bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of noncalcified plaques and coronary artery stenosis in patients with coronary calcium scores of zero
Authors: Al-Muhaidb Saud M. , Aljebreen Abdul Mohsen M. , AlZamel Zamel A. , Fathala Ahmed
Published: August 2020

Objectives

A higher coronary artery calcium score (CACS) is associated with increased coronary artery plaque burden resulting in increased cardiovascular risk. Conversely, the absence of calcium indicates a low risk of cardiovascular events. However, coronary plaque calcification is a late manifestation of atherosclerosis; earlier stages of atherosclerosis present noncalcified plaques (NCPs) A recent study demonstrated that the absence of coronary artery calcification deposit does not preclude obstructive stenosis or the need for revascularization in patients with a high suspicion of coronary artery disease (CAD). Our study aimed to investigate the prevalence of NCP and the severity of coronary artery stenosis in symptomatic patients in our local population who were referred for coronary artery computed tomography angiogram (CCTA) with 0 CACS.

Methods

A total of 299 patients who had undergone CACS and CCTA, and had scored zero for coronary artery calcium. Patients included had clinically appropriate indications, mainly chest pain with variable severity with no history of CAD. The presence of CAD risk factors, such as diabetes, hypertension, and smoking, was obtained from reviewing patient charts. The CCTA analysis was performed to evaluate for coronary artery stenosis and the presence of NCP. The severity of stenosis was quantified by visual estimation and divided into 0% stenosis, 1–25% stenosis, 26–50% stenosis, and more than 50% stenosis.

Results

The prevalence of NCP was 6.4% (19 of the 299). Among the 19 patients with NCP, 52.6% had no identified coronary artery stenosis, 26.3% had less than 25%, and 21% had stenosis between 25 and 50%. None had stenosis greater than 50%. There was a strong association between male sex (P = 0.001), smoking (P = 0.0.004), hypertension, and NCP (P = 0.042), but no association was found between NCP and age or diabetes

Conclusions

In patients with a high clinical suspicion of CAD, the absence of coronary artery calcification does not rule out CAD; up to 6.4% of these patients have early CAD as evidenced by NCP detected by CCTA, and none have more than 50% stenosis, However, future prognostic and long-term follow-up studies are needed to determine prognostic value of NCP in patients with 0 CACS.
Patient safety in nuclear medicine: identification of key strategic areas for vigilance and improvement
Authors: Kasalak Ömer , Yakar Derya , Dierckx Rudi A.J.O. , Kwee Thomas C.
Published: August 2020

Objective

To determine the types of patient safety incidents and associated harm in nuclear medicine practice.

Methods

This study included 147 patient safety incidents related to nuclear medicine practice and submitted to the incident reporting system of a tertiary care nuclear medicine department between 2014 and 2019.

Results

The top-three incident types according to the International Classification for Patient Safety (ICPS) were medication/IV fluids (36/147, 24.5%), clinical administration (28/147, 19.0%), and clinical process/procedure (27/147, 18.4%), altogether comprising 61.9% of incidents. Within the medication/IV fluids domain, half of incident subtypes were attributable to supply/ordering, omitted medicine or dose, and wrong dose/strength of frequency. Within the clinical administration domain, appointment and wrong patient represented the majority of incident subtypes. Within the clinical process/procedure domain, the majority of incident subtypes fell in the categories: specimens/results and incomplete/inadequate. There was no patient harm in 145 (98.6%) of cases, mild patient harm in 1 (0.7%) case, and in 1 (0.7%) case, it remained unclear if there was patient harm. In 4 (2.7%) cases, a Prevention Recovery Information System for Monitoring and Analysis evaluation was performed because of the high risk of reoccurrence and patient harm.

Conclusions

The majority of patient safety incidents in nuclear medicine occur in three main ICPS categories (medication/IV fluids, clinical administration, and clinical process/procedure, in order of decreasing frequency). These can be considered as key strategic areas for incident prevention and patient safety improvement. Nevertheless, the rate of actual patient harm was very low in our series.
Gene Expression Profiling of the Pancreas in Patients Undergoing Total Pancreatectomy With Islet Autotransplant Suggests Unique Features of Alcoholic, Idiopathic, and Hereditary Pancreatitis
Authors: Blobner Brandon M. , Bellin Melena D. , Beilman Gregory J. , Shelton Celeste A. , Park Hyung Jung , Whitcomb David C.
Published: August 2020

Objectives

To determine if RNA collected from pancreatic tissue, without the use of RNAlater, is useful for RNA sequencing (RNA-seq) despite degradation, and if so, then, via RNA-seq analysis, how does gene expression vary between pancreatitis etiologies.

Methods

Data were assessed in 2 dimensions, based on RNA-seq signal shape assessed by RSeQC v.2.6.4 and RNA expression after accounting for different degrees of degradation.

Results

Six measures of RNA characteristics (median RNA fragment size, reads per million kilobases saturation, transcript integrity number, distribution of hexamers, percentage of nucleotides that are guanine or cytosine, and duplicated reads) were significantly different between hereditary pancreatitis and idiopathic pancreatitis. Differential expression analysis revealed that 150 genes were differentially expressed between hereditary and idiopathic etiologies, 197 genes were differentially expressed between alcoholic and idiopathic etiologies, and 200 genes were differentially expressed between alcoholic and hereditary etiologies. We then determined that many enriched pathways between hereditary and idiopathic etiologies are related to the matrisome, and many of the enriched pathways between alcoholic and idiopathic etiology or hereditary etiology are related to ion transport.

Conclusions

We found distinct RNA-seq signals between different pancreatitis etiologies in both of the dimensions in critical pathways for pancreas biology.
The Effect of Age on Short- and Long-Term Outcomes in Patients With Pancreatic Ductal Adenocarcinoma Undergoing Laparoscopic Pancreaticoduodenectomy
Authors: Cai He , Wang Yichao , Cai Yunqiang , Wang Xin , Ouyang Guoqing , Li Yongbin , Meng Lingwei , Peng Bing
Published: August 2020

Objective

The aim of the study was to evaluate the effect of age on outcomes with pancreatic ductal adenocarcinoma (PDAC) undergoing laparoscopic pancreaticoduodenectomy (LPD).

Methods

We retrospectively collected clinical data of consecutive patients with PDAC undergoing LPD from January 2012 to April 2019. The patients were divided into 2 groups according to age at admission for LPD: younger than 70 and 70 years or older.

Results

A total of 147 patients were included (<70 years, n = 96; ≥70 years, n = 51). The elderly LPD patients had lower serum albumin levels (mean, 37.9 [standard deviation, 4.8] g/L vs 40.7 [standard deviation, 6.8] g/L, P = 0.004) and a larger frequency of comorbidities (62.7% vs 36.5%, P = 0.002) than younger patients. The short-term outcomes showed no significant differences. The median overall survival time of the younger patients was not significantly greater than that of the elderly patients (20.0 [95% confidence interval, 16.1–23.9] months vs 19.0 [95% confidence interval, 13.8–24.2] months, P = 0.902).

Conclusions

The short- and long-term outcomes of elderly patients with PDAC after LPD were similar to those of younger patients, despite a higher prevalence of multiple chronic illnesses and poorer nutritional conditioning among the elderly patients. These results show that LPD can be applied safely to elderly patients.
Multimodal Device and Computer Algorithm–Based Monitoring of Pancreatic Microcirculation Profiles In Vivo
Authors: Li Yuan , Song Xiaohong , Liu Mingming , Wang Bing , Zhang Jian , Li Ailing , Zhang Honggang , Xiu Ruijuan
Published: August 2020

Objectives

Pancreatic microcirculation has an essential role in orchestrating pancreatic homeostasis. Inherent complexity and technological limitation lead to interobserver variability and 1-sided microcirculatory data. Here, we introduce a multimodal device and computer algorithm–based platform for monitoring and visualizing integrated pancreatic microcirculation profiles.

Methods

After anesthetizing and exposing pancreas tissue of BALB/c mice, probes of Oxygen to See, Microx TX3, and MoorVMS-LDF2 were positioned at pancreas in situ to capture the pancreatic microcirculatory oxygen (hemoglobin oxygen saturation, relative amount of hemoglobin, and partial oxygen pressure) and microhemodynamic data (microvascular blood perfusion and velocity). To assess and visualize pancreatic microcirculation profiles, raw data of pancreatic microcirculation profiles were processed and transformed using interquartile range and min-max normalization by Python and Apache ECharts.

Results

The multimodal device–based platform was established and 3-dimensional microcirculatory modules were constructed. Raw data sets of pancreatic microcirculatory oxygen and microhemodynamic were collected. The outlier of data set was adjusted to the boundary value and raw data set was preprocessed. Normalized pancreatic microcirculation profiles were integrated into the 3-dimensional histogram and scatter modules, respectively. The 3-dimensional modules of pancreatic microcirculation profiles were then generated.

Conclusions

We established a multimodal device and computer algorithm–based monitoring platform for visualizing integrated pancreatic microcirculation profiles.
A Quantitative Global Proteomics Approach Identifies Candidate Urinary Biomarkers That Correlate With Intraductal Papillary Mucinous Neoplasm Dysplasia
Authors: Flick Katelyn F. , Yip-Schneider Michele T. , Sublette Christopher M. , Simpson Rachel E. , Colgate Cameron L. , Wu Huangbing , Soufi Mazhar , Dewitt John M. , Mosley Amber L. , Ceppa Eugene P. , Zhang Jianjun , Schmidt C. Max
Published: August 2020

Objectives

A proteomic discovery study was performed to determine if urine possesses a unique biosignature that could form the basis for a noninvasive test able to predict intraductal papillary mucinous neoplasm (IPMN) dysplasia.

Methods

Urine was collected from patients undergoing surgery for IPMN (72 low/moderate, 27 high-grade/invasive). Quantitative mass spectrometry-based proteomics was performed. Proteins of interest were identified by differential expression analysis followed by principal component analysis.

Results

Proteomics identified greater than 4800 urinary proteins. Low/moderate and high-grade/invasive IPMN were distinguished by 188 proteins (P < 0.05). Following principal component analysis and heatmap visualization, vitamin D binding protein (DBP), apolipoprotein A1 (APOA1), and alpha-1 antitrypsin (A1AT) were selected. The proteomic abundance of DBP (median [interquartile range]) was significantly higher for high-grade/invasive than for low/moderate IPMN (219,735 [128,882–269,943] vs. 112,295 [77,905–180,773] normalized reporter ion intensity units; P = 0.001). Similarly, APOA1 was more abundant in the high-grade/invasive than low/moderate groups (235,420 [144,933–371,247] vs 150,095 [103,419–236,591]; P = 0.0007) as was A1AT (567,514 [358,544–774,801] vs 358,393 [260,850–477,882]; P = 0.0006).

Conclusions

Urinary DBP, APOA1, and A1AT represent potential biomarker candidates that may provide a noninvasive means of predicting IPMN dysplastic grade.
Symptom Burden of Nonresected Pancreatic Adenocarcinoma
Authors: Mavros Michail N. , Davis Laura E. , Hallet Julie , Tung Stephanie , Mahar Alyson L. , Bubis Lev D. , Hammad Ahmed , Zhao Haoyu , Earle Craig C. , Barbera Lisa , Coburn Natalie G.
Published: August 2020

Objectives

Pancreatic adenocarcinoma (PAC) is a debilitating disease. We sought to analyze symptom burden and trajectories after diagnosis of PAC and identify predictors of severe symptoms for nonresected patients.

Methods

This was a retrospective review of linked administrative health care databases examining patients with PAC not undergoing resection. Primary outcome was severe patient-reported symptoms (Edmonton Symptom Assessment System ≥7). Multivariable modified Poisson regression models were used to identify factors associated with reporting severe symptoms.

Results

A total of 10,753 symptom assessments from 2168 patients were analyzed. The median age was 67 years, and 47% were female; median survival was 7 months. Most common severe symptoms were tiredness (54.7%), anorexia (53.6%), overall impaired well-being (45.3%), and drowsiness (37.1%). Severity of symptoms decreased 1 month after diagnosis and plateaued 4 months after diagnosis. Female sex, comorbidities, and older age were associated with reporting severe symptoms; recent radiation treatment and residence in a rural community were associated with reporting less severe symptoms.

Conclusions

The prevalence of severe symptoms in patients with nonresected PAC was high, but potentially modifiable. We identified vulnerable groups of patients that may benefit from focused interventions. This information is important for patient counseling and design of supportive care strategies.
Second Osteosarcoma in a 16-Year-old Woman Diagnosed With Rothmund-Thomson Syndrome
Authors: Mata Fernández Cristina , Zeferino Feltrin Matheus
Published: August 2020

Rothmund-Thomson syndrome (RTS) is an autosomal recessive disorder associated with an increased predisposition to osteosarcoma (OS) when it is caused by concrete mutations in the RECQL4 gene. Most OSs arise sporadically, but it can also be the first manifestation of a cancer predisposition syndrome as Rothmund Thompson. The early onset, multifocality and metachronism, and a family history of the disease, may suggest a tumor predisposition syndrome. We present the case of a patient with a polymalformative syndrome, who, at 6 years of age, was diagnosed with OS in the right femur. This led to the diagnosis of a RTS type 2. She was cured and surveillance showed no sign of disease. Ten years later, the patient developed a second OS in the contralateral femur. Fortunately, she is in complete remission again after treatment. We describe our patient treatment and recommend a possible screening-surveillance for RTS type II patients.
Rosai-Dorfman Disease and Exocrine Pancreatic Insufficiency in a Patient With a Germline SLC29A3 Mutation
Authors: Blatt Julie , Parekh Preeti , Powell Bradford C. , Fedoriw Yuri , Reddy Indira , Montgomery Nathan D.
Published: August 2020

Rosai-Dorfman disease (RDD) typically presents as bulky lymphadenopathy. Somatic mutations in RAS/MAP kinase pathway genes are common but germline mutations are rare. A patient with RDD and exocrine pancreatic insufficiency was found to have a homozygous germline mutation in SLC29A3, which has been associated with the Histiocytosis/Lymphadenopathy Plus Syndrome. His RDD also was positive for a somatic mutation in lymphoid enhancer binding factor 1 (LEF1). The concurrence of RDD and pancreatic insufficiency should raise consideration of SLC29A3 mutations. Other cases will be needed to confirm this observation and a possible contribution of LEF1 to the development of RDD.
Increased Malignancy Rate in Children With IgE Deficiency: A Single-center Experience
Authors: Ferastraoaru Denisa , Schwartz Deborah , Rosenstreich David
Published: August 2020

Background:

Immunoglobulin (Ig) E-deficient adults (IgE<2.5 kU/L) have increased susceptibility for developing malignancy. We evaluated the association between IgE deficiency and cancer diagnosis in children (age younger than 18 y), compared with those non–IgE-deficient (IgE≥2.5 kU/L).

Materials and Methods:

Information about malignancy diagnosis were compared between 4 cohorts of children who had IgE levels measured at our institution: IgE-deficient (IgE<2.5 kU/L), normal IgE (2.5<IgE≥100 kU/L), high IgE (100≥IgE<1000 kU/L), very high IgE (IgE≥1000 kU/L).

Results:

Overall, 94/4586 (2%) children had IgE deficiency. A significantly higher malignancy rate was found in IgE-deficient children (3/94, 3.2%) compared with non–IgE-deficient cohort (13/4492, 0.3%, P<0.0001). Analysis of the groups with different IgE levels revealed a significantly higher rate of cancer in IgE-deficient children (3.2%) compared with those with normal (0.5%; odds ratio [OR]=7.84; 95% confidence interval [CI]: 1.94-31.61, P=0.004), high (0.2%; OR=25.80; 95% CI: 4.94-134.54, P=0.002), and very high IgE levels (0.2%; OR=42.17; 95% CI: 3.84-463.02, P<0.0001). All 3 IgE-deficient children had lymphoma. Malignancies in the other groups included lymphoma, leukemia, brain, liver, ovarian cancers.

Conclusions:

Malignancy rate was higher in IgE-deficient children compared with those with normal, high, or very high IgE levels, supporting the hypothesis that IgE deficiency may be a marker for malignancy susceptibility in children. Larger, prospective studies are necessary to further evaluate this association.
Intracranial Growing Teratoma Syndrome With Intraventricular Lipid Accumulation
Authors: Tasaka Keiji , Umeda Katsutsugu , Kamitori Tatsuya , Ogata Hideto , Mikami Takashi , Saida Satoshi , Kato Itaru , Hiramatsu Hidefumi , Arakawa Yoshiki , Uto Megumi , Mizowaki Takashi , Yoshizawa Akihiko , Adachi Souichi , Takita Junko
Published: August 2020

Growing teratoma syndrome is a well-recognized condition associated with both intracranial and extracranial nongerminomatous germ cell tumors (NGGCTs), which mostly manifest as rapid growth of cystic and solid components during or within several months after treatment. Here, we report a patient with NGGCT who experienced slow growth of intracranial growing teratoma syndrome with intraventricular lipid accumulation over 10 years without any clinical symptoms. Considering the clinicopathologic heterogeneity of this syndrome, long-term clinical and radiologic follow-up is required for all patients with intracranial NGGCT.
New insights on potential therapeutic options and vaccines for corona virus disease-2019
Authors: Wayah Samson Baranzan , Auta Richard , Waziri Peter Maitalata , Haruna Emmanuel
Published: August 2020

In December 2019, world health organization was acquainted of the outbreak of pneumonia of unknown cause. The causative agent was identified as a novel coronavirus and named severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and the disease coronavirus disease-19 (COVID-19). This disease is a pandemic, which has so far, caused more than 376 320 deaths globally. Owing to the high transmission and mortality of COVID-19, identifying ways to circumvent the imbroglio has become the top priority of researchers across different parts of the world. To date, no treatment or preventive approach has been developed. Two approaches can be employed to solve the conundrum, a curative/therapeutic and a preventive approach. The therapeutic approach can be divided into two aspects, blocking various aspects of viral entry into target cells and completion of its life cycle using antiviral drugs whereas the second aspect involves modification of host immune responses and inhibition of cell surface receptors and enzymes required for SARS-CoV-2 infection. The preventive approach involves the development of vaccines. Recent advances in the development of drugs targeting host cell receptors and enzymes, SARS-CoV-2-specific antibodies, immunomodulatory drugs, and vaccines have been discussed in this review.
Cytokine storm is the cryptic killer behind coronavirus disease-2019 infections, review of the current evidence to identify therapeutic options
Authors: Alrahmany Diaa , Ghazi Islam M.
Published: August 2020

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease 2019) is currently a rapidly disseminating viral infection that turned into a global pandemic with daily increasing mortality. The exaggerated host immune response (hypercytokinemia) caused by SARS-CoV-2 was found to be the main contributor to fatality rather than the genuine effect of the viral infection. The challenging situation caused by the absence of definitive antiviral therapy, as well as the implication of cytokine storm syndrome (CSS) in cases of SARS-CoV-2, necessitate screening for alternate therapeutic targets and examining the possibility of repurposing already approved drugs. Treatment of CSS using immunomodulators and immunosuppressants – indicated for inflammatory diseases, autoimmune diseases and viral infections, with acceptable safety and efficacy – represents a potential therapeutic option for reducing mortality associated with SARS-CoV-2. This article aims to review the role of cytokines in CSS, present an overview of immunomodulators and immunosuppressive clinically indicated to counteract the effect of cytokines with the overarching goal of drawing attention to potential therapeutic options for further investigation, clinical trials, and pharmaceutical research.
The Effects of Preoperative Education for Patients With Cancer
Authors: Kim Nayoung , Yang Jangmi , Lee Kyoung Suk , Shin In-Soo
Published: August 2020

Background

The results of previous experimental studies have been inconsistent in the effect of preoperative education on postoperative outcomes, and there have been no meta-analyses focusing solely on preoperative education for patients with cancer.

Objectives

To identify the magnitude and direction of the effects of preoperative education and to investigate the influence of moderators on postoperative outcomes for patients undergoing cancer-related surgery.

Methods

A systematic review and meta-analysis was conducted following the Cochrane guidelines. Electronic databases were searched until October 2019 using Cochrane database, MEDLINE, EMBASE, and CINAHL for randomized controlled trials and quasi-experimental studies on preoperative education interventions. Ten studies with 45 effect sizes were analyzed in this meta-analysis, and the standardized mean difference was calculated based on Hedges’ g as an effect size.

Results

Meta-analysis showed that the overall effect size of preoperative education was moderate. Preoperative education improved cancer patients’ knowledge and satisfaction and reduced pain. The effects of preoperative education were greater in younger age groups when delivered using verbal or combined educational methods.

Conclusion

This meta-analysis demonstrated the importance of preoperative educational interventions not only in terms of their surgery-related cognitive aspects but also in terms of the physical and psychological aspects linked to the cancer surgery.

Implications for Practice

Interventions to provide the most effective preoperative education for patients with cancer in the hospital setting are required, and this information can be used to develop evidence-based education strategies for patients undergoing cancer-related surgery.
Hispanic Children Hospitalized With Acute Lymphoblastic Leukemia Are at Increased Risk of Pancreatitis
Authors: Savage Beth , Cole Peter D. , Lin Haiqun , Thomas-Hawkins Charlotte
Published: August 2020

Background

There have been remarkable advances in overall survival following the diagnosis of acute lymphoblastic leukemia in childhood, but toxicities, including pancreatitis, remain a concern. Pancreatitis occurs early in therapy, before extensive exposure to the chemotherapy agents associated with its development, indicating there are underlying risk factors for some children. The role of race/ethnicity in treatment-related pancreatitis has not been well established.

Objective

The aim of this study was to examine the relationship between race/ethnicity and pancreatitis in children hospitalized with acute lymphoblastic leukemia in the United States in 2016.

Methods

This was an analysis of a nationally representative database of pediatric hospitalizations. The sample consisted of 21 775 records with documentation of the diagnosis of acute lymphoblastic leukemia. Statistical methods included descriptive statistics, bivariate analyses using the χ
2 test, and multilevel logistic regression models.

Results

Pancreatitis was documented in 1.6% of hospital discharges. Compared with white children, Hispanic children were at increased risk of pancreatitis during hospitalization (P = .002). There were no differences among black (P = .469), Asian (P = .364), or other-race children (P = .937).

Conclusions

Hispanic children hospitalized with acute lymphoblastic leukemia are at greater risk of pancreatitis than white children. Reasons for this disparity are likely due to both genetic and social factors.

Implications for Practice

Nurses must be active participants in the research process with the goal of enrolling patients with diverse backgrounds in clinical trials. Inclusive research will provide increased understanding of a holistic toxicity risk profile.
Complete Blood Count Collected Via Venipuncture Versus Peripherally Inserted Central Catheter in Hematological Patients
Authors: Ponticelli Elena , Clari Marco , Volpes Martina , Valenti Laura , Angioni Marco , Granero Daniele , Bert Mattia , Conti Alessio , Campagna Sara
Published: August 2020

Background

The use of peripherally inserted central catheters (PICCs) in cancer care is increasing over traditional central venous catheters. Nurses frequently collect blood by venipuncture when a PICC is inserted, as there is no available evidence to confirm the reliability of blood tests collected through PICCs in adults.

Objective

The aim of this study was to assess the reliability of blood samples for complete blood count (CBC) obtained through PICCs as an alternative to venipuncture.

Methods

A cross-sectional design was used to recruit adult hematological patients. The blood samples were collected within 5 minutes of each other by a specialist nurse. Hemoglobin, hematocrit, and platelet count were evaluated. To determine method comparison, Passing-Bablok regression, test of linearity, Pearson product-moment correlation coefficient, and Bland-Altman plots were used.

Results

Thirty paired blood samples were collected in 29 hematological patients with a mean age of 66.8 years. A statistical difference was found for hemoglobin (P = .001) and hematocrit (P = .001) levels, but no clinical difference. The regression models revealed no systematic differences and no proportional differences with a linear relationship between the methods. Bland-Altman plots highlighted a good agreement between methods.

Conclusion

Blood samples for CBC drawn by PICCs are as reliable as those collected via venipuncture. Blood sampling via PICC could be recommended in people with hematological malignancies in needs of frequent blood tests.

Implications for Practice

Sampling through a PICC provides reliable laboratory results for CBC, and it could reduce patients’ discomfort and increase the safety of professionals reducing the risk of accidental percutaneous needlestick injuries.
Family Members' Experience of Discussions on End-of-Life Care in Nursing Homes in Japan
Authors: Kato Hiroki , Tamura Keiko
Published: August 2020

In nursing homes, discussions between family members and staff regarding the end of life for residents with cognitive impairment are crucial to the choice of treatment and care consistent with residents' wishes. However, family members experience burden in such discussions, and communication with staff remains inadequate. The purpose of this qualitative descriptive study was to elucidate the meaning of continuous end-of-life discussion for family members. Data were collected using semistructured individual interviews. Thirteen family members of residents from 3 nursing homes in Kyoto, Japan, participated in the study. Data were analyzed using thematic analysis, which focused on both explicit and implicit meanings. Four themes emerged regarding the experience of end-of-life discussion: “the end of life soaking in,” “hardship of making the decision to end my family member's life,” “wavering thoughts about decisions made and actions taken,” and “feeling a sense of participation about the care.” Family members had come to accept the deaths of residents through continuous discussion and experienced strong conflict in facing the death of their family members. Moreover, staff members should understand family members' beliefs and the burden they experience in facing residents' death.
Measuring Virtual Reality Headset Resolution and Field of View: Implications for Vision Care Applications
Authors: Lynn Marissa Howard , Luo Gang , Tomasi Matteo , Pundlik Shrinivas , E. Houston Kevin
Published: August 2020

SIGNIFICANCE

To judge the feasibility of virtual reality (VR) headsets for vision testing and treatment of binocular vision disorders and low vision, angular resolution (logMAR) and field of view must be known and may not be reliably provided. This is the first study to measure the limitations of VR systems for eye care applications.

PURPOSE

This study aimed to measure, in a sample of VR headsets, lens power and other physical and optical characteristics needed to calculate minimum angular resolution in logMAR and field of view in determining feasibility for vision applications.

METHODS

Lens power and horizontal display size were measured, and logMAR, field of view, and maximum convergence demand were calculated for two standalone VR devices, Oculus Rift DK2 and HTC Vive, and, for four smartphone VR headsets, Zeiss VR1, Samsung Gear VR, VR Box, and SunnyPeak, each paired with four high-resolution smartphones, Samsung Galaxy S7/S8, iPhone X, and LG VR30.

RESULTS

On average, the smallest letter that could be displayed in VR was 0.55 ± 0.17 (20/71), ranging from 0.79 (20/123) in the DK2 to 0.28 (20/39) in SunnyPeak with S7. Mean field of view was 67.1 ± 18.0°, ranging from 39.6° in the SunnyPeak with S7 to 85.6° in the HTC Vive. The mean field of view when used as a low vision aid was 30.8° and 16.9° for 2.2× and 4×, respectively. The mean maximum near convergence demand produced for a 60-mm interpupillary distance was 68.2 ± 32.9Δ.

CONCLUSIONS

The minimum angular resolution in logMAR of current VR technology is insufficient for visual acuity testing and may be insufficient for standalone treatment of amblyopia. Field of view may be less than that reported by manufacturers but adequate for some types of visual field testing and similar to existing telescopic low vision aids. Use for vergence testing and training is a concern for headsets with long eye-to-screen distance when interpupillary distance <60 mm.
Embedding Brain Tissue for Routine Histopathology: A Processing Step Worthy of Consideration in the Digital Pathology Era
Authors: Nelson Bela G. , Patel Ela , Arth Dane , Nelson Peter T.
Published: August 2020

The importance of technical quality for histopathologic examination has only increased in recent years with the expanding use of digital pathology. The University of Kentucky Alzheimer’s Disease Center (UK-ADC) Neuropathology Core has decades of experience with brain histopathology and has emphasized the importance of quantitative assessments of histopathologic hallmarks. Technical artifacts and nonuniform samples are challenging for high-throughput digital analyses after the slides have been scanned, so that methodological optimization may be helpful. We do not know of published literature that systematically reviews how different procedures at the various stages of tissue processing can impact the quality of the histopathologic preparations in human brain samples. We wanted to pass along our experience in the hope that it will help others to improve their results. Here we describe the UK-ADC method of embedding for neuropathologic evaluation and provide specific examples (with a comparison to another processing workflow) that help support the idea that the methods and tools used in the embedding process can alter the quality of the formalin-fixed paraffin-embedded histopathologic results. The process used at the UK-ADC has been successful for us, but results may vary in relation to each embedding machine and with other factors.
Immunodetection of Epithelial-Mesenchymal Transition and Tumor Proliferation Markers in GLi-1-positive Oral Squamous Cell Carcinoma
Authors: Dantas Rebeca C.M. , Guimarães Vanessa S.N. , de Souza Renata O. , Valverde Ludmila F. , Vidal Manuela T.A. , Nogueira Raphael L.R. , da Rocha Leonardo O.S. , Araújo Giovana T. , dos Santos Jean N. , Rocha Clarissa A.G.
Published: August 2020

In oral squamous cell carcinoma (OSCC), involvement and activation of the Hedgehog pathway (HH) may be related to epithelial-mesenchymal transition and cell proliferation. The present study aimed to evaluate epithelial-mesenchymal transition and proliferative potential in OSCC cases demonstrating activation of the HH pathway. Twenty-three GLi-1-positive OSCC cases were submitted to immunohistochemical detection of Snail, Slug, N-cadherin, E-cadherin, β-catenin, and MCM3 proteins. Clinical-pathologic immunoexpression data were obtained from the invasion front and tumor islets, and then compared. At the invasion front, OSCC cases presented positive Snail, Slug, and MCM3 expression in the nuclei of tumor cells. Loss of membrane and cytoplasmic expression of E-cadherin and β-catenin was also observed. Positive N-cadherin expression was observed in 31.78% of the cases. GLi-1 immunoexpression was associated with loss of membrane E-cadherin (P<0.001), membrane β-catenin (P<0.001), and cytoplasmic β-catenin (P=0.02) expression. In the tumor islets, we observed nuclear expression of GLi-1, Snail, Slug, and MCM3. E-cadherin and β-catenin showed positivity in tumor cell membranes. Statistically significant positive correlations between GLi-1 and Snail (P=0.05), E-cadherin (P=0.01), and cytoplasmic β-catenin (P=0.04) were found. GLi-1 was associated with clinical staging, while membrane β-catenin expression was related to the presence of metastasis in lymph nodes and to clinical staging. The HH pathway may be involved in regulating the expression of the mesenchymal phenotype. The loss of membrane E-cadherin and β-catenin expression was observed at the tumor front region, whereas cell adhesion protein expression was detected in tumor islets regardless of MCM3.
Artificial Intelligence in Pathology: A Simple and Practical Guide
Authors: Yao Keluo , Singh Amol , Sridhar Kaushik , Blau John L. , Ohgami Robert S.
Published: August 2020

Artificial intelligence (AI) is having an increasing impact on the field of pathology, as computation techniques allow computers to perform tasks previously performed by people. Here, we offer a simple and practical guide to AI methods used in pathology, such as digital image analysis, next-generation sequencing, and natural language processing. We not only provide a comprehensive review, but also discuss relevant history and future directions of AI in pathology. We additionally provide a short tabular dictionary of AI terminology which will help practicing pathologists and researchers to understand this field.
Primary Pulmonary Myxoid Sarcoma and Myxoid Angiomatoid Fibrous Histiocytoma
Authors: Gui Hongxing , Sussman Robyn T. , Jian Bo , Brooks John S. , Zhang Paul J.L.
Published: August 2020

Primary pulmonary myxoid sarcoma (PPMS) is a recently reported, exceedingly rare low-grade lung neoplasm characterized by reticular/lace-like growth of spindle to epithelioid cells embedded in an abundant myxoid matrix. Morphologically, it overlaps with a myxoid variant of angiomatoid fibrous histiocytoma (AFH) of the soft tissue. Genetically, they were both reported to harbor EWSR1-CREB1 fusion, while EWSR1-ATF1 has only been reported in AFH thus far. We report a case of primary pulmonary low-grade myxoid spindle cell tumor with morphologic and immunohistochemical features of PPMS but with an EWSR1-ATF1 fusion gene. In addition, we also encountered a case of endobronchial AFH with EWSR1-CREB1 translocation but also focal morphologic features of PPMS. These findings provide new evidence supporting the concept that PPMS and a myxoid variant of AFH represent a continuum with overlapping histologic, immunohistochemical, and genetic features.
Aberrant GATA3 Staining in Prostatic Adenocarcinoma
Authors: McDonald Timothy M. , Epstein Jonathan I.
Published: August 2020

Distinguishing between poorly differentiated urothelial carcinoma and high-grade prostatic adenocarcinoma is a common challenge in genitourinary pathology, particularly when the tumor involves the bladder neck or prostatic urethra. Clinically, the distinction between these 2 tumors can also be difficult. Proper diagnosis in these patients is essential as they have differing prognoses and clinical management. GATA3 is thought to be a sensitive and relatively specific marker of urothelial carcinoma. However, there is scant data regarding GATA3 labeling of high-grade prostatic adenocarcinoma. The aim of this study is to describe rare cases with strong aberrant GATA3 staining in prostatic adenocarcinoma as a potential diagnostic pitfall. We identified 9 cases of prostatic adenocarcinoma with aberrant positive GATA3 staining from 2015 to 2020 as part of a large consultation service at our institution. All 9 cases were grade group 5, 8 had a Gleason score of 5+5=10 and 1 had a score of 4+5=9. Five of the cases were from the prostate, 3 from the urinary bladder, and 1 from the prostatic urethra. All cases were morphologically typical of high-grade prostatic adenocarcinoma, although were sent for consultation due to uncertainty in the diagnosis. GATA3 positivity was strong, diffuse in 4 cases; strong, patchy in 2 cases and strong, focal in 3 cases. All cases were positive for NKX3.1, 6 positive for p501s, and 6 positive for PSA, with 7/9 cases showing expression of at least 2 prostate-specific markers. The current study describes that rare cases of prostatic adenocarcinoma can show focal or diffuse strong staining for GATA3. In order to avoid this diagnostic pitfall, undifferentiated carcinomas involving the prostate, bladder neck, or trigone should be evaluated not only with GATA3 but also prostate-specific markers.
Effect of Pain Education, Cryotherapy, and Transcutaneous Electrical Nerve Stimulation on the Pain, Functional Capacity, and Quality of Life in Patients With Nonspecific Chronic Low Back Pain
Authors: Caldas Vinicius Vieira de Alencar , Maciel Daniel Germano , Cerqueira Mikhail Santos , Barboza Jean Artur Mendonça , Neto João Batista Viana , Dantas Glauko , de Melo Ronan Romeno Varela , de Souza Rachel Naara Silva , Vieira Wouber Herickson de Brito
Published: August 2020

Objective

The aim of the study was to analyze the effects of pain education and the combined use of cryotherapy and transcutaneous electrical nerve stimulation on the pain sensation, functional capacity, and quality of life of patients with nonspecific chronic low back pain.

Design

This is a randomized controlled and blind clinical trial including patients with nonspecific chronic low back pain in the following 4 groups: control group, cryotherapy group, burst transcutaneous electrical nerve stimulation group, and cryotherapy combined with burst transcutaneous electrical nerve stimulation group. They were evaluated at baseline and after the protocol was concluded using the following: Roland-Morris questionnaire and sit-to-stand test; quality-of-life questionnaire; and pain. The protocol consisted of 10 sessions with pain education associated the combination of the electrophysical agents.

Results

There were no statistical differences between groups after the intervention protocol. In the within analysis, all groups presented an improvement in visual analog scale scores, Roland-Morris questionnaire, sit-to-stand test, and pain domain of quality-of-life questionnaire.

Conclusions

This study showed that with pain education, there was no difference between cryotherapy and transcutaneous electrical nerve stimulation alone, combined, or placebo mode in improving pain, functional capacity, and quality of life in patients with nonspecific chronic low back pain.
Prevalence and Effect of Obesity on Mobility According to Different Criteria in Polio Survivors
Authors: Seo Kyoung-Ho , Lee Joong Hoon , Lee Seung-Yeol , Lee Jae Yon , Lim Jae-Young
Published: August 2020

Objective

Obesity is a major and functionally important problem in polio survivors. The aim of this study was to investigate the prevalence of obesity using body mass index and percentage body fat in polio survivors and to analyze the relationship between obesity and mobility.

Design

Eighty-four polio survivors were included. Anthropometric parameters, knee extensor strength, and the Short Physical Performance Battery were evaluated. A questionnaire was used to explore the late effects of poliomyelitis. Obesity was determined using both body mass index and percentage body fat.

Results

The prevalence of obesity in polio survivors was 39.3% and 81.5% using the body mass index and percentage body fat criteria, respectively. The Short Physical Performance Battery scores were significantly different between the obese and nonobese groups as determined by percentage body fat (P < 0.05). Only percentage body fat was significantly associated with mobility after controlling for the confounding variables in obese polio survivors (P < 0.05).

Conclusions

Obesity in polio survivors was underestimated when the body mass index criteria were used. Percentage body fat was a significantly associated factor for mobility in obese polio survivors. Obesity determined by percentage body fat criteria is useful to address obesity-related problems in polio survivors.
Expert Consensus on Currently Accepted Measures of Harm
Authors: Logan Merranda S. , Myers Laura C. , Salmasian Hojjat , Levine David Michael , Roy Christopher G. , Reynolds Mark E. , Sato Luke , Keohane Carol , Frits Michelle L. , Volk Lynn A. , Akindele Ruth N. , Randazza Juliette M. , Dulgarian Sevan M. , Shahian David M. , Bates David Westfall , Mort Elizabeth
Published: August 2020

Background

Twenty-five years after the seminal work of the Harvard Medical Practice Study, the numbers and specific types of health care measures of harm have evolved and expanded. Using the World Café method to derive expert consensus, we sought to generate a contemporary list of triggers and adverse event measures that could be used for chart review to determine the current incidence of inpatient and outpatient adverse events.

Methods

We held a modified World Café event in March 2018, during which content experts were divided into 10 tables by clinical domain. After a focused discussion of a prepopulated list of literature-based triggers and measures relevant to that domain, they were asked to rate each measure on clinical importance and suitability for chart review and electronic extraction (very low, low, medium, high, very high).

Results

Seventy-one experts from 9 diverse institutions attended (primary acceptance rate, 72%). Of 525 total triggers and measures, 67% of 391 measures and 46% of 134 triggers were deemed to have high or very high clinical importance. For those triggers and measures with high or very high clinical importance, 218 overall were deemed to be highly amenable to chart review and 198 overall were deemed to be suitable for electronic surveillance.

Conclusions

The World Café method effectively prioritized measures/triggers of high clinical importance including those that can be used in chart review, which is considered the gold standard. A future goal is to validate these measures using electronic surveillance mechanisms to decrease the need for chart review.
The Morbidity and Mortality Conference: Opportunities for Enhancing Patient Safety
Authors: Lazzara Elizabeth H. , Salisbury Mary , Hughes Ashley M. , Rogers Jordan E. , King Heidi B. , Salas Eduardo
Published: August 2020

Since the 20th century, health care institutions have used morbidity and mortality conferences (MMCs) as a forum to discuss complicated cases and fatalities to capitalize on lessons learned. Medical technology, health care processes, and the teams who provide care have evolved over time, but the format of the MMC has remained relatively unchanged. The present article outlines 5 key areas for improvement within the MMC along with prescriptive and actionable recommendations for mitigating these challenges. This work incorporates the contributions of numerous researchers and practitioners from the educational, training, debrief, and health care fields. With the best practices and lessons learned from various domains in mind, we recommend optimizing the MMC by (1) encouraging a culture that leverages expertise from multiple sources, (2) allocating ample time for innovative thinking, (3) using a global approach that considers individual, team, and system-level factors, (4) leveraging learnings from errors as well as near misses, and (5) promoting communication, innovative thinking, and actionable planning. The 5 evidence-based recommendations herein serve to ensure that MMCs are structured learning events that promote, encourage, and support safe, reliable care. Furthermore, the outlined recommendations seek to capitalize upon the MMC’s opportunity to engage early discovery as well as proactive risk assessment and action-oriented solutions.
A Noninvasive Stroke Volume Monitoring for Early Detection of Minimal Blood Loss: A Pilot Study
Authors: Epstein Danny , Guinzburg Ariel , Sharon Saar , Kiso Shai , Glick Yuval , Marcusohn Erez , Glass Yehuda Daniel , Miller Asaf , Minha Sa’ar , Furer Ariel
Published: August 2020

Introduction:

Alternation in traditional vital signs can only be observed during advanced stages of hypovolemia and shortly before the hemodynamic collapse. However, even minimal blood loss induces a decrease in the cardiac preload which translates to a decrease in stroke volume, but these indices are not readily monitored. We aimed to determine whether minor hemodynamic alternations induced by controlled and standardized hypovolemia can be detected by a whole-body bio-impedance technology.

Methods:

This was a non-randomized controlled trial that enrolled healthy blood donors. Vital signs, as well as shock index and stroke volume (SV), were recorded using noninvasive cardiac system, a noninvasive whole-body impedance-based hemodynamic analysis system, during phlebotomy.

Results:

Sixty subjects were included in the study group and 20 in the control group. Blood loss of 450 mL resulted in a significant decrease in systolic blood pressure (5 mm Hg; 95% CI 3, 6) and SV (5.07 mL; 95% CI 3.21, 6.92), and increase in shock index (0.03 bpm/mm Hg; 95% CI 0.01, 0.05). Clinically detectable changes (≥10%) in blood pressure and shock index were detectable in 15% and 5%, respectively. SV decreased by more than 10% in 40% of blood donors. No significant changes occurred in the control group.

Conclusion:

Continuous noninvasive monitoring of SV may be superior to conventional indices (e.g., heart rate, blood pressure, or shock index) for early identification of acute blood loss. As an operator-independent and point-of-care technology, the SV whole body bio-impedance measurement may assist in accurate monitoring of potentially bleeding patients and early identification of hemorrhage.