bluuebunny/crossref_metadata_2025 huggingface dataset:
Cricoid Pressure Controversies
Authors: Salem M. Ramez , Khorasani Arjang , Zeidan Ahed , Crystal George J.
Published: December 2016

Since cricoid pressure was introduced into clinical practice, controversial issues have arisen, including necessity, effectiveness in preventing aspiration, quantifying the cricoid force, and its reliability in certain clinical entities and in the presence of gastric tubes. Cricoid pressure–associated complications have also been alleged, such as airway obstruction leading to interference with manual ventilation, laryngeal visualization, tracheal intubation, placement of supraglottic devices, and relaxation of the lower esophageal sphincter. This review synthesizes available information to identify, address, and attempt to resolve the controversies related to cricoid pressure. The effective use of cricoid pressure requires that the applied force is sufficient to occlude the esophageal entrance while avoiding airway-related complications. Most of these complications are caused by excessive or inadequate force or by misapplication of cricoid pressure. Because a simple-to-use and reliable cricoid pressure device is not commercially available, regular training of personnel, using technology-enhanced cricoid pressure simulation, is required. The current status of cricoid pressure and objectives for future cricoid pressure–related research are also discussed.
Parental Perception of Risk Associated With Their Premature Infant
Authors: Fletcher Laura , Pham Tammy , Papaioannou Helen , Spinazzola Regina , Milanaik Ruth , Thibeau Shelley
Published: December 2016

Background:

Preterm birth has been linked to increased parental stress, depression, and anxiety. Although the rate of neonatal morbidity and mortality decreases with increasing gestational age, recent research has revealed that there is no threshold age for risk or parental concern.

Purpose:

This study examines parental concern about medical and developmental outcomes of their premature infant.

Methods:

Parents of 60 premature infants were surveyed in a follow-up clinic regarding their level of concern about 11 morbidities and their child's gestation-adjusted age; these were compared with the infant's inpatient chart. “Concern scores” were tallied and compared across gestational age groups and knowledge of gestation-adjusted age using Chi-square tests of independence.

Findings:

Many parents reported concerns about morbidities that were unsupported by their child's diagnoses. Across parents of extremely, very, and moderate-late preterm children, the mean concern scores were 13.9, 15.7, and 19.7, respectively. Overall, 62% of parents incorrectly reported the gestation-adjusted age of their child. Parents who were correct were significantly more likely to correctly anticipate abnormal developmental patterns (70%) and growth patterns (65%) than those who were incorrect (33% and 31%, respectively).

Implications for Research:

Future research should focus on whether NICU graduate parental stress levels are directly linked to the severity of their child's condition, and how physicians can help decrease NICU graduate parental stress.

Implications for Practice:

Parental anxiety regarding all gestational age neonatal intensive care unit infant outcomes can be decreased by a thorough explanation of gestation-adjusted age and a discussion of expected prematurity-related issues.
Effects of Stimulus Polarity and Artifact Reduction Method on the Electrically Evoked Compound Action Potential
Authors: Hughes Michelle L. , Goehring Jenny L. , Baudhuin Jacquelyn L.
Published: December 2016

Objective:

Previous research from our laboratory comparing electrically evoked compound action potential (ECAP) artifact reduction methods has shown larger amplitudes and lower thresholds with cathodic-leading forward masking (CathFM) than with alternating polarity (AltPol). One interpretation of this result is that the anodic-leading phase used with AltPol elicits a less excitatory response (in contrast to results from recent studies with humans), which when averaged with responses to cathodic-leading stimuli, results in smaller amplitudes. Another interpretation is that the latencies of the responses to anodic- and cathodic-leading pulses differ, which when averaged together, result in smaller amplitudes than for either polarity alone due to temporal smearing. The purpose of this study was to separate the effects of stimulus polarity and artifact reduction method to determine the relative effects of each.

Design:

This study used a within-subjects design. ECAP growth functions were obtained using CathFM, anodic-leading forward masking (AnodFM), and AltPol for 23 CI recipients (N = 13 Cochlear and N = 10 Advanced Bionics). N1 latency, amplitude, slope of the amplitude growth function, and threshold were compared across methods. Data were analyzed separately for each manufacturer due to inherent differences between devices.

Results:

N1 latencies were significantly shorter for AnodFM than for CathFM and AltPol for both Cochlear and Advanced Bionics participants. Amplitudes were larger for AnodFM than for either CathFM or AltPol for Cochlear recipients; amplitude was not significantly different across methods for Advanced Bionics recipients. Slopes were shallowest for CathFM for Cochlear subjects, but were not significantly different among methods for Advanced Bionics subjects. Thresholds with AltPol were significantly higher than both FM methods for Cochlear recipients; there was no difference in threshold across methods for the Advanced Bionics recipients.

Conclusions:

For Cochlear devices, the smaller amplitudes and higher thresholds observed for AltPol seem to be the result of latency differences between polarities. These results suggest that AltPol is not ideal for managing stimulus artifact for ECAP recordings. For the Advanced Bionics group, there were no significant differences among methods for amplitude, slope, or threshold, which suggests that polarity and artifact reduction method have little influence in these devices. We postulate that polarity effects are minimized for symmetrical biphasic pulses that lack an interphase gap, such as those used with Advanced Bionics devices; however, this requires further investigation.
Effect of Context and Hearing Loss on Time-Gated Word Recognition in Children
Authors: Lewis Dawna , Kopun Judy , McCreery Ryan , Brennan Marc , Nishi Kanae , Cordrey Evan , Stelmachowicz Pat , Moeller Mary Pat
Published: December 2016

Objectives:

The purpose of this study was to examine word recognition in children who are hard of hearing (CHH) and children with normal hearing (CNH) in response to time-gated words presented in high- versus low-predictability sentences (HP, LP), where semantic cues were manipulated. Findings inform our understanding of how CHH combine cognitive-linguistic and acoustic-phonetic cues to support spoken word recognition. It was hypothesized that both groups of children would be able to make use of linguistic cues provided by HP sentences to support word recognition. CHH were expected to require greater acoustic information (more gates) than CNH to correctly identify words in the LP condition. In addition, it was hypothesized that error patterns would differ across groups.

Design:

Sixteen CHH with mild to moderate hearing loss and 16 age-matched CNH participated (5 to 12 years). Test stimuli included 15 LP and 15 HP age-appropriate sentences. The final word of each sentence was divided into segments and recombined with the sentence frame to create series of sentences in which the final word was progressively longer by the gated increments. Stimuli were presented monaurally through headphones and children were asked to identify the target word at each successive gate. They also were asked to rate their confidence in their word choice using a five- or three-point scale. For CHH, the signals were processed through a hearing aid simulator. Standardized language measures were used to assess the contribution of linguistic skills.

Results:

Analysis of language measures revealed that the CNH and CHH performed within the average range on language abilities. Both groups correctly recognized a significantly higher percentage of words in the HP condition than in the LP condition. Although CHH performed comparably with CNH in terms of successfully recognizing the majority of words, differences were observed in the amount of acoustic-phonetic information needed to achieve accurate word recognition. CHH needed more gates than CNH to identify words in the LP condition. CNH were significantly lower in rating their confidence in the LP condition than in the HP condition. CHH, however, were not significantly different in confidence between the conditions. Error patterns for incorrect word responses across gates and predictability varied depending on hearing status.

Conclusions:

The results of this study suggest that CHH with age-appropriate language abilities took advantage of context cues in the HP sentences to guide word recognition in a manner similar to CNH. However, in the LP condition, they required more acoustic information (more gates) than CNH for word recognition. Differences in the structure of incorrect word responses and their nomination patterns across gates for CHH compared with their peers with NH suggest variations in how these groups use limited acoustic information to select word candidates.
Prevalence, Incidence Proportion, and Heritability for Tinnitus: A Longitudinal Twin Study
Authors: Bogo Renata , Farah Ahmed , Karlsson Kjell K. , Pedersen Nancy L. , Svartengren Magnus , Skjönsberg Åsa
Published: December 2016

Objectives:

The purpose of this longitudinal twin study was to explore the effect of tinnitus on hearing thresholds and threshold shifts over two decades and to investigate the genetic contribution to tinnitus in a male twin cohort (n = 1114 at baseline and 583 at follow-up). The hypothesis was that participants with faster hearing deterioration had a higher risk for developing tinnitus and there is an underlying role of genetic influences on tinnitus.

Design:

Male mono- and dizygotic twin pairs, born between 1914 and 1958 were included. Mixed models were used for comparison of hearing threshold shifts, adjusted for age. A co-twin comparison was made within pairs discordant for tinnitus. The relative influence of genetic and environmental factors was estimated by genetic modeling.

Results:

The overall prevalence of tinnitus was 13.5% at baseline ( JOURNAL/earher/04.03/00003446-201705000-00003/inline-graphic1/v/2024-02-09T190736Z/r/image-tiff age 50) and 34.4% at follow-up ( JOURNAL/earher/04.03/00003446-201705000-00003/inline-graphic2/v/2024-02-09T190736Z/r/image-tiff age 67). The overall incidence proportion was 27.8%. Participants who reported tinnitus at baseline or at both time points were older. At baseline, the hearing thresholds differed between tinnitus cases and controls at all frequencies. New tinnitus cases at follow-up had the greatest hearing threshold shift at the high-frequency area compared with the control group. Within pairs, the tinnitus twin had poorer hearing than his unaffected co-twin, more so for dizygotic than monozygotic twin pairs. The relative proportion of additive genetic factors was approximately 0.40 at both time points, and the influence of individual-specific environment was 0.56 to 0.61. The influence of genetic factors on tinnitus was largely independent of genetic factors for hearing thresholds.

Conclusions:

Our hypotheses were confirmed: The fastest hearing deterioration occurred for new tinnitus cases. A moderate genetic influence for tinnitus was confirmed.
Associations Between Low Back Pain and Muscle-strengthening Activity in U.S. Adults
Authors: Alnojeidi Albatool H. , Johnson Tammie M. , Richardson Michael R. , Churilla James R.
Published: December 2016

Study Design.

This was a cross-sectional study.

Objective.

The primary aim of the study was to examine the association between low back pain (LBP) and muscle-strengthening activity (MSA) among U.S. adults using gender-stratified analyses.

Summary of Background Data.

LBP is a common medical condition that impacts quality of life and professional productivity and increases the financial burden on the health care system by augmenting medical treatment costs. Previous studies analyzing gender-dependent relationships between MSA and LBP have produced mixed results.

Methods.

Our sample included 12,721 participants from the 1999 to 2004 National Health and Nutrition Examination Survey (NHANES). Participants were categorized into one of three levels of self-reported MSA: no MSA, insufficient MSA (1 day/wk), or meeting the 2008 Department of Health and Human Services (DHHS) recommendation for MSA (≥2 days/wk).

Results.

Gender-stratified analyses revealed significantly lower odds of reporting LBP among women [odds ratio (OR) 0.82, 95% confidence interval (CI) 0.70–0.96, P = 0.03] and men (OR 0.86; 95% CI 0.70–0.96, P = 0.01) who reported amounts of MSA that met the DHHS recommendation compared with those reporting no MSA. Following adjustment for smoking status, the odds remained significant among women (P = 0.03) but not among men (P = 0.21).

Conclusion.

These findings indicate that engaging in MSA at least 2 days/wk is associated with lower odds of LBP and that smoking may be an important mediating factor that should be considered in future LBP research.

Level of Evidence: 4
Superficial Acral Fibromyxoma: Report of 13 Cases With New Immunohistochemical Findings
Authors: Cullen Daniella , Díaz Recuero José Luis , Cullen Roberto , Rodríguez Peralto José Luis , Kutzner Heinz , Requena Luis
Published: December 2016

Background:

Superficial acral fibromyxoma (SAF) is a benign, soft tissue neoplasm preferably located on the digits.

Methods:

We collected 13 cases of SAF and evaluated their clinical, histopathologic, and immunohistochemical features.

Results:

This study included 9 males and 4 females, median age 54 years. The patients presented with a solitary asymptomatic or tender mass, most of them arising on fingers or toes. Histopathologically all lesions consisted of nonencapsulated dermal nodules, composed of spindled cells with variable myxoid and/or fibrotic stroma. Some lesions were well circumscribed (6/12, 50%), whereas other ones appeared poorly demarcated (6/12, 50%). The stroma was predominantly myxoid (53%), myxoid-collagenous (31%) or mostly collagenous (15%). Neoplastic cells expressed immunoreactivity for CD34 (8/11), CD99 (9/12), and nestin (7/7); whereas MUC4 (0/11) and Bcl-2 (0/7) resulted negative.

Conclusions:

Nestin is the best immunohistochemical marker for SAF with higher sensitivity than CD34, although nestin is also positive in dermatofibrosarcoma protuberans and therefore is not helpful in differential diagnosis between SAF and dermatofibrosarcoma protuberans. Cellular digital fibromas and acquired reactive digital fibroma probably are neoplasms closely related to SAF. The homogeneous reactivity for CD99, the negativity for Bcl-2 and lack of the honeycomb infiltration of the subcutis help to rule out myxoid dermatofibrosarcoma protuberans, whereas the negativity for MUC4 and Bcl-2 are helpful tools to rule out low-grade fibromyxoid sarcoma and spindled-cell lipoma, respectively.
Nevus Spilus (Speckled Lentiginous Nevus) in the Oral Cavity: Report of a Case and Review of the Literature
Authors: Torres Karen G. , Carle Laura , Royer Michael
Published: December 2016

The congenital melanocytic nevus is a pigmented melanocytic lesion that presents at birth or shortly thereafter. It is commonly described on the skin, usually on the trunk and extremities. Only five intraoral cases of congenital melanocytic nevi have been described in the English literature. A nevus spilus (speckled lentiginous nevus) is a clinical variant of congenital melanocytic nevus. The authors present the case of a 19-year-old male with an intraoral nevus spilus. The anterior mandibular gingiva exhibited multiple speckled, pigmented papules and macules on a thickened, hyperplastic macular background. Microscopic examination revealed characteristic morphologic features of intramucosal nevi extending into the deep portions of the submucosa. Although other authors have reported similar clinical presentation in the oral mucosa, no other case reports were found in the English literature classifying an intraoral congenital nevus as an intraoral nevus spilus. The sixth case of an intraoral congenital melanocytic nevus and the first case subclassified as an intraoral nevus spilus (speckled lentiginous nevus) is reported, with a review of the literature.
Anti-NXP2–Positive Paraneoplastic Dermatomyositis With Histopathologic Changes Confined to the Acrosyringia
Authors: Ramírez-Bellver Jose Luis , Macías Elena , Bernárdez Claudia , López-Robles Joaquín , Vegas-Sánchez Maria del Carmen , Díaz-Recuero Jose Luis , Quiceno Hernán , Requena Luis
Published: December 2016

Background:

Paraneoplastic syndromes consist of a group of disorders that are not related to the extension of the primary tumor or its metastases and that might be the first manifestation of a hidden neoplasm. It is a well-known association between dermatomyositis (DM) and cancer, especially gynecological tumors in women and lung cancer in men.

Methods:

We describe the case of a 67-year-old male who developed muscular weakness and pruritic skin lesions. Skin biopsies were performed and histologic findings were consistent with DM.

Results:

Skin biopsy showed interface dermatitis with vacuolar degeneration of the basal layer, dermal mucin deposits, and necrotic keratinocytes in the acrosyringia, a finding that has been previously reported in lupus erythematous but not in DM. Autoimmunity tests showed positivity for antinuclear antibodies and anti-NXP2, a recently described antibody associated with juvenile DM and, more rarely, with paraneoplastic DM.

Conclusion:

We present the first case in the literature with histopathologic changes of DM affecting the acrosyringia. Besides, our patient autoimmunity results support the utility of the new myositis-specific autoantibodies and its relation with a clinical phenotype.
Next-Generation Sequencing Reveals Pathway Activations and New Routes to Targeted Therapies in Cutaneous Metastatic Melanoma
Authors: Carlson J. Andrew , Caldeira Xavier Jose Candido , Tarasen Ashley , Sheehan Christine E. , Otto Geoff , Miller Vincent A. , Stephens Philip J. , Elvin Julia A. , Vergilio Jo-Anne , Suh James , Gay Laurie M. , Ross Jeffrey S.
Published: December 2016

Background:

Comprehensive genomic profiling of clinical samples by next-generation sequencing (NGS) can identify one or more therapy targets for the treatment of metastatic melanoma (MM) with a single diagnostic test.

Methods:

NGS was performed on hybridization-captured, adaptor ligation–based libraries using DNA extracted from 4 formalin-fixed paraffin-embedded sections cut at 10 microns from 30 MM cases. The exons of 182 cancer-related genes were fully sequenced using the Illumina HiSeq 2000 at an average sequencing depth of 1098X and evaluated for genomic alterations (GAs) including point mutations, insertions, deletions, copy number alterations, and select gene fusions/rearrangements. Clinically relevant GAs (CRGAs) were defined as those identifying commercially available targeted therapeutics or therapies in registered clinical trials.

Results:

The 30 American Joint Committee on Cancer Stage IV MM included 17 (57%) male and 13 (43%) female patients with a mean age of 59.5 years (range 41–83 years). All MM samples had at least 1 GA, and an average of 2.7 GA/sample (range 1–7) was identified. The mean number of GA did not differ based on age or sex; however, on average, significantly more GAs were identified in amelanotic and poorly differentiated MM. GAs were most commonly identified in BRAF (12 cases, 40%), CDKN2A (6 cases, 20%), NF1 (8 cases, 26.7%), and NRAS (6 cases, 20%). CRGAs were identified in all patients, and represented 77% of the GA (64/83) detected. The median and mean CRGAs per tumor were 2 and 2.1, respectively (range 1–7).

Conclusion:

Comprehensive genomic profiling of MM, using a single diagnostic test, uncovers an unexpectedly high number of CRGA that would not be identified by standard of care testing. Moreover, NGS has the potential to influence therapy selection and can direct patients to enter relevant clinical trials evaluating promising targeted therapies.
Efficacy and Safety of Novel Oral P2Y12 Receptor Inhibitors in Patients With ST-Segment Elevation Myocardial Infarction Undergoing PCI: A Systematic Review and Meta-Analysis
Authors: Sun Jianjun , Xiang Qian , Li Chao , Wang Zining , Hu Kun , Xie Qiufen , Cui Yimin
Published: December 2016

The efficacy and safety of novel oral P2Y12 receptor inhibitors (prasugrel and ticagrelor) are subjects of contention in patients with ST-segment elevation myocardial infarction (STEMI) undergoing PCI, and the optimal duration of therapy remains uncertain. We searched PubMed, Embase, Cochrane Library, CNKI, VIP, and WanFang Data to identify randomized controlled trials comparing novel oral P2Y12 receptor inhibitors with clopidogrel in patients with STEMI undergoing PCI until February 2016. The primary efficacy and safety endpoint were all-cause mortality and major/minor bleeding. Twelve studies were included. Novel oral P2Y12 inhibitors significantly reduced the incidence of all-cause death (relative risk: 0.65, 95% confidence interval, 0.53–0.78), major adverse cardiac events [0.68 (0.56–0.83)], and stent thrombosis [0.56 (0.43–0.75)] without significant difference in bleeding (P = 0.11) compared with clopidogrel. Identical results were observed in the longer dual antiplatelet therapy (DAPT) and shorter-DAPT subgroups, albeit Chinese patients with ticagrelor treatment had a slight increase in bleeding (P = 0.08). Furthermore, the pooled relative risk ratio for each endpoint showed no significant difference between the longer-DAPT and shorter-DAPT subgroups. In conclusion, prasugrel and ticagrelor decreased the risk of all-cause death, major adverse cardiac events, and stent thrombosis without causing more bleeding events compared with clopidogrel in patients with STEMI undergoing PCI.
Bleeding Risk of Antithrombotic Treatment in Patients on Hemodialysis
Authors: Vázquez Eduardo , Sánchez-Perales Carmen , Ortega Sonia , Vázquez-Sánchez Teresa , Quesada Enrique , Salas Daniel , Fernández-Guerrero Juan Carlos
Published: December 2016

Background:

The risk–benefit of antithrombotic treatment (ATT) has not been established in patients on dialysis. Our objective was to determine the influence of ATT on the risk of hemorrhage in patients on hemodialysis.

Methods:

We included patients who began dialysis between 2003 and 2007. We determined the rates of fatal bleeding or bleeding leading to hospitalization or transfusion.

Results:

Two hundred twenty-one patients were included. Over the follow-up period (45.5 ± 34 months), there were 76 hemorrhages in 52 patients. There were 10 fatal bleedings. The annual incidence of patients presenting with hemorrhagia was 6.2%. Bleeding occurred in 5.2% of those being treated with aspirin, 7% with acenocumarol, 12.3% with clopidogrel, 15.2% with aspirin + clopidogrel, 45.9% with anticoagulants + antiplatelets, 49.6% with low-molecular-weight heparin, and 3.9% without ATT. On multivariate analysis, masculine gender [hazard ratio (HR): 2.421; 95% confidence interval (CI), 1.261–4.650; P = 0.003], treatment with dicumarins (HR: 2.406; 95% CI, 1.013–5.718; P = 0.047), treatment with clopidogrel (HR: 2.697; 95% CI, 1.440–5.051; P = 0.002), and treatment with low-molecular-weight heparin (HR: 21.463; 95% CI, 9.067–50.806; P = 0.001) were independent predictors of bleeding.

Conclusions:

ATT increases the risk of bleeding in patients on hemodialysis. The incidence of hemorrhage varies with the type of antithrombotics used.
Quantitative Method for Simultaneous Analysis of Acetaminophen and 6 Metabolites
Authors: Lammers Laureen A. , Achterbergh Roos , Pistorius Marcel C. M. , Romijn Johannes A. , Mathôt Ron A. A.
Published: December 2016

Background:

Hepatotoxicity after ingestion of high-dose acetaminophen [N-acetyl-para-aminophenol (APAP)] is caused by the metabolites of the drug. To gain more insight into factors influencing susceptibility to APAP hepatotoxicity, quantification of APAP and metabolites is important. A few methods have been developed to simultaneously quantify APAP and its most important metabolites. However, these methods require a comprehensive sample preparation and long run times. The aim of this study was to develop and validate a simplified, but sensitive method for the simultaneous quantification of acetaminophen, the main metabolites acetaminophen glucuronide and acetaminophen sulfate, and 4 Cytochrome P450–mediated metabolites by using liquid chromatography with mass spectrometric (LC-MS) detection.

Methods:

The method was developed and validated for the human plasma, and it entailed a single method for sample preparation, enabling quick processing of the samples followed by an LC-MS method with a chromatographic run time of 9 minutes. The method was validated for selectivity, linearity, accuracy, imprecision, dilution integrity, recovery, process efficiency, ionization efficiency, and carryover effect.

Results:

The method showed good selectivity without matrix interferences. For all analytes, the mean process efficiency was >86%, and the mean ionization efficiency was >94%. Furthermore, the accuracy was between 90.3% and 112% for all analytes, and the within- and between-run imprecision were <20% for the lower limit of quantification and <14.3% for the middle level and upper limit of quantification.

Conclusions:

The method presented here enables the simultaneous quantification of APAP and 6 of its metabolites. It is less time consuming than previously reported methods because it requires only a single and simple method for the sample preparation followed by an LC-MS method with a short run time. Therefore, this analytical method provides a useful method for both clinical and research purposes.
IMAGING AND MEASUREMENT OF THE PRERETINAL SPACE IN VITREOMACULAR ADHESION AND VITREOMACULAR TRACTION BY A NEW SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY ANALYSIS
Authors: Stopa Marcin , Marciniak Elżbieta , Rakowicz Piotr , Stankiewicz Agnieszka , Marciniak Tomasz , Dąbrowski Adam
Published: December 2016

Purpose:

To evaluate a new method for volumetric imaging of the preretinal space (also known as the subhyaloid, subcortical, or retrocortical space) and investigate differences in preretinal space volume in vitreomacular adhesion (VMA) and vitreomacular traction (VMT).

Methods:

Nine patients with VMA and 13 with VMT were prospectively evaluated. Automatic inner limiting membrane line segmentation, which exploits graph search theory implementation, and posterior cortical vitreous line segmentation were performed on 141 horizontal spectral domain optical coherence tomography B-scans per patient. Vertical distances (depths) between the posterior cortical vitreous and inner limiting membrane lines were calculated for each optical coherence tomography B-scan acquired. The derived distances were merged and visualized as a color depth map that represented the preretinal space between the posterior surface of the hyaloid and the anterior surface of the retina. The early treatment d retinopathy study macular map was overlaid onto final virtual maps, and preretinal space volumes were calculated for each early treatment diabetic retinopathy study map sector.

Results:

Volumetric maps representing preretinal space volumes were created for each patient in the VMA and VMT groups. Preretinal space volumes were larger in all early treatment diabetic retinopathy study map macular regions in the VMT group compared with those in the VMA group. The differences reached statistical significance in all early treatment diabetic retinopathy study sectors, except for the superior outer macula and temporal outer macula where significance values were P = 0.05 and P = 0.08, respectively. Overall, the relative differences in preretinal space volumes between the VMT and VMA groups varied from 2.7 to 4.3 in inner regions and 1.8 to 2.9 in outer regions.

Conclusion:

Our study provides evidence of significant differences in preretinal space volume between eyes with VMA and those with VMT. This may be useful not only in the investigation of preretinal space properties in VMA and VMT, but also in other conditions, such as age-related macular degeneration, diabetic retinopathy, and central retinal vein occlusion.
STAINING-ASSISTED REMOVAL OF SILICONE OIL FOR THE IDENTIFICATION OF SUBCLINICAL PROLIFERATIVE VITREORETINOPATHY
Authors: Rizzo Stanislao , Barca Francesco , Faraldi Francesco , Caporossi Tomasso , Virgili Gianni
Published: December 2016

Purpose:

Retinal detachment is a frequent complication after removal of silicone oil (ROSO). A retrospective study was conducted to determine whether staining-assisted removal of silicone oil (st-ROSO) allowed better identification and removal of proliferative vitreoretinopathy (PVR) processes compared with a conventional removal of silicone oil technique.

Methods:

All individuals underwent pars plana vitrectomy (PPV) and silicone oil fill-in for complicated retinal detachments. In conventional removal of silicone oil (Group 1), no staining was used. In staining-assisted removal of silicone oil (Group 2), a mixture of trypan blue and brilliant blue G dyes was used to identify proliferative vitreoretinopathy and subclinical epiretinal membrane.

Results:

After the first 3-month follow-up, 15.9% of patients (N = 608) developed a retinal detachment. Retinal detachment occurred in 22.8% of patients in Group 1 (n = 284) and 9.8% of patients in Group 2 (n = 324; P < 0.001). In Group 2, proliferative vitreoretinopathy removal was performed in 153 eyes (47.2%).

Conclusion:

The incidence of retinal redetachment was significantly lower after staining-assisted removal of silicone oil compared with a conventional technique. Staining-assisted removal of silicone oil allowed better identification and removal of proliferative vitreoretinopathy processes.
LATE-ONSET CHOROIDAL METASTASIS FROM BREAST CANCER
Authors: Levison Ashleigh L. , Erenler Feyza , Zhao Yue , Martin Daniel F. , Lowder Careen , Budd G. Thomas , Singh Arun D.
Published: December 2016

Purpose:

Report occurrence of late-onset choroidal metastasis from breast cancer.

Methods:

Retrospective chart review.

Results:

The authors report 3 patients with choroidal metastasis from breast cancer that presented more than 20 years after diagnosis of the primary tumor. The choroidal metastases were the presenting feature of metastatic disease in all three patients, but after imaging, all patients had metastasis elsewhere as well. Two of the patients' tumors were known, ER+, and the hormone receptor status of the third patient was unknown. All three patients were treated with aromatase inhibitors with good response.

Conclusion:

Late onset of metastatic disease, an excellent response to hormonal therapy, and a prolonged survival despite presence of systemic disease suggests a milder variant within the broad category of breast cancer patients with uveal metastases. Awareness of this entity can minimize the risk of misdiagnosis and avoid potentially toxic local therapy.
Implementation and Quality Improvement of a Screening and Counseling Program for Unhealthy Alcohol Use in an Academic General Internal Medicine Practice
Authors: Jonas Daniel E. , Miller Thomas , Ratner Shana , McGuirt Brooke , Golin Carol E. , Grodensky Catherine , Sturkie Emily , Kinley Jennifer , Dale Maureen , Pignone Michael
Published: December 2016

Unhealthy alcohol use is the third leading cause of preventable death in the United States. The U.S. Preventive Services Task Force (USPSTF) recommends screening for unhealthy alcohol use but little is known about how best to do so. We used quality improvement techniques to implement a systematic approach to screening and counseling primary care patients for unhealthy alcohol use. Components included use of validated screening and assessment instruments; an evidence-based two-visit counseling intervention using motivational interviewing techniques for those with risky drinking behaviors who did not have an alcohol use disorder (AUD); shared decision making about treatment options for those with an AUD; support materials for providers and patients; and training in motivational interviewing for faculty and residents. Over the course of one year, we screened 52% (N = 5,352) of our clinic's patients and identified 294 with positive screens. Of those 294, appropriate screening-related assessments and interventions were documented for 168 and 72 patients, respectively. Although we successfully implemented a systematic screening program and structured processes of care, ongoing quality improvement efforts are needed to screen the rest of our patients and to improve the consistency with which we provide and document appropriate interventions.
Body Composition Trajectories From Infancy to Preschool in Children Born Premature Versus Full‐term
Authors: Scheurer Johannah M. , Zhang Lei , Gray Heather L. , Weir Katherine , Demerath Ellen W. , Ramel Sara E.
Published: December 2016

Objectives:

The aim of the study was to longitudinally characterize infancy to preschool body composition trajectories and the association of early fat and fat‐free mass gains with preschool age body composition in children born premature versus full‐term.

Methods:

A cohort of appropriate‐for‐gestational age preterm (n = 20) and term (n = 51) infants were followed at 3 visits: “neonatal” visit 1 at 2 weeks of age for term and near term corrected age for preterm; “infancy” visit 2 at 3 to 4 months (preterm corrected age); “preschool” visit 3 at 4 years. Body composition via air displacement plethysmography and anthropometrics were measured at all visits. Tracking of infancy weight and body composition with preschool measurements was tested using Pearson partial correlation coefficients. Associations between serial body composition measurements were assessed using multiple linear regression.

Results:

Early differences in body composition between premature (mean gestational age 31.9 weeks, mean birth weight 1843 g) and full‐term (mean gestational age 39.8 weeks) infants were not present at preschool age. Visit 1 body composition was not correlated with preschool measurements in the preterm infants. Visit 2 measurements were correlated with preschool measures. Fat‐free mass accretion from visit 1 to visit 2 was positively associated with preschool lean mass (β = 0.038, P = 0.049) in preterm children, whereas fat accretion was not associated with preschool body composition.

Conclusions:

Children born prematurely and full‐term have similar body composition at preschool age. For preterms infancy fat‐free mass gains, and not adiposity gains, are positively associated with preschool fat‐free mass; this may be associated with lower risk of later obesity and adverse metabolic outcomes.
The Association Between Celiac Disease and Eosinophilic Esophagitis
Authors: Hommeida Salim , Alsawas Mouaz , Murad Mohammad H. , Katzka David A. , Grothe Rayna M. , Absah Imad
Published: December 2016

Background:

The association between celiac disease (CD) and eosinophilic esophagitis (EoE) has been the focus of multiple studies with variable results. Both diseases are immune mediated, and dietary triggers play a role in their pathogenesis.

Objectives:

The aim of the study was to analyze the risk of EoE in children with CD, assess the magnitude of association between CD and EoE in children, and report the characteristics and outcomes of children with both conditions.

Methods:

We conducted a retrospective study of the Mayo Clinic Electronic medical records between January 1, 1998 and December 31, 2015. Systematic review and meta‐analysis of multiple databases was conducted to include studies reporting on the same association. Random‐effects model was used to report pooled odds ratio (OR) and 95% confidence interval (CI).

Results:

In this cohort study, of 10,201 children who underwent at least 1 endoscopy, 595 had EoE, and 546 had CD. The risk of having EoE was not increased in children with CD compared to those without CD (OR, 0.29; 95% CI, 0.154–0.545). Nine of 10 children improved with gluten‐free diet, topical glucocorticosteroid, and/or elimination diet. One child lost to follow‐up.

Meta‐analysis of 5 studies showed similar results (OR, 0.525; 95% CI, 0.364–0.797). A total of 45 cases in the literature had both CD and EoE (mean age, 10 years; 64% boys; majority presenting with abdominal pain, vomiting, and diarrhea).

Conclusions:

Based on our cohort and the observational data, the diagnosis of CD in children is not associated with increased risk of EoE.
Agenda for Sleep Research in Older Adults With Cancer
Authors: Matthews Ellyn E. , Hacker Eileen Danaher , Otte Julie L. , Dean Grace E.
Published: December 2016

Background:

Sleep problems are common but often neglected in older adults, particularly in the context of cancer. Underlying mechanisms are poorly understood and interventions frequently lack a clear scientific basis.

Objective:

The objective of this report was to examine scientific content presented at a National Institutes of Health–sponsored U13 “Bedside to Bench” conference using a qualitative and iterative review procedure. Analysis of current scientific issues regarding sleep in older adults with cancer is needed to direct nurse scientists and clinicians toward research opportunities.

Methods:

A multistep review procedure for the analysis/synthesis of knowledge gaps and research opportunities was undertaken by oncology nurse scientists in attendance.

Results:

Conceptual problems in this area include the lack of standard sleep terminology and absence of an overarching conceptual model. Methodological problems are inconsistent sleep/napping measurement and complex operational challenges in designing comprehensive yet feasible studies in older adults. Knowledge gaps in basic and clinical science relate to cellular and molecular mechanisms that underlie sleep and circadian rhythm disturbances, contribution of sleep to adverse outcomes, and impact of disturbed sleep during hospitalization and the transition from hospital to home.

Conclusions:

Focused and interdisciplinary research that advances conceptual and operational understanding of biological and behavioral determinants of sleep health in the aging cancer population can lead to more effective, safe, and targeted interventions for those with cancer-related sleep-circadian disturbances.

Implications for Practice:

Research that addresses current conceptual, methodological, and physiological issues can lead to more effective, safe, and targeted care for older adults with cancer-related sleep-circadian disturbances.
Exploring Meaning in the Life of Chinese Breast Cancer Survivors
Authors: Xia Hao-Zhi , Gao Lei , Yue Hong , Shi Bao-Xin
Published: December 2016

Background:

Breast cancer is the most common cancer among women worldwide, and spiritual fulfillment such as experiencing meaning in life plays an important role in coping with the disease.

Objective:

The objectives of this study were to explore and understand Chinese breast cancer survivors’ perspective on meaning in life.

Methods:

This study used Grounded Theory; 23 participants were recruited using convenience sampling, purposive sampling, and theoretical sampling. Semistructured interviews were conducted, and the data were analyzed using open coding, axial coding, and selective coding.

Results:

A core category emerged as “satisfaction with my life” to explain Chinese breast cancer survivors’ perspective of meaning in life, and 4 subcategories described the core category including (1) living a healthy and peaceful life, (2) having a good relationship with others, (3) achieving purpose in life, and (4) fulfilling responsibility.

Conclusion:

Chinese breast cancer survivors value physical health as well as spiritual fulfillment. The experience of adapting to life with cancer, having a good relationship with others, pursuing life goals, and fulfilling responsibility consists of a satisfying life, which makes life more meaningful.

Implications for Practice:

Health providers should pay more attention to survivors’ experience of meaning in life and help them enhance meaning in life and improve their quality of life through building good relationship with others, achieving purpose in life, and fulfilling responsibility for family and society.
Using Q Methodology to Assess Learning Outcomes Following the Implementation of a Concept-Based Curriculum
Authors: Hensel Desiree
Published: December 2016

The use of a concept-based curriculum in nursing education is increasing, but assessing its impact remains challenging. This project discusses how Q methodology was used to evaluate our prelicensure program’s outcome of creating practitioners who were ready to practice in diverse environments before and after a concept-based curricular revision. The successes and challenges of the revision are discussed.
Data Collection for Adverse Events Reporting by US Dental Schools
Authors: Rooney Deborah , Barrett Kimberly , Bufford Blake , Hylen Alexandra , Loomis Matthew , Smith Joshua , Svaan Angela , Pinsky Harold M. , Sweier Domenica
Published: December 2016

Objectives

Accreditation of US dental schools requires a formal system of quality assessment of clinical adverse events (AE). There is no universal system to collect, record, interpret, or release findings or trends pertaining to AEs. The objective of this study was to compare similarities and differences among the AE reporting forms used at US dental schools.

Methods

Sixteen (24%) dental schools responded to a query to provide copies of their AE forms. The forms were analyzed to identify unique AE items. A total of 69 unique AE items were identified, grouped, and ranked according to frequency. Methods of AE data collection were also noted.

Results

The forms were different in organization, form, and content. The 69 AE items represented a wide variety of information, with no standardization of the type of information, how it was collected, or by whom. We identified 9 most requested AE items and 4 least requested AE items. The schools differed in how the information was obtained: 2 schools used a menu, 8 schools used free response, and 6 schools used a hybrid of both methods.

Conclusions

We found that dental school clinic AE reporting forms are not standardized in structure, organization, or content. We conclude that a hybrid form containing both guided responses and free responses would ensure that proper information is being reported to fully understand why/how an AE occurred. In addition, dental schools need to develop a standardized method of collecting and assessing AE data which will allow for quality improvement and increased patient safety.
Overview on Criteria for MEP Monitoring
Authors: MacDonald David B.
Published: December 2016

Intraoperative motor evoked potentials include the D-wave as a surrogate for long-term motor outcome and muscle motor evoked potentials as a surrogate for early outcome. Their efficacy depends on excluding confounding factors and on warning criteria; insufficiently sensitive criteria could result in unpredicted deficits, whereas excessively sensitive ones could cause false alarms deterring surgical treatment and jading surgeons to alerts, eventually leading to deficits through failure to intervene. Although D-waves have few indications, they are nonsynaptic, linear, and stable—properties that support amplitude reduction criteria: >50% for intramedullary spinal cord tumor surgery and >30% to 40% for peri-Rolandic brain surgery. Muscle motor evoked potentials have many indications but are polysynaptic, nonlinear, and unstable—properties that challenge warning criteria and make them unusually capricious and sensitive. Disappearance is a remarkably frequent pathologic sign compared with other evoked potentials and is always a major criterion. Marked (>80%) amplitude reduction may be a minor or moderate spinal cord criterion, depending on the surgical circumstance. Modest (>50%) reduction may be a major criterion for brain, brainstem, and facial nerve monitoring, if justified by sufficient preceding stability. Acute ≥100-V threshold elevation may be a minor or moderate spinal cord criterion, depending on the surgical circumstance and on adherence to reported methodology. Morphology criteria lack support. Tailoring warning criteria to different monitoring situations based on anatomy, surgical goals, and published evidence seems advisable.
The Interpretation of Muscle Motor Evoked Potentials for Spinal Cord Monitoring
Authors: Kothbauer Karl F.
Published: December 2016

Objective:

To provide a summary of the intraoperative monitoring of muscle motor evoked potentials (MEPs) based on the presence–absence concept during neurosurgical operations along the spinal cord.

Method:

Expert review.

Discussion:

The measurable parameters of MEPs, such as signal amplitudes and thresholds vary considerably both during a single surgery in a single individual patient as well as between individuals and operations. The presence or absence of responses irrespective of stimulus intensity and response amplitude is much more clearly defined. The correlation of intraoperative MEP data to clinical findings preoperatively and postoperatively so far is best if a presence–absence paradigm is used. The most reliable correlation of postoperative motor deficits is with the disappearance of previously present MEPs, not with the deterioration of amplitudes or the elevation of thresholds. However, in intraoperative decision making an elevation of threshold, without signal loss may still be considered a practical warning sign as it may be a subclinical injury indicator, and may therefore induce a change in surgical strategy. This may be considered a minor warning criterion. A practical concept of the combined use of MEPs with D-wave recordings produced a neurophysiological pattern, which correlates with a reversible motor deficit: Disappearance of MEPs correlates with transient motor deficits if the D-wave amplitude is preserved above an approximate value of 50% of its baseline. Disappearance of the D-wave correlates to paraplegia.

Conclusions:

To date, the best correlation of muscle MEP data to clinical deficits lies in the assessment of disappearance of a previously present MEP regardless of thresholds or amplitudes. Increase in stimulus thresholds for MEPs or to a lesser degree decrement of signal amplitudes may be considered subclinical injury indicators without correlation to neurological dysfunction and thus is considered a minor warning criterion.