bluuebunny/crossref_metadata_2025 huggingface dataset:
Genetics of human malignant peripheral nerve sheath tumors
Authors: Pemov Alexander , Li Hua , Presley William , Wallace Margaret R , Miller David T
Published: November 2019

Malignant peripheral nerve sheath tumors (MPNSTs) are heterogeneous, highly aggressive tumors with no widely effective treatment other than surgery. Genomic architecture of MPNST is similar to other soft tissue sarcomas, with a relatively modest burden of single nucleotide variants and an elevated frequency of copy-number alterations. Recent advances in genomic studies identified previously unrecognized critical involvement of polycomb repressor complex 2 (PRC2) core components SUZ12 and EED in transition to malignancy. Notably, somatic changes in NF1, CDKN2A/B, and PRC2 are found in most MPNST regardless of their etiology (e.g. neurofibromatosis type 1-associated vs. sporadic vs. radiation-induced), indicating that similar molecular mechanisms impact pathogenesis in these neoplasms. The timing and specific order of genetic or epigenetic changes may, however, explain the typically poorer prognosis of NF1-associated MPNSTs. Studies that reveal genes and regulatory pathways uniquely altered in malignancies are essential to development of targeted tumor therapies. Characterization of MPNST molecular profiles may also contribute to tools for earlier detection, and prediction of prognosis or drug response. Here we review the genetic discoveries and their implications in understanding MPNST biology.
Patients with Idiopathic Pulmonary Nontuberculous Mycobacterial Disease Have Normal Th1/Th2 Cytokine Responses but Diminished Th17 Cytokine and Enhanced Granulocyte-Macrophage Colony-Stimulating Factor Production
Authors: Wu Un-In , Olivier Kenneth N , Kuhns Douglas B , Fink Danielle L , Sampaio Elizabeth P , Zelazny Adrian M , Shallom Shamira J , Marciano Beatriz E , Lionakis Michail S , Holland Steven M
Published: November 2019

Objective

Although disseminated nontuberculous mycobacterial infection is attributed to defects in the interleukin (IL)-12/interferon-γ circuit, the immunophenotype of idiopathic pulmonary nontuberculous mycobacterial (PNTM) disease is not well defined.

Method

We phenotyped Th1, Th2, Th17, and Treg cytokines and colony-stimulating factor production from patients with idiopathic PNTM disease. Data were compared with healthy donors, cystic fibrosis (CF), and primary ciliary dyskinesia (PCD) patients with PNTM disease. Both supernatant cytokine production and intracellular cytokines expressed by various leukocyte subpopulations following mitogen and antigen stimulation were assayed by electrochemiluminescence–based multiplex immunoassay and flow cytometry, respectively.

Results

Regardless of antigen or mitogen stimulation, neither intracellular nor extracellular Th1, Th2, and Treg cytokine levels differed between patients and controls. Th17 cells and IL-17A levels were lower in idiopathic PNTM patients, whereas monocyte granulocyte-macrophage colony-stimulating factor (GM-CSF) expression in response to NTM stimulation was higher compared with healthy donors. Besides, distinct cytokine responses following stimulation by Mycobacterium abscessus and Mycobacterium avium were observed consistently within each group.

Conclusions

The IL-12/IFN-γ circuit appeared intact in patients with idiopathic PNTM disease. However, idiopathic PNTM patients had reduced Th17 response and higher mycobacteria-induced monocyte GM-CSF expression.
Uveitis-glaucoma-hyphema syndrome associated with an in-the-bag square-edge intraocular lens
Authors: Yang Jin , Qiu Xiaodi , Cai Lei , Fan Qi , Wang Anjian , Zhang Kang , Lu Yi
Published: November 2019

A 54-year-old woman presented with recurrent redness and blurred vision of the left eye with elevated intraocular pressure (IOP) for one year. She was treated as “iridocyclitis” and ``Posner-Schlossman syndrome'' at the local hospitals. However, the patient developed intermittent ocular inflammation and hyphema. Patient had a cataract surgery and intraocular lens (IOL) implantation in the left eye one year before at the local hospital. A diagnostic procedure was performed and the possible pathogenesis was discussed.
Gibberellin Promotes Fungal Entry and Colonization during Paris-Type Arbuscular Mycorrhizal Symbiosis in Eustoma grandiflorum
Authors: Tominaga Takaya , Miura Chihiro , Takeda Naoya , Kanno Yuri , Takemura Yoshihiro , Seo Mitsunori , Yamato Masahide , Kaminaka Hironori
Published: November 2019

Arbuscular mycorrhizas (AMs) are divided into two types according to morphology: Arum- and Paris-type AMs. Gibberellins (GAs) mainly inhibit the establishment of Arum-type AM symbiosis in most model plants, whereas the effects of GAs on Paris-type AM symbiosis are unclear. To provide insight into the mechanism underlying this type of symbiosis, the roles of GAs were investigated in Eustoma grandiflorum when used as the host plant for Paris-type AM establishment. Eustoma grandiflorum seedlings were inoculated with the model AM fungus, Rhizophagus irregularis, and the effects of GA and the GA biosynthesis inhibitor uniconazole-P on the symbiosis were quantitatively evaluated. Exogenous GA significantly increased hyphopodium formation at the epidermis, thus leading to the promotion of fungal colonization and arbuscule formation in the root cortex. By contrast, the suppression of GA biosynthesis and signaling attenuated fungal entry to E. grandiflorum roots. Moreover, the exudates from GA-treated roots strongly induced the hyphal branching of R. irregularis. Our results show that GA has an contrasting effect on Paris-type AM symbiosis in E. grandiflorum compared with Arum-type AM symbiosis. This finding could be explained by the differential regulation of the early colonization stage, where fungal hyphae make contact with and penetrate the epidermis.
Effect of left ventricular diastolic dysfunction on development of primary graft dysfunction after lung transplant
Authors: Yoon Jeongae , Salamanca-Padilla Yuliana
Published: November 2019

Purpose of review

Primary graft dysfunction (PGD) is one of the most common complications after lung transplant and is associated with significant early and late morbidity and mortality. The cause of primary graft dysfunction is often multifactorial involving patient, donor, and operational factors. Diastolic dysfunction is increasingly recognized as an important risk factor for development of PGD after lung transplant and here we examine recent evidence on the topic.

Recent findings

Patients with end-stage lung disease are more likely to suffer from cardiovascular disease including diastolic dysfunction. PGD as result of ischemia–reperfusion injury after lung transplant is exacerbated by increased left atrial pressure and pulmonary venous congestion impacted by diastolic dysfunction. Recent studies on relationship between diastolic dysfunction and PGD after lung transplant show that patients with diastolic dysfunction are more likely to develop PGD with worse survival outcome and complicated hospital course.

Patients with diastolic dysfunction is more likely to suffer from PGD after lung transplant. From the lung transplant candidate selection to perioperative and posttransplant care, thorough evaluation and documentation diastolic dysfunction to guide patient care are imperative.
Pharmacodynamics and pharmacokinetics in older adults
Authors: Thürmann Petra A.
Published: November 2019

Purpose of review

With the growing of the aging population, increased and new methods of anesthesia and surgery allow for surgery and other interventions in older adults.

Pharmacokinetics and pharmacodynamics of drugs in older adults differ from those in younger and middle-aged adults. However, the geriatric population is frequently neglected in the context of clinical trials. The present review focuses on the consequences of multimorbidity and pharmacokinetic and pharmacodynamic alterations and their implications on anesthesia.

Recent findings

Physiologically based pharmacokinetic and pharmacodynamic modeling may serve as an option to better understand the influence of age on drugs used for anesthesia. However, difficulties to adequately characterize geriatric patients are described.

Further research of drug effects in the aging population may include physiologically based pharmacokinetic and pharmacodynamic complex models and randomized controlled trials with thoroughly conducted geriatric assessments.
Impact of geriatric co-management programmes on outcomes in older surgical patients: update of recent evidence
Authors: Van Grootven Bastiaan , Mendelson Daniel Ari , Deschodt Mieke
Published: November 2019

Purpose of review

To determine the impact of geriatric co-management programmes on outcomes in older patients undergoing a surgical procedure.

Recent findings

Twelve programmes were identified. Time to surgery was decreased in two of four studies [pooled mean difference = −0.7 h (95% CI, −3.1 to 4.4)]. The incidence of complications was reduced in two of seven studies (pooled absolute risk reduction = −4% (95% CI −10 to 2%)). Length of stay was reduced in four of eight studies [pooled mean difference = −1.4 days (95% CI −2.7 to −0.1)]. In-hospital mortality was reduced in one of six studies [pooled absolute risk reduction = −2% (95% CI −4 to −0%)]. Unplanned hospital readmissions at 30 days follow-up was reduced in two of three studies [pooled absolute risk reduction = −3% (95% CI −5 to −0%)].

There was a shorter length of stay, less mortality and a lower readmission rate. However, there was uncertainty whether the results are clinically relevant and the GRADE of evidence was low. It was uncertain whether the outcomes time to surgery and complications were improved. The evidence is limited to hip fracture patients.
Clinical Outcomes Following Tongue Type Calcaneus Fractures
Authors: Burnett Zachary , Barzee Brigham M. , Hymes Robert , Cannada Lisa K.
Published: November 2019

Background:

Calcaneus fractures have serious potential complications. Tongue type calcaneus fractures, in particular, are at risk for secondary soft tissue breakdown due in part to the tension placed on the soft tissue by the forces of the Achilles tendon on the superior fragment of the posterior calcaneal tuberosity. The current literature is limited regarding outcomes in pure tongue type calcaneus fractures. The purpose of this study is to report injury details, treatment, and complications in this group of fractures.

Methods:

The study is a retrospective study of patients between 2007 and 2015 with tongue type calcaneus fractures. Demographic data and comorbidities were collected for each patient. Clinical data including details of the injury, time to surgery, length of hospital stay, wound complications, additional surgical procedures, and follow-up data were evaluated.

Results:

There were 25 patients with 26 fractures included in this study, including 7 open fractures. Wound complications occurred in 7 (27%) patients, and fixation failure occurred in 4 (21%) patients. Patients with open fractures reached full healing in less time (2.8±0.4 mo) compared with patients with closed fractures (4±1.3 mo). The difference in time to full healing was not statistically significant (P>0.05) when comparing smokers and nonsmokers.

Conclusions:

The literature is limited regarding outcomes of pure tongue type calcaneus fractures. We found these fractures had similar or even higher rates of wound complications compared with other studies investigating intra-articular calcaneus fractures. This is one of the first studies to report on the complication rates associated specifically with these fractures.

Level of Evidence:

Level IV.
Brain Hypoxia Secondary to Diffusion Limitation in Hypoxic Ischemic Brain Injury Postcardiac Arrest
Authors: Sekhon Mypinder S. , Ainslie Philip N. , Menon David K. , Thiara Sharanjit S. , Cardim Danilo , Gupta Arun K. , Hoiland Ryan Leo , Gooderham Peter , Griesdale Donald E.
Published: November 2019

Objectives:

We sought to characterize 1) the difference in the diffusion gradient of cellular oxygen delivery and 2) the presence of diffusion limitation physiology in hypoxic-ischemic brain injury patients with brain hypoxia, as defined by parenchymal brain tissue oxygen tension less than 20 mm Hg versus normoxia (brain tissue oxygen tension > 20 mm Hg).

Design:

Post hoc subanalysis of a prospective study in hypoxic-ischemic brain injury patients dichotomized into those with brain hypoxia versus normoxia.

Setting:

Quaternary ICU.

Patients:

Fourteen adult hypoxic-ischemic brain injury patients after cardiac arrest.

Interventions:

Patients underwent monitoring with brain oxygen tension, intracranial pressure, cerebral perfusion pressure, mean arterial pressure, and jugular venous bulb oxygen saturation. Data were recorded in real time at 300Hz into the ICM+ monitoring software (Cambridge University Enterprises, Cambridge, United Kingdom). Simultaneous arterial and jugular venous bulb blood gas samples were recorded prospectively.

Measurements and Main Results:

Both the normoxia and hypoxia groups consisted of seven patients. In the normoxia group, the mean brain tissue oxygen tension, jugular venous bulb oxygen tension, and cerebral perfusion pressure were 29 mm Hg (sd, 9), 45 mm Hg (sd, 9), and 80 mm Hg (sd, 7), respectively. In the hypoxia group, the mean brain tissue oxygen tension, jugular venous bulb oxygen to brain tissue oxygen tension gradient, and cerebral perfusion pressure were 14 mm Hg (sd, 4), 53 mm Hg (sd, 8), and 72 mm Hg (sd, 6), respectively. There were significant differences in the jugular venous bulb oxygen tension–brain oxygen tension gradient (16 mm Hg [sd, 6] vs 39 mm Hg sd, 11]; p < 0.001) and in the relationship of jugular venous bulb oxygen tension–brain oxygen tension gradient to cerebral perfusion pressure (p = 0.004) when comparing normoxia to hypoxia. Each 1 mm Hg increase in cerebral perfusion pressure led to a decrease in the jugular venous bulb oxygen tension–brain oxygen tension gradient by 0.36 mm Hg (95% CI, –0.54 to 0.18; p < 0.001) in the normoxia group, but no such relation was demonstrable in the hypoxia group.

Conclusions:

In hypoxic-ischemic brain injury patients with brain hypoxia, there is an elevation in the jugular venous bulb oxygen tension–brain oxygen tension gradient, which is not modulated by changes in cerebral perfusion pressure.
Dexmedetomidine's Relationship to Delirium in Patients Undergoing Cardiac Surgery
Authors: Halpin Emily , Inch Heather , O'Neill Meghan
Published: November 2019

This systematic review aims to determine the relationship between postoperative delirium and the use of dexmedetomidine in comparison with commonly used sedatives/analgesics in the postoperative cardiac surgery patient. A systematic literature search of PubMed plus, CINAHL, Scopus, and Ovid, and limited to the English language in the last 10 years, was performed. Randomized controlled trials, observational and retrospective studies, and meta-analyses with at least 1 delirium assessment tool were included. The search found 196 potential articles; however, only 12 met the criteria outlined. The systematic review revealed a decrease in postoperative delirium for patients receiving dexmedetomidine in all studies. Seven studies demonstrated statistically significant reductions in postoperative delirium with dexmedetomidine compared with other sedatives/analgesics. One study also revealed reduction of delirium with dexmedetomidine as compared with normal saline. Two studies showed a delayed time to delirium onset in patients receiving dexmedetomidine versus propofol or morphine. The 2 meta-analyses found that all included studies had a statistically significant reduction in postoperative delirium when using dexmedetomidine. Postoperative use of dexmedetomidine in cardiac surgery patients may reduce the incidence of postoperative delirium.
Generating Evidence of Critical Care Nurses' Perceptions, Knowledge, Beliefs, and Use of Music Therapy, Aromatherapy, and Guided Imagery
Authors: Meghani Naheed , Tracy Mary Fran , O’Conner-Von Susan , Hadidi Niloufar Niakosari , Mathiason Michelle A. , Lindquist Ruth
Published: November 2019

Background

Critical care settings are known to be fast-paced and technologically advanced. To optimize humanistic care, integration of evidence-based complementary and alternative therapies holds promise. However, evidence of critical care nurses' use of complementary and alternative therapies in clinical practice has not been evaluated recently.

Objectives

This study sought to determine critical care nurses' perspectives of music therapy, aromatherapy, and guided imagery (GI) including perceptions of legitimacy, self-reported knowledge, interest in gaining knowledge, beliefs of harm/benefits, professional use, personal use, recommendations for use in critical care practice, and requests for these therapies by critical care patients or families.

Methods

A descriptive cross-sectional design with repeated measures was conducted with critical care nurses (N = 53) practicing in 3 intensive care units at a Midwestern academic-affiliated medical center. The nurses' current perceptions, knowledge, beliefs, and use of music therapy, aromatherapy, and GI were assessed. In addition, an evaluation of the consistency of participants' responses using the Critical Care Nurses' Use of Complementary Therapies survey was performed on a subset of the sample (n = 15) at 2 time points 4 to 6 weeks apart.

Results

Most nurses (66%-83%) endorsed the legitimacy of these therapies for use with their patients. Nurses had the most knowledge of aromatherapy, followed by music therapy and GI; they showed interest in gaining further knowledge of the therapies even when reporting “some” to “a lot” of knowledge. Nurses showed a positive response regarding their beliefs about the benefits of each therapy. Professional use was highest for aromatherapy (85%), followed by music therapy (75%), corresponding with greater self-reported knowledge and personal use. A majority recommended aromatherapy (79%) and music therapy in practice (64%) and reported that these therapies were requested by patients or families. Responses on the survey items at 2 time points of administration showed consistency.

Discussion

On the basis of the overall survey responses, developing a robust scientific base and addressing educational needs through expanding resources and continuing education programs may promote use of these therapies to benefit patients in critical care.
Improving Compliance With Protocol-Driven Care in Adult Traumatic Brain Injury Patients by Implementing an Electronic Clinical Compliance Monitoring Tool
Authors: Gorman Kimberly M. , Drahnak Dawn , Dumire Russell D. , Noon Jodi , Nahouraii Richard , Morrissey Shawna , Kieta Cheryl , Guttendorf Jane
Published: November 2019

Background:

Traumatic brain injury (TBI) remains a major cause of death and disability each year in the United States. Implementation of preestablished evidence-based guidelines has been associated with a decrease in overall TBI mortality and disability.

Objectives

An electronic clinical monitoring tool was developed for monitoring compliance with evidence-based TBI treatment protocols to improve the overall care and outcomes in this patient population.

Methods

This project was designed as a process improvement project. For the preimplementation cohort of TBI patients, aggregate compliance data (by patient) were obtained from the Brain Trauma Foundation Trial patient registry maintained at Conemaugh Memorial Medical Center for the time between 2011 and 2012. The postimplementation cohort includes all patients older than 18 years who have sustained a TBI requiring clinical monitoring devices.

Results

There was a statistical significance between groups; the TBI-2017 group demonstrated better compliance with anticonvulsant use and cerebral perfusion pressure maintenance. In addition, overall compliance was better in the TBI-2017 cohort compared with the TBI-2012 cohort.

Conclusions

Traumatic brain injury–specific education and frequent assessments improved compliance between TBI-2012 and TBI-2017, resulting in a higher percentage in overall survivors in the latter group.
Prone Position in Acute Respiratory Distress Syndrome Patients
Authors: Lucchini Alberto , Bambi Stefano , Mattiussi Elisa , Elli Stefano , Villa Laura , Bondi Herman , Rona Roberto , Fumagalli Roberto , Foti Giuseppe
Published: November 2019

Background

Early application of prolonged prone positioning has been shown to improve patient survival in moderate to severe adult respiratory distress syndrome (ARDS) patients. Prone position is a key component of lung protective mechanical ventilation in association with low tidal volume and neuromuscular blocking agents in patients with severe ARDS. Pressure sores are the major prone position complication. The rate of complication is lowering with the increase in center expertise.

Aims

The aim of this study was to examine the onset of pressure sores and other complications caused by the use of prone position in patients having ARDS.

Design

This is a single-center, retrospective, observational study.

Results

One hundred seventy patients were enrolled, with a median age of 49 years (interquartile range [IQR], 38-63). Of all participants, 58% (n = 98) survived the intensive care unit recovery. The total prone position maneuvers were 526, with a median of 2 prone position sessions for each patient (IQR, 1-3). The median length of the prone position session was 9 hours (IQR, 7-12). Twenty-three patients developed pressure sores after prone position (14%). The anatomical positions of pressure sores were as follows: face/chin, 5% (n = 8); face/cheekbones, 6% (n = 11); thorax, 2% (n = 3); trochanter, 1% (n = 1); and other sites, 5% (n = 8). Complications were observed in 1% (n = 6) of all pronation maneuvers (vomit, 2%; respiratory device removal, 0.4%). No removal of intravascular catheter was observed.

Conclusions

The onset rate of complications given by the use of prone position in ARDS patients is similar to data reported by previous literature. The implementation of a dedicated protocol in specialized centers and the involvement of 5 trained and skilled professionals while moving the patient in the prone position are recommended to prevent the occurrence of similar adverse events.
Chronic Liver Disease in the Obstetric Patient
Authors: ALBRIGHT CATHERINE M. , FAY EMILY E.
Published: November 2019

Chronic liver disease in pregnancy is rare. Historically, many chronic liver diseases were considered contraindications to pregnancy; however, with current monitoring and treatment strategies, pregnancy may be considered in many cases. Preconception and initial antepartum consultation should focus on disease activity, medication safety, risks of pregnancy, as well as the need for additional monitoring during pregnancy. In most cases, a multidisciplinary approach is necessary to ensure optimal maternal and fetal outcomes. Despite improving outcomes, pregnancy in women with the chronic liver disease remains high risk.
Central aortic blood pressure estimation in children and adolescents: results of the KidCoreBP study
Authors: Mynard Jonathan P. , Goldsmith Greta , Springall Gabriella , Eastaugh Lucas , Lane Geoffrey K. , Zannino Diana , Smolich Joseph J. , Avolio Alberto , Cheung Michael M.H.
Published: November 2019

Background:

Central aortic SBP (cSBP) may have superior prognostic value compared with peripheral SBP (pSBP), but noninvasive cSBP measurement techniques have not been formally validated in children and adolescents.

Method:

This study assessed the accuracy of two automated devices and the radial tonometry/transfer function method (RT-TF) for estimating central pressures and pulse pressure amplification (PPA) in this population, with adherence to validation guidelines for central pressure devices. In 69 children/adolescents aged 3–18 years undergoing clinically indicated aortic catheterization, high fidelity ascending aortic cSBP was measured with a micromanometer-tipped wire and compared with values from SphygmoCor XCEL, Mobil-O-Graph (systolic/diastolic calibration, MoG-C1, or mean/diastolic calibration, MoG-C2) and RT-TF. Reference intra-arterial pSBP was derived from the tonometry pulse calibrated to central mean/diastolic pressures.

Results:

XCEL, MoG-C1 and MoG-C2 overestimated cSBP by 7.9 ± 6.8 mmHg (mean ± SD), 5.7 ± 10.3 mmHg, and 19.1 ± 14.9 mmHg, exceeding the validation cut-off (5 ± 8 mmHg). Brachial pSBP was also overestimated by XCEL (10.9 ± 8.4 mmHg) and Mobil-O-Graph (11.5 ± 12.3 mmHg). By contrast, central and brachial diastolic pressures were underestimated by the automated devices, albeit mostly within acceptable limits; pulse pressures were, therefore, substantially overestimated. Central-brachial PPA (4.5 ± 4.4 mmHg) was overestimated by XCEL (8.7 ± 3.2 mmHg) and MoG-C1 (11.1 ± 6.4 mmHg), but underestimated by MoG-C2 (−3.0 ± 6.6 mmHg). Given accurate pulse calibration, RT-TF achieved acceptable accuracy for cSBP (−0.2 ± 4.6 mmHg) and central-radial PPA (1.9 ± 5.1 mmHg).

Conclusion:

In conclusion, XCEL and Mobil-O-Graph overestimated pSBP and cSBP in children and adolescents. cSBP can be obtained via the same transfer function used in adults, but accurate pressure pulse calibration is critical.

Video Abstracts: http://links.lww.com/HJH/B222
Lacrimal Puncta Agenesis in Kabuki Syndrome
Authors: Diez M.T. Sarandeses , Lemaitre S. , Gonzalez-Valdivia H. , Gonzalez-Candial M.G.
Published: November 2019

Kabuki syndrome (KS) is a rare congenital disorder characterized by multiple systemic anomalies and facial characteristics. Here, the authors present the first case, to the best of the authors' knowledge, of bilateral lacrimal puncta agenesis in a patient with KS.#8232;The proband patient was a 29-year-old woman diagnosed with this syndrome, brought to our office due to recurrent conjunctivitis where agenesia of lacrimal puncta was observed. Therapeutic options were exposed but, as the concomitant medication (topiramate) produced ocular dryness, conservative treatment was decided. Diagnosis of KS is challenging because it is a complex syndrome with many associated findings. The authors recommend taking into account the agenesis of lacrimal points in the differential diagnosis of KS if it is associated with other phenotypic alterations as well as including lacrimal examination in patients with KS diagnosis. The authors emphasize the importance of individualizing treatment since drugs used for the systematic management of these patients can influence tear symptoms.
A Survey of Physical Therapist Education: Relationships Among Pediatric Curriculum Delivery, Faculty, and Clinical Education
Authors: Anderson Deborah K. , Kenyon Lisa K. , Frost Jody S.
Published: November 2019

Introduction.

This study is a secondary analysis of a 2014 survey study exploring pediatric clinical education in professional physical therapist (PT) education and describes PT education programs within the United States with respect to (1) how the pediatric curricular content is delivered; (2) the characteristics of the individual primarily responsible for delivering the pediatric content; (3) the relationship between characteristics of the individual primarily responsible for delivering the pediatric content and a program's report of sufficient numbers and variety of pediatric clinical education sites; and (4) the relationship between the type of pediatric curricular design used by a program and the program's report of sufficient numbers and variety of pediatric clinical education sites.

Methods.

A single Director of Clinical Education/Academic Coordinator of Clinical Education from 159 accredited professional PT programs completed the survey. Survey questions in this secondary analysis of the 2014 survey study pertain to the delivery of the pediatric content, characteristics of faculty, and pediatric clinical education experiences. Cross tabulations were used to examine possible relationships.

Results.

Ninety-nine (62.3%) responding programs reported delivery of the pediatric content through a single stand-alone course. One hundred and twelve (70.4%) responding programs reported that the pediatric content was delivered by a core faculty member with pediatric clinical experience. No significant relationships were found between a report of sufficient numbers and variety of pediatric clinical education sites and either characteristics of individuals delivering the pediatric curricular content or the type of pediatric curricular design used by a program.

Discussion and Conclusion.

Delivery methods for the pediatric curricular content are variable. Characteristics of the individual delivering this pediatric content are mixed.
Neutrophil extracellular traps and NETosis: a report of two autopsies and review of literature
Authors: Krishnamurthy Kritika , Febres-Aldana Christopher A. , Imperatore Kailee , Sriganeshan Vathany , Poppiti Robert
Published: November 2019

Recent studies reveal that neutrophil extracellular traps (NETs) play a significant role in platelet entrapment and consequent activation of the coagulation cascade. Herein we present two autopsy cases of NETosis. The first case is a 76-year-old man, with metastatic squamous cell carcinoma of the lung who expired 5 days post admission. Autopsy revealed extensively necrotic poorly differentiated squamous cell carcinoma of the right lung. A 30-cm cylindrical thrombus was identified, extending from the left ventricle to the thoracic aorta, composed of numerous neutrophils enmeshed in abundant fibrin representing a NET. The second case is a 73-year-old man who suffered a cardiopulmonary arrest of unknown cause and expired 2 days post admission. Autopsy revealed a 5-cm mural thrombus with numerous neutrophils in the descending aorta consistent with NET, bilateral bronchopneumonia and infarcted bowel. These two autopsies highlight the pathogenic role of NET in causing thrombosis.
Evidence-based strategies to increase vaccination uptake: a review
Authors: Cataldi Jessica R. , Kerns Mattie E. , O’Leary Sean T.
Published: November 2019

Purpose of review

To summarize evidence-based strategies for improving pediatric immunization rates including physician behaviors, clinic and public health processes, community-based and parent-focused interventions, and legal and policy approaches

Recent findings

Studies continue to show the effectiveness of audit and feedback, provider reminders, standing orders, and reminder/recall to increase immunization rates. Provider communication strategies may improve immunization rates including use of a presumptive approach and motivational interviewing. Centralized reminder/recall (using a state Immunization Information System) is more effective and cost-effective compared to a practice-based approach. Recent work shows the success of text messages for reminder/recall for vaccination. Web-based interventions, including informational vaccine websites with interactive social media components, have shown effectiveness at increasing uptake of pediatric and maternal immunizations. Vaccination requirements for school attendance continue to be effective policy interventions for increasing pediatric and adolescent vaccination rates. Allowance for and ease of obtaining exemptions to vaccine requirements are associated with increased exemption rates.

Strategies to increase vaccination rates include interventions that directly impact physician behavior, clinic and public health processes, patient behaviors, and policy. Combining multiple strategies to work across different settings and addressing different barriers may offer the best approach to optimize immunization coverage.
Digital sextortion: Internet predators and pediatric interventions
Authors: Hong Suyeon , Lu Nancy , Wu Doreen , Jimenez David E. , Milanaik Ruth L.
Published: November 2019

Purpose of review

Sextortion is defined as the act of coercing people into sending explicit images of themselves and subsequently blackmailing victims with the public release of said images. Prosecutions of sextortion cases involving minors have increased almost two-fold in the past 5 years. The purpose of this review is to explore the literature regarding the behavior of both victims and perpetrators, the effects on victims, and the support resources available for clinicians, victims, and parents.

Recent findings

Sextortion begins as an unassuming request for personal pictures and quickly escalates. Minors targeted by predators fear both punishment by guardians and the social consequences that follow the release of their explicit pictures. This cycle of victimization endangers minors and may lead to mental health problems, such as anxiety and depression. Recently, sextortion cases have risen to the forefront of national attention through the mainstream media with celebrities revealed as both perpetrators and victims. This higher visibility of sextortion highlights the importance of reviewing recent research regarding minors and their online behavior and the tactics of perpetrators.

Sextortion, an extreme form of cyber abuse, endangers minors and may lead to anxiety and depression. Pediatricians should be familiar with the concept of sextortion and discuss its dangers and available resources with parents and minors.
Tarsal coalition
Authors: Soni Jamil F. , Valenza Weverley , Matsunaga Carolina
Published: November 2019

Purpose of review

Tarsal coalitions may cause painful pes planovalgus and recurrent sprains, and can lead to arthrosis if improperly managed. In this review, we discuss the current topics related to talocalcaneal and calcaneonavicular coalitions.

Recent findings

Tarsal coalitions are initially managed with conservative therapy, and when this approach fails, surgery is performed. Treatment of calcaneonavicular coalitions involves resection of the coalition and interposition of the extensor digitorum brevis muscle or fat, and in cases of marked valgus deformity, correction of the deformity. In talocalcaneal coalitions, recommendations include coalition resection for those affecting less than 50% of the area of the posterior facet and with a less than 16° valgus, coalition resection and valgus correction for those affecting less than 50% of the area and valgus greater than 16°, and isolated valgus correction for those affecting more than 50% of the area and with a more than or less than 16° valgus. Arthrodesis is reserved as a salvage procedure.

Talocalcaneal and calcaneonavicular coalitions can cause painful pes planovalgus. Their diagnoses are confirmed by plain radiograph, computed tomography, and, in cases of fibrous or cartilaginous coalitions, MRI. Initial treatment is conservative, and when symptoms persist, resection of the coalition is recommended along with tissue graft interposition with or without associated valgus correction. Arthrodesis is indicated as a salvage procedure whenever treatment fails or with advanced arthrosis.
Human leukocyte antigen molecular mismatch to risk stratify kidney transplant recipients
Authors: Wiebe Chris , Nickerson Peter W.
Published: November 2019

Purpose of review

Stalled drug development and the lack of improvement in long-term graft survival reflect the unmet need for prognostic and predictive biomarkers in transplantation. Although conventional human leukocyte antigen (HLA) mismatch is too imprecise to fulfill this need, HLA molecular mismatch increases the precision in alloimmune risk assessment by quantifying the difference between donors and recipients at the molecular level.

Recent findings

Within each conventional HLA mismatch, recipients exhibit a wide range of HLA molecular mismatches with their donors. Quantifying HLA molecular mismatch improves the precision of alloimmune risk assessment for de novo donor-specific antibody development (dnDSA). Alloimmune risk categories developed analyzing dnDSA development were also found to correlate with T-cell-mediated rejection, antibody-mediated rejection, and all cause graft loss in adjusted and unadjusted models.

All alloimmunity is driven by differences between donors and recipients at the molecular level. HLA molecular mismatch may represent a fast, reproducible, cost-effective, way to improve alloimmune risk assessment at the time of transplantation to move the field towards precision medicine.
Pediatric Nasopharyngeal Carcinoma: A Rare Tumor in a Developing Country—What Do We Learn?
Authors: Zekri Wael , Wahed Mohamed A. , Attia Eman , Khalil Ehab
Published: November 2019

Background/Aim:

Nasopharyngeal carcinoma (NPC) is rare in children, accounting for 1% of pediatric malignancies. The 5-fluorouracil Cisplatin regimen could be considered as a standard of care induction chemotherapy followed by concomitant chemoradiotherapy. This study aimed at detecting the survival outcome in correlation with different prognostic factors together with the toxicity of different treatment modalities.

Patients and Methods:

This was a retrospective study carried out from 2007 to 2016 that included all NPC patients below 18 years treated at the National Cancer Institute, Egypt.

Results:

A total of 21 patients were included with a median follow-up period of 33.9 months. The median age was 14.8 years (range: 9 to 18). All patients were treated by neoadjuvant chemotherapy with cisplatin and 5- fluorouracil, followed by concurrent radiotherapy (median dose: 61.2 Gy) and cisplatin as a radiosensitizer. After induction chemotherapy, the response rate was 53%. After completion of treatment, 67% had a complete response; partial response was seen in 14%; and progressive disease was seen in 19%. By the end of the study, 7 (33.3%) patients had progression/relapse; 4 of them died from disease. The 3-year overall survival and event-free survival were 85.7% and 66.7%, respectively.

Conclusions:

Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy was an effective strategy in the treatment of pediatric NPC with good overall survival and event-free survival. High systemic failure (33.3%) remains another challenge to solve. More efforts should be made to improve survival by developing more efficient systemic treatment modalities, especially for progressive/relapsed disease. Multicenter studies on a larger number of patients are needed to identify different prognostic factors and standardize treatment strategies.
Developing a Virtual Nursing Team to Support Predictive Analytics and Gaps in Patient Care
Authors: Lisk Laure E. , Buckley Jacqueline D. , Wilson Kristine , Martinez Vanessa A. , Cadiz Vilma R. , Poropat Lorelle , Scruth Elizabeth Ann
Published: November 2019

Purpose/Aims

Development and implementation of a predictive analytic scoring system in a system of 21 hospitals required 24-hour surveillance to ensure alerts were responded and acted upon. Identification of gaps in patient care created an opportunity to innovate and develop a team to integrate both workflows.

Description of Project/Program

A Virtual Nurse team of master's degree–prepared nurses with backgrounds in intensive care and management led by a clinical nurse specialist work remotely from their homes. Each nurse is assigned to either of 2 workflows: Advance Alert Monitor—predictive analytic scores or e-Hospital involving capturing of care gaps. The Virtual Nurse team covers 24 hours a day/7 days a week.

Outcomes

The program has resulted in 169 lives saved and an observed-to-expected mortality of 0.8. Improvements in standard workflows across the system have enabled Rapid Response Teams to be implemented in each hospital.

Conclusions

The success of the Virtual Nurse team has resulted in developments to spread the program into other Kaiser Permanente regions. The Virtual Nurse team has grown to 40 nurses and will expand as the program spreads.
Implementation of a Neonatal Audit Tool to Drive Quality Initiatives
Authors: Grayson Stephanie , McKenna Kristin , Carroll Jean M. , Koran Jeanette , Chuo John
Published: November 2019

Introduction:

Audit tools optimize the delivery of healthcare to patients. A network of 11 neonatal intensive care units (NICUs) affiliated with a large urban pediatric care institution implemented an audit tool for use on daily patient rounds. The article reports findings collected from 2011 to 2016.

Methods:

Primary drivers for implementation were (1) engagement from local providers; (2) identification of local improvement needs and improvement progress; (3) ability to customize audit questions based on local needs; (4) encouragement of information sharing between NICUs; and (5) improving measurable outcomes in neonatal care delivery. The Level IV NICU managed and refined a centralized process for managing site-specific tools, data analysis, and reporting. Each NICU customized the number and wording of action questions based on their needs. Answer choices were limited to “yes” or “no,” which corresponded to favorable or unfavorable actions toward the patient. Users also answered, “Was action taken as a result of an unfavorable response?”

Results:

Plan-Do-Study-Action cycles were completed to refine the tool and its implementation process. Adherence was variable among and within each network site. Across the network, 11.4% of actions tracked by the audit indicated improvement over time.

Conclusion:

Generalized use of the Audit Tool resulted in limited optimization of care actions addressed in the NICUs. Success depended on multi-disciplinary, multi-professional teamwork, respect for local autonomy, and leadership support. Increasing the use of the Audit Tool likely depends on the team’s ability to evolve the tool’s intrinsic value from a reminder to a monitoring system.
The Effect of Smartphone-Based Application Learning on the Nursing Students’ Performance in Preventing Medication Errors in the Pediatric Units
Authors: Pourteimour Sima , Hemmati MalsakPak Masumeh , Jasemi Madineh , Eghtedar Samereh , Parizad Naser
Published: November 2019

Introduction:

Medication errors (MEs) are potentially harmful patient safety events in all age groups. MEs are particularly hazardous in the pediatric population, especially with patients who require special attention due to the high incidence and severity of disease. This study aimed to determine the effect of a smartphone messenger application on nursing students’ learning regarding the prevention of MEs in pediatric patients.

Methods:

We performed this quasi-experimental study with 80 nursing students who were randomly divided into intervention and control groups. We collected the data using a researcher-made checklist. We conducted learning through Telegram, a smartphone messenger application (app), for 3 weeks. We analyzed data using SPSS version 16.0 by utilizing descriptive and inferential statistics, and P < 0.05 was considered to be significant.

Results:

The mean age of the students was 23.5 ± 2.9 years. The majority of mistakes related to MEs in the control groups included the lack of proper control of the following: high risk medication administration, medication incompatibility interactions, medication administration card, medication dose calculations, adverse drug event recognition, pharmaceutical name recognition during drug selection, aseptic and sterile technique adherence, microbore IV tubing flush practices, IV drip rate adjustment, and medication administration schedules. The mean scores of students’ performance were significantly different in the knowledge of preventing MEs between the 2 groups. (P = 0.022).

Conclusions:

Smartphone learning with the Telegram messenger app improves nursing student knowledge regarding the prevention of MEs in pediatric patients. We recommend that this form of learning be used in nursing schools to prevent errors related to medication ordering, dosing, and administration.
Noncontact Phased-Array Ultrasound Facilitates Acute Wound Healing in Mice
Authors: Wakabayashi Nao , Sakai Atsushi , Takada Hiroya , Hoshi Takayuki , Sano Hitomi , Ichinose Shizuko , Suzuki Hidenori , Ogawa Rei
Published: November 2019

Background:

The authors developed a noncontact low-frequency ultrasound device that delivers high-intensity mechanical force based on phased-array technology. It may aid wound healing because it is likely to be associated with lower risks of infection and heat-induced pain compared with conventional ultrasound methods. The authors hypothesized that the microdeformation it induces accelerates wound epithelialization. Its effects on key wound-healing processes (angiogenesis, collagen accumulation, and angiogenesis-related gene transcription) were also examined.

Methods:

Immediately after wounding, bilateral acute wounds in C57BL/6J mice were noncontact low-frequency ultrasound– and sham-stimulated for 1 hour/day for 3 consecutive days (10 Hz/90.6 Pa). Wound closure (epithelialization) was recorded every 2 days as the percentage change in wound area relative to baseline. Wound tissue was procured on days 2, 5, 7, and 14 (five to six per time point) and subjected to histopathology with hematoxylin and eosin and Masson trichrome staining, CD31 immunohistochemistry, and quantitative polymerase-chain reaction analysis.

Results:

Compared to sham-treated wounds, ultrasound/phased-array–treated wounds exhibited significantly accelerated epithelialization (65 ± 27 percent versus 30 ± 33 percent closure), angiogenesis (4.6 ± 1.7 percent versus 2.2 ± 1.0 percent CD31+ area), and collagen deposition (44 ± 14 percent versus 28 ± 13 percent collagen density) on days 5, 2, and 5, respectively (all p < 0.05). The expression of Notch ligand delta-like 1 protein (Dll1) and Notch1, which participate in angiogenesis, was transiently enhanced by treatment on days 2 and 5, respectively.

Conclusions:

The authors’ noncontact low-frequency ultrasound phased-array device improved the wound-healing rate. It was associated with increased early neovascularization that was followed by high levels of collagen-matrix production and epithelialization. The device may expand the mechanotherapeutic proangiogenesis field, thereby helping stimulate a revolution in infected wound care.
Bone Tissue Engineering in the Growing Calvaria Using Dipyridamole-Coated, Three-Dimensionally–Printed Bioceramic Scaffolds: Construct Optimization and Effects on Cranial Suture Patency
Authors: Maliha Samantha G. , Lopez Christopher D. , Coelho Paulo G. , Witek Lukasz , Cox Madison , Meskin Alan , Rusi Sejndi , Torroni Andrea , Cronstein Bruce N. , Flores Roberto L.
Published: November 2019

Background:

Three-dimensionally–printed bioceramic scaffolds composed of β-tricalcium phosphate delivering the osteogenic agent dipyridamole can heal critically sized calvarial defects in skeletally mature translational models. However, this construct has yet to be applied to growing craniofacial models. In this study, the authors implanted three-dimensionally–printed bioceramic/dipyridamole scaffolds in a growing calvaria animal model and evaluated bone growth as a function of geometric scaffold design and dipyridamole concentration. Potential adverse effects on the growing suture were also evaluated.

Methods:

Bilateral calvarial defects (10 mm) were created in 5-week-old (approximately 1.1 kg) New Zealand White rabbits (n = 16 analyzed). Three-dimensionally–printed bioceramic scaffolds were constructed in quadrant form composed of varying pore dimensions (220, 330, and 500 μm). Each scaffold was coated with collagen and soaked in varying concentrations of dipyridamole (100, 1000, and 10,000 μM). Controls consisted of empty defects. Animals were killed 8 weeks postoperatively. Calvariae were analyzed using micro–computed tomography, three-dimensional reconstruction, and nondecalcified histologic sectioning.

Results:

Scaffold-induced bone growth was statistically greater than bone growth in empty defects (p = 0.02). Large scaffold pores, 500 μm, coated in 1000 μM dipyridamole yielded the most bone growth and lowest degree of scaffold presence within the defect. Histology showed vascularized woven and lamellar bone along with initial formation of vascular canals within the scaffold lattice. Micro–computed tomographic and histologic analysis revealed patent calvarial sutures without evidence of ectopic bone formation across all dipyridamole concentrations.

Conclusion:

The authors present an effective pediatric bone tissue-engineering scaffold design and dipyridamole concentration that is effective in augmentation of calvarial bone generation while preserving cranial suture patency.