bluuebunny/crossref_metadata_2025 huggingface dataset:
P38 Never say never: new onset uveitis in adolescence
Authors: Kelly Imogen , Davidson Joyce , Brennan Mary , MacRae Mary , Duncan Julie
Published: October 2019

Background

To highlight the importance of considering new onset uveitis in adolescent patients with longstanding juvenile idiopathic arthritis (JIA).

Methods

We performed a retrospective review of electronic medical records.

Results

A 16 year-old girl was diagnosed in 2004, aged 15 months with extended oligoarticular JIA (ANA positive, >1/640 homogeneous). Her initial treatment included intra-articular steroid injections and approximately eighteen months later methotrexate, which she remained on for four years. During this time she received occasional intra-articular steroid injections. Etanercept was added in 2009 due to persistent active disease and she continued on this treatment regime for the next five years. Methotrexate was discontinued in 2013 due to intolerance. Etanercept was discontinued in 2014 due to disease remission but was restarted after three months when her arthritis flared.

In 2018 biologic treatment was changed due to poor disease control. Etanercept was switched to adalimumab, initially alternate weeks but increasing to weekly together with multiple joint injections. Six months later, her disease control remained poor and drug levels and antibodies were measured. She had a strongly positive anti-drug antibody level>200 AU/ml and her adalimumab level was <0.4mgs/L (normal range 5-10).

At this time our patient now aged 16 presented with a four-week history of intermittent reduced vision in her right eye. Ophthalmology review found bilateral anterior uveitis. This patient had regular eye screening from her JIA diagnosis until her 11th birthday, showing no previous evidence of uveitis.

Following diagnosis of uveitis she was commenced on steroid eye drops and IV methylprednisolone to treat both her uveitis and arthritis. Infliximab, (6mg/kg) was commenced then increased (10mg/kg) for ongoing uveitis and methotrexate was restarted. Despite this treatment she has persistent low grade right uveitis. Her left eye has settled and she has no lens opacities or raised intraocular pressures. She continues with joint discomfort secondary to her hypermobility but her arthritis is currently quiescent.

Conclusion

Type of arthritis and age at onset historically dictated the risk of developing uveitis. However uveitis can present in any age group and in patients with any type of JIA. In our case uveitis developed for the first time almost 15years after diagnosis.

With disease modifying treatments now widely used early in the management of JIA, uveitis may be masked and therefore present late or atypically. It is rare for uveitis to present so long after diagnosis, however this case highlights that rheumatology teams should be aware that it can still develop. Therefore we should never say never!

Conflicts of Interest

The authors declare no conflicts of interest.
P45 Treat the arthritis, not just the chest
Authors: Pilbury Madeline , Clarke Elizabeth , Taylor Julia , Watson Pippa , Jobling Alison
Published: October 2019

Background

Very little literature exists in supporting the assessment and management of cystic fibrosis related arthritis (CFA) particularly in paediatric and adolescent cases.

Methods

A 12 year-old male with cystic fibrosis (CF) was admitted via A&E with severe joint pain that was thought to be associated with a respiratory infection and was treated accordingly. Repeated exacerbations of joint disease occurred every 1-2 months, lasting approximately 1 week with significant joint pain, stiffness, and reduced function.

The patient did not feel his exacerbations of CFA were related to his respiratory symptoms, admitting he under reported arthritis symptoms to avoid being admitted for IV antibiotics. Initial rheumatology review resulted in treatment with IV antibiotics and piroxicam. Flares continued, prompting his CF physiotherapist and multidisciplinary team to seek further specialist review for his now longstanding symptoms. He scored 16 out of 50 on the McGill Pain Questionnaire (MPQ) with a visual analogue score (VAS) of 46 out of 100.

At 16 years old he was seen by an MSK physiotherapy and rheumatology team working within a wider CF team. He had a 4 year history of symmetrical joint pain affecting knees, wrists and hands, on a background of bronchiectasis with previous non-tuberculous mycobacteria infection, cystic fibrosis related diabetes, and poor nutrition.

He reported some episodes being so bad he was unable to get out of bed, and struggling with the stairs at college. He had 6 swollen and 8 tender joints including wrists, MCPs and knees. Ultrasound imaging of the wrists and hands showed confirmed active synovitis with grade 3 greyscale changes and grade 2 power Doppler. Hydroxychloroquine was commenced with naproxen as required, and wrist splints were provided.

Results

At follow-up he reported significant symptomatic improvement with occasional minor stiffness in wrists and knees which responded quickly to naproxen and was no longer limiting his activities. Repeat ultrasound confirmed improvement with no active power Doppler, but some ongoing grade 1 greyscale changes and a small wrist effusion. He has returned to previous function with an MPQ score of 0, and VAS of 10 out of 100. He reported improved quality of life due to reduced pain and fewer, shorter, and more manageable exacerbations.

Conclusion

Specialist review and commencement on disease modifying anti-rheumatic medication helped to manage CFA in this case. All cases of suspected CFA should be referred for specialist rheumatology opinion. CF physiotherapists are in an excellent position to identify cases and empowering the multidisciplinary team has been vital in this case.

Further trials are required to investigate optimal management of CFA, but it seems likely that directly addressing the arthritis with disease modifying therapy may play an important role.

Conflicts of Interest

The authors declare no conflicts of interest.
P63 Evaluation of new patients seen by physiotherapy for obesity
Authors: Pattenden Amy , Hurley Matthew , Deepak Samundeeswari
Published: October 2019

Background

Obesity levels have been increasing rapidly worldwide for the past two decades. The WHO has estimated the UK to be among the most overweight countries in the world, and according to government figures, the UK is now the fattest country in Europe with one in four adults obese. Obesity levels continue to rise within upcoming generations and if current trends continue, the forecast for the future health of today’s children is bleak.

Methods

We aim to evaluate the body mass index (BMI) of children seen at the paediatric physiotherapy team.

All new patients seen by a paediatric physiotherapist during the one month period June 2019 had their heights and weight measured at the first visit. The heights and weights of children were measured for all the children attending one physiotherapist’s clinic. The BMI was calculated for these children using NHS BMI child calculator.

Results

A total of 28 new children attended the physiotherapist clinic. Of these, only 11 children were in the healthy BMI range and 17 were above the 90th centile. Among these 17 children, 12 were on the 98/99th centile. Ankle pain, lower back pain, knee or hip pain appeared to be the most common presenting symptoms of these children.

Among the 28 children seen, 61% were above the 90th centile and 43% were on 98-99th centile. This data reflects only the children seen be one general paediatric physiotherapist. Children known to rheumatology team were seen by the therapists attached to the rheumatology team.

Conclusion

This audit highlights that children who are overweight and obese, experience more mechanical musculoskeletal symptoms. We conclude that further studies are needed to determine the epidemiology of musculoskeletal symptoms in children who are obese and overweight. The limitations of this project are small size and no collection of comorbidity data.

As the trend of obesity is increasing, these issues should be addressed at every opportunity of contact with the health professionals. It is important, linking the weight issues to the conditions we are treating, and raising awareness to patient and carers.

Conflicts of Interest

The authors declare no conflicts of interest.
The association between the “Plate it Up Kentucky” supermarket intervention and changes in grocery shopping practices among rural residents
Authors: Gustafson Alison , Ng Shu Wen , Jilcott Pitts Stephanie
Published: October 2019

Rural communities experience higher rates of obesity, and residents have a lower intake of fruits and vegetables. Innovative healthy food promotions in supermarkets may improve healthy food access and dietary intake among residents, yet few supermarket interventions have been translated to the rural context. The aim of this project was to determine whether a supermarket-based intervention “Plate it Up Kentucky” was associated with change in fruit, vegetable, and sugar-sweetened beverage (SSB) purchases among rural supermarket customers. Ten Kentucky supermarkets participated in an intervention titled “Plate It Up” to provide in-store promotions, including recipe cards, samples, price reductions for specific fruits and vegetables, and marketing on shopping carts. Six stores in rural Kentucky and North Carolina were controls. Two cross-sectional customer intercept surveys were conducted among grocery store customers in Spring of 2016 (baseline, n = 131 control and n = 181 intervention store customers) and Spring–Summer of 2017 (post-intervention, n = 100 control and n = 83 intervention store customers). Customers were asked to provide store receipts and participate in a survey assessing grocery shopping practices and dietary intake. The primary outcome was purchases in fruit and vegetable (obtained from receipt data). The secondary outcome was dietary intake (captured with the National Cancer Institute's Fruit and Vegetable Screener and BRFSS questionnaire). An adjusted, difference-in-difference model was used to assess the differences between control and intervention store customers at baseline, post-intervention, and then between the two time points. Post-intervention, there was a greater increase in customers stating that they “liked the food” as one main reason for shopping in the store where surveyed among intervention versus control store customers. The adjusted difference-in-difference model indicated that intervention store customers spent on average 8% more on fruits and vegetables from baseline to post-intervention (p = .001) when compared with customers from control stores. Among controls, spending on SSB decreased from $3.61 at baseline to $3.25 at post-intervention, whereas among intervention customers, spending on SSB decreased from $2.75 at baseline to $1.81 at post-intervention (p = .02). In-store promotions that provide recipe cards, samples, price reductions for specific fruits and vegetables, and marketing on shopping carts hold promise as a method to promote healthy food purchases among rural supermarket customers at two time points.
The introduction of new food retail opportunities in lower-income communities and the impact on fruit and vegetable intake: a systematic review
Authors: Hollis-Hansen Kelseanna , Vermont Leah , Zafron Michelle L , Seidman Jennifer , Leone Lucia
Published: October 2019

A lack of access to fresh fruits and vegetables (F&Vs) is associated with consumption of fewer F&Vs and higher risk of obesity, especially for lower-income individuals. It is widely believed that the addition of new food retail opportunities could improve F&V consumption and subsequently reduce the chronic disease burden. Observational studies provide some support for these hypotheses, but contradictions exist. In this study we sought to examine if the introduction of a food retailer affects F&V consumption in lower-income communities. We used a systematic PRISMA approach to conduct this study. We searched PubMed, EMBASE, and ProQuest Dissertations & Theses for academic journal references and gray literature published before August 2018. Included studies were those looking at the effect of the introduction of a new food retailer on F&V consumption. Studies were also categorized based on which dimensions of food access were targeted by the food retailer. We identified 15 studies meeting inclusion criteria: 11 studies reported a positive increase in F&V consumption attributable to the introduction of a new food retailer, of which 6 were statistically significant. The remaining 4 studies, all of which examined the impact of introducing a new retail supermarket, showed no change or a decrease in F&V intake. Results from studies which change the food environment generally support the idea that increased access to healthy food improves diet, but more studies are needed in order to assess the differences between the various types of retailers, and to identify strategies for improving impact. Understanding which types of new food retail programs are most likely to impact diet has implications for policies which incentivize new food retail.
Adoption and Reach of a statewide policy, systems, and environment intervention to increase access to fresh fruits and vegetables in West Virginia
Authors: Abildso Christiaan G , Bias Thomas K , Coffman Jessica
Published: October 2019

Local public health professionals’ consistency, connections, and presence at meetings were critical to making changes in schools, farmers markets, and retail food stores to improve access to fruits and vegetables in rural, low-income food deserts.
RE-AIM analysis of a community-partnered policy, systems, and environment approach to increasing consumption of healthy foods in schools serving low-income populations
Authors: Escaron Anne L , Martinez Corina , Vega-Herrera Celia , Enger Shelley M
Published: October 2019

While working in partnership with a school district on their wellness policy builds a culture of health, additional strategies are needed to reinforce students eating healthy.
Tramadol Withdrawal in the Setting of Buprenorphine Induction: A Case Report
Authors: Terasaki Dale , Klie Kaylin
Published: October 2019

Initiating opioid use disorder treatment with buprenorphine conventionally requires the cessation of other opioid medications, including tramadol. Tramadol's spectrum of activity differs from most opioids, acting through serotonin and norepinephrine reuptake inhibition. Here, we report a case of 45-year-old man who experienced a complicated transition from tramadol to buprenorphine. We believe there were similarities to antidepressant discontinuation syndrome, which could be explained by tramadol's serotoninergic activity. Clinicians should be aware of these effects when discontinuing tramadol, even if replacing with another opioid.
Referral to Treatment After Positive Screens for Unhealthy Drug Use in an Outpatient Veterans Administration Setting
Authors: Hodgkin Dominic , Gao Wenwu , Larson Mary Jo , Drebing Charles E. , Merrick Elizabeth L. , Pugatch Marianne , Horgan Constance M. , Zolotusky Galina , Petry Nancy M. , Saitz Richard
Published: October 2019

Objectives:

To measure the rates and predictors of clinician recommendation for follow-up after a positive screen for unhealthy drug use, in a context of mandatory routine screening. To measure response to clinician recommendations and identification of new drug use diagnoses.

Methods:

Data are from a Veterans Health Administration (VHA) medical center that introduced mandatory routine screening for unhealthy drug use in outpatient primary care and mental health settings, using a validated single question. This study analyzed VHA electronic health records data for patients who screened positive for unhealthy drug use (n = 570) and estimated logistic regression models to identify the predictors of receiving a recommendation for any follow-up and for specialty substance use disorder (SUD) treatment. Bivariate tests were used for other analyses.

Results:

Among patients who screened positive for unhealthy drug use, 66% received no recommendation to return to primary care or another setting from the screening clinician. Further, among the 23% of patients who received a recommendation to visit specialty SUD treatment, only 25% completed the visit within 60 days. Six percent of all positive screens both received a referral to specialty SUD treatment and acted upon it.

Conclusions:

In the context of mandatory drug use screening using a single item, rates of clinician action and patient receipt of care appeared low. Improved follow-up will require health systems to provide more supports for clinicians and patients at each of the stages from positive screen to attending the follow-up appointment.
Observations of Distortion Product Otoacoustic Emission Components in Adults With Hearing Loss
Authors: Prieve Beth A. , Thomas Lisa , Long Glenis , Talmadge Carrick
Published: October 2019

Objectives:

Distortion product otoacoustic emissions (DPOAEs) measured in the ear canal are composed of OAEs generated by at least two mechanisms coming from different places in the cochlea. Otoacoustic emission (OAE) models hypothesize that reduction of cochlear gain will differentially impact the components. The purpose of the current experiment was to provide preliminary data about DPOAE components in adults with hearing loss in relation to OAE models and explore whether evaluation of the relative amplitudes of generator and reflection components can enhance identification of hearing loss.

Design:

DPOAEs were measured from 45 adult ears; 21 had normal hearing (≤15 dB HL) and 24 with mild-to-severe sensorineural hearing loss (>15 dB HL). The higher frequency primary (f

2
) was swept logarithmically between 1500 and 6000 Hz, and f

2
/f

1
was 1.22. The two equal-level primaries varied from 55 to 75 dB SPL in 5 dB steps. The swept primary procedure permitted the measurement of the amplitude and phase of the DPOAE fine structure and the extraction of the two major components (generator and reflection) by varying the predicted delays of the analysis windows.

Results:

DPOAE fine structure was reduced or absent in ears with hearing loss. DPOAE generator and reflection components were lower in ears with hearing loss than those with normal hearing, especially for the reflection component. Significant correlations were found between the generator component and hearing threshold but not between reflection levels and hearing threshold. Most ears with normal hearing had both components, but only a small number of ears with hearing loss had both components.

Conclusions:

The reflection component is not recordable or low in level in ears with hearing loss, explaining the reduced or absent DPOAE fine structure. DPOAE generator components are also lower in level in ears with hearing loss than in ears without hearing loss. In ears that had both measurable generator and reflection components, the relationship between the two did not depend on the presence or absence of hearing loss. Because reflection components are not measurable in many ears with hearing thresholds >15 dB HL, stimuli that evoke other types of reflection emissions, such as stimulus-frequency or long-latency transient-evoked emissions, should be explored in conjunction with DPOAE generator components.
Perioperative Outcome of Severe Idiopathic Scoliosis (Cobb Angle ≥ 90°)
Authors: Mihara Yuki , Chung Weng Hong , Chiu Chee Kidd , Hasan Mohd Shahnaz , Lee Sin Ying , Ch’ng Pei Ying , Chan Chris Yin Wei , Kwan Mun Keong
Published: October 2019

Study Design.

Retrospective study from a prospectively collected database.

Objective.

To compare the perioperative outcome between after-hours and daytime surgery carried out by a dedicated spinal deformity team for severe Idiopathic Scoliosis (IS) patients with Cobb angle ≥ 90°.

Summary of Background Data.

There were concerns that after-hours corrective surgeries in severe IS have higher morbidity compared to daytime surgeries.

Methods.

Seventy-one severe IS patients who underwent single-staged Posterior Spinal Fusion (PSF) were included. Surgeries performed between 08:00H and 16:59H were classified as “daytime” group and surgeries performed between 17:00H and 06:00H were classified as “after-hours” group. Perioperative outcome parameters were average operation start time and end time, operation duration, intraoperative blood loss, intraoperative hemodynamic parameters, preoperative and postoperative hemoglobin, blood transfusion rate, total patient-controlled anesthesia (PCA) morphine usage, length of postoperative hospitalization, and complications. Radiological variables assessed were preoperative and postoperative Cobb angle, side bending flexibility, number of fusion levels, number of screws used, Correction Rate, and Side Bending Correction Index.

Results.

Thirty patients were operated during daytime and 41 patients were operated after-hours. The mean age was 16.1 ± 5.8 years old. The mean operation start time for daytime group was 11:31 ± 2:45H versus 19:10 ± 1:24H for after-hours group. There were no significant differences between both groups in the operation duration, intraoperative blood loss, intraoperative hemodynamic parameters, postoperative hemoglobin, hemoglobin drift, transfusion rate, length of postoperative hospitalization, postoperative Cobb angle, Correction Rate, and Side Bending Correction Index. There were four complications (1 SSEP loss, 1 massive blood loss, and 2 superficial wound infections) with no difference between daytime and after-hours group.

Conclusion.

After-hours elective spine deformity corrective surgeries in healthy ambulatory patients with severe IS performed by a dedicated spinal deformity team using dual attending surgeon strategy were as safe as those performed during daytime.

Level of Evidence: 4
Hyperprogression after first dose of immunotherapy in a patient with radioresistant metastasis from nonsmall cell lung cancer
Authors: Bosch-Barrera Joaquim , Oliva Esther , Sais Elia , Vásquez Carmen Amalia , Roselló Alvar , Menéndez Javier A.
Published: October 2019

Immune checkpoint inhibitors (ICIs) represent a new standard of care for patients with advanced nonsmall cell lung cancer, improving overall survival compared with standard chemotherapy. However, a new pattern of response to ICIs characterized by accelerated tumor growth has been recently described, termed hyperprogressive disease (HPD). We report the case of a 73-year-old patient with advanced lung adenocarcinoma who developed HPD following treatment with a unique dose of atezolizumab for a skin metastasis that was refractory to chemotherapy and radiotherapy. Potential clinical biomarkers related to HPD to ICIs are reviewed.
Advancing the Health of Populations Across the Life Course
Authors: Grewal Jagteshwar , Buck Louis Germaine M. , Hinkle Stefanie N. , Mumford Sunni L. , Lu Ya-Ling , Nansel Tonja R. , Perkins Neil , Mills James L. , Liu Aiyi , Schisterman Enrique F.
Published: October 2019

In 2017, the Division of Intramural Population Health Research (DIPHR), within the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), reached a significant milestone: 50 years in existence. DIPHR celebrated this anniversary with a scientific program that reviewed past accomplishments and reflected on future directions in support of promoting the health of populations across the life course. Extending from the scientific program, the impetus of this article is to contribute to archiving and consolidating the legacy of intramural population health research at NICHD over the past 50 years. We present a brief history of the origin and evolution of intramural population health research at NICHD. Next, we conduct an empirical assessment of the scientific impact and evolving scope of this research over the past five decades and present specific key discoveries emerging from topics spanning the life course: (1) reproductive health, (2) the health of pregnant women and fetuses, (3) the health of children, and (4) associated methodologies. We also explore the Division’s service to the profession in the form of mentorship of the next generation of scientists in population health research. Finally, we conclude with thoughts about future directions of population health research and reaffirm the DIPHR’s commitment to promoting the health and well-being of the many populations we serve, both locally and globally.
The Uniqueness and Importance of Children in Addressing Health Disparities Across the Life Course: Implications for Research
Authors: Cheng Tina L. , Mistry Kamila B.
Published: October 2019

As the Eunice Kennedy Shriver National Institute of Child Health and Human Development's Division of Intramural Population Health Research celebrates its 50th Anniversary, it is appropriate to recognize great achievements in reducing child morbidity and mortality and increasing life expectancy. Unfortunately large racial/ethnic and socioeconomic health and healthcare disparities persist. This commentary suggests a framework to clarify the research and interventions needed to eliminate health disparities starting early in the life course.
The Relation of Birth Weight and Adiposity Across the Life Course to Semen Quality in Middle Age
Authors: Kahn Linda G. , Widen Elizabeth M. , Janevic Teresa , Straka Nadine , Liu Xinhua , Cirillo Piera M. , Cohn Barbara A. , Buck Louis Germaine M. , Factor-Litvak Pam
Published: October 2019

Background:

Studies of body mass index and semen quality have reported mixed results, but almost all were cross-sectional and many were conducted in selected populations. Longitudinal studies in population-based cohorts are necessary to identify how timing and duration of excess adiposity may affect semen quality.

Methods:

In 193 members of the Child Health and Development Studies birth cohort, we examined associations of birth weight and adiposity at six time points spanning early childhood and adulthood with sperm concentration, motility, and morphology at mean age 44 years, as well as with corresponding 2010 World Health Organization (WHO) subfertility reference levels.

Results:

Birth weight for gestational age percentile was positively associated with square-root sperm concentration (regression coefficientB[95% confidence interval] = 0.02 × 103 sperm/ml [0.004, 0.04]). Overweight/obesity in men’s 20s was associated with lower percent progressive motility (B=−5.2 [−9.9, −0.63]), higher odds of low motility (odds ratio (OR) = 2.4 [1.3, 4.4]), and higher odds of poor morphology (OR = 1.9 [0.94, 3.8]). Those who were overweight/obese in their 20s were also more likely to meet two or three WHO subfertility criteria (OR = 3.9 [1.6, 9.4]) compared with normal-weight men. Each additional adult decade in which a participant was overweight/obese was associated with higher odds of low motility (OR = 1.3 [0.96, 1.6]) and higher odds of meeting two or three WHO subfertility criteria (OR = 1.5 [1.0, 2.2]).

Conclusions:

In our data, associations among adiposity and sperm concentration, motility, and morphology varied according to timing and duration of exposure, potentially reflecting different biological mechanisms that influence these semen parameters.
Combining Biomarker Calibration Data to Reduce Measurement Error
Authors: Perkins Neil J. , Weck Jennifer , Mumford Sunni L. , Sjaarda Lindsey A. , Mitchell Emily M. , Pollack Anna Z. , Schisterman Enrique F.
Published: October 2019

Biomarker assay measurement often consists of a two-stage process where laboratory equipment yields a relative measure which is subsequently transformed to the unit of interest using a calibration curve. The calibration curve establishes the relation between the measured relative units and sample biomarker concentrations using stepped samples of known biomarker concentrations. Samples from epidemiologic studies are often measured in multiple batches or plates, each with independent calibration experiments. Collapsing calibration information across batches before statistical analysis has been shown to reduce measurement error and improves estimation. Additionally, collapsing in practice can also create an additional layer of quality control (QC) and optimization in a part of the laboratory measurement process that is often highly automated. Principled recalibration is demonstrated via. a three-step process of identifying batches where recalibration might be beneficial, forming a collapsed calibration curve and recalibrating identified batches, and using QC data to assess the appropriateness of recalibration. Here, we use inhibin B measured in biospecimens from the BioCycle study using 50 enzyme-linked immunosorbent assay (ELISA) batches (3875 samples) to motivate and display the benefits of collapsing calibration experiments, such as detecting and overcoming faulty calibration experiments, and thus improving assay coefficients of variation from reducing unwanted measurement error variability. Differences in the analysis of inhibin B by testosterone quartile are also demonstrated before and after recalibration. These simple and practical procedures are minor adjustments implemented by study personnel without altering laboratory protocols which could have positive estimation and cost-saving implications especially for population-based studies.
Volumetric Symmetry after Unilateral Autologous Breast Reconstruction: A Reasonable Goal
Authors: Glener Adam D. , Suresh Visakha , Shammas Ronnie L. , Broadwater Gloria , Sergesketter Amanda , Taskindoust Mahsa , Guo Xiaoshuang , Hollenbeck Scott T.
Published: October 2019

Background:

With growing concerns about the overuse of contralateral prophylactic mastectomy, optimizing unilateral mastectomy reconstruction outcomes becomes a priority. However, there remains a paucity of objective data that describe volumetric symmetry between a natural and autologous-reconstructed breast.

Methods:

We evaluated patients who underwent unilateral mastectomy reconstruction with free-flap abdominal tissue transfer from 04/2006 to 01/2015, and had at least 2 postoperative magnetic resonance images (MRIs; n = 28). Using these MRI data, volumetric measurements of the reconstructed and natural breast were performed at the first postoperative MRI (after all revisions were complete) and the most recent MRI. Relationships were analyzed using Spearman correlation coefficients. A symmetry score (SS) was calculated such that values closer to 1.0 reflected volumetric symmetry.

Results:

The mean age (years) and BMI of the patients was 44.8 and 26.8, respectively. The mean interval time between the MRIs was 3.03 years (range 0.43–6.6). After surgical revisions were complete, volumetric symmetry between reconstructed and nonreconstructed breasts was typically achieved (mean SS 0.92). This symmetry was also retained at the end of follow-up (mean SS 0.96), despite a mean change in BMI of 3.9% (range 1.1–7.7). Additionally, the mean number of flap revisions was 0.75 (range 0–2), and 39% of patients had a procedure performed on the natural breast.

Conclusion:

In patients undergoing unilateral abdominal-based breast reconstruction, volumetric symmetry is attainable; however, it can require flap revisions and procedures to natural breast. Interestingly, this study does show that initial symmetry is retained postoperatively, regardless of changes in BMI.
A Simple and Low-cost Method of Sleeve to Insert Silicone Gel Breast Implants
Authors: Panczel Georg , Munhoz Alexandre Mendonça
Published: October 2019

Contact between silicone implants and skin/breast parenchyma has been described as an agent of implant contamination and biofilm formation, resulting in implant complications. The no-touch technique was introduced to avoid implant contact and reduce skin/breast contamination. The authors propose an easily available sleeve option using a saline sterile plastic container that provides elastic and transparent protection for inserting silicone implants. These sterile containers can be easily converted into a sleeve by cutting off the narrow end of the container, which then easily fits into the small inframammary, periareolar, and transaxillary incisions. The authors have performed this technique in 10 patients (20 implants) undergoing primary breast augmentation or revision breast surgery, with microtexturized implants ranging in size from 255 to 500 ml (mean, 325 ml) and obtained satisfactory results with no cases of complications. Our clinical outcome shows that this new sleeve does not interact with the implant or the patient’s skin and soft tissues and has the added advantage of low cost compared with similar available devices, but further randomized and controlled studies are required to corroborate this effect.
Discovery of Novel Small Molecules that Block Myofibroblast Formation: Implications for Capsular Contracture Treatment
Authors: Park Rachel H. , Pollock Stephen J. , Phipps Richard P. , Langstein Howard N. , Woeller Collynn F.
Published: October 2019

Background:

Capsular contracture is a devastating complication that occurs in patients undergoing implant-based breast reconstruction. Ionizing radiation drives and exacerbates capsular contracture in part by activating cytokines, including transforming growth factor-beta (TGF-β). TGF-β promotes myofibroblast differentiation and proliferation, leading to excessive contractile scar formation. Therefore, targeting the TGF-β pathway may attenuate capsular contracture.

Methods:

A 20,000 small molecule library was screened for anti-TGF-β activity. Structurally diverse anti-TGF-β agents were identified and then tested on primary human capsular fibroblasts. Fibroblasts were irradiated or not, and then treated with both TGF-β and candidate molecules. Resulting cells were then analyzed for myofibroblast activity using myofibroblast markers including alpha-smooth muscle actin, collagen I, Thy1, and periostin, using Western Blot, quantitative real-time polymerase chain reaction, and immunofluorescence.

Results:

Human capsular fibroblasts treated with TGF-β showed a significant increase in alpha-smooth muscle actin, collagen I, and periostin levels (protein and/or mRNA). Interestingly, fibroblasts treated with latent TGF-β and 10 Gy radiation also showed significantly increased levels of myofibroblast markers. Cells that were treated with the novel small molecules showed a significant reduction in myofibroblast activation, even in the presence of radiation.

Conclusions:

Several novel small molecules with anti-TGF-β activity can effectively prevent human capsular fibroblast to myofibroblast differentiation in vitro, even in the presence of radiation. These results highlight novel therapeutic options that may be utilized in the future to prevent radiation-induced capsular contracture.
Human Papilloma Virus Vaccination After Pediatric Sexual Abuse Evaluations in the Outpatient Child Sexual Abuse Subspecialty Clinic: A Quality Improvement Project
Authors: Goodman Elizabeth A. , Goodpasture Meggan
Published: October 2019

The nonavalent human papilloma virus (HPV) vaccination prophylactically contributes to the prevention of nine types of HPV-associated oral and genital cancers. HPV vaccination rates remain lower than the national Healthy People 2020 goal of 80%. Victims of pediatric sexual abuse are at a higher risk for acquiring and developing HPV-related outcomes. Current research supports vaccination after sexual abuse as soon as eligible and suggests utilizing multiple types of medical encounters to increase vaccination rates.

An institutional-review-board-approved quality improvement project was developed to determine the impact of promoting and providing HPV vaccination during the medical encounter after pediatric sexual abuse in a child protection team (CPT) clinic. Twenty percent of the 111 total clinic patients evaluated in the preintervention period and 21% of the 99 patients evaluated in the postintervention period were HPV vaccine eligible, illustrating a significant opportunity for impact. During the intervention period, 62% of patients who were vaccine eligible and presented for their CPT clinic visit received HPV vaccine. Barriers to vaccination in the outpatient CPT clinic setting included high appointment no-show rates, high social and medical visit complexity, and absence of an appropriate consenting caretaker. Implications for forensic nursing practice are discussed.
Effect of physical fitness on colorectal tumor development in patients with familial adenomatous polyposis
Authors: Nakamura Tomiyo , Ishikawa Hideki , Sakai Toshiyuki , Ayabe Makoto , Wakabayashi Keiji , Mutoh Michihiro , Matsuura Nariaki
Published: October 2019

Although accumulated epidemiological evidence indicates that a good physical fitness level may prevent the development of sporadic colorectal cancer (CRC), few studies have examined the effect of physical fitness level on familial adenomatous polyposis (FAP). This cross-sectional study aimed to examine the relationship between physical fitness and CRC development in patients with FAP.

A total of 119 patients (54 male; 65 female) with FAP, aged 17 to 73 years, underwent a step test to induce exercise stress. Predicted maximal oxygen uptake (VO2max) was calculated for each patient by using heart rate as an index of physical fitness. The association of VO2max with the presence or absence of CRC and polyp diameter was examined. Patients with FAP were divided into 3 categories according to their VO2max (high, medium, and low). The association between maximum polyp size and VO2max among the patients with FAP without a history of colectomy was examined.

The risk of CRC was significantly higher in the low VO2max group than in the high VO2max group (odds ratio = 4.07; 95% confidence interval, 1.02–16.26). The maximum polyp diameter was significantly negatively correlated with the VO2max among the patients with FAP without a history of colectomy (r = −.44, P = .01). In the multiple linear regression analysis, maximum polyp diameter was independently correlated with VO2max.

Our results suggest a preventive association between physical fitness and CRC development or colorectal adenoma growth exists in patients with FAP.
Efficacy of methylprednisolone for treatment of persistent vertigo
Authors: Ding Guo-rong , Ni Jian-ming , Zhang Shan-jing , Xie Yan-zhong , Feng Jun-fei
Published: October 2019

Background:

This study will systematically investigate the efficacy and safety of methylprednisolone for treatment of persistent vertigo (PV).

Methods:

All following electronic databases will be searched from inception to the June 30, 2019 without language restrictions: MEDILINE, EMBASE, Cochrane Library, Web of Science, and Chinese Biomedical Literature Database. All randomized controlled trials focusing on assessing the efficacy and safety of methylprednisolone for patients with PV will be fully considered for inclusion. Cochrane risk of bias tool will be used for assessing methodological quality, and RevMan 5.3 software (Cochrane Community, London, UK) will be utilized for statistical analysis.

Results:

This study will assess the efficacy and safety of methylprednisolone for PV via assessing primary outcome of vertigo, and secondary outcomes of somatization, depression, anxiety, health-related quality of life, and adverse events.

Conclusion:

This study will provide a high-quality evidence to judge whether methylprednisolone is an effective and safety therapy for patients with PV.

Dissemination and ethics:

No individual data will be utilized in this study, thus, it does not need ethical approval. The results of this study will be published at peer-reviewed journals.

Systematic review registration:

PROSPERO CRD42019138890.
Prognostic value of radiologically determined sarcopenia prior to treatment in urologic tumors
Authors: Li Jialin , Deng Yinan , Zhang Menghui , Cheng Yusheng , Zhao Xin , Ji Zhigang
Published: October 2019

Objective:

Increasing evidence suggests that radiologically determined sarcopenia prior to treatment can serve as a prognostic marker in various tumors. However, there are conflicting conclusions about the prognostic role of sarcopenia in urological tumors. We performed a meta-analysis to assess the association between radiologically determined sarcopenia before treatment and survival outcomes in urological tumors.

Methods:

A systematically literature search in PubMed, Cochrane databases, and EMBASE was performed. We estimated hazard ratios (HRs) for overall survival (OS) and cancer-specific survival (CSS). Hazard ratios (HR) with 95% confidence interval (CI) were calculated using STATA 12.0 software.

Results:

A total of 16 studies enrolling 2264 patients with urologic tumors were included in our meta-analysis. Among these studies, 13 studies with 1941 patients explored the association between sarcopenia and OS, and 10 studies with 1790 patients investigated the relationship between sarcopenia and OS. The synthesized result suggested that sarcopenia was significantly associated with poor OS (Fixed-effect model, HR 1.73, 95% CI: 1.48–2.01, P <.05; heterogeneity: P = .064; I2 = 40.5%), and poor CSS (Fixed-effect model, HR: 1.85, 95% CI: 1.51–2.28, P <.05, heterogeneity: P = .053; I2 = 46.2%).

Conclusion:

This meta-analysis showed that sarcopenia was associated with poor OS and CSS, suggesting that sarcopenia may serve as a promising prognostic marker in urologic cancer patients. Considering several limitations in our study, in the future more high-quality studies on this topic should be conducted to confirm our findings.
Management of postpartum pulmonary embolism combined with retained placenta accreta
Authors: Tong An , Zhao Fumin , Liu Ping , Zhao Xia , Qi Xiaorong
Published: October 2019

Rationale:

Retained placenta accreta is an increasing obstetric problem in recent years, and pulmonary embolism (PE) during pregnancy and the postpartum period is a vital condition, but lack of standard therapy guidelines. This report describes a case of postpartum PE combined with retained placenta accreta.

Patient concerns:

A 27-year-old woman presenting with fever and dyspnea after delivery was admitted to our hospital with retained placenta accreta.

Diagnoses:

The patient was diagnosed with the infection, postpartum PE, and residual placenta.

Interventions:

The antibiotics and low molecular weight heparin were initially started to cure the infection and control PE. Mifepristone was then used to promote the necrosis of residual placenta while long-term use of warfarin was served as continuous anticoagulant therapy. Hysteroscopic resection of retained placenta was not performed until thrombi had been almost disappeared after more than 2 months of anticoagulation therapy.

Outcomes:

The patient's menstruation returned to normal within several weeks after hysteroscopic resection and she completely recovered from PE after 3 months of anticoagulant therapy.

Lessons:

Treatment of retained placenta accreta can be postponed when encountering complicated cases, such as postpartum PE. PE in perinatal stage can be managed referring to nonmaternal PE.
Ipsilateral radial nerve, median nerve, and ulnar nerve injury caused by crush syndrome due to alcohol intoxication
Authors: Zhang Yuan-Wei , Ju Cheng , Ke Xue-Lei , Xiao Xin , Xiao Yan , Chen Xi , Zhang Su-Li , Ge Hong-Yan , Deng Liang
Published: October 2019

Rationale:

Autologous peripheral nerve injury caused by crush syndrome due to alcohol intoxication is relatively rare, and to our knowledge, the compression of 3 upper limb nerves at the same time has not been reported previously. If a compressive peripheral nerve injury is not treated in a timely manner, it is difficult to recover neurological function, and the prognosis is poor.

Patient concerns:

Here, we present a case of a 50-year-old man with ipsilateral radial nerve, median nerve, and ulnar nerve injuries caused by autogenous compression after drunkenness.

Diagnosis:

Electromyography and nerve conduction studies suggested peripheral nerve injury in the left upper limb. The diagnosis was injury to the radial nerve, median nerve, and ulnar nerve in the left upper arm.

Interventions:

Exploratory neurolysis surgery of the radial nerve, median nerve, and ulnar nerve was performed in the left upper arm. Postoperative oral neurotrophic drugs were administered, and functional exercise was performed.

Outcomes:

After timely diagnosis and treatment, the strength of the left upper arm muscle recovered, and the prognosis of neurological function was satisfactory during 3 years of follow-up sessions.

Lessons:

In the treatment of such patients, a comprehensive understanding of their medical history and a strict physical examination should be performed. Combined with neuroelectrophysiological and imaging examination, the diagnosis can be confirmed. After timely diagnosis and treatment, the prognosis is mostly excellent.
Psychological intervention and its immune effect in cancer patients
Authors: Zhang Ping , Mo Lin , Li Xia , Wang Qiyao
Published: October 2019

Objective:

To determine whether psychological intervention (PI) changes the levels of immune indicators in cancer patients.

Methods:

We conducted a systematic search published up to July 2018, followed by a manual search. Randomized controlled trials were included. Two reviewers independently screened and extracted data, which were analyzed using Review manager 5.3.

Results:

Twenty-nine studies were included including four kinds of PI. Only stress management didn’t result in immune changes; only cognitive behavior therapy affect NK cell activity. PI did not change immune indicators on cancer patients who completed therapy. Compared to patients not receiving PI, those received PI had significantly higher NK cell count and activity in whole blood; and serum levels of IL-2, IL-4, IFN-γ, lgA, and lgG. However, the differences in the serum levels of IL-6, IL-10, TNF-α, and IgM were not significant (P > .05), and the changes recorded for the CD3+, CD4+, and CD8+ cell count, and CD4+/CD8+ ratios were inconsistent.

Conclusions:

Although there are considerable evidences of PI's immune effect, but its magnitude was moderate. Therefore, it may be premature to conclude whether PI affects immunity of cancer patients. Further research is warranted, with special focus on the PI types and treatment methods.