bluuebunny/crossref_metadata_2025 huggingface dataset:
Social media communication shorten door-to-balloon time in patients with ST-elevation myocardial infarction
Authors: Yu Shao-Hua , Shih Hong-Mo , Chang Shih-Sheng , Chen Wei-Kung , Li Chi-Yuan
Published: March 2019

Primary percutaneous coronary intervention (PPCI) is the preferred treatment method for ST-segment elevation myocardial infarction (STEMI). Many efforts had been made to reduce door-to-balloon (DTB) time in patients with STEMI. The objective of this study is to demonstrate how intrahospital social media communication reduced DTB times in STEMI patients requiring an interhospital transfer.

We retrospectively enrolled patients with STEMI who had been transferred from other hospitals during 2016 and 2017. Patients were divided into 2 groups. The previewed group had an electrocardiogram (ECG) done at the first hospital that was previewed by the cardiologist via social media. The control group was treated using the conventional clinical approach. We compared DTB time and outcome between 2 groups.

The 2 groups shared some similar clinical characteristics. However, the previewed group had significantly shorter DTB times than the control group (n = 51, DTB 52.61 ± 42.20 vs n = 89, DTB time 78.40 ± 50.64, P = .003). The time elapsed between ECG and the call to the laboratory decreased most apparently in the previewed group (−11.24 ± 48.81 vs 16.96 ± 33.08, P < .001). The previewed group also tended to have less in-hospital major adverse cardiovascular events (P = .091).

When the patients with STEMI required transfer to the PCI-capable hospital, using social media to preview ECG reduced DTB time, mainly because the cardiologists activated the catheter laboratories much earlier, sometimes even before the patients arrived at the PCI-capable hospital.
Percutaneous vertebroplasty vs balloon kyphoplasty in the treatment of newly onset osteoporotic vertebral compression fractures
Authors: Cheng Junjie , Muheremu Aikeremujiang , Zeng Xianming , Liu Liebin , Liu Yang , Chen Yaying
Published: March 2019

To compare percutaneous vertebroplasty (VP) and balloon kyphoplasty (BKP) for their effectiveness and safety in the treatment of newly onset osteoporotic vertebral compression fractures (VCF).

Patients with confirmed diagnosis of newly onset osteoporotic VCF and treated in our center between January 2008 and December 2016 were retrospectively included in the study. Patients were divided into 2 groups according the surgical treatment they have received. They were followed for 12 months after surgery by outpatient visits and phone interviews. Changes in VAS and ODI scores, quantity of injected bone cement, cost of treatment, changes in the height of the vertebra, incidence of complications such as bone cement leakage, adjacent level vertebral fracture during follow up and total were compared between the 2 groups.

A total of 338 patients were included in the final analysis. Demographic characteristics were similar in 2 groups. There were no significant differences between the 2 groups concerning VAS and ODI scores after the surgery and at last follow up (P > .05). However, total cost of treatment, quantity of injected bone cement, incidence of adjacent level fracture, restored vertebral height and the loss of vertebral body height at the last follow up were significantly higher in the BKP group than the VP group (P < .05).

Considering the similar key outcome parameters such as VAS and ODI scores and significantly more cost of BKP, VP can be prioritized over BKP in the treatment of patients with newly onset osteoporotic VCF.
HCV core antigen is a useful predictor during pegylated-interferon/ribavirin therapy in patients with hepatitis C virus genotype 1b
Authors: Fan Zhijuan , Liu Junfeng , Wang Fengmei , Liu Jingmin , Ding Xian , Liu Shuye
Published: March 2019

Enzyme immunoassays for quantifying hepatitis C virus (HCV) core antigen (Ag) have been proposed as an alternative to HCV RNA detection. The present study aimed to investigate the early kinetics of serum HCVcAg and its usefulness in predicting virological responses.

The clinical data of 135 patients with chronic hepatitis C treated with pegylated interferon alpha (PEG-IFN-α) and ribavirin was retrospectively collected. The patients were grouped according to their treatment outcomes as follows: sustained virological response (SVR), nonsustained virological response (N-SVR), and relapse.

Higher HCVcAg and HCV RNA levels were observed in patients in the N-SVR group than in the other groups at baseline. HCVcAg better predicted rapid virological response (RVR) compared with HCV RNA and had a predictive value similar to that of HCV RNA for SVR and early virological response. In the relapse group, HCV RNA decreased to 0 after 48 weeks, whereas HCVcAg was still detectable, indicating that HCVcAg more sensitively predicted relapse in antiviral therapy than HCV RNA.

For patients treated with PEG-INF-α and ribavirin, HCVcAg may more sensitively predict relapse than HCV RNA.
Is tamsulosin effective for the passage of symptomatic ureteral stones
Authors: Sun Yi , Lei Guo-Lin , Yang Lu , Wei Qiang , Wei Xin
Published: March 2019

Background:

Some trials have stated that there is no benefit to tamsulosin administration for clearing ureteral stones, which is contrary to previous studies. To confirm the efficacy of tamsulosin for treating symptomatic ureteral stones, we performed this review.

Methods:

We searched the PubMed, Embase, and Cochrane Library databases to identify all studied variables, including tamsulosin, urinary stones, expulsion, and side effects. In addition, for all patients and different stone sizes, the treatment efficacy, expulsion rate, and expulsion time were also recorded for this treatment.

Results:

Forty-nine studies involving 6436 patients met the inclusion criteria. The data synthesized from these studies indicated that tamsulosin improved the renal stone clearance rate (80.5% vs 70.5%; mean difference (MD), 1.16; 95% confidence interval (CI), 1.13–1.19; P <.00001) and reduced the expulsion time (MD, −3.61; 95% CI, −3.77 to −3.46; P ≤.00001). Regarding complications, no significant difference was found between the 2 groups in terms of the total side effects (MD, 1.15; 95% CI, 0.97–1.35; P = .10) or divided complications, including retrograde ejaculation (P = .01), hypotension (P = .52), dizziness (P = .07), diarrhea (P = .58), vomiting (P = .88), headache (P = .84), nausea (P = .91), and fatigue (P = .10).

Conclusions:

Tamsulosin should be strongly recommended for patients with ureteral stones to increase treatment efficacy. The side effects were not significantly different between the tamsulosin and control treatments.
A comparison of the impact of current smoking on 2-year major clinical outcomes of first- and second-generation drug-eluting stents in acute myocardial infarction
Authors: Kim Yong Hoon , Her Ae-Young , Jeong Myung Ho , Kim Byeong-Keuk , Hong Sung-Jin , Ahn Chul-Min , Kim Jung-Sun , Ko Young-Guk , Choi Donghoon , Hong Myeong-Ki , Jang Yangsoo
Published: March 2019

There are limited studies comparing the effect of current smoking on first-generation (1G)-drug-eluting stents (DES) and second-generation (2G)-DES in acute myocardial infarction (AMI) patients after successful percutaneous coronary intervention (PCI). We investigated the clinical impact of current smoking on 2-year clinical outcomes between the 1G-DES and the 2G-DES in AMI patients after PCI.

A total of 11,812 AMI patients with a history of current smoking who underwent successful PCI with 1G-DES (n = 4622) or 2G-DES (n = 7190) were enrolled. The primary endpoint was the occurrence of major adverse cardiac events (MACE) defined as all-cause death, recurrent AMI (re-MI) or any revascularization (target lesion revascularization [TLR], target vessel revascularization [TVR], and non-TVR). The secondary endpoint was the incidence of definite or probable stent thrombosis (ST).

Two propensity score-matched (PSM) groups (3900 pairs, n = 7800, C-statistic = .708) were generated. After PSM analysis, the 2-year cumulative incidence of MACE was significantly higher in the 1G-DES group compared with the 2G-DES (9.4% vs 7.4%, Log-rank P = .002; hazard ratio, 1.281; 95% confidence interval, 1.097–1.495; P = .002) and this increased incidence of MACE was associated with the increased incidence of any revascularization including TLR, TVR, and non-TVR. However, the incidences of ST, all-cause death, re-MI were not significantly different during 2-year follow-up period.

2G-DES was the preferred treatment strategy for AMI patients with a history of current smoking to reduce MACE especially, any revascularization rate rather than 1G-DES in this study.
Concomitant occurrence of primary renal non-Hodgkin lymphoma and a colon cancer
Authors: Li Ji , Zou Yabin , Wang Bin , Meng Xiangwei , Sun Xun
Published: March 2019

Rationale:

Primary renal lymphoma (PRL) is a rare malignancy due to the absence of lymphatic tissues in the kidney, and patients with PRL have been reported to have a poor prognosis due to its rapid invasiveness and limited treatment strategies. Colon cancer is the third most common cancer, and has a high mortality rate. Both malignant diseases predominantly affected elderly men; however, a case with concomitant occurrence of the 2 cancers is extremely rare.

Patient concerns:

A 78-year-old male patient with abdominal pain came to our hospital. Computed tomography (CT) indicated malignant masses in the left kidney, left adrenal gland, and the lower part of the descending colon.

Diagnoses:

PRL and colon cancer were diagnosed based on pathological examinations.

Interventions:

The patient was treated with laparoscopic radical nephrectomy and laparoscopic radical resection of colon cancer.

Outcomes:

The patient was then transferred to the intensive care unit (ICU) because of poor condition after surgery. He died 3 months after discharge without receiving any other treatment.

Lessons:

It is worth thinking about whether surgery was reasonable for elderly patients with double malignancies, or palliative treatment to improve the quality of life was more meaningful. This case also contributes to the understanding of the 2 malignancies and highlights the need to pay more attention to patients with multiple primary malignant neoplasms (MPMNs), explore genetic features, and investigate treatments with more survival benefits.
Wernicke encephalopathy concurrent with polyradiculoneuropathy in a young man after bariatric surgery
Authors: Chang Heng-Wei , Yang Pei-Yu , Han Ting-I , Meng Nai-Hsin
Published: March 2019

Rationale:

Bariatric surgery is the recommended treatment for morbid obesity because of its rapid and sustained body weight loss effect. Nutrient deficiency-related neurological complications after bariatric surgery are often disabling. Thus, early recognition of these complications is important. Neurological complications involving the central and peripheral nerve system after bariatric surgery were reported. However, the report on the clinical course of the concurrent involvement of central and peripheral nervous system is limited. We present a rare case of a patient who developed Wernicke encephalopathy concurrent with polyradiculoneuropathy after receiving bariatric surgery.

Patient concerns:

A 22-year-old man with a history of morbid obesity presented progressive bilateral lower limbs weakness, blurred vision, and gait disturbance 2 months after receiving laparoscopic sleeve gastrectomy. Bilateral lower limb numbness and cognition impairment were also noted.

Diagnosis:

Brain magnetic resonance imaging and electrophysiologic studies confirmed the diagnosis of Wernicke encephalopathy concurrent with acute polyradiculoneuropathy.

Interventions:

Vitamin B and folic acid were given since admission. He also received regular intensive rehabilitation program.

Outcomes:

The subject's cognitive impairment and diplopia improved 1 week after admission under medical treatments, yet lower limb weakness and gait disturbance were still noted. After a month of intensive inpatient rehabilitation, he was able to ambulate with a walker for 30 munder supervision.

Lessons:

Nutrient deficiency-related neurological complications after bariatric surgery are often disabling and even fatal. Prevention of neurological complications can be improved through close postsurgical follow-up of the nutritional status. Recognizing the signs and symptoms and evaluating the medical history are critical to the early diagnosis and treatment of this potentially serious yet treatable condition.
Simultaneous spontaneous bilateral quadriceps tendon rupture with secondary hyperparathyroidism in a patient receiving hemodialysis
Authors: Wu Weiqian , Wang Chongyang , Ruan Jianwei , Wang Haibao , Huang Yang , Zheng Wenbiao , Chen Fanghu
Published: March 2019

Rationale:

Simultaneous spontaneous bilateral quadriceps tendon rupture is a rare orthopedic injury; its initial diagnosis is misdiagnosed in up to 50% of patients with secondary hyperparathyroidism. Early diagnosis and surgical repair are important to achieve an excellent functional outcome.

Patient concerns:

We report a case of simultaneous spontaneous bilateral quadriceps tendon rupture associated with secondary hyperparathyroidism.

Diagnosis:

Magnetic resonance imaging showed that the quadriceps tendon was completely ruptured at the osteotendinous junction. We then found bilateral quadriceps tendon rupture during the operation.

Interventions:

The patient underwent successful tendon repair surgery.

Outcomes:

The 31-year-old female patient regained full active movement of both knee joints and was able to participate in her activities of daily living.

Lessons:

Simultaneous spontaneous bilateral quadriceps tendon rupture in a patient with secondary hyperparathyroidism (undergoing hemodialysis) is a rare orthopedic injury that can be easily overlooked at the initial presentation. Early diagnosis and surgical repair is important to achieve an excellent functional outcome. For patients with secondary hyperparathyroidism receiving hemodialysis, strict systematic treatment of hyperparathyroidism is needed to prevent rupture or re-rupture of the quadriceps tendon.
Association between intensive periodontal treatment and spontaneous intracerebral hemorrhage—a nationwide, population-based cohort study
Authors: Huang Jia-Lun , Chen Wei-Kung , Lin Cheng-Li , Lai Ching-Yuan , Kao Chia-Hung , Chiang Hsien-Hsiung , Yang Tse-Yen , Shih Hong-Mo
Published: March 2019

Periodontal disease is a chronic inflammation of periodontium and has a high prevalence. Periodontal disease has been discovered to be a possible risk factor for cerebrovascular diseases. The available evidence are not enough to set up a causal relationship between periodontal disease and cerebrovascular diseases. Patients with spontaneous intracerebral hemorrhage have high mortality rates. The present study investigated whether intensive periodontal treatment is a protective factor of spontaneous intracerebral hemorrhage and can reduce the risk of spontaneous intracerebral hemorrhage.

In total, 64,960 patients with a history of periodontal disease were picked out from the National Health Insurance Research Databases as a case-cohort from January 01, 2000 to December 31, 2010. They were divided on the basis of whether periodontal disease patients received intensive surgical treatment (treatment cohort) or not (control cohort). The periodontal disease patients in treatment and control cohorts were selected by propensity score matching at a ratio of 1:1. Incidences of spontaneous intracerebral hemorrhage in both cohorts were analyzed and compared.

The total hazard of spontaneous intracerebral hemorrhage was significantly decreased in the treatment cohorts compared with the control cohorts (adjusted hazard ratio = 0.60, 95% confidence interval = 0.45–0.79).

Compared with the control cohort, intensive periodontal treatment may reduce the overall incidence of spontaneous intracerebral hemorrhage, particularly in elderly patients, males, and those who received more than 2 intensive treatments.
What is the optimal cut-off threshold in self-home blood pressure measurement?
Authors: Coll-de-Tuero Gabriel , Saez Marc , Rodriguez-Poncelas Antonio , Bayó-Llibre Joan , Beltran-Vilella Marta , Reyes-Negre Carla , Dalfó-Baqué Antoni , Barceló MªAntonia
Published: March 2019

Two aspects arise concerning the use of self-measured blood pressure monitoring to diagnose white-coat hypertension (WCH): the presence of target organ damage (TOD) and the normal cut-off threshold. This study aims to evaluate the cardiovascular risk of WCH according to different self-measured blood pressure normal cut-off thresholds and the influence of TOD at baseline.

In all, 678 patients were followed for 6.2 years; 223 normotensive patients, 271 patients with sustained hypertension (HT), and 184 with WCH. TOD was defined as: left ventricular hypertrophy according to ECG, albuminuria, or low estimated glomerular filtration rate. The risk for different cutting points of self-measured blood pressure (<135/85 mm Hg, <130/85 mm Hg, and <130/80 mm Hg) has been determined.

The patients with HT experienced an increase in cardiovascular risk and death higher than the normotensive patients (odds ratio [OR] 7.9, 95% confidence interval [CI] 3.8–16.2 for sustained HT; and OR 3.5, 95% CI 1.6–7.4 for WCH). This was observed for all the cut-off thresholds analyzed. In white-coat hypertensive patients (cut-off <135/85 mm Hg) with TOD, the risk was higher than in normotensive patients (OR 4.5; 95% CI 1.9–10.6). Using a self-monitoring blood pressure cut-off threshold of <130/80 mm Hg without TOD at baseline, the WCH cases exhibited no differences in risk to the normotensive patients (OR 2.0, 95% CI 0.5–7.7).

The decisions being taken for patients with WCH based on the presence of TOD and a self-administered home monitoring blood pressure measurement cut-off point probably lower than the one that is currently recommended.
The Brazilian experience of implementing the active pharmacovigilance of dolutegravir
Authors: Batista Cynthia Julia Braga , Correa Renato Girade , Evangelista Livia Ramalho , Fleck Karen , Silva Leandro , Renaud Francoise , Vitoria Marco , Doherty Meg , Benzaken Adele Schwartz
Published: March 2019

In 2017, the Ministry of Health Brazilian started using dolutegravir (DTG) 50 mg to all people living with HIV who began antiretroviral therapy (ART) or rescue regimens. Although DTG is thought to have better tolerability levels and a lower possibility of causing adverse reactions, it is necessary to continuously evaluate the safety profile of the drug in the population. Therefore, an active pharmacovigilance project for DTG was implemented. The objective of this study was to describe the Brazilian experience of implementing pharmacovigilance and the results obtained during the period between April and December 2017.

Active pharmacovigilance was implemented through patient interviews and an online questionnaire developed in the Medication Logistics Control System (SICLOM).

Of the total number of people on DTG in Brazil (79,742) 90.33% participated in the project, and 2.24% of those who participated reported adverse reactions to the drug; of those who reported adverse reactions, 73.86% were on first-line ART regimens, and 26.13% were on third-line regimens. The mean age of the patients who had adverse reactions to DTG was 39 years; 68.79% were male, and 31.21% were female. Of the adverse reactions reported, 50.39% were considered persistent. The 3 most frequent reactions were nausea (13.34%), diarrhea (9.83%), and headaches (9.23%).

The Brazilian experience with this project has been deemed successful by federal and local managers, and the online tool to collect data has proved to be an important strategy for the pharmacovigilance of DTG as well as that of other drugs.
Pitfalls in the interpretation of the cosyntropin stimulation test for the diagnosis of adrenal insufficiency
Authors: Burgos Nydia , Ghayee Hans K. , Singh-Ospina Naykky
Published: March 2019

Purpose of review

Adrenal insufficiency is a rare disease characterized by cortisol deficiency. The evaluation of patients suspected of having adrenal insufficiency can be challenging because of the rarity of the disease and limitations in the biochemical assessment of the cortisol status by either basal or dynamic testing [adrenocorticotropic hormone (ACTH) stimulation test]. Prompt and adequate diagnosis is of paramount importance to avoid adverse outcomes. We aimed to summarize the recent developments in the conduction and interpretation of the ACTH stimulation test for the diagnosis of adrenal insufficiency.

Recent findings

The ACTH stimulation test is commonly performed in patients suspected of having adrenal insufficiency when the basal serum cortisol levels are inconclusive. Recent literature has evaluated the impact of technical aspects such as time of the day the test is performed, type of assay and sample source used for cortisol measurement on the clinical value of this test, as well as the feasibility of reliable low dose ACTH testing.

Clinicians evaluating patients with suspected adrenal insufficiency should take into consideration the clinical presentation (likelihood of adrenal insufficiency before testing) when interpreting the results of the ACTH stimulation test and be aware of clinical and technical factors that can affect cortisol values and diagnostic accuracy of this test.
Deregulation of Drosha in the pathogenesis of hereditary hemorrhagic telangiectasia
Authors: Hata Akiko , Lagna Giorgio
Published: March 2019

Purpose of review

The TGFβ (transforming growth factor β) superfamily – a large group of structurally related and evolutionarily conserved proteins – profoundly shapes and organizes the vasculature during normal development and adult homeostasis. Mutations inactivating several of its ligands, receptors, or signal transducers set off hereditary hemorrhagic telangiectasia (HHT), a disorder that causes capillary networks to form incorrectly. Drosha, an essential microRNA-processing enzyme, also interfaces with TGFβ signal transducers, but its involvement in vascular conditions had not been tested until recently. This review summarizes current evidence that links mutations of Drosha to HHT.

Recent findings

Genetic studies have revealed that rare missense mutations in the Drosha gene occur more commonly among HHT patients than in healthy people. Molecular analyses also indicated that Drosha enzymes with HHT-associated mutations generate microRNAs less efficiently than their wild-type counterpart when stimulated by TGFβ ligands. In zebrafish or mouse, mutant Drosha proteins cause the formation of dilated, leaky blood vessels deprived of capillaries, similar to those typically found in patients with HHT.

Recent evidence suggests that Drosha-mediated microRNA biogenesis contributes significantly to the control of vascular development and homeostasis by TGFβ. Loss or reduction of Drosha function may predispose carriers to HHT and possibly other vascular diseases.
Oxidation and erythropoiesis
Authors: Matte Alessandro , De Franceschi Lucia
Published: March 2019

Purpose of review

Erythropoiesis is a complex multistep process going from committed erythroid progenitors to mature red cells. Although recent advances allow the characterization of some components of erythropoiesis, much still remains to be investigated particularly on stress erythropoiesis. This review summarizes recent progresses made to understand the impact of oxidative stress on normal and pathologic erythropoiesis.

Recent findings

During erythroid maturation, reactive oxygen species might function as second messenger through either transient oxidation of cysteine residues on signaling targets or modulation of intracellular signaling pathways. Thus, in erythropoiesis, efficient cytoprotective systems are required to limit possible reactive oxygen species-related toxic effects especially in stress erythropoiesis characterized by severe oxidation such as β-thalassemia. In addition, prolonged or severe oxidative stress impairs autophagy, which might contribute to the block of erythroid maturation in stress erythropoiesis. Understanding the functional role of cytoprotective systems such as peroxiredoxin-2 or classical molecular chaperones such as the heat shock proteins will contribute to develop innovative therapeutic strategies for ineffective erythropoiesis.

We provide an update on cytoprotective mechanisms against oxidation in normal and stress erythropoiesis. We discuss the role of oxidative sensors involved in modulation of intracellular signaling during erythroid maturation process in normal and stress erythropoiesis.
PIK3CA mutations in vascular malformations
Authors: Castillo Sandra D. , Baselga Eulalia , Graupera Mariona
Published: March 2019

Purpose of review

Recently, it has been discovered that a subset of vascular malformations, of the lymphatic and venous type, are caused by oncogenic mutations in the PIK3CA gene. Now, efforts have been focused in the understanding of the molecular and cellular consequences of these mutations and the opportunities for novel-targeted therapies for these diseases.

Recent findings

Here, we review the latest findings in the biology of oncogenic PIK3CA mutations in the pathogenesis of vascular malformations. We focus on the recent development of in-vitro and in-vivo tools for the study of PIK3CA-mutant vascular malformations with special interest in preclinical models for drug testing. Also, we review the latest advances in phosphoinositide 3-kinase (PI3K) inhibitors in the clinic and their repurposing for the treatment of lymphatic malformations and venous malformations.

Oncogenic mutations on PIK3CA causing lymphatic malformations and venous malformations are also frequently found in epithelial cancer. Thus, fundamental research done in the cancer field during the past decades might be applied to the understanding of lymphatic malformations and venous malformations. Likewise, repurposing PI3K pathway inhibitors that are currently in cancer clinical trials can be used as a novel strategy for the treatment of these diseases. Here, we also open a debate for the consideration of lymphatic malformations and venous malformations as developmental tumours.
The Distributional Characteristic and Growing Trend of Pancreatic Cancer in China
Authors: Zhao Chengfei , Gao Feng , Li Quwen , Liu Qicai , Lin Xinhua
Published: March 2019

Pancreatic cancer is a malignant tumor with difficulty in diagnosis and treatment and was the sixth leading cause of cancer death among both men and women in China. The 5-year relative survivals of pancreatic cancer were only 7.2% in China and the lowest level in all cancers. The proportion of estimated new cases of pancreatic cancer in China was comparatively high in East China, Northeast, North China, and Northwest and relatively low in Central China, Southwest, and South China, showing obvious regional characteristics. It implies that the incidence and mortality in the eastern region are significantly higher than those in the western region, which is consistent with the result that the incidence and mortality increased from low to middle to high urbanization areas in China, and the prevalence of diabetes increased from underdeveloped to intermediately developed to developed region.
Overcoming Immunobiological Barriers Against Porcine Islet Xenografts
Authors: Li Xinyu , Meng Qiang , Zhang Lei
Published: March 2019

Porcine islets might represent an ideal solution to the severe shortage of living donor islets available for transplantation and thus have great potential for the treatment of diabetes. Although tremendous progress has been achieved through recent experiments, the immune response remains a major obstacle. This review first describes the 3 major pathways of rejection: hyperacute rejection mediated by preformed natural antibodies and complement, instant blood-mediated inflammatory reactions, and acute cell-mediated rejection. Furthermore, this review examines immune-related strategies, including major advances, which have been shown to extend the life and/or function of porcine islets in vitro and in vivo: (1) genetic modification to make porcine islets more compatible with the recipient, (2) optimization of the newly defined biological agents that have been shown to promote long-term survival of xenografts in nonhuman primates, and (3) development of novel immunoisolation technologies that maintain the long-term survival of islet xenografts without the use of systemic immunosuppressive drugs. Finally, the clinical application of porcine islet transplantation is presented. Even though less clinical information is available, experimental data indicate that porcine islet xenografts are likely to become a standard treatment for patients with type 1 diabetes in the future.
Clinical Features and Treatment Outcomes of Children With Anaplastic Large Cell Lymphoma in Pakistan: A Multicenter Study
Authors: Resham Shahzadi , Khan Rahil , Ashraf Shamvil , Rizvi Arjumand , Altaf Sadaf
Published: March 2019

Background:

Different approaches have been adopted in the treatment of anaplastic large cell lymphoma (ALCL); there is a lack of consensus with regard to standard treatment. Because of paucity of data from low and middle-income countries, we reviewed the clinical features and treatment outcomes of children with ALCL.

Methods:

All ALCL patients under 16 years of age diagnosed from 2005 to 2015 at Aga Khan University Hospital and The Indus Hospital were identified. Clinical features and treatment outcomes were analyzed.

Results:

Thirty-two (n=32) patients met the inclusion criteria. Cervical Lymphadenopathy was the most common presentation (34.3%, n=11). Advanced disease was seen in 68.7% (n=22) (stages III and IV). Fourteen (42.4%) were treated on ALCL-99, 30.3% (n=10) on multicenter protocol-842 regimen, 9% (n=3) on adriamycin-prednisolone-oncovin (doxorubicin, prednisone, vincristine) regimen, and 16% (n=5) were treatment abandonments. Five-year overall survival was 70.6% (95% confidence interval: 47.8%-84.9%), and 5-year event-free survival (EFS) considering treatment abandonment and death as an event was 52.3 % (95% confidence interval: 23.5%-74.8%).

Conclusions:

Significant therapy-related mortality (27.7%) was observed. Treatment abandonment and therapy-related toxicity were the major barriers for better outcomes. However, less intensive outpatient regimens, such as adriamycin-prednisolone-oncovin regimen, may decrease the number of hospitalizations, hence reducing treatment abandonment in the low and middle-income country.
Same-Sex Mothers and Lactation
Authors: Juntereal Nina A. , Spatz Diane L.
Published: March 2019

Investigation of the needs of same-sex mothers practicing lactation is limited in the nursing literature. The heteronormative structure of the healthcare system has stigmatized these postpartum women and minimized the level of nursing care provided. Case reports demonstrate that same-sex mothers value inclusivity and understanding of their healthcare needs that is missing in healthcare settings. Perinatal nurses must listen attentively and think critically about their words and actions to avoid inappropriate judgments when providing care to this population. Active engagement and ongoing competence education builds the foundation that will provide perinatal nurses the knowledge they need to best support the unique needs of same-sex mothers in their lactation experience.
Surgical Technical Evidence Review for Gynecologic Surgery Conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery
Authors: Kalogera Eleftheria , Nelson Gregg , Liu Jessica , Hu Q. Lina , Ko Clifford Y. , Wick Elizabeth , Dowdy Sean C.
Published: March 2019

(Abstracted from Am J Obstet Gynecol 2018;219:563.e1–563.e19)

The Safety Program for Improving Surgical Care and Recovery (ISCR) was developed by the Agency for Healthcare Research and Quality (AHRQ) in partnership with the American College of Surgeons and the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality. The goal of this national program was to assist hospitals in improving perioperative care through adoption and implementation of evidence-based enhanced recovery pathways (ERPs).
“Pregnancy Brain”: A Review of Cognitive Changes in Pregnancy and Postpartum
Authors: Brown Elinor , Schaffir Jonathan
Published: March 2019

Importance

The idea that pregnant women suffer from deficits in memory is widespread but poorly documented in obstetrical literature.

Objective

To review available psychology literature on the subject of cognitive changes in pregnancy in order to guide the prenatal care provider on how to counsel pregnant women.

Evidence Acquisition

An extensive review of PubMed and PsycINFO databases was conducted to gather and analyze relevant studies on cognitive changes in pregnancy.

Results

A large body of literature examining basic science and animal studies support the effects of pregnancy hormones in remodeling brain architecture and neural function. However, studies in humans are hampered by small sizes, heterogeneous methodology, and varying definitions of memory. Nevertheless, the consensus among researchers is that pregnancy does confer deficits in working memory relative to nonpregnant controls.

Conclusions and Relevance

Cognitive effects of pregnancy are likely small, and the impact on daily life is debatable. Further research is needed to determine whether these effects may confer an advantage to parous women comparable to that seen in lower mammals.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After reading this article, readers should be better able to explain prior research into the incidence of brain-related changes brought on by pregnancy; identify different types of cognition and memory that may be affected by pregnancy; and anticipate questions and appropriately counsel pregnant patients about concerns regarding cognitive changes.
Surgical Anatomy of the Uterosacral Ligament Colpopexy
Authors: Siff Lauren N. , Jallad Karl , Hickman Lisa C. , Walters Mark D.
Published: March 2019

(Abstracted from Female Pelvic Med Reconstr Surg 2017;24:380–382)

The most frequent complication in reports of uterosacral ligament (USL) colpopexy is ureteral compromise, resulting from either kinking or direct ureteral injury. The incidence of this complication was 3% to 5% in a number of studies.
Association Between Third-Trimester Tdap Immunization and Neonatal Pertussis Antibody Concentration
Authors: Healy C. Mary , Rench Marcia A. , Swaim Laurie S. , O'Brian Smith E. , Sangi-Haghpeykar Haleh , Mathis Marsenia H. , Martin Monte D. , Baker Carol J.
Published: March 2019

(Abstracted from JAMA 2018;320(14):1464–1470)

Pertussis incidence is highest in infants too young to have completed their primary immunization series (6 months or younger), who are also at the highest risk of developing life-threatening complications. In high-income countries, pertussis-related mortality occurs predominantly in infants 3 months or younger.
Generation of Human Oogonia From Induced Pluripotent Stem Cells In Vitro
Authors: Yamashiro Chika , Sasaki Kotaro , Yabuta Yukihiro , Kojima Yoji , Nakamura Tomonori , Okamoto Ikuhiro , Yokobayashi Shihori , Murase Yusuke , Ishikura Yukiko , Shirane Kenjiro , Sasaki Hiroyuki , Yamamoto Takuya , Saitou Mitinori
Published: March 2019

(Abstracted from Science 2018;362:356–360)

Studies have shown that mouse pluripotent stem cells (PSCs) can be induced into primordial germ cell–like cells (hPGCLCs), which, following transplantation under appropriate conditions, can contribute to the development of gametes capable of developing into fertile offspring. Human in vitro gametogenesis from PSCs has long-reaching implications in reproductive medicine but has not yet been achieved.
A Comparison Study of Conventional Ultrasound and Ultrasound Strain Elastography in the Evaluation of Myopathy
Authors: Teng P. P. C. , Lo Y. L.
Published: March 2019

The aim of this study was to compare ultrasound strain elastography (USE) with conventional ultrasonography echogenicity (EL) in detecting muscle pathology. For conventional ultrasonography, biceps EL was obtained. For USE, elasticity index (EI) of biceps was represented as a range, from 0 (softest) to 6 (hardest). Muscle-to-fats elasticity ratio compared EI of muscle with that of surrounding fats. Color distribution of elastogram was analyzed using open-source ImageJ software showing % red, % green, and % blue within a region of interest. Increased biceps EL, decreased biceps EI, and elasticity ratio were observed in patients with myopathy. In the color elastogram, there is no significant difference in % green between healthy control and patient, but significance was observed in % red and % blue (P < 0.001). Utilization of USE parameters has increased sensitivity up to 100% compared with 63% with conventional US. It is a promising adjunct for the clinical diagnosis of myopathy.
Noninvasive Assessment of Liver Parenchyma Using Gray-Scale Ultrasound-Based Histogram Analysis in Patients With Chronic Hepatitis B Infection
Authors: Beyazal Mehmet , Beyazal Polat Hatice , Ertürk Ayşe , Bedir Recep
Published: March 2019

The aims of this study were to examine the alterations of liver echo-intensity histogram parameters in chronic hepatitis B (CHB) patients and to assess the potential role of histogram parameters in the evaluation of hepatic fibrosis. A total of 52 patients with CHB who underwent liver biopsies were included in the study. The control group consisted of 30 healthy individuals. Histogram parameters were obtained from histogram analysis of gray-scale ultrasound images of both groups. The histogram parameters of the groups were compared. The association of histogram parameters with the grading and staging of histological activity index (HAI) in patients with CHB were evaluated. The patient group had statistically significant lower skewness, kurtosis, and higher variance, mean, 50th, and 90th percentile values compared with control group. When patients with CHB were divided into subgroups according to HAI stage, there was the increasing trend in skewness values and decreasing trend in kurtosis values across subgroups. The first percentile values showed negative correlation with HAI staging in patients with CHB. Ultrasound is a fast, inexpensive, and reproducible imaging method; histogram analysis of gray-scale ultrasound images may provide useful information for evaluation of hepatic fibrosis in CHB patients.
Neonatal Head Ultrasound
Authors: Maller Vijetha V. , Cohen Harris L.
Published: March 2019

Ultrasound of the infant brain has proven to be an important diagnostic tool in the evaluation of neonatal brain morphology and pathology since its introduction in the late 1970s and early 1980s. It is a relatively inexpensive examination that can be performed in the isolette in the neonatal intensive care unit. There is no radiation exposure and no need for sedation. This article will discuss gray scale and Doppler techniques and findings in normal head ultrasounds of premature neonates. It will discuss intracranial pathologies noted in such neonates and their neurodevelopmental outcome.
Use of an Augmentation Spreader Graft for Management of Nasofacial Angle in Patients With Pseudo-Hump
Authors: Kim Baek-Kyu , Han Jihyeon
Published: March 2019

Background

Correction of the hump nose entails more than just simple elimination of the dorsal hump. Recent trend is toward conservative reduction of the hump and appropriate adjustment of the radix height. East Asians often present with pseudo-hump due to underprojected radix or tip, which accentuates the height of the hump. This study introduces our method of pseudo-hump correction and achieving a balanced nasal profile with minimal reduction of the hump and augmentation of the dorsum and tip with a modified augmentation spreader graft.

Methods

A retrospective review was conducted of 97 consecutive cases of Korean patients undergoing hump reduction with simultaneous augmentation of the radix with resected hump fragments and augmentation of the nasal dorsum with augmentation spreader graft. No implants were used in any of the patients. Anthropometric analysis was performed, and patient satisfaction was evaluated at postoperative 1 year.

Results

Postoperatively, hump was eliminated, and the dorsum and tip were successfully elevated using only autologous septal cartilage. The radix was augmented without surface irregularity or graft visibility. Nasal dorsum, tip, and radix projection increased significantly after surgery. Subjective evaluation revealed a high level of satisfaction in 84%.

Conclusions

Our multipurpose bilateral augmentation spreader graft positioned above the septal plane was effective in dorsal and tip augmentation without the need for alloplastic material. Conservative hump reduction combined with augmentation of the relatively deficient areas of the nose produces a balanced nasal profile.
Diagnostic Criteria for Symptomatic Neuroma
Authors: Arnold Denise M. J. , Wilkens Suzanne C. , Coert J. Henk , Chen Neal C. , Ducic Ivica , Eberlin Kyle R.
Published: March 2019

Introduction

After nerve injury, disorganized or incomplete nerve regeneration may result in a neuroma. The true incidence of symptomatic neuroma is unknown, and the diagnosis has traditionally been made based on patient history, symptoms, physical examination, and the anatomic location of pain, along with response to diagnostic injection. There are no formally accepted criteria for a diagnosis of neuroma.

Materials and Methods

A literature search was performed to identify articles related to neuroma: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed and Pubmed, Embase, and the Cochrane Library were searched for all relevant articles pertaining to neuroma. Articles were screened by title and abstract for relevance. If an article was considered potentially relevant, the full article was reviewed. After consideration, 50 articles were included in this systematic review.

Results

No previous articles directly addressed diagnostic criteria for symptomatic neuroma. Factors related to neuroma diagnosis gleaned from previous studies include pain and cold intolerance (patient history), positive Tinel sign or diminished 2-point discrimination (physical examination findings), response to diagnostic nerve block, and presence of neuroma on diagnostic imaging (ultrasound or magnetic resonance imaging). Based on literature review, the importance and number of references, as well as clinical experience, we propose criteria for diagnosis of symptomatic neuroma. To receive a diagnosis of symptomatic neuroma, patients must have (1) pain with at least 3 qualifying “neuropathic” characteristics, (2) symptoms in a defined neural anatomic distribution, and (3) a history of a nerve injury or suspected nerve injury. In addition, patients must have at least 2 of the following 4 findings: (1) positive Tinel sign on examination at/along suspected nerve injury site, (2) tenderness/pain on examination at/along suspected nerve injury site, (3) positive response to a diagnostic local anesthetic injection, and (4) ultrasound or magnetic resonance imaging confirmation of neuroma.

Conclusions

The diagnosis of neuroma is based on a careful history and physical examination and should rely on the proposed criteria for confirmation. These criteria will be helpful in more precisely defining the diagnosis for clinical and research purposes.
An Algorithm for the Management of Residual Head and Neck Melanoma In Situ Using Topical Imiquimod
Authors: Tsay Cynthia , Kim Samuel , Norwich-Cavanaugh Amanda , Hsia Henry C. , Narayan Deepak
Published: March 2019

Introduction

Melanoma in situ (MIS) is an early variant of melanoma in which the disease is limited to the epidermis. Standard therapy is currently surgical excision with at least 5-mm margins. In some instances, there are large or anatomically difficult lesions where complete excision will result in significant esthetic or functional impairment. Our experience has shown a 6-week course to be sufficient in certain patients compared with the suggested 12-week course. In this context, we propose a shortened duration of treatment of positive margins with topical imiquimod and propose an algorithm that results in the least amount of dysfunction for the patient.

Methods

Our inclusion criteria were patients undergoing excision of a lesion found to have postsurgical margins, which were positive for MIS. Patients applied 5% imiquimod 3 to 5 times per week for at least 6 weeks at the site of the positive margin(s). Duration and frequency of treatment were titrated based on response. A reexcision skin biopsy using 1-mm margins was performed after residual inflammation subsided. Our endpoints were recurrence and effectiveness with length of treatment.

Results

Sixteen patients met our criteria. All patients were found to have MIS in the margins after surgical excision. Twelve of those lesions were classified as MIS in the initial biopsy; the remaining 4 were either melanoma stage T1A or T1B. Mean follow-up time was 14.3 months, and 1 patient was lost to follow-up. We had 3 patients without response, and of these, 1 was found to have atypical squamous cell carcinoma and the other had a recurrence of MIS. Cure rate after use of topical imiquimod was 93.3% (14/15).

Discussion

The proposed algorithm for the treatment of residual disease in head and neck melanoma and MIS using topical imiquimod offers various advantages. This anatomical region is cosmetically sensitive, and the option of using 1 mm versus 5 mm reexcision margins after imiquimod treatment yields comparable cure rates with less tissue excised overall. Our algorithm demonstrates that 6 weeks of active inflammation provides comparable results with the traditional 12-week course. This decreased treatment time reduces patient discomfort and improves patient adherence.
Incisional Negative Pressure Wound Therapy Augments Perfusion and Improves Wound Healing in a Swine Model Pilot Study
Authors: Shah Ajul , Sumpio Brandon J. , Tsay Cynthia , Swallow Matthew , Dash Biraja , Thorn Stephanie L. , Sinusas Albert J. , Koo Andrew , Hsia Henry C. , Au Alexander
Published: March 2019

Background

A commonly used treatment for open wounds, negative pressure wound therapy (NPWT) has recently been used to optimize wound healing in the setting of surgically closed wounds; however, the specific mechanisms of action by which NPWT may benefit patients after surgery remain unknown. Using a swine wound healing model, the current study investigates angiogenesis as a candidate mechanism.

Methods

Multiple excisional wounds were created on the dorsa of 10 male Yorkshire pigs and closed by primary suture. The closed wounds underwent treatment with either NPWT dressing or control dressings in the absence of negative pressure. Dressings were maintained for 8 days followed by euthanasia of the animal. Scar evaluation of the wounds by photographic analysis was performed, and wounds were analyzed for angiogenesis markers by enzyme-linked immunosorbent assay and immunohistochemistry.

Results

Scar evaluation scores were observed to be significantly higher for the NPWT-treated sites compared with the control sites (P < 0.05). The enzyme-linked immunosorbent assay results demonstrated increases for vascular endothelial growth factor (VEGF) staining at the incision site treated with NPWT compared with other treatment groups (P < 0.05). In addition, an approximately 3-fold elevation in VEGF expression was observed at the NPWT-treated sites (2.8% vs. 1%, respectively; P < 0.0001).). However, there was no significant difference in immunohistochemistry staining.

Conclusions

The use of NPWT improves the appearance of wounds and appears to increase VEGF expression after 8 days in the setting of a closed excisional wound model, suggesting that improved angiogenesis is one mechanism by which NPWT optimizes wound healing when applied to closed surgical wound sites.