bluuebunny/crossref_metadata_2025 huggingface dataset:
The Risk of Cervical Cancer After Cervical Intraepithelial Neoplasia Grade 3: A Population-Based Cohort Study With 80,442 Women
Authors: Loopik Diede L. , IntHout Joanna , Ebisch Renée M. F. , Melchers Willem J. G. , Massuger Leon F. A. G. , Siebers Albert G. , Bekkers Ruud L. M.
Published: June 2020

(Abstracted from Gynecol Oncol 2020;157:195–201)

Cervical cancer screening programs and prophylactic high-risk human papillomavirus have significantly decreased the incidence and increased early detection of cervical intraepithelial neoplasia (CIN), which can progress to cervical cancer if left untreated. Surgical excision of CIN is very effective; however, research shows that women who have previously treated CIN are at an increased risk for developing cervical cancer compared with the general population.
Perinatal Outcomes for Untreated Women With Gestational Diabetes by IADPSG Criteria: A Population-Based Study
Authors: Shah B. R. , Sharifi F.
Published: June 2020

(Abstracted from BJOG 2020;127:116–122)

Gestational diabetes mellitus (GDM) has increased among pregnant women as a product of the rise in obesity, advanced maternal age, and sedentarism. Diagnostic criteria for GDM are controversial and heterogeneous across providers.
Neonatal Developmental and Behavioral Outcomes of Immediate Delivery Versus Expectant Monitoring in Mild Hypertensive Disorders of Pregnancy: 5-Year Outcomes of the HYPITAT II Trial
Authors: Zwertbroek Eva F. , Zwertbroek Julia , Broekhuijsen Kim , Franssen Maureen T. M. , Ganzevoort Wessel , Langenveld Josje , Mol Ben W. J. , van Pampus Marielle , Scherjon Sicco , van Baar Anneloes L. , Groen Henk
Published: June 2020

(Abstracted from Eur J Obstet Gynecol Reprod Biol 2020;244:172–179)

One in 10 pregnancies is affected by hypertensive disorders. These disorders, including hypertension, preeclampsia, worsening chronic hypertension, and superimposed preeclampsia, often require intervention in the form of delivery of the baby.
Predictive Value of Midtrimester Universal Cervical Length Screening Based on Parity
Authors: Rosenbloom Joshua I. , Raghuraman Nandini , Temming Lorene A. , Stout Molly J. , Tuuli Methodius G. , Dicke Jeffery M. , Macones George A. , Cahill Alison G.
Published: June 2020

(Abstracted from J Ultrasound Med 2020;39:147–154)

Midtrimester universal transvaginal cervical length (TVCL) measurement can be used as a tool to screen for spontaneous preterm birth (sPTB). Currently, the guidelines and recommendations do not differ based on parity, and it is not known whether the predictive value of cervical length (CL) screening for preterm birth differs between multiparous and nulliparous women.
First Place Award: A quantitative analysis of the effect of glenoid bone volume on baseplate failure in reverse total shoulder arthroplasty in patients with inflammatory arthritis: a retrospective case control study
Authors: DelBello Steven , Dopico Pablo , Mihalko William , Brolin Tyler , Azar Frederick , Throckmorton Thomas W.
Published: June 2020

Background:

The purpose of this study was to determine and compare the glenoid vault bone volumes in patients undergoing reverse total shoulder arthroplasty (RTSA) for inflammatory arthritis to determine if a threshold exists where baseplate fixation is at risk for failure.

Methods:

Fourteen patients who had primary RTSA for inflammatory arthritis were included in this study; 10 had humeral head autografting to augment glenoid deficiency. Four patients experienced baseplate failure with component pull-out from the glenoid. Preoperative glenoid vault volume was measured on CT images.

Results:

The average glenoid vault bone volumes were significantly different between failures and nonfailures for both men and women. The average volume in women with baseplate failure was 3.5 cm3, while the average nonfailure volume in women was 8.6 cm3 (P=0.03). The average glenoid volume in men with baseplate failure was 11.8 cm3, while the average volume in men without failure was 18.3 cm3 (P=0.02). There were no baseplate failures in men with glenoid vault volumes greater than 14 cm3 or in women with volumes greater than 5 cm3.

Conclusions:

Patients with baseplate failure after RTSA for inflammatory arthritis had significantly lower average glenoid vault volumes than their gender-specific counterparts without failure. These findings suggest a level of glenoid volume below which baseplate fixation is potentially compromised: 14 cm3 in men and 5 cm3 in women.

Level of Evidence:

Level III.
Systemic Absorption and Nephrotoxicity Associated With Topical Vancomycin Powder for Fracture Surgery
Authors: O'Toole Robert V. , Degani Yasmin , Carlini Anthony R. , Castillo Renan C. , O'Hara Nathan N. , Joshi Manjari ,   and METRC
Published: June 2020

Objectives:

To determine whether using topical vancomycin powder in fracture surgery may result in low levels of vancomycin in the serum and not result in nephrotoxicity.

Design:

Prospective observational at a single site as a substudy of the VANCO trial.

Setting:

Single, large urban level I trauma center.

Patients/Participants:

Fifty-eight patients with tibial plateau and pilon fractures randomized to the treatment arm at the principal investigator's site.

Intervention:

Topical vancomycin powder (1000 mg) applied directly in the wound over all metal implants at the time of wound closure.

Main Outcome Measurements:

Serum vancomycin levels at 1 hour and 6–8 hours after surgery. Secondary outcomes included serum creatinine before surgery, a day after surgery, and at 2 weeks postoperatively and complete blood count at 2 weeks postoperatively.

Results:

Except in 2 patients who also received intravenous vancomycin, none of the study patients had detectable (>5 µg/mL) serum vancomycin levels at 1 hour and 6–8 hours after surgery. One patient with a history of elevation of serum creatinine had a minor increase of serum creatinine but had undetectable vancomycin levels. None of the other patients had a clinically significant increase in creatinine levels.

Conclusions:

Despite its relatively widespread usage, little data exist regarding the systemic levels and nephrotoxicity associated with the topical use of vancomycin powder in orthopaedic fracture surgery. These prospective data indicate that there seems to be little clinical concern regarding toxicity associated with systemic absorption of vancomycin powder in this specific clinical application.

Level of Evidence:

Therapeutic Level IV. See instructions for authors for a complete description of levels of evidence.
Use of an Electronic Reporting Tool and Clinical Surveillance Process in the Neonatal Intensive Care Unit to Decrease Risk for Central Venous Catheter Complications Associated With Tip Migration
Authors: Ulloa Jodi A. , Zurmehly Joyce , Fortney Christine A. , Bowles Wendy
Published: June 2020

This quality improvement project formalized central venous catheter tip surveillance augmented by the use of electronic patient reporting tool. The project setting was a large level IV academic neonatal intensive care unit with a representative convenience sample of patients with central venous catheters and quality improvement reports of complications from tip migration. Providers received education before implementation of a central venous catheter tip surveillance program using a revised electronic reporting tool was initiated. Provider evaluations of the electronic reporting tool included compliance with the guidelines and use of the tool in multidisciplinary patient rounds, and were entered into a database for analysis. Nine evaluations of the electronic reporting tool were completed, with an average of 97% compliance with guidelines. Seven evaluations during multidisciplinary patient rounds using the reporting tool data demonstrated use by both resident physicians and advanced practice nurses. Central venous catheter patient data were reviewed after process implementation. Overall, infant central venous catheter complications related to tip migration decreased following implementation. Therefore, the use of an electronic reporting tool improved compliance with evidence-based clinical practice guidelines and resulted in a decrease in the risk for central venous line complications related to tip migration in this setting.
Twenty-Eight Cases of Extraocular Sebaceous Carcinoma: A Correlative Clinicopathological and Immunohistochemical Analysis of Extraocular Sebaceous Carcinomas and Benign Sebaceous Gland Tumors
Authors: Boecker Werner , Reusch Michael , Mielke Volker , Reusch Ursula , Hallermann Christian , Loening Thomas , Tiemann Markus , Buchwalow Igor
Published: June 2020

Extraocular sebaceous carcinoma (ESC) is a rare appendiceal skin tumor. In contrast to ocular sebaceous carcinoma, information about the exact cellular architecture of these lesions is scarce and the histogenesis of ESC is unknown. Here, we extend our previous study and investigate 28 extraocular carcinomas in comparison to 54 benign sebaceous tumors and 8 cases of normal sebaceous glands using a broad spectrum of antibodies against p63, several keratins, adipophilin, EMA, Ki67, androgen receptor, and mismatch repair proteins. This observational study demonstrates that p63- and K5/14-positive basaloid cells are key cells in normal sebaceous gland and in all sebaceous tumors and that these basaloid cells give rise to EMA+, adipophilin+ sebocytes, and K5/14+, K7±, K10± ductal structures. Finally, about half of ESC is associated with superficial in situ neoplasia, which provides evidence that at least part of these carcinomas arises from flat superficial in situ carcinoma. In contrast to the normal sebaceous gland, about half of all sebaceous tumors lack keratin K7. MMR protein IHC-profiles role will be discussed.
An Unusual Histopathological Presentation of Epidermotropic Metastatic Pharyngeal Squamous Cell Carcinoma
Authors: Savari Omid , Shahabi Ali , Bennett Lauren , Somach Stephen
Published: June 2020

Epidermotropic metastasis of head and neck squamous cell carcinoma is rare. We report a case of a 56-year-old white man with a history of oral squamous cell carcinoma who presented with multiple papules on the face, eyelid, and chest wall. The histopathologic examination of the skin lesions revealed nests of malignant cells with basaloid features and zones of cytoplasmic vacuolization predominantly within the dermis but focally involving the epidermis. Central necrosis, focal papilla formation, and lymph-vascular invasion were also seen. Two of these lesions, each read by different dermatopathologists, were initially diagnosed as sebaceous carcinoma. However, further evaluation, including adipophilin immunohistochemistry, confirmed the metastatic nature of the skin lesions. Cytoplasmic vacuolization in metastatic deposits of squamous cell carcinoma may mimic primary sebaceous carcinoma. This presentation highlights the need to consider the possibility of a metastatic deposit when making a diagnosis of primary sebaceous carcinoma.
A New Digital Method for Counting Mast Cells in Cutaneous Specific Lesions of Mastocytosis: A Series of Adult Cases of Mastocytosis With Clinical–Pathological Correlations
Authors: Drabent Philippe , Mitri Rana , Le Naour Gilles , Hermine Olivier , Rossignol Julien , Molina Thierry Jo , Barete Stéphane , Fraitag Sylvie
Published: June 2020

Cutaneous mastocytosis is characterized by the abnormal accumulation of mast cells in the skin. However, mast cell counting is not always easy and reproducible with classical methods. This work aims to demonstrate the reliability, usability, and virtues of a new software used on digital tablets for counting mast cells in cutaneous specific lesions of mastocytosis, to assess differences in mast cell counts between clinical subtypes of mastocytosis in the skin, and to consider the feasibility of applying a diagnostic mast cell count cutoff to urticaria pigmentosa, which is the most frequent form of cutaneous mastocytosis. Using a new digital tablet software that was accessible by multiple observers through its own wireless network and allowed high resolution of the image without data compression, we counted the number of mast cells on slides of patients and control skins immunostained for CD117. We found that our counting method was highly reproducible and that the new software allowed very quick counting. We evidenced strong differences in the mast cell count between most of the clinical subtypes of mastocytosis in the skin. However, when applied to a subset of patients with urticaria pigmentosa, a diagnostic cutoff in the mast cell count lacked sensitivity. Thus, our digital method for counting CD117-immunostained mast cells was highly accurate and was of a significant value for the diagnosis of mastocytosis in the skin. However, some subtypes with low mast cell counts will still require the application of additional diagnostic criteria.
Explantation of Cloudy Oculentis Intraocular Lens With Primary Pars Plana Vitrectomy and Deflooring of the Capsular Bag
Authors: Pilli Suman , Murjaneh Salem
Published: June 2020

Background:

To report a novel technique for explantation of cloudy Oculentis intraocular lens (IOL).

Methods:

A retrospective review of patient's electronic records was performed. The technique includes pars plana vitrectomy, deflooring (large posterior capsulectomy) of the capsular bag, IOL explantation with preserving the anterior capsule, and a secondary IOL placement.

Results:

Twenty eyes of 19 symptomatic patients were studied. Preoperative Snellen visual acuity ranged from 6/60 to 6/6; 15 eyes (75%) had visual acuity of 6/12 or better. Postoperative visual acuity ranged from 6/60 to 6/6; 18 eyes (90%) had visual acuity of 6/12 or better, and 2 eyes (10%) had visual acuity worse than 6/12. Among these eyes, 13 eyes (65%) had sulcus-fixated IOL, 5 eyes (25%) had sutureless scleral-fixated IOL, and 2 eyes (10%) had retropupillary iris clip IOL. Perioperative surgical complications included localized choroidal detachment in one eye and retinal detachment in another eye. In addition, most patients reported significant improvement in their postoperative vision satisfaction.

Conclusion:

Our new technique for explantation of cloudy Oculentis IOL provides a standard surgery allowing a safe predictable and repeatable removal of these lenses comparing with the anterior segment approach. This technique could also be used for removal of other IOLs.
PREOPERATIVE DOMED MACULAR CONTOUR CORRELATES WITH POSTOPERATIVE VISUAL GAIN AFTER VITRECTOMY FOR SYMPTOMATIC EPIRETINAL MEMBRANE
Authors: Zeyer John C. , Parker Paul , Dajani Omar , MacCumber Mathew W.
Published: June 2020

Purpose:

Evaluate macular features on preoperative ocular coherence tomography as indicators of postoperative visual gain following vitrectomy for epiretinal membrane (ERM).

Methods:

A retrospective chart review of 66 eyes that underwent vitrectomy with membrane and internal limiting membrane peeling for symptomatic ERM. Inclusion criteria required a pre-op visual acuity of at least 20/200 and minimum follow-up of 1 year. In addition, 31 of these eyes with complete 5-line raster pre-op ocular coherence tomography had segmentation analysis which included noncentral ERM to inner nuclear layer and ERM to outer plexiform layer measurements.

Results:

Eyes with “domed” pre-op macular contour had a mean preoperative acuity of 20/70 and gained a mean 2.4 lines at one year, compared with those with “flat” or “depressed” macular contour, having a 20/60 mean preoperative acuity and 0.6 lines gained (P = 0.02). Changes for other ocular coherence tomography features examined were not statistically significant. Paracentral ERM to inner nuclear layer measurements had moderate correlation, whereas paracentral ERM to outer plexiform layer measurements had weak correlation with gain in visual acuity.

Conclusion:

An inner macular-domed contour in eyes with ERM predicted better visual gain after vitrectomy with ERM and internal limiting membrane peeling compared with a flat or depressed contour.
VASCULAR COMPLEXITY ANALYSIS IN OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY OF DIABETIC RETINOPATHY
Authors: Alam Minhaj , Le David , Lim Jennifer I. , Yao Xincheng
Published: June 2020

Purpose:

This study aimed to verify the feasibility of using vascular complexity features for objective differentiation of controls and nonproliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) patients.

Methods:

This was a cross-sectional study conducted in a tertiary, subspecialty, academic practice. The cohort included 20 control subjects, 60 NPDR patients, and 56 PDR patients. Three vascular complexity features, including the vessel complexity index, fractal dimension, and blood vessel tortuosity, were derived from each optical coherence tomography angiography image. A shifting-window measurement was further implemented to identify local feature distortions due to localized neovascularization and mesh structures in PDR.

Results:

With mean value analysis of the whole-image, only the vessel complexity index and blood vessel tortuosity were able to classify NPDR versus PDR patients. Comparative shifting-window measurement revealed increased sensitivity of complexity feature analysis, particularly for NPDR versus PDR classification. A multivariate regression model indicated that the combination of all three vascular complexity features with shifting-window measurement provided the best classification accuracy for controls versus NPDR versus PDR.

Conclusion:

Vessel complexity index and blood vessel tortuosity were the most sensitive in differentiating NPDR and PDR patients. A shifting-window measurement increased the sensitivity significantly for objective optical coherence tomography angiography classification of diabetic retinopathy.
APPLICATION OF MODIFIED NEI VFQ-25 AFTER RETINAL DETACHMENT TO VISION-RELATED QUALITY OF LIFE
Authors: Potic Jelena , Bergin Ciara , Giacuzzo Clarice , Konstantinidis Lazaros , Daruich Alejandra , Wolfensberger Thomas J.
Published: June 2020

Purpose:

We examined the postoperative visual recovery and quality of life after retinal detachment (RD) surgery.

Methods:

In addition to a baseline clinical examination, patients filled out the National Eye Institute Visual Functioning Questionnaire at three time points: preoperatively and 1 and 3 months postoperatively (M1 and M3, respectively). We analyzed the composite score and short-form scores (socioemotional scale [SFSES] and visual functioning scale [SFVFS]).

Results:

One hundred ninety-four patients were enrolled in this study; 47 (26 macula-ON RD and 21 macula-OFF RD) returned all three questionnaires. The best corrected visual acuity was Snellen equivalent 20/25, 20/25, and 20/20 at the preoperative, M1, and M3 assessment, respectively. At M3, we found a positive correlation between SFSES and best corrected visual acuity measures among macula-OFF patients (P < 0.001, R2 = 0.58). A significant correlation with the best corrected visual acuity among macula-ON patients was observed only at M3 with the SFVFS score (P < 0.001, R2 = 0.41).

Conclusion:

The quality of life differs between ON and OFF RD in regard to the composite score and especially SFSES and SFVFS. We found a transient decrease in the quality of life at M1 for macula-ON patients, whereas the quality of life improved throughout follow-up among macula-OFF patients. These data may help improve the management of patients' expectations after RD surgery.
Ocular Anterior Segment Pathology in the Emergency Department: A 5-Year Study
Authors: Tang Vincent D. , Safi Mustafa , Mahavongtrakul Angelique , Mahmood Bilawal , Ling Jennifer , Kyrillos Ralph , Li Jennifer , Mannis Mark
Published: June 2020

Introduction:

Patients with ocular complaints frequently present to emergency departments (EDs) for care. Emergency department practitioners are often the first to evaluate these patients and determine the next steps in their care, which can be a challenging task. The purpose of this study is to determine the frequency of anterior segment pathology in the setting of the ED in hopes that this information will be useful in creating more effective management algorithms.

Methods:

A retrospective study based on electronic patient charts from the University of California Davis ED that included ophthalmology consults. We reviewed the charts for demographic data, as well as visual acuity (VA), intraocular pressure (IOP), and diagnosis as determined by ED and ophthalmology personnel, respectively.

Results:

The most common anterior segment diagnoses were uveitis, corneal abrasion, corneal ulcer, meibomian gland dysfunction/dry eyes/blepharitis/punctate epithelial erosions, and conjunctivitis/epidemic keratoconjunctivitis. Emergency Department personnel measured the VA and IOP in 40.8% and 16.7% of patients, respectively. The ophthalmologist measured the VA and IOP in 78.4% and 95.1% of patients, respectively. The percentage agreement in VA measurement between ophthalmology and ED was 11.8%. The percentage agreement in IOP measurement between ophthalmology and ED was 0.86%. The percentage agreement in diagnosis between ophthalmology and ED was 49.4%.

Conclusions:

Most ocular conditions that present in the ED are nonurgent and can be treated in an outpatient setting. However, ED personnel are often unable to obtain the proper “ocular vital signs” (the VA and IOP) and diagnoses. Our findings suggest a need for clear interprofessional discussion in creating an algorithm for triage and the management of eye conditions in the ED to deliver effective care.
Visual outcomes after toric intraocular lens implantation in pediatric eyes undergoing cataract surgery
Authors: Vasavada Vaishali , Shastri Lajja , Vasavada Abhay R. , Patel Priyanka , Agarwal Deepa , Vasavada Shail A. , Vasavada Viraj A. , Praveen Mamidipudi , Srivastava Samaresh
Published: June 2020

Purpose:

To evaluate long-term visual outcomes and complications after toric intraocular lens (IOL) implantation in children with preexisting corneal astigmatism undergoing cataract surgery.

Setting:

Iladevi Cataract & IOL Research Center, Ahmedabad, India.

Design:

Prospective, interventional case series.

Methods:

Children with regular corneal astigmatism of at least 1.5 diopters (D) were included. A standardized surgical technique with in-the-bag implantation of a toric IOL was performed. All children were followed up on postoperative day 1 and periodically thereafter, until 36 months postoperatively. The uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and residual refractive astigmatism were documented 36 months postoperatively. Rotational stability of toric IOL was also evaluated through the follow-up duration. Complications, particularly visual axis obscuration (VAO) and glaucoma, were documented.

Results:

In total, 76 eyes (51 children) were included in the study. Mean age at surgery was 7.41 ± 2.82 years (SD) and mean preoperative keratometric astigmatism was 1.56 ± 2.13 D. The CDVA (logarithm of the minimum angle of resolution [logMAR]) improved significantly from 0.59 ± 0.43 preoperatively to 0.23 ± 0.27 36 months postoperatively (P = .03). Mean postoperative UDVA was 0.32 ± 0.26 logMAR. Mean refractive astigmatism at final follow-up was −0.55 ± 0.40 D, with 74% patients having a UDVA of at least 20/40; 5% of eyes needed VAO treatment and none developed glaucoma. No eye required repositioning of toric IOL until final follow-up.

Conclusions:

Toric IOL implantation reduced postoperative refractive astigmatism and gave excellent UDVA at 36 months follow-up in pediatric eyes undergoing nontraumatic cataract surgery.
The efficacy of mindfulness-based interventions in acute pain: a systematic review and meta-analysis
Authors: Shires Alice , Sharpe Louise , Davies Jonathan N. , Newton-John Toby R.O.
Published: June 2020

Recent meta-analyses have shown mindfulness-based interventions (MBIs) to be effective for chronic pain, but no pooled estimates of the effect of MBIs on acute pain are available. This meta-analysis was conducted to fill that gap. A literature search was conducted in 4 databases. Articles were eligible if they reported on randomized controlled trials of MBIs for people with acute pain and one of the following outcomes: pain severity, pain threshold, pain tolerance, or pain-related distress. Two authors independently extracted the data, assessed risk of bias, and provided GRADE ratings. Twenty-two studies were included. There was no evidence of an effect of MBIs on the primary outcome of pain severity in clinical {Hedges' g = 0.52; (95% confidence interval [CI] −0.241 to 1.280)} or experimental settings (Hedges' g = 0.04; 95% CI [−0.161 to 0.247]). There was a beneficial effect of MBIs on pain tolerance (Hedges' g = 0.68; 95% CI [0.157-1.282]) and pain threshold (Hedges' g = 0.72; 95% CI [0.210-1.154]) in experimental studies. There was no evidence of an effect of MBIs compared to control for pain-related distress in clinical (Hedges' g = 0.16; 95% CI [−0.018 to 0.419]) or experimental settings (Hedges' g = 0.44; 95% CI [−0.164 to 0.419]). GRADE assessment indicated that except for pain tolerance, the data were of low or very low quality. There is moderate evidence that MBIs are efficacious in increasing pain tolerance and weak evidence for pain threshold. However, there is an absence of good-quality evidence for the efficacy of MBIs for reducing the pain severity or pain-related distress in either clinical or experimental settings.
The Impact of Adherence to Clinical Practice Guidelines on Medical Costs
Authors: Castillo Renan C. , Heins Sara , Feldman Dorianne , DuGoff Eva H. , Roberts Eric , Staguhn Elena D. , Wegener Stephen , Anderson Gerard , Trujillo Antonio
Published: June 2020

Objective:

To examine the association between non-adherence to clinical practice guidelines (CPGs) and medical and indemnity spending among back and shoulder injury patients.

Methods:

Workers compensation claims data was used from a large, US insurer (1999 to 2010). Least square regression models were created to examine the association between spending and guideline-discordant care.

Results:

Non-adherence to CPGs was associated with higher medical and indemnity spending for 11 of the 28 CPG indicators. Failure to adhere to the other CPGs did not increase medical or total spending. After covariate adjustment, non-adherence to these 11 CPGs was associated with spending increases that ranged from $16,000 for physical therapy (PT) to $114,000 for surgery.

Conclusions:

Our results demonstrate that failure to adhere to a subset of CPG indicators significantly predicts increased medical and indemnity spending for two important occupational injuries.
Role of 18F-FDG PET/CT in restaging of esophageal cancer after curative-intent surgical resection
Authors: Pande Shantanu S. , Purandare Nilendu , Puranik Ameya , Shah Sneha , Agrawal Archi , C.S. Pramesh , Prabhash Kumar , Agarwal Jai Prakash , Rangarajan Venkatesh
Published: June 2020

Objective

The aim of the study was to evaluate diagnostic performance of FDG PET-CT in suspected recurrence of carcinoma esophagus after curative-intent surgical resection and impact of FDG PET-CT on intended management.

Material and methods

This was retrospective study of patients with clinical or radiological suspicion of recurrent esophageal carcinoma who were referred for PET-CT from January 2006 to December 2017. Diagnostic performance of PET-CT was evaluated for disease recurrence and its impact on management decisions. PET-CT findings were confirmed with tissue diagnosis. When tissue diagnosis was not available clinical and radiological follow-up was used as reference standard.

Results

Relevant clinical data were available in 68 patients which were considered for analysis. In 91% (62/68) patients FDG PET-CT findings were suggestive of disease recurrence. Histopathological confirmation was available in 43 patients, whereas in remaining patients recurrence was confirmed by radiological and clinical follow-up. Forty percent (28/68) patients were detected with distant metastases. Sensitivity, specificity, positive and negative predictive values of FDG PET-CT was found to be 98.4, 80, 98 and 80% with accuracy of 97%. Change in management was observed in 41% (28/68) of patients from salvage radiotherapy/surgery to palliative chemotherapy/best supportive care based on evidence of distant metastases seen on FDG PET-CT.

Conclusion

FDG PET-CT is highly sensitive in detection of recurrent disease in esophageal cancer patients after surgical resection. It can detect distant metastases in high proportion of patients thus changing the intent of management from radical salvage to palliative chemotherapy/best supportive care.
Optimization of the radiosynthesis of [68Ga]Ga-PSMA-11 using a Trasis MiniAiO synthesizer: do we need to heat and purify?
Authors: Reverchon Jérémy , Khayi Fouzi , Roger Marianne , Moreau Aurélie , Kryza David
Published: June 2020

Introdution:

[68Ga]Ga-prostate specific membrane antigen (PSMA)-11 showed a clear gain in sensitivity for lesion detection in the biological recurrence of prostate cancer as compared to the standard [18F]fluorocholine radiopharmaceutical. To meet the strong demand for [68Ga]Ga-PSMA-11, we aimed to optimize an automated radiolabeling process by evaluating the influence of different key parameters on radiochemical purity and radiochemical yield.

Methods:

The radiosynthesis of [68Ga]Ga PSMA-11 was performed using a Trasis MiniAio synthesizer and a 68Ge/68Ga GalliaPharm generator supplied by Eckert & Ziegler, Berlin, Germany. Optimized labeling parameters were evaluated by variation of sodium acetate concentrations and temperature of radiolabeling as well as the purification process.

Results:

For each condition tested, radiochemical purity was higher than 99% in the final vial without batch failure, indicating a robust and fast radiosynthesis process. Radiosynthesis without the solid phase extraction purification process at room temperature in less than 5 min resulted in a radiolabeling efficiency of over 99% and remained stable at least 4 h without manual processing to limit operator radiation exposure.

Conclusion:

The procedure was completely automated and provided a high radiochemical yield. It can be performed several times a day, facilitating the clinical demand of this radiopharmaceutical.
Emergency Department Provider Survey Regarding Acute Sickle Cell Pain Management
Authors: Martin Olufunke Y. , Thompson Sean M. , Carroll Aaron E. , Jacob Seethal A.
Published: June 2020

Sickle cell disease (SCD) can lead to potentially devastating complications that occur secondary to vaso-occlusion. Current national clinical guidelines are largely based on expert opinion, resulting in significant variation of management. Provider awareness regarding emergency department (ED) management of vaso-occlusive crises (VOC) remains unknown. A 23-question assessment of VOC management was administered to all eligible ED providers at Riley Hospital for Children between September and November 2018. Univariate analyses were performed to evaluate responses between groups. Of 52 respondents comprised of ED staff attendings (27%), resident trainees (58%), and ED nurses (15%), the majority were not aware of SCD management guidelines being available. Approximately 54% of providers endorsed a high comfort level in managing VOC, with staff and nurses more likely to report this than trainees (P=0.02). Less than 10% of all providers knew the recommended timeframe from triage to initial medication administration. Prolonged time between pain assessments was reported by 25% of providers with a high comfort level in managing VOC, which was similar to providers with a lower comfort level (13%, P=0.217). Only one fourth of all respondents appropriately did not use vital signs as an indication of a patient’s pain level, and >10% reported not utilizing patient-reported pain scores. This was not significantly different between provider comfort levels (P=0.285 and 0.412, relatively). Our results suggest education regarding recommended practices was inadequate regardless of reported provider comfort. Further provider education and/or standardized ED VOC management guidelines may serve as areas for improvement in SCD care.
A Challenge for Hemophilia Treatment: Hemophilia and Cancer
Authors: Koc Basak , Zulfikar Bulent
Published: June 2020

Background:

The risk of developing cancer increases with age and also adverse environmental conditions. The same holds true in the aging people with hemophilia (PwH). Furthermore, cancer is an important challenge for physicians working in multidisciplinary hemophilia care centers.

Aim:

Here, the authors report 7 hemophiliacs with malignancies diagnosed and managed at our center.

Study Design:

Hemophilia A and B were included.

Method:

Patients with mild, moderate, or severe hemophilia A or B, who were followed-up in our center between January 1999 and December 2018 were included in the study. A total of 470 PwH (391 Hemophilia A and 79 Hemophilia B) were followed in this time period.

Results:

With a minimum 1 and maximum 20 years (median: 11.5 y) of the following time, 7 of 470 (1.48%) PwH were diagnosed with cancer. The diagnosed cancer types were acute lymphoblastic leukemia, acute myeloid leukemia, thyroid cancer, rectum cancer, malign melanoma, basal cell carcinoma, and gastric cancer. All patients except patients with leukemia had major surgical intervention and the hemostasis control was provided on the basis of institutional protocols. At the end of the study, all of the patients were alive besides the patient with acute myeloid leukemia.

Conclusions:

Nowadays, the management of PwH has improved immensely and the life span has progressively become similar to healthy male individuals. For accurate improvement and standardizing care, prospective data collection on the epidemiology of cancer in PwH is an important tool.
Reducing Delirium in Hospitalized Adults Through a Structured Sleep Promotion Program
Authors: Gode Autumn , Kozub Elizabeth , Joerger Kyla , Lynch Cassandra , Roche Maren , Kirven Justin
Published: June 2020

Background:

Delirium affects approximately 1 in 4 patients during their hospitalization and is associated with numerous complications. Sleep deprivation is a significant risk factor for developing delirium and is a patient dissatisfier.

Problem:

An internal assessment revealed that up to 25% of all patients on medical-surgical units had a diagnosis of delirium while in the hospital.

Approach:

An evidence-based practice project was implemented to reduce the development of delirium through sleep promotion on 2 inpatient units. A dedicated time was selected, and key strategies were identified to promote sleep with minimal interruptions.

Outcomes:

Delirium decreased by 33% and 45% on the 2 units over 1 year. Overall, patient satisfaction for quietness at night survey responses also increased (P = .0005; CI, 0.05 to 0.67) with ongoing sustainment.

Conclusions:

Implementation of a dedicated period to sleep was associated with a reduction in delirium and increased patient satisfaction for quietness at night.
Care of the Spirit
Authors: Petersen Cheryl L. , Schiltz Sarah
Published: June 2020

The purpose of this pilot was to identify the effects of a 4-credit interdisciplinary undergraduate course focused on communication strategies to enhance spiritual care at the end of life. The course provided students with opportunities to enhance their ability to communicate empathically with individuals facing the end of life. Evidence-based content focused on ways to live each day with hope and gratitude, strengthen relationships, create a legacy, and find meaning and purpose in life and death. Narayanasamy's (1999) Actioning Spirituality and Spiritual Care Education and Training in Nursing model guided project development. The study used a prospective, pretest/posttest design. Participants included undergraduate students (n = 34) from nursing, premedicine, athletic training, business, economics, and religious studies at a Midwest liberal arts college. Statistically significant differences were found in students' attitudes toward and knowledge of spirituality/spiritual care (P < .0001, Cohen's d = 0.59), spiritual care competence (P < .0001, Cohen's d = 0.79), and level of response empathy through role play (P < .0001, Cohen's d = 0.92). Many students referred to this course as “life changing” and “healing.” As our students go out into the community, they may intimately touch the lives and hearts of future patients, family, and friends who face the end of life with their compassionate words.
Patterns of Growth and Nutrition From Birth to 6 Months in Infants With Complex Congenital Cardiac Defects
Authors: Steward Deborah K. , Ryan-Wenger Nancy , Harrison Tondi M. , Pridham Karen F.
Published: June 2020

Background

Infants with complex congenital heart defects (CCHDs) experience alterations in growth that develop following surgical intervention and persist throughout early infancy, but the roles of nutritional intake and method of feeding require further exploration as their roles are not fully explained.

Objectives

The purpose of this study was to characterize trends in growth and nutritional intake during the first 6 months of life in infants with CCHD.

Methods

We conducted a secondary analysis of growth and nutritional data from a pilot study designed to test the feasibility of nurse-guided participatory intervention with parents of infants with CCHD. Measures included demographic data, anthropometric data at birth, hospital discharge, and 6 months of age, nutritional intake at 2 and 6 months of age from parent-completed 24-hour nutrition diaries, and assessment of oral–motor skills between 1 and 2 months of age. Descriptive statistics and correlation and group differences were examined.

Results

Data for 28 infants were analyzed. Infants demonstrated a decrease in weight-for-age z score (WAZ) and length-for-age z score (LAZ) from birth to hospital discharge and an increase in WAZ and LAZ by 6 months of age. Many of the infants developed failure to thrive. Across the study period, one third of the infants were receiving enteral nutrition. Infants who were orally fed had better growth WAZ and LAZ at 6 months of age when compared to infants who were enterally fed.

Discussion

Infants with CCHD exhibit growth faltering throughout early infancy. Reliance on enteral nutrition did not improve growth outcomes in these infants. Findings suggest nutritional intake may not be enough to meet the nutrient requirements to stimulate catch-up growth.
Preconception Evaluation Before In Vitro Fertilization
Authors: Howell Elizabeth P. , Harris Benjamin S. , Kuller Jeffrey A. , Acharya Kelly S.
Published: June 2020

Importance

Infertility poses a substantial public health problem for women of reproductive age, in the United States and globally. Infertility can be overcome with a variety of emerging assisted reproductive technologies (ARTs). In vitro fertilization (IVF) currently represents the most commonly utilized method of ART and is typically associated with the highest clinical pregnancy rate and live birth rate compared with other infertility treatment options. However, proper preconception evaluation and counseling is paramount for optimizing IVF and pregnancy outcomes.

Objective

This article aims to outline current guidelines and recommendations for comprehensive preconception evaluation before initiation of IVF.

Evidence Acquisition

Articles were obtained from PubMed, ACOG committee opinions 781 and 762, and relevant textbook chapters.

Results

A variety of recommendations and best practices exist for optimally managing patients seeking IVF. Special attention must be paid to the workup of certain patient populations, such as those with age older than 35 years, uterine abnormalities, comorbidities (especially hypertension, diabetes, and thrombophilias), and obesity. In addition, many lifestyle factors must be addressed before IVF initiation, such as smoking, illicit drug use, and inadequate nutrition. Preconception counseling and expectation management is key to optimizing pregnancy outcome.

Conclusions and Relevance

A myriad of patient and environmental factors impact the potential success rates of IVF in treating infertility. Providers must be equipped to provide data-driven, patient-centered counseling before initiation of IVF.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After completion of this CME article, readers should be better able to explain the importance of IVF in treating infertility for a variety of patient populations; describe current recommendations and best practices for preconception workup and counseling; identify important risk factors and patient-specific comorbidities that warrant additional evaluation or attention before IVF treatment; and recommend patient-centered preconception counseling for their future patients seeking IVF.
Postoperative Narcotic Use in Patients With Ovarian Cancer on an Enhanced Recovery After Surgery (ERAS) Pathway
Authors: Kay Allison H. , Venn Monica , Urban Renata , Gray Heidi J. , Goff Barbara
Published: June 2020

(Abstracted from Gynecol Oncol 2020;156:624–628)

In light of the current opioid epidemic, the medical community is exploring potential means to reduce postoperative narcotic use. This retrospective cohort study aimed to assess the impact of a gynecologic oncology enhanced recovery after surgery (ERAS) pathway on postoperative need for narcotics in the first 3 months after an open surgery in patients with ovarian cancer.
Perineorrhaphy Compared With Pelvic Floor Muscle Therapy in Women With Late Consequences of a Poorly Healed Second-Degree Perineal Tear: A Randomized Controlled Trial
Authors: Bergman Ida , Söderberg Marie Westergren , Ek Marion
Published: June 2020

(Abstracted from Obstet Gynecol 2020;135:341–351)

Perineal trauma and tears during vaginal childbirth is common in primiparous women. Reported rates of perineal tears range from 47% to 78%.
Shigellosis Among Gay and Bisexual Men: A Qualitative Assessment to Examine Knowledge, Attitudes, and Practices
Authors: Caruso Elise , Wright Eric R. , Respress Ebony Townsend , Evener Steve L. , Jacobson Kathleen , Bowen Anna , Kachur Rachel , Garcia-Williams Amanda
Published: June 2020

Background

Shigellosis is a highly contagious enteric bacterial disease transmitted through the fecal-oral route. It is primarily transmitted through person-to-person contact and via contaminated food and water. Outbreaks of shigellosis among men who have sex with men (MSM) attributed to sexual person-to-person contact have been reported. These outbreaks are of concern because they are often caused by multidrug-resistant strains ofShigella. Little is known about shigellosis-related knowledge, attitudes, and practices among gay, bisexual, and other MSM.

Methods

Six focus groups were conducted among self-identified gay or bisexual men in Atlanta, GA, in Fall 2017. Participants were asked about shigellosis-related knowledge, attitudes, and practices. Focus groups were audio recorded, and the transcribed audio was analyzed using inductive and deductive thematic coding.

Results

Among the 24 focus group participants, most perceived that diarrheal illness was caused by contaminated food. Knowledge of shigellosis andShigellawas low, with most never having heard of the disease or bacteria. Participants did not perceive shigellosis to be a serious health concern, especially when compared with HIV; however, they did perceive gay and bisexual men to be at risk ofShigellainfection. Participants reported mixed intentions to change sexual behaviors to prevent shigellosis or talk with sexual partners about diarrhea.

Conclusions

Health communication and education efforts could be used to increase knowledge about shigellosis and shift perceptions about the severity of shigellosis among gay, bisexual, and other MSM. Additional work is needed to identify effective ways to promote shigellosis-related prevention behaviors among gay, bisexual, and other MSM.
Incidental Massive Hydrocephalus Associated With an Unruptured Choroid Plexus Arteriovenous Malformation and Complete Agenesis of the Corpus Callosum Found in an Adult at Autopsy
Authors: Conway Kyle , Smith Zachary , Nguyen Teresa , Hlavaty Leigh , Venneti Sriram , Camelo-Piragua Sandra , Webb Milad
Published: June 2020

Undiagnosed significant hydrocephalus is an uncommon finding at forensic autopsy as many cases present in life with complex neurological symptoms. We present a case of a 46-year-old man with no neurological deficits or history of head trauma that was incidentally found to have a massive hydrocephalus at autopsy. This was found to be associated with an unruptured arteriovenous malformation completely confined to the choroid plexus as well as complete agenesis of the corpus callosum. The arteriovenous malformation was found to form a calcified obstruction at the foramen of Monro analogous to a mass lesion, such as a colloid cyst of the third ventricle. The association of this malformation and agenesis of the corpus callosum has never been described. Histologic examination of the brain confirmed significant loss of white matter tracts and thinning of the cortical ribbon due to pressure atrophy of the ependymal lining without significant gliosis, cortical dysplasia, or evidence of other developmental malformations. Autopsy is a vital tool in the evaluation of such rare cases, enhances epidemiologic data, and increases the understanding of these pathophysiological associations.
An Inflamed, Giant, True, Extramural Duodenal Diverticulum
Authors: Sakry Rachel C. , Kemp Walter L.
Published: June 2020

A 53-year-old man was found to have a giant 16 × 6-cm hemorrhagic and cystic mass centered on the pancreas and duodenum. Initially diagnosed as a pancreatic pseudocyst at the time of autopsy, the cystic mass was later determined by histologic examination to be a true diverticulum of the duodenum as microscopic examination of the wall revealed 2 layers of muscle, as well as a neutrophilic infiltrate. While the cause of death of the individual was certified as methamphetamine toxicity, cardiomegaly and probable dehydration associated with a giant duodenal diverticulum were listed as contributory conditions. While duodenal diverticula in general are relatively uncommon findings, an extramural, true, giant duodenal diverticulum that is inflamed is a rare clinical or autopsy finding, with only 2 case reports identified in the clinical medical literature and none in the forensic literature.
An Illustrative Case of Suicidal Hanging Versus Accidental Hanging Associated With Autoerotic Activity
Authors: Zou Jalynn , Bauler Laura D. , Brown Theodore T.
Published: June 2020

The majority of hanging deaths are relatively straightforward when opining the manner of death, typically determined to be suicide. However, there are rare hanging deaths that require the forensic pathologist to seek additional information. Forensic pathologists commonly consider an accidental manner of death when the hanging death scene includes evidence of solitary sexual activity consistent with autoerotic asphyxia. Here, the authors present a case of an initially apparent suicidal hanging where important death scene details photographed by the medical examiner investigator and history provided by family members during subsequent conversations ultimately helped the forensic pathologist conclude an opinion that the hanging was accidental, likely due to autoerotic activity. The decedent, who hanged himself in the closet of his bedroom, was wearing shorts that were initially believed to be inadvertently torn; however, further investigation revealed his shorts were intentionally modified to expose his genitalia. Additional evidence documented from the death scene photographs and conversations with his mother revealed items and activities consistent with autoerotic behavior. Before opining a manner of death in hanging deaths, forensic pathologists are encouraged to consider details beyond that obtained from the initial death scene investigation and postmortem examination. A thorough medicolegal death investigation should not be viewed as introducing cognitive bias, but rather as necessary information needed to determine the most accurate cause and manner of death.