bluuebunny/crossref_metadata_2025 huggingface dataset:
Validation of the Swedish Multiple Sclerosis Register
Authors: Alping Peter , Piehl Fredrik , Langer-Gould Annette , Frisell Thomas
Published: November 2018

The Swedish Multiple Sclerosis Register is a national register monitoring treatment and clinical course for all Swedish multiple sclerosis (MS) patients, with high coverage and close integration with the clinic. Despite its great value for epidemiologic research, it has not previously been validated. In this brief report, we summarize a large validation of >3,000 patients in the register using clinical chart review in the context of the COMBAT-MS study. While further improving the data quality for a central cohort of patients available for future epidemiologic research, this study also allowed us to estimate the accuracy and completeness of the register data.
Gland Suspension Improves Breast Augmentation Outcomes
Authors: Andjelkov Katarina , Sijan-Miskovic Nina , Colic Milan , Colic Miodrag , Lalic Anja , Llull Ramon
Published: November 2018

Background:

While dual plane breast augmentation successfully addresses low ptosis grades, concomitant hypomastia and greater ptosis often requires combined immediate or staged mastopexy with extended incisions beyond those required for breast augmentation. In an attempt at offering a minimal scar in a single procedure, we evaluated the benefit of a gland suspension maneuver in addition to a dual plane dissection and implant placement to improve breast contour, avoid postoperative ptosis, and thus reduce staged reintervention procedures.

Methods:

A consecutive group of 73 patients presenting ptotic hypomastia were jointly categorized and underwent implant placement, dual plane dissection level 3, and gland suspension maneuver. An age, implant volume, ptosis degree matched historical cohort was used as control (no gland suspension). All subjects were followed longer than 1 year postoperatively. Outcome analysis included reintervention rates and objective geodesic changes using objective morphometric parameters as measured by 3D scan analysis.

Results:

When experimental and control cohorts were segregated according to ptosis grade, gland suspension maneuver was associated to a lower frequency of subsequent ancillary mastopexy procedures (reintervention rate) for all ptosis grades except ptosis grade III. When gland suspension was compared with ptosis equivalent control groups, gland suspension was associated to a higher upper pole volume increment and higher pole convexity and lower pole morphometry.

Conclusion:

The addition of gland suspension to implant dual plane breast augmentation appears to be a clinically beneficial maneuver with measurable contour impact and appears to avoid subsequent mastopexy procedures, except for high ptosis grade candidates.
Concordant Evidence-Based Interventions in Cardiac and Pulmonary Rehabilitation Guidelines
Authors: Smith Sheree M. S. , Chaudhary Katrina , Blackstock Felicity
Published: November 2018

Chronic conditions such as chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) contribute to a significant burden to patients and many experience a reduction in physical functioning, psychological health, and quality of life. The sentinel symptom for COPD and CVD is breathlessness. Rehabilitation programs have been proven to reduce disease symptoms and increase levels of physical and psychological wellness. Pulmonary and cardiac rehabilitation programs have been recommended in international and national guidelines for managing COPD and CVD. Given that these programs seek to reduce breathlessness and improve the physical and psychological functioning of people with COPD and CVD, this review examines the concordant evidence-based interventions in rehabilitation guidelines. The findings of this review indicate that there was concordance in the program design, location of programs, types of health professionals involved in program delivery, assessments of patient at commencement and completion of program, and the delivery of educational topics with minor deviations that were related to disease-specific topics. Apart from disease-specific recommendations, the main divergence from rehabilitation guidelines was found to be dietary screening, inspiratory muscle training, and psychological assessments in evidence-based recommendations for cardiac and pulmonary programs.
RIDGE-SHAPED MACULA IN YOUNG MYOPIC PATIENTS AND ITS DIFFERENTIATION FROM TYPICAL DOME-SHAPED MACULA IN ELDERLY MYOPIC PATIENTS
Authors: Xu Xian , Fang Yuxin , Jonas Jost B. , Du Ran , Shinohara Kosei , Tanaka Noriko , Yokoi Tae , Onishi Yuka , Uramoto Kengo , Kamoi Koju , Yoshida Takeshi , Ohno-Matsui Kyoko
Published: November 2018

Purpose:

To assess and compare clinical features of a ridge-shaped macula (defined as macular elevation only in one meridian across the fovea) in individuals younger than 20 years with those of a dome-shaped macula (DSM) in patients aged 20+ years.

Methods:

The retrospective observational case series study included 185 highly myopic eyes of 100 consecutive patients younger than 20 years, who were compared with highly myopic patients with DSMs, aged 20+ years and examined in previous studies.

Results:

Seventeen (9.2%) eyes of the highly myopic young patients showed macular elevations all of which ran only in the horizontal direction across the vertical optical coherence tomographic section fulfilled the definition of a ridge and did not show any staphylomas or any macular Bruch membrane defects. By contrast, in the older patients with DSMs, the DSMs were significantly higher and had a narrower base than the ridges in the young patients, and showed macular Bruch membrane defects in their vicinity, with the axial length being significantly longer, the myopic maculopathy more severe, and the subfoveal choroid thinner.

Conclusion:

Macular elevations detected in children and adolescents are usually ridge-shaped maculas and do not have the characteristics of DSMs. In comparison with DSMs, ridge-shaped maculas do not show a spatial association with macular Bruch membrane defects or posterior staphylomas and have a wider basis and smoother elevation slope. As a hypothesis, ridge-shaped maculas may be due to a folding of Bruch membrane at the posterior pole, potentially caused by an asymmetrical enlargement of Bruch membrane in the equatorial region.
The association between endogenous opioid function and morphine responsiveness: a moderating role for endocannabinoids
Authors: Bruehl Stephen , Burns John W. , Morgan Amanda , Koltyn Kelli , Gupta Rajnish , Buvanendran Asokumar , Edwards David , Chont Melissa , Kingsley Philip J. , Marnett Larry , Stone Amanda , Patel Sachin
Published: November 2018

We sought to replicate previous findings that low endogenous opioid (EO) function predicts greater morphine analgesia and extended these findings by examining whether circulating endocannabinoids and related lipids moderate EO-related predictive effects. Individuals with chronic low-back pain (n = 46) provided blood samples for endocannabinoid analyses, then underwent separate identical laboratory sessions under 3 drug conditions: saline placebo, intravenous (i.v.) naloxone (opioid antagonist; 12-mg total), and i.v. morphine (0.09-mg/kg total). During each session, participants rated low-back pain intensity, evoked heat pain intensity, and nonpain subjective effects 4 times in sequence after incremental drug dosing. Mean morphine effects (morphine-placebo difference) and opioid blockade effects (naloxone-placebo difference; to index EO function) for each primary outcome (low-back pain intensity, evoked heat pain intensity, and nonpain subjective effects) were derived by averaging across the 4 incremental doses. The association between EO function and morphine-induced back pain relief was significantly moderated by endocannabinoids [2-arachidonoylglycerol (2-AG) and N-arachidonoylethanolamine (AEA)]. Lower EO function predicted greater morphine analgesia only for those with relatively lower endocannabinoids. Endocannabinoids also significantly moderated EO effects on morphine-related changes in visual analog scale–evoked pain intensity (2-AG), drug liking (AEA and 2-AG), and desire to take again (AEA and 2-AG). In the absence of significant interactions, lower EO function predicted significantly greater morphine analgesia (as in past work) and euphoria. Results indicate that EO effects on analgesic and subjective responses to opioid medications are greatest when endocannabinoid levels are low. These findings may help guide development of mechanism-based predictors for personalized pain medicine algorithms.
Evidence-Based Practice Curriculum Development for Undergraduate Nursing Students: The Preliminary Results of an Action Research Study in Taiwan
Authors: HUNG Hsiao-Ying , WANG Yu-Wen , FENG Jui-Ying , WANG Chi-Jane , LIN Esther Ching-Lan , CHANG Ying-Ju
Published: November 2018

Background:

Equipping undergraduate nursing students with sufficient competence in evidence-based practice (EBP) is essential to meeting future practice needs. Integrating necessary EBP knowledge and skills systematically into the formal curriculum allows students to obtain better learning experience and outcomes. However, in Taiwan, a systematic nursing curriculum that integrates EBP concepts across the 4-year nursing baccalaureate program has not yet been developed. Moreover, engaging students in the clinical application of evidence remains a key challenge facing nursing education.

Purpose:

This study aimed to construct an EBP undergraduate nursing curriculum and develop clinical scenarios that support EBP teaching.

Methods:

Three cycles of action research, incorporating both focus group interviews and questionnaire surveys, were applied to construct and evaluate the appropriateness and feasibility of the EBP nursing curriculum and relevant teaching strategies.

Results:

An EBP nursing curriculum was constructed that integrates the three levels of learning objectives and corresponding learning outcomes, teaching content, and learning activities. Scenario activities were developed to familiarize students with the EBP process and to maximize their learning with regard to the clinical application of evidence. Next, a preliminary evaluation showed the appropriateness and feasibility of the developed curriculum, which was shown to foster the EBP competency of students and increase their confidence and positive attitudes toward EBP.

Conclusions/Implications for Practice:

A systematic EBP bachelor nursing curriculum with effective pedagogical strategies was developed. The associated process and the elicited information may offer a valuable reference for other nursing schools.
Citation and Characteristic Analysis of Physician Assistant Programs Placed on Accreditation–Probation, 2015–2017
Authors: Snyder Jennifer A. , Skala Taylor
Published: November 2018

Purpose

The Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) is responsible for accrediting the current 236 entry-level physician assistant (PA) programs in the United States. This study analyzes citations levied against PA programs by the ARC-PA and how those citations relate to the commission's ultimate accreditation decisions; in addition, this study compares PA program characteristics and assesses those characteristics as they relate to recent accreditation outcomes.

Methods

This study used citations for specific violations of ARC-PA Standards to analyze the ARC-PA's accreditation decisions from September 2015 through September 2017. The institutional characteristics of programs that received an accreditation–probation decision were compared with those that received an accreditation–continued or accreditation–provisional decision. Where possible, outcome decisions were benchmarked using national data obtained from publications distributed by the Physician Assistant Education Association.

Results

On average, programs that were placed on accreditation–probation during the time frame of this study had received their initial accreditation 16 years before being placed on probation. Altogether, 393 citations were levied against those programs (range: 2–60 citations; median: 13.5 citations). Physician assistant programs that were awarded provisional or continued accreditation were cited for slightly different Standards violations than PA programs that were placed on probation. The average 5-year pass rate for students taking the Physician Assistant National Certifying Examination for the first time was not very different for students from PA programs that were placed on probation and all other programs.

Conclusions

Faculty members, institutions, and entities that support PA program development can use this information to compare PA programs. The results of this study can help PA programs identify areas of frequent noncompliance with the ARC-PA's Standards; provide context that PA programs can use to assess their performance against other programs in the accreditation process; and help PA programs identify areas in need of priority attention nationwide.
Application of Ultrasonic Bone Aspirator for Decompression of the Internal Auditory Canal via the Middle Cranial Fossa Approach
Authors: Kohlberg Gavriel D. , Lipschitz Noga , Tawfik Kareem O. , Walters Zoe , Breen Joseph T. , Zuccarello Mario , Andaluz Norberto , Dinapoli Vincent A. , Pensak Myles L. , Samy Ravi N.
Published: November 2018

Objective:

Evaluate the safety and efficacy of the ultrasonic bone aspirator (UBA) during middle cranial fossa (MCF) approach to vestibular schwannoma (VS).

Study Design:

Retrospective case series.

Setting:

Tertiary referral center.

Patients:

Charts of 192 consecutive VS patients over 18 years of age were reviewed to identify 65 patients who underwent MCF approach to VS resection between 2006 and 2017. A combination of UBA and high-speed drill (HSD) was used to decompress the internal auditory canal (IAC) in 25 patients and HSD alone was used in the other 40 patients.

Intervention(s):

Use of UBA during vestibular schwannoma surgery via MCF approach for decompression of the IAC.

Main Outcome Measure(s):

Postoperative facial nerve outcomes assessed by the House–Brackmann (HB) facial nerve grading scale. Rates of gross total resection (GTR) and cerebrospinal fluid (CSF) leak.

Results:

There were no significant differences in postoperative facial nerve function, in rate of GTR of tumor, or in rate of CSF leak. In the UBA group 24/25 (96%) had postoperative HB grade I–II compared with 36/40 (90%) in the HSD group (p-value = 0.66). GTR was achieved in 25/25 (100%) in the UBA group compared with 38/40 (95%) in the HSD group (p-value = 1). In the UBA group, there were 0/25 (0%) cases of CSF leak compared with 1/40 (2.5%) in the HSD group (p-value = 1).

Conclusions:

UBA use is a safe and effective alternative or adjunct to HSD during MCF approach to expose the IAC contents. This surgical tool allows for bone removal with low risk of injury to adjacent structures.
The Epidemiology of Otosclerosis in a British Cohort
Authors: Crompton Michael , Cadge Barbara A. , Ziff Joanna L. , Mowat Andrew J. , Nash Robert , Lavy Jeremy A. , Powell Harry R. F. , Aldren Christopher P. , Saeed Shakeel R. , Dawson Sally J.
Published: November 2018

Objective:

To analyse the epidemiology of otosclerosis in a British cohort collected between 2011 and 2017.

Design:

Retrospective cohort study.

Setting:

Five UK ENT Departments.

Patients:

Patients with surgically confirmed otosclerosis.

Main Outcome Measures:

Questionnaire data documented family history of otosclerosis, age of onset, medical history, and information on associated risk factors for 657 patients. Pre and post-surgical pure-tone audiometry was collected for 154 of these patients.

Results:

The age of onset, incidence of bilateral disease, tinnitus and vertigo, a higher prevalence of women (65%) than men (35%) are similar to those reported previously for otosclerosis cohorts. No association with measles infection was detected. Patients with a family history (40%) have an earlier age of onset and a higher incidence of bilateral disease and vertigo than non-familial subjects. Pedigree analysis is consistent with an autosomal dominant inheritance with reduced penetrance being apparent in 44/91 pedigrees studied. Women who associate their hearing loss with pregnancy have an earlier age of onset than those that do not (p = 6 × 10−6).

Conclusions:

This study confirms that otosclerosis is an early adult onset disease that is more prevalent in women than men with a large minority of patients having a family history of otosclerosis. We report new evidence to support a relationship between pregnancy and otosclerosis progression in a proportion of women. In addition, this is the first study to identify differences in severity between familial and non-familial cases of otosclerosis, highlighting the possibility that more than one etiology may be involved.
Utility of Postoperative Magnetic Resonance Imaging in Patients Who Fail Superior Canal Dehiscence Surgery
Authors: Chemtob Raphaelle A. , Epprecht Lorenz , Reinshagen Katherine L. , Huber Alexander , Caye-Thomasen Per , Nakajima Hideko H. , Lee Daniel J.
Published: November 2018

Objective:

The etiology of symptoms following primary repair of superior canal dehiscence (SCD) may be due to a persistent third window. However, the extent of surgery cannot be seen on postoperative computed tomography (CT) since most repair materials are not radiopaque. We hypothesize that the extent of superior semicircular canal (SSC) occlusion following primary repair can be quantified based on postoperative magnetic resonance imaging (MRI) data.

Study design:

Retrospective series.

Setting:

Tertiary care center.

Patients:

Adult patients with a history of SCD syndrome who 1) report persistent symptoms following primary SCD repair and 2) underwent heavily T2-weighted MRI postoperatively.

Interventions:

Analysis of SSC using 3D-reconstruction of CT co-registered with MRI data.

Main outcome measures:

Arc length of fluid void on MRI and quantification of persistent SCD based on CT/MRI co-registration.

Results:

We identified 9 revision cases from a cohort of 145 SCD repairs at our institution (2002–2017) with CT/MRI data. A fluid void on postoperative MRI (indicating occlusion of the SSC) was observed in all cases (anterior limb: 50.1 degrees [±21.8 SD] and posterior limb 48.1 degrees [±28.5 SD]). Co-registration of CT/MRI revealed a residual defect that was most commonly found along the posterior limb in most patients with persistent symptoms.

Conclusions:

The extent of SCD repair can be determined using reformatted or direct T2-weighted MRI sequences in the plane of Pöschl. Co-registration of CT/MRI may be useful to determine the location of a residual superior canal defect and when present was found most commonly along the posterior limb.
Improve the ethical review of clinical trials on traditional medicine
Authors: Zhao Hongjie , Zhang Junhua , Yang Fengwen , Tan Lizi
Published: November 2018

Recently, there is an increasing number of clinical trials on Traditional Chinese medicine (TCM) published, but the implementation of Clinical Trial Registration (CTR), Ethical Review (ER), and Informed Consent (IC) in clinical trials of TCM is unclear. This study aims to investigate the status of CTR, ER, and IC in clinical trials of TCM.

Clinical trials of TCM published in 10 high-quality Chinese journals in 2016 were selected as a sample. Information of clinical trial registration, ethical review, and informed consent of clinical trials was extracted for analysis. Two authors independently screened the literature and extracted the relevant information.

A total of 659 clinical trials met the criteria and were included for analysis. Only 9 clinical trials reported information of clinical trial registration (1.4%). The number for ethical review and informed consent were 156 (23.7%) and 502 (76.2%).

Trial registration, protocol approval, and informed consent were not well executed. Especially registration and ethical review of clinical trials in TCM should be carefully concerned by researchers, clinicians, and journal editors. Training on methodology of clinical trial should be strengthened.
The combination of apatinib and S-1 for the treatment of advanced gastric cancer in China
Authors: Liu Yan , Zhou Changchun , Zhang Kai , Feng Yikuan , Zhang Ruihua
Published: November 2018

Background:

Apatinib-targeted therapy is considered a promising treatment option for malignancies. This study systematically evaluated the efficacy and safety of the combination of apatinib and S-1 for the treatment of patients with advanced gastric cancer (GC).

Methods:

Clinical trials were searched from the PubMed, Cochrane Library, Embase, CNKI, and Wanfang databases. Outcome measures including therapeutic efficacy, quality of life (QoL), and adverse events were extracted and evaluated.

Results:

Data from 8 trials including 393 patients with advanced GC were included. The results indicated that, compared with S-1 alone, the combination of apatinib with S-1 significantly improved patient partial response rate (odds ratio [OR] = 1.91, 95% confidence interval [CI] = 1.21–3.02, P = .005), overall response rate (ORR, OR = 2.40, 95% CI = 1.51–3.82, P = .0002), and disease control rate (DCR, OR = 2.78, 95% CI = 1.51–5.10, P = .0010), whereas the rates of complete response (CR, OR = 2.38, 95% CI = 0.93–6.12, P = .07) and stable disease (SD, OR = 0.99, 95% CI = 0.64–1.54, P = .97) and QoL (OR = 1.22, 95% CI = 0.51–2.92, P = .66) did not differ significantly. Moreover, the group receiving the combined therapy had higher rates of hand-foot syndrome (OR = 2.23, 95% CI = 1.19–4.17, P = .01), hypertension (OR = 8.85, 95% CI = 4.07–19.26, P < .00001), albuminuria (OR = 11.25, 95% CI = 3.32–38.06, P = .0001), and hemoglobin reduction (OR = 3.19, 95% CI = 1.32–7.67, P = .010), whereas analysis of other adverse events did not show significant differences (P > .05).

Conclusion:

The combination of apatinib and S-1 is more effective for GC treatment than S-1 alone. However, this combined treatment could lead to increased hand-foot syndrome, hypertension, albuminuria, and hemoglobin reduction. Therefore, the benefits and risks should be considered before treatment.
The multi-vessel and diffuse coronary spasm is a risk factor for persistent angina in patients received anti-angina medication
Authors: Park Sang-Ho , Choi Byoung Geol , Rha Seung-Woon , Kang Tae Soo
Published: November 2018

Coronary artery spasm (CAS) is known to be a risk factor for cardiovascular events. However, there is limited data whether the multi-vessel and diffuse spasm (MVDS) is related to more adverse clinical outcomes compared to the Non-MVDS. The aim of this study is to evaluate the impact of the MVDS on clinical outcomes during a 3-year clinical follow-up period.

A total 2797 patients underwent coronary angiography (CAG) with acetylcholine (ACH) provocation test from Nov 2004 to Oct 2010 were enrolled. It is a single-center, observational, prospective, all-comers registry designed to reflect the “real world” practic. The patients were divided into the 3 groups; the negative spasm (NS) group (n = 1188), the Non-MVDS group (n = 1081), and the MVDS group (n = 528). The incidence of major adverse cardiac events (MACE) and recurrent angina was evaluated up to 3 years. To minimize confounding factors, multivariable Cox-proportional hazards regression analysis was performed.

In the 3-year clinical follow-up, the incidence of total death, myocardial infarction, de novo percutaneous coronary intervention (PCI), cerebrovascular accident and MACE were similar among the 3 groups. However, recurrent angina occurred more frequently in the MVDS group than in the NS group (hazard ratio [HR], 1.96; 95% confidence interval [CI], 1.27–3.02; P = .002). Recurrence angina between the MVDS group and the Non-MVDS group was not statistically significant (HR, 1.36; 95% CI, 0.91–2.03; P = .129).

In this study, although the incidence of major adverse cardiovascular events were not different regardless of spasm type, the MVDS was associated with higher incidence of recurrent chest pain requiring repeat CAG during the 3-year follow-up period, suggesting more intensive optimal medical therapy with close clinical follow up would be necessary for this particular subset of patients.
Primary diffuse large B-cell lymphoma as a chest-wall mass
Authors: Zhang Qianwen , Ju Yuanrong , Qu Tao , Wang Tao , Liu Xiaoqin
Published: November 2018

Rationale:

Primary diffuse large B-cell lymphoma of the chest wall is extremely rare. A majority of the pleural lymphomas develop in patients with chronic tuberculous pyothorax. The underlying mechanism might be attributed to the sustained stimulation of chronic inflammation. Surgery followed by adjuvant chemotherapy can improve the outcome in some patients with lymphoma localized only in the chest wall. Thus, an early diagnosis of pyothorax-associated lymphoma is essential as it is a malignant, life-threatening condition.

Patient concerns:

A 79-year-old male complained of left-side chest pain for more than 2 months, which was not alleviated with nitrates and aspirin. The patient presented an intermittent low fever, anorexia, and marasmus, accompanied by tuberculosis 40 years ago and chronic left-side pyothorax. Also, ANCA (antineutrophil cytoplasmic autoantibody)-associated vasculitis occurred for >3years.

Diagnosis:

Computed tomography scan showed a solid mass in the left lateral chest wall. The patient underwent ultrasonic-guided biopsy of the lesion. A diagnosis of primary diffuse large B-cell lymphoma of the chest wall was established after histological examination.

Intervention:

Due to advanced age and poor physical condition, the patient received CHOP chemotherapy at a reduced dose.

Outcomes:

The patient died 5 days after the first cycle of chemotherapy with severe dyspnea and high fever.

Lessons:

The chronic inflammation stimulation might result in the development of lymphoma in the chest wall of patients with long-term pyothorax, vasculitis, or other autoimmune diseases associated with malignancies. The fever, chest pain, or other nonspecific clinical symptoms in these patients should be under intensive focus as it might indicate the development of malignant lymphoma. Thus, histological examination in these patients is essential for accurate early diagnosis.
The time course of cervical alignment after cervical expansive laminoplasty
Authors: Choi Il , Roh Sung Woo , Rhim Seung Chul , Jeon Sang Ryong
Published: November 2018

Retrospective Cohort study

To analyze cervical lordosis angle (CLA) change after cervical expansive laminoplasty (CEL) over time, and to determine optimal cut-off angle for predicting postoperative kyphosis

Postoperative development of sagittal malalignment after laminoplasty is associated with neurological dysfunction and neck pain. However, there is no information on the serial CLA change over time and cut-off angle for predicting postoperative kyphosis

The Cobb angle between C2 and C7 in a series of lateral cervical X-rays in the neutral position was retrospectively reviewed for 36 months. And, the effect of time on CLA after CEL and the risk factors associated with postoperative cervical kyphosis (Cobb's angle ≤0°) were analyzed. Also, the optimal cut-off angle for predicting postoperative kyphosis was determined.

A total of 110 cases of CEL for cervical myelopathy were enrolled from February 2005 to May 2010. The mean cervical alignment changed from 12.3 ± 10.4° (mean ± standard deviation [SD]) at the preoperative evaluation to 8.2 ± 11.6°, 10.6 ± 10.1°, 9.1 ± 10.0°, 8.4 ± 11.2°, 8.5 ± 10.5°, 8.1 ± 9.9°, and 8.7 ± 10.1° at 1, 3, 6, 12, 18, 24, and 36 postoperative months, respectively. The cervical lordosis showed statistically significant decreased at the 1st month, then the lordotic angle was partially restored at the 3rd, and 6th, and then no significant changes after the 6th. The only risk factor for kyphosis development was the preoperative CLA. The optimal cut-off preoperative angle for predicting postoperative kyphosis was 8.5°.

The decrease of CLA after expansive laminoplasty peaked in the 1st month. Some of the lordotic angles were restored in the 3rd and 6th months, before reaching a plateau after the 6th month. The optimal cut-off preoperative angle for predicting postoperative kyphosis was 8.5°.

Level of Evidence of their study: Level 4.
Giant sellar metastasis from renal cell carcinoma
Authors: Shen Zhiwei , Yang Chengxian , Bao Xinjie , Wang Renzhi
Published: November 2018

Rationale:

Sellar metastasis is a rare and complex disease whose clinical features are strongly associated with the primary malignancy. Here, we present a rare case of giant sellar metastasis spread from renal cell carcinoma (RCC).

Patient concerns:

A 30-year-old Chinese woman was admitted to our Hospital, reporting headache, nasal congestion, nausea, vomiting, and a sharp decline in her right eye vision.

Diagnoses:

Brain magnetic resonance imaging (MRI) revealed an invasive sellar mass with cavernous sinus and nasal cavity extension. Additionally, the patient had a medical history of right radical nephrectomy for clear-cell RCC.

Interventions:

The patient underwent a successful subtotal resection of the tumor. Final pathological diagnosis confirmed sellar metastasis from RCC. After surgery, the patient was referred to our medical oncology department and received further systemic therapy.

Outcomes:

No light perception remained in her right eye even after prompt surgical decompression. Follow-up MRI showed subtotal resection of the giant sellar metastasis.

Lesson:

Sellar metastasis, although rare, should be particularly considered for elderly patients with deteriorating visual function and medical histories of cancer.
Impact of carcinoid syndrome symptoms and long-term use of somatostatin analogs on quality of life in patients with carcinoid syndrome
Authors: Halperin Daniel M. , Huynh Lynn , Beaumont Jennifer L. , Cai Beilei , Totev Todor , Bhak Rachel H. , Duh Mei S. , Neary Maureen P. , Cella David
Published: November 2018

To evaluate association of carcinoid syndrome (CS) symptom burden and somatostatin analog (SSA) duration with quality of life (QoL) using Functional Assessment of Cancer Therapy-General (FACT-G) and Patient-Reported Outcomes Measurement Information System (PROMIS-29) instruments.

Adults who received treatment for CS symptoms in the US were recruited to participate in a cross-sectional online survey (July–October, 2016). Demographic, clinical, and QoL questions (FACT-G, 29 CS-related supplemental questions, PROMIS-29) were included. Descriptive and multivariable regression analyses adjusting for demographic and clinical characteristics followed.

Most (98%) of the 117 patients received SSAs in the prior month. Multivariable regression analysis showed ≥4 bowel movements/day (vs <4) and each additional CS symptom was associated with 7.1 (P = .043) and 3.4 (P = .034) point FACT-G total score decreases, respectively. Requiring bed rest (vs normal activity) was associated with significant decreases in FACT-G total score (P < .001). There were similar associations for FACT-G subscales, supplemental questions, and PROMIS-29. After adjustment, FACT-G total score was significantly higher (11.3 points; P = .033) for patients treated with SSA >8 years versus <2.7 years.

CS symptom burden was observed to be associated with lower QoL scores, measured by FACT-G. Patients with >8 years SSA treatment duration versus <2.7 years had higher QoL.
The Nepean Dyspepsia Index is a valid instrument for measuring quality-of-life in functional dyspepsia
Authors: Jones Michael P. , Sato Yuri A. , Talley Nicholas J.
Published: November 2018

Background

The Nepean Dyspepsia Index (NDI) has been in widespread use since its publication in 1999 and the addition of a short form in 2001. The NDI was one of the first disease-specific quality-of-life instruments created for functional dyspepsia (FD). However, its psychometric properties have never been validated in an independent sample.

Aim

This study aimed to evaluate the validity and reliability of the NDI in an a-priori driven approach in an independent population.

Patients and methods

In 289 individuals who fulfilled the Rome criteria for FD enrolled in a randomized placebo-controlled trial (FD treatment trial), we examined construct validity, convergent validity, and internal consistency.

Results

Construct validity was supported in its 25-item unweighted and weighted forms as well as the 10-item short form. All items in the 25-item form yielded considerable (>0.5) standardized loadings on their respective latent variables and all reached statistical significance (P<0.0001), supporting their relationships with the hypothesized domains. Convergent validity was strongly supported, with every domain being correlated with multiple external instruments; the majority of correlations were in the range 0.3–0.5 (in absolute values). The items comprising each domain showed good internal consistency, with the lowest value of Chronbachαat 0.80. Scores based on the short form (10-item) version of the NDI correlated strongly with the full 25-item form (tensionρ=0.88, interferenceρ=0.94, eat/drinkρ=0.95, knowledgeρ=0.84 and work/studyρ=0.97; allP<0.0001).

Conclusion

The NDI is a valid instrument that can be used to measure the disease-specific impact of FD on quality of life.
Sexual Orientation Disparities in Physical Activity
Authors: Fricke Julie , Gordon Nancy , Downing Janelle
Published: November 2018

Background:

The majority of adults in the United States fail to meet the Centers for Disease Control and Prevention (CDC) physical activity (PA) guideline recommendations for health promotion. Despite evidence of disparities by sexual orientation in adverse health outcomes related to PA, little is known about whether PA patterns and the likelihood of meeting these guidelines differ between heterosexual and sexual minority (SM) men and women.

Methods:

In 2018, we pooled unweighted respondent data from Kaiser Permanente Northern California Member Health Surveys conducted in 2008, 2011, and 2014/15 (N=42,534) to compare PA patterns among heterosexual and SM men and women.

Results:

In total, 38.8% of heterosexual men, 43.4% of SM men, 32.9% of heterosexual women, and 40.0% of SM women meet the CDC PA guidelines, yet there was no statistically significant difference in the adjusted odds of meeting these guidelines. Compared with heterosexual women, SM women engage in PA more frequently [odds ratio=0.81; 95% confidence interval (CI), 0.74–0.89], for more minutes per week on average (12.71; 95% CI, 4.85–20.57), and at higher levels of intensity (relative risk ratio=1.26; 95% CI, 1.02–1.56). Compared with heterosexual men, SM men engage in PA more frequently (OR=0.85; 95% CI, 0.74–0.98), for fewer minutes per week on average (−12.89; 95% CI, −25.84 to 0.06), and at lower levels of intensity (relative risk ratio=0.83; 95% CI, 0.67–0.99).

Conclusions:

We find that SMs get more frequent PA than their heterosexual peers, which suggests that the higher prevalence of obesity and other PA-related adverse health outcomes among SMs may be due to factors other than PA patterns.
Assessment of Nutritional Status and Malnutrition Risk at Diagnosis and Over a 6-Month Treatment Period in Pediatric Oncology Patients With Hematologic Malignancies and Solid Tumors
Authors: Yoruk Mustafa A. , Durakbasa Cigdem U. , Timur Cetin , Sahin Seyma S. , Taskin Esra C.
Published: November 2018

In total, 74 pediatric oncology patients with hematologic malignancies (n=56) or solid tumors (n=18) and a median age of 78.5 months were included in this prospective study. The aims were to assess malnutrition risks and nutritional status over a 6-month treatment period measured at regular intervals. The rate of patients with high risk for malnutrition at diagnosis was 28.4% by Screening Tool for Risk of Impaired Nutritional Status and Growth tool and 36.5% by Pediatric Yorkhill Malnutrition Score. Body mass index (BMI) z-scores at diagnosis showed 12.3% undernutrition (<−2 SD) and 6.8% overnutrition (>2 SD), which changed to 6.7% and 11.1% at the sixth month, respectively. Malnutrition (BMI<5th age percentile) was detected in 13.7% at diagnosis. Despite an initial deterioration noted in BMI, BMI for age percentile, and z-scores at month 1 in all malignancy subgroups (at month 3 for acute lymphoblastic leukemia), the scores improved later on. There was an increase in weight from baseline in 88.2% of patients over 6 months. This study revealed a decrease in the prevalence of undernutrition and malnutrition over a 6-month treatment period with improved anthropometrics despite an initial deterioration in all malignancy subgroups and even in patients with high risk for malnutrition at baseline screening. Solid tumors and acute lymphoblastic leukemia seem to be associated with higher likelihood of undernutrition and overnutrition, respectively, during treatment.
Results of a Pilot Study of a Mail-Based Human Papillomavirus Self-Testing Program for Underscreened Women From Appalachian Ohio
Authors: Reiter Paul L. , Shoben Abigail B. , McDonough Deborah , Ruffin Mack T. , Steinau Martin , Unger Elizabeth R. , Paskett Electra D. , Katz Mira L.
Published: November 2018

Background

Human papillomavirus (HPV) self-testing is an emerging cervical cancer screening strategy, yet few mail-based HPV self-testing programs have been implemented in the United States. We report the results of a pilot study of a mail-based program, the Health Outcomes through Motivation and Education Project.

Methods

In 2015 to 2016, we recruited 103 women from Appalachian Ohio who were aged 30 to 65 years and had not received a Papanicolaou (Pap) test in at least 3 years. Women were mailed an HPV self-test and randomized to receive either (a) self-test instructions developed by the device manufacturer and a standard information brochure about cervical cancer (control group) or (b) self-test instructions developed by the Health Outcomes through Motivation and Education Project and a photo story information brochure about cervical cancer (intervention group). Logistic regression compared study arms on HPV self-test return and receipt of a Pap test.

Results

Overall, 80 (78%) women returned their HPV self-test. Return was similar among the intervention and control groups (78% vs. 77%; odds ratio, 1.09; 95% confidence interval, 0.43–2.76). Among returners, 26% had an oncogenic HPV type detected in their sample. Women who returned their self-test reported high levels of satisfaction and positive experiences with the self-testing process. Few women overall received a Pap test (11%), and Pap testing was similar among the intervention and control groups (14% vs. 8%; odds ratio, 1.91; 95% confidence interval, 0.52–6.97).

Conclusions

Mail-based HPV self-testing programs are a potentially promising strategy for reaching underscreened women in Appalachia. Efforts are needed to better understand how to optimize the success of such programs.
Prevalence of Syphilis and Related Risk Behaviors Among Women in 5 Distinct Indigenous Populations in Paraguay
Authors: Aguilar Gloria , Estigarribia Gladys , Ortiz Analia , Miranda Angelica E. , McFarland Willi , Kawabata Anibal , Muñoz Sergio , Mendez Julieta , Rios-Gonzalez Carlos , Samudio Tania
Published: November 2018

Background

The objective of this study was to measure the prevalence of syphilis among women of reproductive age from 5 distinct indigenous populations in Paraguay. We also sought to identify the demographic profile and behaviors of women with elevated prevalence of syphilis.

Methods

We conducted a population-based, cross-sectional survey among women aged 15 to 49 years from 5 distinct language families in Paraguay in 2016. The 5 language families were Guaraní, Maskoy, Mataco, Guaicurú, and Zamuco, sampled through a probability-based, multistage cluster design. Participants completed a questionnaire on demographic characteristics and risk-related behavior. Blood samples were drawn for rapid testing for syphilis with confirmation and titers. Participants provided written informed consent; minors had written parental consent and provided their own assent.

Results

A total of 1732 indigenous women were enrolled. Overall syphilis prevalence was 6.8% (95% confidence interval [CI], 5.6–8.0). Syphilis prevalence varied by language family/ethnic group (P = 0.010), with Mataco having the highest prevalence (8.2%; 95% CI, 5.3–11.9) and Maskoy having the lowest (2.5%; 95% CI, 1.1–4.7). Women reporting multiple partners (11.3%; 95% CI, 6.9–17.1; P = 0.031) and transactional sex in the last year (18.7%; 95% CI, 7.2–36.4; P = 0.010) had higher prevalence of syphilis.

Conclusions

Our survey found high prevalence of syphilis in indigenous women in Paraguay, in association with transactional sex and multiple partners. Interventions to reduce sexual behaviors associated with an increased risk of sexually transmitted infections (STI) in indigenous women must be carried out with programs aimed at addressing transactional sex, appropriately framed to respect interculturality and an indigenous worldview.
Distinct Genomic Patterns in Pigmented Epithelioid Melanocytoma
Authors: Isales Maria C. , Mohan Lauren S. , Quan Victor L. , Garfield Erin M. , Zhang Bin , Shi Katherine , Arva Nicoleta , Beaubier Nike , Yazdan Pedram , White Kevin , Taxter Timothy J. , Gerami Pedram
Published: November 2018

Pigmented epithelioid melanocytoma (PEM) is considered an intermediate grade melanocytic lesion that is histologically indistinguishable from epithelioid blue nevi associated with Carney complex. PEM are characterized by an intradermal population of heavily pigmented epithelioid-shaped melanocytes along with some spindled and dendritic melanocytes with frequent melanophages. These melanocytic tumors occasionally involve regional lymph nodes but only rarely result in distant metastases. Recent studies have demonstrated a variable but limited number of specific genomic aberrations including protein kinase A regulatory subunit alpha (PRKAR1A), BRAF, GNAQ, and MAP2K1 mutations as well as protein kinase C alpha isoform (PRKCA) fusions. We performed an 8-year retrospective review of our database and identified 16 cases of PEM. Using targeted DNA sequencing and RNA-seq to assess 1714 cancer-related genes, we detected gene fusions involving PRKCA in 31% of cases (5/16) with 5’ partners SCARB1(12q24) in 2 cases, CD63 (12q13) in 1 case, ATP2B4 (1q32) in 1 case, and MAP3K3 (17q23) in 1 case. Additional fusions were identified in TPR-NTRK1 (1/16), ALK (1/16), and MYO5A-NTRK3 (1/16). PRKCA fusion lesions tended to occur in younger-aged patients and histologic examination demonstrated sheets of monomorphic epithelioid-shaped melanocytes, moderate to high-grade nuclear atypia, and higher mitotic activity (P=0.037). Our gene panel also identified previously described mutations in PRKAR1A, GNAQ, MAP2K1, BRAF, NF1. To our knowledge, this is the largest and most comprehensive study of PEM integrating molecular data with histologic features that can be utilized in future studies for improved subclassification and prognostication of heavily pigmented melanocytic neoplasms.
Outcomes of Children With Critical Bronchiolitis Meeting at Risk for Pediatric Acute Respiratory Distress Syndrome Criteria*
Authors: Slain Katherine N. , Rotta Alexandre T. , Martinez-Schlurmann Natalia , Stormorken Anne G. , Shein Steven L.
Published: November 2018

Objectives:

New definitions of pediatric acute respiratory distress syndrome include criteria to identify a subset of children “at risk for pediatric acute respiratory distress syndrome.” We hypothesized that, among PICU patients with bronchiolitis not immediately requiring invasive mechanical ventilation, those meeting at risk for pediatric acute respiratory distress syndrome criteria would have worse clinical outcomes, including higher rates of pediatric acute respiratory distress syndrome development.

Design:

Single-center, retrospective chart review.

Setting:

Mixed medical-surgical PICU within a tertiary academic children’s hospital.

Patients:

Children 24 months old or younger admitted to the PICU with a primary diagnosis of bronchiolitis from September 2013 to April 2014. Children intubated before PICU arrival were excluded.

Interventions:

None.

Measurements and Main Results:

Collected data included demographics, respiratory support, oxygen saturation, and chest radiograph interpretation by staff radiologist. Oxygen flow (calculated as Fio
2 × flow rate [L/min]) was calculated when oxygen saturation was 88–97%. The median age of 115 subjects was 5 months (2–11 mo). Median PICU length of stay was 2.8 days (1.5–4.8 d), and median hospital length of stay was 5 days (3–10 d). The criteria for at risk for pediatric acute respiratory distress syndrome was met in 47 of 115 subjects (40.9%). Children who were at risk for pediatric acute respiratory distress syndrome were more likely to develop pediatric acute respiratory distress syndrome (15/47 [31.9%] vs 1/68 [1.5%]; p < 0.001), had longer PICU length of stay (4.6 d [2.8–10.2 d] vs 1.9 d [1.0–3.1 d]; p < 0.001) and hospital length of stay (8 d [5–16 d] vs 4 d [2–6 d]; p < 0.001), and increased need for invasive mechanical ventilation (16/47 [34.0%] vs 2/68 [2.9%]; p < 0.001), compared with those children who did not meet at risk for pediatric acute respiratory distress syndrome criteria.

Conclusions:

Our data suggest that the recent definition of at risk for pediatric acute respiratory distress syndrome can successfully identify children with critical bronchiolitis who have relatively unfavorable clinical courses.
Protocol-Driven Management of Convulsive Status Epilepticus at a Tertiary Children’s Hospital: A Quality Improvement Initiative
Authors: Cassel-Choudhury Gina , Beal Jules , Longani Neha , Leone Bridget , Rivera Ruby , Katyal Chhavi
Published: November 2018

Objectives:

Convulsive status epilepticus is a medical emergency. Prompt treatment has been shown to decrease progression to refractory convulsive status epilepticus. We aimed to reduce time to second-line anti-seizure medication through implementation of a standardized treatment protocol.

Design:

Quality improvement project. We constructed a multidisciplinary team and completed Plan-Do-Study-Act cycles to achieve the project aim.

Setting:

A tertiary care children’s hospital.

Patients:

Patients presenting to the Children’s Hospital at Montefiore emergency department with convulsive status epilepticus or new-onset seizures during admission to Children’s Hospital at Montefiore.

Interventions:

Implementation of a standardized treatment protocol, uploading the protocol to the hospital’s intranet, adding anti-seizure medications to the hospital’s Pyxis system, and creating a standardized convulsive status epilepticus order set in the electronic medical record. The primary outcome measure was time from order to administration of second-line anti-seizure medication, and secondary outcome was total seizure time.

Measurements and Main Results:

Seventy-eight patients were analyzed, including 41 from the baseline period (January 2014 through June 2015) and 37 from the postintervention period (July 2015 through December 2016). The median time to administration of second-line anti-seizure medication decreased from 52 to 21 minutes (p = 0.001) and total seizure time from 65 to 31 minutes (p = 0.09).

Conclusions:

A standardized treatment protocol for convulsive status epilepticus decreased time to administration of second-line therapy by 60%, but there was no statistically significant decrease in total seizure time.