bluuebunny/crossref_metadata_2025 huggingface dataset:
Gross Total Resection of a Grade IV Astrocytoma Adjacent to the Precentral Gyrus With Nonawake Motor Mapping and Motor-Evoked Potential Monitoring: 3-Dimensional Operative Video
Authors: Ozaydin Burak , Dogan Ihsan , Wheeler Bryan J , Baskaya Mustafa K
Published: July 2019

Surgical treatment of the gliomas located in or adjacent to the eloquent areas poses significant challenge to neurosurgeons. The main goal of the surgery is to achieve maximal safe resection while preserving the neurological function. This might be possible with utilizing pre- and intraoperative adjuncts such as functional magnetic resonance imaging (MRI), image guidance, mapping of the function of interest, intraoperative MRI, and neurophysiological monitoring. In this video, we demonstrate the utilization of nonawake mapping and motor-evoked potential (MEP) monitoring for the resection of a right-sided posterior superior frontal gyrus grade IV astrocytoma adjacent to the primary motor cortex. The patient is a 69-yr-old woman presented with multiple episodes of simple partial seizures involving her left leg and spreading to the left arm. MRI and functional MRI examinations showed a heterogeneously enhancing mass with peritumoral edema adjacent to the primary motor cortex. Because the patient did not want to undergo an awake craniotomy, a decision was made to perform the resection of the tumor with nonawake motor mapping and continuous MEP monitoring. Nonawake motor mapping and MEP monitoring enabled us to perform gross total resection. Because it has been shown that supratotal resection may provide improved survival outcome,
1
,
2
we extended the white matter resection beyond the contrast enhancing area in noneloquent parts of the tumor. Surgical steps in dealing with vascular anatomy as well as utilizing intraoperative adjuncts such as motor mapping and MEP monitoring to enhance the extent of resection while preserving the function are demonstrated in this 3-dimensional surgical video.

 The patient consented to publication of her operative video.
Transdiagnostic Prediction of Affective, Cognitive, and Social Function Through Brain Reward Anticipation in Schizophrenia, Bipolar Disorder, Major Depression, and Autism Spectrum Diagnoses
Authors: Schwarz Kristina , Moessnang Carolin , Schweiger Janina I , Baumeister Sarah , Plichta Michael M , Brandeis Daniel , Banaschewski Tobias , Wackerhagen Carolin , Erk Susanne , Walter Henrik , Tost Heike , Meyer-Lindenberg Andreas
Published: July 2019

The relationship between transdiagnostic, dimensional, and categorical approaches to psychiatric nosology is under intense debate. To inform this discussion, we studied neural systems linked to reward anticipation across a range of disorders and behavioral dimensions. We assessed brain responses to reward expectancy in a large sample of 221 participants, including patients with schizophrenia (SZ; n = 27), bipolar disorder (BP; n = 28), major depressive disorder (MD; n = 31), autism spectrum disorder (ASD; n = 25), and healthy controls (n = 110). We also characterized all subjects with an extensive test battery from which a cognitive, affective, and social functioning factor was constructed. These factors were subsequently related to functional responses in the ventral striatum (vST) and neural networks linked to it. We found that blunted vST responses were present in SZ, BP, and ASD but not in MD. Activation within the vST predicted individual differences in affective, cognitive, and social functioning across diagnostic boundaries. Network alterations extended beyond the reward network to include regions implicated in executive control. We further confirmed the robustness of our results in various control analyses. Our findings suggest that altered brain responses during reward anticipation show transdiagnostic alterations that can be mapped onto dimensional measures of functioning. They also highlight the role of executive control of reward and salience signaling in the disorders we study and show the power of systems-level neuroscience to account for clinically relevant behaviors.
Resisting Neoliberal Social Work Fragmentation: The Wall-to-Wall Alliance
Authors: Strier Roni
Published: July 2019

Worldwide neoliberal policies are transforming the landscape of social work. Studies have shown that these policies increased social workers’ caseloads, regulated welfare expenditures, impaired public services’ capabilities to attend to the needs of growing demand, transformed social services delivery by implanting new public management methods, and often also worsened working conditions and deteriorated the professional status of social workers. Moreover, these policies have raised both poverty and inequality levels and left their negative marks on social work education, by prioritizing academic disciplines more attuned with the needs of neoliberal regimes. This article seeks to encourage schools of social work, social workers in the social services, and people living in poverty to challenge the harmful impact of this context by engaging in meaningful alliances focused on the fight against poverty and social exclusion. This article presents a long-term partnership project between a school of social work, local public social services, and groups of active clients, to tackle the issue of poverty in Israel. The article describes the project, introduces the theoretical and methodological principles, analyzes achievements and challenges, and finally discusses the potential contribution of such partnerships for the future of the profession.
Abnormal tapetum development in hermaphrodites of an androdioecious tree, Tapiscia sinensis
Authors: Ren Xiaolong , Xin Guiliang , Du Xiaomin , Ni Xilu , Jia Guolun , Liu Huidong , Hao Nan , Liu Wenzhe
Published: July 2019

Tapiscia sinensis Oliv. (Tapisciaceae) has been proven to be a functional androdioecious species with both male and hermaphroditic individuals, and the pollen viability of males is far higher than that of hermaphrodites. To better understand the causes of the low pollen viability in hermaphroditic flowers, different stages of anther development were observed. We found that hermaphroditic flowers exhibit abnormal tapetum development, resulting in low pollen viability. To clarify the underlying molecular mechanism of abnormal tapetum development in hermaphrodites, quantitative real-time PCR analyses were performed. The results revealed that the expression levels of an important transcription factor for tapetum development and function, T. sinensis DYSFUNCTIONAL TAPETUM1 (TsDYT1), and its potential downstream regulatory genes T. sinensis DEFECTIVE in TAPETAL DEVELOPMENT and FUNCTION1 (TsTDF1), T. sinensis ABORTED MICROSPORE (TsAMS) and T. sinensis MALE STERILITY 1 (TsMS1) were all significantly downregulated in hermaphrodites compared with males at some key stages of anther development. The amino acid sequence similarity, expression pattern, gene structure and subcellular localization of these genes were analyzed, and the results indicated functional conservation between T. sinensis and homologues in Arabidopsis thaliana. Next, rapid amplification of cDNA end and thermal asymmetric interlaced PCR were employed to clone the full-length cDNA and promoter sequences of these genes, respectively. In addition, results of yeast two-hybrid analysis showed that TsDYT1 can form heterodimers with TsAMS, and yeast one-hybrid analysis demonstrated that TsDYT1 directly binds to the promoter regions of TsTDF1 and TsMS1. TsTDF1 can directly regulate expression of TsAMS, suggesting that a functionally conserved pathway exists between A. thaliana and T. sinensis to regulate tapetum development. In conclusion, the results suggest that abnormal expression of core transcription factors for tapetum development, including TsDYT1, TsTDF1, TsAMS and TsMS1, plays an important role in the abnormal development of the tapetum in T. sinensis hermaphrodites. Furthermore, a hermaphroditic tapetum with abnormal function causes the low pollen viability of hermaphroditic trees. Our results provide new insight into our understanding of the underlying mechanism of why pollen viability is much higher in males than hermaphrodites of the androdioecious tree T. sinensis.
Noninvasive Intracranial Pressure Estimation With Transcranial Doppler: A Prospective Observational Study
Authors: Cardim Danilo , Robba Chiara , Czosnyka Marek , Savo Davide , Mazeraud Aurelién , Iaquaniello Carolina , Banzato Erika , Rebora Paola , Citerio Giuseppe
Published: July 2019

Background:

Transcranial Doppler (TCD) ultrasonography has been described for the noninvasive assessment of intracranial pressure (ICP). This study investigates the relationship between standard, invasive intracranial pressure monitoring (ICPi) and noninvasive ICP assessment using a simple formula based on TCD-derived flow velocity (FV) and mean arterial blood pressure values (ICPTCD).

Material and Methods:

We performed a prospective observational study on 100 consecutive traumatic brain injury patients requiring invasive ICP monitoring, admitted to the Neurosciences and Trauma Critical Care Unit of Addenbrooke’s Hospital, Cambridge, UK. ICPi was compared with ICPTCD using a method based on the “diastolic velocity-derived estimator” (FVd), which was initially described for the noninvasive estimation of cerebral perfusion pressure but subsequently utilized for ICP assessment.

Results:

Median ICPi was 13 mm Hg (interquartile range: 10, 17.25 mm Hg). There was no correlation between ICPi and ICPTCD (R=−0.17; 95% confidence interval [CI]: −0.35, 0.03; P=0.097). Bland-Altman analysis demonstrated wide 95% limits of agreement between ICPi and ICPTCD (−27.58, 30.10; SD, 14.42). ICPTCD was not able to detect intracranial hypertension (ICPi >20 mm Hg); the area under the receiver operating characteristic curve for prediction was 34.5% (95% CI, 23.1%-45.9%) with 0% sensitivity and 74.4% specificity for ICPTCD to detect ICPi>20 mm Hg.

Conclusions:

Using a formula based on diastolic FV, TCD is an insufficiently accurate method for the noninvasive assessment of ICP. Further studies are warranted to confirm these results in a broader patient cohort.
Propofol But Not Desflurane Maintains Rat Cerebral Arteriolar Responses to Acetylcholine During Acute Hyperglycemia
Authors: Sakata Koji , Kito Kazuhiro , Tanabe Kumiko , Fukuoka Naokazu , Nagase Kiyoshi , Iida Hiroki
Published: July 2019

Background:

Acute hyperglycemia causes vascular endothelial dysfunction in various organs including the cerebral vessels. It is associated with increased mortality and morbidity in the perioperative period. The impact of anesthetic agents on cerebral vasodilatory responses during hyperglycemia remains unclear. We investigated endothelial function in rat cerebral arterioles during acute hyperglycemia, under propofol or desflurane anesthesia.

Materials and Methods:

A closed cranial window preparation was used to measure changes in pial arteriole diameter induced by topical application of acetylcholine (ACh), an endothelium-dependent vasodilator, in rats anesthetized with propofol or desflurane. Pial arteriole responses to ACh were measured during normoglycemia and hyperglycemia. We then investigated whether the response of cerebral arterioles to acute hyperglycemia under propofol anesthesia were related to propofol or its vehicle, intralipid.

Results:

ACh resulted in a dose-dependent dilation of cerebral arterioles during propofol and desflurane anesthesia under normoglycemic conditions. The vasodilatory effects of ACh were also maintained under hyperglycemic conditions during propofol anesthesia, but the vasodilator response to ACh was significantly impaired during hyperglycemia compared with normoglycemia with desflurane anesthesia. The vasodilatory effects of ACh were maintained during normoglycemia and hyperglycemia in rats receiving propofol or intralipid.

Conclusions:

Rat pial arteriole responses to ACh are maintained during conditions of acute hyperglycemia with propofol anesthesia but suppressed compared with normoglycemia with desflurane anesthesia.
Referral Patterns for the Evaluation of Asymptomatic Microscopic Hematuria in Women in a Single Health Care System
Authors: Handler Stephanie J. , Ackerman A. Lenore , Samimi Parisa. A. , Bresee Catherine , Anger Jennifer T. , Eilber Karyn S.
Published: July 2019

OBJECTIVE:

To identify patterns of care for women referred for asymptomatic microhematuria in a single, hospital-based health care system and estimate the cost of unindicated evaluation.

METHODS:

We conducted a retrospective study of 100 women with a diagnosis of asymptomatic microhematuria referred to a tertiary female pelvic medicine and reconstructive surgery practice. Our analysis focused on referral patterns by obstetrician–gynecologists and primary care physicians. Data analyzed included whether asymptomatic microhematuria was documented using urine microscopy (vs urine dipstick) and whether the urine microscopy correctly identified asymptomatic microhematuria with three red blood cells (RBCs).

RESULTS:

Forty-six patients were referred who met the American Urological Association's guidelines for asymptomatic microhematuria with a workup estimated at $8,298 per patient. Fifty-four were referred to a female pelvic medicine and reconstructive surgery specialist despite clearly not meeting the American Urological Association's definition of asymptomatic microhematuria. Of these, 33 patients were referred based on dipstick-positive results only, 11 were referred based on microscopic urinalysis demonstrating fewer than three RBCs per high-power field (HPF), and the remaining 10 patients were referred with urine microscopy demonstrating at least 3 RBC/HPF but in the setting of a clearly benign cause, such as infection or menstruation. The total estimated cost of the unnecessary asymptomatic microhematuria workup in patients who did not meet American Urological Association criteria for referral was $1,213 per patient.

CONCLUSION:

Fewer than half of the referrals for asymptomatic microhematuria were appropriate, leading to wasted and entirely preventable health care expenditures. This study highlights the need for education of health care providers making these referrals.
Use and Misuse of Opioids After Gynecologic Surgical Procedures
Authors: Wright Jason D. , Huang Yongmei , Melamed Alexander , Tergas Ana I. , St. Clair Caryn M. , Hou June Y. , Khoury-Collado Fady , Ananth Cande V. , Neugut Alfred I. , Hershman Dawn L.
Published: July 2019

OBJECTIVE:

To examine the rate of opioid use for gynecologic surgical procedures and to investigate persistent opioid use among those women who received an initial opioid prescription.

METHODS:

A retrospective cohort study using the MarketScan database was performed. MarketScan is a claims-based data source that captures claims from more than 50 million privately insured patients and 6 million Medicaid enrollees from 12 states. We identified women who underwent major and minor gynecologic surgery from 2009 to 2016. Among women who received an opioid prescription, new persistent opioid use was defined as receipt of one or more opioid prescriptions from 90 to 180 days after surgery with no intervening additional procedures or anesthesia. Multivariable models were used to examine associations between clinical characteristics and any use and new persistent use of opioids.

RESULTS:

A total of 729,625 patients were identified. Overall, 60.0% of patients received a perioperative opioid prescription. Receipt of an opioid prescription ranged from 36.7% in those who underwent dilation and curettage to 79.5% of patients who underwent minimally invasive hysterectomy. Among patients who received a perioperative opioid prescription, the rate of new persistent opioid use overall was 6.8%. The rate of new persistent opioid use was 4.8% for myomectomy, 6.6% for minimally invasive hysterectomy, 6.7% for abdominal hysterectomy, 6.3% for endometrial ablation, 7.0% for tubal ligation, and 7.2% for dilation and curettage (P<.001). In a multivariable model, patients who underwent dilation and curettage and endometrial ablation were at highest risk for new persistent opioid use. Younger patients, Medicaid recipients, and patients with depression, anxiety, and substance use disorder more commonly had new persistent opioid use (P<.001 for all). Among women who received an opioid prescription, the rate of new persistent opioid use decreased over time from 7.0% in 2010 to 5.5% in 2016 (P<.001).

CONCLUSION:

The rate of new persistent opioid use after major and minor gynecologic procedures is substantial.
Clinical outcome of delayed surgical treatment of grade III acromioclavicular joint dislocation with and without acromioclavicular capsule reconstruction
Authors: Fadel Mohie-Eldin , Hosni Yaser
Published: July 2019

Background:

Surgical management of grade III acromioclavicular joint dislocation should be considered in patients who have significant deformity, tenting of the skin, or persistent pain despite nonsurgical management, or in patients who have a higher functional demand. Coracoclavicular ligament reconstruction alone may not be sufficient to prevent anteroposterior translation at the acromioclavicular joint despite preventing superior translation. Reconstruction of the acromioclavicular capsule may be necessary for additional joint stability. The aim of this study was to evaluate the necessity of the capsular reconstruction in the treatment of acromioclavicular dislocation.

Methods:

This is a retrospective comparative study between two groups. The first group, 14 patients, had anatomical coracoclavicular ligament reconstruction without capsular reconstruction. The second group, 19 patients, had capsular reconstruction in addition to acromioclavicular ligament reconstruction.

Results:

Pain, American Shoulder and Elbow Surgery, and Constant Shoulder scores were better in the second group. No cases of failure were reported in any group. Loss of reduction occurred in seven patients in first group (50%).

Conclusions:

Reconstruction of the acromioclavicular capsule in surgical treatment of grade III acromioclavicular joint dislocation may play an important role against loss of reduction.
The Community Orthopedic Surgeon Taking Trauma Call: Pediatric Distal Radius and Ulna Fracture Pearls and Pitfalls
Authors: Hennrikus William L. , Mehlman Charles T.
Published: July 2019

Distal radius and ulna fractures are common injuries in children. Fractures typically involve the distal radius and ulna metaphysis or physis or a combination of the 2. The goals of treatment are aimed at achieving satisfactory anatomic alignment within defined parameters based on growth remaining. Nonoperative treatment approaches are recommended for most fractures, whereas surgical intervention is indicated for select cases. Potential issues with skeletal growth and bone remodeling are common. This article will offer evidence- and experience-based pearls regarding common closed fractures of the distal radius and ulna intended to benefit the community orthopaedic surgeon caring for children during the course of their on-call duties.
Determination of Cetuximab in Plasma by Liquid Chromatography–High-Resolution Mass Spectrometry Orbitrap With a Stable Labeled 13C,15N-Cetuximab Internal Standard
Authors: Millet Aurélien , Lebert Dorothée , Picard Guillaume , You Benoit , Ceruse Philippe , Guitton Jérôme
Published: July 2019

Background:

Cetuximab (CTX) is a chimeric IgG1 Kappa monoclonal antibody used to treat head and neck cancer and colorectal cancer. Previous clinical studies indicated that the pharmacokinetics of CTX influences patient survival. Thus, individualizing CTX treatment by measuring trough levels of the drug in plasma could have a major impact on clinical efficacy.

Methods:

To measure these levels, a full-length stable isotope-labeled CTX standard was used in a generic, rapid, and high-throughput sample preparation protocol based on IgG capture followed by trypsin digestion, on-line solid-phase extraction cleanup, and liquid chromatography–high resolution mass spectrometry (LC-HRMS).

Results:

The optimized method displayed good analytical performance and was linear over a range from 5 to 150 mcg/mL. The within-run and between-run imprecision of the assay were equal to or less than 10%, for 6 replicates at 3 different concentrations and for runs performed on 5 separate days. The plasma CTX concentrations in 19 patients were also determined.

Conclusions:

The results showed that quantification of mAb in clinical samples does not strictly require a tandem mass spectrometry system, and LC-HRMS is also relevant in this context. This first study implementing a quantitative LC-HRMS assay with a specific stable isotope-labeled mAb internal standard paves the way for more robust clinical monitoring of anticancer mAbs.
Five-Year Trends in Marital Stability, Academic Achievement, and Socioeconomic Indicators After Concussion: A National Register Study
Authors: Graff Heidi Jeannet , Siersma Volkert , Møller Anne , Egerod Ingrid , Rytter Hana Malá
Published: July 2019

Objective:

To examine long-term trends in marital stability, academic achievement, income, and socioeconomic status in patients with concussion.

Design and setting:

Danish national register–based cohort study with 5 years of follow-up.

Participants:

A total of 23 549 hospital-admitted or emergency-treated patients between 18 and 60 years of age with concussion (International Classification of Diseases, Tenth Revision [ICD-10] diagnosis S06.0) and 22 228 matching controls.

Main measures:

Outcomes were the differences between patients with concussion and controls in the change from injury date to 5 years postinjury in the dichotomized outcomes—martial stability, academic achievement, income, and socioeconomic status.

Results:

Fewer patients had high education (19.43%) compared with controls (23.96%) and the adjusted odds ratio (OR) of high education beyond the difference in prevalence at baseline became even lower at 5 years of follow-up (OR: 0.93, 95% confidence interval [CI]: 0.90-0.95). Patients were to a lesser extent gainfully employed (67.05%) compared with controls (77.32%) and had lower odds of being gainfully employed (OR: 0.83, 95% CI: 0.79-0.88), self-employed, leaders, or managers (OR: 0.89, 95% CI: 0.84-0.95) at 5 years postinjury, beyond differences at baseline.

Conclusions:

Academic achievement and socioeconomic status are affected by concussion. There is no evidence that marital stability and income are affected. Supporting interventions should be considered those at risk of persistent symptoms.
Self- and Parent-Reported Fatigue 7 Years After Severe Childhood Traumatic Brain Injury: Results of the Traumatisme Grave de l'Enfant Prospective Longitudinal Study
Authors: Câmara-Costa Hugo , Francillette Leila , Opatowski Marion , Toure Hanna , Brugel Dominique , Laurent-Vannier Anne , Meyer Philippe , Dellatolas Georges , Watier Laurence , Chevignard Mathilde
Published: July 2019

Objective:

To investigate presence of and factors associated with self- and parent-reported fatigue 7 years after severe childhood traumatic brain injury (TBI) in the prospective longitudinal study TGE (Traumatisme Grave de l'Enfant—severe childhood trauma).

Methods:

Self-reports and/or parent reports on the Multidimensional Fatigue Scale were collected for 38 participants (aged 7-22 years) 7 years after severe childhood TBI, and 33 controls matched for age, gender, and parental educational level. The data collected included sociodemographic characteristics, age at injury and injury severity scores, overall disability (Glasgow Outcome Scale Extended), intellectual outcome (Wechsler scales), and questionnaires assessing executive functions, health-related quality of life, behavior, and participation.

Results:

Fatigue levels were significantly worse in the TBI than in the control group, especially for cognitive fatigue. Correlations of reported fatigue with age at injury, gender, TBI severity, and intellectual ability were moderate and often not significant. Fatigue was significantly associated with overall level of disability (Glasgow Outcome Scale Extended) and with all questionnaires completed by the same informant.

Conclusion:

High levels of fatigue were reported by 30% to 50% of patients 7 years after a severe childhood TBI. Reported fatigue explained more than 60% of the variance of reported health-related quality of life by the same informant (patient or parent).
Anti-NMDA-receptor Encephalitis in an Adolescent With HIV Infection and Review of the Literature
Authors: Pinzon-Charry Alberto , Wallace Geoff , Clark Julia E. , Nourse Clare
Published: July 2019

Anti-N-Methyl-D-Aspartate-receptor encephalitis is the most common antibody-mediated autoimmune encephalopathy. A HIV-infected African boy presented with subacute psychosis as manifestation of anti-N-Methyl-D-Aspartate-receptor encephalitis. Intravenous immunoglobulin and corticosteroids induced complete remission. Although this is the first pediatric case described, 5 adult cases have been reported. The role of HIV in the etiology of this autoimmune condition requires further exploration.
Antiphospholipid syndrome in pediatric patients
Authors: Tarango Cristina , Palumbo Joseph S.
Published: July 2019

Purpose of review

The purpose of this review is to summarize the diagnosis and management of the antiphospholipid syndrome (APS) in children.

Recent findings

APS is a rare, acquired autoimmune systemic disease that can result in significant morbidity in children related to vascular thrombosis. The diagnosis and management of APS in children can be challenging due to a lack of validated diagnostic criteria and the rarity of the disease. In addition, many healthy children have transient circulating antiphospholipid antibodies without thrombotic complications. Nevertheless, epidemiological studies suggest that APS represents a greater relative proportion of thrombotic disease in children than it does in adults. Management of pediatric APS is largely inferred from adult data despite unique characteristics of pediatric APS. The current recommendations include long-term anticoagulation, which can be problematic in young, active individuals. There is little data on potential benefits of nonantithrombotic therapy in the management of pediatric APS.

Data on pediatric APS are limited, but evidence suggests that using current available diagnostic testing is valuable and, until further evidence is available, treating thrombotic complications with heparins or warfarin should be standard of care.
Recent advances in inherited platelet disorders
Authors: Pluthero Fred G. , Kahr Walter H.A.
Published: July 2019

Purpose of review

The increasing use of high throughput sequencing and genomic analysis has facilitated the discovery of new causes of inherited platelet disorders. Studies of these disorders and their respective mouse models have been central to understanding their biology, and also in revealing new aspects of platelet function and production. This review covers recent contributions to the identification of genes, proteins and variants associated with inherited platelet defects, and highlights how these studies have provided insights into platelet development and function.

Recent findings

Novel genes recently implicated in human platelet dysfunction include the galactose metabolism enzyme UDP-galactose-4-epimerase in macrothrombocytopenia, and erythropoietin-producing hepatoma-amplified sequence receptor transmembrane tyrosine kinase EPHB2 in a severe bleeding disorder with deficiencies in platelet agonist response and granule secretion. Recent studies of disease-associated variants established or clarified roles in platelet function and/or production for the membrane receptor G6b-B, the FYN-binding protein FYB1/ADAP, the RAS guanyl-releasing protein RASGRP2/CalDAG-GEFI and the receptor-like protein tyrosine phosphatase PTPRJ/CD148. Studies of genes associated with platelet disorders advanced understanding of the cellular roles of neurobeachin-like 2, as well as several genes influenced by the transcription regulator RUNT-related transcription factor 1 (RUNX1), including NOTCH4.

The molecular bases of many hereditary platelet disorders have been elucidated by the application of recent advances in cell imaging and manipulation, genomics and protein function analysis. These techniques have also aided the detection of new disorders, and enabled studies of disease-associated genes and variants to enhance understanding of platelet development and function.
Developing a Process for Criteria-Led Discharge
Authors: Lees-Deutsch Liz , Jackson Julia , Balaji Ariyur , Topping Annie
Published: July 2019

Background:

Criteria-led discharge (CLD) is an approach for maximizing bed capacity by expediting patient discharge.

Problem:

In acute medicine settings, patients commonly have multiple medical problems, which render single care pathway and clinical protocols of limited use. CLD offers potential, but little evidence exists about how to best implement it in these contexts.

Approach:

Retrospective case note analysis generated characteristics from patients' discharge plans to design a criterion-based framework to aid patient selection for CLD. These criteria were hypothetically tested on patient case notes (n = 50).

Outcomes:

CLD was identified as suitable (n = 27) and unsuitable (n = 23) from 50 case notes. Interrater agreement was 86% between 3 reviewers.

Conclusions:

This review has provided greater understanding of the complexity of discharge in acute medicine settings. Implementing CLD to optimize timeliness of patient discharge might offer a solution for selected patients.
Implementing and Evaluating the Impact of a Nurse-Led Oral Care Initiative
Authors: Castillo Dora H. , Smith Daniel J. , Rosenfeld Peri
Published: July 2019

Background:

Nursing interventions in oral hygiene have been shown to be important for health promotion and illness prevention. This medical center advanced a registered nurse (RN)-led oral health initiative to introduce and standardize oral care practices.

Problem:

To examine the impact of the oral health initiative, we conducted an evaluation of documentation trends among RNs and the effect of the initiative on patients' oral health during hospitalization.

Approach:

We used a single-group pretest-posttest design and drew a sample of all inpatients who were admitted to the medical center from October 1 through December 31, 2017.

Outcomes:

Of the 13 303 patients admitted, the empirical evidence demonstrates 99.5% compliance in documentation at admission and discharge. Among 13 237 patients, there was improvement in patients' oral health during hospitalization (−0.03, P < .001), especially those initially assessed with moderate or severe dysfunction.

Conclusions:

The oral health initiative standardized assessment and care practices that have improved outcomes in patients' oral hygiene.
Methods and Processes Used to Collect Pressure Injury Risk and Prevention Measures in the National Database of Nursing Quality Indicators® (NDNQI®)
Authors: Waugh Shirley Moore , Bergquist-Beringer Sandra
Published: July 2019

Background:

Previous research found that reliability estimates for chart-extracted quality of care data vary.

Purpose:

The purpose was to examine methods and processes used to gather data on the National Database of Nursing Quality Indicators (NDNQI) pressure injury (PI) risk and prevention measures to identify factors that may influence their reliability.

Methods:

Study participants (N = 120) from 36 hospitals completed a 35-item online survey. Included were the NDNQI PI Survey Team member with the most experience and/or skill in patient record review from each hospital (n = 36) and 84 other NDNQI PI Survey Team members.

Results:

In general, participants followed NDNQI PI data collection guidelines. However, deviations were noted such as 60 (50%) participants collected PI data on units where they work, and 92 (76.7%) determined whether moisture management was performed by direct observation of patients rather than chart documentation.

Conclusions:

Findings provide insight on how to improve the reliability of hospital-acquired PI risk and prevention measures that includes clarification of the data collection guidelines.
The Association Between Child Abuse and Emotional and Behavioral Problems in Chinese School-Aged Boys With Attention Deficit Hyperactivity Disorder
Authors: Zou Shaohong , Yu Wenwen , Liang Sixiang , Ma Xiaojuan , Li Dazhi , Bian Yanhui , Zhang Yong
Published: July 2019

The aim of our study was to investigate the relationship between child abuse and emotional and behavioral problems in Chinese school-aged boys with attention deficit hyperactivity disorder (ADHD). Forty-eight school-aged boys with ADHD and 77 male healthy controls completed the final assessments that included the Child Behavior Checklist, the Barratt Impulsiveness Scale Version 11, the Screen for Child Anxiety Related Disorders, the Depression Self-Rating Scale for Children, and the Childhood Trauma Questionnaire, Short Form. Our findings showed that child abuse could associate with the behavioral problems in ADHD. Regression analysis further showed that child abuse (especially emotional abuse and physical abuse), adverse living conditions, and school anxiety significantly could be contributors to behavioral problems in boys with ADHD. Our study indicated that child abuse may be associated with the behavioral problems in Chinese school-aged boys with ADHD.
SATB1 Expression of Colorectal Adenomatous Polyps is Higher than that of Colorectal Carcinomas
Authors: Yalcin Gulsum S. , Gonultas Mehmet A. , Hucumenoglu Sema , Simsek Gulcin , Pekcici Mevlut R.
Published: July 2019

“Special AT-rich sequence-binding protein-1” (SATB1) is a global genome organizer and is found to have effects on carcinogenesis and progression of various malignancies including colorectal carcinoma (CRC). We aimed to investigate the expression of SATB1 in CRC and colorectal adenomatous polyps (CAP), the correlation between clinicopathologic parameters, and overall survival. We examined 227 CRCs and 129 CAPs. SATB1 protein expression was evaluated by immunohistochemistry. We found higher SATB1 expression in adenomatous epithelium than in CRC tissues (55.0% vs. 42.7%, respectively) (P<0.05). None of the adjacent normal colorectal mucosa stained positive in CRC cases, and only one of the adjacent normal mucosa of the CAP cases was positive. SATB1 expression of left-sided CRC was higher than that of right-sided CRC (46.3% vs. 28.6%, respectively) (P<0.05), and SATB1 expression of conventional adenocarcinomas was higher than that of mucinous carcinomas (45.5% vs. 6.3%, respectively) (P<0.05). SATB1 expression was higher in CAPs consisting of high-grade dysplasia than in polyps with low-grade dysplasia (77.8% vs. 51.4%) (P<0.05). SATB1 expression did not correlate with patients’ overall survival. In conclusion, due to the higher expression of SATB1 in CAP than in CRC, we think SATB1 may have a role in the early stages of carcinogenesis of CRCs. This is the first study investigating SATB1 expression in CAPs. Besides this is the first report that shows different SATB1 expressions in conventional colorectal adenocarcinoma and mucinous carcinoma, and also in right-sided and left-sided CRC. Our results, with supporting new studies, can provide SATB1 as a possible candidate for targeted therapy for CRC patients.
Foci of Programmed Cell Death-Ligand 1 (PD-L1)-positive Tumor Areas With Tumor-infiltrating Leukocytes (TILs) Evocative of a PD-1/PD-L1-related Adaptive Immune Resistance are Frequent in Merkel Cell Carcinoma
Authors: Bénigni Paolo , Guénolé Morgan , Bonsang Benjamin , Marcorelles Pascale , Schick Ulrike , Uguen Arnaud
Published: July 2019

Immune checkpoint inhibitors (ICIs) targeting the programmed cell death 1 (PD-1)/programmed cell death-ligand 1 (PD-L1) axis have revolutionized the treatment of patients with Merkel cell carcinoma (MCC). To date, no biomarker conditions access to these ICIs in MCC. We compared the tumor microenvironment of PD-L1+ and PD-L1− areas in a case series of MCC searching for foci evocative of PD-1/PD-L1 adaptive immune resistance. Among 58 tumors studied on digitalized serial tissue sections, 11 (19%) were concluded as “PD-L1+ tumors” [≥1% positive tumor cells (TCs) using PD-L1 immunohistochemistry in the whole tumor slide]. In addition, among the remaining 47 (81%) “PD-L1− tumors,” we nevertheless also identified “PD-L1+ FOV” (ie, “field of view” of about 3 mm² containing ≥1% positive TCs) in 22 (38%) additional tumors. Comparison between paired “PD-L1+ field of view (FOV)” and “PD-L1− FOV” within tumors, and between “PD-L1+ tumors” and “PD-L1− tumors”, revealed correlations between PD-L1 positivity and the abundance of tumor-infiltrating leukocytes, arguing for areas of PD-1/PD-L1-related adaptive immune resistance at least in some foci of “PD-L1+ tumors” and also in “PD-L1− tumors.” Tumor heterogeneity consists in a challenge searching for biomarkers able to predict the response/nonresponse to ICIs. Progress in digital pathology and multiplex immunolabeling may permit to overcome this challenge by better analyzing the interactions between TCs and immune and nonimmune non-TCs in the same tissue section. This approach of tumor heterogeneity may contribute to elucidate and to predict why some patients respond impressively to ICIs, whereas others do not.
Positive Predictive Values of Lumbar Spine Magnetic Resonance Imaging Findings for Provocative Discography
Authors: Chelala Lydia , Trent Graham , Waldrop Greer , Dagher Azar P. , Reinig James W.
Published: July 2019

Purpose

The purpose of this study was to calculate the positive predictive value (PPV) of lumbar spine magnetic resonance imaging (MRI) findings for a painful disc using provocative discography.

Materials and Methods

Lumbar spine discography records and prediscography MRIs of 736 patients (2457 discs) who underwent discography for diagnostic purposes from 2003 to 2007 were retrospectively reviewed in an Institutional Review Board–exempt and Health Insurance Portability and Accountability Act–compliant protocol. Each level was identified as having high-intensity zone (HIZ) disc, disc protrusion, disc extrusion, or combination (any herniation type), disc bulge, disc degeneration, and spondylolisthesis. Statistical analysis used a 2 × 2 contingency table of significant discography results for each of the MRI variables to calculate P value and PPV with a confidence interval from a binomial distribution.

Results

An HIZ disc has a PPV of 0.71 (0.65–0.76, P = 4.31E − 44) for a provocative discography. A disc protrusion has a PPV of 0.79 (0.73–0.83, P = 2.68E − 53). A disc extrusion has a PPV of 0.93 (0.79–0.98, P = 1.34E − 14), a bulge of 0.43 (0.37–0.48, P = 0.002), and a degenerative disc of 0.32 (0.28–0.35, P = 0.08), and spondylolisthesis has a PPV of 0.67 (0.59–0.73, P = 1.70E − 20). A herniation of either type (extrusion or protrusion) has a PPV of 0.80 (0.75–0.84, P = 5.86E − 69).

Conclusions

Disc herniations and HIZ discs have high predictive value in identifying a pain generator. An extruded disc herniation has the highest PPV for discogenic pain.
Nivolumab-Induced Pneumonitis in Patient With Metastatic Melanoma Showing Complete Remission on 18F-FDG PET/CT
Authors: Razzouk-Cadet Micheline , Picard Alexandra , Grangeon-Chapon Caroline , Lacour Jean-Philippe , Montaudié Henri
Published: July 2019

A 49-year-old patient with metastatic melanoma was treated with nivolumab (Opdivo). An early 18F-FDG PET/CT after 2 cycles showed a progressive metabolic disease. A 4-month optimal follow-up 18F-FDG PET/CT showed a complete metabolic response. The treatment was stopped after 22 cycles because of immunotherapy-related pneumonitis. After discontinuation of treatment, PET/CT examinations demonstrated a metabolic complete remission during 2 years. The metabolic pattern on early PET was suggestive of pseudoprogression, which is a rare phenomenon reflecting an activation of inflammatory cells within the tumor microenvironment causing lesions to increase in size and to accumulate FDG until a sufficient immune response is developed.
Incidental Finding of Acute Lymphocytic Leukemia in a Prostate-Specific Membrane Antigen PET/CT
Authors: Acksteiner Christian , Sounness Brett
Published: July 2019

PSMA PET/CT is known to show uptake in various benign and malignant processes. The following PSMA PET/CT was performed for prostate carcinoma staging (Gleason 3 + 4 left apex; PSA 5.8). It shows incidental diffuse PSMA marrow uptake, not typical for prostate metastatic disease. No treatment had been commenced at the time of the scan. Serology and bone marrow biopsy showed B-cell acute lymphocytic leukemia. Focal PSMA uptake in the right ischium was correlated with a T1 hypointense lesion on a previous MRI and was convincing for a skeletal metastasis. Alternative diagnoses in diffuse skeletal PSMA uptake need therefore to be considered.
18F-Fluorocholine PET/CT in the Prediction of Molecular Subtypes and Prognosis for Gliomas
Authors: García Vicente Ana María , Pérez-Beteta Julian , Amo-Salas Mariano , Pena Pardo Francisco José , Villena Martín Maikal , Sandoval Valencia Hernán , Mollejo Villanueva Manuela , Barbella Rosa , Klein Zampaña Christoph José , Borrás Moreno José María , Soriano Castrejón Ángel María , Pérez-García Víctor Manuel
Published: July 2019

Aim

To study the association of metabolic features of 18F-fluorocholine in gliomas with histopathological and molecular parameters, progression-free survival (PFS) and overall survival (OS).

Methods

Prospective multicenter and nonrandomized study (Functional and Metabolic Glioma Analysis). Patients underwent a basal 18F-fluorocholine PET/CT and were included after histological confirmation of glioma. Histological and molecular profile was assessed: grade, Ki-67, isocitrate dehydrogenase status and 1p/19q codeletion. Patients underwent standard treatment after surgery or biopsy, depending on their clinical situation. Overall survival and PFS were obtained after follow-up. After tumor segmentation of PET images, SUV and volume-based variables, sphericity, surface, coefficient of variation, and multilesionality were obtained. Relations of metabolic variables with histological, molecular profile and prognosis were evaluated using Pearson χ2 and t test. Receiver operator caracteristic curves were used to obtain the cutoff of PET variables. Survival analysis was performed using Kaplan-Meier and Cox regression analysis.

Results

Forty-five patients were assessed; 38 were diagnosed as having high-grade gliomas. Significant differences of SUV-based variables with isocitrate dehydrogenase status, tumor grade, and Ki-67 were found. Tumor grade, Ki-67, SUVmax, and SUVmean were related to progression. Kaplan-Meier analysis revealed significant associations of SUVmax, SUVmean, and multilesionaly with OS and PFS. SUVmean, sphericity, and multilesionality were independent predictors of OS and PFS in Cox regression analysis.

Conclusions

Metabolic information obtained from 18F-fluorocholine PET of patients with glioma may be useful in the prediction of tumor biology and patient prognosis.
68Ga-DOTATATE Uptake in Pancreatic Metastasis of Renal Cell Carcinoma Mimicking Pancreatic Neuroendocrine Tumor
Authors: Soydal Cigdem , Nak Demet , Araz Mine , Demirkazik Ahmet , Kucuk Nuriye Ozlem
Published: July 2019

A 61-year-old man, with a history of prior clear cell renal cell carcinoma in remission, was referred to 68Ga-DOTATATE PET/CT for the further evaluation of pancreatic tail mass. 68Ga-DOTATATE PET/CT showed pathologically intense uptake on the pancreatic mass; subsequent biopsy of the pancreatic mass confirmed the diagnosis of clear cell renal cell carcinoma metastasis. 68Ga-DOTATATE uptake is not specific for neuroendocrine tumors. In the presence of prior malignancy, it should be kept in mind that malignancies apart from neuroendocrine tumors express somatostatin receptors, and they can show 68Ga-DOTATATE uptake.
Brain 123I-FP-CIT SPECT of a Holmes Tremor Due to Midbrain Pilocytic Astrocytoma
Authors: Louarn Nicolas , Kharroubi Dris , Fourquet Aloÿse , Vidailhet Marie , Kas Aurélie
Published: July 2019

A 24-year-old woman with an unresectable right mesencephalic pilocytic astrocytoma was treated with stereotaxic radiation therapy. Three months after a radiation therapy–induced bleeding, she presented a severe disabling low frequency rest and kinetic tremor involving the left upper limb, associated with dystonia, and a Holmes tremor was suspected. Thereby, we performed a 123I-FP-CIT SPECT (DATSCAN) that revealed a normal distribution of radiotracer over the left striatum, whereas no binding was seen in the right caudate and putamen. This pattern was consistent with a right severe nigrostriatal dopaminergic denervation due to an ipsilateral red nucleus injury.
Heat-Damaged Red Blood Cell Scintigraphy in Helping Interpretation of 68Ga-DOTATATE PET/CT
Authors: Wen Zhe , Edwards Kevin W. , States Lisa J. , Zhuang Hongming
Published: July 2019

68Ga-DOTATATE PET/CT was performed to determine the cause of endogenous Cushing syndrome in a 10-year-old boy whose MRI studies did not reveal pituitary or adrenal gland abnormality. The PET/CT images demonstrated an intense activity in a small soft tissue nodule in the left upper abdomen where splenules are commonly located. Heat-damaged 99mTc-labeled red blood cell imaging showed that this soft tissue nodule did not have increased red blood cell activity, which indicated that this lesion was a true somatostatin receptor–rich lesion. The pathology result following surgical resection of the lesion confirmed adrenocorticotropic hormone–producing neuroendocrine tumor.
Incidental Finding of Benign Trichilemmal Cysts on 99mTc-Octreotide Scan
Authors: Neshandar Asli Isa , Norouzi Ghazal
Published: July 2019

A 63-year-old woman with neuroendocrine carcinoma of the colon was referred to our department for staging with 99mTc-octreotide scan. Two focal, highly intense, superficial lesions were detected in patient's scalp and paralumbar region, medial to the right kidney. Pathology correlation was recommended, revealing them both to be benign trichilemmal cysts. This unexpected finding strengthens the hypothesis of Merkel cell carcinoma and trichilemmal cysts originating from pluripotent stem cells of adnexal epithelium, making a neuroendocrine differentiation for the latter plausible.
Virtual Surgical Planning and One-Stage Treatment of Active Hemimandibular Hyperplasia
Authors: Diniz Jiordanne Araújo , Siqueira Allancardi dos Santos , Torres Luiz Henrique Soares , Faro Tatiane Fonseca , Rodrigues Ewerton Daniel Rocha , Laureano Filho José Rodrigues
Published: July 2019

Hemimandibular hyperplasia was first described in 1836 by Adams as a disorder that causes condylar hyperplasia, deforming facial asymmetry and has an unknown etiology. The objective of this study was to report a patient with surgical correction through orthognathic surgery and high condilectomy for the treatment of hemimandibular hyperplasia. The patient complained of pain and cracking in the right temporomandibular joint region and was dissatisfied with the aesthetic appearance of the face. Virtual planning was done for bimaxillary orthognathic surgery and preparation of prototyped surgical guides. Stereolithographic models were used for the preparation of the acrylic guides of the osteotomies for the high condilectomy and the contour of the mandibular base. Orthognathic surgery resulted in the maxillary repositioning with correction of the inclination of the occlusal plane, reduction of the height of the ramus and right mandibular body and class I dental attachment. Mandibular contour osteotomy was performed with acrylic guide in the basilar. The condilectomy was performed by endaural access. In 2-year follow-up, there are no signs of recurrence.