bluuebunny/crossref_metadata_2025 huggingface dataset:
Introducing point-of-care ultrasound through structured multifaceted ultrasound module in the undergraduate medical curriculum at the University of Hong Kong
Authors: Coiffier Benedicte , Shen Pascale Chung Hang , Lee Elaine Yuen Phin , Kwong Teresa Sui Ping , Lai Alta Yee Tak , Wong Esther Man Fung , Chiu Keith Wan Hang , Vardhanabhuti Varut , Khong Pek Lan
Published: May 2019

Incorporation of point-of-care ultrasound in the undergraduate medical curriculum is of great importance to ensure early exposure and safe use of the modality. We aimed to assess the students' learning experiences following implementing an ultrasound module in the medical curriculum at the University of Hong Kong. Medical students in semester 6 (n = 221) were enrolled in the module in 2018. It consisted of 1 hour of didactic lecture, followed by 3 hours of hands-on session. The students had the opportunity to enroll into a four-week Special Study Module to further practice their skills. The students had access to an e-learning platform to assist in their learning. Outcome measures include task-based performance, quizzes, feedback, and round-table discussion to assess the learning experiences. The module was highly rated by over 90% of students (response rate of 96%). Students practiced on peer subject on upper abdominal scanning. Post-training assessment showed an increment of 16% in their understanding of the modality. Students were motivated to enroll into the Special Study Module, where they were trained and became proficient with Focused Assessment with Sonography with Trauma. More than 86% of the students found the e-learning platform easy to use and assisted the training session. Round-table discussion suggested more simulated clinical cases to be added and expansion of future modules. Ultrasound module was successfully implemented into the undergraduate medical curriculum at the University of Hong Kong through new pedagogical approaches. This integration was highly rated by the medical students with improved awareness and better understanding of point-of-care ultrasound.
Bibliometric synthesis of educational productivity research: Benchmarking the visibility of German educational research
Authors: Seel Norbert M , Zierer Klaus
Published: May 2019

This paper investigates the fitness-for-purpose and soundness of bibliometric parameters for measuring and elucidating the performance of researchers in the field of education sciences in Germany and other European countries for the purpose of benchmarking. In order to take into account the specificities of the publication pattern of researchers in education sciences, bibliometric data are used as benchmarks. Specifically, the analysis is based on the data of Scopus and SCImago and exploits the contributions of educational researchers from Germany, Spain, the Netherlands, and Scandinavian countries to leading international journals within the period 2010 to 2015–2016. The results demonstrate that the visibility of German education in international journals is not as bad as is often assumed. Nevertheless, substantial shortcomings are revealed. After discussing some factors responsible for these shortcomings, the article concludes with considerations on possible consequences to be drawn from the status quo of international visibility of German educational science.
Evidence for short-term, but not long-term, transfer effects in the temporal preparation of auditory stimuli
Authors: Crowe Emily M , Kent Christopher
Published: May 2019

Starting procedures in racing sports consist of a warning (e.g., “Set”) followed by a target (e.g., “Go”) signal. During this interval (the foreperiod), athletes engage in temporal preparation whereby they prepare to respond to the target as quickly as possible. Despite a long history, the cognitive mechanisms underlying this process are debated. Recently, it has been suggested that traces of previous temporal durations drive temporal preparation performance rather than the traditional explanation that performance is related to the currently perceived hazard function. Los and colleagues used visual stimuli for the warning and target signals. As racing sports typically rely upon auditory stimuli, we investigated the role of memory on temporal preparation in the auditory domain. Experiment 1 investigated long-term transfer effects. In an acquisition phase, two groups of participants were exposed to different foreperiod distributions. One week later, during a transfer phase, both groups received the same distribution of foreperiods. There was no evidence for transfer effects. Therefore, Experiment 2 examined short-term transfer effects in which acquisition and transfer phases were completed in the same testing session. There was some evidence for transfer effects, but this was limited, suggesting that there may be modality-specific memory differences.
Structural reliability and reliability sensitivity analysis of extremely rare failure events by combining sampling and surrogate model methods
Authors: Wei Pengfei , Tang Chenghu , Yang Yuting
Published: May 2019

The aim of this article is to study the reliability analysis, parametric reliability sensitivity analysis and global reliability sensitivity analysis of structures with extremely rare failure events. First, the global reliability sensitivity indices are restudied, and we show that the total effect index can also be interpreted as the effect of randomly copying each individual input variable on the failure surface. Second, a new method, denoted as Active learning Kriging Markov Chain Monte Carlo (AK-MCMC), is developed for adaptively approximating the failure surface with active learning Kriging surrogate model as well as dynamically updated Monte Carlo or Markov chain Monte Carlo populations. Third, the AK-MCMC procedure combined with the quasi-optimal importance sampling procedure is extended for estimating the failure probability and the parametric reliability sensitivity and global reliability sensitivity indices. For estimating the global reliability sensitivity indices, two new importance sampling estimators are derived. The AK-MCMC procedure can be regarded as a combination of the classical Monte Carlo Simulation (AK-MCS) and subset simulation procedures, but it is much more effective when applied to extremely rare failure events. Results of test examples show that the proposed method can accurately and robustly estimate the extremely small failure probability (e.g. 1e–9) as well as the related parametric reliability sensitivity and global reliability sensitivity indices with several dozens of function calls.
Disruption and continuity on telenovela with the surge of a new hybrid prime-time fictional serial: The super series
Authors: Piñón Juan
Published: May 2019

The Latin American telenovela genre has enjoyed a long-lasting hegemonic position in prime-time television across the region, and particularly within US Spanish-language television market. However, in the last several years, Spanish-language national television networks, as well as their prime-time telenovela product, are being challenged by the new digital and mobile media landscape. Television networks have deployed a variety of strategies to better accommodate to new audiences’ consumption routines in a digital age. This article focuses on a particular moment of disruption – and continuity –, which has been a game changer for US Hispanic television and has transformed the face of fictional serial (telenovelas) in prime time. The surge in popularity of a telenovela subgenre originating in Colombia and widely adopted by US television corporations, known as narconovela, has transformed the telenovela genre/format, prompting industry professionals to initiate new institutional discourses aimed to mark these texts as super series, and in doing so labelling them as a new type of genre. Super series are an excellent case study for understanding the dialectic notion of disruption and continuity both in television studies and the television industry.
Drawing conclusions about what co-participants know: Knowledge-probing question–answer sequences in new employee orientation lectures
Authors: Mikkola Piia , Lehtinen Esa
Published: May 2019

This study aims to uncover the processes of interaction through which knowledge acquisition in new employee orientation is monitored and controlled. Using video-recordings of orientation lectures as data, the study focuses on question–answer sequences in which the lecturer’s question probes into the state of the employees’ knowledge; in particular, it looks at the third turn of the sequence, in which the lecturer comes to a conclusion concerning the participants’ knowledge. This is shown to be an unavoidably practical accomplishment, which is contingent on both the often ambivalent responses of the participants and the design of the knowledge-probing question. Also, the lecturer orients to being responsible for providing the employees with the necessary knowledge that they do not have. The study contributes to discussion of the interactional organization of knowledge in institutional settings, and it sheds light on the pros and cons of lectures as interactional encounters.
Charlie Hebdo, 2015: ‘Liveness’ and acceleration of conflict in a hybrid media event
Authors: Sumiala Johanna , Tikka Minttu , Valaskivi Katja
Published: May 2019

In this article, the authors examine the intensification of liveness and its effects in the Charlie Hebdo attacks that took place in Paris in January 2015. In their investigation they first re-visit the existing theoretical literature on media, event and time, and discuss in particular the relationship between media events and the idea of liveness. They then move on to the empirical analysis of the Charlie Hebdo attacks and demonstrate the aspects of intensified liveness in the circulation of selected tweets. The analysis is based on a multi-method approach developed for the empirical study of hybrid media events. In conclusion, the authors argue that the liveness, experienced and carried out simultaneously on multiple platforms, favours stereotypical and immediate interpretations when it comes to making sense of the incidents unfolding before the eyes of global audiences. In this condition, incidents are interpreted ‘en direct’, but within the framework of older mnemonic schemes and mythologization of certain positions (e.g. victims, villains, heroes) in the narrative. This condition, they claim, further accelerates the conflict between the different participants that took part in the event.
Radiation exposure of patients during mini C-arm use: an audit in 2032 procedures
Authors: McCann Mark R. , Rust Philippa A. , Brown Katie , Lawrie David
Published: May 2019

This study aimed to audit large quantities of mini C-arm data used in hand and wrist surgery and to analyse what effect the type and anatomical location of procedures had on screening time and dose area product. Of a total of 2032 procedures, the median screening time was 11 seconds and median dose area product was 0.75 cGycm2. The third quartile value for screening time was 23 seconds and dose area product was 1.62 cGycm2. The median screening time for closed procedures was 7 seconds and the dose area product was 0.57 cGycm2. The median screening time for open surgery was 23 seconds with a median dose area product of 1.45 cGycm2. The data for steroid injection procedures were similar to those of the closed procedures, with a median screening time of 7 seconds and dose area product of 0.45 cGycm2. We found no significant differences in the screening time or dose area product between procedures on the wrist and forearm compared with the hand and digits.

Level of evidence: III
Robot-assisted percutaneous scaphoid fracture fixation: a report of ten patients
Authors: Liu Bo , Wu Feiran , Chen Shanlin , Jiang Xieyuan , Tian Wei
Published: May 2019

This study reports the technique, efficacy and safety of robotic-assisted, computer-navigated, percutaneous fixation of scaphoid fractures. Ten males with acute undisplaced waist fractures underwent fixation with this method using a commercially available three-dimensional fluoroscopy unit and robotic navigation system. The mean total operative duration was 40 minutes, which comprised of a set-up time of 18 minutes and planning and surgical time of 22 minutes. All patients required only a single guidewire insertion attempt, and there were no screw protuberances or other complications. All fractures united at a mean of 8 weeks. At a mean follow-up of 6.5 months (range 6–8), the mean Mayo wrist score was 96, patient-rated wrist evaluation was 2, flexion-extension arc was 96% and grip strength was 91% of the contralateral side. We conclude from our patients that robotic-assisted percutaneous scaphoid fixation is feasible, safe and accurate, and is a satisfactory method for treating these injuries.

Level of evidence: IV
The supernatant of cervical carcinoma cells lines induces a decrease in phosphorylation of STAT-1 and NF-κB transcription factors associated with changes in profiles of cytokines and growth factors in macrophages derived from U937 cells
Authors: Sánchez-Reyes Karina , Pedraza-Brindis Eliza J , Hernández-Flores Georgina , Bravo-Cuellar Alejandro , López-López Brenda A , Rosas-González Vida C , Ortiz-Lazareno Pablo C
Published: May 2019

Macrophages are presents in the tumor microenvironment and acquire different phenotypic and functional characteristics in response to microenvironmental signals. Macrophages can be differentiated into two phenotypes: M1 or pro-inflammatory (classically activated), and M2 or anti-inflammatory macrophage (alternatively activated). In response to the microenvironment, macrophages activate transcription factors as STAT1 and NF-κB-p65 for M1 macrophages or STAT3 and STAT6 for M2 macrophages; activation impacts on the profile of cytokine, chemokines and growth factors secreted by macrophages. We evaluated the effect of the supernatant of cervical-derived carcinoma cell lines HeLa, SiHa, and C-33A on the phosphorylation of transcriptional factors STAT1, NF-κB-p65, and STAT6, and their impact in the profile of secretion of cytokines and growth factors by macrophages derived from the U937 cell line. The results show that in macrophages, these supernatants induce a decrease in the phosphorylation of NF-κB-p65 and STAT1 in U937-macrophages accompanied by an increase in the secretion of IL-10, IL-6, MCP-1, and IL-8, as well as GM-CSF, G-CSF, PDGF-AA, PDGF-BB, and VEGF. Our results suggest that HeLa, SiHa, and C-33A cell lines down-regulate the activation of transcription factors characteristic of M1 macrophages (STAT1, NF-κB-p65) and induce the secretion of factors that favor tumor growth.
Pioglitazone improves phagocytic activity of liver recruited macrophages in elderly mice possibly by promoting glucose catabolism
Authors: Nakashima Masahiro , Kinoshita Manabu , Nakashima Hiroyuki , Kotani Aya , Ishikiriyama Takuya , Kato Shoichiro , Hiroi Sadayuki , Seki Shuhji
Published: May 2019

Recent studies have revealed that the immunological function of leukocytes is dependent on their cellular metabolism, and some researchers have advocated the beneficial effects of pioglitazone against sepsis in young mice, although bacterial infections are more prevalent in elderly hosts. Here, we investigated pioglitazone’s preventative effect against sepsis induced by intravenous injection of a lethal dose of Escherichia coli in elderly mice (50–60 wk old) and examined its immunological and metabolic effects on liver leukocytes. Pioglitazone improved bacterial elimination in the peripheral blood, lowered serum pro-inflammatory cytokines (TNF-α, IL-12, IFN-γ), and prevented septic death. It also enhanced bacterial elimination in the liver, by increasing the phagocytic and bactericidal activities of liver F4/80+CD11b+ recruited macrophages (Mφ), their CD206 expression and reactive oxygen species production. Quantitative PCR revealed that pioglitazone treatment enhanced gene expression of rate-limiting enzymes for glycolysis in hepatic CD11b+ cells (including neutrophils and recruited Mφ), and their improved phagocytic and bactericidal activities were abolished by glycolysis inhibiting reagents. These findings present the possibility that pioglitazone strengthens the phagocytic and bactericidal activities of liver recruited Mφ and that these immunological activities are closely associated with their glucose catabolism.
Axitinib overcomes multiple imatinib resistant cKIT mutations including the gatekeeper mutation T670I in gastrointestinal stromal tumors
Authors: Liu Feiyang , Zou Fengming , Chen Cheng , Yu Kailin , Liu Xiaochuan , Qi Shuang , Wu Jiaxin , Hu Chen , Hu Zhenquan , Liu Juan , Liu Xuesong , Wang Li , Ge Juan , Wang Wenchao , Ren Tao , Bai Mingfeng , Cai Yujiao , Xiao Xudong , Qian Feng , Tang Jun , Liu Qingsong , Liu Jing
Published: May 2019

Background:

cKIT kinase overexpression and gain-of-function mutations are the critical pathogenesis of gastrointestinal stromal tumors (GISTs). Although the multiple kinase inhibitors such as imatinib, sunitinib, and regorafenib have been approved for GISTs, the acquisition of polyclonal secondary resistance mutations in KIT is still a limitation for GIST treatment. Here we explored the KIT inhibitory activity of axitinib in preclinical models and describe initial characterization of its activity in GIST patient-derived primary cells.

Methods:

The activities of axitinib against mutant KIT were evaluated using protein-based assay and a panel of engineered and GIST-derived cell lines. The binding modes of axitinib-KIT/KIT mutants were analyzed. Four primary cells derived from GIST patients were also used to assess the drug response of axitinib.

Results:

Axitinib exhibited potent activities against a variety of cKIT associated primary and secondary mutations. It displayed better activity against cKIT wild-type, cKIT V559D/A/G, and L576P primary gain-of-function mutations than imatinib, sunitinib, and regorafenib. In addition, it could inhibit imatinib resistant cKIT T670I and V654A mutants in vitro and in vivo GIST preclinical models.

Conclusion:

Our results provide the basis for extending the application of axitinib to GISTs patients who are unresponsive or intolerant to the current therapies.
Extraction of Nobiletin and Tangeretin From Peels of Shekwasha and Ponkan Using [C2mim][(MeO)(H)PO2] and Centrifugation
Authors: Mizuno Hitomi , Yoshikawa Hibiki , Usuki Toyonobu
Published: May 2019

The polymethoxyflavonoids nobiletin and tangeretin are isolated from peels of shekwasha ( Citrus depressa Hayata) and ponkan ( Citrus reticulata Blanco). These natural products possess biological activities, including anticancer and anti-inflammation properties. This report describes an efficient method for the extraction and isolation of nobiletin and tangeretin from citrus peels using 1-ethyl-3-methylimidazolium methylphosphonate ([C2mim][(MeO)(H)PO2]) and centrifugation/decantation. The results showed that the extraction yield of nobiletin and tangeretin using [C2mim][(MeO)(H)PO2]/organic solvent (1:1 w/w) was 1.4 to 1.6 times higher than that using organic solvent. This extraction method is expected to be applicable for obtaining other organic compounds from natural sources.
From Michotte Until Today: Why the Dichotomous Classification of Modal and Amodal Completions Is Inadequate
Authors: Scherzer Tom R. , Faul Franz
Published: May 2019

The distinction between modal and amodal completion is ubiquitous in the perception literature. It goes back to the seminal publication “Les compléments amodaux des structures perceptives” by A. Michotte, G. Thinès, and G. Crabbé (Publications Universitaires de Louvain: Louvain) in 1964. We review and discuss this work in this article and show commonalities and differences to today’s view. We then argue that the dichotomous distinction between modal and amodal completions is problematic in phenomenological, empirical, logical, and theoretical terms. Finally, we propose alternative criteria allowing for a more differentiated classification scheme for completion phenomena. This scheme seems to be consistent with all known empirical findings and can also be generalized to nonvisual domains of perception.
High doses of folic acid induce a pseudo-methylenetetrahydrofolate syndrome
Authors: Cornet Dominique , Clement Arthur , Clement Patrice , Menezo Yves
Published: May 2019

A 41-year-old Caucasian woman with a history of infertility dating from 2011 was identified as wild-type (no mutations) for methylenetetrahydrofolate reductase single nucleotide polymorphisms (MTHFR-SNPs). Previous treatment included three failed in vitro fertilization/intracytoplasmic sperm injection cycles as well as one failed cycle of in vitro fertilization/intracytoplasmic sperm injection with donated oocytes. Counseling for a further oocyte donation cycle included advice to take high doses of folic acid (5 mG per day). Prior to initiation of this cycle, in October 2017 she attended our unit for general gynecological assessment and was found to have a slightly increased level of homocysteine, 12.2 µmol/L. A further test in February 2018 showed an increase to 17.2 µmol/L. Folic acid was stopped, and she was treated with 5-MTHF (500 µG daily), which supports the one-carbon cycle. After 5 days of treatment, her homocysteine level dropped to a baseline level of 8.2 µmol/L. As previously described in mice, high doses of folic acid can induce a “pseudo MTHFR” syndrome in wild-type patients, leading to an elevated unmetabolized folic acid syndrome which results in increased serum levels of homocysteine.
Development of Rational Emotive Education Module for Stress Intervention of Malaysian Boarding School Students
Authors: Mahfar Mastura , Noah Sidek Mohd , Senin Aslan Amat
Published: May 2019

This article discusses the development and validation of a Rational Emotive Education (REE) module for the stress intervention of Malaysian boarding school students. The module comprises four submodules, namely, Acceptance, Feelings, Beliefs, and Disputing Beliefs that have been developed by using the Rational Emotive Behavioral Therapy (REBT) approach. The validation stage which was evaluated by a panel of experts showed that the module’s content validity value is .92. Meanwhile, the reliability testing performed using a set of questionnaires indicated the reliability coefficient of .93 This article demonstrates how a rigorous procedure can be applied to develop and validate an effective stress intervention module before it can be administered in an actual study. The results also demonstrate how the REE module which is based on the REBT approach can be applied by school counselors for the purpose of stress intervention in an educational setting.
Improving Adherence to Mental Health Treatment in a Low-Income Clinic
Authors: Gandy Janice , Sawin Erika Metzler , Zook Sharon , Eggert Lynne
Published: May 2019

The increasing prevalence of mental illness in the United States presents significant challenges for primary care providers particularly in low-income settings. Integrated Behavioral Health (IBH) programs have resulted in improved general health for low-income participants; however, managing appointment adherence, in which the patient attends appointment as scheduled, is particularly challenging. The purpose of this pilot project was to implement bundled interventions at a low-income primary care clinic in a Mid-Atlantic state to improve patient adherence to behavioral health treatment using a collaborative, community-based approach. Interventions were delivered in a bundle format and included patient education, warm patient handoffs, and follow-up phone calls by behavioral health counselors. In the 4-month postintervention time frame, the average number of patients who did not come to their appointment decreased by 60%, and the average number of patients who canceled decreased by 15%. These differences were significant (χ2 = 9.263, df = 2, p < .01). This pilot project showed that patients who became engaged as active participants in a bundle of interventions were more likely to keep their appointments.
Effect of Surgical Setting on Hospital-Reported Outcomes for Elective Lumbar Spinal Procedures: Tertiary Versus Community Hospitals
Authors: Weir Tristan B. , Sardesai Neil , Jauregui Julio J. , Jazini Ehsan , Sokolow Michael J. , Usmani M. Farooq , Camacho Jael E. , Banagan Kelley E. , Koh Eugene Y. , Kurtom Khalid H. , Davis Randy F. , Gelb Daniel E. , Ludwig Steven C.
Published: May 2019

Study Design:

Retrospective cohort study.

Objective:

As hospital compensation becomes increasingly dependent on pay-for-performance and bundled payment compensation models, hospitals seek to reduce costs and increase quality. To our knowledge, no reported data compare these measures between hospital settings for elective lumbar procedures. The study compares hospital-reported outcomes and costs for elective lumbar procedures performed at a tertiary hospital (TH) versus community hospitals (CH) within a single health care system.

Methods:

Retrospective review of a physician-maintained, prospectively collected database consisting of 1 TH and 4 CH for 3 common lumbar surgeries from 2015 to 2016. Patients undergoing primary elective microdiscectomy for disc herniation, laminectomy for spinal stenosis, and laminectomy with fusion for degenerative spondylolisthesis were included. Patients were excluded for traumatic, infectious, or malignant pathology. Comparing hospital settings, outcomes included length of stay (LOS), rates of 30-day readmissions, potentially preventable complications (PPC), and discharge to rehabilitation facility, and hospital costs.

Results:

A total of 892 patients (n = 217 microdiscectomies, n = 302 laminectomies, and n = 373 laminectomy fusions) were included. The TH served a younger patient population with fewer comorbid conditions and a higher proportion of African Americans. The TH performed more decompressions ( P < .001) per level fused; the CH performed more interbody fusions ( P = .007). Cost of performing microdiscectomy ( P < .001) and laminectomy ( P = .014) was significantly higher at the TH, but there was no significant difference for laminectomy with fusion. In a multivariable stepwise linear regression analysis, the TH was significantly more expensive for single-level microdiscectomy ( P < .001) and laminectomy with single-level fusion ( P < .001), but trended toward significance for laminectomy without fusion ( P = .052). No difference existed for PPC or readmissions rate. Patients undergoing laminectomy without fusion were discharged to a facility more often at the TH ( P = .019).

Conclusions:

We provide hospital-reported outcomes between a TH and CH. Significant differences in patient characteristics and surgical practices exist between surgical settings. Despite minimal differences in hospital-reported outcomes, the TH was significantly more expensive.
Racial Differences in Perioperative Opioid Utilization in Lumbar Decompression and Fusion Surgery for Symptomatic Lumbar Stenosis or Spondylolisthesis
Authors: Davison Mark A. , Lilly Daniel T. , Desai Shyam A. , Vuong Victoria D. , Moreno Jessica , Bagley Carlos , Adogwa Owoicho
Published: May 2019

Study Design:

Retrospective cohort study.

Objectives:

To assess for racial differences in opioid utilization prior to and after lumbar fusion surgery for patients with lumbar stenosis or spondylolisthesis.

Methods:

Clinical records from patients with lumbar stenosis or spondylolisthesis undergoing primary <3-level lumbar fusion from 2007 to 2016 were gathered from a comprehensive insurance database. Records were queried by International Classification of Diseases diagnosis/procedure codes and insurance-specific generic drug codes. Opioid use 6 months prior, through 2 years after surgery was assessed. Multivariate regression analysis was employed to investigate independent predictors of opioid use following lumbar fusion.

Results:

A total of 13 257 patients underwent <3-level posterior lumbar fusion. The cohort racial distribution was as follows: 80.9% white, 7.0% black, 1.0% Hispanic, 0.2% Asian, 0.2% North American Native, 0.8% “Other,” and 9.8% “Unknown.” Overall, 57.8% patients utilized opioid medications prior to index surgery. When normalized by the number opiate users, all racial cohort saw a reduction in pills disbursed and dollars billed following surgery. Preoperatively, Hispanics had the largest average pills dispensed (222.8 pills/patient) and highest average amount billed ($74.67/patient) for opioid medications. The black cohort had the greatest proportion of patients utilizing preoperative opioids (61.8%), postoperative opioids (87.1%), and long-term opioid utilization (72.7%), defined as use >1 year after index operation. Multivariate logistic regression analysis indicated Asian patients (OR 0.422, 95% CI 0.191-0.991) were less likely to use opioids following lumbar fusion.

Conclusions:

Racial differences exist in perioperative opioid utilization for patients undergoing lumbar fusion surgery for spinal stenosis or spondylolisthesis. Future studies are needed corroborate our findings.
Arthroscopic Treatment of First-Time Shoulder Dislocations in Younger Athletes
Authors: Terra Bernardo Barcellos , Ejnisman Benno , Belangero Paulo Santoro , Figueiredo Eduardo , De Nadai Anderson , Ton Angelo , Cohen Moisés
Published: May 2019

Background:

The glenohumeral joint is characterized by its large degree of movement and consequently is the most susceptible joint to dislocations. There are few studies on the first episode of a shoulder dislocation in younger athletes.

Purpose:

To report the results of arthroscopic treatment for the first episode of a glenohumeral dislocation in younger athletes.

Study Design:

Case series; Level of evidence, 4.

Methods:

In this retrospective study, 53 patients younger than 40 years (N = 54 shoulders) sustained their first anterior shoulder dislocation and underwent arthroscopic surgery. Surgery was undertaken in the lateral decubitus position. Standard posterior, anteroinferior, and anterosuperior portals were used, and the number of anchors and the degree of capsular plication were individualized and based on the arthroscopic findings of each patient. The minimum follow-up was 2 years (mean, 2.31 years), and patients were evaluated with the Rowe functional score, Athletic Shoulder Outcome Rating Scale (EROE; acronym in Portuguese), and visual analog scale (VAS) for pain.

Results:

The mean EROE score was 93.8, with 98% of results being good or excellent, and the mean Rowe score was 95.0, with 98% good or excellent results. The mean VAS pain score was <1.0. The rate of recurrence of dislocations was 2%. The return-to-sports rate was 83%; patients with associated superior labral anterior-posterior (SLAP) lesions had a lower return-to-sports rate ( P = .001) and lower EROE ( P = .017) and Rowe ( P = .019) scores.

Conclusion:

The present study showed favorable results for arthroscopic surgical treatment after the first dislocation episode in young athletes. It was an effective and safe treatment option in this population.
Rodent 2-year cancer bioassays and in vitro and in vivo genotoxicity tests insufficiently predict risk or model development of human carcinomas
Authors: Smith Carr J , Perfetti Thomas A , King Judy A
Published: May 2019

In 2018, the National Institutes of Health estimated that 1,735,350 new cancer cases were diagnosed in the United States and 609,640 patients died from various forms of cancer. The vast majority of those cancer deaths occurred from cancers derived from epithelial cells, that is, carcinomas. The most lethal cancers in American women based upon estimated deaths occurred in the lung and bronchus (352,209), breast (205,675), colon and rectum (123,617), pancreas (96,571), and ovary (71,141). The largest cancer killers in men occurred in the lung and bronchus (427,587), prostate (140,086), colon and rectum (135,542), pancreas (100,599), and liver (80,526). Histologically different carcinomas are initiated, clonally expanded, and progressed in association with particular changes in genes and also epigenetic alterations. Currently employed genotoxicity testing protocols emphasize testing for the initiating (mutational) potential of the test agent. While 2-year chronic rodent cancer bioassays test for the entire spectrum of carcinogenic transformation and development, the high doses used in these assays induce cytotoxicity leading to increased cellular proliferation rates and high false-positive rates of tumor induction in non-genotoxic chemicals. The low cancer induction from high radiation exposures experienced by atomic bomb survivors in Hiroshima and Nagasaki, Japan, and the epidemiological evidence showing that cigarette smoking duration and not intensity is associated with lung cancer risk both support a more important role for tumor promotion rather than initiation in the clinical presentation of human carcinomas. Cancer hazard assessment testing protocols and weight-of-the-evidence analysis of agent-specific cancer risk should be better aligned with the pathogenesis of human carcinoma.
Health outcomes and services in children with sickle cell trait, sickle cell anemia, and normal hemoglobin
Authors: Reeves Sarah L. , Jary Hannah K. , Gondhi Jennifer P. , Kleyn Mary , Dombkowski Kevin J.
Published: May 2019

The health effects of sickle cell trait among children are unknown. We compared select health outcomes and health services utilization among children with sickle cell trait, sickle cell anemia (SCA), and normal hemoglobin. Newborn screening records were used to identify children with sickle cell trait and SCA born in Michigan (1997-2014) who were enrolled in Michigan Medicaid for ≥1 year from 2012 to 2014. Each select health outcome (acute otitis media, acute respiratory infections, fever, invasive pneumococcal disease, pneumonia and influenza, renal complications, spleen problems, stroke) was defined as ≥1 claim with a diagnosis code for the respective outcome within a study year. Health services utilization was summarized as counts of emergency department, inpatient, and outpatient encounters. The relationship between hemoglobin status and each health outcome or utilization was assessed by logistic or negative binomial regression with generalized estimating equations. The study population consisted of 18 257 children with sickle cell trait, 368 with SCA, and 74 523 with normal hemoglobin (227 188 total person-years). Compared with those with normal hemoglobin, children with sickle cell trait had lower odds of acute otitis media (odds ratio [OR], 0.88; 95% confidence interval [CI], 0.84-0.91), acute respiratory infections (OR, 0.94; 95% CI, 0.92-0.97), pneumonia and influenza (OR, 0.93; 95% CI, 0.87-0.99), and outpatient visits (incidence rate ratio, 0.95; 95% CI, 0.93-0.97). Children with SCA had higher or nonsignificant odds of all outcomes and types of health services utilization. These results indicate that children with sickle cell trait may not be at additional health risk for these outcomes. However, additional case-control studies may be necessary to identify rare events.
Retrospective parental assessment of childhood neurodevelopmental problems: the use of the Five to Fifteen questionnaire in adults
Authors: Lugnegård Tove , Bejerot Susanne
Published: May 2019

Background

Attention-deficit hyperactivity disorder and autism are increasingly recognised in adults. For a diagnostic evaluation, parental information on childhood development is needed. However, no instruments that retrospectively describe neurodevelopmental problems in childhood are validated for evaluating adults. The 181-item parent-report questionnaire Five to Fifteen (FTF) is nevertheless frequently used for assessments in adulthood.

Aims

To examine if FTF is reliable for obtaining retrospective neurodevelopmental history among young adults.

Method

Details of parents who had assessed their children with the FTF for neuropsychiatric evaluation were retrieved and they were asked to complete the FTF again 10–19 years later. Agreements between original and retrospective scorings were analysed.

Results

Long-term reliability for FTF varies considerably between individual items. Several difficulties are reported as more severe at the retrospective scoring than at the original scoring. A selection of 24 items (FTF-Brief) with good agreement over time, is presented for use in adult psychiatry settings.

Conclusion

Neuropsychiatric symptoms may fluctuate over time and become more prominent when demands increase. Informants' recollections of their child's neurodevelopmental symptoms may be a selection of symptoms that are longstanding rather than present at a specific age in childhood.

Declaration of interest

None.
Sensitivity and specificity of early screening for autism
Authors: Surén Pål , Saasen-Havdahl Alexandra , Bresnahan Michaeline , Hirtz Deborah , Hornig Mady , Lord Catherine , Reichborn-Kjennerud Ted , Schjølberg Synnve , Øyen Anne-Siri , Magnus Per , Susser Ezra , Lipkin W. Ian , Stoltenberg Camilla
Published: May 2019

Background

Early identification and diagnosis is beneficial for children with autism spectrum disorder (ASD). Universal early screening is recommended by many experts, but disputed because evidence is limited, and sensitivity and specificity in general populations are largely unknown.

Aims

To estimate the sensitivity and specificity of early population-based screening for ASDs.

Method

The study was based on the Norwegian Mother and Child Cohort Study. The 36-month cohort questionnaire included the Social Communication Questionnaire (SCQ), a 40-item screening instrument for ASD.

Results

A total of 58 520 mothers (58%) responded to the questionnaire. By the end of follow-up on 31 December 2015, 385 (0.7%) individuals with ASD had been identified among the responders' children. The distributions of SCQ scores in those with ASD and other children had large degrees of overlap. With the cut-off of 15 recommended in the SCQ manual, screening sensitivity was 20% (95% CI 16–24) for ASD overall. For children with ASD who had not developed phrase speech at 36 months, sensitivity was 46% (95% CI 35–57%), whereas it was 13% (95% CI 9–17) for children with ASD with phrase speech. Screening specificity was 99% (95% CI 99–99). With the currently recommended cut-off of 11, sensitivity increased to 42% for ASD overall (95% CI 37–47), 69% (95% CI 58–79) for ASD without phrase speech and 34% (95% CI 29–40) for ASD with phrase speech. Specificity was then reduced to 89% (95% CI 89–90).

Conclusions

Early ASD screening with a parent checklist had low sensitivity. It identified mainly individuals with ASD with significant developmental delay and captured very few children with ASD with cognitive skills in the normal range. Increasing sensitivity was not possible without severely compromising specificity.

Declaration of interest

C.L. receives royalty for the Social Communication Questionnaire, which she has co-authored.
Urbanicity and risk of first-episode psychosis: incidence study in Brazil
Authors: Del-Ben Cristina Marta , Shuhama Rosana , Loureiro Camila Marcelino , Ragazzi Taciana Cristina Carvalho , Zanatta Daniela Perocco , Tenan Silvia Helena Galo , Ferreira Santos Jair Lício , Louzada-Junior Paulo , dos Santos Antonio Carlos , Morgan Craig , Menezes Paulo Rossi
Published: May 2019

We estimated the incidence of first-episode psychosis over a 3-year period in a Brazilian catchment area comprising the region's main city, Ribeirão Preto (1 425 306 persons-years at risk), and 25 other municipalities with a total of 1 646 556 persons-years at risk. The incidence rates were estimated and adjusted by gender and age, using the direct standardisation method to the world population as reference. The incidence of psychosis was higher in the younger groups, men, and among Black and minority ethnic Brazilians. Psychosis incidence was lower in Ribeirão Preto (16.69/100 000 person-years at risk; 95% CI 15.68–17.70) compared with the average incidence in the remaining municipalities (21.25/100 000 person-years at risk; 95% CI 20.20–22.31), which have lower population density, suggesting a distinct role for urbanicity in the incidence of first-episode psychosis in low- and middle-income countries.
Managing Immuno-Oncology Toxicity: Top 10 Innovative Institutional Solutions
Authors: Cole Suzanne , Zibelman Matthew , Bertino Erin , Yucebay Filiz , Reynolds Kerry
Published: May 2019

Expanded use of immuno-oncology (IO) therapy to treat cancer has led to an increased frequency of novel toxicities known as immune-related adverse events (irAEs). Delayed recognition of IO toxicity can be life-threatening or even fatal. To address this issue, intervention is possible at three levels: patients, medical providers, and institutions. Patients and the medical community need institutional safeguards in place to promote swift recognition, assessment, and treatment of IO toxicity. Patients receiving IO therapy must be educated to identify the drugs they have received and to recognize potential IO toxicity, and they must know how to report symptoms. Medical providers must be able to reliably identify that patients have received IO therapy as well as recognize rare or subtle symptoms of IO toxicity. Institutions can establish guidelines and order sets to standardize the treatment of patients receiving IO therapy with irAEs, including the complex management of steroid-refractory irAEs. Additional interventions at an institutional level include identification of IO toxicity champions (subspecialists with expertise in IO toxicity), creating immunotherapy-specific tumor boards and lecture series to educate clinicians and staff, and establishing research programs to evaluate IO toxicity. IO therapy and toxicity experiences must be published and shared with both oncology and nononcology providers in the local, national, and international medical community. These efforts aim to improve patient-related outcomes, increase provider education and awareness, and build institutional safety standards for our oncology patients.
Pain Management for Patients With Advanced Cancer in the Opioid Epidemic Era
Authors: Dalal Shalini , Bruera Eduardo
Published: May 2019

Use of opioids for the treatment of pain is necessary for the majority of patients with advanced cancer, however its use has become challenging in the face of the opioid epidemic and the emerging evidence that patients with cancer are also at risk for nonmedical opioid use. This article proposes an assessment and treatment plan that incorporates universal screening with monitoring for all patients with cancer who are considered for opioid treatment to assess their risk for opioid misuse and harm. Timely identification with appropriate management, including referral of at-risk patients, will allow oncology professionals to optimize the risk-to-benefit and support the safe use of opioids for patients with cancer.
Current and Future Aspects of Immunotherapy for Esophageal and Gastric Malignancies
Authors: De Mello Ramon Andrade , Lordick Florian , Muro Kei , Janjigian Yelena Y.
Published: May 2019

Esophagogastric (EG) cancer has a poor prognosis despite the use of standard therapies, such as chemotherapy and biologic agents. Recently, immune checkpoint inhibitors (ICIs) have been introduced as treatments for EG cancer; nivolumab and pembrolizumab have been approved in the United States and Europe to treat advanced EG cancer. Other ICIs, such as avelumab, durvalumab, ipilimumab, and tremelimumab, have been evaluated in several trials, although their roles are still not established in clinical practice. In addition, preclinical evidence suggests that combining an ICI with a tumor-targeting antibody can result in greater antitumor effects in metastatic EG cancer. There are not yet validated predictive biomarkers to identify which patients will respond best to ICI treatment. PD-L1 expression may predict intensity of response, although PD-L1–negative patients can still respond to ICIs. Despite differences in PD-L1 expression between Asian and non-Asian populations, no geographic differences in rates of treatment-related or immune-mediated/infusion-related adverse events have been reported. Also, several trials are currently evaluating combinations of ICIs, standard chemotherapy, and biologic agents as well as novel biomarkers to improve treatments and outcomes. Our review will address the current use of and evidence for ICIs for advanced EG cancer treatment and future trends in this area for clinical practice.
Gastroesophageal Junction Adenocarcinoma: Is There an Optimal Management?
Authors: Lin Daniel , Khan Uqba , Goetze Thorsten O. , Reizine Natalie , Goodman Karyn A. , Shah Manish A. , Catenacci Daniel V. , Al-Batran Salah-Eddin , Posey James A.
Published: May 2019

The incidence of gastroesophageal junction (GEJ) adenocarcinomas has been rising over the past few decades, creating a need for effective therapeutic strategies. Treatment of locally advanced GEJ tumors, in particular, present a unique challenge because these tumors have generally been approached as either esophageal or gastric cancers, and thus optimal preoperative management remains uncertain. Both neoadjuvant chemoradiation and perioperative chemotherapy have been widely adopted in standard practice; however, it is unclear which approach offers the optimal outcome for the fit patient capable of receiving any planned strategy. In this review, we debate the management of locally advanced GEJ adenocarcinoma, and discuss areas of ongoing investigation which may provide more effective and individualized treatment of patients with GEJ cancers.
Reassessing the Role of Cytoreductive Nephrectomy for Metastatic Renal Cell Carcinoma in 2019
Authors: Psutka Sarah P. , Chang Steven L. , Cahn David , Uzzo Robert G. , McGregor Bradley A.
Published: May 2019

Cytoreductive nephrectomy (CRN) has long been considered a standard of care in the management of mRCC. This is largely based on randomized trials in the era of interferon (IFN) that demonstrate an improvement in overall survival (OS). With the advent of targeted therapies, the role of CRN has been questioned and multiple retrospective analyses have shown a potential benefit, particularly in intermediate-risk disease. Two long-awaited prospective trials have been published in the past year that explore the role of CRN. The CARMENA trial randomly assigned patients to therapy with sunitinib with or without CRN, showing noninferiority of sunitinib alone versus sunitinib plus CRN with a median OS of 18.4 months versus 13.9 months, respectively (hazard ratio [HR] for mortality, 0.89; 95% CI, 0.71–1.1). The SURTIME trial randomly assigned patients to immediate CRN followed by sunitinib versus a deferred CRN after three cycles of sunitinib. Analysis is limited by early termination as a result of low accrual. Although there was no difference in progression-free survival (PFS), median OS was significantly improved among patients in the deferred CRN arm (HR, 0.57; 95% CI, 0.34–0.95; p = .032). Early systemic therapy is paramount, but there are patients who may derive benefit by incorporating the removal of the primary tumor in their multimodal therapy, perhaps in a deferred setting. As systemic treatment paradigms shift and immunotherapy again moves to the frontline setting with the potential for novel therapeutic approaches, the role of CRN will continue to evolve with the potential to offer surgical interventions with minimal, if any, delay in systemic treatment.