bluuebunny/crossref_metadata_2025 huggingface dataset:
Neonatal and Maternal Adverse Outcomes Among Low-Risk Parous Women at 39–41 Weeks of Gestation
Authors: Chen Han-Yang , Grobman William A. , Blackwell Sean C. , Chauhan Suneet P.
Published: July 2019

OBJECTIVE:

To compare the composite neonatal or maternal adverse outcome among low-risk, parous women at 39–41 weeks of gestation.

METHODS:

This was a retrospective cohort study using the U.S. vital statistics data sets (2012–2016). We evaluated low-risk parous women with nonanomalous singleton gestations who delivered at 39, 40, or 41 weeks of gestation (as reported in completed weeks, eg, 39 weeks includes 39 0/7–39 6/7 weeks of gestation). The primary outcome, the composite neonatal adverse outcome, included any of the following: Apgar score less than 5 at 5 minutes, assisted ventilation for longer than 6 hours, neonatal seizure, or neonatal mortality. The secondary outcome, the composite maternal adverse outcome, included any of the following: intensive care unit admission, blood transfusion, uterine rupture, or unplanned hysterectomy. We used multivariable Poisson regression analyses to estimate the association between gestational age and adverse outcome (using adjusted relative risks [aRR] and 95% CI).

RESULTS:

Of 19.9 million live births during the study period, 5.4 million (27.1%) met inclusion criteria. Among them, 54.4% delivered at 39 weeks of gestation, 35.7% at 40 weeks, and 9.9% at 41 weeks. The overall rate of the composite neonatal adverse outcome was 4.86 per 1,000 live births. The risk of the composite neonatal adverse outcome was higher for those delivered at 40 (aRR 1.18; 95% CI 1.15–1.22) and 41 (aRR 1.59; 95% CI 1.53–1.65) weeks of gestation when compared with 39 weeks. The overall rate of the composite maternal adverse outcome was 2.31 per 1,000 live births. The risk of the composite maternal adverse outcome was also significantly higher with delivery at 40 (aRR 1.15; 95% CI 1.11–1.19) and 41 weeks of gestation (aRR 1.50; 95% CI 1.42–1.58) than at 39 weeks.

CONCLUSION:

Though only modestly, the rates of the composite neonatal and maternal adverse outcomes increase, from 39 through 41 weeks of gestation, among low-risk parous women.
Long-Term Assessment of a Prospective Cohort of Patients Undergoing Laparoscopic Sacrocolpopexy
Authors: Pacquée Stefaan , Nawapun Katika , Claerhout Filip , Werbrouck Erika , Veldman Joan , D'hoore André , Wyndaele Jan , Verguts Jasper , De Ridder Dirk , Deprest Jan
Published: July 2019

OBJECTIVE:

To report long-term outcomes after laparoscopic sacrocolpopexy.

METHODS:

We conducted a prospective descriptive cohort study on 331 consecutive patients who underwent laparoscopic sacrocolpopexy for symptomatic prolapse (Pelvic Organ Prolapse Quantification [POP-Q] system stage 2 or greater) at one center, with minimum 1.5 years of follow-up by April 30, 2014. Primary outcome measures were Patient Global Impression of Change score and failure at the apex (C≥−1 cm; POP-Q stage 2 or greater). Secondary outcomes were anatomical failure in other compartments, duration of follow-up, occurrence and time point of complications, reinterventions, and functional outcomes by response to a standardized 24-question interview on prolapse and bladder, bowel, and sexual function. Assessment was by an experienced clinician not involved in patient management.

RESULTS:

The follow-up rate was 84.6% (280/331); 185 of 331 (55.9%) patients were both physically examined and interviewed, and 95 of 331 (25.7%) were interviewed only. The median age at interview was 72 years (interquartile range 13 years), with a follow-up period of 85.5 months (interquartile range 46 months). Approximately 83% (231/280) reported improvement; 5.7% (16/280) were unchanged, 5.7% (16/280) felt slightly worse, and 6.8% (17/280) reported clear deterioration. Anatomical failure at point-C was 8.6% (16/185); anterior (22.2%, 41/185) and posterior (28.6%, 53/185) prolapse were more common than apical prolapse. Of those with level-I anatomical cure, 10.1% (17/185) felt worse; half of them (9/17) because of prolapse in another compartment. The others had urinary problems (41.2%, 7/17), obstructive defecation (11.8%, 2/17), or dyspareunia (11.8%, 2/17). Conversely, the majority of patients with recurrence at the vault (62.5%, 10/16) self-reported to be improved. The reoperation rate was 17.8% (48/270), including 19 (7.0%) for graft-related complications and nine (3.3%) for prolapse.

CONCLUSION:

More than four out of five patients (82.5%) felt improved 86 months after laparoscopic sacrocolpopexy. Of those not improved, two thirds had recurrent prolapse; however, typically mid-vaginal. The other third reported urinary or bowel problems or dyspareunia. Reintervention for prolapse was 3.3%. The most common reasons for reoperation were graft-related complications (7.0%) and urinary incontinence (6.7%).
The Community Orthopaedic Surgeon Taking Trauma Call: Pediatric Femoral Neck Fracture Pearls and Pitfalls
Authors: Sankar Wudbhav N. , Mehlman Charles T.
Published: July 2019

Pediatric hip fractures are uncommon injuries but are associated with a high complication rate including avascular necrosis, coxa vara, nonunion, and premature physeal arrest. This is due in part to the unique anatomy of the proximal femur. Management principles are aimed at minimizing the risk of complications and emphasize the importance of early treatment with anatomic reduction and stable internal fixation with a low threshold for supplementing fixation with a spica cast. The age of the patient and Delbet fracture type dictate the optimal type of fixation for a given case. This article will offer evidence and experience-based tips intended to benefit on-call surgeons caring for these injuries.
The Community Orthopaedic Surgeon Taking Trauma Call: Pediatric Foot Fracture Pearls and Pitfalls
Authors: Denning Jaime R. , Mehlman Charles T.
Published: July 2019

Although foot fractures are relatively rare in children, they deserve respect and attention because they may be associated with troublesome long-term consequences. These injuries are more common in adolescents and teenagers. In an epidemiological study in Britain (Cooper et al 2004), the incidence of pediatric foot fractures was 10.5 per 10,000 children occurring equally in boys and girls and peaking around 13 years of age. This article focuses on 5 fracture types which are at higher risk of complications in the pediatric and adolescent age group.
Danhong Injection Attenuates High-Fat–Induced Atherosclerosis and Macrophage Lipid Accumulation by Regulating the PI3K/AKT Insulin Pathway
Authors: Zhou Mingxue , Ren Pan , Li Sinai , Kang Qunfu , Zhang Ying , Liu Weihong , Shang Juju , Gong Yanbing , Liu Hongxu
Published: July 2019

Background and Aims:

High-fat diet (HFD) is reported to induce atherosclerosis and insulin resistance. Macrophage lipid accumulation has been implicated as key mediators during the development of HFD-induced atherosclerosis. Traditional Chinese formula, which has long been used to improve disorder of glucose and lipid metabolism of patients, is now gradually being used as complementary therapy. This study aimed to investigate the effect of Danhong injection (DHI), a Chinese medicine used for the treatment of coronary artery disease, on atherosclerosis and its underlying mechanisms.

Methods and Results:

We observed the effects of DHI on HFD-induced atherosclerosis in a mice model, macrophage lipid accumulation in an ox-LDL–stimulated macrophage model, and the role of PI3K/AKT insulin pathway in the process of DHI ameliorating atherosclerosis. The data demonstrated that DHI attenuated atherosclerosis by ameliorating blood lipids, reducing the atherosclerotic index and atherosclerotic plaque area in HFD-induced atherosclerotic mice, and inhibiting TC levels in an ox-LDL–induced macrophage model. By estimating the levels of serum insulin resistance–related indexes and protein expression of GLUT-4, DHI treatment dramatically inhibited the levels of fasting serum NEFA and fasting serum insulin and promoted the protein expression of GLUT-4 in aortas of the HFD-induced atherosclerotic mice. Moreover, according to the hints provided by microarray-based transcriptional profiling, the results demonstrated that DHI treatment also promoted the activation of PI3K/AKT insulin signaling pathway induced by IRS-1 in aortas of HFD-induced atherosclerotic mice. Furthermore, in an ox-LDL–induced macrophage model, the activation of PI3k/AKT signaling pathway also effectively functioned in the process of DHI inhibiting macrophage lipid accumulation.

Conclusions:

These results highlight that DHI treatment attenuates atherosclerosis and macrophage lipid accumulation by promoting the activation of PI3K/AKT insulin signaling pathway. It provides new insights into the molecular mechanism of DHI and its therapeutic potential in the treatment of atherosclerosis.
The Pharmacodynamic Effects of a Dopamine–Somatostatin Chimera Agonist on the Cardiovascular System
Authors: van Esdonk Michiel Joost , Stevens Jasper , Stuurman Frederik E. , de Boon Wadim M. I. , Dehez Marion , van der Graaf Piet Hein , Burggraaf Jacobus
Published: July 2019

The quantification of the effect of pharmacological treatment on the cardiovascular system is complicated because of the high level of interindividual and circadian variability. Recently, a dopamine–somatostatin chimera, BIM23B065, was under investigation to concurrently target the somatostatin and dopamine D2 receptors for the treatment of neuroendocrine tumors. However, both dopamine and somatostatin interact with different components of the cardiovascular system. This study established the response of the heart rate and the systolic blood pressure after administration of BIM23B065 in healthy male volunteers by analysis of the rate-pressure product (RPP), in a model-informed analysis. The RPP in the supine position of placebo-treated subjects showed a clear circadian component, best described by 2 cosine functions. The pharmacokinetics of BIM23B065 and its metabolite were best described using 2-compartment models with different forms of elimination kinetics. The administration of BIM23B065 gave a statistically significant reduction in the RPP, after which the effect diminished because of the tolerance to the cardiovascular effects after prolonged exposure to BIM23B065. This model provided insight in the circadian rhythm of the RPP in the supine position and the level of interindividual variability in healthy male volunteers. The developed population pharmacokinetic/pharmacodynamic model quantified the interaction between BIM23B065 and the RPP, informing on the clinical pharmacological properties of BIM23B065.
Impact of Postdischarge Bleeding on Long-Term Mortality in Percutaneous Coronary Intervention Patients Taking Oral Anticoagulants
Authors: Yoshida Ruka , Ishii Hideki , Morishima Itsuro , Tanaka Akihito , Morita Yasuhiro , Takagi Kensuke , Yoshioka Naoki , Hirayama Kenshi , Iwakawa Naoki , Tashiro Hiroshi , Kojima Hiroki , Mitsuda Takayuki , Hitora Yusuke , Furusawa Kenji , Tsuboi Hideyuki , Murohara Toyoaki
Published: July 2019

Although postdischarge bleeding (PDB) is known to negatively affect long-term outcome in patients undergoing percutaneous coronary intervention (PCI) with antiplatelet therapy (APT), the prognostic importance of PDB in patients who require both oral anticoagulants (OACs) and APT has not been fully elucidated. Among 3718 consecutive patients who underwent PCI, 302 patients were treated with both OACs and APT. We evaluated the association between PDB and 3-year all-cause mortality, as estimated by a time-updated Cox proportional hazard regression model. We performed nearest-neighbor matching on the propensity score to adjust the differences in baseline characteristics. Among 302 patients treated with OACs and APT, PDB was observed in 98 patients at a median time of 239 days. Patients experienced PDB had significantly higher incidence of 3-year all-cause mortality in the overall cohort and 94 propensity-score–matched pairs (hazard ratio 6.21, 95% confidence interval 3.29–11.72, P < 0.0001; and hazard ratio 6.13, 95% confidence interval 2.68–14.02, P < 0.0001, respectively). The risk of subsequent mortality was the highest within 180 days after PDB (58.3% within 180 days and 75.0% within 1 year). In conclusion, PDB was significantly associated with long-term mortality in patients taking both OACs and APT after PCI.
Correlation of Inhaled Long-Acting Bronchodilators With Adverse Cardiovascular Outcomes in Patients With Stable COPD: A Bayesian Network Meta-Analysis of Randomized Controlled Trials
Authors: Wu Jinchun , Ye Yi , Li Chenxi , Zhou Wenqin , Chang Rong
Published: July 2019

A majority of existing studies have focused on the efficacy of inhaled long-acting bronchodilators (ILABs), such as long-acting muscarinic antagonists (LAMAs) and long-acting β2–agonists (LABAs), and LABAs combined with LAMAs in treating chronic obstructive pulmonary disease (COPD). The current meta-analysis aimed to investigate the correlation of ILABs with specific cardiovascular adverse events (CAEs). Five electronic databases, including PubMed, Embase, Cochrane Library, Scopus, and Web of Science were systematically retrieved. Finally, 16 randomized controlled trials were enrolled into the current meta-analysis. Typically, the efficacy of 3 major classes of drugs (LABAs, LAMAs, and LABAs combined with LAMAs), and 7 specific drugs (including formoterol, glycopyrrolate, indacaterol, olodaterol, Salmeterol, tiotropium, and vilanterol) for 4 CAEs, including myocardial infarction, cardiac failure (CF), ischemic heart disease (IHD), and stroke in stable COPD patients, was examined. All the pooled results were analyzed through the odds ratios (ORs) with the corresponding 95% confidence intervals (CIs). The direct meta-analysis results suggested that LABAs could increase the risk of CF in patients with stable COPD compared with placebo controls (OR 1.70, 95% CI, 1.00–2.90). In addition, network meta-analysis results indicated that LAMAs combined with LABAs would result in an increased risk of CF in patients with stable COPD (OR 2.31, 95% CI, 1.10–5.09). According to the ILABs specific drug analysis, formoterol may potentially have protective effects on IHD compared with placebo controls (OR 0.45, 95% CI, 0.18–1.00). In conclusion, among these 3 kinds of ILABs, including LAMAs, LABAs, and LABAs/LAMAs, for stable COPD patients, LAMAs and LABAs are associated with the least possibility to induce myocardial infarction and stroke, respectively. However, the application of LABAs will probably increase the risk of CF; they should be used with caution for stable COPD patients with CF. In addition, in specific-drug analysis, the use of formoterol can reduce the risk of treatment-related IHD. Nevertheless, more studies on different drug doses are needed in the future to further validate this conclusion.
Selective Serotonin Reuptake Inhibitors and Fertility: Considerations for Couples Trying to Conceive
Authors: Sylvester Christie , Menke Marie , Gopalan Priya
Published: July 2019

Background

Depression and anxiety are prevalent disorders and are often treated with selective serotonin reuptake inhibitors (SSRIs). Infertility is also common among couples, and rates of depression and anxiety are elevated in this population, but the impact of SSRIs on fertility has received modest attention. This review explores the literature available on SSRIs, fertility, and infertility-treatment outcomes to assist clinicians in better counseling their patients.

Methods

A literature search was performed using the search terms infertility, fertility, antidepressants, and SSRIs to identify studies that investigated the relationship between SSRI use and fertility or infertility-treatment outcomes.

Results

Twenty relevant articles were identified, 16 of which were original research studies. The studies varied in design, quality, and outcome measures, limiting meta-analysis. The prevalence of antidepressant use ranged from 3.5%–10% in reproductive-age women, with infertile populations reporting less use. The two studies examining the impact of SSRIs in fertile women had conflicting results. Six of the seven studies in infertility patients found no significant association between SSRIs and treatment outcomes; three observed a trend, however, toward reduced fecundability or negatively influenced fertility biomarkers. One study found treatment increased pregnancy rates. In males, most studies were of relatively poor quality, though six of the seven studies found SSRIs to have an adverse effect on semen parameters.

Conclusions

There is insufficient evidence at present to propose that SSRIs reduce fertility or influence infertility-treatment outcomes. SSRIs may have an adverse impact on sperm quality, but further research is warranted.
Activity Level During Acute Concussion May Predict Symptom Recovery Within an Active Duty Military Population
Authors: Remigio-Baker Rosemay A. , Bailie Jason M. , Gregory Emma , Cole Wesley R. , McCulloch Karen L. , Cecchini Amy , Stuessi Keith , Andrews Taylor R. , Mullins Lynita , Ettenhofer Mark L.
Published: July 2019

Objective:

To evaluate the impact on symptom resolution of activity acutely following a concussion and the role of acute-phase symptoms on this relationship among active duty service members (SMs).

Setting:

Three military installations.

Participants:

Sixty-two SMs aged 18 to 44 years who sustained a concussion within 72 hours of enrollment.

Design:

Longitudinal design with data collected within 72 hours of injury (baseline,n= 62) and at 1 week (n= 57), 1 month (n= 50), 3 months (n= 41), and 6 months (n= 40) postinjury.

Main Measures:

Baseline activity level using a 60-item Activity Questionnaire. Symptom level at baseline and during follow-up using Neurobehavioral Symptoms Inventory.

Results:

Significant interaction (Pi< .05) was found, with significant main effects (P< .05) limited to SMs with elevated baseline symptomatology. Among these participants, greater baseline total activity was significantly related to greater vestibular symptoms at 1, 3, and 6 months (β = .61, .63, and .59, respectively). Significant associations were also found for particular types of baseline activity (eg, physical; vestibular/balance; military-specific) and symptoms at 1, 3, and/or 6 months postinjury.

Conclusion:

These results provide support for clinical guidance that symptomatic SMs, particularly those with high levels of acute symptoms, may need to avoid excessive activity acutely following concussion.
Changing Healthcare and School Needs in the First Year After Traumatic Brain Injury
Authors: Keenan Heather T. , Clark Amy E. , Holubkov Richard , Ewing-Cobbs Linda
Published: July 2019

Objective:

To examine children's unmet and unrecognized healthcare and school needs following traumatic brain injury (TBI).

Setting:

Two pediatric trauma centers.

Participants:

Children with all severity of TBI aged 4 to 15 years.

Design:

Prospective cohort.

Main Measures:

Caregivers provided child health and school service use 3 and 12 months postinjury. Unmet and unrecognized needs were categorized compared with norms on standardized physical, cognitive, socioemotional health, or academic competence measures in conjunction with caregiver report of needs and services. Modified Poisson models examined child and family predictors of unmet and unrecognized needs.

Results:

Of 322 children, 28% had unmet or unrecognized healthcare or school needs at 3 months, decreasing to 24% at 12 months. Unmet healthcare needs changed from primarily physical (79%) at 3 months to cognitive (47%) and/or socioemotional needs (68%) at 12 months. At 3 months, low social capital, preexisting psychological diagnoses, and 6 to 11 years of age predicted higher healthcare needs and severe TBI predicted higher school needs. Twelve months postinjury, prior inpatient rehabilitation, low income, and preexisting psychological diagnoses were associated with higher healthcare needs; family function was important for school and healthcare needs.

Conclusions:

Targeted interventions to provide family supports may increase children's access to services.
Biomarkers of Systemic Inflammation in Ugandan Infants and Children Hospitalized With Respiratory Syncytial Virus Infection
Authors: Sawatzky Julia , Soo Jeremy , Conroy Andrea L. , Bhargava Ravi , Namasopo Sophie , Opoka Robert O. , Hawkes Michael T.
Published: July 2019

Background:

Optimizing outcomes in respiratory syncytial virus (RSV) pneumonia requires accurate diagnosis and determination of severity that, in resource-limited settings, is often based on clinical assessment alone. We describe host inflammatory biomarkers and clinical outcomes among children hospitalized with RSV lower respiratory tract infection (LRTI) in Uganda and controls with rhinovirus and pneumococcal pneumonia.

Methods:

58 children hospitalized with LRTI were included. We compared 37 patients with RSV, 10 control patients with rhinovirus and 11 control patients with suspected pneumococcal pneumonia.

Results:

Patients in the RSV group had significantly lower levels of C-reactive protein (CRP) and chitinase-3-like protein 1 (CHI3L1) than the pneumococcal pneumonia group (P < 0.05 for both). Among children with RSV, higher admission levels of CRP predicted prolonged time to resolution of tachypnea, tachycardia and fever. Higher levels of CHI3L1 were associated with higher composite clinical severity scores and predicted prolonged time to resolution of tachypnea and tachycardia, time to wean oxygen and time to sit. Higher levels of lipocalin-2 (LCN2) predicted prolonged time to resolution of tachypnea, tachycardia and time to feed. Higher admission levels of all 3 biomarkers were predictive of a higher total volume of oxygen administered during hospitalization (P < 0.05 for all comparisons). Of note, CHI3L1 and LCN2 appeared to predict clinical outcomes more accurately than CRP, the inflammatory biomarker most widely used in clinical practice.

Conclusions:

Our findings suggest that CHI3L1 and LCN2 may be clinically informative biomarkers in childhood RSV LRTI in low-resource settings.
Narcolepsy and Pandemic Influenza Vaccination
Authors: Edwards Kathryn , Lambert Paul-Henri , Black Steven
Published: July 2019

After the initial identification of the H1N1 pandemic influenza strain in Mexico in April 2009 and its subsequent global spread, several monovalent influenza vaccines were developed as part of the pandemic response. Three of these vaccines, Pandemrix, Arepanrix and Focetria were adjuvanted. One of these, the AS03-adjuvanted Pandemrix vaccine, was primarily used in Europe. Following widespread Pandemrix vaccine administration in Scandinavia, an increased risk of narcolepsy was noted in observational studies. Subsequently, this increased risk was also reported in other European countries as well. In contrast, studies from Canada of a similar AS03-adjuvanted vaccine, Arepanrix, did not demonstrate a similar increased risk of narcolepsy. No studies have identified an increased risk of narcolepsy following the MF59-adjuvanted Focetria vaccine. For many potential pandemic influenza strains, adjuvants might be required to solicit a protective immune response. Thus, it is critical that we understand the nature of the association between adjuvanted vaccine receipt and narcolepsy. Here, we present a potential hypothesis for narcolepsy seen during the 2009 H1N1 pandemic in AS03-adjuvanted influenza vaccine recipients.
Does fibrinogen serve the host or the microbe in Staphylococcus infection?
Authors: Negrón Oscar , Flick Matthew J.
Published: July 2019

Purpose of review

Fibrin(ogen) is a multifunctional clotting protein that not only has critical roles in hemostasis but is also important in inflammatory processes that control bacterial infection. As a provisional extracellular matrix protein, fibrin(ogen) functions as a physical barrier, a scaffold for immune cell migration, or as a spatially-defined cue to drive inflammatory cell activation. These mechanisms contribute to overall host antimicrobial defense against infection. However, numerous bacterial species have evolved mechanisms to manipulate host fibrin(ogen) to promote microbial virulence and survival. Staphylococcal species, in particular, express numerous virulence factors capable of engaging fibrin(ogen), promoting fibrin formation, and driving the dissolution of fibrin matrices.

Recent findings

Recent studies have highlighted both new insights into the molecular mechanisms involved in fibrin(ogen)-mediated host defense and pathogen-driven virulence. Of particular interest is the role of fibrin(ogen) in forming host protective biofilms versus pathogen protective barriers and biofilms as well as the role of fibrin(ogen) in mediating direct host antimicrobial responses.

Current data suggest that the role of fibrin(ogen) in staphylococcal infection is highly context-dependent and that better defining the precise cellular and molecular pathways activated will provide unique opportunities of therapeutic intervention to better treat Staphylococcal disease.
A Randomized Controlled Trial Assessing the Efficacy of Group Psychological First Aid
Authors: Despeaux Katie E. , Lating Jeffrey M. , Everly George S. , Sherman Martin F. , Kirkhart Matthew W.
Published: July 2019

A randomized controlled trial assessed the efficacy of group psychological first aid (PFA) by comparing the Johns Hopkins RAPID-PFA model with a group conversation condition in 119 participants using the state version of State Trait Anxiety Scale and the Positive and Negative Affect Schedules. Both groups showed similar baseline scores, and after watching a distressing 5-minute video, both groups showed similar significant increases in state anxiety scores and negative affect scores, as well as similar decreases in positive affect scores. However, compared with the group conversation condition, the RAPID-PFA group evidenced significantly lower state anxiety scores at postintervention and at 30-minute delay. RAPID-PFA, compared with the group conversation condition, was also more effective in lowering negative affect scores postintervention, and significantly increasing positive affect scores at 30-minute delay. These results support the two primary goals of PFA, which are mitigating acute distress and instilling hope.
Whole-Lesion Computed Tomography–Based Entropy Parameters for the Differentiation of Minimally Invasive and Invasive Adenocarcinomas Appearing as Pulmonary Subsolid Nodules
Authors: Chen Xiangmeng , Feng Bao , Chen Yehang , Hao Yixiu , Duan Xiaobei , Cui Enming , Liu Zhuangsheng , Zhang Chaotong , Long Wansheng
Published: July 2019

Objective

The aim of this study was to investigate the differentiation of computed tomography (CT)–based entropy parameters between minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC) lesions appearing as pulmonary subsolid nodules (SSNs).

Methods

This study was approved by the institutional review board in our hospital. From July 2015 to November 2018, 186 consecutive patients with solitary peripheral pulmonary SSNs that were pathologically confirmed as pulmonary adenocarcinomas (74 MIA and 112 IAC lesions) were included and subdivided into the training data set and the validation data set. Chest CT scans without contrast enhancement were performed in all patients preoperatively. The subjective CT features of the SSNs were reviewed and compared between the MIA and IAC groups. Each SSN was semisegmented with our in-house software, and entropy-related parameters were quantitatively extracted using another in-house software developed in the MATLAB platform. Logistic regression analysis and receiver operating characteristic analysis were performed to evaluate the diagnostic performances. Three diagnostic models including subjective model, entropy model, and combined model were built and analyzed using area under the curve (AUC) analysis.

Results

There were 119 nonsolid nodules and 67 part-solid nodules. Significant differences were found in the subjective CT features among nodule type, lesion size, lobulated shape, and irregular margin between the MIA and IAC groups. Multivariate analysis revealed that part-solid type and lobulated shape were significant independent factors for IAC (P < 0.0001 and P < 0.0001, respectively). Three entropy parameters including Entropy-0.8, Entropy-2.0-32, and Entropy-2.0-64 were identified as independent risk factors for the differentiation of MIA and IAC lesions. The median entropy model value of the MIA group was 0.266 (range, 0.174–0.590), which was significantly lower than the IAC group with value 0.815 (range, 0.623–0.901) (P < 0.0001). Multivariate analysis revealed that the combined model had an excellent diagnostic performance with sensitivity of 88.2%, specificity of 73.0%, and accuracy of 82.1%. The AUC value of the combined model was significantly higher (AUC, 0.869) than that of the subjective model (AUC, 0.809) or the entropy model alone (AUC, 0.836) (P < 0.0001).

Conclusions

The CT–based entropy parameters could help assess the aggressiveness of pulmonary adenocarcinoma via quantitative analysis of intratumoral heterogeneity. The MIA can be differentiated from IAC accurately by using entropy-related parameters in peripheral pulmonary SSNs.
Unexpected Lymphatic Drainage of the Treated Breast
Authors: Raghoo Richard , Pereira Arias-Bouda Lenka M. , Valdés Olmos Renato A.
Published: July 2019

This case highlights the use of lymphoscintigraphy with SPECT/CT in patients with previous chest and/or axillary surgery. A 67-year-old woman with a history of left breast carcinoma treated with lumpectomy and radiotherapy, and a second lumpectomy of the ipsilateral breast for a second breast carcinoma, underwent a lymphoscintigraphy for a new left breast lesion. Planar images visualized an alternative lymphatic drainage to the contralateral axilla and to the left paravertebral area. SPECT/CT confirmed sentinel nodes in both stations.
Added Value of Myocardial Blood Flow Quantification and Calcium Scoring During CZT SPECT Myocardial Perfusion Imaging for Coronary Artery Disease Screening
Authors: Bailly Matthieu , Thibault Frédérique , Courtehoux Maxime , Metrard Gilles , Ribeiro Maria-Joao
Published: July 2019

Dedicated cadmium-zinc-telluride cardiac cameras have been shown to provide accurate measurements of absolute myocardial blood flow and flow reserve when PET is not available. We report the case of a 66-year-old woman who underwent 1-day stress/rest myocardial perfusion imaging (MPI) for coronary artery disease (CAD) screening. Relative MPI analysis was normal, whereas low-dose CT showed high calcium score. Myocardial blood flow and flow reserve were strongly impaired in all territories. Coronary angiography confirmed extended CAD. Flow parameters derived from cadmium-zinc-telluride SPECT MPI acquisition and calcium scoring can improve diagnostic accuracy and confidence of CAD.
In Vivo Microbial Targeting of 99mTc-Labeled Human β-Defensin-3 in a Rat Model of Infection
Authors: Follacchio Giulia Anna , Pala Alessandro , Scaccianoce Sergio , Monteleone Francesco , Colletti Patrick M. , Rubello Domenico , Liberatore Mauro
Published: July 2019

Objective

Differentiation of infection from aseptic inflammation represents a major clinical issue. None of the commercially available compounds (labeled granulocytes, antigranulocyte antibodies, 67Ga-citrate, labeled immunoglobulin G, 18F-FDG) is capable of this differentiation, producing a nonnegligible false-positive rate. Recently, our group reported on a reliable labeling procedure of the antimicrobial peptide human β-defensin 3 (HBD-3) with 99mTc. The aim of this study was to evaluate in vivo 99mTc-HBD-3 uptake in a rat model of infection.

Methods

Recombinant HBD-3 was radiolabeled with 99mTc. Radiolabeling yield and specific activity of the compound were calculated. Chromatographic behavior and biological activity of 99mTc-HBD-3 were also assessed. An experimental model involving Staphylococcus aureus–induced infection and carrageenan-induced aseptic inflammation was performed in 5 Wistar rats. Serial planar scintigraphic acquisitions were performed from 15 to 180 minutes after 99mTc-HBD-3 intravenous administration. Radiotracer uptake was evaluated qualitatively and semiquantitatively as a target-to-nontarget ratio.

Results

Radiolabeling yield of 99mTc-HBD-3 was 70% with a specific activity of 6 to 8 MBq/μg. A significant and progressive 99mTc-HBD-3 uptake was observed in the site of S. aureus–induced infection, with a maximum average target-to-nontarget ratio of 5.7-fold higher in the infection site compared with an inflammation site observed at 140 minutes.

Conclusions

In vivo imaging with 99mTc-HBD-3 in a rat model of S. aureus–induced infection demonstrated favorable uptake in the infection site compared with sterile inflammation and background. These promising results, together with previous ex vivo uptake and toxicity assessment, suggest the potential of 99mTc-HBD-3 as a novel agent for specific infection imaging.
Quality and Safety in Healthcare, Part LV
Authors: Harolds Jay A.
Published: July 2019

Leadership is very important to reduce burnout and promote happiness in the healthcare workplace. Whereas burnout and unhappiness lead to doctor turnover, more errors, more accidents, and decreased patient satisfaction, joy in the workplace results in better patient care, enhanced engagement and productivity, and more profitability for the healthcare organization. Many leadership characteristics are critical including integrity, putting the well-being of others first, being fair, standing for important principles, being a good role model, being an excellent communicator, encouraging new ideas and adopting them when feasible, and loving people.
68Ga–Prostate-Specific Membrane Antigen-11 PET/CT
Authors: Alçin Göksel , Gündoğan Cihan , Mutlu İlhan Nahit , Çermik Tevfik Fikret
Published: July 2019

A 77-year-old man with newly diagnosed prostate adenocarcinoma with a total prostate-specific antigen level of 6.4 ng/mL and Gleason score 7 (4 + 3) was referred to 68Ga–prostate-specific membrane antigen-11 (PSMA) PET/CT for initial staging. An intense focal PSMA uptake was shown in the right peripheral zone of the prostate gland consistent with the primary tumor. Additionally, PET/CT demonstrated a PSMA-avid soft tissue mass in the left cerebellopontine angle. The patient had a history of left-sided sensorineural hearing loss.
68Ga-PSMA PET/CT Uptake in the Ureter Caused by Ligand Expression in Urothelial Cancer
Authors: Zacho Helle D. , Pedersen Sine H. , Petersen Astrid , Petersen Lars J.
Published: July 2019

68Ga-PSMA PET/CT has become a well-established imaging modality to detect prostate cancer (PCa) metastases in biochemical recurrence. Despite its claimed specificity for PCa, 68Ga-PSMA uptake in tissues unrelated to PCa, particularly in the neovascular tissue of other cancers, has been reported in numerous studies. A 73-year-old man underwent 68Ga-PSMA PET/CT for biochemical recurrence of PCa 7 years after radical prostatectomy. The 68Ga-PSMA PET/CT showed 1 lesion with PSMA uptake in the distal left ureter. Histology revealed a low-grade noninvasive papillary urothelial carcinoma. By immunohistochemistry, PSMA expression was observed in the neoplastic urothelial cells and in the vessels of the papillary structures.
Quality and Safety in Healthcare, Part LVII
Authors: Harolds Jay A.
Published: July 2019

Problems with healthcare organizations frequently result in burnout. Teams are very important not only to decrease burnout, but also to increase wellness and joy in healthcare, by changing the organization for the better. These organizational improvements, and teamwork itself, not only make life better for the workers, but also promote efficiency for the institution, increase quality and safety for patients and workers, and stimulate collaboration among the workers.
68Ga-DOTATATE Uptake by Cervicothoracic (Stellate) Ganglia
Authors: Berg Zachary , Koppula Bhasker Rao
Published: July 2019

68Ga-DOTATATE PET/CT, a functional imaging modality for assessment of well-differentiated neuroendocrine tumors, targeting the somatostatin receptors, has essentially replaced the conventional gamma camera-based imaging with 111In-labeled octreotide. Physiologic distribution, normal variations, and common pitfalls with 68Ga-DOTATATE imaging have been well described in the literature. Here, we describe uptake of 68Ga-DOTATATE in 2 different patients at cervicothoracic junction within the stellate ganglia.
Normal Variant 18F-Sodium Fluoride Uptake in the Falx Cerebri Ossification
Authors: Usmani Sharjeel , Marafi Fahad , Al Kandari Fareeda , Ahmed Najeeb
Published: July 2019

Falx cerebri ossification is an incidental finding. Mostly it is easy to diagnose, but can be challenging in few cases, and should be distinguished from calcified meningioma, hematoma, and meningeal infiltration. We report a case of a 46-year-old woman with breast cancer complaining of back pain. 18F-NaF PET/CT images show focal increase uptake at facet joints of L5/S1 vertebrae and both knees joints, suggesting degenerative disease. There is normal variant 18F-NaF uptake noted in the ossification at the falx cerebri. Recognition of normal and abnormal extraosseous 18F-NaF uptake is important for correct interpretation to avoid unnecessary further investigations.
A Novel Stitching Technique: Adjustable Closed-Loop Sewing Machine Lock Stitching Technique to Bend or Unbend Cartilages
Authors: Sibar Serhat , Manav Safa , Cenetoglu Seyhan , Elmas Cigdem
Published: July 2019

This study aimed to evaluate the effect of a novel adjustable, closed-loop sewing machine lock stitching technique on cartilage shape. This study was performed on 18 rabbits that were divided into 3 groups to evaluate the short- (Group I), medium- (Group II), and long-term (Group III) effects of the technique on cartilage shape. Three cartilage grafts were obtained from the right and left ears of the rabbits and measured angularly. For the cartilage grafts obtained from the right ears, contours were corrected using the stitching technique proposed herein. The cartilage grafts obtained from the left ears were not stitched; these were maintained as the control group. Angular measurements were performed for the stitched cartilage grafts, and all the cartilages grafts obtained were finally embedded into the rabbits’ backs. The rabbits in Groups I, II, and III were euthanized at week 2, 6, and 12, respectively, after which the cartilages were reevaluated for angular measurement and submitted for histopathological examination. A significant improvement from baseline was detected in the angular measurements of the stitched cartilage grafts obtained from the rabbits in each group. For the stitched cartilage grafts obtained from Group II and III rabbits, the angular measurements obtained immediately after stitching were found to be better than those obtained after euthanasia. In histopathological evaluation elevated collagen, perichondrium, and connective tissue levels were detected in grafts obtained from Group III rabbits. The novel stitching technique proposed herein appears to have beneficial long-term effects on the maintenance of cartilage contour.
Virtual Surgical Planning in Craniofacial Surgery
Authors: Teal Lindsey N. , Day Kristopher M.
Published: July 2019

Background:

Virtual surgical planning (VSP) is increasingly described in craniofacial surgery literature. However, the quality of the literature that has been published is unknown. The objective of this systematic review was to determine the level of evidence of published articles on VSP.

Methods:

In this systematic review, PubMed, Web of Science, and ScienceDirect databases were queried for key terms in craniofacial VSP. Inclusion and exclusion criteria concentrated on patient-specific surgical outcomes in studies that could be rated for level of evidence. The articles were ranked according to their level of evidence, with level I being the highest level of evidence (randomized-controlled trials) and level V being the lowest (eg, case reports).

Results:

The initial keyword search yielded 1524 articles, 273 of which were ranked and included in the systematic review. The average level of evidence for an article published was 4.1 (between level IV and level V). Level IV was the most common level of evidence (65.6%), followed by level V (24.9%), level III (7.3%), level II (2.2%), respectively. There were not any level I articles. The most common study type was case series, accounting for 68.1% of the studies, followed by case reports (23.0%), case-control studies (4.7%), cohort studies (3.3%), and randomized controlled trials (1.1%), respectively.

Conclusion:

Although the quantity of craniofacial VSP studies has proliferated, the quality of the studies has not. In order for VSP literature to feature a higher level of evidence, future studies would require more sophisticated study design, such as prospective cohort or prospective randomized control trials.
Long-term Effects of Augmented Corticotomy-Assisted Orthodontics in Patients With Mandibular Anterior Alveolar Defect
Authors: Wang Bo , Shen Guofang , Guo Qiuman , Fang Bing , Yu Hongbo
Published: July 2019

Objective:

The purpose of this study was to quantitatively investigate the long-term effects of augmented corticotomy-assisted orthodontics in adult patients with alveolar defect in mandibular anterior region.

Materials and Methods:

Thirty lower incisors with alveolar defect on the labial sides were included in this study from 10 adult patients received augmented corticotomy-assisted orthodontics in mandibular anterior region. Cone-beam computed tomography images were obtained before orthodontic treatment (T0), 3 months after augmented corticotomy (T1) and 2 years after removal of orthodontic appliance (T2). Measurements of variables at different time points were compared using Student–Newman–Keuls test.

Results:

Each patient completed augmented corticotomy-assisted orthodontics successfully. In the 30 subjects studied, root length and bone thickness on the labial side at 1/2 root length level were maintained from T0 to T2 (P >.05). Bone thickness at 3/4 root length level increased from T0 to T1 (P <.001), then decreased from T1 to T2 (P <.001), and which of T2 is greater than that of T0 (P <.001). Bone thickness at root apex level increased from T0 to T1 (P <.001), and remained steady from T1 to T2 (P >.05).

Conclusions:

Augmented corticotomy-assisted orthodontics is a promising approach for the treatment of adult patients with alveolar defect, which showed stable long-term effect of bone augmentation and minimal periodontal iatrogenic sequelae during treatment.
A New Way of Managing Canalicular Injury Associated With Late Eyelid Burns
Authors: Ma Yingjie , Mao Bangxun , Lan Shuqin , Chen Tingting , Yu Bo
Published: July 2019

Purpose:

This study aimed to introduce a new way to rebuild the canalicular system of patients with occluded punctums after long-time burns.

Methods:

Cases with eyelid burns associated canalicular injury presented at Eye Hospital of Wenzhou Medical University from June 1st, 2015 to September 30th 2017 were referred to department of Orbital & Oculoplastic Surgery. Cases with occluded both superior and inferior punctuns were recommended to surgery. Twenty-seven cases were enrolled in our study. Patients were followed up at 1, 2, and 4 weeks and 3, 4, 6, and 12 months postoperatively. Success of the surgery was defined as being free of epiphora and purulence postoperatively, a normal functional endoscopic dye test, free-flowing irrigation through the lacrimal system, and the presence of upper and lower punctum ostium.

Results:

With a follow-up of 12 months postoperative, there were 22 cases that showed surgical success outcome according to the set criteria. The success rate of our surgery is 81.48%.

Conclusion:

The surgical procedure used in our study is an effective and easy way to treat patiens with occluded punctum after long-time burns. The utility of silicone intubation is necessary and delayed tubing removal maybe meaningful in these kinds of patients.
Radiologic Evaluation of Exiting Points of Supraorbital Region Neurovascular Bundles in Patients With Migraine
Authors: Bucioğlu Helen , Elvan Özlem , Esen Kaan , Temel Gülhan , Öksüz Nevra , Yilmaz Gülcan Göçmez , Özcan Cengiz , Tezer Mesut Sabri
Published: July 2019

Purpose:

To reveal the presence and nature of exiting points of supraorbital region neurovascular structures and determine the distances of those structures to midline with computed tomography images by taking into account gender and sides in patients with migraine.

Methods:

The study was conducted retrospectively on computed tomography images of 70 migraine and 70 control patients with a mean age of 39.5 ± 13.8 years (range: 18–80). Presence and nature (foramen or notch) of exiting points of neurovascular structures in terms of side and gender in both groups, and the distances of these structures to the midline of the face were evaluated.

Results:

In migraine and control groups, the most commonly seen structure was single notch. Coexistence of foramen and notch was statistically significant in migraine and female migraine groups than control and female control groups (P < 0.05). Bilateral presence of supraorbital structure was 51.4% in migraine group and 64.3% in control group patients. In all cases, foramen-midline distance was statistically significant longer than the notch-midline distance (P < 0.05). In migraine patients, no statistically significant difference was detected regarding distances of foramen and notch to midline in terms of side and gender.

Conclusion:

Consideration of variable presence and location of the supraorbital notch and foramen, analysis of computed tomography scan might be beneficial in preoperative planning of foraminotomy and fascial band release in adult migraine patients to prevent intraoperative complications. Also, coexistence is more frequent on left side in migraine patients that might cause overlooking those structures during surgery.
Binocular Diplopia Caused by an Epiretinal Membrane With Foveal Displacement
Authors: Gold Doria M. , Modi Yasha S. , Warren Floyd A. , Rucker Janet C.
Published: July 2019

A 73-year-old woman presented with 3 years of monocular visual distortion and progressive binocular diplopia. She was found to have a comitant left hypertropia due to an epiretinal membrane causing inferior foveal drag. Displacement of the fovea from an epiretinal membrane is a likely under-recognized cause ocular cause of a comitant binocular diplopia.
Causes and consequences of female centrality in cetacean societies
Authors: Rendell Luke , Cantor Mauricio , Gero Shane , Whitehead Hal , Mann Janet
Published: July 2019

Cetaceans are fully aquatic predatory mammals that have successfully colonized virtually all marine habitats. Their adaptation to these habitats, so radically different from those of their terrestrial ancestors, can give us comparative insights into the evolution of female roles and kinship in mammalian societies. We provide a review of the diversity of such roles across the Cetacea, which are unified by some key and apparently invariable life-history features. Mothers are uniparous, while paternal care is completely absent as far as we currently know. Maternal input is extensive, lasting months to many years. Hence, female reproductive rates are low, every cetacean calf is a significant investment, and offspring care is central to female fitness. Here strategies diverge, especially between toothed and baleen whales, in terms of mother–calf association and related social structures, which range from ephemeral grouping patterns to stable, multi-level, societies in which social groups are strongly organized around female kinship. Some species exhibit social and/or spatial philopatry in both sexes, a rare phenomenon in vertebrates. Communal care can be vital, especially among deep-diving species, and can be supported by female kinship. Female-based sociality, in its diverse forms, is therefore a prevailing feature of cetacean societies. Beyond the key role in offspring survival, it provides the substrate for significant vertical and horizontal cultural transmission, as well as the only definitive non-human examples of menopause.

This article is part of the theme issue ‘The evolution of female-biased kinship in humans and other mammals’.