undertake. To be valid, the will must comply with the formality requirements in the Wills Act 1837. However, some wills fail to do so, and are invalidated on technicalities. Other jurisdictions, such as Australia, have given the courts a dispensing power to validate documents that would otherwise fail as wills, provided that it represents the testator’s true testamentary wishes. This article will consider whether such a dispensing power should be introduced into English law.
Gender Differences and Similarities in Accelerated Nursing Education Programs: Evidence of Success From the New Careers in Nursing Program
Authors: Spurlock Darrell R. , Patterson Barbara J. , Colby Normajean
Published: June 2019

AIM

The aim of the study was to examine the profile of male students in accelerated nursing education programs (ANEPs) focusing on key demographic, educational, and outcome variables and compare male and female students on these variables.

BACKGROUND

Though ANEPs have proliferated over the last two decades, there has been little study of students enrolled in these programs and, consequently, the role ANEPs could play in enhancing nursing workforce diversity.

METHOD

This study is a secondary analysis of data collected from 3,502 students who participated in the Robert Wood Johnson Foundation New Careers in Nursing Program from 2008 to 2016.

RESULTS

ANEP completion and NCLEX-RN® success rates were strong overall. Male and female ANEP students differed on several dimensions often associated with academic success, differences that have relevance for purposes of teaching, research, and program planning.

CONCLUSION

ANEPs could be an effective mechanism for increasing the gender, racial, and ethnic diversity of the nursing workforce.
Use of Music Lyrics to Engage Millennial Learners in Undergraduate Research
Authors: Sethares Kristen A. , Chin Elizabeth
Published: June 2019

Undergraduate research, a high-impact learning practice, peaks interest and enthusiasm for research and contributes to development of research process knowledge, skills, and competency. Fifty millennial sophomore nursing students participated in the innovative learning activity using lyrics from popular songs to complete qualitative analysis in a research course. Students analyzed, synthesized, and developed themes from music lyrics that helped them to more fully understand the processes and perspectives of qualitative research. This activity taught students about qualitative research and provided an opportunity to develop analysis, synthesis, and teamwork knowledge and skills transferable to the professional environment.
Using High-Fidelity Simulation to Evaluate Clinical Skills in Prelicensure Nursing Students
Authors: Turner Douglas M.
Published: June 2019

A prelicensure associate degree nursing program identified the need to formally validate clinical skills and decision-making within nursing students across the program and implemented a process using high-fidelity simulation. The simulated experiences provided an opportunity for both formative and summative evaluation while also affording an opportunity to level student performance across the program. Faculty reported improved consistency in their expectations of student performance within each nursing course, and students reported improved confidence in their clinical practice skills.
Second generation antihistamines: an update
Authors: Sánchez-Borges Mario , Ansotegui Ignacio J.
Published: June 2019

Purpose of review

This article presents an update on the clinical pharmacology, mechanisms of action, and safety of second generation antihistamines (SGAHs).

Recent findings

Recent research has shown the efficacy and good tolerance of SGAHs supporting its indication as first line medications for the treatment of allergic rhinoconjunctivitis and urticaria.

The information contained in this review is relevant for the correct utilization of SGAHs by practicing physicians who take care of these highly prevalent clinical disorders.
Alliance, Trust, and Loss: Experiences of Patients Cared for by Students in a Longitudinal Integrated Clerkship
Authors: Flick Robert J. , Felder-Heim Caitlin , Gong Jennifer , Corral Janet , Kalata Kathryn , Marin Alejandro , Adams Jennifer E.
Published: June 2019

Purpose

The longitudinal integrated clerkship (LIC) model, which allows medical students to participate in comprehensive care of a panel of patients over time, is rapidly expanding because of recognized benefits to students and faculty. This study aimed to determine how LIC student contact affected patients’ experiences and self-described health outcomes.

Method

This qualitative case study used semistructured patient interviews to understand the impact of LIC learners at the University of Colorado School of Medicine on patients at Denver Health. Patients with at least 3 encounters with an LIC student and over age 18 were selected. Thirty patients were invited to participate in 2016–2017; 14 (47%) completed interviews before the thematic analysis reached saturation. Four researchers independently analyzed interview transcripts and reached consensus on emergent categories and themes.

Results

Six broad themes were identified: beginnings of a relationship, caring demonstrated by student, growing to trust student, reaching a therapeutic alliance, improvement of patient outcomes due to student involvement, and a sense of loss after students completed the LIC program.

Conclusions

Patients deeply valued the therapeutic alliances built with LIC students involved in their care over time. These alliances led to improved patient experience, mitigation of perceived health system failures, and subjective improvement in health outcomes. Patients described a sense of loss at the end of the LIC when students were no longer involved in their care. Curricula that support students building longitudinal therapeutic relationships with their patients are an opportunity to improve patient experience while promoting students’ professional development.
Competency Committees in Undergraduate Medical Education: Approaching Tensions Using a Polarity Management Framework
Authors: Monrad Seetha U. , Mangrulkar Rajesh S. , Woolliscroft James O. , Daniel Michelle M. , Hartley Sarah E. , Gay Tamara L. , Highet Alexandra , Vijayakumar Nithya , Santen Sally A.
Published: June 2019

Implementing competency-based medical education in undergraduate medical education (UME) poses similar and unique challenges to doing so in graduate medical education (GME). To ensure that all medical students achieve competency, educators must make certain that the structures and processes to assess that competency are systematic and rigorous. In GME, one such key structure is the clinical competency committee. In this Perspective, the authors describe the University of Michigan Medical School’s (UMMS’s) experience with the development of a UME competency committee, based on the clinical competency committee model from GME, and the first year of implementation of that committee for a single cohort of matriculating medical students in 2016–2017.

The UMMS competency committee encountered a number of inter dependent but opposing tensions that did not have a correct solution; they were “both/and” problems to be managed rather than “either/or” decisions to be made. These tensions included determining the approach of the committee (problem identification versus developmental); committee membership (curricular experts versus broad-based membership); student cohort makeup (phase-based versus longitudinal); data analyzed (limited assessments versus programmatic assessment); and judgments made (grading versus developmental competency assessment).

The authors applied the Polarity Management framework to navigate these tensions, leveraging the strengths of each while minimizing the weaknesses. They describe this framework as a strategy for others to use to develop locally relevant and feasible approaches to competency assessment in UME.
Moving Toward Summative Competency Assessment to Individualize the Postclerkship Phase
Authors: Keeley Meg G. , Gusic Maryellen E. , Morgan Helen K. , Aagaard Eva M. , Santen Sally A.
Published: June 2019

In the move toward competency-based medical education, leaders have called for standardization of learning outcomes and individualization of the learning process. Significant progress has been made in establishing defined expectations for the knowledge, skills, attitudes, and behaviors required for successful transition to residency training, but individualization of educational processes to assist learners in reaching these competencies has been predominantly conceptual to date. The traditional time-based structure of medical education has posed a challenge to individualization within the curriculum and has led to more attention on innovations that facilitate transition from medical school to residency. However, a shift of focus to the clerkship-to-postclerkship transition point in the undergraduate curriculum provides an opportunity to determine how longitudinal competency-based assessments can be used to facilitate intentional and individualized structuring of the long-debated fourth year.

This Perspective demonstrates how 2 institutions—the University of Virginia School of Medicine and the University of Michigan Medical School—are using competency assessments and applying standardized outcomes in decisions about individualization of the postclerkship learning process. One institution assesses Core Entrustable Professional Activities for Entering Residency, whereas the other has incorporated Accreditation Council for Graduate Medical Education core competencies and student career interests to determine degrees of flexibility in the postclerkship phase. Individualization in addition to continued assessment of performance presents an opportunity for intentional use of curriculum time to develop each student to be competently prepared for the transition to residency.
Implications of juvenile idiopathic arthritis genetic risk variants for disease pathogenesis and classification
Authors: Nigrovic Peter A. , Martínez-Bonet Marta , Thompson Susan D.
Published: June 2019

Purpose of review

We assess the implications of recent advances in the genetics of juvenile idiopathic arthritis (JIA) for the evolving understanding of inflammatory arthritis in children.

Recent findings

JIA exhibits prominent genetic associations with the human leukocyte antigen (HLA) region, extending perhaps surprisingly even to the hyperinflammatory systemic JIA category. Some HLA associations resemble those for adult-onset inflammatory arthritides, providing evidence for pathogenic continuity across the age spectrum. Genome-wide association studies have defined an increasing number of JIA-linked non-HLA loci, many again shared with adult-onset arthritis. As most risk loci contain only noncoding variants, new experimental methods such as SNP-seq and innovative big-data strategies help identify responsible causative mutations, termed functional SNPs (fSNPs). Alternately, gene hunting in multiplex families implicates new genes in monogenic childhood arthritis, including MYD88 and the intriguing innate immune gene LACC1.

Genetic data indicate a continuity between JIA and adult arthritis poorly reflected in current nomenclature. Advancing methodologies will help to identify new pathogenic mechanisms that inform the understanding of biologic subdivisions within JIA. Resulting insights will facilitate the application of lessons learned across the age spectrum to the treatment of arthritis in children and adults.
The Natural History of Lower Extremity Malalignment
Authors: McClure Philip K. , Herzenberg John E.
Published: June 2019

Background:

Lower extremity malalignment is a common problem presented to pediatric orthopaedists. Risk for early arthritis is often a concern among parents seeking advice and treatment. We seek to review previous research with regard to the natural history of malalignment.

Methods:

A search of available literature on PubMed was constructed to capture articles covering the natural history of malalignment, secondary to childhood fracture as well as congenital and acquired pediatric deformity. In order to remain strictly relevant to pediatrics, articles reviewing deformities acquired in adulthood were not referenced. Biomechanical data and animal studies were included when deemed appropriate.

Results:

High-quality data with regard to long-term risk of arthritis due to malalignment is lacking. Through a combination of biomechanical data, animal models, and a small body of longitudinal clinical data, it is clear that some patients with malalignment progress to early arthritic change. Unfortunately, detailed risk factors of who is at high risk versus low risk remains difficult to determine.

Conclusions:

Treatment of minor lower extremity malalignment is not supported by the current orthopaedic literature. Treatment plans should focus on the presence of symptoms, and in asymptomatic but severe cases. Even in more severe cases, strong evidence to support prophylactic realignment is not available. Evidence to suggest that preventative realignment is superior to intervention at the time of symptom onset does not exist.
The Natural History of Femoroacetabular Impingement
Authors: Wylie James D. , Kim Young-Jo
Published: June 2019

Background:

Structural hip abnormalities have long been suspected of causing hip osteoarthritis. The concept of deformity of the proximal femur as a cause of osteoarthritis (OA) started with description of the tilt deformity and progressed to the pistol grip, then eventually cam-type femoroacetabular impingement (FAI). Acetabular over-coverage or retroversion as a cause of impingement is commonly referred to as pincer-type FAI. The primary research question we asked was: what is the natural history of hips with FAI?

Methods:

We reviewed the literature to identify studies with cross-sectional and longitudinal evidence of the effect of FAI on the development of or association with hip OA.

Results:

In cross-sectional and longitudinal natural history studies of hip OA, cam-type FAI has consistently shown an association with developing OA. In regard to pincer-type FAI, the data are less convincing with some studies suggesting an increased risk and others showing a protective effect of the acetabular over-coverage. It is clear that not all patients with cam FAI get OA but the altered anatomy does increase the relative risk of developing OA.

Conclusions:

Cam-type FAI is associated with the development of hip OA; however, there is no role for prophylactic surgery in the asymptomatic hip with the anatomy predisposing to FAI. Further interventional studies are needed to determine whether surgical correction of cam-type FAI in the symptomatic hip alters the natural history of the condition.
Leg Length Discrepancy: The Natural History (And What Do We Really Know)
Authors: Gordon J. Eric , Davis Lauren E.
Published: June 2019

Background:

The long-term effects of small limb length discrepancies have been poorly documented in the literature. References to low back pain, hip pathology, knee pathology, and foot problems abound in the popular literature. Health care providers frequently recommend the use of lifts for structural and functional limb length discrepancies, yet the natural history of limb length inequality as well as the effectiveness of treatments that may be recommended are obscure. The purpose of this paper is to document and evaluate the literature associated with small limb length discrepancies.

Methods:

A search of the English literature was carried out using PubMed to identify papers dealing with the effects of limb length discrepancies. Papers reporting only expert opinion or case reports were excluded.

Results:

Papers dealing with the natural history of limb length discrepancy as well as studies in which gait analysis was performed in patients with limb length discrepancy were identified. Only 10% of the population has exactly equal lower limb lengths. Approximately 90% of the population has a limb length discrepancy <1.0 cm. Hip and knee pathology is present in an increased number of patients with limb length discrepancies over 5 mm. Hip pathology is more often present in the long leg, knee pathology has been reported in various studies to be more common in either the long or short leg. Low back problems seem to be more common on the short side in patients with limb length discrepancies. A number of different compensatory mechanisms for limb length discrepancy have been identified during gait analysis.

Conclusions:

There seems to be a consensus that limb length discrepancies >2.0 cm are frequently a problem. There is some evidence that limb length discrepancies as little as 5 mm can lead to long-term pathology.
Increasing Povidone-Iodine Exposure in Endothelial Keratoplasty Tissue Processing and Fungal Infection Impact
Authors: Salisbury C. Drew , Kirk Carter N. , Lee W. Barry , Hamilton Stephen M. , Kozarsky Alan M. , Meinecke Eric , Stulting R. Doyle
Published: June 2019

Purpose:

To evaluate the effect on donor rim cultures and postoperative infections of doubling the povidone-iodine exposure time during corneal tissue recovery before its use in keratoplasty.

Methods:

Consecutive donor cornea recoveries were evaluated for positive donor corneal rim cultures and postoperative infections before and after a protocol change of doubling the exposure time of povidone-iodine during donor preparation.

Results:

In 631 consecutive cornea donor recoveries, 18 (2.9%) had positive fungal rim cultures and 41 (6.5%) had positive bacterial rim cultures. Three (0.48%) developed postoperative fungal infections, and no bacterial infections occurred. After doubling the povidone-iodine exposure time during the recovery process, 725 consecutive corneas were reviewed. Four (0.6%) had positive fungal rim cultures, and 29 (4.0%) had positive bacterial rim cultures. No postoperative fungal or bacterial infections occurred. No noticeable increase in epithelial toxicity developed between the 2 groups.

Conclusions:

Increasing the povidone-iodine exposure time during the donor cornea recovery process decreased the rate of positive donor corneal rim fungal cultures (P = 0.001), positive donor corneal rim bacterial cultures (P = 0.04), and postoperative fungal infections (P = 0.06).
Identification of the culprit artery in inferior myocardial infarction through the 12-lead ECG
Authors: Ruiz-Mateos Borja , García-Borbolla Rafael , Nunez-Gil Ivan , Almendro-Delia Manuel , Vivas David , Seoane-García Tania , Cristo-Ropero Maria J. , Izquierdo-Bajo Alvaro , Madrona-Jimenez Luis , Fernandez-Ortiz Antonio , Hidalgo-Urbano Rafael , Ibanez Borja , Garcia-Rubira Juan C.
Published: June 2019

Background

Identification of the culprit artery can be helpful in the management of inferior infarction with ST-segment elevation myocardial infarction. Some studies suggest that previously published algorithms intended to help identify the infarct-related artery are suboptimal. Our aim is to develop a better method to localise the culprit artery on the basis of the 12-lead ECG.

Patients and methods

We analysed the ECG and coronary angiograms of two different cohorts of patients with inferior ST-segment elevation myocardial infarction. Patients from the first cohort were labelled the derivative cohort (group A), whereas patients in the second cohort were labelled the validation cohort (group B). ST-segment elevation was measured in each lead, and a multiple logistic regression analysis was carried out to determine the best equation to predict the culprit artery. A derived algorithm was then applied to the validation cohort. Next, our algorithm was applied to the total cohort of both groups and compared with four different previously published algorithms. We analysed differences in sensitivity, specificity and area under the curve (AUC).

Results

We included 252 patients in the derivative group and 90 in the validation group. The multiple models analysis concluded that the best model should include five leads. This model was validated by internal bootstrapping with 1000 repetitions in group A and externally in group B. The resultant algorithm was as follows: (ST-elevation in III + aVF + V3) − (ST-elevation in II + V6) less than 0.75 mm means that the culprit artery is the left circumflex artery (Cx). If the result is at least 0.75, the culprit artery is the right coronary artery. The total group of both cohorts comprised 342 patients, aged 61.2 ± 12.4 years, of whom 19.6% were female and 80.4% were male. The Cx was the culprit artery in 67 (19.6%) patients. Our algorithm had a sensitivity of 72.3, a specificity of 80.9 and an AUC of 0.766. The AUC value was better compared with the other algorithms.

Conclusion

The best algorithm to localise the culprit artery includes ST-elevation in leads II and V6 related to Cx, and ST-elevation in leads III, aVF and V3 related to right coronary artery. Our algorithm has been validated internally and externally, and works better than other previously published algorithms.
Total knee arthroplasty for a valgus deformity angle of >90°
Authors: Guo Jianbin , Cao Guihua , Zhang Yumin , Song Wei , Qin Siqing , Ma Tao , Wang Yakang , Yang Weixia
Published: June 2019

Rationale:

Valgus knees are relatively rare in the clinic. Treatments for valgus deviations >90° represent a surgical challenge to achieve a balance between the soft tissue and bone and prevent nerve damage.

Patient concerns:

A 63-year-old woman with valgus deviations >90° in both knees complained that she had been unable to walk for 50 years.

Diagnoses:

Congenital malformation valgus deformity.

Interventions:

Bilateral total knee arthroplasty (TKA) was performed using a rotating hinge knee instrument from Endo-Model for axial correction and stabilization of the joint.

Outcomes:

The patient fully recovered 3 months after surgery. At the follow-up 6 years after the operation, the function of the knee joint clearly improved. The knee society score (KSS) increased from 35 to 90.

Lessons:

Constrained implants are commonly used to stabilize the joint and correct the bone axis in patients with severe ligamental instability, gross deformity, bone loss, and extreme deviation of the straight leg axis. Intraoperative exploration of the common peroneal nerve and the postoperative flexed position of the knee joints could help prevent nerve injuries.
Radiomics signature on 3T dynamic contrast-enhanced magnetic resonance imaging for estrogen receptor-positive invasive breast cancers
Authors: Nam Kyung Jin , Park Hyunjin , Ko Eun Sook , Lim Yaeji , Cho Hwan-Ho , Lee Jeong Eon
Published: June 2019

To evaluate the ability of a radiomics signature based on 3T dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) to distinguish between low and non-low Oncotype DX (OD) risk groups in estrogen receptor (ER)-positive invasive breast cancers.

Between May 2011 and March 2016, 67 women with ER-positive invasive breast cancer who performed preoperative 3T MRI and OD assay were included. We divided the patients into low (OD recurrence score [RS] <18) and non-low risk (RS ≥18) groups. Extracted radiomics features included 8 morphological, 76 histogram-based, and 72 higher-order texture features. A radiomics signature (Rad-score) was generated using the least absolute shrinkage and selection operator (LASSO). Univariate and multivariate logistic regression analyses were performed to investigate the association between clinicopathologic factors, MRI findings, and the Rad-score with OD risk groups, and the areas under the receiver operating characteristic curves (AUC) were used to assess classification performance of the Rad-score.

The Rad-score was constructed for each tumor by extracting 10 (6.3%) from 158 radiomics features. A higher Rad-score (odds ratio [OR], 65.209; P <.001), Ki-67 expression (OR, 17.462; P = .007), and high p53 (OR = 8.449; P = .077) were associated with non-low OD risk. The Rad-score classified low and non-low OD risk with an AUC of 0.759.

The Rad-score showed the potential for discrimination between low and non-low OD risk groups in patients with ER-positive invasive breast cancers.
Nociceptive pain unmasking a serious pathology – paraneoplastic hypertrophic osteoarthropathy
Authors: Ribigan Athena Cristina , Bajenaru Ovidiu Lucian , Antochi Florina Anca , Bajenaru Ovidiu Alexandru
Published: June 2019

Rationale:

Hypertrophic osteoarthropathy, also named Pierre Marie–Bamberger syndrome, represents a rare medical condition that may be considered either a primary or a secondary disease, and lung malignancies are responsible for more than two-thirds of the cases with secondary forms of the disease.

Patient concerns:

We present the case of a 41-year-old man referred to our Neurology Department for pain that was considered secondary to cervical disc protrusions. The neurologic examination was normal. However, the general examination showed digital clubbing, right lateral cervical adenopathy, and pachydermia. The radiographic examinations of the upper and lower limbs depicted osseous abnormalities typical for periostosis, and the computed tomography of the thorax showed the presence of a mass lesion in the right upper pulmonary lobe. High values of vascular endothelial growth factor were also found. The patient was admitted to the Pneumology Clinic, where biopsy was performed from the lateral cervical adenopathy.

Diagnoses:

The anatomopathological examination revealed multiple neoplastic infiltrates suggestive of adenocarcinoma metastasis. Based on the clinical examination and radiological and histologic findings, the diagnosis of pulmonary adenocarcinoma with lymph nodes metastases and paraneoplastic hypertrophic osteoarthropathy was established.

Interventions:

The patient received treatment with nonsteroidal antiinflammatory drugs and opiate analgesics that relieved the pain.

Outcomes:

The patient was referred to the Oncology Department for further treatment of the primary pathology. He received different types of chemotherapeutics, immunotherapy, and radiotherapy. However, despite all therapeutic measures, the disease rapidly progressed and the patient died 9 months later.

Lessons:

This is an interesting case of a patient with an overlooked pathology, which was refereed to our clinic for further investigations of a pain that was considered neuropathic, secondary to small cervical protrusions. Conversely, the pain proved to be nociceptive and Pierre Marie–Bamberger syndrome was the positive diagnosis in our patient, as it can be associated with numerous diseases, especially of neoplastic origin.
Five-year follow-up outcomes of comprehensive rehabilitation in Korean siblings with cerebral, ocular, dental, auricular, skeletal anomalies (CODAS) syndrome
Authors: Yoo Seung Don , Han Young Rok , Kim Dong Hwan , Lee Seung Ah
Published: June 2019

Rationale:

Cerebral, ocular, dental, auricular, skeletal anomalies (CODAS) syndrome is a very rare multisystem disorder, which shows malformations of the central nervous system, ears, eyes, teeth, and skeleton that was first reported in 1991. Only a few cases that sporadically occurred have been reported worldwide. The research investigating the pathogenesis and patterns of CODAS inheritance is still ongoing. There is no satisfactory treatment for this rare genetic disease yet. Due to the lack of curative medical treatment, rehabilitation could play a major role in treatment for genetic disease.

Patient concerns:

To our best knowledge, the 2 children described in this study are the only CODAS syndromes siblings reported in the world so far. These Korean siblings show highly distinctive features consisting of developmental delay, cataracts, vulnerability to tooth decay, epiphyseal dysplasia, and anomalous ears.

Diagnoses:

CODAS syndrome.

Interventions:

Comprehensive long-term rehabilitation treatment during 5 years.

Outcomes:

We report on the progress of the comprehensive long-term rehabilitation treatment at 5-year follow-up. Their fine motor and language skills development improved similarly to that of same-aged children. We observed the positive effect of rehabilitation on the quality of life.

Lessons:

The therapy of genetic disorders is challenging for pediatric neurologists and pediatric physiatrists. We suggest that rehabilitation is the best treatment currently available for this genetic disease that yields satisfactory therapeutic effect.
Risk factors and impact of postoperative hyperglycemia in nondiabetic patients after cardiac surgery
Authors: Moorthy Vikaesh , Sim Ming Ann , Liu Weiling , Chew Sophia Tsong Huey , Ti Lian Kah
Published: June 2019

Cardiac surgery induces a significant inflammatory hypermetabolic stress response, resulting in postoperative hyperglycemia in both preoperatively diabetic and nondiabetic patients. Such postoperative hyperglycemia has been associated with adverse outcomes in surgery and postsurgical recovery. Yet, while diabetes is a known risk factor for postoperative hyperglycemia, predictors of postoperative hyperglycemia among nondiabetics in the local Southeast Asian population remain unknown.

We aim to investigate the predictors and outcomes associated with hyperglycemia after cardiac surgery among nondiabetics in the local Southeast Asian population. We analyzed data from 1602 nondiabetic adult patients undergoing elective cardiac surgery, from 2008 to 2010 at the 2 main heart centers in Singapore.

Nondiabetic patients who developed postoperative hyperglycemia tended to be women, older, more obese, and hypertensive. Higher body mass index (BMI), age, aortic cross-clamp time, and blood transfusion were identified as independent risk factors of postoperative hyperglycemia. Postoperative hyperglycemia was also significantly associated with postoperative cardiac arrhythmias (26.9% vs 15.0%, P < .001), acute kidney injury (30.0% vs 20.1%, P < .001), longer intensive care unit (ICU) stay (46.7 ± 104.1 vs 37.2 ± 76.6 hours, P = .044) and longer hospitalization (11.5 ± 12.2 vs 9.6 ± 8.0 days, P < .001).

Our study identified aortic cross-clamp time and blood transfusion as independent risk factors of postoperative hyperglycemia after cardiac surgery in nondiabetics. Similar to other studies, higher BMI and age were independent risk factors for postoperative hyperglycemia. Postoperative hyperglycemia was also associated with adverse perioperative outcomes and should thereby be avoided by treating modifiable risk factors identified in this study including reducing blood transfusion and aortic cross-clamp time. Our findings contribute to early risk stratification of nondiabetic patients who are at increased risk of postoperative hyperglycemia.
The trim-and-fill method for publication bias: practical guidelines and recommendations based on a large database of meta-analyses
Authors: Shi Linyu , Lin Lifeng
Published: June 2019

Publication bias is a type of systematic error when synthesizing evidence that cannot represent the underlying truth. Clinical studies with favorable results are more likely published and thus exaggerate the synthesized evidence in meta-analyses. The trim-and-fill method is a popular tool to detect and adjust for publication bias. Simulation studies have been performed to assess this method, but they may not fully represent realistic settings about publication bias. Based on real-world meta-analyses, this article provides practical guidelines and recommendations for using the trim-and-fill method. We used a worked illustrative example to demonstrate the idea of the trim-and-fill method, and we reviewed three estimators (R
0, L
0, and Q
0) for imputing missing studies. A resampling method was proposed to calculate P values for all 3 estimators. We also summarized available meta-analysis software programs for implementing the trim-and-fill method. Moreover, we applied the method to 29,932 meta-analyses from the Cochrane Database of Systematic Reviews, and empirically evaluated its overall performance. We carefully explored potential issues occurred in our analysis. The estimators L
0 and Q
0 detected at least one missing study in more meta-analyses than R
0, while Q
0 often imputed more missing studies than L
0. After adding imputed missing studies, the significance of heterogeneity and overall effect sizes changed in many meta-analyses. All estimators generally converged fast. However, L
0 and Q
0 failed to converge in a few meta-analyses that contained studies with identical effect sizes. Also, P values produced by different estimators could yield different conclusions of publication bias significance. Outliers and the pre-specified direction of missing studies could have influential impact on the trim-and-fill results. Meta-analysts are recommended to perform the trim-and-fill method with great caution when using meta-analysis software programs. Some default settings (e.g., the choice of estimators and the direction of missing studies) in the programs may not be optimal for a certain meta-analysis; they should be determined on a case-by-case basis. Sensitivity analyses are encouraged to examine effects of different estimators and outlying studies. Also, the trim-and-fill estimator should be routinely reported in meta-analyses, because the results depend highly on it.
Storage of Extracellular Vesicles in Human Milk, and MicroRNA Profiles in Human Milk Exosomes and Infant Formulas
Authors: Leiferman Amy , Shu Jiang , Upadhyaya Bijaya , Cui Juan , Zempleni Janos
Published: June 2019

The objectives of this study were to lay the methodological groundwork for field studies of microRNA analysis in exosomes from small sample volumes of human milk, and assess exosome and microRNA content in infant formulas. When human milk was stored at 4°C for 4 weeks, the count of exosome‐sized vesicles decreased progressively to 49% ± 13% of that in fresh milk. Exosomes were purified from 1 mL of fresh human milk and their microRNA content was assessed by microRNA‐sequencing analysis and compared with that in infant formulas. We identified 221 microRNAs in exosomes from 3 samples of fresh human milk; 84 microRNAs were present in all 3 samples. MicroRNAs were not detectable in infant formulas and their exosome‐sized vesicles, which appeared to be casein micelles. We conclude that large‐scale studies of microRNAs in human milk exosomes are feasible, and exosomes and microRNAs are not detectable in formulas.
The Role of Inflammation in the Endothelial Dysfunction in a Cohort of Pediatric Patients With Inflammatory Bowel Disease
Authors: Andreozzi Marialuisa , Giugliano Francesca P. , Strisciuglio Teresa , Pirozzi Elisabetta , Papparella Alfonso , Caprio Angela M. , Miele Erasmo , Strisciuglio Caterina , Perrone Filardi Pasquale
Published: June 2019

Objectives:

Chronic inflammation plays a central role in the etiology of endothelial damage. Endothelial dysfunction (ED) is the inability of the artery to dilate in response to an endothelial stimulus. We assessed the ED by measuring the reactive hyperaemia index (RHI) and the flow‐mediated dilation (FMD) in a cohort of pediatric patients affected by inflammatory bowel disease (IBD) and comparing these parameters to a group of healthy controls (HC).

Methods:

Forty‐one patients were consecutive enrolled. ED was evaluated by both the plethysmographic RHI method and the measurement of the FMD of brachial artery after occlusion of the blood flow. Differences between patients and controls were assessed by the Mann‐Whitney test. In each patient with IBD, the main inflammation markers were detected and correlated to RHI and FMD by a linear regression test.

Results:

We enrolled 26 (59%) patients with IBD and 18 (41%) HC. When comparing FMD value at diagnosis it was significantly lower in IBD patients than in HC (P= 0.04). This result was confirmed at follow‐up, when this difference became even more significant (P= 0.004). A significant indirect correlation was found between FMD and fecal calprotectin (r2: 0.17;P= 0.04). No differences were found when comparing RHI.

Conclusions:

Our results suggest that inflammation could lead to ED assessed by ultrasound FMD. These data were not confirmed by RHI; however, this could be due to the lack of a standardized pediatric cut‐off. More studies are necessary to confirm our data.
The Use of Jejunal Tube Feeding in Children
Authors: Broekaert Ilse J. , Falconer Jackie , Bronsky Jiri , Gottrand Frederic , Dall'Oglio Luigi , Goto Eunice , Hojsak Iva , Hulst Jessie , Kochavi Brigitte , Papadopoulou Alexandra , Ribes‐Koninckx Carmen , Schaeppi Michela , Werlin Steven , Wilschanski Michael , Thapar Nikhil
Published: June 2019

Objectives:

Jejunal tube feeding (JTF) is increasingly becoming the standard of care for children in whom gastric tube feeding is insufficient to achieve caloric needs. Given a lack of a systematic approach to the care of JTF in paediatric patients, the aim of this position paper is to provide expert guidance regarding the indications for its use and practical considerations to optimize its utility and safety.

Methods:

A group of members of the Gastroenterology and Nutrition Committees of the European Society of Paediatric Gastroenterology Hepatology and Nutrition and of invited experts in the field was formed in September 2016 to produce this clinical guide. Seventeen clinical questions treating indications and contraindications, investigations before placement, techniques of placement, suitable feeds and feeding regimen, weaning from JTF, complications, long‐term care, and ethical considerations were addressed.

A systematic literature search was performed from 1982 to November 2018 using PubMed, the MEDLINE, and Cochrane Database of Systematic Reviews. Grading of Recommendations, Assessment, Development, and Evaluation was applied to evaluate the outcomes.

During a consensus meeting, all recommendations were discussed and finalized. In the absence of evidence from randomized controlled trials, recommendations reflect the expert opinion of the authors.

Results:

A total of 33 recommendations were voted on using the nominal voting technique.

Conclusions:

JTF is a safe and effective means of enteral feeding when gastric feeding is insufficient to meet caloric needs or is not possible. The decision to place a jejunal tube has to be made by close cooperation of a multidisciplinary team providing active follow‐up and care.
A Pilot Evaluation of a Capacitance-Based Automatic Urinometer in a Pediatric Intensive Care Setting
Authors: Slettengren Martin , Wetterfall Hanna , Eklund Anton , van der Linden Jan
Published: June 2019

Objectives:

To compare a modified capacitance-based automatic urinometer to a manual urinometer, with regard to precision of measurement and to evaluate the staff’s opinion regarding the automatic urinometer.

Design:

Prospective observational cohort study.

Setting:

PICU at Astrid Lindgren’s Children Hospital in Solna, Sweden.

Patients:

Twelve children weighing up to 10 kg with an indwelling urinary catheter in place before enrollment.

Interventions:

Measurement of hourly diuresis using either an automatic urinometer or manual urinometer.

Measurements and Main Results:

Hourly diuresis was measured with an automatic urinometer (n = 127; Sippi; Observe Medical Nordic AB, Gothenburg, Sweden) or an manual urinometer (n = 83; Unometer Safeti Plus; Convatec, Lejre, Denmark) and thereafter validated with a measuring cylinder. The absolute mean bias was –1.1 mL for the automatic urinometer (CI, –0.6 to –1.5) and –0.6 mL (CI, ± 0.0 to –1.2) for the manual urinometer (p = 0.21). The sds were 2.6 and 2.8 mL, respectively. User evaluation comparing the automatic urinometer with the manual urinometer concerning the ease of use was made with a questionnaire (n = 18). The majority of staff preferred the automatic urinometer to the manual urinometer in terms of ease of use, learning, and handling.

Conclusions:

The two urinometers were comparable in performance for children weighing up to 10 kg. Taking into account the overwhelming staff satisfaction with the automatic urinometer and benefits in less well-staffed wards as well as lack of temporal deviation, the modified automatic urinometer may be considered for clinical use in the PICU.
How to prevent, minimize, or extinguish nocebo effects in pain: a narrative review on mechanisms, predictors, and interventions
Authors: Manaï Meriem , van Middendorp Henriët , Veldhuijzen Dieuwke S. , Huizinga Tom W.J. , Evers Andrea W.M.
Published: June 2019

Nocebo effects, such as side effects due to negative expectations regarding the pain treatment, are a concern for health care providers and come with significant costs. This narrative review focuses on underlying mechanisms and possible factors that contribute to the susceptibility to the nocebo effect on pain and related outcomes and suggests strategies that can prevent, minimize, or extinguish nocebo effects in clinical settings. Nocebo effects are the result of psychological (eg, conditioning, verbal suggestions, and observational learning) and neurobiological (eg, cholecystokinin and dopamine regulation) mechanisms. Evidence from clinical and experimental studies lead to various recommendations and strategies to alter the nocebo effect in order to optimize pain treatments, such as providing patients with enhanced information, optimizing patient–physician communication and relationships, and offering psychoeducation on coping skills in order to manage patient expectations. The current literature from both clinical and experimental studies provides a better understanding of the nocebo effect and possible factors that modulate its strength on treatment outcomes. This allows for the development of evidence-based strategies aimed at the prevention, minimization, and treatment of the nocebo effect in pain conditions and possible other somatic disorders.