bluuebunny/crossref_metadata_2025 huggingface dataset:
Profile of Patients With Acute Low Back Pain Who Sought Emergency Departments
Authors: Oliveira Indiara Soares , Vanin Adriane Aver , Pena Costa Leonardo Oliveira , Medeiros Flávia Cordeiro , Ananias Oshima Renan Kendy , Inácio Angela Augusto , Matos da Cunha Thayane Araújo , Palomo Andressa Santos , Fukuda Thiago Yukio , de Freitas Diego Galace , Benvenuto Fernando , Menezes Costa Lucíola da Cunha
Published: September 2019

Study Design.

A cross-sectional study.

Objective.

The aim of this study is to describe the profile of patients with acute low back pain (LBP) who sought emergency departments (EDs) in Brazilian public hospitals. We also described the profile of these patients according to the STarT Back Screening Tool (SBST).

Summary of Background Data.

LBP is the most common musculoskeletal condition worldwide and is one of the main complaints in EDs. There is a lack of evidence describing the profile of these patients from low- to middle-income countries.

Methods.

This is a cross-sectional study involving patients with a new episode of nonspecific acute LBP that was conducted between August 2014 and August 2016. Variables related to clinical, psychological, sociodemographic and work status characteristics were investigated through structured, in-person oral questionnaire.

Results.

A total of 600 patients were included in the study. The majority of the patients were women (58%), with a median of eight points on pain intensity (measured on an 11-point scale) and 17 points on disability (measured on a 24-item questionnaire). With regards to the SBST evaluation, 295 (49.2%) patients were classified as being at high risk of developing an unfavorable prognosis with a median pain intensity of nine points on pain intensity, 20 points on disability, and seven points on depression (measured on an 11-point scale). Despite this, the majority of the patients (74%) continued working normally without interference from LBP.

Conclusion.

Identifying the profile of patients seeking care in EDs can help to define effective management for LBP in low- and middle-income countries. Patients with nonspecific acute LBP who seek EDs in Brazil present high levels of pain intensity and disability. Most patients were classified as having a high risk of developing an unfavorable prognosis.

Level of Evidence: 2
Selecting the Last Substantially Touching Vertebra as Lowest Instrumented Vertebra in Lenke type 2A-R and 2A-L Curves
Authors: Qin Xiaodong , He Zhong , Yin Rui , Qiu Yong , Zhu Zezhang
Published: September 2019

Study Design.

A retrospective study.

Objective.

The aim of this study was to determine whether the last substantially touching vertebra (LSTV) can be selected as the optimal lowest instrumented vertebra (LIV) for Lenke 2A adolescent idiopathic scoliosis (AIS) with different lumbar modifiers (2A-R and 2A-L) and to investigate its relationship with the distal adding-on.

Summary of Background Data.

Previous studies have documented good outcomes in Lenke 1A curve when LSTV was selected as LIV.

Methods.

A total of 101 female patients were included with a minimum of 2-year follow-up after selective posterior surgery. Patients were classified on the basis of the direction of L4 tilt: 2A-L and 2A-R. Patients with LSTV-1, LSTV, or LSTV+1 selected as LIV were assigned to three groups. Factors associated with adding-on were analyzed through comparison among the three groups.

Results.

The level of LSTV was more distal in the 2A-R group than that in the 2A-L group (P = 0.011). Distal adding-on was observed in 24 patients (23.8%). In the 2A-R curves, 26.1% patients were found to have adding-on. The incidence of adding-on was significantly higher in LSTV-1 than LSTV or LSTV+1 group. Logistic regression analysis showed the distance between LIV and LSTV (LIV-LSTV <0) was the independent factor associated with adding-on (odds ratio [OR] = 8.7, 95% confidence interval [CI] = 3.1–45.5, P = 0.011). In the 2A-L curves, 21.8% patients were found to have adding-on. The incidence of adding-on was significantly lower in LSTV+1 than LSTV-1 or LSTV group. Similarly, logistic regression showed the distance between LIV and LSTV (LIV-LSTV ≤0) had significant association with adding-on (OR = 11.9, 95% CI = 2.5–53.2, P = 0.009).

Conclusion.

The distance between LIV and LSTV was a significant factor associated with adding-on for both 2A-R and 2A-L patients. The rule of selecting LIV should be different between 2A-R and 2A-L curves. We recommend to extend the fusion level to LSTV in 2A-R curve and to LSTV+1 in 2A-L curve to avoid distal adding-on.

Level of Evidence: 3
Periapical-dropout Screws Strategy For 3-Dimensional Correction of Lenke 1 Adolescent Idiopathic Scoliosis in Patients Treated by Posterior Spinal Fusion
Authors: Lertudomphonwanit Thamrong , Jain Viral V. , Sturm Peter F. , Patel Saral
Published: September 2019

Study Design:

This was a single-center, retrospective study.

Objective:

The objective of this study was to compare periapical-dropout screws strategy (PDSS) with traditional-multilevel pedicle screws strategy (TMSS) for 3-plane correction of Lenke 1 adolescent idiopathic scoliosis deformity.

Summary of Background Data:

There are limited data in 3-plane correction and the optimal pedicle screw (PS) configuration for Lenke 1 adolescent idiopathic scoliosis surgery.

Materials and Methods:

Sixty-one consecutive patients with Lenke 1 curves (range: 50–80 degrees), undergoing single-stage posterior spinal fusion with PS fixation, were included. Patients with a minimum follow-up of 1 year were divided into 2 groups according to PS strategy. The PDSS group included 33 patients with PS placement bilaterally at both ends and apex of the construct. The TMSS group included 28 patients with conventional PS placement. Baseline, immediate, and last follow-up demographic, radiographic, and clinical outcomes were analyzed. Radiographic outcomes were assessed in axial (using rib index and apical vertebral rotation using Raimondi ruler and Upasani methods), coronal, and sagittal planes. The implant costs were also evaluated.

Results:

There were no differences in demographic, preoperative radiographic parameters and levels fused. The number of PSs per level fused was significantly lower in the PDSS group (1.3 vs. 1.4; P=0.0002). At last follow-up, major Cobb correction averaged 79% for the PDSS group and 69.5% for the TMSS group (P=0.001). T2–T12 kyphosis angle changes were 1 degree in the PDSS group and −2.5 degrees in the TMSS group (P=0.35). Rib index correction was 28.2% for the PDSS group and 17.7% for the TMSS group (P=0.02). Upasani grade apical vertebral rotation was significantly better in the PDSS group (0.7 vs. 1.4; P=0.0001). Clinical outcomes evaluated by Scoliosis Research Society-30 scores were similar in both groups. Total implant costs were significantly lower in the PDSS group ($16,852 vs. $18,926; P<0.001).

Conclusion:

The PDSS construct provides better deformity correction in all 3 planes and helps decrease implant costs compared with the TMSS construct. Thus, the PDSS construct can be considered as a rational strategy and cost-effective technique when treating moderate Lenke 1 curves with posterior spinal fusion.
Impact of K-Line (–) in the Neck-Flexion Position on Patient-reported Outcomes After Cervical Laminoplasty For Patients With Ossification of the Posterior Longitudinal Ligament
Authors: Kimura Atsushi , Shiraishi Yasuyuki , Sugawara Ryo , Inoue Hirokazu , Endo Teruaki , Takeshita Katsushi
Published: September 2019

Study Design:

This study was a post hoc analysis of prospective data.

Objective:

The objective of this study was to investigate whether K-line (–) in the neck-flexion position [f-K-line (–)] affects patient-reported outcome measures after cervical laminoplasty for patients with ossification of the posterior longitudinal ligament (OPLL).

Summary of Background and Data:

The f-K-line was recently proposed as a predictor of poor outcomes after laminoplasty for patients with OPLL. However, its impact on patient-reported outcome measures remains to be elucidated.

Patients and Methods:

We analyzed prospectively collected data from 68 patients with cervical myelopathy due to OPLL who underwent double-door laminoplasty between 2008 and 2015. Patients were categorized into f-K-line (–) and f-K-line (+) groups on a baseline neck-flexion radiograph. Outcome measures included the Japanese Orthopaedic Association score, EuroQol 5-Dimensional Questionnaire, the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire, and 11-point Numerical Rating Scale for pain. The degree of satisfaction with the outcome was assessed at the 2-year follow-up using a 7-point Numerical Rating Scale.

Results:

Of the 68 patients, 22 (32%) and 46 (68%) were grouped into the f-K-line (–) and f-K-line (+) groups, respectively. The 2 groups showed no significant difference in baseline functions. The f-K-line (–) group showed a significantly lower recovery rate of the Japanese Orthopaedic Association score and a significantly lower gain in EuroQol 5-Dimensional Questionnaire score than compared with the f-K-line (+) group at the 2-year follow-up. Among the 5 domains of the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire, cervical function, and upper extremity function were significantly lower in the f-K-line (–) group than in the f-K-line (+) group. Patients in the f-K-line (–) group also reported a significantly higher pain intensity in the upper and lower extremities and a significantly lower degree of satisfaction compared with those in the f-K-line (+) group.

Conclusion:

The f-K-line (–) was significantly associated with poorer functional recovery, higher pain intensity in the extremities, and lower patient satisfaction after cervical laminoplasty for patients with OPLL.
Relationship between arterial stiffness and unattended or attended blood pressure values
Authors: Paini Anna , Aggiusti Carlo , Bertacchini Fabio , Stassaldi Deborah , Capellini Sara , de Ciuceis Carolina , Sacca’ Giovanni , Verzeri Laura , Gatta Roberto , Rosei Enrico Agabiti , Muiesan Maria Lorenza , Salvetti Massimo
Published: September 2019

Background and method:

Measurement of ‘unattended’ blood pressure (BP) may reduce or eliminate the ‘white-coat effect’. Despite the possible advantages of this approach for BP measurement, only few studies analysed the relationship between unattended BP and cardiovascular events or with hypertension-mediated organ damage (HMOD). The aim of our study was to evaluate the relationship between ‘attended’ or ‘unattended’ BP values and carotid-femoral pulse wave velocity (PWV) in 285 individuals undergoing a visit and assessment of arterial stiffness at an ESH Excellence Centre. Unattended BP (measured with the patient alone in the room, with an oscillometric device programmed to perform three BP measurements, at 1-min intervals, after 5 min) and attended BP were measured with the same device, on the same day of the measurement of PWV, in a random order.

Results:

Mean age was 63 ± 13 years, mean BMI 26 ± 4, 47% were women, 76% had hypertension (55% treated). Systolic unattended BP was lower than attended SBP (124.4 ± 14.3 vs. 130.9 ± 16.1 mmHg). PWV was similarly correlated with attended and unattended SBP values (r = 0.428 and r = 0.404, P < 0.0001, respectively). No difference for the prediction of increased arterial stiffness was observed at receiver operator curves (ROCs) analysis [attended SBP area under the curve (AUC) 0.665, 95% confidence interval (95% CI) 0.607–0.720 vs. unattended SBP: AUC 0.651, 95% CI 0.593–0.706, P for the comparison = ns].

Conclusion:

Attended and unattended BP values are similarly correlated with PWV, the gold standard measure of arterial stiffness. These findings may provide further information on the clinical value of unattended BP.
Contributors to Racial Disparities in Minimally Invasive Hysterectomy in the US Department of Veterans Affairs
Authors: Katon Jodie G. , Bossick Andrew S. , Doll Kemi M. , Fortney John , Gray Kristen E. , Hebert Paul , Lynch Kristine E. , Ma Erica W. , Washington Donna L. , Zephyrin Laurie , Callegari Lisa S.
Published: September 2019

Background:

Minimally invasive hysterectomy for fibroids decreases recovery time and risk of postoperative complications compared with abdominal hysterectomy. Within Veterans Affair (VA), black women with uterine fibroids are less likely to receive a minimally invasive hysterectomy than white women.

Objective:

To quantify the contributions of patient, facility, temporal and geographic factors to VA black-white disparity in minimally invasive hysterectomy.

Research Design:

A cross-sectional study.

Subjects:

Veterans with fibroids and hysterectomy performed in VA between October 1, 2012 and September 30, 2015.

Measures:

Hysterectomy mode was defined using ICD-9 codes as minimally invasive (laparoscopic, vaginal, or robotic-assisted) versus abdominal. The authors estimated a logistic regression model with minimally invasive hysterectomy modeled as a function of 4 sets of factors: sociodemographic characteristics other than race, health risk factors, facility, and temporal and geographic factors. Using decomposition techniques, systematically substituting each white woman’s characteristics for each black woman’s characteristics, then recalculating the predicted probability of minimally invasive hysterectomy for black women for each possible combination of factors, we quantified the contribution of each set of factors to observed disparities in minimally invasive hysterectomy.

Results:

Among 1255 veterans with fibroids who had a hysterectomy at a VA, 61% of black women and 39% of white women had an abdominal hysterectomy. Our models indicated there were 99 excess abdominal hysterectomies among black women. The majority (n=77) of excess abdominal hysterectomies were unexplained by measured sociodemographic factors beyond race, health risk factors, facility, and temporal or geographic trends.

Conclusion:

Closer examination of the equity of VA gynecology care and ways in which the VA can work to ensure equitable care for all women veterans is necessary.
The Effects of the Affordable Care Act on Health Care Access and Utilization Among Asian American Subgroups
Authors: Park Sungchul , Stimpson Jim P. , Pintor Jessie K. , Roby Dylan H. , McKenna Ryan M. , Chen Jie , Ortega Alexander N.
Published: September 2019

Objectives:

We examined changes in health care access and utilization associated with the Patient Protection and Affordable Care Act (ACA) for different Asian American subgroups relative to non-Latino whites (whites).

Research Design:

Using 2003–2017 California Health Interview Survey data, we examined changes in 4 health care access measures and 2 utilization measures among whites and 7 Asian American subgroups. We estimated the unadjusted and adjusted percentage point changes on the absolute scale from the pre-ACA to post-ACA periods. Adjusted estimates were obtained from multivariable logistic regression models that controlled for predisposing, enabling, and need factors. We also estimated the pre-ACA to post-ACA changes between whites and Asian American subgroups using a difference-in-difference approach.

Results:

After the ACA was implemented, uninsurance decreased among all Asian American subgroups, but improvements in disparities relative to whites in these measures were limited. In particular, Koreans had the largest absolute reduction in uninsurance (−16.8 percentage points) and were the only subgroup with a significant reduction in terms of disparities relative to whites (−10.1 percentage points). However, little or no improvement was observed in the other 3 access measures (having a usual source of care, delayed medical care in past year, or delayed prescription drug use in past year) and 2 utilization measures (having a physician visit or emergency department visit in past year).

Conclusions:

Despite coverage gains among Asian American subgroups, especially Koreans, disparities in access and utilization persisted across all Asian American subgroups.
Who Will be the Costliest Patients? Using Recent Claims to Predict Expensive Surgical Episodes
Authors: Chhabra Karan R. , Nuliyalu Ushapoorna , Dimick Justin B. , Nathan Hari
Published: September 2019

Introduction:

Surgery accounts for almost half of inpatient spending, much of which is concentrated in a subset of high-cost patients. To study the effects of surgeon and hospital characteristics on surgical expenditures, a way to adjust for patient characteristics is essential.

Design:

Using 100% Medicare claims data, we identified patients aged 66–99 undergoing elective inpatient surgery (coronary artery bypass grafting, colectomy, and total hip/knee replacement) in 2014. We calculated price-standardized Medicare payments for the surgical episode from admission through 30 days after discharge (episode payments). On the basis of predictor variables from 2013, that is, Elixhauser comorbidities, hierarchical condition categories, Medicare’s Chronic Conditions Warehouse (CCW), and total spending, we constructed models to predict the costs of surgical episodes in 2014.

Results:

All sources of comorbidity data performed well in predicting the costliest cases (Spearman correlation 0.86–0.98). Models on the basis of hierarchical condition categories had slightly superior performance. The costliest quintile of patients as predicted by the model captured 35%–45% of the patients in each procedure’s actual costliest quintile. For example, in hip replacement, 44% of the costliest quintile was predicted by the model’s costliest quintile.

Conclusions:

A significant proportion of surgical spending can be predicted using patient factors on the basis of readily available claims data. By adjusting for patient factors, this will facilitate future research on unwarranted variation in episode payments driven by surgeons, hospitals, or other market forces.
Is Perceived Stigma in Clinical Settings Associated With Poor Health Status Among New York City’s Residents of Color?
Authors: De Prabal , Pozen Alexis , Budhwani Henna
Published: September 2019

Objectives:

Our objectives were to assess rates of perceived stigma in health care (clinical) settings reported by racially diverse New York City residents and to examine if this perceived stigma is associated with poorer physical and mental health outcomes.

Methods:

We analyzed data from the 2016 New York City Community Health Survey. We applied bivariable and multivariable methods to assess rates of perceived stigma, and perceived stigma’s statistical relationship with health care access, physical health status, and mental health status controlling for sociodemographics and health insurance status.

Results:

Perceived stigma was associated with poorer health care access [odds ratio (OR)=7.07, confidence interval (CI)=5.32–9.41), depression (OR=3.80, CI=2.66–5.43), diabetes (OR=1.86, CI=1.36–2.54), and poor overall general health (OR=0.43, CI=0.33–0.57). Hispanic respondents reported the highest rate of perceived stigma among racial and ethnic minority groups (mean=0.07, CI=0.05–0.08).

Conclusions:

We found that perceived stigma in health care settings was a potential barrier to good health. Prior studies have illustrated that negative health outcomes are common for patients who avoid or delay care; thus, the unfortunate conclusion is that even in a diverse, heterogeneous community, stigma persists and may negatively affect well-being. Therefore, eliminating stigma in clinical settings should be a top priority for health care providers and public health professionals seeking to improve health equity.
HRSA-funded Health Centers Are an Important Source of Care and Reduce Unmet Needs in Primary Care Services
Authors: Pourat Nadereh , Chen Xiao , Lee Christopher , Zhou Weihao , Daniel Marlon , Hoang Hank , Sharma Ravi , Sim Hwa , Sripipatana Alek , Nair Suma
Published: September 2019

Background:

Evidence indicates the unmet need for primary care services including medical, mental health, and dental care is greater among uninsured and Medicaid beneficiaries than privately insured individuals, many of whom use Health Resources and Services Administration–funded health centers (HRSA HCs).

Objective:

We examined differences in rates of unmet need between low-income uninsured and Medicaid patients of HRSA HCs and safety-net clinics in general or private physicians.

Research Design:

We used logistic regression models to compare the predicted probabilities of unmet need for uninsured and Medicaid individuals whose usual source of care is HRSA HCs versus clinics in general or private physicians.

Sample:

We used a nationally representative survey of low income, adult patients who identified HRSA HCs as their usual source of care. We used the National Health Interview Survey to independently identify low-income individuals whose usual source of care was clinics (National Health Interview Survey clinics) or physicians (National Health Interview Survey physicians) in the general population.

Measures:

Dependent variables were unmet need and delay in medical care, and unmet need for prescription medications, mental health, and dental care. The primary independent variable of interest was the usual source of care. We controlled for potential confounders.

Results:

We found the probability of unmet need for medical and dental care to be lower among HRSA HC patients than individuals whose usual source of care were not HRSA HCs.

Conclusions:

HRSA HC patients have lower probabilities of unmet need for medical and dental care. This is likely because HRSA HCs provide accessible, affordable, and comprehensive primary care services. Expanding capacity of these organizations will help reduce unmet need and its consequences.
Racial/Ethnic Disparities in Pain Treatment
Authors: Kennel Jamie , Withers Elizabeth , Parsons Nate , Woo Hyeyoung
Published: September 2019

Background:

Despite the critical role that Emergency Medical Services (EMS) provides in the health care system, racial/ethnic treatment disparities in EMS remain relatively unexamined.

Objective:

To investigate racial/ethnic treatment disparities in pain assessment and pain medication administration in EMS.

Research Design:

A retrospective analysis was performed on 25,732 EMS encounters from 2015 to 2017 recorded in the Oregon Emergency Medical Services Information System using multivariate logistic regression models to examine the role of patient race/ethnicity in pain assessment and pain medication administration among patients with a traumatic injury.

Results:

Hispanic and Asian patients were less likely to receive a pain assessment procedure and all racial/ethnic patients were less likely to receive pain medications compared with white patients. In particular, regarding the adjusted likelihood of receiving a pain assessment procedure, Hispanic patients were 21% less likely [95% confidence interval (CI), 10%–30%; P<0.001], Asian patients were 31% less likely (95% CI, 16%–43%; P<0.001) when compared with white patients. Regarding the adjusted likelihood of receiving any pain medications, black patients were 32% less likely (95% CI, 21%–42%; P<0.001), Hispanic patients were 21% less likely (95% CI, 7%–32%; P<0.01), and Asian patients were 24% less likely (95% CI, 1%–41%; P<0.05) when compared with white patients.

Conclusions:

Racial/ethnic minorities were more likely to experience disadvantages in EMS treatment in Oregon. Hispanic and Asian patients who requested EMS services in Oregon for traumatic injuries were less likely to have their pain assessed and all racial/ethnicity patients were less likely to be treated with pain medications when compared with white patients.
Patient Possession of Excess Medication Supply in the VA
Authors: Linsky Amy , Stolzmann Kelly , Simon Steven R. , Cabral Howard , Rosen Amy K.
Published: September 2019

Background:

Medication overlap leading to medication excess is a form of therapeutic duplication, itself a type of potentially inappropriate prescribing.

Objective:

To determine the prevalence of potential medication excess in the Veterans Health Administration (VHA) and identify associated medication-level, patient-level, and system-level factors.

Research Design:

A retrospective database study.

Subjects:

All veterans who received ≥1 prescription dispensed by a VHA pharmacy in fiscal year 2014.

Measures:

The primary outcome of “medication excess” was defined for each patient as the number of excess days’ worth of medications for all overlap episodes (concurrently dispensed medications with the same name for >10 d). Predictors included medication-level, patient-level, and system-level factors. Multivariable negative binomial regression analyses estimated the rate ratio of each predictor with medication excess.

Results:

Among 4,687,453 veterans, 64% had ≥1 medication overlap episodes. Patients were prescribed a median of 7 [interquartile range (IQR), 3–12] unique medications, had a median of 2 (IQR, 0–5) overlap episodes, and a median of 27 (IQR, 0–96) days of medication excess. In adjusted regression models, factors associated with greater risk of medication excess included having more comorbidities, multiple prescribers, a combination of filling locations (consolidated mail-order pharmacy vs. local pharmacy), and multiple prescription durations (≥90 d vs. less).

Conclusions:

Medication excess was high among VHA users, with nearly two-thirds of patients experiencing at least 1 duplicative medication. As systems such as mail-order pharmacies and 90-day supply are increasingly implemented to reduce costs and improve medication adherence, it is important to recognize the potential for systems-level inefficiencies and potentially inappropriate prescribing.
Current state of nonengrafting donor leukocyte infusion (focus on microtransplantation for acute myeloid leukemia)
Authors: Krakow Elizabeth F.
Published: September 2019

Purpose of review

Microtransplantation (or micro-stem cell transplantation, MST) is one permutation of alloreactive immunotherapy increasingly studied in clinical trials. It is most commonly applied to patients with myeloid malignancies who are not suitable candidates for allogeneic hematopoietic cell transplantation. This review highlights the past 2 years of work on stem/progenitor cell products in the field of nonengrafting donor leukocyte infusion (NE-DLI), with a focus on applications of MST in acute myeloid leukemia (AML).

Recent findings

Assessing the utility of MST is hampered by lack of randomized controlled trials and by variability in donor selection algorithms, treatment timing, and unknown factors. The inherent complexity of the bidirectional alloreactive reactions, implicating many cell types, makes it challenging to move beyond correlative, population-level biology toward mechanistic explanations for MST's actions in any given patient–donor pair. Yet there are indicators that by stimulating a recipient-vs.-tumor effect, MST might substantially improve complete remission rates in AML and that it might find a role in postremission therapy.

The mechanistic underpinnings of MST are gradually being disentangled and its clinical development remains in early stages.
The cause and pathogenesis of hemolytic transfusion reactions in sickle-cell disease
Authors: Pirenne France
Published: September 2019

Purpose of review

The current review aims to summarize the epidemiology, cause, pathophysiology, and management of hemolytic transfusion reactions in sickle-cell disease (SCD).

Recent findings

Patients undergoing occasional, isolated transfusions have been shown to have a higher risk of developing this condition. Despite the identification of well known risk factors, including alloimmunization, the pathophysiology of this syndrome remains unclear, as very severe forms with hyperhemolysis may develop in the absence of detectable antibodies, or with antibodies that are not considered to be clinically significant. Complement plays a crucial role in this reaction, particularly in cases of intravascular hemolysis. Complement triggers the reaction, but it also amplifies the inflammatory response and aggravates tissue damage. Free heme and hemoglobin are released and interact with complement, causing tissue damage.

Hemolytic transfusion reactions are the most feared complications of blood transfusion in patients with SCD. This reaction is underdiagnosed because it mimics a vaso-occlusive crisis. Alloimmunization against red blood cell antigens is known to be a major trigger of this reaction, but abnormal complement activation and the underlying condition in patients with chronic hemolysis, may amplify the reaction. There is an urgent need to develop evidence-based approaches for preventing and treating this reaction.
The extended understanding of chronic granulomatous disease
Authors: Lacerda-Pontes Raissa , Gomes Lillian Nunes , Albuquerque Rafael Sales de , Soeiro-Pereira Paulo Vítor , Condino-Neto Antonio
Published: September 2019

Purpose of review

We briefly address the advances in genetics, pathophysiology, and phenotypes of chronic granulomatous disease (CGD). This is one of the most studied primary immunodeficiencies, which comprise mutations in genes encoding the different subunits of the NADPH oxidase system. Those mutations lead to defective reactive oxygen species production, and consequently a failure to eliminate pathogens.

Recent findings

Patients with CGD are susceptible to fungal, bacterial, and parasitic infections. Other symptoms, as systemic adverse effects to BCG vaccine and hyperinflammation, are also important clinical conditions in this disease. This wide-ranging clinical spectrum of CGD comes from heterogeneity of mutations, X-linked-CGD or autosomal recessive inheritance, and diverse environmental pressure factors. Early accurate diagnosis and prompt treatment are necessary to diminish the consequences of the disease. The most used diagnostic tests are dihydrorhodamine, cytochrome c reduction, and luminol-enhanced chemiluminescence assay.

The determination of mutations is essential for diagnosis confirmation and genetic counseling. CGD treatment usually includes prophylactic antibiotics and antifungals. Prophylactic recombinant human interferon-γ, immunosuppressors or immune modulators may be, respectively, indicated for preventing infections or inflammatory manifestations. Hematopoietic stem cell transplantation and gene therapy are currently the available options for curative treatment of CGD.
Hereditary angioedema in children: a review and update
Authors: Pancholy Neha , Craig Timothy
Published: September 2019

Purpose of review

Hereditary angioedema (HAE) most often presents in the first two decades of life. Despite these patients often see multiple doctors and go many years before confirmation of the diagnosis. the impact on quality of life, productivity and risk of anxiety, depression, and posttraumatic stress emphasizes the need for early diagnosis and appropriate treatment.

Recent findings

Over the past decade, therapy in the USA has emerged from fresh-frozen plasma and androgens to more than seven medications that are specific for bradykinin-induced disease. During the same time, treatment has evolved from intravenous to subcutaneous and the future will be a focus on oral therapy.

Much optimism exists that patients with HAE will live a life with minimal disease and impact on their quality of life making it even more important to diagnose children at an early age.
Personalized Nutrition
Authors: Bashiardes Stavros , Abdeen Suhaib K. , Elinav Eran
Published: September 2019

The human genome has been proposed to contribute to interpersonal variability in the way we respond to nutritional intake. However, personalized diets solely based on gene‐nutrient interactions have not lived up to their expectations to date. Advances in microbiome research have indicated that a science‐based generation of a personalized diet based on a combination of clinical and microbial features may constitute a promising new approach enabling accurate prediction of dietary responses. In addition, scientific advances in our understanding of defined dietary components and their effects on human physiology led to the incorporation and testing of defined diets as preventive and treatment approaches for diseases, such as epilepsy, ulcerative colitis, Crohn disease, and type 1 diabetes mellitus. Additionally, exciting new studies show that tailored diet regiments have the potential to modulate pharmaceutical treatment efficacy in cancer treatment. Overall, the true therapeutic potential of nutritional interventions is coming to light but is also facing substantial challenges in understanding mechanisms of activity, optimization of dietary interventions for specific human subpopulations, and elucidation of adverse effects potentially stemming from some dietary components in a number of individuals.
Abnormal 24‐hour pH‐impedance Testing Does Not Predict Reduced Quality of Life in Children With Reflux Symptoms
Authors: Mahoney Lisa B. , Mitchell Paul D. , Fishman Eliza , Lurie Margot , Rosen Rachel
Published: September 2019

Objectives:

Symptoms of gastroesophageal reflux (GER) have been associated with reduced health‐related quality of life (QOL) in children, though it is unclear whether reflux burden on objective diagnostic testing, such as 24‐hour multichannel intraluminal impedance with pH (pH‐MII) is associated with impaired QOL in children. Our aim was to identify predictors of QOL impairment based on the results of esophageal reflux testing.

Methods:

In this prospective, cross‐sectional study of children undergoing pH‐MII and esophagogastroduodenoscopy (EGD) for evaluation of suspected gastroesophageal reflux disease, we collected validated questionnaires (Pediatric Gastroesophageal Symptom and Quality of Life Questionnaire [PGSQ], Pediatric Quality of Life Inventory 4.0 [PedsQL] and PedsQL Gastrointestinal Symptoms Module [GI PedsQL]) to determine the relationship between objective measures of GER, patient‐reported symptoms and QOL outcomes.

Results:

Of the 82 subjects, 38% of children had an abnormal pH‐MII study. There were no significant differences in QOL scores on any questionnaire between patients with normal and abnormal pH‐MII studies (P > 0.11). There was no correlation between individual pH‐MII parameters and QOL scores. Subjects with gross esophagitis on EGD reported significantly worse QOL with lower total PedsQL (P = 0.002) and GI PedsQL (P = 0.03) scores. Microscopic esophagitis was not associated with differences in QOL scores (P > 0.32).

Conclusions:

There was no relationship between abnormalities on pH‐MII testing and reduced QOL in children. These findings highlight the importance of considering other diagnoses beyond GERD as they may be significant drivers for QOL impairment.
Imaging Findings of Klippel-Trenaunay Syndrome
Authors: Abdel Razek Ahmed Abdel Khalek
Published: September 2019

We aim to review the imaging findings of Klippel-Trenaunay syndrome. This disorder characterized clinically by a triad of capillary malformations manifesting as a port-wine stain, venous varicosities typically along the lateral aspect of the lower extremities, and bone and/or soft tissue hypertrophy. Imaging of extremities shows unilateral venous varicosities, persistent embryonic veins, anomalous of the superficial and deep venous system, low-flow venolymphatic malformations, and bony and soft tissue hypertrophy. Other findings include neurospinal as cavernoma, aneurysm, and hemimegalencephaly, pulmonary as pulmonary thromboembolism and pulmonary hypertension and visceral as gastrointestinal and genitourinary vascular anomalies. Imaging may detect associated lesions and differentiate from simulating lesions.
Contrast Material Injection Protocol With the Dose Determined According to Lean Body Weight at Hepatic Dynamic Computed Tomography: Comparison Among Patients With Different Body Mass Indices
Authors: Matsumoto Yoriaki , Masuda Takanori , Sato Tomoyasu , Arataki Keiko , Nakamura Yuko , Tatsugami Fuminari , Awai Kazuo
Published: September 2019

Objective

The objective of this study was to compare enhancement of the aorta and liver on hepatic dynamic computed tomography scans acquired with contrast material doses based on the lean body weight (LBW) or the total body weight (TBW).

Methods

We randomly divided 529 patients (279 men, 250 women; median age, 66 years) scheduled for hepatic dynamic computed tomography into 2 groups. The LBW patients (n = 278) were injected with 679 mg iodine/kg (men) or 762 mg iodine/kg (women). The TBW group (n = 251) was injected with 600 mg iodine/kg TBW. Each group was subdivided into the 3 classes based on the body mass index (BMI; low, normal, high). Aortic enhancement during the hepatic arterial phase and hepatic enhancement during the portal venous phase was compared. The aortic and hepatic equivalence margins were 100 and 20 Hounsfield units, respectively.

Results

Comparison of the median iodine dose in patients with a normal or high BMI showed that it was significantly lower under the LBW protocol than the TBW protocol (558.2 and 507.0 mg iodine/kg, P < 0.001, respectively). However, in patients with a low BMI, the LBW protocol delivered a significantly higher dose than the TBW protocol (620.7 vs 600.0 mg iodine/kg, P < 0.001). The 95% confidence interval for the difference in aortic and hepatic enhancement between the 2 protocols was within the range of the predetermined equivalence margins in all BMI subgroups.

Conclusions

Contrast enhancement was equivalent under both protocols. The LBW protocol can avoid iodine overdosing, especially in patients with a high BMI.
Carotid Artery Imaging Is More Strongly Associated With the 10-Year Atherosclerotic Cardiovascular Disease Score Than Coronary Artery Imaging
Authors: Li Ying , Zhu Guangming , Ding Victoria , Jiang Bin , Boothroyd Derek , Rodriguez Fatima , Fleischmann Dominik , Desai Manisha , Saloner David , Saba Luca , Hom Jason , Wintermark Max
Published: September 2019

Purpose

The aim of this study was to compare coronary and carotid artery imaging and determine which one shows the strongest association with atherosclerotic cardiovascular disease (ASCVD) score.

Patients and Methods

Two separate series patients who underwent either coronary computed tomography angiography (CTA) or carotid CTA were included. We recorded the ASCVD scores and assessed the CTA imaging. Two thirds were used to build predictive models, and the remaining one third generated predicted ASCVD scores. The Bland-Altman analysis analyzed the concordance.

Results

A total of 110 patients were included in each group. There was no significant difference between clinical characteristics. Three imaging variables were included in the carotid model. Two coronary models (presence of calcium or Agatston score) were created. The bias between true and predicted ASCVD scores was 0.37 ± 5.72% on the carotid model, and 2.07 ± 7.18% and 2.47 ± 7.82% on coronary artery models, respectively.

Conclusions

Both carotid and coronary artery imaging features can predict ASCVD score. The carotid artery was more associated to the ASCVD score than the coronary artery.
Cinematic Rendering With Positive Oral Contrast: Virtual Fluoroscopy
Authors: Rowe Steven P. , Chu Linda C. , Fishman Elliot K.
Published: September 2019

Recently, a novel 3-dimensional visualization methodology for volumetric computed tomography data has become available. This method, known as cinematic rendering, uses an advanced lighting model to create photorealistic images from standard computed tomography acquisition data composed of isotropic voxels. We have observed that cinematic rendering visualizations in which patients have been administered dense, positive oral contrast do not have any substantive visual artifacts and can be used to demonstrate bowel pathology to advantage (ie, “virtual fluoroscopy”). In this technical note, we describe our acquisition and visualization parameters, and we also include demonstrative examples.
Evaluation of Intravoxel Incoherent Motion Diffusion-Weighted Magnetic Resonance Imaging for Detection of Bowel Inflammation in Patients With Crohn Disease
Authors: Yang Hai-Jing , Xi Yu-Ling , Guan Xue-Ni , Xie Qian , Rong Lan , Liang Zong-Hui
Published: September 2019

Objectives

This study aimed to evaluate the feasibility of intravoxel incoherent motion diffusion-weighted magnetic resonance imaging (DW-MRI) in detecting bowel inflammation in patients with Crohn disease (CD).

Methods

Sixteen patients who underwent intravoxel incoherent motion DW-MRI for CD and colonoscopy were recruited. Seventy-nine bowel segments were selected, and their mean D, D*, f, and apparent diffusion coefficient (ADC) values were measured. The receiver operating characteristic curve was performed to distinguish inflamed from normal bowel.

Results

The mean D, D*, f, and ADC values of inflamed bowel were significantly lower than those of normal bowel (P < 0.05). The area under the receiver operating characteristic curve for f (0.906) and ADC values (0.924) was greater than that for D (0.709) or D* values (0.686) for differentiating inflamed bowel from normal bowel (P < 0.05).

Conclusions

Intravoxel incoherent motion DW-MRI is a feasible technique for detecting inflammation in CD patients. The ADC and f values have more potential than the D and D* values.
Image Quality and Reliability of a Novel Dark-Blood Late Gadolinium Enhancement Sequence in Ischemic Cardiomyopathy
Authors: Muscogiuri Giuseppe , Gatti Marco , Dell’Aversana Serena , Guaricci Andrea I. , Guglielmo Marco , Baggiano Andrea , Andreini Daniele , Mushtaq Saima , Conte Edoardo , Annoni Andrea , Formenti Alberto , Mancini Maria E. , Gripari Paola , Janich Martin A. , Rabbat Mark G. , Pepi Mauro , Pontone Gianluca
Published: September 2019

Purpose:

The aim of this study was to assess the reliability of a 2D dark-blood phase-sensitive late gadolinium enhancement sequence (2D-DBPSLGE) compared with 2D phase-sensitive inversion recovery late gadolinium enhancement sequence (2D-BBPSLGE) in patients with ischemic cardiomyopathy (ICM).

Materials and Methods:

A total of 73 patients with a clinical history of ICM were prospectively enrolled. The following endpoints were evaluated: (a) comparison of image quality between 2D-BBPSLGE and 2D-DBPSLGE for differentiation between blood pool-late gadolinium enhancement (LGE), remote myocardium-LGE, and blood pool-remote myocardium; (b) diagnostic accuracy of 2D-DBPSLGE compared with gold standard 2D-BBPSLGE for the evaluation of infarcted segments; (c) diagnostic accuracy of 2D-DBPSLGE for the evaluation of microvascular obstruction (MVO); (d) comparison of transmurality index between 2D-BBPSLGE and 2D-DBPSLGE; (e) comparison of papillary muscle hyperenhancement between 2D-BBPSLGE and 2D-DBPSLGE; inter-reader agreement for depiction of hyperenhanced segments in both LGE sequences. Data were analyzed using paired t test, Wilcoxon test, and McNemar test, and η2 coefficient and intercorrelation coefficient (ICC).

Results:

Image quality was superior for 2D-DBPSLGE for differentiation of blood pool-LGE (P<0.001). 2D-DBPSLGE, compared with 2D-BBPSLGE, showed a sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 96.93%, 99.89%, 99.71%, 98.78, and 99.04%, respectively. Concerning MVO detection, 2D-DBPSLGE showed a sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 66.67%, 100.00%, 100.00%, 80.95%, and 86.21%, respectively. 2D-DBPSLGE underestimated the transmurality (P=0.007) and identified papillary muscle hyperenhancement (P<0.001). Both LGE sequences showed comparable interobserver agreement for the evaluation of infarcted areas (2D-BBPSLGE: ICC 0.99;2D-DBPSLGE: ICC 0.99).

Conclusions:

Compared with 2D-BBPSLGE, 2D-DBPSLGE sequences provide better differentiation between LGE and blood-pool, while underestimating LGE trasmurality and the presence of MVO.
Dealing with prognostic uncertainty: the role of prognostic models and websites for patients with advanced cancer
Authors: Hui David , Maxwell John P. , Paiva Carlos Eduardo
Published: September 2019

Purpose of review

To provide an updated overview of prognostic models in advanced cancer and highlight the role of prognostic calculators.

Recent findings

In the advanced cancer setting, many important healthcare decisions are driven by a patient's prognosis. However, there is much uncertainty in formulating prognosis, particularly in the era of novel cancer therapeutics. Multiple prognostic models have been validated for patients seen by palliative care and have a life expectancy of a few months or less, such as the Palliative Performance Scale, Palliative Prognostic Score, Palliative Prognostic Index, Objective Prognostic Score, and Prognosis in Palliative Care Study Predictor. However, these models are seldom used in clinical practice because of challenges related to limited accuracy when applied individually and difficulties with model selection, computation, and interpretation. Online prognostic calculators emerge as tools to facilitate knowledge translation by overcoming the above challenges. For example, www.predictsurvival.com provides the output for seven prognostic indexes simultaneously based on 11 variables.

Prognostic models and prognostic websites are currently available to augment prognostication in the advanced cancer setting. Further studies are needed to examine their impact on prognostic accuracy, confidence, and clinical outcomes.
The value of the ethnographic approach to research issues in palliative care
Authors: Reigada Carla , Sapeta Paula , Centeno Carlos
Published: September 2019

Purpose of review

Qualitative research in the field of palliative care allows for a crucial study of the final stage of life from a social point of view and cultural perspective. This review evaluates the advantages and challenges of applying an ethnographic approach to palliative care research.

Recent findings

Thirteen ethnographic articles on organization or quality of care, decision-making, delirium, death, and the process of dying, were reviewed. Most studies use interviews, participant observation, and field notes as their primary data collection techniques. In ethnographic research, cultural issues, relationships and interactions of a group, the meanings and perceptions of the participants, the communication process, and the use of language in a particular and natural context were analyzed. Data collection and information analysis took an average of 14 months in the included studies.

The ethnographic method, applied with rigor, is valuable in the analysis of a real phenomenon if the particular context in which the study developed is well defined. With an ethnographic approach, researchers can uncover cultural nuances that evidence different realities.
Measuring the success of interventions for caregivers: a focussed systematic review
Authors: Drummond Maria , Johnston Bridget , Quinn Terence J.
Published: September 2019

Purpose of review

The selection and application of outcome measures are fundamental steps in the research process because they inform decisions around intervention efficacy. We aimed to describe the outcomes used in trials of supportive interventions for adult caregivers of people with three exemplar life-limiting conditions: heart failure, dementia or stroke.

Recent findings

We performed a focussed review of 134 published trials that included interventions designed to improve caregivers’ health and wellbeing and/or ability to function in their caring role. We extracted and categorized all caregiver outcomes described in the studies. We identified inconsistency in the outcomes measured; frequent use of bespoke and adapted tools (29% of outcomes were bespoke), and a lack of clarity in outcome priorities (the mean number of outcomes per trial was four [range: 1–11]). Outcome scales that purport to measure the psychological impact of the caring role were the most popular tools in all three caregiver groups.

Outcomes used in trials related to adult caregivers are characterized by inconsistencies in outcome measure selection and assessment. This heterogeneity complicates comparisons of treatments and attempts to pool data.