bluuebunny/crossref_metadata_2025 huggingface dataset:
The Most Valuable Resource Is Time: Insights From a Novel National Program to Improve Retention of Physician–Scientists With Caregiving Responsibilities
Authors: Jones Rochelle D. , Miller Jacquelyn , Vitous C. Ann , Krenz Chris , Brady Kathleen T. , Brown Ann J. , Daumit Gail L. , Drake Amelia F. , Fraser Victoria J. , Hartmann Katherine E. , Hochman Judith S. , Girdler Susan , Libby Anne M. , Mangurian Christina , Regensteiner Judith G. , Yonkers Kimberly , Jagsi Reshma
Published: July 2019

Purpose

To enhance understanding of challenges related to work–life integration in academic medicine and to inform the ongoing implementation of an existing program and the development of other interventions to promote success of physician–scientists.

Method

This study is part of a prospective analysis of the effects of the Fund to Retain Clinical Scientists (FRCS), a national program launched by the Doris Duke Charitable Foundation at 10 U.S. institutions, which provides financial support to physician–scientists facing caregiving challenges. In early 2018, 28 of 33 program awardees participated in semistructured interviews. Questions were about challenges faced by physician–scientists as caregivers and their early perceptions of the FRCS. Multiple analysts reviewed deidentified transcripts, iteratively revised the coding scheme, and interpreted the data using qualitative thematic analysis.

Results

Participants’ rich descriptions illuminated 5 interconnected themes: (1) Time is a critical and limited resource, (2) timing is key, (3) limited time resources and timing conflicts may have a particularly adverse effect on women’s careers, (4) flexible funds enable reclamation and repurposing of time resources, and (5) FRCS leaders should be cognizant of time and timing conflicts when developing program-related offerings.

Conclusions

Programs such as the FRCS are instrumental in supporting individuals to delegate time-consuming tasks and to control how they spend their valuable time. Qualitative analysis suggests that access to and command of valuable time resources are crucial to career advancement, research productivity, and work–life flexibility, especially during critical time points along the physician–scientist trajectory.
Irrigation and Debridement of an Open Ankle Fracture With Open Reduction and Internal Fixation and Syndesmotic Fixation Using a Suture Button Device
Authors: Davis Max E. , Blum Laura , Talusan Paul G. , Hake Mark E.
Published: July 2019

Ankle fractures are among the most common surgically treated fractures. The incidence of syndesmotic injury in ankle fractures is 13%–20%. The goal of syndesmotic fixation is a stable, symmetric ankle joint. Missing or poorly reducing a syndesmotic injury can result in diminished function and tibiotalar arthritis. Recently, a suture button–type device has been used instead of the traditional trans-syndesmotic screw-type fixation. This case-based video demonstrates a technique for using suture button–type devices to repair syndesmotic ankle injuries and presents the data regarding the outcomes of this novel technique.

Video available at:
http://links.lww.com/JOT/A807
Treatment of a Complex Interprosthetic Humerus Fracture
Authors: DeFroda Steven , Henry Havalee , Paxton E. Scott
Published: July 2019

Interprosthetic humeral shaft fractures involving shoulder and elbow arthroplasty can be difficult to manage surgically, both due to fracture and patient characteristics. Adequate fixation can be difficult, given the intramedullary nature of the adjacent implants. Careful attention must be paid to regional anatomy, and care must be taken to not damage the radial or ulnar nerve during dissection and mobilization of the fracture, especially if scar tissue exists from multiple previous surgeries. Finally, fixation strategies must be used to gain stability in areas where there is a cement mantle or well-fixed intramedullary stem to impart the stability required for adequate healing and postoperative mobilization. Biologic augmentation is often used as well, given the relatively poor biologic environment for bone healing. We review our technique for operative fixation of a patient with a humeral shaft fracture between a cemented shoulder hemiarthroplasty and total elbow arthroplasty.

Video available at:
http://links.lww.com/JOT/A788
Radial Head Replacement Through a Kocher Approach
Authors: Petersen Kyle A. , Siesel Craig , Miller Eric T.
Published: July 2019

Purpose:

Radial head fractures are some of the most common elbow fractures. Fractures with 3 or more fracture fragments have been shown to have worse outcomes when treated with open reduction and internal fixation (ORIF). Radial head replacement offers an alternative treatment for those more comminuted radial head fractures.

Methods:

Three-part radial head fractures make anatomical reduction more difficult to obtain with ORIF. Radial head fractures requiring replacement have shown good clinical outcomes. As a result, radial head arthroplasty offers a good treatment option for 3-or-more-part radial head fractures.

Results:

This video presents a case of a radial head arthroplasty for a 3-part radial head fracture in a 23-year-old man. The radial head implant provides a smooth and concentric surface for articulation with the capitellum while providing stability to the elbow.

Conclusions:

Radial head replacement provides a good alternative to ORIF, producing similar elbow range of motion and providing good stability compared with the contralateral elbow.

Video available at:
http://links.lww.com/JOT/A793
Arm Fasciotomy Through Lateral Approach
Authors: Carlock Kurtis D. , Shenoy Kartik , Ramme Austin , McLaurin Toni M.
Published: July 2019

Acute compartment syndrome represents one of the few true orthopaedic emergencies. Timely management is essential to prevent permanent sequelae. This video describes a case of acute compartment syndrome of the arm. Relevant patient history, physical examination, and laboratory findings are discussed, and a presentation of the operative technique for arm fasciotomy through a lateral approach is highlighted. Diagnostic criteria for acute compartment syndrome and indications for fasciotomy are reviewed, with a discussion of published outcomes after fasciotomy.

Video available at:
http://links.lww.com/JOT/A792
Repair of Distal Femoral Periprosthetic Nonunion: Linked Nail Plate Construct
Authors: Egol Kenneth A. , Delsole Edward , Mandel Jessica , Konda Sanjit
Published: July 2019

Introduction:

Periprosthetic fracture nonunions represent a rare problem in orthopaedic practice, although their incidence has increased with the increased frequency of joint replacement surgery. This video demonstrates the use of a linked nail-plate construct to repair a distal femoral periprosthetic fracture nonunion.

Methods:

The patient is a 93-year-old woman who is 1-year status-post a left distal femoral periprosthetic fracture with known delayed healing. She presents with a low energy trauma and hardware failure. The patient was indicated for operative fixation using a linked nail-plate construct given the patient's previous hardware failure, advanced age, and poor bone quality.

Results:

This video demonstrates the linked nail-plate technique for the repair of a distal femoral periprosthetic fracture nonunion. Anatomical reduction and stable fixation with bone graft was performed with excellent results. There were no intraoperative or postoperative complications and no issues related to metallurgy.

Conclusions:

In this video, we present the case of an atrophic distal femoral periprosthetic nonunion treated with a linked nail-plate construct with autologous bone graft. Although femoral periprosthetic fracture nonunions are a rare occurrence, they can be successfully treated with operative intervention aimed at compression plating with supplemental bone grafting.

Video available at:
http://links.lww.com/JOT/A797
Comparing Dried Blood Spots and Plasma Concentrations for Busulfan Therapeutic Drug Monitoring in Children
Authors: Dilo Ana , Daali Youssef , Desmeules Jules , Chalandon Yves , Uppugunduri Chakradhara R. S. , Ansari Marc
Published: July 2019

Background:

Busulfan (Bu) is one of the conditioning regimen components for pediatric hematopoietic stem cell transplantation. Bu therapeutic drug monitoring (TDM) is essential for a successful treatment outcome and toxicity evasion. Dried blood spot (DBS) sampling is a rapid and simple method for Bu TDM, compared with conventional plasma sampling. This study evaluated the feasibility of using the DBS method for Bu TDM. The hematocrit (Hct) and conditioning day were also examined for their impact on the DBS method's performance.

Methods:

Venous blood collected from 6 healthy volunteers was diluted, using their plasma into 4 samples of varying Hct values. Each sample was spiked with Bu calibrators (300, 600, and 1400 ng/mL), prepared using DBS and dried plasma spot (DPS) sampling and analyzed using a validated liquid-chromatography tandem-mass spectrometry method. Clinical blood samples (n = 153) from pediatric patients (n = 15) treated with Bu (mainly from doses 1, 2, 5, and 9) were used to prepare paired volumetric DBS and DPS samples. A Bland–Altman plot and Deming regression were used to define the agreement between the paired DBS and DPS measurements. Passing–Bablok regression analyses investigated the effects of Hct and conditioning day on the linearity between both methods.

Results:

In vitro analyses showed good agreement between DBS and DPS measurements, with a mean difference of −5.4% and a 95% confidence interval on the limits of agreement of −15.3% to 4.6%. Clinical samples showed good correlation (Pearson correlation coefficient = 0.96; slope = 1.00) between the DBS and DPS methods. The DBS method met the clinical acceptance limits for clinical samples, with a bias <±20%. Bland–Altman plots showed good agreement, with only 5.8% of paired measurements exceeding the limits of agreement (±1.96 SD), although within its 95% confidence interval. Hct observations ranged from 21.7% to 34.7% and did not affect Bu concentrations measured from DBS in either the in vitro or in vivo studies.

Conclusions:

These results show that DBS is a useful method for Bu TDM, provided samples are analyzed on the collection day. DBS sampling offers advantages over traditional plasma sampling in infants and younger children because only small volumes of blood are required.
Prepectoral Site Conversion for Animation Deformity
Authors: Jones Glyn E. , King Victor A. , Yoo Aran
Published: July 2019

Background:

A signifcant disadvantage of subpectoral breast reconstruction procedures is animation deformity during pectoralis major contraction. In this study, we discuss one surgeon’s experience with elective subpectoral to prepectoral implant site conversion as a definitive solution to animation deformity..

Methods:

Authors performed a retrospective review of pre-pectoral and sub-pectoral breast reconstructions performed by a single surgeon. Implants placed in the prepectoral plane were supported with total anterior AlloDerm coverage.

Results:

One hundred forty-two breasts in 90 patients who had underwent elective subpectoral to prepectoral implant site conversion. Postoperative resolution of animation deformity was 100%. Overall, complications are minimal with rates at 4.2% for infection, 2.1% for seroma, and 0.7% for hematoma, dehiscence, partial thickness necrosis, and explantation. One patient requested reoperation for reduction in implant volume. Baker grades II–IV capsular contractures are 0% at 43 months.

Conclusion:

Breast implant site conversion from the subpectoral to the prepectoral plane is a safe and definitive solution for animation deformity.
The Simultaneous Application of OASIS and Skin Grafting in the Treatment of Tendon-exposed Wound
Authors: Nobuyma Ayami , Ayabe Shinobu , Kang Songsu , Akome Kenji , Motomura Hisashi
Published: July 2019

In the present case, we successfully applied the OASIS extracellular matrix to a tendon-exposed wound and simultaneously performed skin grafting. In the future, this approach can be used to further reduce a patient’s burden, as it is more effective than PAT transplantation for wounds with exposed tendons.
Gut Microbiota, Atherosclerosis, and Therapeutic Targets
Authors: Mantziaris Vasileios , Kolios George
Published: July 2019

Several studies have gathered interest in the relationship between gut microbiota and atherosclerosis. Gut microbiota and its metabolites, such as trimethylamine-N-oxide, and gut dysbiosis play an important role in the development of atherosclerosis. Also, inflammation, derived by the intestinal tract, adds another mechanism through which the ecosystem of the human body affects the metabolic diseases and, furthermore, cardiovascular diseases. The scientific world should fixate the understanding of the exact physiologic and pathophysiologic mechanisms for atherogenesis by gut microbiota and through that, new ways for novel therapeutic targets will be available in the coming years. This review summarizes the latest data on this matter.
Possible Missed Acute Coronary Syndrome Rate in North Texas: Is There Room to Improve?
Authors: Chang Mary P. , Vigen Rebecca , Sharma Sushma , Diercks Deborah B.
Published: July 2019

Background:

Acute coronary syndrome (ACS) is a common diagnosis in the emergency department (ED). Missing this diagnosis may lead to increased morbidity or mortality. With improved cardiac biomarkers tests, it is unknown if that has decreased the prevalence of ACS diagnoses in ED patients who were recently evaluated in the ED.

Methods:

This is a retrospective review of ED patients who were diagnosed with ACS and seen in the ED 7 and 30 days before that visit in North Texas between 2009 and 2015. The demographics and temporal trends of missed ACS rates are described. Logistic regression was used to evaluate if any factors (ie, age, ethnicity, sex, insurance status) were significant.

Results:

Between December 26, 2008 and June 29, 2015, there were 24,914 diagnoses of ACS in the ED. The overall prevalence of patients diagnosed with ACS 7 days after their ED visit was 3.2% and 8.8% at 30 days. For patients diagnosed with ACS 7 days and 30 days after an ED visit, the most common initial ED diagnoses were nonspecific chest pain (57.7%), atherosclerotic disease (19.5%), and heart failure (12.8%). Between 2009 and 2015, there was no overall change in the rate of ACS diagnoses in patients seen 7 or 30 days before an ED visit.

Conclusions:

The prevalence of missed ACS in the North Texas region at 7 and 30 days after the initial ED visit is low and has not changed over the past several years.
Human Ocular Surface Particulate Composition in the Clinical Versus Home Environment
Authors: Kaplan Carol , Galor Anat , Blackwelder Patricia , Hackam Abigail S. , Jeng Bennie H. , Menendez Dhariyat , Kim Sung-Jin , Kumar Naresh
Published: July 2019

Purpose:

Our eyes are chronically exposed to airborne particulate matter shown to adversely affect the ocular surface. This research examines size, type (organic vs. inorganic), and elemental composition of particles recovered from the ocular surface in 2 environments and their associations with dry eye (DE) metrics.

Methods:

Particles were recovered from the right eye using Schirmer strips obtained both in the clinic and home environments 9 ± 8 days apart. Particle size and elemental composition were assessed using scanning electron microscopy and energy dispersive spectroscopy. The paired t test was used to evaluate the differences in the size and types of ocular surface particles recovered from the clinic and home settings. Associations of particle size and type with home environmental conditions and DE measures were evaluated using correlation analyses.

Results:

The mean age of the 15 patients was 56 years, standard deviation (±) 12 years; 93% were men and 53% self-identified as white. Size, type, and elemental composition did not vary significantly between clinic and home. Particle surface area was marginally associated with home indoor temperature (25 °C ± 2, ρ=−0.53, P = 0.06) and significantly associated with the select DE signs: tear osmolality (304 mOsm/L ± 14, ρ= −0.60, P = 0.02), inflammation (0.7 ± 0.8, ρ = 0.53, P = 0.04), and tear breakup time (7 seconds ± 3, ρ = 0.56, P = 0.03).

Conclusions:

Ocular surface particles were consistently detected across 2 different environments. Greater particle area detected on Schirmer strips correlated with some DE measures, suggesting that particles detected on the ocular surface may affect eye health.
Sensorineural Hearing Loss in the Nonimplanted Ear Following Cochlear Implantation in a Patient With Bilateral Enlarged Vestibular Aqueducts
Authors: Vaisbuch Yona , Thai Anthony , Pirko Sarah L. , Santa Maria Peter L.
Published: July 2019

Objective:

To document the case of a patient with bilateral enlarged vestibular aqueducts who experienced sensorineural hearing loss in the nonimplanted ear following unilateral cochlear implantation complicated by perilymph gusher requiring lumbar drain insertion and to highlight the need to counsel regarding the risk of potential hearing loss to the contralateral ear when preparing for cochlear implants in the setting of inner ear malformations.

Patients:

One patient with bilateral enlarged vestibular aqueducts in a tertiary referral center.

Intervention(s):

Cochlear implantation complicated by perilymph gusher requiring lumbar drain insertion.

Main Outcome Measure(s):

Bone conduction hearing thresholds, word recognition scores.

Results:

The patient underwent unilateral cochlear implantation, which was complicated by a perilymphatic gusher and necessitated placement of an intraoperative lumbar drain. On postoperative day 1, the patient reported hearing loss in the opposite ear. The word recognition score in the contralateral ear dropped from 24% at preimplantation to 8% at 2-weeks postimplantation, and did not improve at 6 months postimplantation. Moreover, the bone conduction threshold at 1 kHz worsened from 20 dB preoperatively to no response at 75 dB (the limit of the testing equipment) at 2-weeks postoperatively and only partially improved to 40 dB at 6 months postimplantation.

Conclusion:

As patients with inner ear malformations potentially have direct high-pressure anatomical connections between the perilymphatic spaces and the cerebrospinal fluid, they are at risk of hearing loss in the nonimplanted ear during cochlear implantation. This case highlights the need for potential additional patient counseling regarding this risk in the nonimplanted ear.
Hearing Improvement Following Middle Cranial Fossa Floor Defect Repair Utilizing a Modified Middle Fossa Approach and Reconstructive Techniques
Authors: Alwan Mostafa , Ibbett Imogen , Pullar Michael , Lai Leon T. , Gordon Michael
Published: July 2019

Background:

Few studies report hearing preservation following middle cranial fossa (MCF) floor defect repair.

Objective:

To investigate audiological outcomes following MCF floor defect repair using a modified MCF suprapetrous approach.

Study Design:

Retrospective cohort.

Setting:

Tertiary referral center.

Patients:

Eleven patients, with MCF floor defects.

Interventions:

MCF floor defect surgical repairs with either fascia or fascia and bone graft.

Main Outcome Measured:

Hearing outcomes.

Results:

Eleven patients (two men) aged 34 to 82 years (median, 62 yrs) were identified. All patients were operated on by the same two senior surgeons (M.P. and M.G.). One patient with conductive hearing loss (based on tuning fork test) was excluded from the analysis due to missing preoperative audiogram data. All patients had middle fossa plate defects leading to cerebrospinal fluid (CSF) otorrhoea, rhinorrhoea, or meningitis. Nine patients had retrieval of herniated contents from the defect. Five patients had repair with temporalis fascia and split calvarial bone graft, and six patients had repair with fascia only. Follow up audiogram was performed at a mean 7.5 months (range, 0.5–24 mo). There was no recurrent CSF leak during the follow up period. The 10 patients (90.9%, 95% confidence interval [CI] 60.1–100.6) who had complete audiologic data sets demonstrated a mean improvement of 18.86 dB (range, –7.5 to 33.75 dB) in hearing postoperatively. One of these patients acquired a 7.5 dB reduction in postoperative hearing due to post-procedural middle ear effusion which subsequently resolved. Hearing improvement following fascial graft alone versus fascial graft with bone was 12.5 and 26.5 dB, respectively (p < 0.01).

Conclusion:

Middle fossa craniotomy with or without retrieval of herniated contents and floor reconstruction with fascia and bone is associated with improved hearing. Clinical efficacy of this technique, however, can be only fully established when a statistically meaningful number of cases have been performed.
Endoscopic Versus Microscopic Middle Ear Surgery: A Meta-analysis of Outcomes Following Tympanoplasty and Stapes Surgery
Authors: Manna Sayan , Kaul Vivian F. , Gray Mingyang L. , Wanna George B.
Published: July 2019

Objective:

This meta-analysis compares the efficacy and safety of endoscopic and microscopic approaches to tympanoplasty and stapes surgery, two common middle ear procedures.

Data Sources:

A comprehensive electronic search of PubMed/MEDLINE, Scopus, Web of Science, and Cochrane Library was conducted for studies published from the year 1960 through June 2018. Article selection and screening proceeded according to the strategies outlined in the standard Preferred Reporting Items for Systematic Reviews and Meta-analysis statement.

Methods:

Studies were assessed for quality using the Newcastle-Ottawa Scale and the Jadad scale depending on the presence of randomization. Bias was analyzed using funnel plots. For each outcome measure, a forest plot was generated and a pooled relative risk or risk difference was calculated to assess significance.

Results:

Twenty-one studies met the inclusion criteria, 16 tympanoplasty (1,323 ears) and 5 stapes surgery (283 ears). The nonrandomized studies scored moderately well but the randomized studies were of low quality with respect to the Newcastle-Ottawa Scale and the Jadad Scale, respectively. With respect to tympanoplasty, statistical analysis demonstrated that the endoscopic approach had significantly lower canalplasty rates, better cosmetic outcomes, and shorter operative times. Furthermore, endoscopic compared to microscopic methods were similar in terms of audiological outcome, graft success rate, and complication rate. Among stapes surgeries, the endoscopic approach demonstrated a significantly decreased incidence of postoperative pain and chorda tympani injury but was similar to the microscopic approach with respect to audiological outcome, postoperative dizziness, and operative time.

Conclusions:

Though the merits of endoscopic techniques are becoming more well known, there are still concerns regarding their efficacy and safety. An analysis of the current literature suggests that audiological, functional, and safety outcomes are similar, if not superior, for the endoscopic approach to both tympanoplasty and stapes surgery compared to the microscopic approach. With respect to tympanoplasty, patients undergoing the endoscopic approach had lower canalplasty rates, better cosmetic outcomes, and shorter operative times. Among stapes surgeries, patients in the endoscopic group had a lower incidence of postoperative pain and injury to the chorda tympani. This meta-analysis of the current evidence supports the use of endoscopic techniques for tympanoplasty and stapes surgery.
E-cadherin expression is associated with susceptibility and clinicopathological characteristics of thyroid cancer
Authors: Zhou Changlin , Yang Chunsheng , Chong Daoqun
Published: July 2019

Background:

Recently, many studies have been carried out to investigate the clinicopathological significance of E-cadherin expression in thyroid cancer. However, the results remained inconsistent. In the present study, we performed a meta-analysis to evaluate the associations of E-cadherin expression with susceptibility and clinicopathological characteristics of thyroid cancer.

Methods:

Eligible studies were searched from Medicine, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang databases. The strength of associations between E-cadherin expression and susceptibility and clinicopathological features of thyroid cancer were assessed by pooled odds ratios (ORs) and 95% confidence intervals (CIs).

Results:

Forty-six studies with 1700 controls and 2298 thyroid cancer patients were included for this meta-analysis. Pooled results indicated that E-cadherin expression was significantly associated with susceptibility of papillary cancer and follicular cancer (papillary cancer, ORs = 14.31, 95% CIs = 3.42–59.90; follicular cancer, ORs = 10.14, 95% CI = 4.52–22.75). Significant association between E-cadherin expression and thyroid cancer risk was also observed in the subgroup analysis based on control group (normal thyroid tissue, ORs = 28.28, 95% CI = 8.36–95.63; adjacent thyroid tissue, ORs = 8.83, 95% CI = 3.27–23.85; benign thyroid tissue, ORs = 43.96, 95% CI = 9.91–194.95). In addition, E-cadherin expression was significantly correlated with lymph node metastasis, differentiation, and tumor-node-metastasis (TNM) stage of thyroid cancer (lymph node metastasis, ORs = 3.21, 95% CI = 1.98–5.20; differentiation, ORs = 0.25, 95% CI = 0.07–0.82; TNM stage, ORs = 4.85, 95% CI = 2.86–8.25).

Conclusions:

The present study showed that E-cadherin expression was significantly associated with susceptibility and clinicopathological characteristics of thyroid cancer, which suggested that E-cadherin expression might be a potential predictive factor for clinical progression of thyroid cancer.
Thyroid cartilage loci and hyoid bone analysis using a video fluoroscopic swallowing study (VFSS)
Authors: Na Yong Jae , Jang Jong Seong , Lee Kyu Hoon , Yoon Yu Jun , Chung Min Sung , Han Seung Hoon
Published: July 2019

Introduction:

Hyoid bone movement can be useful for diagnosing oropharyngeal dysphagia. In most clinical settings, the movement can be evaluated by a video fluoroscopic swallowing study (VFSS) that induces radiation exposure. In contrast with the hyoid bone, the thyroid cartilage is easily seen through the anterior neck surface. We hypothesized that the movement of thyroid cartilage correlates with hyoid bone movement in various axis and can be used as a parameter to evaluate swallowing. The purpose of this study was to investigate whether thyroid cartilage and hyoid bone movement were correlated and to collect basic data to determine if thyroid cartilage can be used as a parameter to evaluate swallowing.

Methods:

A total of 25 subjects were included, and the VFSS image with normal swallowing function was collected retrospectively. The VFSS image was analyzed by specially developed semi-automatic software. Laryngeal prominence and anterior-superior margins of the hyoid were automatically extracted during swallowing. Two-point sets of the loci during swallowing were obtained in all VFSS frames. The X-coordinates showed an anterior-posterior axis, and the Y-coordinates showed a superior-inferior axis. Pearson correlation coefficients for each X- and Y-coordinate component were computed.

Results:

X- and Y-coordinates of the thyroid cartilage and hyoid bones in all subjects showed movement in similar patterns, although each subject's movement differed. Pearson correlation coefficients of X- and Y-coordinate components of all subjects ranged from 0.611 to 0.981, which indicated that thyroid cartilage and hyoid bone movement was strongly correlated in anterior-posterior and superior-inferior axes, respectively.

Conclusion:

We analyzed thyroid cartilage and hyoid bone movement using a specifically developed semi-automatic software and concluded that the movement of thyroid cartilage and hyoid bone was strongly correlated in anterior-posterior and superior-inferior axes, respectively, during swallowing. The present study implies that analysis of thyroid cartilage movement can be used as a parameter for swallowing evaluation.
A group-focused rational emotive behavior coaching for management of academic burnout among undergraduate students
Authors: Ezenwaji Ifeyinwa O. , Eseadi Chiedu , Ugwoke Samuel C. , Vita-Agundu Uche C. , Edikpa Edith , Okeke Francisca C. , Nwafor Bernadette N. , Ozioko Agatha N. , Ebinyasi Justina O. , Nwabuko Linus O. , Njoku Lily G. , Agu Michael A.
Published: July 2019

Background:

High-stress level affects students’ health and many of them experiencing high levels of stress are at risk of burnout. School administrators are often concerned about the experiences and negative effects of burnout among students and staff. Burnout is described as a psychological reaction to chronic stress. The aim of the current study was to investigate the effect of a group-focused intervention (rational emotive behavior coaching, REBC) on academic burnout among undergraduate students attending public universities in Southeast Nigeria.

Methods:

A group randomized controlled trial design was adopted for this study. A total of 52 convenient samples of undergraduate students (with a high degree of burnout symptoms) took part in the research. We used a group REBT program manual for the management of burnout which was complemented with REBC techniques. Data were gathered with the aid of the perceived stress scale (PSS-10) and Oldenburg Burnout inventory-student (OLBI-S). Data were analyzed using ANOVA and paired t test at .05 probability level.

Results:

Results showed that the group-focused REBC program significantly alleviated burnout symptoms among students in the treatment group compared to students in the control group as measured by OLBI-S subscales: exhaustion (F(1,51) = 41.789, P = .000,

JOURNAL/medi/04.03/00005792-201907260-00010/inline-graphic1/v/2023-09-14T035853Z/r/image-tiff

, ΔR
2 = 0.634, SE = 1.00), and disengagement (F(1,51) = 196.036, P = .000,

JOURNAL/medi/04.03/00005792-201907260-00010/inline-graphic2/v/2023-09-14T035853Z/r/image-tiff

, ΔR
2 = 0.869, SE = 0.69). The students who benefitted from the group-focused REBC program maintained reduced symptoms of burnout after three months when the researchers conducted a follow-up as measured by OLBI-S subscales: exhaustion (F(1,51) = 34.012, P = .000,

JOURNAL/medi/04.03/00005792-201907260-00010/inline-graphic3/v/2023-09-14T035853Z/r/image-tiff

, ΔR
2 = 0.467, SE = 1.21), and disengagement (F(1,51) = 108.941, P = .000,

JOURNAL/medi/04.03/00005792-201907260-00010/inline-graphic4/v/2023-09-14T035853Z/r/image-tiff

, ΔR
2 = 0.765, SE = 0.85).

Conclusion:

This research indicates that group-focused REBC can be applied to reduce burnout symptoms among undergraduate students. The group-focused REBC intervention may be adapted to overcome employee burnout and school administrators’ burnout. Researchers may need to investigate the possibility of storing and harnessing data from studies on REBC and burnout and delivering computer-based/internet REBC program following evidence-based computing strategies and principles.
Primary malignant melanoma of the female genital tract synchronously involving the vulva and uterine cervix
Authors: Pang Yingxin , Yuan Hang , Ren Anji , Zhang Shiqian , Liu Peishu
Published: July 2019

Rationale

Primary melanomas of the female genital tract are rare and usually occur in the vulva and vagina. Involvement of the cervix, uterus, and ovary are extremely rare. Surgery and adjuvant therapy remain the mainstay of treatment. The majority of patients experience poor long-term survival. This report aimed at highlighting an extremely rare case of primary melanoma of the female genitalia, synchronously involving the vulva and uterine cervix.

Patient concerns

A 58-year-old multiparous female presented with postmenopausal bleeding for 10 days.

Diagnoses

Speculum examination and histologic analysis of the surgical specimens revealed synchronous involvement of the vulva and uterine cervix by malignant melanoma. According to the American Joint Committee on Cancer stage grouping for melanoma, this tumor was at stage V.

Interventions

The patient subsequently underwent radical surgery and postoperative chemotherapy.

Outcomes

She has been on regular follow-up, and is now free of disease for 50 months after the operation.

Lessons

Primary melanomas of the female genital tract have biologically aggressive characteristics. Optimal management consists of individualized surgery and adjuvant therapy. However, early recognition and prompt intervention offer maximal benefit from treatment.
A critical review of obstetric and gynecological physical examination videos available on YouTube
Authors: Abdulghani Hamza Mohammad , Haque Shafiul , Ahmad Tauseef , Irshad Mohammad , Sattar Kamran , Al-harbi Mohammed Meteb , Khamis Nehal
Published: July 2019

Background:

Video-sharing website “YouTube” is a growing source of healthcare information. But, the videos uploaded on this open platform are not peer reviewed, therefore, the information available needs to be sufficiently evaluated. No studies have been conducted to evaluate the authenticity and utility of obstetrics and gynecology (Obs/Gyne) physical examination YouTube videos. This study was performed to analyze the sources, contents, and quality of videos about the Obs/Gyne clinical examination available on YouTube.

Methods:

A systematic search was performed on YouTube website using the following key words: “OBSTETRIC,” “GYNECOLOGICAL,” “SPECULUM OBSTETRIC,” “OBSTETRIC CLINICAL,” “BIMANUAL PELVIC,” and “EXAMINATION” to analyze the sources, contents, and the quality of YouTube videos about the Obs/Gyne clinical examination during the period between November 2015 and March 2017. The videos were classified into educationally useful and useless based on the content, accuracy of the knowledge, and the demonstration.

Results:

Out of total 457 screened videos, 176 (38.51%) videos met the pre-set inclusion criteria. After review, out of 176 pertinent videos, 84 (47.7%) videos were found educationally useful, and out of these 84 useful videos, only 29 (34.5%) were highly educational in nature.

Conclusion:

YouTube videos showed variable educational value. Only, a small number of videos were identified as useful and can be used by the medical students for self-directed learning and by the clinical teachers for educational purposes or other academic activities.
Development and internal validation of a novel model and markers to identify the candidates for lymph node metastasis in patients with prostate cancer
Authors: Cao Hai-ming , Wan Zi , Wu Yu , Wang Hong-yang , Guan Chao
Published: July 2019

Background

High-grade prostate cancer (PCa) has a poor prognosis, and up to 15% of patients worldwide experience lymph node invasion (LNI). To further improve the prediction lymph node invasion in prostate cancer, we adopted risk scores of the genes expression based on the nomogram in guidelines.

Methods

We analyzed clinical data from 320 PCa patients from the Cancer Genome Atlas database. Weighted gene coexpression network analysis was used to identify the genes that were significantly associated with LNI in PCa (n = 390). Analyses using the Gene Ontology and Kyoto Encyclopedia of Genes and Genomes databases were performed to identify the activated signaling pathways. Univariate and multivariate logistic regression analyses were performed to identify the independent risk factors for the presence of LNI.

Results

We found that patients with actual LNI and predicted LNI had the worst survival outcomes. The 7 most significant genes (CTNNAL1, ENSA, MAP6D1, MBD4, PRCC, SF3B2, TREML1) were selected for further analysis. Pathways in the cell cycle, DNA replication, oocyte meiosis, and 9 other pathways were dramatically activated during LNI in PCa. Multivariate analyses identified that the risk score (odds ratio [OR] = 1.05 for 1% increase, 95% confidence interval [CI]: 1.04–1.07, P < .001), serum PSA level, clinical stage, primary biopsy Gleason grade (OR = 2.52 for a grade increase, 95% CI: 1.27–5.22, P = .096), and secondary biopsy Gleason grade were independent predictors of LNI. A nomogram built using these predictive variables showed good calibration and a net clinical benefit, with an area under the curve (AUC) value of 90.2%.

Conclusions

In clinical practice, the application of our nomogram might contribute significantly to the selection of patients who are good candidates for surgery with extended pelvic lymph node dissection.
New perspectives on treatment strategies for patient with acute myeloid leukemia and complex karyotype abnormalities after percutaneous coronary intervention
Authors: Wang Jie , Chen Rong , Lin Xiaoqi , Wang Yubo , Wang Jian-Hua , Wu Yun
Published: July 2019

Rationale

Acute myeloid leukemia (AML), in patients with coronary heart disease (CHD) and treated percutaneous coronary intervention (PCI), is rarely seen in clinic. There are few similar cases reported, and there are no evidence-based medicine guidelines for the treatment.

Patient concerns

A 52-year-old man was diagnosed with coronary atherosclerotic heart disease in November 2011, and received a stent placement in the left anterior descending coronary artery 1 year later. One day after the surgery, his laboratory tests showed pancytopenia.

Diagnoses

Based on precise diagnosis of leukemia, namely cell morphology, immunology, cytogenetics, and molecular biological typing, the patient was diagnosed with AML-M2.

Interventions

The patient received idarubicin with cytarabine in 1st cycles, and single cytarabine regimen was used in 2nd and 3rd cycles for the accumulative toxicity of idarubicin in postinduction chemotherapy. Meanwhile, staged-treatment strategy was implemented by using antiplatelet drugs during different chemotherapy phases, and personalized pharmaceutical care on the basis of the recognition of potential adverse effects of chemotherapy regimen.

Outcomes

Until now, the disease-free survival in the patient has been over 6 years, and he is still followed up in clinic.

Lessons

Although leukemia accompanied with coronary heart disease, even after receiving the coronary stenting therapy is rarely seen in clinic, the treatment with antiplatelet drugs for post chemotherapy patients with coronary disease is necessary. Clinical pharmacists are supposed to be more proficient in developing personalized drug treatment strategies, especially maintaining the balance between the effect and the risk in difficult and complex cases.
Effect of auricular electroacupuncture combined with body acupuncture in improving the consciousness of patients after traumatic brain injury
Authors: Liu Tong , Lu Yanqing , Yu Jiani , Kuang Weichuan , Wang Xiaoyin , Jiang Ye , Qiu Xiaojia , Wen Xi , Zeng Yao , Zhang Guitao , Liu Yue
Published: July 2019

Background:

Traumatic brain injury (TBI) has become a major cause of morbidity and mortality both in China and abroad. Disorders of consciousness following severe TBI is a common refractory complication, resulting in difficult rehabilitation and poor life quality. However, effective therapeutic approaches remain limited. Although acupuncture has been widely applied in the treatment of neurological disorders in China, its efficacy and safety for consciousness recovery remain to be elucidated.

Methods:

Here, we conduct a study design and protocol of a randomized, blinded, controlled study to evaluate the efficacy and safety of electroacupuncture at auricular acupoints “heart” and “brainstem” combined with body acupuncture in the consciousness recovery of patients with TBI. A total of 80 patients with initial Glasgow coma scale score between 3 and 8 points will be recruited in the trial and randomized into intervention (combined application of auricular electroacupuncture and body acupuncture) group or control (conventional treatment) group. Patients in the intervention group will receive electroacupuncture at bilateral auricular acupoints “heart” and “brainstem” (4 points in total) combined with body acupuncture in addition to conventional treatment while patients in the control group will receive conventional treatment alone for 8 weeks. The primary outcomes are changes of Glasgow coma scale score and mismatch negativity of event-related brain potentials at baseline after 4 weeks after the final treatment and 4 weeks after the final treatment. The secondary outcome measures will be changes of Barthel and FuglMeyer scores at baseline after 4 weeks after the final treatment and 4 weeks after the final treatment. The safety will also be assessed by monitoring the incidence of adverse events and changes in vital signs during the study.

Discussion:

Results from this trial will significantly support the application of auricular acupuncture and body acupuncture in the consciousness recovery of patients with severe TBI. If found to be effective and safe, auricular acupuncture combined with body acupuncture will be a valuable complementary option for comatose patients with TBI.

Trial registration:

Chinese Clinical Trial Registry: ChiCTR1800020245. Registered on 21 December 2018.
Pheochromocytoma, paragangliomas, and pituitary adenoma
Authors: Lemelin Annie , Lapoirie Marion , Abeillon Juliette , Lasolle Hélène , Giraud Sophie , Philouze Pierre , Ceruse Philippe , Raverot Gérald , Vighetto Alain , Borson-Chazot Françoise
Published: July 2019

Rationale:

Pituitary adenomas and paragangliomas are both rare endocrine diseases. Paragangliomas (PGL)/pheochromocytomas (PHEO) are part of an inherited syndrome in about 30% to 40% of cases. Among familial cases, mutations of the succinate dehydrogenase (SDH) subunit genes (succinate dehydrogenase subunit [SDH]B, SDHC, SDHD, succinate dehydrogenase subunit AF2 [SDHAF2] , and SDHA) are the most common cause.
[1]

Patient concerns:

We here report a 31-year-old patient with a known SDHD mutation whose disease has been revealed by a left PHEO during childhood and who presented at age 29 years a large paraganglioma of the right jugular foramen, a concomitant PHEO of the left adrenal and 2 retroperitoneal paragangliomas. A pituitary incidentaloma was found during investigations on a fluorodeoxyglucose (FDG)-positron emission tomography (PET) (FDG-PET).

Diagnosis:

A pituitary magnetic resonance imaging (MRI) confirmed the presence of a 14 mm pituitary macroadenoma. The pituitary function was normal except for hypogonadotropic hypogonadism. On examination of the fundus, a diagnosis of Pseudo Foster-Kennedy syndrome was made due to a venous compression of the right jugular vein caused by the paraganglioma (PGL). The pituitary adenoma was not compressive to the optic chiasm.

Interventions:

A treatment with acetazolamide was started in order to improve intracranial hypertension. The patient couldn’t benefit of a surgical approach for the paraganglioma of the right jugular foramen; the patient has been treated with stereotactic radiosurgery (Gamma Knife).

Outcomes:

The most recent MRI revealed that the right jugular foramen PGL is stable and the latest visual assessment demonstrated stability despite a recent reduction in acetazolamide dosage. A surveillance by MRI of the pituitary adenoma has been planned.

Lessons:

The association of a pituitary adenoma to paragangliomas within a same patient is very uncommon and raises the question of related physiopathological mechanisms.
Efficacy and safety of prostaglandin analogues in primary open-angle glaucoma or ocular hypertension patients
Authors: Tang Wenquan , Zhang Feng , Liu Ke , Duan Xuanchu
Published: July 2019

Background:

To evaluated and compared the efficacy and safety of 3 prostaglandin analogues (0.005% latanoprost, 0.004% travoprost, and 0.03% bimatoprost) in treatment of primary open-angle glaucoma (POAG) or ocular hypertension (OHT).

Methods:

PubMed, Embase, Cochrane library, Web of science, CNKI, Wanfang, and Vip database, published between January 1, 2000 and June 1, 2018, were systematically examined for randomized controlled trials (RCT) based on prostaglandin analogues for POAG or OHT treatment. Statistical analyses including weighted mean difference (WMD) calculation and odds ratio (OR) were performed using Review Manager Software version 5.3.

Result:

The 17 studies were included in this analysis (N = 2433 participants) with 1∼12 months’ follow-ups. The difference of intraocular pressure (IOP) reduction between latanoprost and travoprost group had not significant; there was significant difference of IOP reduction between latanoprost and bimatoprost group in the third month and sixth month; Travoprost was significantly different from bimatoprost in reducing IOP in the third month. Travoprost revealed an elevated risk of conjunctival hyperemia compared with latanoprost. An elevated risk of conjunctival hyperemia and growth of lashes compared with latanoprost. Bimatoprost shows lower ocular tolerability with higher incidence of side effects such as conjunctival hyperemia.

Conclusions:

0.03% bimatoprost appears more effective following long time use (3 and 6 month post-treatment) for IOP control compared to 0.005% latanoprost, and is more effective compared to 0.004% travoprost after being used for a certain period of time (3 months post-treatment); nevertheless, 0.005% latanoprost is better tolerated in patients with POAG or OHT.
Predicting factors related with uncured hypertension after retroperitoneal laparoscopic adrenalectomy for unilateral primary aldosteronism
Authors: BiLiGe WuYun , Wang Chaoqi , Bao JiRiGaLa , Yu Dahai , Min A , Hong Zhi , Chen Xiangbao , Wang Min , Wang Dongmei
Published: July 2019

Although unilateral primary aldosteronism (PA) is the most common surgically correctable cause of hypertension, the cure rate varies widely. The predicting factors related to uncured hypertension are not completely established. This study was designed to determine predicting factors associated with resolution of hypertension after adrenalectomy for PA.

The records of unilateral PA patients who had undergone retroperitoneal laparoscopic adrenalectomy were retrospectively reviewed from January 2010 to December 2017 in a single center. Patient demographics and preoperative factors were analyzed, including age, sex, smoking history, family history of hypertension, the presence of diabetes, body mass index (BMI), systolic blood pressure, diastolic blood pressure, biochemical results and tumor characteristics. Univariate and multivariate Logistic regression analysis were used for statistical assessment.

126 patients with unilateral PA were enrolled, and the mean age at the time of surgery was 54.2 years. Of these patients, 74 (58.7%) were women, and the mean BMI and duration of hypertension were 26 kg/m2 and 61 months, respectively. Hypertension was cured in 46% patients, of the patients with uncured hypertension, 91% had improved control of hypertension. In univariate analysis, age (P = .03), BMI (P = .01), duration of hypertension >5 years (P = .03), preoperative antihypertensive agents>2 (P = .02), contralateral abnormalities (P = .03) were the main factors related to uncured hypertension after adrenalectomy. In multivariate regression analysis, uncured hypertension was independently associated with obesity (25.00–29.99: odds ratio [OR], 2.97, P < .02; ≥30: OR, 6.42, P < .01), duration of hypertension >5 years (OR, 6.25, P < .01), preoperative antihypertensive agents >2 (OR, 5.30, P < .001), and contralateral adrenal abnormalities (OR, 8.38, P < .01).

The hypertension cure rate of unilateral adrenalectomy in PA is not high. Obesity, duration of hypertension >5 years, preoperative antihypertensive agents >2 and contralateral adrenal abnormalities were independently associated with uncured hypertension.