bluuebunny/crossref_metadata_2025 huggingface dataset:
Fostering Student–Faculty Partnerships for Continuous Curricular Improvement in Undergraduate Medical Education
Authors: Scott Kirstin W. , Callahan Dana G. , Chen Jie Jane , Lynn Marissa H. , Cote David J. , Morenz Anna , Fisher Josephine , Antoine Varnel L. , Lemoine Elizabeth R. , Bakshi Shaunak K. , Stuart Jessie , Hundert Edward M. , Chang Bernard S. , Gooding Holly
Published: March 2019

Problem

A number of medical schools have used curricular reform as an opportunity to formalize student involvement in medical education, but there are few published assessments of these programs. Formal evaluation of a program’s acceptability and use is essential for determining its potential for sustainability and generalizability.

Approach

Harvard Medical School’s Education Representatives (Ed Reps) program was created in 2015 to launch alongside a new curriculum. The program aimed to foster partnerships between faculty and students for continuous and real-time curricular improvement. Ed Reps, course directors, and core faculty met regularly to convey bidirectional feedback to optimize the learning environment in real time.

Outcomes

A survey to assess the program’s impact was sent to students and faculty. The majority of students (202/222; 91.0%) reported Ed Reps had a positive impact on the curriculum. Among faculty, 35/37 (94.6%) reported making changes to their courses as a result of Ed Reps feedback, and 34/37 (91.9%) agreed the program had a positive impact on the learning environment. Qualitative feedback from students and faculty demonstrated a change in school culture, reflecting the primary goals of partnership and continuous quality improvement (CQI).

Next Steps

This student–faculty partnership demonstrated high rates of awareness, use, and satisfaction among faculty and students, suggesting its potential for local sustainability and implementation at other schools seeking to formalize student engagement in CQI. Next steps include ensuring the feedback provided is representative of the student body and identifying new areas for student CQI input as the curriculum becomes more established.
Practicalities of Total Intravenous Anesthesia and Target-controlled Infusion in Children
Authors: Anderson Brian J. , Bagshaw Oliver
Published: March 2019

Propofol administered in conjunction with an opioid such as remifentanil is used to provide total intravenous anesthesia for children. Drugs can be given as infusion controlled manually by the physician or as automated target-controlled infusion that targets plasma or effect site. Smart pumps programmed with pharmacokinetic parameter estimates administer drugs to a preset plasma concentration. A linking rate constant parameter (keo) allows estimation of effect site concentration. There are two parameter sets, named after the first author describing them, that are commonly used in pediatric target-controlled infusion for propofol (Absalom and Kataria) and one for remifentanil (Minto). Propofol validation studies suggest that these parameter estimates are satisfactory for the majority of children. Recommended target concentrations for both propofol and remifentanil depend on the type of surgery, the degree of surgical stimulation, the use of local anesthetic blocks, and the ventilatory status of the patient. The use of processed electroencephalographic monitoring is helpful in pediatric total intravenous anesthesia and target-controlled infusion anesthesia, particularly in the presence of neuromuscular blockade.
Pathogenesis and treatment of autoimmune rheumatic diseases
Authors: Liu Eric , Perl Andras
Published: March 2019

Purpose of review

Autoimmune diseases are of unknown origin, and they represent significant causes of morbidity and mortality. Here, we review new developments in the understanding of their pathogenesis that have led to development of well tolerated and effective treatments.

Recent findings

In addition to the long-recognized genetic impact of the HLA locus, interferon regulatory factors, PTPN22, STAT4, and NOX have been implicated in pathogenesis of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). Smoking, ultraviolet light, diet, and microbiota exert strong environmental influence on development of RA and SLE. Metabolism has been recognized as a critical integrator of genetic and environmental factors, and it controls immune cell differentiation both under physiological and pathological conditions.

With the advent of high-throughput genetic, proteomic, and metabolomic technologies, the field of medicine has been shifting towards systems-based and personalized approaches to diagnose and treat common conditions, including rheumatic diseases. Regulatory checkpoints of metabolism and signal transduction, such as glucose utilization, mitochondrial electron transport, JAK, mTOR, and AMPK pathway activation, and production of pro-inflammatory cytokines IL-1, IL-6, and IL-17 have presented new targets for therapeutic intervention. This review amalgamates recent discoveries in genetics and metabolomics with immunological pathways of pathogenesis in rheumatic diseases.
Screen Media and Autism Spectrum Disorder: A Systematic Literature Review
Authors: Slobodin Ortal , Heffler Karen Frankel , Davidovitch Michael
Published: March 2019

Objective:

Previous studies suggest that psychiatric disorders are associated with problematic use of screen media. This article systematically reviews the literature on the associations between screen media and autism spectrum disorder (ASD). The review uses the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Method:

Electronic databases were searched from inception to April 2018, using the term “ASD/autism” along with one of the following terms: “screen time”/“media”/“computer”/“phone”/“television”/“video game.”

Results:

A total of 16 studies met the inclusion criteria. The studies support the view that children and adolescents with ASD are exposed to more screen time than their typically developing peers or other clinical groups and that the exposure starts at a younger age. The content and context of screen use (e.g., with parents vs alone) may affect the behaviors associated with media exposure. Correlates and long-term consequences of early screen exposure (before the age of 3 years) remain largely unexamined.

Conclusion:

The current review provides important information about how ASD is associated with screen use and exposure. Future longitudinal research should examine the impact of early screen exposure on child development while accounting for potential moderating environmental factors (e.g., socioeconomic status, parent-child relationship). This will help determine whether—and if so, how much—exposure is detrimental and allow appropriate recommendations and interventions related to screen time among children with ASD.
When Children Are Not Read to at Home: The Million Word Gap
Authors: Logan Jessica A. R. , Justice Laura M. , Yumuş Melike , Chaparro-Moreno Leydi Johana
Published: March 2019

Objective:

In the United States, there are numerous ongoing efforts to remedy the Word Gap: massive differences in heard
vocabulary for poor versus advantaged children during the first 5 years of life. One potentially important resource for vocabulary exposure is children's book reading sessions, which are more lexically diverse than standard caregiver-child conversations and have demonstrated significant correlational and causal influences on children's vocabulary development. Yet, nationally representative data suggest that around 25% of caregivers never read with their children.

Method:

This study uses data from 60 commonly read children's books to estimate the number of words that children are exposed to during book reading sessions. We estimated the total cumulative word exposure for children who are read to at varying frequencies corresponding to nationally representative benchmarks across the first 5 years of life.

Results:

Parents who read 1 picture book with their children every day provide their children with exposure to an estimated 78,000 words each a year. Cumulatively, over the 5 years before kindergarten entry, we estimate that children from literacy-rich homes hear a cumulative 1.4 million more words during storybook reading than children who are never read to.

Conclusion:

Home-based shared book reading represents an important resource for closing the Word Gap.
Promoting Earlier Access to Pediatric Behavioral Health Services with Colocated Care
Authors: Valleley Rachel J. , Leja Ashley , Clarke Brandy , Grennan Allison , Burt Jennifer , Menousek Kathryn , Chadwell Mindy , Sjuts Tara , Gathje Rebecca , Kupzyk Kevin , Hembree Kristen
Published: March 2019

Objective:

This study aimed to determine whether youth access behavioral health (BH) care earlier (i.e., when problems are less severe) when receiving services in colocated pediatric primary care clinics.

Methods:

Six primary care clinics in the Midwest with a colocated BH provider participated in this study. Data on number of sessions attended/not attended with the BH provider, BH symptom severity as measured by the Child Behavior Checklist, parent report of length of presenting problem, and improvement ratings were collected and compared for on-site referrals and off-site referrals. Descriptive, independent sample t tests and regression analyses compared those referred from on-site physicians versus off-site referral sources.

Results:

Results demonstrated that youth receiving BH services at their primary care physician's office accessed services when problems were less severe and had been impacting their functioning for a shorter duration.

Conclusion:

This study is among the first to explore whether youth receiving BH services in primary care are accessing those services earlier than those who are referred from outside sources, resulting in improved patient outcomes.
Internal Dose Assessment after 131I-Iodide Misadministration in a Patient With Incompletely Blocked Thyroid Uptake: Personalized Internal Dose Assessment by Estimating Individual-Specific Biokinetics
Authors: Kwon Tae-Eun , Park MinSeok , Kang Jin-Kyu , Cho Minsu , Jang Seongjae , Kim Kyeong Min , Ha Wi-Ho , Jin Young Woo
Published: March 2019

In July 2017, a medical accident occurred in South Korea, in which 131I-iodide solution was misadministered to the wrong patient. Although the International Commission on Radiological Protection provided internal dose coefficients for iodine for blocked thyroid, they were not reliable enough for determining the dose to the patient (whose thyroid uptake was incompletely blocked) due to a discrepancy in biokinetics. Therefore, a personalized dose assessment was performed to derive the individual-specific dose coefficients for the patient. Initially, the thyroid biokinetics of the patient were statistically clarified by fitting bioassay monitoring results and the corresponding predicted bioassay values, which were calculated repeatedly for varying iodine transfer rates in an iodine biokinetic model. After determining the transfer rate for the patient, the individual-specific dose coefficients were then calculated in accordance with latest recommendations of the International Commission on Radiological Protection. According to the individual-specific biokinetics, the 24 h thyroid uptake fraction of iodine was estimated as 0.52%. The thyroid absorbed dose of the patient was evaluated as 21.2 Gy, which differed greatly (by about 9 Gy) from the dose evaluated simply using the reference data for blocked thyroid uptake. The personalized dose assessment carried out for the patient not only reduced considerable uncertainties in the internal dose calculation, but also improved the reliability of the calculated internal dose by adopting the latest dosimetric data, including specific absorbed fraction values based on voxel phantoms. Through the dose assessment of the patient, the methodology of personalized dose assessment considering individual-specific biokinetics was developed.
Trichofolliculoma of the Eyelid Margin: A Case Report and Review of Literature
Authors: Kapoor Anasua Ganguly , V.S. Vijitha , Mittal Ruchi
Published: March 2019

Trichofolliculoma is a rare benign tumor of the skin, with distinct pilar differentiation and a predilection for the head and neck. To the best of the authors’ knowledge, only 10 cases of eyelid trichofolliculoma has been described in the English literature. Moreover, these benign hair follicle lesions have been reported to clinically mimic eyelid malignancy. The authors report a case of a 58-year-old woman with a nodule on the eyelid margin, with typical clinical features and characteristic histopathological findings aiding the diagnosis of trichofolliculoma. Complete resection was performed to prevent recurrence. The authors also reviewed all the cases of eyelid trichofolliculoma reported in literature to highlight the demography, clinical features, and management of this rare eyelid tumor.
Angiolipoma of the Orbit
Authors: Aljerian Khaldoon , Fathaddin Amany , Almajed Norah , Kalantan Hatem
Published: March 2019

Angiolipoma is characteristically described as an encapsulated mass of mature adipose tissue containing clusters of small blood vessels. The authors have described an extremely rare case of angiolipoma of the orbit. This rare case is only the third reported in the orbit and should be readily recognized from other differential diagnoses. The patient had an excellent prognosis after full surgical excision.
An iPad-based Measure of Processing Speed in Older Adults Hospitalized for Heart Failure
Authors: Gorodeski Eiran Z. , Rosenfeldt Anson B. , Fang Karen , Kubu Cynthia , Rao Stephen M. , Jansen Elizabeth A. , Dey Tanujit , Alberts Jay L.
Published: March 2019

Background

In older adults hospitalized with heart failure (HF), cognitive impairment is associated with increased hospital readmission and mortality risk. There is no consensus on an objective, scalable method of cognitive screening in this population.

Objective

The aim of this project was to determine the feasibility, test-retest reliability, and convergent validity of the Processing Speed Test (PST), a test of information processing, attention, and working memory administered on an iPad in older adults hospitalized with HF.

Methods

Patients hospitalized with HF (n = 30) and age-, sex-, and education-matched controls (n = 30) participated in the study. To determine test-retest reliability, the PST was administered on an iPad on 2 occasions, separated by 12 to 48 hours. The Symbol Digit Modalities Test was administered at the first testing time point to determine convergent validity.

Results

Test-retest reliability of the PST was 0.80 and 0.92 in individuals with HF and controls, respectively. Convergent validity was 0.72 and 0.90 for individuals with HF and controls, respectively. Time to complete the PST was similar for both individuals with HF and controls (<5 minutes).

Conclusion

The iPad-based deployment of the PST was a feasible, reliable, and valid cognitive screen for older adults hospitalized with HF. Using a tablet-based self-administered cognitive screen in older adults with HF provides a method of cognitive assessment that is amenable to widespread clinical utilization.
Motivational Counseling to Reduce Sedentary Behaviors and Depressive Symptoms and Improve Health-Related Quality of Life Among Women With Metabolic Syndrome
Authors: Chiang Li-Chi , Heitkemper Margaret McLean , Chiang Shang-Lin , Tzeng Wen-Chii , Lee Meei-Shyuan , Hung Yi-Jen , Lin Chia-Huei
Published: March 2019

Background

Motivational interviewing, as a counseling approach, could promote not only behavioral changes but also individuals' psychological adaptation. Previous studies provide evidence that motivational interviewing focused on increasing physical activity decreases the risk of metabolic syndrome in women. Its effects on sedentary behaviors, depressive symptoms, and health-related quality of life (HRQL) remain unknown.

Objectives

The aim of this study was to evaluate whether a 12-week motivational counseling program reduces sedentary behaviors and depressive symptoms and improves HRQL in Taiwanese women.

Methods

A randomized controlled study was conducted. Participants (n = 115) were randomly assigned into 3 groups: experimental group (received a brochure on lifestyle modification combined with 12 weeks of motivational counseling), comparison group (received a lifestyle modification brochure), and usual care group (UCG). Outcome variables were measured at baseline and at 12 weeks post intervention by the International Physical Activity Questionnaire, Beck Depression Inventory, and Medical Outcomes Short Form-36 Health Survey. Generalized estimating equations were applied to analyze the intervention effects of groups by interaction of group and time.

Results

Women in the experimental group not only reduced (P < .001) weekly sitting time by 374 minutes but also decreased (P < .05) depressive symptoms, as well as had greater overall HRQL including 8 subscales as compared with the UCG. As compared with the UCG, the women in the comparison group had no change in sedentary behaviors, but they had reduced depressive symptoms and improvement on some HRQL subscales.

Conclusions

Motivational counseling that incorporates behavioral change principles is effective in reducing sedentary behaviors and depressive symptoms and improving HRQL for women with metabolic syndrome.
A Randomized, 8-Week Study of the Effects of Extended-Release Paliperidone and Olanzapine on Heart Rate Variability in Patients With Schizophrenia
Authors: Pu Zheng-Ping , Li Guo-Rong , Zou Zhan-Ping , Tao Feng , Hu Shao-Hua
Published: March 2019

Purpose

This study aimed to explore the effect of extended-release paliperidone (paliperidone ER) and olanzapine on heart rate variability (HRV) in patients with schizophrenia.

Methods

A total of 106 patients with schizophrenia diagnosed by the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) were randomly divided into the paliperidone ER group or the olanzapine group for an 8-week clinical trial, with 53 patients in each group. The time domain and frequency domain analyses including the SD of all the R-R intervals in 24 hours (SDNN), the SD of the mean value of all the normal R-R intervals in every 5-minute interval within 24 hours (SDANN index), the mean value of the SD of all the normal R-R intervals in every 5-minute interval within 24 hours (SDNN index), the root mean square of successive R-R differences, the percentage of adjacent R-R intervals that differ by more than 50 milliseconds, high-frequency power (HF), low-frequency power (LF), and LF/HF were adopted to assess the HRV of patients at baseline and after treatment for 8 weeks in each group. The Positive and Negative Symptom Scale was used to evaluate the clinical efficacy. The incidence rates of adverse reactions were also calculated.

Results

In total, 48 patients in the paliperidone ER group and 45 patients in the olanzapine group completed the entire 8-week treatment. The SDNN, SDNN index, and SDANN index in the olanzapine group were significantly lower than those in the paliperidone ER group (P < 0.05) after treatment for 8 weeks, whereas their mean LF level was higher than that in the paliperidone ER group (P < 0.05) after completion of treatment. Patients in the olanzapine group showed a significant decrease in the SDNN, SDANN index, and SDNN index as well as a statistical increase in the LF and LF/HF in comparison with the pretreatment values (P < 0.05), whereas patients in the paliperidone ER group showed a decrease in the SDANN index and a statistical increase in the LF in comparison with the pretreatment values (P < 0.05).

Conclusion

The HRV of patients with schizophrenia changes when they are administered with paliperidone ER or olanzapine, and more attention should be paid to their cardiac autonomic function when using these 2 antipsychotics.
Evaluation of Esophageal Contraction Reserve Using HRM in Symptomatic Esophageal Disease
Authors: Penagini Roberto , Gyawali C. Prakash
Published: March 2019

Esophageal high resolution manometry (HRM) is the gold standard for assessment of esophageal motor disorders, but motor responses to the standard 5 mL water swallow protocol may not provide precision in defining minor motor disorders. Provocative maneuvers, particularly multiple rapid swallows (MRS), have been used to assess deglutitive inhibition during the repetitive swallows, and the contractile response following the final swallow of the sequence. The augmentation of esophageal smooth muscle contraction following MRS is termed contraction reserve. This is determined as the ratio between esophageal body contraction vigor (distal contractile integral, DCI) following MRS to the mean DCI after single swallows, which is ≥1 in the presence of contraction reserve. Reliable assessment of contraction reserve requires the performance of 3 MRS maneuvers during HRM. Absence of contraction reserve is associated with a higher likelihood of late postfundoplication dysphagia and may correlate with higher esophageal reflux burden on ambulatory reflux monitoring. Esophageal motor responses to abdominal compression, functional lumen imaging probe (FLIP) balloon distension, and pharmacologic testing (using edrophonium and cisapride) may correlate with contraction reserve. Other provocative tests useful during HRM include rapid drink challenge, solid and viscous swallows, and standardized test meals, which are more useful in evaluation of esophageal outflow obstruction and dysphagia syndromes than in identification of contraction reserve. Provocative maneuvers have been recommended as part of routine HRM protocols, and while useful clinical information can be gleaned from these maneuvers, further research is necessary to determine the precise role of provocative testing in clinical esophagology.
Prevalence of cervical cancer and pre-cancerous lesions among unscreened Women in Kumasi, Ghana
Authors: Donkoh Emmanuel Timmy , Agyemang-Yeboah Francis , Asmah Richard Harry , Wiredu Edwin K.
Published: March 2019

Ghana does not have a universal population-based cervical cancer screening program and there is very limited information about the distribution of cervical epithelial cell lesions. This study provides evidence that a moderately high prevalence of cervical cancer and precancerous lesions exists among unscreened women in Kumasi.

The prevalence of cervical epithelial cell abnormalities among a cross-section of women attending cervical cancer screening for the first time in a suburb of Ghana from 2011 to 2014 was studied. Cervical smears were prepared and examined independently by 2 cytotechnologists and confirmed by a pathologist. Cervical lesions were classified according to the Bethesda System for cervical cytology 2001.

Out of the 592 women for whom a Pap smear was available for evaluation, 555 (93.8%) were negative for intraepithelial lesion or malignancy. Eight women (1.4%) showed atypical squamous cells of undetermined significance (ASCUS), 9 (1.4%) low-grade squamous intraepithelial lesions, and 2 (0.3%) high-grade squamous intraepithelial lesions. A total of 15 (2.5%) smears were unsatisfactory for cervical cytology. Additionally, 3 women (0.5%) had squamous cell carcinoma, giving an overall rate of 3.7% for epithelial cell abnormalities.

Cervical cancer and precursor epithelial cell abnormalities are common among women in Kumasi for a disease that can be prevented by early detection through routine screening and management. This study provides adequate background data to recommend the implementation of cervical cancer screening in all eligible women in Ghana.
The clinical significance of microRNA-122 in predicting the prognosis of patients with hepatocellular carcinoma
Authors: Zhang Yanfang , Li Yongguo , Jiang Wenhui , Li Qian , Lan Yinghua
Published: March 2019

Background:

Although the prognostic value of microRNA-122 (miR-122) for hepatocellular carcinoma (HCC) patients have been evaluated by numerous studies, the results of them were not completely consistent. The present study aims to comprehensively evaluate the predicting value of miR-122 on the prognosis of patients with HCC based on all eligible literatures.

Methods:

Numerous electronic databases (MEDLINE, Embase, Pubmed, Google Scholar, and China Biology Medicine disc) were applied to retrieve relevant studies. Overall survival (OS) and progression-free survival (PFS) were used as primary endpoints. All statistical analyses were performed by RevMan software version 5.3.5 and STATA software version 14.1. In addition, the results of this meta-analysis were validated by an independent dataset from the Cancer Genome Atlas (TCGA).

Results:

A total of 11 studies containing 1124 patients were included in this meta-analysis. The pooled results showed that low miR-122 expression in HCC tissues significantly associated with unfavorable OS (hazard ratio [HR] = 1.48, 95% confidence interval [CI] 1.22–1.80, P < .001) and PFS (HR = 1.54, 95% CI 1.28–1.85, P < .001) in patients with HCC. However, the expression level of miR-122 in blood did not have the ability in predicting OS (HR = 0.75, 95% CI 0.44–1.28, P = .29) and PFS (HR = 0.84, 95% CI 0.58–1.20, P = .33) of HCC. Subgroup analysis further indicated that low expression of miR-122 in tumor tissues predicted poor OS in HCC patients who received curative liver resection (HR = 2.00, 95% CI 1.08–3.70, P = .03). Analysis using TCGA dataset suggested that low miR-122 expression in HCC tissues was significantly associated with OS (HR = 1.61, 95% CI 1.13–2.27, P = .008) other than PFS (HR = 1.30, 95% CI 0.96–1.75, P = .09).

Conclusion:

Low miR-122 expression in HCC tissues was a reliable indicator for predicting the OS of HCC patients who underwent curative resection. Owing to the disagreement between this meta-analysis and the TCGA dataset, the predictive value of miR-122 in tissues for PFS needs to be verified by future well-designed studies with large sample size.
Risk factors for acquisition and mortality of multidrug-resistant Acinetobacter baumannii bacteremia
Authors: Zhou Hua , Yao Yake , Zhu Bingquan , Ren Danhong , Yang Qing , Fu Yiqi , Yu Yunsong , Zhou Jianying
Published: March 2019

Bloodstream infection caused by Acinetobacter baumannii has become a major clinical concern, especially multidrug-resistant A baumannii (MDRAB). The aim of this study was to identify the risk factors of nosocomial acquired MDRAB bacteremia and to determine the risk factors related to the mortality of patients with MDRAB bacteremia. Patients with nosocomial acquired A baumannii bacteremia were enrolled between January, 2013 and December, 2017 at the First Affiliated Hospital, School of Medicine, Zhejiang University. Medical records were reviewed, and the clinical and microbial characteristics were collected. Among the 338 patients suffering from A baumannii bacteremia, 274 patients were infected with MDRAB bacteremia. Bacteremia-related mortality was 46.4% for the overall sample; 56.2% for MDRAB bacteremia patients, 4.7% for non-MDRAB bacteremia patients. The identified risk factors for developing MDRAB bacteremia were previous exposure to carbapenems [odds ratio (OR) 5.78, P = .005] and penicillins+β-lactamase inhibitors (OR 4.29, P = .009). Primary bacteremia tended to develop non-MDR bacteremia (OR 0.10, P = .002). The risk factors for MDRAB bacteremia-related mortality were old age (OR 1.02, P = .036), a high Pitt bacteremia score (OR 1.32, P < .001), bacteremia occurring after severe pneumonia (OR 8.66, P < .001), while catheter-related infection (OR 0.47, P = .049) and operations for treating infection (OR 0.51, P = .043) may have a better outcome. Patients with MDRAB had a higher mortality rate. Patients with previous carbapenems and penicillins+β-lactamase inhibitor exposure are at an increased risk of MDRAB bacteremia, whereas patients with primary bacteremia tended to develop non-MDR bacteremia. The risk factors for MDRAB bacteremia-related mortality were old age, a high Pitt bacteremia score, and bacteremia occurring after severe pneumonia, whereas catheter-related infection and operations for the treatment of infection may have a better outcome.
HMG CoA reductase expression as a prognostic factor in Korean patients with breast cancer
Authors: Kim Hyojeong , Seol Young Mi , Choi Young Jin , Shin Ho-Jin , Chung Joo Seop , Shin Nari , Kim Ahrong , Kim Jee Yeon , Kim Keun Young , Bae Youngtae
Published: March 2019

There are many preclinical and epidemiological reports suggesting a correlation between 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMG-CoAR) or HMG-CoAR inhibitor (statin) treatment and prognosis in breast cancer. This study aimed to investigate the expression of HMG-CoAR in Korean patients with breast cancer.

The expression of HMG-CoAR on tissue microarrays from 191 patients who underwent resection from 2005 to 2006 in the Pusan National University Hospital was assessed by immunohistochemistry (IHC). The IHC assessment by a board-certified pathologist included areas of both carcinoma and peritumoral tissue of the breast. The scores of cancer-specific staining were adjusted by the scores of peritumoral staining.

The patients were followed for a median 9.1 years. Disease-free survival (DFS) was shorter in patients with a positive adjusted HMG-CoAR score by log-rank test (not reached vs 11.6 years, P = .011). After adjusting for age, T stage, N stage, pathological grade, perioperational chemotherapy, adjuvant radiotherapy, estrogen receptor positivity, progesterone receptor positivity, human epidermal growth factor receptor-2 positivity, and high Ki-67 (>10%), a positive adjusted HMG-CoAR IHC score was also associated with shorter DFS (hazard ratio = 2.638, 95% confidence interval [CI] 1.112–6.262, P = .028).

The expression of HMG-CoAR might be an independent prognostic factor in breast cancer. There are established drugs targeting HMG-CoAR, and further studies on its potential as a predictive marker are needed.
Serum ATX as a novel biomarker for breast cancer
Authors: Shao Yingbo , Yu Yang , He Yaning , Chen Qi , Liu Hui
Published: March 2019

Recent accumulating evidence indicates the biological actions of Autotaxin-Lysophosphatidic acid (ATX-LPA) signaling axis in malignant tumors. However, the role of Autotaxin-Lysophosphatidic acid signaling axis in breast cancer has not been reported. The present study aims to examine the alterations of serum autotaxin in breast cancer and discuss whether serum autotaxin could be useful as a novel parameter of breast cancer.

Serum autotaxin antigen was measured in 112 patients with breast cancer and 50 healthy volunteers by ELISA. The association of serum autotaxin antigen levels with clinicopathological parameters and outcomes of breast cancer was analyzed.

Serum autotaxin antigen was significantly higher in breast cancer patients than healthy volunteers (291.32 ± 38.02 ng/ml vs 254.04 ± 21.03 ng/ml, respectively; P < .0001). Serum autotaxin measurement successfully discriminated breast cancer patients from normal and healthy controls (AUC = 0.798, 95% CI: 0.732–0.864) with an optimal cut-off value of 267.34 ng/ml (sensitivity = 0.741, specificity = 0.800). Increased serum autotaxin was associated with breast cancer nodal status (P = .007), Tumor-Node- Metastasis (TNM) stage (P = .009) and Ki-67 index (P = .004). Univariate and multivariate Cox regression analysis revealed that elevated serum autotaxin showed an independent prognostic value for poor Disease-free survival.

Our present study confirmed the elevation, potential diagnostic, and independent prognostic value of serum autotaxin for breast cancer. Serum autotaxin could serve as a reliable novel biomarker for breast cancer.
Radical modular pancreatoduodenectomy for pancreatic head cancer using a combination of multiple artery-first approaches technique
Authors: Leng Kai-Ming , Zhong Xiang-Yu , Tai Sheng , Kang Peng-Cheng , Wan Ming , Jiang Xing-Ming , Wang Hao , Xu Yi , Wang Zhi-Dong , Cui Yun-Fu
Published: March 2019

The aim of this study was to describe and assess the efficacy of a combination of multiple artery-first approaches (CMAFA) in pancreatoduodenectomy (PD) depending on the tumor location from an embryonic point of view.

Between January 2011 and December 2016, seventy-nine consecutive patients with pancreatic head cancer (PHC) underwent PD with curative intent. Patients were classified into two groups according to the surgical procedure: CMAFA-PD group (n = 38) and conventional PD (Co-PD) group (n = 41). Clinicopathlogical variables and clinical outcomes were compared among the two groups.

The CMAFA technique demonstrated an improved rate of R0 resection (89.5% vs. 70.7%, P = .038) and a higher median lymph node yield (24 vs.20, P = .034). The CMAFA-PD group was associated with reduced blood loss (450 vs. 600 ml, P = .049), lower rate of blood transfusion (23.7% vs. 46.3%, P = .035), and shorter length of hospital stay (19 vs. 26 days, P < .001). The rates of 90-day mortality, major morbidity, and readmission were comparable among the two groups.

This study demonstrates that CMAFA is a feasible and efficient technique with acceptable perioperative and oncological outcomes in treating patients with PHC.
Dramatic effect in passive ROM exercise under sedation in a patient with intractable complex regional pain syndrome (type I)
Authors: Oh Hyun-Min , Kim Chul-Hyun , Kim Ae-Ryoung
Published: March 2019

Rationale:

Complex regional pain syndrome (CRPS) usually occurs after trauma and surgery but can also occur spontaneously. There are various known pathophysiology and treatment protocols for CRPS. However, there is no established treatment guideline. Although physical therapy is known as the first line treatment for CRPS, performing physical therapy is difficult due to severe pain. This case reports the first case with positive effect of physical therapy under sedation that allowed early physical therapy.

Patient concerns:

A 19-year old female had her right elbow area slightly hit by someone else, after which it began to swell and become more painful. Active and passive range of motion (ROM) of the right upper extremity gradually decreased through 3 months, and pain and edema worsened.

Diagnoses:

She had allodynia, nonpitting edema, temperature asymmetry, and trophic change in fingernails in the right upper extremity, which met the diagnostic criteria for CRPS. In the 3-phase bone scan, which is a specific tool to diagnose CRPS, there was trace uptake increase in the right elbow and wrist, indicating possibility of CRPS.

Interventions:

Despite conventional treatments such as pharmacologic and interventional therapies, neither pain nor edema subsided. Pain was so severe that it was impossible to apply physical therapy. Therefore, the patient underwent passive ROM exercise in the right upper extremity under sedation for 30 minutes, which was relatively easier due to decreased pain. After 2 days of passive ROM exercise under sedation, the patient was able to receive passive ROM exercise twice daily without sedation for 18 days.

Outcomes:

After 20 days of passive ROM exercise, including 2 days of passive ROM exercise under sedation, the circumference of her right hand decreased by 5 cm, wrist 2 cm, and elbow 6 cm compared to the initial measurement. Numeric pain rating scale improved from 9 to 3, and her manual muscle test marked fair plus from trace, Jebsen–Taylor hand function test score 43 from 0.

Lessons:

This case suggests that passive ROM exercise under sedation may be a successful alternative as a treatment when exercise, currently known as a treatment to CRPS, is impossible.
Novel treatment of severe radial artery spasm using “homemade sheathless technique”
Authors: Zhang Zaiyong , Xie Qiang
Published: March 2019

Rationale:

Transradial access (TRA) is common for cardiac catheterization, but radial artery spasm (RAS) is suggested to be highlighted. Severe radical artery spasm could be solved by a relative novel approach called “sheathless technique,” using a Tiger diagnostic catheter.

Patient concerns:

A 73-year-old woman presented to our institution with a recurrent feeling of discomfort in her chest. Her electrocardiogram showed ST segment depression. Her medical history indicated arterial hypertension, diabetes, and chronic renal failure. She was on hemodialysis for 5 years for the management of renal problems. Five stents were implanted from femoral access in another hospital via 2 percutaneous coronary interventions. The patient agreed to angiography this time and wanted a more comfortable solution.

Diagnosis:

Recurrent exertional angina was confirmed based on the chief complaint, electrocardiogram, and history.

Interventions:

After a successful radial artery puncture, a 6F arterial sheath pipe and a 5F Tiger diagnostic ductus could only advance slightly because of the RAS. Glonoin and verapamil functioned with the help of the radial sheath, and systemic nitroglycerin was applied later but had a negative outcome. Warm covers were positioned on the antebrachium, but no relief was reported.

The “homemade sheathless technique” was applied. The 5F tube was held, and the 6F sheath was withdrawn. A blade was used to damage the sheath in reverse, and the excess sheath tube was removed.

Outcomes:

The diagnostic catheter was successfully advanced to the ascending aorta, enabling left main and right coronary engagement and angiography. No significant coronary lesion was observed. The patient was discharged 3 days after angiography. Moreover, no complications were observed. A follow-up for 1 month after discharge also showed no complications.

Lessons:

Severe RAS causing failure of TRA is frequent in the transradial catheterization procedure. The sheathless technique may be useful in relieving spasm when other measures fail.
Does the use of proton pump inhibitors increase the risk of hypomagnesemia
Authors: Liao Shengtao , Gan Li , Mei Zhechuan
Published: March 2019

Background:

Proton pump inhibitors (PPIs) are commonly used in the treatment of acid-related diseases; however, the association between the use of PPIs and potential risk of hypomagnesemia is controversial.

Methods:

In the present study, databases including PubMed, EMBASE, MEDLINE, PsycINFO, CINAHL, the Cochrane Library, and 4 Chinese databases were searched since the inception until April 2018. Previous observational studies on the incidence of hypomagnesemia in individuals exposed to PPIs were included.

Results:

This systematic review involved 15 studies including 129,347 participants, and the sample size varied from 52 to 95,205. Meta-analysis of 14 studies indicated that the use of PPIs increased the risk of hypomagnesemia [RR, 1.44, 95% CI, 1.13–1.76; I2, 85.2%]. Subgroup analysis revealed that the use of PPI was not associated with the incidence of hypomagnesemia in outpatients [RR, 1.49; 95% CI, 0.83–2.14; I2, 41.4%] and hospitalized patients [RR, 1.05; 95% CI, 0.81–1.29; I2, 62.1%], respectively. The use of PPIs was not related to the risk of hypomagnesemia based on the cut-off values of 1.8 mg/dL [RR, 1.73; 95% CI, 0.87–2.58; I2, 65.2%], 1.7 mg/dL [RR, 1.48; 95% CI, 0.90–2.06; I2, 87.6%], and 1.6 mg/dL [RR, 0.98; 95% CI, 0.69–1.27; I2, 67.9%].

Conclusion:

The association between the exposure to PPI and the incidence of hypomagnesemia remained unclear. Due to the remarkable heterogeneity in previous studies, a definitive conclusion could not be drawn. Further research should be conducted to investigate the relationship between the use of individual PPI and potential risk of hypomagnesemia, and a dose-response analysis may be required.
Primary hepatic mucosa-associated lymphoid tissue lymphoma
Authors: Xie Huazhi , Lv Jian , Ji Yong , Du Xinjian , Yang Xin
Published: March 2019

Rationale:

Primary hepatic mucosa-associated lymphoid tissue (MALT) lymphoma is a rare disease, and there is no consensus yet on the treatment modalities. Here, we report a new case of MALT lymphoma and review the current literature on this disease.

Patient concerns:

A 73-year-old man was admitted to our department following the incidental finding of a solitary 1.8-cm diameter mass in the liver.

Diagnosis:

Microscopic findings identified the mass as a tumor with infiltration of diffuse atypical B lymphocytes. Immunohistochemical analysis showed positivity for CD20 and CD79a, and negativity for CD3 and CD5. These collective data led to the diagnosis of primary hepatic MALT lymphoma.

Interventions:

The tumor was removed by surgical resection. The patient refused additional treatment after the surgery.

Outcomes:

At the time of writing this report, the patient has been disease free for 6 months postsurgery.

Lessons:

Review of the previously published case reports on this rare tumor type indicates that in addition to chronic liver inflammation due to infection or other reasons, genetic aberrations can also contribute to the development of hepatic MALT lymphoma. Additionally, IgH rearrangement is a good genetic hallmark of this tumor. Owing to no specific clinical or radiologic features to define the disease profile for diagnosis, surgery may be a good choice for both diagnosis and therapy if the patient's condition permits.
Cavernous sinus-orbital apex aspergillus infection in a diabetic patient
Authors: Huang Yuanyuan , Gui Li
Published: March 2019

Rationale:

Cavernous sinus-orbital apex aspergillosis is a rare but serious complication of rhinosinusitis. Pathology results are scarce, and this condition is difficult to diagnose based on clinical and radiological results.

Patient concerns:

A 64-year-old woman presented with cavernous sinus-orbital apex syndrome. Axial and sagittal T1 contrast-enhanced magnetic resonance imaging (MRI) showed a right orbital apex mass abutting the right posterior ethmoid sinus, sphenoid sinus, and cavernous sinus.

Diagnosis:

Cavernous sinus and orbital apex aspergillosis.

Interventions:

Functional endoscopic sinus surgery was performed, and a biopsy of the lesion tissue was submitted for examination, which showed the presence of aspergillus.

Outcomes:

One year after surgical debridement, antifungal, and anticoagulation treatments, the patient is still asymptomatic without recurrence.

Lessons:

Early surgical debridement is crucial to confirm the diagnosis of cavernous sinus-orbital apex aspergillosis and prevent mortality. There is no evidence of negative effects of antibiotic and anticoagulation treatments. Despite controversy, among physicians, most opt to treat patients via anticoagulation therapy.
Effectiveness of nurse-initiated X-ray for emergency department patients with distal limb injuries: a systematic review
Authors: Considine Julie , Shaban Ramon Z. , Curtis Kate , Fry Margaret
Published: March 2019

The aim of this study was to systematically review the literature on the effectiveness of nurse-initiated X-ray for emergency department patients with distal limb injuries. The review protocol was registered with PROSPERO and CINHAL, MEDLINE and EMBASE were searched for studies comparing nurse-initiated vs physician-initiated X-ray. Because of heterogeneity of patients, providers and outcomes, a meta-analysis was not performed. The 16 included studies were conducted between 1971 and 2018 and involved 8881 participants. There were four randomised trials and 12 observational studies that focussed on X-ray request accuracy (n = 14), emergency department processes (n = 6) and patient outcomes (n = 2). The quality of evidence for each outcome ranged from very low-to-moderate. Compared with physician-initiated X-ray, nurse-initiated X-ray uses no more resources, is safe and acceptable to patients. Nurse-initiated X-ray did not reduce time to X-ray or waiting time but in some studies, reduced emergency department length of stay and unplanned follow-up.
Presbylaryngis: a state-of-the-art review
Authors: Mallick Ali Sameer , Garas George , McGlashan Julian
Published: March 2019

Purpose of review

Presbylaryngis is the term used to describe changes in the larynx with ageing. It represents an increasingly common complaint as global populations continue to grow and get older. Presbylaryngis has a significantly negative impact on patients’ quality of life and their ability to participate in society. This article will review the relevant literature on the incidence, pathophysiology, clinical evaluation, and treatment modalities for presbylaryngis.

Recent findings

The recently developed Ageing Voice Index (AVI) constitutes the first validated instrument for voice complaints specifically for the elderly. The evidence suggests that the bedrock of treating presbylaryngis centres on voice therapy. Thus, voice therapy should represent the primary treatment offered with surgery reserved for those failing to adequately respond. However, the comparative effectiveness of the different surgical interventions, namely injection laryngoplasty and thyroplasty, remains undetermined highlighting the need for larger, prospective, comparative studies.

Presbylaryngis is characterized by specific changes at the microscopic level resulting in age-related vocal fold atrophy. However, its presence alone does not always result in symptomatic dysphonia and equally, presbyphonia is often multifactorial involving the lower respiratory tract in addition to the larynx. Thus, the role of a multidisciplinary voice clinic for presbylaryngis cannot be overstated.
Sedation and the Food and Drug Administration Warning
Authors: Fishman Douglas S. , Andropoulos Dean B. , Lightdale Jenifer R.
Published: March 2019

Pediatric gastroenterologists recommend and perform a range of procedures requiring sedation and anesthesia in young children. A recent warning from the US Food and Drug Administration (FDA) states that “repeated or lengthy use of general anesthetics and sedation drugs during surgeries or procedures in children younger than 3 years or in pregnant women during their third trimester may affect the development of children's brains.” 1 As it relates to time, the FDA warning details risks of “procedures lasting longer than 3 hours or if multiple procedures are required.” Pediatric gastroenterologists and related specialists should be aware of the warning and its relevance to their patients.
Sleep Quality Among Teenagers and Young Adults With Cancer
Authors: Fortmann Judith , Fisher Abigail , Hough Rachael , Gregory Alice , Pugh Gemma
Published: March 2019

Background

Teenagers and young adults (TYAs) with cancer are known to suffer poor sleep quality and sleep disturbances; understanding the level of burden is essential to improving patient outcomes via supportive care interventions.

Objectives

To compare sleep quality and the prevalence of sleep disturbances among TYA cancer patients, TYA survivors, and general population TYAs with no history of cancer.

Methods

Teenager and young adult patients receiving active cancer treatment (n = 70), TYA cancer survivors (n = 151), and general population TYAs (n = 324) aged between 13 and 24 years completed the Pittsburgh Sleep Quality Index. Analyses of covariance were used to investigate potential group differences. Age at survey diagnosis, gender, ethnicity, and health status were included as covariates.

Results

84.29% of TYA patients, 62.91% of TYA cancer survivors, and 65.12% of general population TYAs reported Pittsburgh Sleep Quality Index scores greater than 5, suggesting clinically significant sleep disorders. Teenager and young adult patients reported significantly poorer global sleep quality compared with TYA survivors (mean difference, 0.99; 95% confidence interval, 0.03–1.96; P = .044) and general population TYAs (mean difference, 1.34; 95% confidence interval, 0.26–2.41; P = .009). Teenager and young adult patients and survivors reported significantly poorer sleep latency (P = .003 for TYA patients, P = .035 for TYA survivors off treatment) and habitual sleep efficiency (P < .001 for TYA patients, P = .014 for TYA survivors) than general population controls.

Conclusions

The significant differences observed suggest young people with cancer, particularly those on treatment, may benefit from specialized sleep interventions.

Implications for Practice

Efforts to ensure health professionals have the knowledge and skills to provide advice about sleep to young people with cancer are needed.