bluuebunny/crossref_metadata_2025 huggingface dataset:
Neutrophil-to-lymphocyte ratio as a biomarker for predicting the intravenous immunoglobulin-resistant Kawasaki disease
Authors: Wu Gang , Yue Peng , Ma Fan , Zhang Yi , Zheng Xiaolan , Li Yifei
Published: February 2020

Abstrat

Background:

In recent years, many studies focused on the association between the neutrophil-to-lymphocyte ratio (NLR) and the risk of intravenous immunoglobulin (IVIG)-resistant Kawasaki disease (rKD), with inconsistent results. Therefore, we aimed to investigate the role of NLR as a biomarker in detecting rKD.

Methods:

We searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, and China National Knowledge Infrastructure through May 18th, 2019. Meta-disc 1.4 and STATA 15.1 were used to perform this metaanalysis in a fixed/random-effect model.

Results:

A total of 7 relevant studies were eligible to analyze pooled accuracy. The overall performance of NLR detection was: pooled sensitivity, 0.66 (95% confidence interval [CI], 0.63 – 0.70); pooled specificity, 0.71 (95%CI, 0.69 – 0.73); and area under the summary receiver operating characteristic curves value (SROC), 0.7956. The meta-regression analysis showed that the type of samples was the sources of heterogeneity. The subgroup analysis suggested that NLR detection after the initial treatment of IVIG had the largest area under curve of SROC in all the subgroups: pooled sensitivity, 0.58 (95%CI, 0.53 – 0.63); pooled specificity, 0.77 (95%CI, 0.75 – 0.79); and SROC, 0.8440.

Conclusions:

This is the first meta-analysis demonstrated that NLR might be a biomarker for detecting rKD, especially NLR value after the initial treatment of IVIG. More well-designed researches need to be done to launch the application of NLR for predicting rKD in the clinic.
Rare malignant ulcer related to primary intestinal diffuse large B-cell lymphoma
Authors: Jia Ning , Tang Yanping , Li Yang
Published: February 2020

Rationale:

The specific pathogenesis of the diffuse large B-cell lymphoma(DLBCL)is still indefinite and argumentative. It is known that DLBCL is the most common type of non-Hodgkin's lymphomas (NHL). A lot of cases of DLBCL such as primary gastric diffuse large B-cell lymphoma(PG-DLBCL) are reported. However, primary intestinal diffuse large B-cell lymphoma(PI-DLBCL) is unusual.

Patient concerns:

We present a case of a 57-year-old male diagnosed in the Gastroenterology Department, which presented a bleeding duodenal ulcer with irregular borders.

Diagnoses:

The immunohistochemical staining showed: CD20(+++), CD10(+) and Ki-67>40%.

Interventions:

The patient was successfully treated by Poly-chemotherapy with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vindesine and prednisolone).

Outcomes:

After 6 courses of chemotherapy treatment, the duodenal ulcer was completely healed by reviewing the UGIE.

Lessons:

Our report might give further strength to avoiding the erroneous and missed diagnosis for PI-DLBCL which is different from common duodenal ulcer.
Efficacy of guided internet-assisted intervention on depression reduction among educational technology students of Nigerian universities
Authors: Ofoegbu Theresa Onyema , Asogwa Uche , Otu Mkpoikanke Sunday , Ibenegbu Christopher , Muhammed Abdullahi , Eze Ben
Published: February 2020

Background/Objective:

The study's objective was to determine the efficacy of guided internet-assisted intervention (GIAI) on depression reduction among educational technology students of Nigerian universities.

Methods:

The design of the study was a 10-weeks group-randomized trial (GRT) which involved a pre-test, post-test, and follow-up assessment. A total of 192 educational technology students who were identified as having depression formed the sample of the study. Beck's Depression Inventory-II (BDI-II) was the measure used for data collection in the study. Data collected were analyzed using ANOVA with repeated measures.

Results:

The initial assessment results showed that the participants in both treatment and usual-care control groups had depression. After 10-weeks participation in GIAI, the assessment results showed a significant reduction in depression among students in the treatment group when compared to those in the usual-care control group. The follow-up assessment indicated a further significant reduction in the depression among participants in the treatment group when compared to those in the usual-care control group.

Conclusion:

The authors concluded that GIAI was significantly effective in reducing depression among university students in the treatment group compared to those in the usual-care control group. Therefore, educational technologists, counselors, psychologists, health workers, and other social workers should adopt educational intervention using GIAI in helping university students undergo depression reduction.
Giant pyoderma gangrenosum in a patient with ulcerative colitis
Authors: Niu Ruixian , Zheng Jiangtao , Ding Dongmei , Kuang Weian , Lu Fengyan , Yin Xunguo
Published: February 2020

Introduction:

Pyoderma gangrenosum (PG) is a phenomenon of cutaneous ulceration with unknown etiology. About half the cases have associated extracutaneous manifestations or associated systemic diseases. The most commonly associated systemic disorders include inflammatory bowel disease (IBD), hematologic malignancies, autoimmune arthritis, and vasculitis. This is a case report about giant PG with ulcerative colitis (UC), which is extremely rare.

Case Presentation:

A 39-year-old female farmer with UC for the past 3 years presented with multiple painful ulcers, erosion, exudation, and crusting on the right leg for 1 month. A cutaneous examination showed diffusely distributed, multiple, well-defined, deep purulent ulcers on the right medial shank measuring 6 to 20 cm and sporadic worm-eaten ulceration on the right ectocnemial, with severe oozing and erosions. The ulcerations exhibited deep undermined borders, granulated tissue and a black eschar at the base. The right shank and feet were severely swollen, restricting movement. The arteria dorsalis pedis pulse was good, with normal sensation on the skin of the right shank and feet. Laboratory examinations showed a white cell count of 11.8 × 109/L, hemoglobin was 91 g/L, erythrocyte sedimentation rate was 82 mm/h, unelevated procalcitonin, serum C-reactive protein was 131.29 mg/L, and a negative tuberculin skin test. Enteroscopy demonstrated endoscopic evidence of UC. A skin lesion biopsy showed superficial erosion and scarring. Partial epidermal hyperplasia, partial epidermal atrophy and thinning, mild edema of the dermal papill. Most of the middle and lower part of the dermis, showed dense lymphocytes, histiocytes, multinucleated giant cells, and neutrophil infiltration. PG with UC was diagnosed based on clinical manifestations, laboratory examinations and enteroscopy results.

Interventions:

She was treated with topical applications of povidone iodine and kangfuxin solution twice daily, methylprednisolone sodium succinate 40 mg and compound glycyrrhizin 60 mg via intravenous drip once a day, along with thalidomide 50 mg twice daily. The UC was controlled with mesalazine.

Outcomes:

She required multiple therapies to achieve PG healing 3 months later. No PG recurrence was observed during the 1-year follow-up.

Conclusion:

Recognizing the clinical features of PG and its pathogenic nature, ensuring timely management fundamental for preventing severe destruction and deformity, and control of associated diseases are important aspects of treatment. Combination therapy is essential for PG patients with IBD.
Ancestry specific associations of FTO gene variant and metabolic syndrome
Authors: Hardy Dale S. , Garvin Jane T. , Mersha Tesfaye B. , Racette Susan B.
Published: February 2020

Cross-sectional studies indicate that the fat mass and obesity-associated (FTO) rs9939609 gene variant is associated with metabolic syndrome (MetS) primarily in European ancestry. However, the association is not fully elucidated in African Americans.

We hypothesized that rs9939609 (AT = moderate-risk carriers or AA = high-risk carriers compared to TT = low-risk carriers) is associated with MetS and its component risk factors over time; and that its association is ancestry-specific. A secondary hypothesis was that higher levels of physical activity can decrease the deleterious effect of rs9939609 at higher body mass index (BMI).

Atherosclerosis Risk in Communities study repeated measures data from 4 visits (1987–1998) were obtained from the database of Genotypes and Phenotypes for 10,358 participants (8170 Whites and 2188 African Americans) aged 45 to 64 years at baseline. Guidelines for elevated blood pressure by the American College of Cardiology and American Heart Association Task Force were updated within the MetS criteria. Risk ratios (RR) and 95% confidence intervals from generalized estimating equations assessed population-average risks.

MetS was present among 3479 (42.6%) Whites and 1098 (50.2%) African Americans at baseline, and 50.3% Whites and 57% African Americans over 11-years of follow-up. Among MetS component risk factors, high waist circumference was most prevalent among White AT (RR = 1.07; 1.06–1.09) and AA (RR = 1.12; 1.10–1.14) higher-risk carriers. High triglycerides were elevated among African American AA high-risk carriers (RR = 1.11; 1.02–1.21) compared to TT low-risk carriers. Over time, White AT-and AA higher-risk carriers had 1.07 and 1.08-fold increase (P < .0001) in MetS risk. Physical activity had independent protective effects on MetS among both races (P < .05). White AA high-risk carriers with normal BMI and low vs high physical activity had higher MetS risk (RR = 1.69; 1.25–2.30 and RR = 0.68;0.53–0.87, respectively). In rs9939609 × BMI× physical activity interaction, White A-allele high-risk carriers had lower MetS risk (RR = 0.68; 0.53–0.87). Among Whites, physical activity can lessen the effect of rs9939609 and high BMI on risk for MetS.
Evaluation of duloxetine and innovative pelvic floor muscle training in women with stress urinary incontinence (DULOXING)
Authors: Hagovska Magdalena , Svihra Jan
Published: February 2020

Introduction:

There is a lack of published studies about the combination of duloxetine and pelvic floor muscle training (PFMT) in women with stress urinary incontinence (SUI). The aim of our work will be to evaluate the effect of this intervention by assessing whether there is a change in the incontinence episode frequency (IEF), Incontinence Quality of Life (I-QoL), Patient Global Impression of Improvement score (PGI-I) and mean time between voids (MTBV). Combined therapy with duloxetine and PFMT will be compared to duloxetine treatment alone with respect to its efficacy and side effects.

Methods:

This study will be a randomized intervention, parallel, multicenter study in collaboration with 45 urological outpatient clinics at the national level. Patients will be assigned in a 1:1 ratio to the experimental and control groups using simple randomization according to odd and even numbers assigned sequentially to the patients at each clinic. The experimental intervention will be 12 weeks. The experimental group will receive oral treatment with duloxetine at a daily dose of 2 × 40 mg and will be required to perform innovative PFMT. The control group will receive the same oral duloxetine treatment (2 × 40 mg a day) but will not perform PMFT. Data will be collected from both groups before intervention and after the 12-week intervention is completed.

Discussion:

The study protocol presents the starting points, design and randomization of an interventional multicenter study to monitor the effect of the combination of duloxetine with innovative PFMT compared to duloxetine treatment alone in women with SUI. This study may provide evidence of the efficacy of this combined treatment for SUI and highlight benefits associated with active approaches to treatment through exercise.

Registration:

This study was retrospectively registered in the ClinicalTrials.go NCT04140253. Protocol version 1.0. date 11.1.2019.
Oral liposarcoma in elderly
Authors: Ohta Keiichi , Yoshimura Hitoshi , Matsuda Shinpei , Imamura Yoshiaki , Sano Kazuo
Published: February 2020

Rationale:

Oral liposarcoma is an extremely rare lesion that is often clinically misdiagnosed as a benign lesion because of its asymptomatic and indolent clinical course. we report a case of atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDL) of buccal mucosa, provisionally diagnosed as lipoma.

Patient concerns

A 97-year-old female was referred to dentistry and oral surgery department with an asymptomatic mass on the right buccal mucosa which had been present for an unknown period of time.

Diagnosis

Magnetic resonance imaging demonstrated a well-circumscribed lesion at the right buccal mucosa, and a lipoma was suspected.

Interventions

Surgical removal was performed, and a diagnosis of ALT/WDL was made. She and her family refused additional treatment due to her age.

Outcomes

At the 10 months follow-up, the patient remained free of disease.

Lessons

The indolent clinical course and small size of oral liposarcoma can lead to provisional clinical diagnosis of benign lesion.
Effect of green tea supplementation on blood pressure
Authors: Xu Renfan , Yang Ke , Ding Jie , Chen Guangzhi
Published: February 2020

Background:

Although evidence from animal and observational studies has supported the beneficial effects of green tea intake for lowering blood pressure (BP), randomized placebo-controlled trials (RCTs) have yielded conflicting results. In this meta-analysis of RCTs, we aimed to assess the effects of green tea supplementation on measures of BP control.

Methods:

The PubMed, Embase, and Cochrane Library databases were electronically searched from inception to August 2019 for all relevant studies. The results were pooled using the generic inverse-variance method with random-effects weighting and expressed as mean differences (MDs) with 95% confidence intervals (CIs). The quality of studies was assessed using the Jadad score. Publication bias was evaluated using funnel plots, Egger test, and Begg test.

Results:

Twenty-four trials with 1697 subjects were included in the meta-analysis. The pooled results showed that green tea significantly lowered systolic BP (SBP; MD: −1.17 mm Hg; 95%CI: −2.18 to −0.16mm Hg; P = .02) and diastolic BP (DBP; MD: −1.24 mm Hg; 95%CI:−2.07 to −0.40mm Hg; P = .004). Significant heterogeneity was found for both SBP (I
2 = 43%) and DBP (I
2 = 57%). In addition, no evidence of significant publication bias was found from funnel plots or Egger test (P = .674 and P = .270 for SBP and DBP, respectively).

Conclusion:

Overall, green tea significantly reduced SBP and DBP over the duration of the short-term trials. Larger and longer-term trials are needed to further investigate the effects of green tea supplementation on BP control and clinical events.
Applicability of the masseter muscle as a nutritional biomarker
Authors: Hwang Yunsup , Lee Yoon Hyun , Cho Dae Hyun , Kim Maru , Lee Dae-Sang , Cho Hang Joo
Published: February 2020

Nutritional assessment is feasible with computed tomography anthropometry. The abdominal muscle at the L3 vertebra is a well-known nutritional biomarker for predicting the prognosis of various diseases, especially sarcopenia. However, studies on nutritional assessment of the brain using computed tomography are still scarce. This study aimed to investigate the applicability of the masseter muscle as a nutritional biomarker.

Patients who underwent simultaneous brain and abdominopelvic computed tomography in the emergency department was retrospectively analyzed. We assessed their masseter muscle 2 cm below the zygomatic arch and abdominal muscle at L3 via computed tomography anthropometry. The skeletal muscle index, prognostic nutritional index, and other nutritional biomarkers were assessed for sarcopenia using the receiver operating characteristic curve analysis.

A total of 314 patients (240 men and 72 women) were analyzed (mean age, 50.24 years; mean areas of the masseter and abdominal muscles, 1039.6 and 13478.3 mm2, respectively). Masseter muscle areas significantly differed in sarcopenic, obese, and geriatric patients (P < .001). The areas under the curve of the masseter muscle in sarcopenic, geriatric, and obese patients were 0.663, 0.686, and 0.602, respectively. Multivariable linear regression analysis showed a correlation with the abdominal muscle area, weight, and age.

The masseter muscle, analyzed via computed tomography anthropometry, showed a statistically significant association with systemic nutritional biomarkers, and its use as a nutritional biomarker would be feasible.
The Association Between the Supply of Nonpharmacologic Providers, Use of Nonpharmacologic Pain Treatments, and High-risk Opioid Prescription Patterns Among Medicare Beneficiaries With Persistent Musculoskeletal Pain
Authors: Karmali Ruchir N. , Skinner Asheley C. , Trogdon Justin G. , Weinberger Morris , George Steven Z. , Hassmiller Lich Kristen
Published: February 2020

Background:

Opioids are prescribed more frequently than nonpharmacologic treatments for persistent musculoskeletal pain (MSP). We estimate the association between the supply of physical therapy (PT) and mental health (MH) providers and early nonpharmacologic service use with high-risk opioid prescriptions among Medicare beneficiaries with persistent MSP.

Research Design:

We retrospectively studied Medicare beneficiaries (>65 y) enrolled in Fee-for-Service and Part D (2007–2014) with a new persistent MSP episode and no opioid prescription during the prior 6 months. Independent variables were nonpharmacologic provider supply per capita and early nonpharmacologic service use (any use during first 3 mo). One year outcomes were long-term opioid use (LTOU) (≥90 days’ supply) and high daily dose (HDD) (≥50 mg morphine equivalent). We used multinomial regression and generalized estimating equations and present adjusted odds ratios (aORs).

Results:

About 2.4% of beneficiaries had LTOU; 11.9% had HDD. The supply of MH providers was not associated with LTOU and HDD. Each additional PT/10,000 people/county was associated with greater odds of LTOU [aOR: 1.06; 95% confidence interval (CI), 1.01–1.11). Early MH use was associated with lower odds of a low-risk opioid use (aOR: 0.81; 95% CI, 0.68–0.96), but greater odds of LTOU (aOR: 1.93; 95% CI, 1.28–2.90). Among beneficiaries with an opioid prescription, early PT was associated with lower odds of LTOU (aOR: 0.75; 95% CI, 0.64–0.89), but greater odds of HDD (aOR: 1.25; 95% CI, 1.15–1.36).

Conclusions:

The benefits of nonpharmacologic services on opioid use may be limited. Research on effective delivery of nonpharmacologic services to reduce high-risk opioid use for older adults with MSP is needed.
Changes in Preventative Health Care After Medicaid Expansion
Authors: Tummalapalli Sri Lekha , Keyhani Salomeh
Published: February 2020

Background:

Medicaid expansion substantially increased health insurance coverage, but its effect on the delivery of preventative health care is unclear.

Objective:

The objective of this study was to assess the impact of Medicaid expansion on the receipt of 15 different measures of preventive care including cancer screening, cardiovascular risk reduction, diabetes care, and other primary care measures.

Research Design:

We performed serial cross-sectional analysis of Behavioral Risk Factor Surveillance System (BRFSS) survey data from 2012 to 2017. We used a quasi-experimental design with difference-in-differences (DiD) analyses to examine changes in preventative health care delivery over 3 time periods in Medicaid expansion compared with nonexpansion states.

Subjects:

We included low-income (<138% federal poverty level) nonelderly (age younger than 65 y) adults residing in 46 US states.

Measures:

Our predictor was residing in a Medicaid expansion state (24 states) versus nonexpansion state (19 states). Our primary outcomes were preventative health care services, which we categorized as cancer screening (breast cancer, cervical cancer, and colorectal cancer); cardiovascular risk reduction (serum cholesterol screening in low-risk groups, serum cholesterol monitoring in high-risk groups, and aspirin use); diabetes care (serum cholesterol monitoring, hemoglobin A1c monitoring, foot examination, eye examination, and influenza vaccination, and pneumonia vaccination); and other primary care measures [influenza vaccination, alcohol use screening, and human immunodeficiency virus (HIV) screening].

Results:

Survey responses from 500,495 low-income nonelderly adults from 2012 to 2017 were included in the analysis, representing 68.2 million US adults per year. Of the 15 outcomes evaluated, we did not detect statistically significant differences in cancer screening (3 outcomes), cholesterol screening or monitoring (2 outcomes), diabetes care (6 outcomes), or alcohol use screening (1 outcome) in expansion compared with nonexpansion states. Aspirin use (DiD 8.8%, P<0.001), influenza vaccination (DiD 1.4%, P=0.016), and HIV screening (DiD 1.9%, P=0.004) increased in expansion states compared with nonexpansion states.

Conclusions:

Medicaid expansion was associated with an increase in aspirin use, influenza vaccination, and HIV screening in expansion states. Despite improvements in access to care, including health insurance, having a primary care doctor, and routine visits, Medicaid expansion was not associated with improvements in cancer screening, cholesterol monitoring, diabetes care, or alcohol use screening. Our findings highlight implementation challenges in delivering high-quality primary care to low-income populations.
Potential therapeutic implications of the new tumor, node, metastasis staging system for human papillomavirus-mediated oropharyngeal cancer
Authors: Huang Shao H. , Li Jishi , Xu Zhiyuan , O'Sullivan Brian
Published: February 2020

Purpose of review

The 8th edition tumor, node, metastasis (TNM) classification (TNM-8) introduced a new classification for human papillomavirus (HPV)-mediated oropharyngeal carcinoma (HPV+ OPC). This review summarizes its potential therapeutic implications focusing on literature published since 2018.

Recent findings

The following are active research areas involved in clinical care and therapy relevant to TNM-8: tumor HPV testing and its clinical implications; stage I disease: treatment selection and lessons learned from recent deintensification trials; emerging strategies addressing stage II and III disease.

The TNM-8 classification depicts prognosis of HPV+ OPC much more reliably compared with TNM-7. Among the advantages in outcome comparison and stratification for clinical trial entry and conduct, it also enables more satisfactory individual patient consultation to adequately estimate prognosis, and facilitates clinical and translational research. However, clinicians must remain mindful that the TNM classification is not a guideline for treatment but, instead, provides a framework for clinical research and treatment decision-making. The TNM-8 has potential to improve risk-tailored treatment algorithms for HPV+ OPC including selection of treatment modality (primary trans-oral surgery vs. radiotherapy, addition of chemotherapy) and adjusting the intensity of approaches. To realize these goals fully, it is apparent that the TNM-8 needs to evolve further.
Airway management, symptom relief and best supportive care in anaplastic thyroid cancer
Authors: Moyer Kelly F. , Marcadis Andrea R. , Shaha Ashok R.
Published: February 2020

Purpose of review

Anaplastic thyroid cancer (ATC) is a rare but aggressive form of thyroid cancer that is associated with significant morbidity and mortality. Because ATC is locally invasive, airway management is a critical component of treating these patients. Timely decisions regarding airway interventions can contribute to symptom relief and supportive care for patients. Over the last decade, there has been a paradigm shift in our recommendations for airway management. The purpose of this review is to summarize airway management, symptom relief and best supportive care for patients with ATC.

Recent findings

More recent literature discusses the morbidities associated with tracheostomy and instead focuses on the benefits of supportive care and surgical resection. The multidisciplinary treating team should initiate early discussions for airway management, end-of-life care and palliative goals for patients with ATC. Tracheostomy should be offered to patients with careful thought and preoperative planning.

Our goal in symptom relief and airway management is to improve the quality of life of patients with ATC and avoid the unnecessary morbidity of tracheostomy until clinically indicated.
Evaluation of Fluorodeoxyglucose Positron Emission Tomography Scanning in the Neoadjuvant Therapy Paradigm in Pancreatic Ductal Adenocarcinoma
Authors: Itchins Malinda , Chua Terence C. , Arena Jennifer , Jamieson Nigel B. , Nahm Christopher B. , O'Connell Rachel L. , Bailey Elizabeth A. , Schembri Geoffrey P. , Gill Anthony J. , Kneebone Andrew , Hruby George , Mittal Anubhav , Pavlakis Nick , Clarke Stephen J. , Samra Jaswinder S.
Published: February 2020

Objectives

Little data exist on the utility of fluorodeoxyglucose positron emission tomography (FDG-PET) in operable pancreatic ductal adenocarcinoma (PDAC) treated with neoadjuvant (NA) therapy.

Methods

Consecutively treated patients with potentially operable PDAC were recruited from a quaternary referral center between 2015 and 2018. Data were collated on demographic, clinical, radiological, treatment, and disease-free and overall survival (OS) outcome measures, correlated with FDG-PET findings.

Results

Of 115 patients recruited, 61% were deemed upfront operable (n = 70), 33% borderline (n = 38), and 6% (n = 7) locally advanced. Ninety-five (83%) received NA chemotherapy with 23 (24%) sequential radiotherapy. Sixty-nine (73%) treated with NA were resected, 37 (54%) attained an R0 resection, 43 (62%) had N1 disease with median tumor viability of 50%. The median OS in the entire cohort was 30.48 months and in those who received NA chemotherapy followed by resection 37.98 months. Twelve percent (n = 13) were upstaged during NA therapy by PET. Preoperative standardized uptake value maximum of less than 5 versus 5 or greater after NA predicted for improved OS, 42.95 months versus 26.05 months, P = 0.02.

Conclusions

In this real-world cohort study of PDAC, the utility of FDG-PET in informing the patient treatment pathway was meaningfully demonstrated.
Intratumoral Fibrosis and Tumor Growth Pattern as Prognostic Factors in Optimally Resected Pancreatic Neuroendocrine Neoplasms
Authors: Chatterjee Deyali , Trikalinos Nikolaos A. , Williams Greg A. , Liu Jingxia , Hawkins William G. , Hammill Chet
Published: February 2020

Objectives

Pancreatic neuroendocrine neoplasms (PanNENs) can recur after curative resection. We sought to establish the significance of tumor fibrosis and tumor growth pattern as predictors of recurrence-free survival and overall survival.

Methods

A retrospective query of an institutional surgical database was performed from 2000 to 2018 to identify optimally resected PanNENs. All eligible slides were reviewed by an experienced gastrointestinal pathologist for established histopathologic prognostic factors, as well as fibrosis and tumor growth pattern. We evaluated the effect of the interested variables through Cox proportional hazards models.

Results

One hundred sixty-eight cases were considered. The majority of patients (90%) had grade 1 or 2 tumors, 46% showed significant fibrosis, and 22% demonstrated an infiltrative growth pattern. Twenty-one percent of patients had a recurrence. In multivariable analysis, lymphovascular invasion with a hazard ratio (HR) of 5.1 and infiltrative growth pattern (HR, 2.8) were significantly associated with increased risk of recurrence and increased risk of death (HR, 3.6 and 2.7, respectively). There was a significant decrease in recurrence-free survival and overall survival for fibrosis and infiltrative growth pattern.

Conclusions

In optimally resected PanNENs, the presence of fibrosis and infiltrative growth pattern are significant risk factors for recurrence and/or decreased survival.
Radiological and Pathological Assessment of the 2017 Revised International Association of Pancreatology Consensus Guidelines for Intraductal Papillary Mucinous Neoplasm, With an Emphasis on the Gastric Pyloric Gland Type
Authors: Nakahodo Jun , Fukumura Yuki , Saito Tsuyoshi , Mitomi Hiroyuki , Saiura Akio , Fujisawa Toshio , Ishii Shigeto , Isayama Hiroyuki , Kurahayashi Isao , Yao Takashi
Published: February 2020

Objectives

This study aimed to assess the pitfalls of the current International Association of Pancreatology guidelines (IAPCG2017) for pancreatic intraductal papillary mucinous neoplasm (IPMN) and identify the criteria for future guidelines.

Methods

Eighty surgically resected, consecutive IPMN cases were analyzed. Data including tumor site, IPMN duct type, and surgery type were collected. Based on radiological data, cases were retrospectively classified as high-risk stigmata (HRS) and non-HRS. Pathological grades and histological subtypes of IPMN cases were determined. Severe stromal sclerosis of the IPMN septa/marked parenchymal atrophy in the upstream pancreas was investigated pathologically. Positive/negative predictive values of the IAPCG2017 were calculated. Clinicopathological features of HRS-benign cases (pathologically benign IPMN cases meeting the HRS criteria) were extracted.

Results

The positive/negative predictive values were 72.7%/64.0%, 70.0%/34.6%, and 54.0%/63.3% for IAPCG2017, HRS-main pancreatic duct, and HRS-nodule criteria, respectively. The 15 HRS-benign cases (18.8%) included 13 pancreatoduodenectomies and 10 cases of gastric pyloric (GP) gland subtype. Severe upstream atrophy was significantly related to IPMN malignancy, unlike the severe sclerosis of IPMN septa.

Conclusions

Benign IPMNs of GP subtype are sometimes categorized as HRS with the IAPCG2017. Collecting data on the natural course of GP-IPMN is necessary. To evaluate upstream atrophy may be of value to predict IPMN malignancy.
The Regulatory Effect of the Kinase Inhibitor PD98059 on Autophagic Flux During Trypsinogen Activation in Pancreatic Acinar Cells
Authors: Yao Wenchao , Zhu Defu , Lu Haifeng , Liu Chao , Sun Bei , Zhang Weihui , Xue Dongbo
Published: February 2020

Objectives

To study the role of kinase inhibitor PD98059 on autophagy flow in the process of trypsinogen activation in pancreatic acinar cell and its related mechanism.

Methods

In the present study, bioinformatics analysis was used to predict kinases and their most relevant inhibitor (PD98059) which participates in autophagy of acute pancreatitis (AP). The rat pancreatic acini AR42J cells were divided into 4 groups: control group, sodium taurocholate hydrate (TLC) group, PD98059 group, and TLC + PD group. Twenty-seven Sprague-Dawley rats were divided into 3 groups (n = 9), including control group, severe AP (SAP) group, and SAP + PD group. We detected trypsinogen activation, autophagic activation, lysosome pH, and cathepsin-l activity in vivo and in vitro.

Results

Results revealed trypsinogen activation was significantly inhibited in mitogen-activated protein kinase 1, JAK2, LYN, and their common inhibitor was PD98059. The trypsinogen activation, Beclin1, and light chain 3 II expressions were reduced, whereas the expressions of lysosomal-associated membrane protein 2, cathepsin L1, and cathepsin-l activity is upregulated after the PD98059 pretreatment, both in vivo and in vitro.

Conclusions

Lysosomal dysfunction blocked autophagy flux, accompanied by increasing pancreatic acinar cell autophagy in the process of trypsinogen activation. PD98059 inhibited AP occurrence and pancreatic injury via improving the blocked autophagic pathway and reducing trypsinogen activation.
Cell-free DNA Oncogene Copy Number as a Surrogate Molecular Biomarker in ALK/MYCN-coamplified Neuroblastoma
Authors: Kobayashi Kenichiro , Mizuta Shumpei , Yamane Noriko , Hamabata Takayuki , Maihara Toshiro , Usami Ikuya , Heike Toshio
Published: February 2020

Secondary expansion and/or evolution of aggressive subclones are associated with the disease progression and resistance to chemotherapy in neuroblastoma, and it is important to track the clonal changes during the treatment period. Cell-free (cf) DNA analysis, namely liquid biopsy, can detect the genomic change of tumor cells without surgical procedures. In this report, we showed that serial polymerase chain reaction–based cf DNA neuroblastoma proto-oncogene quantification is sensitive enough to evaluate the aggressive cellular characteristics of ALK/MYCN-coamplified neuroblastoma and stressed the promise of cf DNA analyses as a reliable molecular marker in advanced neuroblastoma.
Carnitine Profile Changes in Pediatric Hematopoietic Stem Cell Transplant: New Role for Carnitine?
Authors: Law Susanna F. , Fenton Tanis R. , Snyder Floyd F. , Fung Ernest , Lewis Victor
Published: February 2020

Carnitine is an essential cofactor for mitochondrial import and oxidation of fatty acids. High-dose chemotherapy and radiation, often required for hematopoietic stem cell transplant (HSCT), leads to tissue damage, mitochondrial dysfunction, and alterations in carnitine metabolism. The aim of this pilot cohort study was to describe plasma and urinary carnitine profiles during pediatric HSCT and their relationships with clinical outcomes. Plasma and urinary carnitine samples were collected from 22 pediatric patients before and through day 180 post-HSCT. Associations were observed between graft-versus-host disease and an elevated plasma total carnitine (P=0.019), and also increased plasma acyl:free carnitine ratio with veno-occlusive disease (P=0.016). Mortality was observed in those with their highest urinary total carnitine losses on day 0 (P=0.005), and in those with an abnormal day 28 plasma ratio either above or below the reference range (P=0.007). Changes in carnitine profiles were more reflective of metabolic stress and negative outcomes than of inadequate dietary intake. Associations observed direct larger studies to assess the validity of carnitine profiles as a prognostic indicator and also to assess whether prophylactic carnitine supplementation pre-HSCT could reduce mitochondrial injury and urinary losses and help mitigate inflammatory and metabolic comorbidities of HSCT.
Changes in Different Cytokines (IL-2, TNF-α, and IFN-γ) Profile in Acquired Aplastic Anemia Patients: A Study From Eastern India
Authors: Dutta Atreyee , De Rajib , Dolai Tuphan K. , Mitra Pradip K. , Halder Ajanta
Published: February 2020

Although aplastic anemia has been extensively investigated, little is known about their circulating cytokine pattern. The present study was done to evaluate the severity of the disease with the 3 major anti-hematopoietic cytokines interleukin-2 (IL-2), tumor necrosis factor-alpha (TNF-α), and interferon-gamma (IFN-γ). This study is ethically cleared. A total of 102 bone marrow plasma and peripheral blood plasma paired samples were collected from the confirmed acquired aplastic anemia (AAA) patients and 10 control cases after taking written consent and analyzed by the quantitative enzyme-linked immunosorbent assay. The Mann-Whitney U test was used for statistical analysis. Considerably increased levels of IL-2, TNF-α, and IFN-γ were found in the peripheral blood plasma and bone marrow plasma of AAA patients as compared with controls, that is, 45.76±20.61 versus 1.99±1.25, P<0.00001; 26.51±15.62 versus 11.7±3.67, P=0.00188; 17.04±11.64 versus 5.27±1.92, P=0.00034 and 70.54± 37.57 versus 3.12±1.82, P<0.00001; 251.82±243.80 versus 15.66±6.35, P<0.00001; 39.35±22.58 versus 11.12±2.41, P=0.00012, respectively. The IL-2, TNF-α, and IFN-γ levels were observed to be extraordinarily elevated in AAA, but were very low in the control cases. The results confirm that IL-2, TNF-α, and IFN-γ may have an imperative association with the disaster in the bone marrow compartment of AAA patients. The levels and ranges of the observed cytokines can also be predicted by the severity basis of this study.
Survey of human alveolar and cystic echinococcosis rates based on ELISA and portable ultrasound in Moghan, northwestern Iran
Authors: mirzanejad-Asl Hafez
Published: February 2020

Background:

Alveolar echinococcosis and cystic echinococcosis are severe helminthic zoonoses. Echinococcus multilocularis (causative agent of alveolar echinococcosis) is widely distributed in the northern hemisphere where it is typically maintained in a wild animal cycle including canids as definitive hosts and rodents as intermediate hosts.

Methods:

This study was conducted to determine the spread of human alveolar echinococcosis and cystic echinococcosis disease among tribes, livestock breeders and farmers in the Moghan plain. Knowledge gains were compared at the sixth and 12th months after study, elementary and guidance courses, and higher education with a basic level of education Prevalence of infection.

Results:

The most important risk factors were excessive consumption of wild vegetables and the use of spring water. Keeping the dog in the yard was the third risk factor. Results were analyzed using logistic regression and SPSS 21 software. From 2453 serum samples, 21 samples were positive for alveolar echinococcosis 0.79% with Em2+ Ag. The prevalence was higher in men than women (1.24 vs. 0.6%). People within the age range of 40–59 years had the highest infection rates. About cystic echinococcosis, for Ag-5 and Ag-B, 172 (6.4%) and 178 (6.7%) serum samples were positive, respectively. Cystic echinococcosis was higher in women than men (8.52 vs. 5.6%). The age range 40–59 years presented the highest infection rates.

Conclusion:

Due to the high prevalence of echinococcosis in these areas, it is necessary to control, prevent, and combat these diseases.
Understanding Nutritional Problems of Metastatic Breast Cancer Patients
Authors: Oostra Dorien L. , Burse Natasha Renee , Wolf Laura J. , Schleicher Erica , Mama Scherezade K. , Bluethmann Shirley , Schmitz Kathryn , Winkels Renate M.
Published: February 2020

Background:

Metastatic breast cancer patients are now living longer but cope with potential symptoms of metastatic disease and prolonged cancer treatment. Nutrition can play a vital role in managing these sequelae, and eHealth tools are emerging as promising delivery options for nutrition interventions.

Objective:

To qualitatively assess nutritional problems and concerns of women with metastatic breast cancer and to explore how to address these problems within an existing eHealth platform.

Methods:

Semistructured interviews were conducted with 21 women with metastatic breast cancer participating in an ongoing eHealth study. Interviews were audiotaped, transcribed verbatim, and analyzed using a team-based content analysis approach.

Results:

Most respondents reported currently or previously experiencing nutritional problems due to adverse effects of cancer treatment or the disease itself; these were rarely addressed during routine clinical care. Five major themes emerged: (1) knowledge about nutrition, (2) nutrition information-seeking, (3) social aspects of nutrition, (4) nutrition interest, and (5) how to address nutrition with an eHealth platform. The respondents reported diverse experiences and perspectives regarding nutrition and diet in the context of metastatic breast cancer within each theme.

Conclusion:

Findings indicate the importance of providing women with metastatic breast cancer with information about nutrition that is tailored to their specific disease, as these patients report both nutritional problems and uncertainty regarding nutritional strategies.

Implications for Practice:

These findings are a first step toward designing supportive care interventions that could fill the gap related to nutritional concerns not addressed during routine clinical care.
Impact of Birth Cohorts in Breast Cancer Risk Among South Korean Women
Authors: Yeo Jung Hee , Kim Miyong T.
Published: February 2020

Background

The incidence of breast cancer among South Korean women, a historically low-risk population, has increased over the past 3 decades, with marked changes in socioeconomic environment by birth cohort.

Objectives

We investigated associations between breast cancer risk and reproductive factors as well as the impact of birth cohort in those associations.

Method

This was a cross-sectional study of data from the Korea National Health and Nutrition Examination Survey for 2013–2016. Data from 10 012 parous women 30 years or older were analyzed using descriptive statistics and Cox multivariate regression after adjusting for socioeconomic status, educational level, occupation, and birth cohort.

Results

Of the reproductive factors considered—age at menarche, number of pregnancies, age at first birth, age at last birth, breastfeeding duration, and use of oral contraceptives—only age at menarche was associated with breast cancer risk. Higher educational level, not having an occupation, and younger birth cohort were also associated with increased risk of breast cancer, with birth cohort the strongest of these impact factors.

Conclusion

Whereas the relationship between reproductive factors and breast cancer risk was relatively weak, birth cohort was the most important risk factor for breast cancer.

Implications for Practice

The results provide a basis and a rationale for developing birth cohort–based clinical guidelines for breast cancer prevention and early detection, treatment, and survivorship. These findings should also be useful to researchers in other countries experiencing rapid changes in breast cancer incidence.
Experiences of BRCA1/2 Gene Mutation–Positive Women With Cancer in Communicating Genetic Risk to Their Relatives
Authors: Seven Memnun , Shah Lisa L. , Daack-Hirsch Sandra , Yazici Hülya
Published: February 2020

Background

When a woman is diagnosed with hereditary breast or ovarian cancer, family members may be at high risk of cancers associated with BRCA1/2 gene mutation and benefit from disclosure of the genetic test result. This duty of informing relatives may be distressing, or relatives may not be properly informed.

Objective

To qualitatively describe breast cancer patients’ experiences communicating genetic risk of cancer to their relatives.

Methods

Probands with BRCA1/2 gene mutations were recruited from an oncology institute in Istanbul, Turkey, and interviewed by telephone. Qualitative content analysis was conducted to derive central elements of the 30 women’s experiences communicating genetic risk to their relatives.

Results

Six themes were identified: response to genetic test results, reason for communication, feelings about communication, reflection after communication, results of communication, and needs.

Conclusion

Women with cancer found to have BRCA1/2 gene mutations tended to share their genetic test results within the family. The main motives for sharing test results were the desire to encourage relatives to get tested and moral and ethical convictions. Women needed explicit information regarding cancer risk and risk-reducing strategies to act upon.

Implications for Practice

The women’s feelings and reflections about the communication process were varied and suggest that personalized genetic risk communication interventions may better support women with BRCA1/2 gene mutations during and after communication with relatives. Long-term follow-up of those women is essential because of the need for informed decision on risk-reducing strategies.
Baseline Cardiopulmonary Resuscitation Skill Performance of Nursing Students Is Improved After One Resuscitation Quality Improvement Skill Refresher
Authors: Kardong-Edgren Suzan , Oermann Marilyn H. , Jastrzembski Tiffany S. , Krusmark Michael A. , Gluck Kevin A. , Molloy Margory A. , Miller Carrie Westmoreland , Webb Suzanne , Frost Erica , Sarasnick Janice A.
Published: February 2020

This article reports the results of baseline cardiopulmonary resuscitation (CPR) skills performance measurements from 467 nursing students. All participants had completed a CPR course. Baseline measurements were compared to performance after one 10-minute refresher training session on the Resuscitation Quality Improvement system. Significant improvements were made after the computer- and practice-based refresher. Findings suggest that staff developers should evaluate the use of audio and visual feedback devices to improve the quality of CPR provided by clinical staff.
Enhancing the Routine Screening Infrastructure to Address a Syphilis Epidemic in Miami-Dade County
Authors: Larios Venegas Alejandro , Melbourne Heather M. , Castillo Ileana Aurora , Spell Kenneth , Duquette William , Villamizar Kira , Gallo Giselle , Parris Don , Rojas Lourdes M.
Published: February 2020

Background

In a recent sexually transmitted disease surveillance report from the Centers for Disease Control and Prevention, Miami-Dade County had the nation's fourth highest rate of infectious syphilis, with rates of congenital syphilis on the rise. As a public health response, Homestead Hospital, in collaboration with the Florida Department of Health, enhanced their emergency department's routine HIV/HCV “opt-out” screening infrastructure to include a syphilis smart screening algorithm. The purpose of this article is to describe the development, implementation, and evaluation of the algorithm.

Methods

A retrospective evaluation of patient records prompted the development of the algorithm. Homestead Hospital's electronic health record system automatically triggers a syphilis test based on the reason for medical visit (e.g., rash, penile discharge, a positive pregnancy test, historical or present sexually transmitted disease result). If a patient tests positive, he/she is counseled and linked to care.

Results

Since implementation (April 2018 to August 2019), the smart screening algorithm triggered 4806 syphilis tests: 122 patients tested positive (2.5% seropositivity). After confirmatory testing, 59 patients were positive for syphilis, of which 27 were pregnant.

Conclusions

The Homestead Hospital and Department of Health–Miami-Dade's response to Miami-Dade County's syphilis problem is innovative and replicable. The program embraces technology, enhances the routine opt-out screening model, and does not affect preexisting workflows. Ultimately, implementation of this algorithm allows patients to get treatment, receive comprehensive prevention services, and, in some cases, avert congenital syphilis.
Vomiting and Cardiac Arrest in a 10-Year-Old Girl
Authors: Zorko David J. , Samaan M. Constantine , Gupta Ronish
Published: February 2020

Primary adrenal insufficiency is a potentially life-threatening condition that provides a diagnostic challenge because many patients have months to years of insidious symptomatology. Adrenal crisis is the extreme acute manifestation of primary adrenal insufficiency, presenting with any, or all, of severe weakness, altered mental status, hypotension, and rarely cardiorespiratory arrest. Primary adrenal insufficiency should be considered in patients with clinical features of glucocorticoid and/or mineralocorticoid deficiency. These features however, such as hyperpigmentation, may be subtle, and so a degree of suspicion is needed to make the diagnosis. In extremis, children may present with fluid and catecholamine refractory shock. The management of an adrenal crisis includes prompt delivery of stress-dose corticosteroids together with aggressive organ support and correction of metabolic and electrolyte disturbances. We report the case of a previously healthy 10-year-old child that presented to a community emergency department in pulseless arrest, in whom adrenal crisis was suspected as well as treated early, and was subsequently successfully resuscitated.