bluuebunny/crossref_metadata_2025 huggingface dataset:
Thoracic Extramedullary Hematopoiesis Mimicking Metastatic Cancer
Authors: Ha Duc , Liao Xiaoyan , Wang Huan-You , Jamieson Catriona , Magaña Marisa , Makani Samir
Published: August 2016

Thoracic extramedullary hematopoiesis (EMH) is a rare manifestation in patients with myeloproliferative neoplasm. A 76-year-old woman with a long-standing history of polycythemia vera presented with a 2-month history of worsening dyspnea and left-sided wheezing. A chest computed tomography showed an ill-defined soft tissue mass encasing the left mainstem bronchus causing airway obstruction, associated with paratracheal and paraesophageal lymphadenopathy. Endobronchial ultrasound-guided fine needle aspiration of the soft tissue mass and mediastinoscopy with excisional biopsy of a paratracheal lymph node demonstrated EMH with increased myeloid blasts. A bone marrow biopsy confirmed postpolycythemic myelofibrosis consistent with progression of polycythemia vera to myelofibrosis. We describe the bronchoscopic management of a case of EMH presenting as a mediastinal mass, mimicking malignancy.
CD4/CD8 Ratio in Mediastinal Lymph Nodes Involved by Sarcoidosis
Authors: Ruiz Sory J. , Zhang Yaxia , Mukhopadhyay Sanjay
Published: August 2016

Background:

Despite mixed results in the literature, some clinicians continue to consider an elevated CD4/CD8 ratio in bronchoalveolar lavage (BAL) fluid to be supportive of a diagnosis of sarcoidosis. However, the CD4/CD8 ratio in mediastinal lymph nodes involved by sarcoidosis has not been extensively studied. The primary aim of this study was to evaluate the utility of the CD4/CD8 ratio in mediastinal lymph node aspirates obtained by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for diagnosing sarcoidosis.

Methods:

Our archives were searched for EBUS-TBNAs in which mediastinal lymph node aspirates had been submitted for flow cytometry (n=160). Clinical and pathologic findings in these cases were reviewed retrospectively. Cases were included in the study if they had (1) a clinical diagnosis of sarcoidosis supported by cytopathologic confirmation of non-necrotizing granulomas in EBUS-TBNA–derived lymph node aspirates (23 cases), or (2) a pathologically confirmed non-neoplastic diagnosis other than sarcoidosis (7 cases). Cases that did not fulfil these criteria were excluded (130 cases).

Results:

The CD4/CD8 ratios in mediastinal lymph nodes and BAL fluid were compared. The CD4/CD8 ratio was elevated in mediastinal lymph nodes in 12/23 (52%) cases of sarcoidosis and 3/7 (43%) pathologically confirmed nonsarcoid cases. BAL fluid had been concurrently submitted for flow cytometry in 20/23 cases of sarcoidosis and 5/7 nonsarcoid cases. CD4/CD8 was elevated in BAL fluid in 9/20 (45%) cases of sarcoidosis and 2/5 (40%) nonsarcoid cases.

Conclusion:

As in BAL fluid, the CD4/CD8 ratio in mediastinal lymph nodes involved by sarcoid granulomas is highly variable and does not reliably confirm or exclude sarcoidosis.
Observational Management of CIN 2 in Young Women: A Prospective Multicenter Trial
Authors: Sykes Peter , Innes Carrie , Harker Dianne , Whitehead Martin , van der Griend Rachael , Lawton Beverley , Hibma Merilyn , Fitzgerald Peter , Dudley Narena , Petrich Simone , Faherty Jim , Bergzoll Cecile , Eva Lois , Parker Catherine , Sadler Lynn , Simcock Bryony
Published: August 2016

Objectives

We present the rationale and methods for PRINCess—a multicenter prospective trial—which aims to determine outcome and predictors of regression in a large cohort of women younger than 25 years with cervical intraepithelial neoplasia grade 2 (CIN 2) undergoing observational management.

Materials and Methods

Six hundred women younger than 25 years with newly diagnosed biopsy-proven CIN 2 are being recruited to observational management (i.e., repeat colposcopy, cytology, and cervical biopsy every 6 months for 2 years). Five hundred fifty-two women from throughout New Zealand and 1 site in Australia have been recruited so far. Measures include histology, cytology, human papillomavirus genotyping, and immunohistochemical staining. Women who develop CIN 3 will be treated with large loop excision of the transformation zone. The primary outcomes are rates of clinical regression of CIN 2 (i.e., 2 consecutive colposcopy follow-ups showing CIN 1 or normal), loss to follow-up, and progression to invasion.

Conclusions

The optimal treatment for young women with a diagnosis of CIN 2 is controversial. Although many undergo surgical treatment, observational management is increasingly recommended. However, there is little evidence from large clinical trials of the safety and practicality of observational management of young women with CIN 2. When completed, we will have adequate evidence by which to counsel women regarding their likely outcomes and to offer advice on clinical follow-up protocols.
Human Papillomavirus–Induced Squamous Intraepithelial Lesions in Vulvar Lichen Planus
Authors: Regauer Sigrid , Eberz Barbara , Reich Olaf
Published: August 2016

Objectives

Approximately 50% of vulvar cancers arise after transforming infections with human papilloma virus (HPV) via the precursor squamous intraepithelial lesion (SIL). Lichen planus (LP)–associated vulvar cancers are typically HPV negative and arise via the precursor differentiated vulvar intraepithelial neoplasia (d-VIN).

Methods

An index case of vulvar high-grade squamous intraepithelial lesion (H-SIL) in an LP patient prompted this 12-year retrospective analysis about frequency of HPV-induced SIL in 785 biopsies of 584 patients with vulvar LP. All SIL were analyzed for p53 and p16ink4aoverexpression and for presence of DNA of 32 HPV subtypes.

Results

Nine (1.6%) of 584 women with papular (3) and mucosal “erosive” LP (6) presented with H-SIL (7) and low-grade SIL (2). All SILs harbored HPV16-DNA and showed p16ink4a-overexpression. Concomitant immune suppression included T-suppressor lymphocyte deficit (1), systemic (1), and topical (2) cortisone therapy. H-SILs regressed spontaneously (1) or after imiquimod therapy (3). Three women with erosive LP discontinued imiquimod because of side effects and had laser destruction (1), skinning vulvectomy (1), and surgery (1) for definitive treatment. Two women have recurrent vulvar SILs, and 1 woman progressed to invasive SCC. In the same patient population, 16 of 584 women had a d-VIN, and 9 of 16 with progression to SCC.

Conclusions

H-SILs in vulvar LP are rare and may occur in the setting of risk factors. If clinical suspicion arises, biopsy and histological examination assist in correct etiologic classification of a precancerous lesion and subsequent therapy decisions. The minimal risk for H-SIL development in vulvar LP patients should not preclude therapy of LP.
Role of albumin, starches and gelatins versus crystalloids in volume resuscitation of critically ill patients
Authors: Zazzeron Luca , Gattinoni Luciano , Caironi Pietro
Published: August 2016

Purpose of review

The review focuses on fluid resuscitation of critically ill patients with either colloid or crystalloid solutions.

Recent findings

In healthy patients, the volume expanding effect of colloids is greater than that of crystalloids. However, in critically ill patients, a similar amount of crystalloids and colloids is required for fluid resuscitation, suggesting a lower efficiency of colloids when capillary permeability is increased, and endothelial glycocalyx disrupted. Recent studies on synthetic colloids in surgical patients confirmed the increased risk of renal failure reported in large clinical trials performed in critically ill patients. Experimental studies suggest that albumin maintains plasma volume expansion efficiency even when the capillary permeability is impaired, and that extravasation of albumin to the interstitium is lower than that of hydroxyethyl starch.

Fluid administration should be tailored to patient characteristics. Synthetic colloids should be avoided when possible, especially in patients at risk for kidney injury. In critically ill patients with suspected increased permeability, colloids may not be superior to crystalloids in expanding plasma volume. Albumin appears to be less harmful than synthetic colloids, although its beneficial effects need to be further investigated. The endothelial glycocalyx layer is the key structure finely regulating intravascular fluid distribution.
Chronic pain disorders after critical illness and ICU-acquired opioid dependence: two clinical conundra
Authors: Puntillo Kathleen Ann , Naidu Ramana
Published: August 2016

Purpose of review

Is to describe the potential for patients to undergo an acute-to-chronic pain transition after ICU discharge as a result of pain they experienced in ICU and to explore the phenomenon of ICU-acquired opioid dependence. Both topics are timely, in that they can negatively influence patient recovery after critical illness and contribute to post-ICU syndrome.

Recent findings

Recognizing and treating pain in patients while they are in the ICU has always been important. However, new knowledge increases the importance of good pain management on patient welfare: recent basic science discoveries on mechanisms of chronic pain development; identification of myriad factors, occurring during the patient's hospital and ICU stay, that put patients at risk for development of chronic pain; the view that a multimodal analgesia treatment approach that is opioid sparing may be the optimum method for acute pain management. Furthermore, recent findings about ICU-acquired opioid dependence provide a foundation for promoting more rigorous assessment, prevention, and treatment of opioid withdrawal in ICU patients.

Providing sufficient analgesia to ICU patients while preventing opioid dependence and withdrawal is essential to promote comfort and rehabilitation. Obtaining this balance requires heightened ICU clinician attention and focused research.
Use of complementary and alternative medicine in Swedish patients with inflammatory bowel disease: a controlled study
Authors: Oxelmark Lena , Lindberg Annelie , Löfberg Robert , Sternby Berit , Eriksson Anders , Almer Sven , Befrits Ragnar , Fossum Bjöörn , Karlén Per , Broström Olle , Tysk Curt
Published: August 2016

Background

There is an increasing interest in complementary and alternative medicine (CAM) in patients with chronic diseases, including those with inflammatory bowel disease (IBD). Patients may turn to CAM when conventional therapies are inadequate or associated with side effects for symptomatic relief or to regain control over their disease. The objectives were to explore CAM use and perceived effects in IBD patients in comparison with a control group.

Methods

A cross-sectional, multicenter, controlled study was carried out. IBD patients were invited from 12 IBD clinics in Sweden. Controls were selected randomly from a residence registry. A study-specific questionnaire was used for data collection.

Results

Overall, 48.3% of patients with IBD had used some kind of CAM during the past year compared with 53.5% in controls (P=0.025, adjusted for age, sex, geographic residence, and diet). The most frequently used CAM among IBD patients was massage (21.3%), versus controls (31.4%) (adjusted P=0.0003). The second most used CAM was natural products, 18.7% in IBD patients versus 22.3% of the controls (unadjusted P=0.018). In all, 83.1% of the patients experienced positive effects from CAM and 14.4% experienced negative effects.

Conclusion

Overall, 48.3% of Swedish IBD patients used some kind of CAM and controls used CAM significantly more. Natural products were used by one-fifth of the patients and even more by controls. This is notable from a patient safety perspective considering the possible risks of interactions with conventional medication. In all, 40% of the patients reported adverse events from conventional medicine. Patients experienced predominantly positive effects from CAM, and so did controls.
Detection of molecular bacterascites in decompensated cirrhosis defines a risk with decreased survival
Authors: Engelmann Cornelius , Krohn Sandra , Prywerek Delia , Hartmann Jan , Herber Adam , Boehlig Albrecht , Zeller Katharina , Boehm Stephan , Berg Thomas
Published: August 2016

Background

The prognostic relevance of bacterial DNA (bactDNA) detection in ascitic fluid of patients with cirrhosis is still under debate. Using quantitative real-time PCR with broad-range primers targeting the V3 and V4 variable region of the 16S rRNA gene, we measured bactDNA concentrations in patients with and without leukocytic ascites and evaluated the impact on short-term survival.

Patients and methods

Ascites samples from 173 patients with decompensated cirrhosis were consecutively collected between February 2011 and December 2012. BactDNA-positive ascites samples were sequenced and chromatograms were identified using RipSeq. Clinical data collection and survival analyses were carried out retrospectively and correlated with ascites bactDNA levels.

Results

BactDNA was detected qualitatively with a similar frequency in both nonleukocytic and leukocytic ascites [40% (57/144) and 43.5% (10/23), respectively; P=0.724]. However, the median bactDNA level was significantly higher in leukocytic ascites than in nonleukocytic ascites (1.2×104 vs. 5.7×102 copies/ml; P=0.008). Patients’ survival was associated significantly with bactDNA level. The 30-day and 180-day survival was reduced if bactDNA was above the quantification limit of 520 copies/ml (84 and 63% vs. 72 and 43%, respectively; P<0.05) and worst if bactDNA was above 5000 copies/ml. The bacterial spectrum was dominated by Gram-positive strains as shown by direct sequencing.

Conclusion

BactDNA quantification in ascitic fluid samples using culture-independent 16S rRNA gene-based methods seems to be an interesting approach to identify patients at risk of reduced survival. Our study warrants further evaluation of antibiotic treatment in patients with molecular bacterascites.
Novel B-cell subsets in atherosclerosis
Authors: Douna Hidde , Kuiper Johan
Published: August 2016

Purpose of review

The number of deaths associated with cardiovascular disease remains high, despite great advances in treating the associated high levels of cholesterol. The main underlying pathology of cardiovascular disease is atherosclerosis, which is recognized as a chronic autoimmune-like inflammatory disease. Hence, there is a pressing need to shed light on the immune pathways associated with atherosclerosis. B cells have long been thought to have a general protective effect in atherosclerosis. However, findings in the last decade have challenged this paradigm, showing that it is crucial to differentiate between the various B-cell subsets when assessing their role/effect on atherosclerosis.

Recent findings

It has become increasingly recognized lately that B cells can have significant effects on the immune system independent of antibody production. The understanding that B cells form a major source of cytokines and can directly influence T-cell responses via surface markers, have led to the identification of novel B-cell subsets. These subsets are important modulators of autoimmune disorders but have not yet been fully investigated in atherosclerosis.

Here we review the current known roles of B-cell subsets and the putative effects of recently identified B cells on atherosclerosis.
Neuropsychological functioning and health-related quality of life in pediatric liver disease: the sum of our perspectives is greater than each alone
Authors: Sorensen Lisa G.
Published: August 2016

Purpose of review

The review will discuss current data on neuropsychological and health-related quality of life (HRQOL) outcomes in children with liver disease. Research has trickled in over the past 30 years, mostly in small, single-center studies with observational or retrospective design. As medical treatment has advanced, survival has improved dramatically, with the majority now living into adulthood. The focus is shifting toward more systematic exploration of functional outcomes.

Recent findings

Contemporary cohorts provide evidence for increased prevalence of IQ deficits despite overall average means in children with end-stage liver disease and long after transplant. Recent studies explore specific neurocognitive domains and populations, such as pediatric acute liver failure and metabolic disorders. HRQOL is reduced in pediatric liver transplant recipients, even years later. Current research examines HRQOL in pediatric acute liver failure, infants with chronic liver disease, and specific diseases. A major psychosocial concern is the transition from pediatric to adult care, and the challenges in assessing transfer readiness.

As research in functional outcomes becomes more sophisticated (more prospective, controlled, and multisite studies), richer data are available. The most comprehensive understanding of how children with liver disease fare is achieved by integrating perspectives into one picture painted by many.
The development of moral sense and moral thinking
Authors: Carpendale Jeremy I.M. , Hammond Stuart I.
Published: August 2016

Purpose of review

The review critically evaluates recent claims that infants have innate knowledge of morality and examines the sources of moral norms.

Recent findings

Many studies show that toddlers readily help adults with daily tasks. A more contentious set of studies suggests that young infants prefer actors who help others to those who hinder them. Some researchers have interpreted these findings as indicating that morality is innately present in humans. Others look to alternative explanations in developmental systems theory.

Explaining the emergence of morality as innate, or wholly socialized, is problematic; instead morality could emerge in a developmental system in which children's early capacities are shaped by interpersonal engagement. Children's improving ability to coordinate with others at a practical level is later transformed through language and reflective thought, as children gain the ability to talk about what was previously implicit in interaction. Throughout, parents and caregivers have many opportunities to foster children's moral development in daily interactions.
Lack of Utility of Anti‐tTG IgG to Diagnose Celiac Disease When Anti‐tTG IgA Is Negative
Authors: Absah Imad , Rishi Abdul R. , Gebrail Rami , Snyder Melissa R. , Murray Joseph A.
Published: August 2016

Objectives:

Guidelines for diagnosing celiac disease (CD) recommend initial testing with a highly sensitive serologic test for anti–tissue transglutaminase immunoglobulin A antibodies (tTG IgA). When the probability of CD is high, IgA deficiency should be considered. The 2 approaches to address this include measuring “both tTG IgA and tTG IgG” or measuring “total IgA.” We aim to assess the utility of an isolated positive tTG IgG result in diagnosing CD.

Methods:

We conducted a retrospective review of patients undergoing serologic testing for CD from January 1997 to June 2014. Patients with positive tTG IgG and negative tTG IgA were included. Moreover, all patients who had any other positive CD‐specific serologic findings were excluded. Demographics, clinical presentation, tests, and biopsy results were recorded.

Results:

The indication for checking celiac serology was gastrointestinal symptoms in 172 of 233 patients, iron deficiency anemia in 12, and high‐risk screening in 48. Small bowel biopsy was performed in 178 patients (77%); 160 had normal results and 18 had histologic changes suggestive of enteropathy. Nine patients had increased intraepithelial lymphocytes, and 9 had partial villous atrophy. Only 6 cases of CD were, however, confirmed. The utility of isolated tTG IgG in diagnosis of CD was low at 3% (6/178).

Conclusion:

In this cohort of patients, the utility of isolated tTG IgG in diagnosing CD was low at 3%.
Comparison of Patients’ and Doctors’ Reports on Health‐related Quality of Life in Celiac Disease
Authors: Vriezinga Sabine L. , Farih Nora , van der Meulen‐de Jong Andrea E. , Putter Hein , Rings Edmond H.H.M. , Schaart Maaike W. , Schweizer Joachim J. , Wessels Margreet M.S. , Mearin M. Luisa
Published: August 2016

Objective:

To investigate whether implementation of a celiac disease (CD)–specific health‐related quality of life (HRQOL) questionnaire would add value to CD follow‐up visits; we compared patients’ self‐reported CD‐specific HRQOL with the physician's report provided during a regular CD follow‐up visit in children and young adults.

Methods:

A cross‐sectional study in the control group of a study on self‐management in CD (CoelKids). Eligible patients had CD for ≥1 year and were 25 years or younger. They completed a CD‐specific HRQOL questionnaire (CDDUX) after their regular follow‐up visit. Their physicians were unaware of the present study's objectives or self‐reported HRQOL. Primary outcome: agreement between physician‐reported and self‐reported HRQOL. Secondary outcomes: patient variables predicting a discrepancy between reports, or a lower HRQOL.

Results:

Physician‐reported HRQOL was available in 70 of 78 enrolled patients. The self‐reported and physician‐reported HRQOL were concordant in 30 of 70 (K = 0.093), 6 of them had a poor self‐reported HRQOL. Reports were discrepant in 40 of 70; all 40 self‐reported a poor HRQOL. Discrepancies occurred more frequently in patients with a disease duration <9 years (32/40 with discrepant reports were diagnosed <9 years ago vs 17/30 with no discrepancy, P<0.001) and in females (35/40 with discrepant reports were girls versus 16 of 30 with no discrepancy, P = 0.001). Both factors were predictors of a poorer HRQOL.

Conclusions:

During regular CD follow‐up visits, physicians did not report a poor HRQOL in 40 of 46 children and young adults with a poor self‐reported HRQOL. This is consistent with previous studies examining other chronic diseases and supports the implementation of self‐reported CD‐specific HRQOL measurements in CD follow‐up visits.
Validity of the Johns Hopkins Fall Risk Assessment Tool for Predicting Falls on Inpatient Medicine Services
Authors: Klinkenberg W. Dean , Potter Patricia
Published: August 2016

The Johns Hopkins Fall Risk Assessment Tool (JHFRAT) is widely used but few studies have examined its psychometric properties. We examined the predictive validity of the JHFRAT for 13 574 patient admissions to medicine units at a large academic medical center in 2014. There were 204 patient falls reported. While patients who fell had higher JHFRAT total scores, a majority of patients who fell were classified by the JHFRAT as moderate or low risk.
Development and Psychometric Analysis of a Nurses' Attitudes and Skills Safety Scale
Authors: Armstrong Gail E. , Dietrich Mary , Norman Linda , Barnsteiner Jane , Mion Lorraine
Published: August 2016

Health care organizations have incorporated updated safety principles in the analysis of errors and in norms and standards. Yet no research exists that assesses bedside nurses' perceived skills or attitudes toward updated safety concepts. The aims of this study were to develop a scale assessing nurses' perceived skills and attitudes toward updated safety concepts, determine content validity, and examine internal consistency of the scale and subscales. Understanding nurses' perceived skills and attitudes about safety concepts can be used in targeting strategies to enhance their safety practices.
Psychiatric Disorders and Predictors Hereof Among Refugee Children in Early Adulthood
Authors: Barghadouch Amina , Carlsson Jessica , Norredam Marie
Published: August 2016

Studies show a high level of mental health problems among refugee children and adults. This study aimed to examine psychiatric disorders among refugee children in early adulthood. A total of 15,264 young adult refugees, who obtained residence permission January 1, 1993 to December 31, 2010, were matched 1:6 on age and sex with 99,313 Danish-born children. Rate ratios (RR) of having a first-time in- or outpatient hospital diagnosis with an affective (F30–39), psychotic (F29–30), neurotic (F40–48), or any psychiatric disorder (F00–99) according to ICD-10 were computed. Refugees had higher RRs of psychotic (RR: 1.81, 95%CI: 1.41–2.32) and nervous (RR: 1.28, 95% CI: 1.14–1.43) disorders compared with Danish-born children. The RRs of having an affective disorder among refugees was 0.74 (95% CI: 0.60–0.90) compared with Danish-born children. Sex, geographical origin, migrant status, household income, age at residence permission, and accompanied/unaccompanied arrival predicted psychiatric contacts among refugees. A focus on both prevention and treatment in vulnerable groups is needed.
The Null Effect of Chewing Gum During Hemodialysis on Dry Mouth
Authors: Duruk Nazike , Eşer Ismet
Published: August 2016

Aims and Objectives:

The study was conducted to determine the effect of chewing gum during hemodialysis on dry mouth and its symptoms.

Background:

The imposition of fluid restriction and the use of medications that reduce saliva production may lead to dry mouth.

Design:

This study is a randomized, controlled, single-blind, crossover experimental study.

Methods:

The subjects consisted of 61 hemodialysis patients recruited from 4 dialysis centers in southern Turkey. The data were collected using a Patient Identification Form, a Form for Assessing the Symptoms of Dry Mouth, and a Patient Follow-up Form. Saliva samples were obtained for analysis of flow rates.

Results:

The salivary flow rates of the patients increased during the first hour on the day when gum was chewed, and this increase was statistically significant. However, no significant difference was found between the salivary flow rates at the 0- and 4-hour time points on the day when gum was chewed (P > .05). In addition, the salivary pH values were in the normal range on both days, although the pH values tended to be more acidic on the day when gum was not chewed.

Conclusions:

Overall, it was found that chewing gum for 15 minutes each hour during a hemodialysis session did not increase the saliva amount, maintain the pH value of the saliva within a normal range, or control dry mouth symptoms.
Brain Injury Vision Symptom Survey (BIVSS) Questionnaire
Authors: Laukkanen Hannu , Scheiman Mitchell , Hayes John R.
Published: August 2016

Purpose

Validation of the Brain Injury Vision Symptom Survey (BIVSS), a self-administered survey for vision symptoms related to traumatic brain injury (TBI).

Methods

A 28-item vision symptom questionnaire was completed by 107 adult subjects (mean age 42.1, 16.2 SD, range 18–75) who self-reported as having sustained mild-to-moderate TBI and two groups of reference adult subjects (first-year optometry students: mean age 23.2, 2.8 SD, range 20–39; and 71 third-year optometry students: mean age 26.0, 2.9 SD, range 22–42) without TBI. Both a Likert-style method of analysis with factor analysis and a Rasch analysis were used. Logistic regression was used to determine sensitivity and specificity.

Results

At least 27 of 28 questions were completed by 93.5% of TBI subjects, and all 28 items were completed by all of the 157 reference subjects. BIVSS sensitivity was 82.2% for correctly predicting TBI and 90.4% for correctly predicting the optometry students. Factor analysis identified eight latent variables; six factors were positive in their risk for TBI. Other than dry eye and double vision, the TBI patients were significantly more symptomatic than either cohort of optometry students by at least one standard deviation (p < 0.001). Twenty-five of 28 questions were within limits for creating a single-dimension Rasch scale.

Conclusions

Nearly all of the adult TBI subjects were able to self-complete the BIVSS, and there was significant mean score separation between TBI and non-TBI groups. The Rasch analysis revealed a single dimension associated with TBI. Using the Likert method with the BIVSS, it may be possible to identify different vision symptom profiles with TBI patients. The BIVSS seems to be a promising tool for better understanding the complex and diverse nature of vision symptoms that are associated with brain injury.
Tear Lipid Layer Thickness Change and Topical Anti-Glaucoma Medication Use
Authors: Lee Sang Yeop , Lee Hun , Bae Hyoung Won , Kim Tae-im , Kim Chan Yun
Published: August 2016

Purpose

To investigate the effects of topical anti-glaucoma medications on tear lipid layer thickness (LLT) and the ocular surface.

Methods

This retrospective study examined ocular surface disease (OSD) subjects who had (n = 34) and who did not have (n = 51) open-angle glaucoma (OAG). OSD was evaluated with lipid layer thickness (using LipiView interferometer), tear breakup time (TBUT), total corneal and conjunctival staining (Oxford grading scale), and Ocular Surface Disease Index (OSDI). Four variables (total duration of anti-glaucoma medication use, duration of current anti-glaucoma medication use, total number of daily anti-glaucoma medication drops applied, and total number of anti-glaucoma medications [bottles]) related to anti-glaucoma medication were used to verify associations with LLT.

Results

Among the parameters, only LLT showed significantly lower values in the OAG group. In both groups, total staining showed a significant negative correlation between LLT and TBUT. Only in the OAG group, the OSDI showed significant correlations with number of medications (r = 0.389, p = 0.012) and daily number of drops (r = 0.354, p = 0.02); LLT showed significant correlations with TBUT (r = 0.381, p = 0.026) and total medication duration (r = −0.387, p = 0.013). In multivariate analyses, TBUT and total medication duration showed significant correlations with LLT (p = 0.032 and p = 0.015, respectively) in the OAG group.

Conclusions

Topically medicated OAG subjects with OSD had a lower tear LLT than those with OSD who did not have OAG. Therefore, our results indicate that one should evaluate ocular surface disease status in patients who take anti-glaucoma medications.
Parafibromin, APC, and MIB-1 Are Useful Markers for Distinguishing Parathyroid Carcinomas From Adenomas
Authors: Hosny Mohammed Kareem , Siddiqui Momin T. , Willis Brian C. , Zaharieva Tsvetkova Dobromira , Mohamed Amr , Patel Snehal , Sharma Jyotirmay , Weber Collin , Cohen Cynthia
Published: August 2016

Background:

Differentiation of parathyroid carcinoma (PC) from parathyroid adenoma (PA) relies solely on the pathologic determination of invasion of surrounding structures and/or distant metastasis. Parathyroid lesions with atypical histologic features with no demonstration of invasion or metastasis present a diagnostic dilemma. Different authors report a parafibromin and adenomatous polyposis coli (APC) loss or reduction in PC cases. High proliferative activity of MIB-1 and increased galectin 3 expression are reported in PC. There is no clear cutoff for the sensitivity, specificity, or predictive value for all these markers.

Methods:

The immunohistochemical expression of parafibromin, APC, MIB-1, and galectin 3 was studied in 73 adenomas, 21 PCs, and 3 atypical adenomas. The presence or absence of each marker was identified through the use of a comprehensive scoring system based on multiplying the percentage of tumor cells stained (0 to 100) and the staining intensity (0 to 3) on each biopsy. The highest score that any slide could reach was 300. A cutoff of >100 was used to consider the specimen positive for parafibromin, APC, or galectin 3 staining. MIB-1 proliferation indices were calculated using image cytometry; proliferation indices >5% were considered positive.

Results:

We identified parafibromin loss in 7/21 (33%) carcinomas and 1/73 (1%) adenomas. Loss of APC was seen in 20/21 (95%) carcinomas and 38/73 (52%) adenomas. MIB-1 indices were elevated in 18/21 (86%) carcinomas. MIB-1 indices were <5% in all (100%) adenomas. MIB-1 indices were elevated in 2/3 (67%) atypical adenomas.

Conclusions:

Our study presents a clear cutoff to determine the practicality of using parafibromin, APC, and MIB-1 as immunohistochemical markers to differentiate between PCs and PAs. Loss of parafibromin and a high MIB-1 index are both independently sensitive and specific markers for the diagnosis of PC. Loss of APC was only specific for PC. This panel of markers provides a novel, useful approach in the diagnosis and differentiation of PCs from PAs.
Factors Associated With Detection of Helicobacter pylori in Gastric Biopsies: A Case-Control Study of 396 Biopsies
Authors: Yang Yu , Xiong Wei , Wang Shiyu , Xu Jie , McNutt Michael A. , Zhang Lanjing
Published: August 2016

Aim of the Study:

Helicobacter pylori (HP) infection is associated with significant gastric mucosal inflammation. We aimed to determine the clinicopathologic features associated with HP in gastric biopsy.

Methods and Results:

Three hundred ninety-six gastric biopsies were evaluated including 165 HP-positive cases and 231 randomly selected HP-negative controls. HP was detected using hematoxylin and eosin (H&E), Giemsa, and immunohistochemistry staining. The univariate and multivariate analyses were conducted to study the relationship of clinicopathologic characteristics and HP infection. Among the HP-positive cases, 131 cases were confirmed by H&E staining and 34 cases were confirmed by Giemsa or immunohistochemistry staining. Compared with chronic inactive gastritis, chronic active gastritis was more likely associated with having HP detected by H&E. Males were more likely to have HP gastritis than females (odds ratio: 1.72, P=0.01). The patients who had chronic active gastritis or chronic gastritis (moderate or severe) were more likely to have HP infection than patients with mild chronic gastritis (P<0.001). Conversely, patients who had intestinal metaplasia were less likely to have HP infection than patients without intestinal metaplasia (odds ratio: 0.22, P<0.001). However, concurrent atrophic gastritis was not related to HP infection (P=0.37). HP infection history was not associated with HP infection (P=0.74).

Conclusions:

HP detection in gastric biopsies is associated with active inflammation, male sex, and the lack of intestinal metaplasia, but not atrophic gastritis or HP infection history. Routine ancillary staining may not be required for HP detection in all biopsy specimens. We do not recommend ancillary staining for mild chronic inactive gastritis.
CD44 Immunoexpression is Unfavorable Predictor in Ovarian Serous Cancer
Authors: Karan Križanac Dragana , Krasić Arapović Antonela , Skočibušić Siniša , Pintarić Irena , Trgo Gorana , Tomić Snježana
Published: August 2016

The aim of this study was to clarify the clinical role of CD44 expression in ovarian serous cancer, and its relation to clinicopathologic prognostic factors, disease free survival and overall survival (OS). Immunohistochemical staining for CD44 was performed on 81 formalin-fixed, paraffin-embedded tumor sections. CD44 expression was found in 43% of ovarian carcinoma samples. Correlations between categorical variables were studied using the χ2 and the Mann-Whitney U test. For survival analysis, the Kaplan-Meier method, the log-rank test and the Cox proportional hazard regression model were used. We did not find any statistically significant difference in the distribution of respondents according to clinical stage of the disease, tumor grade or the presence of vascular invasion in relation to the expression of CD44. According to the results of uninominal analysis, early International Federation of Gynecology and Obstetrics (FIGO) stage of the disease (P=0.003) was associated with longer disease free survival, while the expression of CD44 (P<0.001), FIGO stage III and IV (P=0.009) and the finding of vascular invasion (P=0.005) was related to a shorter OS. In conclusion, we proved that positive CD44 immunoexpression is a independent prognostic indicator of shorter OS of patients with ovarian serous cancer.
Mesenteric Arteriovenous Dysplasia/Vasculopathy Is Distinct From Fibromuscular Dysplasia
Authors: Patil Deepa T. , Kissiedu Juliana , Rodriguez E. Rene , Downs-Kelly Erinn , Liu Xiuli , Rybicki Lisa A. , Tan Carmela D.
Published: August 2016

Fibromuscular dysplasia (FMD) is a noninflammatory, nonatherosclerotic vasculopathy that usually affects the carotid and renal arteries. We have observed FMD-like vascular changes in specimens resected for ischemia or Crohn’s disease (CD). On the basis of a systematic clinicopathologic review of these 11 cases identified between 1982 and 2014, we describe a distinct mesenteric vasculopathy that involves both arteries and veins [mesenteric arteriovenous dysplasia/vasculopathy (MAVD/V)] and is characterized by (1) concentric/eccentric smooth muscle collarette around the tunica media of both the artery and the vein in ≥2 foci, (2) varying degrees of intimal and medial hyperplasia and adventitial fibrosis, and (3) lack of inflammation or thrombi. MAVD/V cases were clinically diagnosed as CD (45%), mass/lesion (27%), ischemia (9%), obstruction (9%), or rectal prolapse (9%). Abdominal pain for >1 year was the most common symptom. Most patients were women (M:F=1:2.7; mean age, 63 y). Mucosal changes mimicking CD, such as architectural distortion (55%), multifocal ulcers (73%), and pyloric gland metaplasia (64%), were common; however, no granulomas or transmural lymphoid aggregates were identified. Ischemic pattern of injury was seen in 4 cases. Upon follow-up (mean, 31.2 mo), 8 patients were found to be asymptomatic, 2 had died of unrelated causes, and 1 was lost to follow-up. We propose the name MAVD/V for a distinct noninflammatory, nonatherosclerotic, localized form of mesenteric vasculopathy that involves both arteries and veins, distinct from FMD. Unlike FMD, surgical resection appears to be curative, with a favorable clinical outcome. Awareness of this vascular entity is important as patients may be potentially misdiagnosed as having CD and ischemic bowel disease.
Interobserver Reproducibility of Percent Gleason Pattern 4 in Prostatic Adenocarcinoma on Prostate Biopsies
Authors: Sadimin Evita T. , Khani Francesca , Diolombi Mairo , Meliti Abdelrazak , Epstein Jonathan I.
Published: August 2016

In the WHO Classification of Tumours of the Urinary System and Male Genital Organs published in 2016, it was officially recommended that the percent of Gleason pattern 4 (GP4) be reported on pathology reports to better reflect the extent in Gleason score 7 tumors. In this study we assessed the reproducibility of reporting GP4 on prostate biopsies. We analyzed prospectively 422 cores containing GP4 from our consult cases over a period of 2.5 months. The percent pattern 4 was assigned to all the cases in 10% increments from 0% to 100% (with the addition of 5%) by 1 of 4 fellows in urological pathology and by the expert urological pathologist. Out of 422 cores, 32% were an exact match and 75% were within ±10% (weighted κ [κW] value 0.67). Cases were further stratified on the basis of (1) scattered versus clustered GP4 in the background of Gleason pattern 3, (2) continuous versus discontinuous tumor involvement, (3) cribriform/glomeruloid pattern only versus poorly formed/fused pattern versus mixed cribriform and poorly formed/fused pattern, and (4) total tumor involvement of the core (≤10% vs. >10% of the core). No significant differences were observed in the first 3 variables. However, in cases with ≤10% involvement of the core, 61% were within ±10% (κW=0.50) compared with cases with >10% involvement of the core, in which 78% were within ±10% (κW=0.70). In summary, we showed that assessment of percent GP4 was relatively reproducible, with substantial agreement within ±10% in cases. However, with <10% involvement of the core, it was more difficult to assess in smaller foci, with only moderate agreement. Given that in a small focus only a few glands of a given pattern can markedly affect the percent GP4, consideration should be given to not recording percent GP4 in small foci of Gleason score 7 tumors on needle biopsy.
Cardiopulmonary Bypass-Induced Inflammatory Response: Pathophysiology and Treatment
Authors: Bronicki Ronald A. , Hall Mark
Published: August 2016

Objectives:

The objectives of this review are to discuss the pathophysiology of the pro-inflammatory response to the cardiopulmonary bypass circuit, the impact of ischemia reperfusion injury on post-operative organ function, the compensatory anti-inflammatory response and the evidence for immune-modulatory strategies and their impact on outcomes.

Data Source:

MEDLINE, PubMed.

Conclusion:

Innovations such as the development of more biocompatible surfaces and miniaturized circuits, as well as the increasing expertise of surgeons, anesthesiologists and perfusionists has transformed cardiac surgery and the use of cardiopulmonary bypass into a relatively routine procedure with favorable outcomes. Despite these refinements, the attendant inflammatory response to bypass, ischemia reperfusion injury and the compensatory anti-inflammatory response contribute to post-operative morbidity and mortality. Additional studies are needed to further delineate the impact of immunomodulatory strategies on outcomes.
Biomarkers in Pediatric Cardiac Critical Care
Authors: Domico Michele , Allen Meredith
Published: August 2016

Objectives:

In this review, we discuss the physiology, pathophysiology, and clinical role of troponin, lactate, and B-type natriuretic peptide in the assessment and management of children with critical cardiac disease.

Data Source:

MEDLINE, PubMed.

Conclusion:

Lactate, troponin, and B-type natriuretic peptide continue to be valuable biomarkers in the assessment and management of critically ill children with cardiac disease. However, the use of these markers as a single measurement is handicapped by the wide variety of clinical scenarios in which they may be increased. The overall trend may be more useful than any single level with a persistent or rising value of more importance than an elevated initial value.
Near Infrared Spectroscopy as a Hemodynamic Monitor in Critical Illness
Authors: Ghanayem Nancy S. , Hoffman George M.
Published: August 2016

Objectives:

The objectives of this review are to discuss the technology and clinical interpretation of near infrared spectroscopy oximetry and its clinical application in patients with congenital heart disease.

Data Source:

MEDLINE and PubMed.

Conclusion:

Near infrared spectroscopy provides a continuous noninvasive assessment of tissue oxygenation. Over 20 years ago, near infrared spectroscopy was introduced into clinical practice for monitoring cerebral oxygenation during cardiopulmonary bypass in adults. Since that time, the utilization of near infrared spectroscopy has extended into the realm of pediatric cardiac surgery and is increasingly being used in the cardiac ICU to monitor tissue oxygenation perioperatively.
Risk Factors of Acute Kidney Injury in Critically Ill Children*
Authors: Slater Morgan B. , Gruneir Andrea , Rochon Paula A. , Howard Andrew W. , Koren Gideon , Parshuram Christopher S.
Published: August 2016

Objectives:

Acute kidney injury may be promoted by critical illness, preexisting medical conditions, and treatments received both before and during ICU admission. We aimed to estimate the frequency of acute kidney injury during ICU treatment and to determine factors, occurring both before and during the ICU stay, associated with the development of acute kidney injury.

Design:

Cohort study of critically ill children.

Setting:

University-affiliated PICU.

Patients:

Eligible patients were admitted to the ICU between January 2006 and June 2009. We excluded those admitted with known primary renal failure, chronic renal failure or postrenal transplant, conditions with known renal complications, or metabolic conditions treated with dialysis. Patients were also excluded if they had a short ICU stay (< 6 hr) and those who had no creatinine or urine output measurements during their ICU stay.

Interventions:

None.

Measurements and Main Results:

Of the 3,865 pediatric patients who met the inclusion criteria, 915 (23.7%) developed acute kidney injury, as classified by the Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease criteria, during their ICU stay. Patients at high risk for development of acute kidney injury included those urgently admitted to the ICU (adjusted odds ratio, 1.88), those who developed respiratory dysfunction during their ICU care (adjusted odds ratio, 2.90), and those who treated with extracorporeal membrane oxygenation (adjusted odds ratio, 2.72). The single greatest risk factor for acute kidney injury was the administration of nephrotoxic medications during ICU admission (adjusted odds ratio, 3.37).

Conclusions:

This study, the largest evaluating the incidence of RIFLE-defined acute kidney injury in critically ill children, found that one-quarter of patients admitted to the ICU developed acute kidney injury. We identified a number of potentially modifiable risk factors, the largest of which was the administration of nephrotoxic medication. The results of this study may be used to inform targeted interventions to reduce acute kidney injury and improve the outcomes of critically ill children.
Impact of Chest Radiography on Antibiotic Treatment for Children With Suspected Pneumonia
Authors: Nelson Kyle A. , Morrow Christopher , Wingerter Sarah L. , Bachur Richard G. , Neuman Mark I.
Published: August 2016

Objective

National guidelines discourage routine chest radiographs (CXRs) to confirm suspected pneumonia in children managed as outpatients. However, limiting CXRs may lead to antibiotic overuse. We examined the impact of CXRs and clinical suspicion on antibiotic treatment for children with suspected pneumonia.

Methods

Children aged 3 months to 18 years undergoing CXR for suspected pneumonia in a pediatric emergency department were prospectively enrolled. Before CXR, physicians indicated their initial plan for antibiotics (yes or no) and clinical suspicion for radiographic pneumonia (<5%, 5–10%, 11–20%, 21–50%, 51–75%, >75%). Subjects had radiographic pneumonia if their CXRs demonstrated definite or possible findings of pneumonia. We compared antibiotic treatment according to pre-CXR antibiotic plan and suspicion for pneumonia and CXR results.

Results

Among the 107 children with a plan for antibiotics before CXR, 72% ultimately received antibiotics compared with 19% of the 1503 children without a pre-CXR plan for antibiotics (P < 0.001). Among those patients with a pre-CXR plan for antibiotics, 96% of children with radiographic pneumonia were ultimately treated compared with 54% without radiographic pneumonia (P < 0.001). If antibiotics were not initially planned, 37% with radiographic pneumonia were treated compared with 8% without radiographic pneumonia (P < 0.001). The use of CXR was more likely to influence antibiotic prescribing patterns when the clinical suspicion of pneumonia was low (<20%).

Conclusions

Among children with high suspicion for pneumonia, CXRs infrequently altered the initial plan for antibiotics. However, when clinical suspicion for pneumonia was low, the use of CXR may reduce unnecessary antibiotic use.
Point-of-Care Ultrasound to Assess Anuria in Children
Authors: Steimle Matthew D. , Plumb Jennifer , Corneli Howard M.
Published: August 2016

Anuria in children may arise from a host of causes and is a frequent concern in the emergency department. This review focuses on differentiating common causes of obstructive and nonobstructive anuria and the role of point-of-care ultrasound in this evaluation. We discuss some indications and basic techniques for bedside ultrasound imaging of the urinary system.
Emergency Department Point-of-Care Hip Ultrasound and Its Role in the Diagnosis of Septic Hip Arthritis
Authors: Garrison Jessica , Nguyen Margaret , Marin Jennifer R.
Published: August 2016

We present a case of an 11-year-old girl with eye swelling and hip pain and the use of point-of-care hip ultrasound (US) to facilitate diagnosis of a septic hip. We review the US technique, sonographic findings, and relevant literature regarding point-of-care hip US.