bluuebunny/crossref_metadata_2025 huggingface dataset:
Temporal Bone Histopathology of First-Generation Cochlear Implant Electrode Translocation
Authors: Ishiyama Akira , Ishiyama Gail , Lopez Ivan A. , Linthicum Fred H.
Published: May 2019

Objective:

To evaluate the histopathology of human temporal bones (HTBs) with cochlear implants (CI).

Background:

Understanding CI translocation injuries is critical for improving outcomes.

Material and Methods:

Thirteen HTBs from 12 CI patients were studied. Six HTBs exhibited translocation with localized injury (Group 1) and seven HTBs exhibited translocation with significant lateral wall injury (Group 2). There were no significant differences between Group 1 and Group 2 for age at death, age at implantation, and years with CI.

Results:

Four out of six of Group 1 had round window approach, while all seven of Group 2 had cochleostomy approach. Translocation injuries tended to occur near 180 degrees of angular insertion with a mean of 186.36 ± 51.62 degrees. Average CI insertion length for Group 2 was 21.86 ± 2.55 mm, significantly longer than Group 1 at 18.50 ± 3.33 mm (p = 0.031). Group 1 had an average of 17300 ± 9415 spiral ganglia neurons (SGNs) while Group 2 had significantly fewer SGNs 6714 ± 4269 (p = 0.015). Group 1 average auditory performance of 66.55 ± 27.20% was higher than that of Group 2 of 39.86 ± 15.36%. Group 2 had a high degree of osteoneogenesis and infiltration of cells generally localized to areas of translocation injury and cochleostomy.

Conclusion:

Translocation injuries tend to occur at an insertion angle of 180 degrees, at 9 to 10 mm. Lateral wall injury and damage to the organ of Corti incites fibrosis, osteoneogenesis, and infiltration, lower SGN count and poorer auditory performance. Longer electrodes were more prone to translocation and higher chance of significant intracochlear injury.
Non-microscopic Middle Ear Cholesteatoma Surgery: A Case Report of a Novel Head-Up Approach
Authors: Minoda Ryosei , Miwa Toru
Published: May 2019

Objective:

To assess the feasibility of a postauricular transcortical mastoidectomy utilizing an exoscope, which offers 3D stereoscopic visualization.

Study Design:

Clinical capsule report.

Patients:

Two consecutive patients with cholesteatoma involvement in the mastoid cavity were included in the study.

Intervention:

After transcanal endoscopic surgery, postauricular mastoidectomy utilizing a surgical 3D exoscope was performed. Then, the cholesteatoma in the mastoid cavity was removed through the mastoidectomy opening with endoscopes.

Results:

The postauricular transcortical mastoidectomy utilizing a 3D exoscope was not only feasible, but importantly, the exoscope took little time to switch to and resulted in a smooth workflow. There was no cholesteatoma recurrence at 9 months.

Conclusion:

During endoscope-based surgery, in patients with cholesteatoma mastoid involvement, we can continue to perform the surgical procedure in a heads-up position utilizing a surgical 3D exoscope. The combination of transcanal endoscopic ear surgery and the postauricular transcortical mastoidectomy utilizing a surgical 3D exoscope is a very novel treatment strategy for cholesteatoma, and it gives us a comfortable and consistent working environment in endoscope-based ear surgery.
Patterns of Marijuana Use Among Patients With Celiac Disease in the United States
Authors: Knotts Rita M. , Zylberberg Haley M. , Jodorkovsky Daniela , Green Peter H.R. , Lebwohl Benjamin
Published: May 2019

Background:

Marijuana use has been assessed in patients with chronic gastrointestinal disorders and may contribute to either symptoms or palliation. Use in those with celiac disease (CD) has not been assessed. Our aim was to evaluate patterns of marijuana use in a large population-based survey among patients with CD, people who avoid gluten (PWAG), and controls.

Study:

We analyzed data from the National Health and Nutrition Examination Survey from 2009 to 2014. χ2 tests and multivariable logistic regression were used to compare participants with CD and PWAG to controls regarding the use of marijuana.

Results:

Among respondents who reported ever using marijuana (overall 59.1%), routine (at-least monthly) marijuana use was reported by 46% of controls versus 6% of participants with diagnosed CD (P=0.005) and 66% undiagnosed CD as identified on serology (P=0.098) and 51% of PWAG (P=0.536). Subjects with diagnosed CD had lower odds of routine marijuana use compared with controls (odds ratio, 0.08; 95% confidence interval, 0.01-0.73), whereas participants with undiagnosed CD had increased odds of routine use (odds ratio, 2.26; 95% confidence interval, 0.83-6.13), which remained elevated even after adjusting for age, sex, race/ethnicity, health insurance status, alcohol, tobacco use, educational level, and poverty/income ratio.

Conclusions:

In all groups, marijuana use was high. Although there were no differences among subjects with CD, PWAG, and controls who ever used marijuana, subjects with diagnosed CD appear to have decreased routine use of marijuana when compared with controls and PWAG. Those with undiagnosed CD have significantly higher rates of regular use. Future research should focus on the utilization of marijuana as it may contribute to further understanding of symptoms and treatments.
Bouveret Syndrome
Authors: Ong John , Swift Carla , Stokell Benjamin G. , Ong Sharon , Lucarelli Pierino , Shankar Arun , Rouhani Foad J. , Al-Naeeb Yasseen
Published: May 2019

Background and Goals:

Bouveret syndrome is characterized by gastroduodenal obstruction caused by an impacted gallstone. Current literature recommends endoscopic therapy as the first line of intervention despite significantly lower success rates compared with surgery. The lack of treatment efficacy studies and the paucity of clinical guidelines contribute to current practices being arbitrary. The aim of this systematic review was to identify factors that predict outcomes of endoscopic therapy. Subsequently, a predictive tool was devised to predict the success of endoscopic therapy and recommendations were proposed to improve current management strategies of impacted gallstones in the upper gastrointestinal tract.

Methods:

A systematic search of PubMed, Medline, Cochrane, and Scopus was performed for articles that contained the terms “Bouveret syndrome,” “Bouveret’s syndrome,” “gallstone” AND “gastric obstruction” and “gallstone” AND “duodenal obstruction” that were published between January 1, 1950 to April 15, 2018. Articles were reviewed by 3 reviewers and raw data collated. χ2 and Kolmogorov-Smirnov tests were used to test associations between predictors and endoscopic outcomes. A logistic regression model was then used to create a predictive tool which was cross validated.

Results:

Failure of endoscopic therapy is associated with increasing gallstone length (P<0.0001) and impaction in the distal duodenum (P<0.05). Using multiple endoscopic modalities is associated with better success rates (P<0.05). The novel predictive tool predicted success of endoscopic therapy with an area under the receiver operating characteristic score of 0.86 (95% confidence interval: 0.79-0.94).

Conclusion:

In Bouveret syndrome, a selective approach to endoscopic therapy can expedite definitive treatment and improve current management strategies.
Immunosuppressive drug withdrawal late after liver transplantation improves the lipid profile and reduces infections
Authors: Duizendstra Aafke A. , de Knegt Robert J. , Betjes Michiel G.H. , Coenen Sandra , Murad Sarwa Darwish , de Man Rob A. , Metselaar Herold J. , Sprengers Dave , Litjens Nicolle H.R. , Kwekkeboom Jaap
Published: May 2019

Background

Treatment with immunosuppressive drugs (IS) after transplantation is accompanied by severe side effects. A limited number of studies have investigated the effect of IS withdrawal on IS-related comorbidities after liver transplantation (LTx) and the results are contradictory.

Patients and methods

We determined in a retrospective case–control study the clinical effects of complete IS withdrawal in operationally tolerant (TOL) LTx recipients who discontinued IS 10.8 ± 5.1 years after LTx (n = 13) compared with a completely matched control (CTRL) group with a regular IS regimen (n = 22). TOL recipients have been IS and rejection free for 4.0 ± 2.8 years.

Results

IS withdrawal in TOL recipients resulted in lower low-density lipoprotein levels (P = 0.027), whereas this was not observed in the CTRL group. Furthermore, persistent infections in individual recipients were resolved successfully by IS withdrawal. TOL recipients also had significantly fewer de novo infections after IS withdrawal (TOL pre vs. post withdrawal P = 0.0247) compared with recipients continued on IS during the same follow-up period (post withdrawal TOL vs. CTRL P = 0.044). Unfortunately, no improvement in kidney function, and lower rates of de novo occurrences of diabetes, hypertension, cardiovascular diseases, and malignancies were observed in the TOL group after IS withdrawal compared with the CTRL group during the same follow-up time period.

Conclusion

IS withdrawal late after LTx reduces infection rates and low-density lipoprotein levels, but other IS-related side effects persist late after LTx. An accurate tolerance immune profile enabling identification of tolerant LTx recipients eligible for safe IS withdrawal earlier after transplantation is needed to prevent the development of irreversible IS-related side effects.
Analysis of the Course of Chronic Pancreatitis
Authors: Hirth Michael , Weiss Christel , Hardt Philip , Gubergrits Natalia , Härtel Nicolai , Ebert Matthias P. , Schneider Alexander
Published: May 2019

Objectives

The pancreatic burnout hypothesis postulated an increasing absence of pain with simultaneous functional insufficiency in advanced stages of chronic pancreatitis (CP). However, the underlying data remain scarce and contradictory. We aimed to analyze, first, the frequency of a pancreatic burnout in CP, and, second, its association with etiological risk factors.

Methods

We performed a multicenter, retrospective, cross-sectional study with 741 patients with CP categorized according to the M-ANNHEIM classification. Pancreatic burnout was defined by different combinations of exocrine or endocrine insufficiency with partial or complete absence of abdominal pain.

Results

The frequency of a pancreatic burnout increased with prolonged disease duration and was observed in a maximum of 38% of patients after 20 years. Development of a pancreatic burnout was significantly associated with alcohol consumption (P < 0.05, Mann-Whitney U test), but not with other etiological risk factors. After a disease duration of more than 10 years, the likelihood of a burnout was 8 times higher in alcoholic CP than in nonalcoholic CP (95% confidence interval, 1.5–42.0; P = 0.015, logistic regression analysis).

Conclusions

A pancreatic burnout does not regularly occur in CP. Increased burnout rates are only observed in patients with alcoholic CP.
Prognostic Validity of the American Joint Committee on Cancer Eighth Edition TNM Staging System for Surgically Treated and Well-Differentiated Pancreatic Neuroendocrine Tumors
Authors: Yang Min , Zhang Yi , Zeng Lin , Ke Neng-wen , Tan Chun-lu , Tian Bo-le , Xiang Bo , Liu Xu-bao
Published: May 2019

Objectives

We aimed to validate the novel American Joint Committee on Cancer (AJCC) eighth edition staging manual for well-differentiated (G1/G2) pancreatic neuroendocrine tumors (pNETs).

Methods

Data of eligible patients were retrospectively collected, grouped, and analyzed by applying the new AJCC system.

Results

According to the AJCC eighth staging manual for pNETs, 93, 66, 53, and 42 patients had stage I, II, III, and IV disease, respectively, with estimated 5-year overall survival (OS) rates of 96.9%, 92.8%, 48.4%, and 16.8% (P < 0.005), respectively. A total of 57, 28, 20, and 17 patients with G1 pNETs and 36, 38, 33, and 25 ones with G2 tumors were defined by the new AJCC system as having stage I, II, III, and IV disease, respectively. The estimated 5-year OS for stage I, II, III and IV disease was 100.0%, 97.1%, 52.5%, and 18.2%, respectively, for G1 pNETs (P < 0.005) and 94.2%, 90.3%, 38.7%, and 12.7%, respectively, for G2 tumors (P < 0.005). The novel AJCC classification, tumor grading, and radical resection were all prognostic predictors for OS in patients with pNETs.

Conclusions

The new AJCC eighth staging system for well-differentiated pNETs was prognostic and might be adopted in clinical practice.
Apigenin Decreases Acinar Cell Damage in Pancreatitis
Authors: Mrazek Amy A. , Bhatia Vandanajay , Falzon Miriam , Spratt Heidi , Chao Celia , Hellmich Mark R.
Published: May 2019

Objective

Chronic pancreatitis is the consequence of multiple episodes of recurrent acute pancreatitis (RAP). We hypothesized that apigenin can minimize the sequelae of RAP by limiting acinar cells' proinflammatory signaling pathways.

Methods

AR42J acinar cells were treated in vitro with transforming growth factor β (TGF-β), apigenin, and other inhibitors. Dual luciferase reporter assay measured parathyroid hormone–related protein (PTHrP) promoter activity. MAPK/ERK pathway activity was assessed by immunoblotting and in vivo by immunohistochemistry with a cerulein-induced RAP mouse model. Nuclear factor κ B nuclear localization was analyzed in vitro in cells stimulated with tumor necrosis factor α. Primary acini were isolated and treated with cerulein; interleukin 6 messenger RNA was measured comparing PTHrP wild-type and knockout mice.

Results

Apigenin and PD98059 each downregulated TGF-β stimulation of PTHrP P3 promoter activity. In a RAP mouse model, apigenin reduced pERK nuclear localization in acinar cells and preserved acinar cell architecture. Apigenin suppressed tumor necrosis factor α–mediated signaling by decreasing nuclear factor κ B nuclear localization and decreased interleukin 6 messenger RNA levels via a PTHrP-dependent mechanism.

Conclusions

Apigenin reduced inflammatory responses in experimental models of RAP. The mechanisms mediating the actions of apigenin, in part, are owing to attenuation of PTHrP and TGF-β proinflammatory signaling.
Thrombopoietin Contributes to Extreme Thrombocytosis After Pediatric Pancreatectomy With Islet Autotransplantation
Authors: Gurria Juan P. , Boucher Alexander A. , Hornung Lindsey , Palumbo Joseph S. , Badia Priscila , Luchtman-Jones Lori , Abu-El-Haija Maisam , Lin Tom K. , Nathan Jaimie D.
Published: May 2019

Objective

This study aims to explore the role of thrombopoietin (TPO) production in extreme thrombocytosis that is often observed after pancreatectomy with islet autotransplantation (IAT) and the effectiveness of hydroxyurea in thrombocytosis management.

Methods

Retrospective chart review was performed for all patients who underwent pancreatectomy with IAT at our institution between April 1, 2015, and December 31, 2016. Data evaluated included demographics, platelet counts, TPO levels, and thrombocytosis management strategies.

Results

Twelve total and 1 subtotal pancreatectomy with IAT cases were reviewed. All operations included splenectomy. No major surgical or thrombotic complications occurred. Thrombopoietin levels, normal preoperatively, rose significantly (median, 219 pg/mL) soon after surgery, peaking on median postoperative day 3. Platelet counts, also normal preoperatively, increased within a week of surgery, with 92% over 1000 K/μL (median peak platelet count, 1403 K/μL). Platelet counts and TPO levels dropped after hydroxyurea initiation in most patients.

Conclusions

After pancreatectomy with IAT, patients experienced marked TPO rise and subsequent thrombocytosis, and both decreased significantly after hydroxyurea initiation. These data suggest that TPO elevation and associated increased platelet production may be one driver of early extreme post–total pancreatectomy with islet autotransplantation thrombocytosis, and this process may be modulated by hydroxyurea.
Predicting Pancreatic Cancer Resectability and Outcomes Based on an Objective Quantitative Scoring System
Authors: Toesca Diego A.S. , Jeffrey R. Brooke , von Eyben Rie , Pollom Erqi L. , Poullos Peter D. , Poultsides George A. , Fisher George A. , Visser Brendan C. , Koong Albert C. , Chang Daniel T.
Published: May 2019

Objective

To quantitatively assess the probability of tumor resection based on measurements of tumor contact with the major peripancreatic vessels.

Methods

This is a retrospective cohort study of pancreatic cancer patients treated between January 2001 and December 2015 in a single academic comprehensive cancer center. Radiographic measurements of the circumferential degree and length of solid tumor contact with major peripancreatic vessels were obtained from diagnostic pancreatic protocol computed tomography images and tested for correlation with tumor resection and margin status.

Results

Of 294 patients analyzed, 113 (38%) were resected, with 71 (63%) with negative margins. Based on the individual measurements of vascular involvement, a resectability scoring system (RSS) was created. The RSS correlated strongly with resection (P < 0.0001) and R0 resection (P < 0.0001) probabilities. Moreover, the RSS correlated with overall survival (P < 0.0001) and metastasis-free survival (P < 0.0001), being able to substratify resectable (P = 0.022) and unresectable patients (P = 0.014) into subgroups with different prognosis based on RSS scores.

Conclusions

Based on a comprehensive and systematic quantitative approach, we developed a scoring system that demonstrated excellent accuracy to predict tumor resection, surgical margin status, and prognosis.
Change in Functional Beta Cell Capacity With Time Following Autologous Islet Transplantation
Authors: Ali Khawla F. , San Martin Vicente T. , Walsh R. Matthew , Bottino Rita , Stevens Tyler , Trucco Massimo , Hatipoglu Betul
Published: May 2019

Objectives

Autologous islet transplantation (AIT) is performed to preserve insulin secretory function in chronic pancreatitis patients undergoing total pancreatectomy (TP). No data exist on the effect of time lapse on beta cell function post TP-AIT. We aimed to investigate the factor of time lapse on beta cell function following TP-AIT.

Methods

Retrospectively, we identified 31 adult patients with chronic pancreatitis who underwent TP-AIT between 2008 and 2016. Changes in beta cell function were assessed using (1) BETA-2 scores and (2) analysis of posttransplant mixed-meal tolerance testing.

Results

Significant decrease in functional beta cell capacity expressed by BETA-2 scores was seen in the first 2 years following TP-AIT, with an annual decrease of 6.3 points in median BETA-2 score (interquartile range, 4.6–11.6; P = 0.002). In the mixed-meal tolerance testing analysis, nonsignificant trends toward higher glucose, lower insulin, and lower C-peptide were seen with time lapse. Additionally, higher hemoglobin A1c values (P = 0.033) and higher insulin requirements (P = 0.04) were seen with longer follow-up after AIT.

Conclusions

A steady drop in functional beta cell capacity was observed in the 2 years following TP and AIT. To our knowledge, to date this is the first report of the BETA-2 score applicability in the AIT setting.
A Comparison of Endoscopic Retrograde Pancreatography With or Without Pancreatoscopy for Removal of Pancreatic Duct Stones
Authors: Han Samuel , Shah Raj J. , Brauer Brian C. , Edmundowicz Steven A. , Hammad Hazem T. , Wagh Mihir S. , Wani Sachin , Attwell Augustin R.
Published: May 2019

Objectives

Pancreatic duct stones contribute to pain in patients with chronic pancreatitis, and per-oral pancreatoscopy (POP) allows visualization, fragmentation, and removal of these stones. This study compared the safety and efficacy of endoscopic retrograde pancreatography (ERP) with and without POP.

Methods

This single-center retrospective review compared ERP with and without POP for treatment of main-duct pancreatic duct stones. The primary outcome was technical success, defined as partial or complete stone removal, which was compared between the 2 groups.

Results

In all, 223 patients underwent 549 ERPs with a technical success rate of 92.4% and complete stone clearance rate of 74.9%. Patients undergoing ERP with POP (n = 94) had higher technical success than patients undergoing ERP without POP (n = 129, 98.9% vs 87.6%, P < 0.001), but required more ERPs (3.1 vs 1.9, P = 0.02). Endoscopic retrograde pancreatography with POP was associated with larger stone size (8.9 vs 6.1 mm, P = 0.001), more stones per case (5+ stones: 33.8% vs 21.1%, P = 0.002), and more impacted stones (48.8% vs 10.3%, P < 0.001).

Conclusions

Per-oral pancreatoscopy–guided lithotripsy permits effective stone removal in cases not amenable to standard ERP techniques, including those with larger or more numerous stones.
Disconnected Pancreatic Duct in Children With Walled OFF Necrosis
Authors: Nabi Zaheer , Basha Jahangeer , Lakhtakia Sundeep , Shava Upender , Pal Partha , Ramchandani Mohan , Gupta Rajesh , Kalapala Rakesh , Darisetty Santosh , Tandan Manu , Reddy Duvuur Nageshwar
Published: May 2019

Objectives:

Disconnected pancreatic duct syndrome (DPDS) is frequently encountered in cases with walled off necrosis (WON). The impact of DPDS on the outcomes of pancreatic fluid collections (PFCs) is not well known. In this study, we aim to evaluate the incidence of DPDS and its clinical impact on the outcomes of endoscopic ultrasound (EUS)‐guided drainage of PFC in children.

Methods:

All children with symptomatic WON who underwent EUS‐guided drainage using metal stents were included in the study. At 4 weeks, pancreatic ductal anatomy was evaluated, and metal stents removed. All the children were followed at regular intervals and evaluated for the recurrence of PFC and the development of new‐onset diabetes.

Results:

A total of 32 children (28 boys, median age 15 years) underwent EUS‐guided drainage of WON. Resolution of WON was documented in all children at 4 weeks. Pancreatic ductal anatomy using magnetic resonance retrograde cholangiopancreatography and endoscopic retrograde pancreatography was available in 30 (93.7%) children. Of these, DPDS was documented in 25 (83.3%) children including proximal disconnection in 12 and distal disconnection in 13 children. Recurrent PFC and new‐onset diabetes were found in 5 (20%) and 2 (8%) children with DPDS, respectively. Of the 5 recurrences of PFC, endoscopic reintervention was required in 3 children.

Conclusions:

Majority of the children with DPDS do not develop a symptomatic recurrence of PFC after the removal of cystogastric stents. DPDS may be a risk factor for the development of new‐onset diabetes. However, future prospective studies are needed.
Group Treatment of Fecal Incontinence
Authors: Gonring Kelsey , Dolan Bridget , Kapke Theresa L. , Begotka Andrea , Sood Manu , Silverman Alan H.
Published: May 2019

Introduction:

Approximately 5% of children in the United States have chronic fecal incontinence. Unfortunately, standard medical management of fecal incontinence fails in 20% to 60% of cases. A combined medical‐behavioral model is often recommended in these cases. The purpose of this pilot study was to describe an interdisciplinary group‐based treatment for fecal incontinence in school‐aged children, and to present a description of changes in treatment adherence rates that affect clinical effectiveness.

Method:

Poop group employed a developmentally appropriate model of care in which caregivers and children participated in separate but simultaneously held therapy groups. This interdisciplinary 6‐week protocol is designed to increase appropriate stooling, decrease soiling events, and increase medication adherence pre‐ to post‐treatment. Group sessions focus on the GI system, medication, toilet sitting posture, hydration, fiber, and behavior contracts. In addition, participant families consult with an Advanced Nurse Practitioner privately at each session discussing symptoms and making medication modifications as needed.

Results:

Nineteen families completed the 6‐week protocol. Appropriate stool frequency was improved (P ⩽ 0.01), and soiling was reduced (P ⩽ 0.00). Medication adherence was also improved (P ⩽ 0.04). Treatment results were maintained at 1‐month follow‐up.

Discussion:

A developmentally targeted intervention and interdisciplinary focus of treatment likely account for treatment successes.

Conclusion:

Poop group may be an effective interdisciplinary treatment option for families of children who fail traditional outpatient treatment.
A Randomized Trial of Maternal Docosahexaenoic Acid Supplementation to Reduce Inflammation in Extremely Preterm Infants
Authors: Valentine Christina J. , Dingess Kelly A. , Kleiman Jeanne , Morrow Ardythe L. , Rogers Lynette K.
Published: May 2019

Maternal supplementation with 1000 mg/day docosahexaenoic acid (DHA) provides third trimester DHA accretion levels in breast milk for the preterm infant. We hypothesized that DHA supplementation to mothers providing breastmilk for extremely preterm infants would result in decreased inflammatory markers, in the infant. Mother/infant dyads (n = 27) were enrolled at birth and mothers were assigned to receive 200 or 1000 mg/day of DHA. Milk and plasma samples were analyzed for fatty acids and inflammatory markers. Decreases in inflammation were observed in both maternal and infant plasma and correlated with red blood cell (RBC) DHA levels. The fact that maternal DHA supplementation decreases infant markers of inflammation implies that DHA, delivered through breastmilk, has the potential to decrease inflammation in the infant.
The Prosthetic Mobility Questionnaire, a tool for assessing mobility in people with lower-limb amputation: validation of PMQ 2.0 in Slovenia
Authors: Burger Helena , Giordano Andrea , Bavec Andrej , Franchignoni Franco
Published: May 2019

The aim of this study was to examine the metric properties of the Prosthetic Mobility Questionnaire, an outcome measure of mobility following lower-limb amputation, in Slovene outpatients undergoing rehabilitation. The 12-item Prosthetic Mobility Questionnaire was administered to 148 Slovene adults (74% men) with unilateral lower-limb amputation since >12 months and regularly wearing a prosthesis. The psychometric analysis included classical test theory methods and Rasch models. Rasch analysis disclosed two pairs of locally dependent items (same task but in opposite directions: walk up/down stairs; walk up/down a hill). Thus, we devised a new version (PMQ 2.0) assessing all 12 Prosthetic Mobility Questionnaire items but calculating the global score on only 10, i.e. considering–for each pair of locally dependent items–just the item with worst performance. The PMQ 2.0 demonstrated correct functioning of rating scale categories, construct validity (item fit, hierarchy of item difficulties), convergent validity, high-reliability indices and unidimensionality. In conclusion, the new 10-item PMQ 2.0 shows good reliability and validity, and an excellent overall metric quality for measuring perceived mobility capabilities in people with lower-limb amputation.
Transitioning Patients to Independence
Authors: Arcilla Diane , Levin Debra , Sperber Marie
Published: May 2019

Approximately one in four to five patients discharged from the hospital is rehospitalized within 30 days. Through the Grotta Fund for Senior Care, we implemented a program to address rehospitalizations among patients with chronic conditions including congestive heart failure, chronic obstructive pulmonary disease, and diabetes mellitus. Patients were introduced to telehealth by a transitions coach while still in the inpatient setting. Patients received three coaching visits, daily monitoring of vital signs, and daily monitoring for signs/symptoms of exacerbation. Patients were educated on disease-specific red flags, participated in role playing, and received two visits with a dietitian who went grocery shopping with them. The 30-day rehospitalization rate for patients participating in the program (n = 102) was 7.8%. The number of hospitalizations in the 90 days prior to the program totaled 126. This was compared with 36 hospitalizations in the 90 days after admission to the program. The Wilcoxon T+ test shows there is a statistically significant difference in the number of hospitalizations (p < .0001). Giving chronically ill patients the tools and support to become independent in their care was shown to decrease hospitalizations.
Ileostomy Care
Authors: Berti-Hearn Linda , Elliott Brenda
Published: May 2019

This article focuses on the care and management of patients living with an ileostomy. Due to shortened hospital stays, patient teaching related to self-care of ostomies has shifted from the hospital to the home setting. It is important for home care clinicians to be knowledgeable about all aspects of ostomy care. Patients with ileostomies are particularly prone to peristomal skin problems, as well as fluid and electrolyte and nutritional imbalances. This article reviews the anatomy and physiology of the gastrointestinal tract, indications for the creation of an ileostomy, and prevention and treatment of early and late complications. Practical advice on ileostomy care and patient teaching is provided.
Acquired Hearing Loss, Anger, and Emotional Distress
Authors: Ferrari Silvia , Monzani Daniele , Gherpelli Chiara , MacKinnon Andrew , Mongelli Francesca , Federici Gaia , Forghieri Matilde , Galeazzi Gian Maria
Published: May 2019

The aim of the study was to test whether acquired hearing loss (AHL)–related perceived disability mediates the association between AHL and psychological outcomes, including anger. Two-hundred ninety-seven consecutive outpatients with AHL assessed by pure tone average (PTA) loss completed the following: Hearing Handicap Inventory for Adults (HHIA), State-Trait Anger Expression Inventory–2 (STAXI-2), Brief Symptom Inventory (BSI), Diagnostic Criteria for Use in Psychosomatic Research (DCPR), and Social Functioning Questionnaire. In the sample, composed of 44.5% males with a mean age of 53.8 and a mean PTA of 30.7, AHL was associated to perceived hearing handicap, also correlating to all psychological measures except DCPR demoralization. Associations were stronger between the HHIA–Emotional Subscale, STAXI-2 State Anger and Feeling Angry, and BSI-Somatization, Interpersonal Sensitivity, Depression, and Psychoticism. Perceived disability predicted the presence of almost all psychosocial outcomes and confirms to be the most significant target of clinical action.
Methotrexate-associated Lymphoproliferative Disorders in Patients With Rheumatoid Arthritis
Authors: Kurita Daisuke , Miyoshi Hiroaki , Ichikawa Ayako , Kato Koji , Imaizumi Yoshitaka , Seki Ritsuko , Sato Kensaku , Sasaki Yuya , Kawamoto Keisuke , Shimono Joji , Yamada Kyohei , Muto Reiji , Kizaki Masahiro , Nagafuji Koji , Tamaru Jun-ichi , Tokuhira Michihide , Ohshima Koichi
Published: May 2019

Methotrexate (MTX) carries a risk of lymphoproliferative disorders (LPDs), but MTX-associated LPDs (MTX-LPDs) can resolve spontaneously after MTX withdrawal. However, the precise clinicopathologic features of MTX-LPD remain unclear. We aimed to investigate the clinicopathologic characteristics, outcomes, and prognostic factors for histologic types of MTX-LPD. Paraffin-embedded tissue samples of 219 patients with MTX-LPD were analyzed. In total, 30,33,106, and 26 had reactive lymphoid hyperplasia (RH), polymorphic-LPD (Poly-LPD), diffuse large B-cell lymphomas (DLBCLs), and classic Hodgkin lymphoma (CHL), respectively. The clinicopathologic features of RH, Poly-LPD, DLBCLs, and CHL were as follows: extranodal involvement: 13.8% (4/29), 36.4% (12/33), 69.5% (73/105), and 15.4% (4/26); Epstein-Barr virus encoded RNA positivity: 55.2% (16/29), 71.9% (23/32), 45.3% (48/106), and 76.9% (20/26); necrosis: 0% (0/29), 51.5% (17/33), 34.3% (36/105), and 12.0% (3/25); and Hodgkin Reed-Sternberg-like cells: 17.2% (5/29), 50% (14/28), and 19.8% (21/106). The median duration from MTX withdrawal to the time of disease regression was 10.4, 3.0, 4.2, and 2.7 months for RH, Poly-LPD, DLBCLs, and CHL. After MTX withdrawal, progression-free survival was the greatest for RH, followed by for Poly-LPD, DLBCL, and CHL (all P<0.05). Overall survival did not differ significantly between the groups. On univariate analysis, the predictive factors for progression-free survival included plasma cell infiltrate for CHL, eosinophil infiltrate, age above 70 years, and extensive necrosis for Poly-LPD, while they were Epstein-Barr virus encoded RNA positivity and International Prognostic Index risk for DLBCL on multivariate analysis. In conclusion, histologic categorization and histology-specific factors could be useful for predicting MTX-LPD progression after MTX withdrawal.
The Burden of Burnout Syndrome in Pediatric Intensive Care Unit and Pediatric Emergency Department
Authors: Yazıcı Mutlu Uysal , Teksam Ozlem , Agın Hasan , Erkek Nilgun , Arslankoylu Ali Ertug , Akca Halise , Esen Feyza , Derinoz Oksan , Yener Nazik , Kılınc Mehmet Arda , Yılmaz Resul , Koksoy ÖzlemTemel , Kendirli Tanıl , Anıl Ayse Berna , Yıldızdas Dincer , Ozturk NiluferYalındag , Tekerek NazanUlgen , Duyu Muhterem , Kalkan Gokhan , Emeksiz Serhat , Kurt Funda , Alakaya Mehmet , Goktug Aytac , Ceylan Gokhan , Bayrakcı Benan
Published: May 2019

Objective

The objective of this study was to detect variables associated with burnout syndrome (BS) in pediatric intensive care units (PICUs) and pediatric emergency medicine departments (PEDs) in high-volume centers from different parts of Turkey.

Methods

An observational, cross-sectional multicenter study was performed. The Maslach Burnout Inventory scale was administered to all of health care providers working in PICUs and PEDs. In this study, health care providers were defined as physicians, nurses, and other staff (secretaries, cleaning and patient care staff) working in PICU and PEDs.

Results

A total of 570 participants completed the survey. The major finding of this study was that 76.1% (n = 434) of PICU and PED health care professionals had BS. The most prominent subscale of BS was emotional exhaustion (62.5%). The rate of BS was higher among health care providers working in PEDs compared with PICUs (79.1% vs 73.7%, P = 0.04). The frequency of BS according to emotional exhaustion and depersonalization subscales was higher in health care providers of PEDs. The rate of BS was also significantly higher in younger employees, females, those working 51 or more hours totally in a week, those having a low monthly salary, those single or divorced, those without children, those with no childcare at home, those not owning a home, those not doing regular exercise and not having regular breakfast, those with total employment time of less than 1 year, and those not having a car or not having a hobby. In PEDs, when the daily evaluated number of patients was equal to or more than 44 (sensitivity, 88%; specificity, 66%), it predicted the occurrence of BS. In PICUs, when the number of patients cared for by 1 nurse was equal to or more than 3, it predicted the occurrence of BS (sensitivity, 78%; specificity, 62%).

Conclusions

By creating early intervention programs to prevent BS, shortages of health care professionals can be avoided and the costs of health care expenditures related to infections can be decreased.
Impact of a Stroke Recovery Program Integrating Modified Cardiac Rehabilitation on All-Cause Mortality, Cardiovascular Performance and Functional Performance
Authors: Cuccurullo Sara J. , Fleming Talya K. , Kostis William J. , Greiss Christine , Gizzi Martin S. , Eckert Anne , Ray Arlen Razon , Scarpati Rosann , Cosgrove Nora M. , Beavers Traymon , Cabrera Javier , Sargsyan Davit , Kostis John B.
Published: May 2019

Objective

Using a feasibility analysis and matched subgroup analysis, this study investigated the implementation/safety/outcomes of a stroke recovery program (SRP) integrating modified cardiac rehabilitation for stroke survivors.

Design

This prospective cohort study of 783 stroke survivors were discharged from an inpatient rehabilitation facility to an outpatient setting; 136 SRP-participants completed a feasibility study and received the SRP including modified cardiac rehabilitation, 473 chose standard of care rehabilitation (nonparticipants), and a group (n = 174) were excluded. The feasibility study assessed the following: safety/mortality/pre-post cardiovascular performance/pre-post function/patient/staff perspective. In addition to the feasibility study, a nonrandomized subgroup analysis compared SRP-participants (n = 76) to matched pairs of nonparticipants (n = 66, with 10 nonparticipants used more than once) for mortality/pre-post function.

Results

The feasibility study showed the SRP to have the following (a) excellent safety, (b) markedly low 1-yr poststroke mortality from hospital admission (1.47%) compared with national rate of 31%, (c) improved cardiovascular performance over 36 sessions (103% increase in metabolic equivalent of tasks times minutes), (d) improved function in Activity Measure of Post-Acute Care domains (P < 0.001), (e) positive reviews from SRP-participants/staff. Subgroup analysis showed the SRP to (a) positively impact mortality, nonparticipants had a 9.09 times higher hazard of mortality (P = 0.039), and (b) improve function in Activity Measure of Post-Acute Care domains (P < 0.001).

Conclusions

Stroke survivors receiving a SRP integrating modified cardiac rehabilitation may potentially benefit from reductions in all-cause mortality and improvements in cardiovascular performance and function.
Physical Medicine and Rehabilitation
Authors: Petriceks Aldis H. , Hales Hannah A. , Srivastava Sakti
Published: May 2019

With an aging and growing US population, American healthcare faces an impending physician shortage. This is important for the field of physical medicine and rehabilitation, because physiatrists’ skills in managing chronic conditions and functional outcomes are especially relevant to an older population. The present study was designed to better understand the future physical medicine and rehabilitation workforce, by recording and analyzing the quantities of Accreditation Council of Graduate Medical Education–accredited physical medicine and rehabilitation graduate medical education programs and positions between 2001–2002 and 2017–2018. Results indicated that physical medicine and rehabilitation graduate medical education has grown since 2001–2002, especially in subspecialties such as pediatric rehabilitation and sports medicine. However, the growth in physical medicine and rehabilitation residency positions has been three-fold lower than that of total graduate medical education. In addition, subspecialization has become increasingly prevalent, and residency positions have declined relative to the population of older adults. The future identity of physical medicine and rehabilitation will continue to develop as professional and demographic trends shape this important medical specialty.
Cannabinoids, cannabis, and cannabis-based medicine for pain management: a protocol for an overview of systematic reviews and a systematic review of randomised controlled trials
Authors: Fisher Emma , Eccleston Christopher , Degenhardt Louisa , Finn David P. , Finnerup Nanna B. , Gilron Ian , Haroutounian Simon , Krane Elliot , Rice Andrew S.C. , Rowbotham Michael , Wallace Mark , Moore R. Andrew
Published: May 2019

Pain is an experience that affects many people worldwide and is associated with higher mortality and lower quality of life. Cannabinoid, cannabis, and cannabis-based medicines (CBMs) are thought to reduce pain, but a proliferation of different products has led to variability in trials, creating a challenge when determining the assessment of efficacy in systematic reviews. We will conduct 2 systematic reviews commissioned by the International Association for the Study of Pain Task Force on the use of cannabinoids, cannabis, and CBMs for pain management: first, an overview review of systematic reviews to summarise the evidence base and second, a systematic review of randomised controlled trials of cannabinoids, cannabis, and CBMs. In these reviews we will determine the harm and benefit of CBM from the current literature and will interpret the findings in light of the quality of evidence and reviews included. We will search online databases and registries in any language for systematic reviews and randomised controlled trials. We will include studies that evaluate any cannabinoid or CBM vs any control for people with acute and chronic pain. Our primary outcomes for both reviews are the number of participants achieving (1) a 30% and (2) 50% reduction in pain intensity, (3) moderate improvement, and (4) substantial improvement. A number of secondary outcome measures will also be included. We will assess risk of bias and quality of evidence. We will analyse data using fixed and random effect models, with separate comparators for cannabis and CBMs. Prospero ID (CRD42019124710; CRD42019124714).
Prospective Relations Between Prenatal Maternal Cortisol and Child Health Outcomes
Authors: Roettger Michael E. , Schreier Hannah M. C. , Feinberg Mark E. , Jones Damon E.
Published: May 2019

Objective

The aim of the study was to investigate prospective, longitudinal associations between maternal prenatal cortisol response to an interpersonal stressor and child health for the subsequent 3 years.

Methods

One hundred twenty-three women expecting their first child provided salivary cortisol samples between 12 and 32 weeks of gestation (M (SD) = 22.4 (4.9) weeks) before and after a videotaped couple conflict discussion with their partner. Mothers reported on overall child health and several indicators of child illness (sick doctor visits, fevers, ear, and respiratory infections) when children were 6 months (n= 114), 1 (n= 116), and 3 (n= 105) years old. Associations between maternal prenatal cortisol reactivity and recovery and later child health at each of the three time points were analyzed using longitudinal regression models.

Results

Greater cortisol reactivity in response to the couple conflict discussion was associated with maternal self-report of better overall child health (p= .016, 95% CI = 0.06–1.30, Cohen'sf= 0.045) across the study period. Greater cortisol reactivity was also associated with lower incidence rate ratios for maternal reports of sick doctor visits (incidence rate ratio 95% CI = 0.25–0.83,p= .006), fevers (95% CI = 0.25–0.73,p= .002), ear infections (95% CI = 0.25–0.58,p< .001), and respiratory infections (95% CI = 0.08–1.11,p= .073). Cortisol recovery was unrelated to study outcomes (allp's > 0.05). Maternal prenatal depressive symptoms moderated the association between cortisol reactivity and overall child health (p= .034, 95% CI = 0.07–1.87 for interaction term) but no other health outcomes (p's > 0.05). Among women with lower depressive symptoms, cortisol reactivity was not associated with overall child health; among women with higher levels of depressive symptoms, greater cortisol reactivity was associated with better overall child health.

Conclusions

This study provides longitudinal evidence that greater maternal cortisol reactivity to a salient interpersonal stressor during pregnancy is associated with fewer child health problems and better maternal report of overall child health during infancy and into early childhood.

Trial Registration:Clinicaltrials.gov ID NCT01901536.
Risk Factors for Falls, Falls With Injury, and Falls With Fracture Among Older Men With or at Risk of HIV Infection
Authors: Erlandson Kristine M. , Zhang Long , Ng Derek K. , Althoff Keri N. , Palella Frank J. , Kingsley Lawrence A. , Jacobson Lisa P. , Margolick Joseph B. , Lake Jordan E. , Brown Todd T.
Published: May 2019

Background:

Falls and fall risk factors are common among people living with HIV (PLWH). We sought to identify fall risk factors among men with and without HIV.

Methods:

Men aged 50–75 years with (n = 279) and without HIV (n = 379) from the Bone Strength Substudy of the Multicenter AIDS Cohort Study were included. Multinomial logistic regression models identified risk factors associated with falling.

Results:

One hundred fourteen (41%) PLWH and 149 (39%) of uninfected men had ≥1 fall; 54 (20%) PLWH and 66 (17%) of uninfected men experienced ≥2 falls over 2 years. Five and 3% of PLWH and uninfected men, respectively, had a fall-related fracture (P = 0.34). In multivariate models, the odds of ≥2 falls were greater among men reporting illicit drug use, taking diabetes or depression medications, and with peripheral neuropathy; obesity was associated with a lower risk (all P < 0.05). In models restricted to PLWH, detectable plasma HIV-1 RNA, current use of efavirenz or diabetes medications, illicit drug use, and peripheral neuropathy were associated with greater odds of having ≥2 falls (P < 0.05). Current efavirenz use was associated with increased odds of an injurious fall; longer duration of antiretroviral therapy was protective (both P < 0.05). Greater physical activity was associated with lower risk of falls with fracture (P < 0.05).

Conclusions:

Identified risk factors for recurrent falls or fall with fracture included low physical activity, detectable HIV-1 RNA, use of efavirenz, or use of medications to treat diabetes and depression. Fall risk reduction should prioritize interventions targeting modifiable risk factors including increased physical activity, antiretroviral therapy adherence, and transition off efavirenz.
Gadolinium-Based MRI Contrast Agents Induce Mitochondrial Toxicity and Cell Death in Human Neurons, and Toxicity Increases With Reduced Kinetic Stability of the Agent
Authors: Bower Danielle V. , Richter Johannes K. , von Tengg-Kobligk Hendrik , Heverhagen Johannes T. , Runge Val M.
Published: May 2019

Objectives

This preclinical study was devised to investigate potential cellular toxicity in human neurons induced by gadolinium-based contrast agents (GBCAs) used for contrast-enhanced magnetic resonance imaging (MRI). Neurons modeling a subset of those in the basal ganglia were tested, because the basal ganglia region is 1 of 2 brain regions that displays the greatest T1-dependent signal hyperintensity changes.

Methods

Eight GBCAs were tested. Dopaminergic neurons modeling a subset of those in the basal ganglia were differentiated from an established human neuroblastoma cell line and exposed to increasing concentrations of each agent for 7 days. The tested dosages ranged from clinically relevant concentrations measured in some autopsy patients who had received repeated injections of contrast for MRI, to higher concentrations to reveal dose-dependent toxicity trends. Cell death, mitochondrial membrane potential, mitochondrial oxidative capacity, and mitochondrial function measured by oxygen consumption were quantified in cells treated with each GBCA or the osmolality control mannitol and compared to untreated cells which served as a negative control.

Results

Mannitol caused no change from negative controls in any of the tests, at any concentration tested. For all GBCAs, cell death increased with exposure dose, with toxicity at clinically relevant doses for agents with lower kinetic stability. Reduction of mitochondrial membrane potential and oxidative respiratory function also generally mirrored the agents' structural kinetic stabilities, with greater impairment at lower concentration for the less stable agents.

Conclusions

In human neurons modeling a subset of those in the basal ganglia, these results demonstrate a toxic effect of gadolinium-containing MRI contrast agents on mitochondrial respiratory function and cell viability. Toxicity increases as agent concentration increases and as the kinetic stability of the agent decreases.