bluuebunny/crossref_metadata_2025 huggingface dataset:
Does pigtail catheters relieve pneumothorax?
Authors: Fang Ming , Liu Guilin , Luo Guoliang , Wu Tianyu
Published: November 2018

Background:

Pigtail catheter drainage has been usually applied for the treatment of pleural effusion and pneumothorax. Our aim was to investigate the application and efficacy of pigtail catheters for pneumothorax.

Methods:

We carried out a meta-analysis of retro- or pro-spective studies addressing the effect of pigtail catheters for pneumothorax. We presented success rates of pigtail catheter drainage as primary outcomes, and considered the duration of drainage, and complication rates as secondary outcomes. Pooled data were available using the fixed or random effects model. Heterogeneity, sensitivity, and subgroup analyses were performed.

Results:

The meta-analysis was based on 16 articles with a total of 1067 patients. Our analyses showed that pooled success rates were 0.77 (0.71–0.82), )furthermore, duration of drainage was 5.61 (3.99–7.23), and complication rates 0.18 (0.09–0.27). Subgroup results according to causes of pneumothorax and patient characteristics were robust and all consistent with overall outcomes.

Conclusion:

These suggested that pigtail catheter insertion within radiological guidance may provide a safe and effective way for the treatment of pneumothorax. More large-scale and prospective studies were required to determine these findings.
A comparison of shoulder muscular performance and lean mass between elite and recreational swimmers
Authors: Cheung Arthur T.H. , Ma Ada W.W. , Fong Shirley S.M. , Chung Louisa M.Y. , Bae Young-Hyeon , Liu Karen P.Y. , Kam Kevin W.K. , Chung Joanne W.Y.
Published: November 2018

This study compared the shoulder muscular performance and lean mass between elite and recreational swimmers.

Thirty elite swimmers (mean age ± standard deviation = 23.1 ± 3.5 years) and 21 recreational swimmers (mean age ± standard deviation = 20.8 ± 2.1 years) participated in the study. Maximum muscle strength and time to maximum muscle strength of shoulder flexor, extensor, abductor, and adductor muscles were measured using a handheld dynamometer. Lean mass of the arms and body (excluding the head) were measured using dual-energy x-ray absorptiometry (DXA).

Results revealed that compared with recreational swimmers, elite swimmers had higher maximum muscle strength of the shoulder flexor, extensor, abductor, and adductor muscles (allP < .001). The time to reach maximum muscle strength of all shoulder muscles showed no significant difference between the 2 groups (P > .05). The lean mass values in the left arm (P = .037), right arm (P < .001), and whole body (P = .014) were higher in elite swimmers than recreational swimmers.

Elite swimmers had greater shoulder maximum muscle strength compared with recreational swimmers though the time taken to reach maximum muscle strength was similar between the 2 groups. Elite swimmers also showed a higher lean mass in both arms and their entire body when compared with recreational swimmers. The results may be useful for recreational swimmers who intend to advance to professional level, and for talent identification and early development of elite swimmers.
Association of smoking with risk of stroke in middle-aged and older Chinese
Authors: Gan Yong , Wu Jiang , Li Liqing , Zhang Shengchao , Yang Tingting , Tan Shuran , Mkandawire Naomie , Zhong Yanyan , Jiang Jie , Wang Zhihong , Lu Zuxun
Published: November 2018

Although the impacts of smoking on health are well established, it is unclear on how they affect the Chinese population aged ≥40 years. This study aimed to investigate the association between smoking and risk of stroke in middle-aged and older Chinese adults, based on the data from the China National Stroke Prevention Project.

A community-based cross-sectional study with 12,704 (5681 men, 7023 women) Chinese adults aged ≥40 years was conducted to examine the association of smoking with stroke. Multivariable logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs).

Among the study population, a total of 524 stroke survivors were identified. The age-adjusted prevalence of stroke was 4.06% for both sexes, 2.95% for women, and 5.38% for men. The multivariate-adjusted ORs (95% CI) of stroke associated with current cigarette smoking and former cigarette smoking were 1.67 (1.24–2.25) and 1.93 (1.29–2.87), respectively. Compared with those who were never-smokers, the multivariate-adjusted OR of stroke (95% CI) were 1.48 (0.96 to –2.29), 1.75 (1.20–2.56), and 2.37 (1.20 to –4.68) for those who smoked 1 to 10, 11 to 20, and ≥21 cigarettes per day; and 0.51 (0.19 to –1.42), 1.90 (1.36 to –2.67), and 2.01 (1.17 to –3.46) for those who smoked 1 to 19, 20 to 39, and ≥40 years, respectively (bothP < .001 for linear trends). Among former smokers, the multivariable-adjusted ORs of stroke by duration of smoking cessation (compared with never smokers) for <5, 5 to 19, and ≥20 years were 3.47 (1.42–8.49), 3.37 (1.95–5.80), and 0.95 (0.49–1.84), respectively (P = .009 for linear trend). The increased odds of stroke with smoking were more evident among participants who were men, >60 years old, or without family history of stroke than their counterparts.

This study suggests the increased odds of stroke in current cigarette smokers with a graded increase in prevalent risk that depended on how many cigarettes and how many years were smoked. Moreover, quitting smoking appears to decrease this excess risk substantially.
Diagnostic challenges and good treatment outcomes in pediatric paraganglioma of the abdomen
Authors: Cui Qingyang , Lu Jun , Zhang Chong , Tan Shun
Published: November 2018

Rationale:

Paraganglioma is a catecholamine-producing neuroendocrine tumor. Management of paraganglioma including its diagnosis is difficult, because it has no characteristic symptoms and many diseases can manifest as headache and high blood pressure. Herein, we report a rare case of paraganglioma of the abdomen with headache and initial normal blood pressure.

Patient concerns:

A 9-year-old Chinese girl was hospitalized because of intermittent headache persisting for more than 9 months and recurrent headache for 15 days, accompanied by weight loss, impaired heat tolerance, and otherwise normal blood pressure.

Diagnoses:

We eventually diagnosed paraganglioma.

Interventions:

Her paroxysmal hypertension subsided over 1 month after surgical removal of the tumor.

Lessons:

Intermittent headache and normal hypertension as the initial symptoms of paraganglioma can easily lead to misdiagnosis as another disease (e.g., renal artery stenosis, primary hyperaldosteronism, Takayasu's arteritis), and its differential diagnosis is difficult. When a patient presents with intermittent hypertension, clinicians should consider a diagnosis of paraganglioma. The comprehensive use of ultrasonography, computed tomography (including enhanced computed tomography and 3D reconstruction), magnetic resonance imaging, and plasma catecholamine measurement can aid the diagnosis of paraganglioma.
Case report of dependent venous contrast pooling and layering in a patient without acute cardiogenic shock
Authors: Wagner Willi L. , Spira Daniel , André Florian , Kantharajah Ajith , Kauczor Hans-Ulrich , Mokry Theresa
Published: November 2018

Rationale:

We present a case of incidental venous contrast pooling and layering in a patient without sudden cardiac arrest or cardiogenic shock.

Patient concerns:

The patient presented with only discrete symptoms and did not suffer fatal cessation of the cardiac pump function during or shortly after the scan.

Diagnosis:

The patient showed stigmata of venous gravity-dependent pooling and layering of contrast medium, which has frequently been described as a sign of imminent cardiogenic shock and cardiac arrest.

Interventions:

A cardiologic consultation including echocardiography was initiated.

Outcomes:

Echocardiography confirmed valvular heart disease and biventricular heart failure. A subsequent follow-up CT acquired 8 months after the incidental finding showed no signs of dependent contrast pooling.

Lessons:

Pooling and layering of contrast medium can occur in patients not suffering acute fatal cessation of the cardiac pump function. Nonetheless, any signs of venous pooling observed in CT examinations, especially gravity-dependent layering of contrast medium, are indicative of severe heart dysfunction and should prompt immediate cardio-pulmonary monitoring and increased level of medical care.
Novel exploration of customized 3D printed shoulder prosthesis in revision of total shoulder arthroplasty
Authors: Zou Yun , Yang Yingying , Han Qing , Yang Kerong , Zhang Kesong , Wang Jincheng , Zou Yongwei
Published: November 2018

Rationale:

This paper describes the application of individual customized 3-dimensional (3D) printed macro-porous Ti6Al4 V shoulder prosthesis in the revision of total shoulder arthroplasty (TSA) for the patient with severe bone defects.

Patient concerns:

A 47-year-old male had been under proximal humeral resection and TSA due to shoulder chondrosarcoma 6 years ago, but a second surgery to insert a new prosthesis was then performed because the prosthesis became loose 2 months ago leaving severe bone defects which conventional prosthesis was not suitable for revision of TSA. American Shoulder and Elbow Surgeons’ Form (ASES), Neer and Constant-Murley score were 36, 39, and 39, respectively.

Diagnoses:

The patient was diagnosed with shoulder bone defects and restriction of the shoulder movement.

Interventions:

3D printed shoulder model and computer-aided design (CAD) were used for prosthesis design and surgical simulation. The novel 3D printed titanium alloy shoulder prosthesis was customized subsequently to be used in the revision of TSA. The patient was followed up regularly after surgery. The ASES, Neer Shoulder score and Constant-Murley Shoulder score were evaluated during pre-operation, post-operation, and follow-up.

Outcomes:

Prosthesis was successfully implanted to complete anatomic reconstruction intraoperatively. The scores of ASES, Neer, and Constant-Murley were gradually increased after the operation. According to the X-ray, the bone healed satisfactorily without change of prosthetic position at 3rd and 12th months after the operation. The function of shoulder could meet the requirements of daily activities.

Lessons:

The application of customized 3D printed titanium alloy shoulder prosthesis in the revision of TSA achieves satisfactory results. It provides a novel method for the similar revision surgery with severe bone defects.
Metastatic thymic carcinoid responds to chemoradiation and octreotide
Authors: Mei Zhu , Wang He , Ren Shengnan , Wei Juan , Gu Yanhong
Published: November 2018

Rationale:

Thymic carcinoids are a rare type of malignant neuroendocrine tumors which have a poor prognosis due to their distant metastasis, invasive behaviour, and postoperative recurrence. Surgical resection is still the fundamental mode for treating thymic carcinoids. Here, we report the rapid shrinkage of an atypical thymic carcinoid with multiple metastases following chemoradiation plus octreotide as a first-line therapy

Patient concerns:

A 39-year-old Chinese man presented with chest tightness, dyspnea with a history of lumbago and untreated malignant thymoma.

Diagnosis:

Thoracic computed tomography (CT) scan revealed an anterior mediastinal mass with pulmonary and multiple bone metastases as well as bilateral pleural and pericardial effusions. Percutaneous needle biopsy was performed on the mediastinal mass and the pathological diagnosis was neuroendocrine carcinoma of moderately differentiation (atypical carcinoid)

Interventions:

The tumor was considered unresectable because of extensive invasion into the lung and various bones. The patient was started on paclitaxel and oxaliplatin per 21 days for 4 cycles, and on 20 mg of depot formulation of octreotide once per 21 days. After 2 cycles of chemotherapy, the patient received concurrently mediastinal radiotherapy (39.6 Gy × 22 fractions).

Outcomes:

A follow-up CT of the chest at the completion of his fourth chemotherapy regimen demonstrated, approximately 22% of tumor shrinkage. There were no signs of disease progression but the patient refused further chemoradiation treatment. The patient received monthly treatment of octreotide and zoledronate and his progression-free survival reached 18 months. Due to uncontrollable disease progression, the patient expired.

Lessons:

Early diagnosis and radical surgery of thymic carcinoid are very important. However, radiotherapy (combined/noncombined chemotherapy) must be considered if radical resection is not performed. We believe that further study of chemoradiation and octreotide with the palliative intent of preparing tumors for shrinkage is warranted as a strategy to improve curative management of neuroendocrine tumors.
Cord-derived mesenchymal stem cells therapy for liver cirrhosis in children with refractory Henoch–Schonlein purpura
Authors: Mu Kai , Zhang Jing , Gu Yan , Li Hongjuan , Han Yan , Cheng Na , Feng Xiaoyu , Ding Guoyu , Zhang Rongjun , Zhao Yuqi , Wang Hongmei
Published: November 2018

Rationale:

To explore the curative effect of human umbilical cord-derived mesenchymal stem cell (ucMSC) therapy for patients with liver cirrhosis complicated with immune thrombocytopenia and refractory Henoch–Schonlein purpura (HSP).

Patient concerns:

A 12-year-old boy presented to our hospital with an 11-month history of purpura on the skin of both lower limbs accompanied by thrombocytopenia. The patient had a history of repeated swelling and painful dorsum pedis, followed by skin redness.

Diagnosis:

Bone marrow slides showed megakaryocyte maturation disorder. Based on the pathology and drug abuse history, he was diagnosed with nodular cirrhosis, secondary allergic purpura, and thrombocytopenia, etiologies related to his drugs and an immune dysfunction.

Interventions:

ucMSC transplantation was performed, the liver damaging drugs were discontinued, and the appropriate liver immunosuppressive drugs were administered. ucMSCs were injected 8 times/wk in 2 months, with a median cell count of 5.65 × 107/L, ranging from 5.48 to 5.98 × 107/L.

Outcomes:

As the patient's skin rash resolved, his platelets gradually increased to >150 × 109/L and liver transaminase levels gradually decreased to a normal level. Ultrasonography of the abdomen indicated that the round nodules in the liver decreased in size and that the spleen thickness also decreased.

Lessons:

This is a unique case of significant HSP with associated thrombocytopenia in a patient with liver cirrhosis. Long-term oral administration of excessive herbal medicine may cause liver damage. We believe that ucMSCs provide a novel approach for the treatment of liver cirrhosis.
Reducing postoperative morbidity of mini-invasive percutaneous nephrolithotomy
Authors: Xu Congcong , Feng Sheng , Lin Caixiu , Zheng Yichun
Published: November 2018

Background:

The aim of this study was to provide a randomized controlled trial comparing single B-mode ultrasound guidance and color doppler ultrasound guidance in minimally invasive percutaneous nephrolithotomy.

Methods:

Three hundred patients with renal calculus were prospectively randomly assigned into 2 groups. In group 1 (150 patients), minimally invasive percutaneous nephrolithotomy (m-PCNL) were managed with single B-mode ultrasound guidance; In group 2 (150 patients), m-PCNL were managed with color Doppler ultrasound guidance and a needle bracket in order to guide placement at a target location beneath the skin. The characteristics of patients, operation, complications and prognosis, including body temperature, urine culture, and hematologic tests after the operation were recorded and compared.

Results:

Our vessel-sparing technique showed a statistically significant decrease in hemoglobin drop, postoperative procalcitonin values, the frequency of postoperative fever, systemic inflammatory response syndrome, and urosepsis (P < .05).

Conclusion:

Using color Doppler ultrasound in real time and a needle bracket to detect and avoid main renal blood vessels decreased incidences of hemorrhagic complications and postoperative infection.
Dystrophic calcinosis in a patient with overlap syndrome (scleroderma and rheumatoid arthritis) treated by leflunomide
Authors: Lee Sang Yeob , Lee Sung Won , Chung Won Tae
Published: November 2018

Rationale:

Dystrophic calcinosis occurs in chronically damaged tissue in patients with complicated autoimmune diseases. The therapeutic options are limited, and the treatment response rate is variable. Here, we describe a rare case of dystrophic calcinosis treated with leflunomide in a patient with overlap syndrome.

Patient concerns:

A 53-year-old woman who was diagnosed with overlaps syndrome (systemic sclerosis [SSc] with rheumatoid arthritis [RA]), presented to our hospital with pain and swelling in both wrists, and underwent radiography, bone scan, and biopsy examination.

Diagnoses:

This patient was diagnosed with dystrophic calcinosis in overlaps syndrome.

Interventions:

The conventional disease-modifying drugs were not effective. Hence, leflunomide was administered.

Outcomes:

Simple radiography and bone scan showed resolved mass-like dystrophic calcinosis on both wrists of the patient after the use of leflunomide.

Lessons:

The control of underlying disease is important in the treatment of dystrophic calcinosis. The use of leflunomide maybe an option in treatment of dystrophic calcinosis combined with RA.
Efficacy and safety of recombinant human parathyroid hormone (1–34) are similar to those of alendronate in the treatment of postmenopausal osteoporosis
Authors: Deng Jing , Feng Zhengping , Li Yue , Pan Tingting , Li Qifu , Zhao Changhong
Published: November 2018

The study evaluates efficacy and safety of recombinant human parathyroid hormone (1–34) [rhPTH (1–34)] and alendronate (ALN) in the treatment of postmenopausal osteoporosis.

Totally 65 postmenopausal women with osteoporosis were divided into 2 groups. PTH group received daily subcutaneous injection of rhPTH (1–34), and ALN group were treated orally with ALN per week. Bone mineral density (BMD) of lumbar spine (1–4), femoral neck, and total hip, serum levels of calcium, phosphorus, total cholesterol, triglyceride, alkaline phosphatase (ALP), N-terminal propeptide of type I collagen (PINP), and C-telopeptide of type I collagen (CTX) were tested before treatment and at week 24 and 48 after treatment. Serum levels of vascular endothelial growth factor (VEGF) and platelet-derived growth factor-BB (PDGF-BB) were measured before treatment and at week 48 after treatment.

The rhPTH (1–34) increased BMD of lumbar spine (1–4), but decreased BMD of femoral neck and total hip at week 48 after treatment. By contrast, ALN enhanced BMD of lumbar spine (1–4) and femoral neck, but reduced BMD of total hip at week 48 after treatment. In PTH group, serum levels of PINP, ALP, and β-CTX were significantly elevated above baseline at week 24 and 48 after treatment. Treatment with ALN decreased levels of PINP, ALP, and β-CTX compared with baseline at week 24 and 48 after treatment. rhPTH (1–34) and ALN significantly decreased levels of PDGF-BB, but not levels of VEGF. rhPTH (1–34) increased levels of calcium, phosphorus and triglyceride, but decreased levels of total cholesterol. ALN increased levels of calcium and triglyceride, but reduced levels of phosphorus and total cholesterol. rhPTH (1–34) and ALN were safe in the treatment of postmenopausal osteoporosis.

The study demonstrates that efficacy of rhPTH (1–34) on BMD of lumbar spine (1–4) is similar to that of alendronate in the treatment of postmenopausal osteoporosis. The effect of rhPTH (1–34) on BMD of femoral neck or total hip is weaker than that of ALN. In addition, rhPTH (1–34) increases BMD of lumbar spine (1–4) maybe by raising serum levels of VEGF, but reduces BMD of femoral neck and total hip maybe by decreasing serum levels of PDGF-BB.
Identification of Cross-sector Service Utilization Patterns Among Urban Medicaid Expansion Enrollees
Authors: Bodurtha Peter J. , Winkelman Tyler , Vickery Katherine D. , Owen Ross , Van Siclen Renee , Erickson Erik , Hougham Courtney , Legler Mark , Jennings Latasha , Shippee Nathan
Published: November 2018

Background:

The expansion of Medicaid as part of the Affordable Care Act opened new opportunities to provide health coverage to low-income adults who may be involved in other public sectors.

Objective:

The main objective of this study was to describe cross-sector utilization patterns among urban Medicaid expansion enrollees.

Research Design:

We merged data from 4 public sectors (health care, human services, housing, and criminal justice) for 98,282 Medicaid expansion enrollees in Hennepin County, MN. We fit a latent class model to indicators of cross-sector involvement.

Measures:

Indicator variables described involvement levels within each sector from March 2011 through December 2014. Demographic and chronic condition indicators were included post hoc to characterize classes.

Results:

We found 6 archetypes of cross-sector involvement: The “Low Contact” class (33.9%) had little involvement in any public sector; “Primary Care” (26.3%) had moderate, stable health care utilization; “Health and Human Services” (15.3%) had high rates of health care and cash assistance utilization; “Minimal Criminal History” (11.0%) had less serious criminal justice involvement; “Cross-sector” (7.8%) had elevated emergency department use, involvement in all 4 sectors, and the highest prevalence of behavioral health conditions; “Extensive Criminal History” (5.7%) had serious criminal justice involvement. The 3 most expensive classes (Health and Human Services, Cross-sector, and Extensive Criminal History) had the highest rates of behavioral health conditions. Together, they comprised 29% of enrollees and 70% of total public costs.

Conclusions:

Medicaid expansion enrollees with behavioral health conditions deserve focus due to the high cost-reduction potential across public sectors. Cross-sector collaboration is a plausible path to reduce costs and improve outcomes.
Emergency Department and Primary Care Use in Massachusetts 5 Years After Health Reform
Authors: Lines Lisa M. , Li Nien-Chen , Mick Eric O. , Ash Arlene S.
Published: November 2018

Objective:

Conceptually, access to primary care (through insurance) should reduce emergency department (ED) visits for primary care sensitive (PCS) conditions. We sought to identify characteristics of insured Massachusetts residents associated with PCS ED use, and compare such use for public versus private insurees.

Population and Setting:

People under age 65 in the Massachusetts All-Payer Claims Data, 2011–2012.

Study Design:

Retrospective, observational analysis of PCS ED use with nonurgent, urgent/primary care treatable, and urgent/potentially avoidable visits being considered PCS. We predicted utilization in 2012 using multivariable regression models and data available in 2011 administrative records.

Principal Findings:

Among 2,269,475 nonelderly Massachusetts residents, 40% had public insurance. Among public insurees, PCS ED use was higher than for private (mean, 36.5 vs. 9.0 per 100 persons; adjusted risk ratio, 2.53; 95% confidence limits, 2.49–2.56), while having any primary care visit was less common (70% vs. 83%), as was having any visit to one’s own (attributed) primary care provider (38% vs. 44%).

Conclusions:

Public insurance was associated with less access to primary care and more PCS ED use; statewide labor shortages and low reimbursement rates from public insurance may have provided inadequate access to care that might otherwise have helped reduce PCS ED use.
Cognitive Behavior Therapy for Persistent Severe Fatigue in Childhood Cancer Survivors: A Pilot Study
Authors: Boonstra Amilie , Gielissen Marieke , van Dulmen-den Broeder Eline , Blijlevens Nicole , Knoop Hans , Loonen Jacqueline
Published: November 2018

Objectives:

Fatigue is a common and disabling late effect in childhood cancer survivors (CCS). In this pilot study, the effectiveness of cognitive behavior therapy (CBT) in CCS with persistent and severe fatigue was retrospectively evaluated.

Materials and Methods:

In total, 33 consecutively referred CCS with persistent severe fatigue were offered CBT. The primary outcome was fatigue severity (Checklist Individual Strength, Fatigue Severity Subscale). Secondary outcomes were functional impairment, psychologic distress, and quality of life (QoL).

Results:

In total, 25 CCS completed CBT (76%). The mean age of CCS was 23.1 years (range, 11 to 42 y), mean age at primary cancer diagnosis was 9.7 years (range, 0 to 17 y), and mean time since primary cancer diagnosis was 13 years (range, 5 to 34 y). Fatigue severity (∆ 17.4; confidence interval (CI)=12.7-22.1; P<0.001), functional impairment (SIP8 ∆ 470.3; CI=312.3-628.4; P<0.001/SF36 ∆ 11.7; CI=17.2-6.3; P<0.001), and psychologic distress (∆ 26.4; CI=15.6-34.9; P<0.001) were significantly decreased at second assessment. QoL (∆ 13.5; CI=22.0-4.3; P=0.005) was significantly improved. A total of 23 CCS of the 33 CCS (70%) met the criteria for clinically significant improvement of fatigue.

Conclusions:

In this pilot study, the majority of severely fatigued CCS showed a clinically significant reduction in fatigue following CBT. Moreover, daily function and QoL improved, and psychologic distress decreased.
Oral Methods of Urinary Alkalinization for High-dose Methotrexate Administration: Alternatives to Intravenous Sodium Bicarbonate During a Critical Drug Shortage
Authors: Visage Rachel , Kaiser Nicole , Williams Megan , Kim Abby
Published: November 2018

A nationwide shortage of intravenous (IV) sodium bicarbonate required institutions to explore alternative options for urinary alkalinization for high-dose methotrexate (HDMTX). Children’s Hospital Colorado implemented a protocol utilizing oral alkalinizing agents as alternatives to intravenous sodium bicarbonate during the shortage. The purpose of this study was to determine the safety and efficacy of oral alkalinization strategies for HDMTX administration. This retrospective study was conducted at a pediatric institution and evaluated cycles of HDMTX administered with at least one dose of oral sodium bicarbonate tablets or sodium citrate-citric acid oral solution. The time to achieve urine pH of ≥7 was 3.48 hours from the start of alkalinization. A median dose of 66.4 mEq/m2/day of oral sodium bicarbonate was administered to maintain a urine pH of ≥7 until methotrexate was cleared. Gastrointestinal side effects occurred with 43% of HDMTX cycles and patients switched to IV sodium acetate in 25.5% of HDMTX cycles, primarily due to inadequate alkalinization or intolerance. During a shortage of IV sodium bicarbonate, oral alkalinization is an effective strategy for most patients to allow for administration of HDMTX.
Hand Mirror Cells and Hypercalcemia: A Rare Presentation of Pediatric Acute Lymphoblastic Leukemia
Authors: Cacciotti Chantel , Leber Brian , Cox Stephanie , Arredondo Jorge , Bassilious Ereny , Athale Uma
Published: November 2018

Hand mirror cell (HMC) leukemia is a variant of acute lymphoblastic leukemia previously described in the adult population where lymphoblasts manifest distinctive hand mirror morphologic features. HMC has been previously identified in 23% of childhood acute lymphoblastic leukemia patients, but its prognostic significance in children is not well understood. Hypercalcemia is also uncommon in childhood leukemias. Hypercalcemia associated with HMC leukemia has not been previously reported. We report a 5-year-old boy with HMC B-lymphoblastic leukemia who presented with hypercalcemia.
Establishment of a Gonococcal Antimicrobial Surveillance Programme, in Accordance With World Health Organization Standards, in Côte d'Ivoire, Western Africa, 2014–2017
Authors: Yéo Alain , Kouamé-Blavo Belinda , Kouamé Clarisse E. , Ouattara Abdoulaye , Yao Ahou C. , Gbedé Brigitte D. , Bazan Francis , Faye-Ketté Hortense , Dosso Mireille , Wi Teodora , Unemo Magnus
Published: November 2018

Background

Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is compromising the treatment of gonorrhea globally. Recent AMR data are extremely limited in Africa, and mainly totally lacking in Western Africa, including Côte d'Ivoire. This study (i) established a quality-assured gonococcal antimicrobial surveillance program, according to World Health Organization quality criteria, (ii) investigated the AMR to 8 therapeutic antimicrobials in gonococcal isolates from 2014 to 2017, and (iii) provided evidence for updating the National Sexually Transmitted Disease Syndromic Management Guidelines in Côte d'Ivoire.

Methods

During 2014 to 2017, gonococcal isolates were obtained from sexually active symptomatic or asymptomatic males and females in 14 sites in Côte d'Ivoire. It was a special focus on symptomatic males, and their sexual partners, due to the higher culture positivity rates in symptomatic males. Patient metadata were collected, including age, gender, sexual orientation, and symptoms. Minimum inhibitory concentrations of 8 antimicrobials were determined by Etest and interpreted using European Committee on Antimicrobial Susceptibility Testing breakpoints. β-lactamase production was detected using cefinase disks.

Results

The level of resistance, examining 212 gonococcal isolates, was as follows: 84.9% to tetracycline, 68.9% to benzylpenicillin, 62.7% to ciprofloxacin, 6.1% to azithromycin, and 1.4% to gentamicin. All isolates were susceptible to ceftriaxone, cefixime and spectinomycin.

Conclusions

We provide the first gonococcal AMR data, quality assured according to World Health Organization standards, from Côte d'Ivoire since more than 20 years. The high ciprofloxacin resistance, which informed a revision of the national syndromic management guideline during study, and relatively high resistance to azithromycin demand an improved gonococcal antimicrobial surveillance program and increased awareness when prescribing treatment in Côte d'Ivoire.
Novel tp0548 Sequence-Type of Treponema pallidum Identified in Barcelona, Spain
Authors: Fernández-Naval Candela , Arando Maider , Espasa Mateu , Antón Andrés , Gimferrer Laura , Piñana Maria , Fernández-Huerta Miguel , González-López Juan José , Serra-Pladevall Judit , Pumarola Tomàs , Vall-Mayans Martí , Esperalba Juliana
Published: November 2018

A novel tp0548 sequence-type of Treponema pallidum has been identified in a genital ulcer sample collected from a patient diagnosed with primary syphilis at the Hospital Universitari Vall d'Hebron in Barcelona. Following the nomenclature used in the Enhanced Centers for Disease Control and Prevention Typing methodology, letter “z” has been assigned to the new sequence type.
Patterns of Urachal Remnant Involvement by Urothelial Carcinoma
Authors: Han Lisa , Gallan Alexander , Paner Gladell P.
Published: November 2018

Benign urachal remnants can be encountered in the adult urinary bladder and it is recognized that these can uncommonly give rise to urachal urothelial carcinoma. However, urachal remnants containing urothelial carcinoma incidentally encountered in cystectomies for bladder cancer has not been previously described. Herein, we present 8 adult bladder cancer cystectomies with incidental urachal remnants containing urothelial carcinoma. All 8 incidental urachal remnants with tumor were located at the dome that varied from small tubular to tubulocystic structures and contained urothelial carcinoma in situ (CIS) (6), noninvasive high-grade papillary urothelial carcinoma (PUC) (1), and coexistent noninvasive high-grade PUC and urothelial CIS (1). Six of the 8 urachal remnants with tumor also showed benign urothelial cells (2), mixed urothelial and glandular cells (2), and cuboidal cells (2). The bladder mucosa directly above the remnant showed urothelial CIS (4), PUC (1), concomitant PUC and urothelial CIS (1), invasive urothelial carcinoma (1), and benign urothelium (1); only 1 remnant intermingled with invasive urothelial carcinoma nests. Two remnants with tumor were at a region away from the main bladder tumor including the one overlaid by benign urothelium. The remnant with tumor extended into the upper half (5) or lower half (3) of muscularis propria (MP) and if misinterpreted as MP invasion, 5 of 8 bladder tumors will be overstaged. In conclusion, urachal remnant can have an early involvement by urothelial CIS or PUC similar in the bladder proper lumen. Urothelial carcinoma involving the urachus can be divided into a: (a) contiguous spread from a bladder urothelial carcinoma, (b) separate (noncontiguous) focus concomitant to bladder urothelial carcinoma, and (c) primary urachal urothelial carcinoma. Caution is warranted not to over interpret urachal remnant involvement by noninvasive urothelial carcinoma as an invasive tumor focus which could lead to overstaging.
Self-Reported Fatigue in Children Following Intensive Care Treatment*
Authors: Colville Gillian A. , Pierce Christine M. , Peters Mark J.
Published: November 2018

Objectives:

Adults report high levels of fatigue after intensive care, but little is known about pediatric survivors. This study aimed to explore rates of self-reported fatigue in children after critical illness.

Design:

Prospective cohort study.

Setting:

Tertiary children’s hospital.

Patients:

Ninety-seven children aged 7–17 years old.

Interventions:

None.

Measurements and Main Results:

Children completed the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale 3 months after discharge from PICU. Comparisons with normative data (n = 209) showed that PICU survivors reported similar mean (sd) total fatigue scores to their healthy peers (79.6 [16.3] vs 81.8 [12.5]; p = 0.239), but greater cognitive fatigue (77.4 [21.9] vs 82.4 [16.4]; p = 0.048). Also children who had sustained a traumatic brain injury reported “less” sleep/rest fatigue (84.6 [15.0] vs 76.8 [16.3]; p = 0.006). Baseline indices of severity of illness were not associated with fatigue.

Conclusions:

The Pediatric Quality of Life Inventory Multidimensional Fatigue Scale appears to be a promising tool for use in outcomes research with PICU survivors. These results highlight the need to bear in mind the heterogeneity of PICU patients and the multidimensional nature of fatigue symptoms.
Does Tracheal Lidocaine Instillation Reduce Intracranial Pressure Changes After Tracheal Suctioning in Severe Head Trauma? A Prospective, Randomized Crossover Study*
Authors: da Silva Paulo Sérgio Lucas , de Aguiar Vania Euzébio , Fonseca Marcelo Cunio Machado
Published: November 2018

Objectives:

Tracheal suctioning is a routine procedure in mechanically ventilated children, however, in severe head-injured patients it can result in potential deleterious increase in intracranial pressure. We aimed to assess the effect of tracheal lidocaine administration on intracranial pressure during tracheal suctioning.

Design:

Prospective randomized controlled crossover study.

Setting:

PICU of a tertiary hospital.

Patients:

Eleven patients with severe head trauma (Glasgow Coma Scale score 4–8)

Interventions:

Lidocaine (1.5 mg/kg) or saline solution was endotracheally instilled before a standardized tracheal suctioning maneuver. Each patient received both treatments in a crossover design. Cerebral hemodynamic and systemic and ventilatory effects were assessed at four time points: in baseline (T0), within 2 minutes (T1), 5 minutes (T2), and 15 minutes after tracheal instillation (T3). The 2-minute time interval around tracheal suctioning was used to assess each treatment efficacy

Measurements and Main Results:

The time course of intracranial pressure was different throughout the study in both treatment groups, with a significant increase of intracranial pressure from 14.82 ± 3.48 to 23.27 ± 9.06 with lidocaine (p = 0.003) and from 14.73 ± 2.41 to 30.45 ± 13.14 with saline (p = 0.02). The mean variation in intracranial pressure immediately after tracheal suctioning was smaller with lidocaine instillation than saline (8.45 vs 15.72 mm Hg; p = 0.006). Patients treated with lidocaine returned to baseline intracranial pressure value at 5 minutes after tracheal suctioning whereas those receiving saline solution returned to baseline intracranial pressure value at 15 minutes. Although patients treated with lidocaine had no significant hemodynamic changes, patients receiving saline solution experienced a higher mean value of mean arterial pressure (99.36 vs 81.73 mm Hg; p = 0.004) at T1.

Conclusions:

This preliminary study showed that tracheal lidocaine instillation can attenuate increase in intracranial pressure induced by tracheal suctioning and favor a faster return to the intracranial pressure baseline levels without significant hemodynamic and ventilatory changes.
Sex-Specific Association Between Coronary Artery Disease Severity and Myocardial Ischemia Induced by Mental Stress
Authors: Almuwaqqat Zakaria , Sullivan Samaah , Hammadah Muhammad , Lima Bruno B. , Shah Amit J. , Abdelhadi Naser , Fang Shuyang , Wilmot Kobina , Al Mheid Ibhar , Bremner J. Douglas , Garcia Ernest , Nye Jonathon A. , Elon Lisa , Li Lian , O'Neal Wesley T. , Raggi Paolo , Quyyumi Arshed A. , Vaccarino Viola
Published: November 2018

Objective

It is unclear whether mental stress–induced myocardial ischemia (MSIMI) is related to obstructive coronary artery disease (CAD). We examined this question and contrasted results with ischemia induced by conventional stress testing (CSIMI). Because women are more susceptible to ischemia without coronary obstruction than men, we examined sex differences.

Methods

We studied 276 patients 61 years and younger with recent myocardial infarction. CAD severity was quantified using the log-transformed Gensini Score (lnGS) and the Sullivan Stenosis Score. Patients underwent myocardial perfusion imaging with mental stress (public speaking) and conventional (exercise or pharmacological) stress testing. MSIMI and CSIMI were defined as a new or worsening perfusion defect.

Results

The prevalence of MSIMI was 15% in men and 20% in women. The median GS for patients with MSIMI was 65.0 in men and 28.5 in women. In logistic regression models adjusted for demographic and cardiovascular risk factors, CAD severity was associated with CSIMI in the full sample (odds ratio [OR] = 1.49, 95% [CI], 1.14–1.95, per 1-unit increase in lnGS), with no significant difference by sex. Although CAD severity was not associated with MSIMI in the entire sample, results differed by sex. CAD severity was associated with MSIMI among men (OR = 1.95, 95% CI, 1.13–3.36, per 1-unit increase in lnGS), but not among women (OR = 1.02, 95% CI, 0.74–1.42, p = .042 for interaction). Analysis using Sullivan Stenosis Score yielded similar results.

Conclusions

Findings suggest that CAD severity is related to MSIMI in men but not women. MSIMI in women may therefore be driven by alternative mechanisms such as coronary microvascular disease.
Psychological Therapy for Centralized Pain: An Integrative Assessment and Treatment Model
Authors: Lumley Mark A. , Schubiner Howard
Published: November 2018

Objective

Chronic pain is a significant health problem that is increasing in prevalence, and advances in treatment are needed.

Methods

We briefly review the leading evidence-based psychological therapies for chronic pain—cognitive-behavioral and acceptance/mindfulness-based therapies—and examine several limitations and missing perspectives of these approaches. We review six lesser-known interventions that address these limitations, and we describe our integrative model for psychological assessment and treatment of centralized pain. We present a typical patient and describe how we apply this approach, along with challenges to its implementation and possible solutions to these challenges.

Results

Greater pain treatment efficacy may be possible if clinicians: (a) distinguish patients with primarily centralized (i.e., somatoform or nociplastic) pain from those with primarily peripheral (nociceptive, inflammatory, or neuropathic) pain; (b) acknowledge the capacity of the brain not only to modulate pain but also generate as well as attenuate or eliminate centralized pain; (c) consider the powerful role that adverse life experiences and psychological conflicts play in centralized pain; and (d) integrate emotional processing and interpersonal changes into treatment. Our integrative treatment involves delivering a progression of interventions, as needed, to achieve pain reduction: tailored pain neuroscience education, cognitive and mindfulness skills to decrease the pain danger alarm mechanism, behavioral engagement in avoided painful and other feared activities, emotional awareness and expression to reverse emotional avoidance and overcome trauma or psychological conflict, and adaptive communication to decrease interpersonal stress.

Conclusions

This integrative assessment and treatment model has the potential to substantially reduce and sometimes eliminate centralized pain by changing the cognitive, behavioral, emotional, and interpersonal processes that trigger and maintain centralized pain.
Transitioning to E-Prescribing: Preformatted Prescription Forms Improve Safety, Formulary Compliance, Prescribing Satisfaction, and Perceived Efficiency
Authors: Richman Mark , Joo Julianne , Rohani Payam
Published: November 2018

Objectives

Compared with blank prescriptions, electronic prescribing (e-prescribing) is safer and more formulary-compliant, satisfying, and efficient. Owing to cost, fewer publicly funded organizations use e-prescribing but may afford preformatted prescription forms. We investigated whether preformatted prescription forms confer similar benefits as e-prescribing.

Methods

Two preformatted prescription forms containing medications’ name, strength, dose, route, frequency, number of refills, and restrictions were released in an adult medicine clinic, which previously used blank forms. Pharmacy data were evaluated for changes in prescribing safety and formulary compliance. Surveys assessed changes in prescribing satisfaction and perceived efficiency.

Results

Preformatted prescription forms yielded safer, more formulary-compliant prescribing than blank forms. Among medications preformatted on forms, a smaller percentage of pharmacy interventions were for prescribing errors compared with the same medications prescribed previously using blank forms (54% vs. 31%, P = 0.014). Among medications preformatted on forms, a smaller percentage of pharmacy interventions were for formulary noncompliance compared with the same medications prescribed previously using blank forms (21% vs. 4%, P = 0.002).

Nearly all respondents felt preformatted forms helped with legibility and choosing the correct dose and proper strength. Fifty percent of respondents indicated the forms improved medication selection.

Preformatted forms were perceived as more satisfying and efficient. Ninety-three percent of respondents stated they would use the forms on their next patient.

Conclusions

Preformatted prescription forms achieved the major objectives of e-prescribing: safer, more formulary-compliant, satisfying, and efficient prescribing. They can serve as a transitional phase to e-prescribing for resource-constrained organizations such as publicly funded clinics.
Preoperative Parathyroid Imaging: Trends in Utilization and Comparative Accuracy of Sonography, Scintigraphy, and 4-Dimensional Computed Tomography
Authors: Bahl Manisha
Published: November 2018

Objective

The purposes of this study were to describe trends in parathyroid imaging utilization and to compare the sensitivities of sonography, scintigraphy, and 4-dimensional computed tomography (4DCT) in different imaging algorithms.

Methods

A retrospective review of consecutive patients who underwent parathyroid surgery from 2009 to 2014 was performed. Utilization and accuracy were compared for sonography, scintigraphy, and 4DCT.

Results

The study population was composed of 604 patients with 850 adenomas or hyperplastic glands. Sonography was the most common imaging modality, performed in 91.2% (551/604) of patients. The utilization of 4DCT increased in the study period from 1.5% (2/133) in 2009–2010 to 75.8% (72/95) in 2013–2014 (P < 0.01). The overall sensitivities of sonography, scintigraphy, and 4DCT, regardless of order of imaging or imaging algorithm, were 58.6% (456/778), 49.1% (317/645), and 82.3% (121/147), respectively (P < 0.01).

Conclusions

Four-dimensional CT has the highest sensitivity for localization of parathyroid adenomas regardless of order of imaging or imaging algorithm.
Transposition of Duplicated Thumb for Reconstruction of Asymmetric Radial Polydactyly
Authors: Chang Chin-Fu , Chen I-Chen , Tsai Yueh-Chi , Lai Chih-Sheng , Chen Yen-Wei , Lu Chen-Te , Yen Jung-Hsing
Published: November 2018

Background

In this study, we present the long-term functional and aesthetic outcomes in patients with complicated asymmetric radial polydactyly treated with this surgical technique involving the transposition of a duplicated thumb.

Methods

We evaluated 6 thumbs in 6 patients who underwent radial polydactyly reconstruction using the transposition of duplicated thumb procedure between 2001 and 2017. The procedure was used when one of the thumbs was not obviously dominant over the other, with one having a better proximal portion and the other having a better distal portion. The average age at the time of surgery was 35 months, and at the final follow-up, average age was 86.5 months. Objective outcome values were obtained, and the Japanese Society for Surgery of the Hand evaluation form was adopted to assess functional and cosmetic outcomes.

Results

Neither soft tissue loss nor nonunion of the osteotomy was noted. No patients reported pain or difficulties in their activities. Mean flexion-extension arc for the metacarpophalangeal joint was 72.9° (range, 8.8° extension to 64.1° flexion), and that for the interphalangeal joint was 44.0° (range, 5.7° extension to 38.3° flexion). Mean key pinch, tip pinch, and grip strength of unaffected thumb were 75.1%, 68.7%, and 81.9%, respectively. Total scores using the Japanese Society for Surgery of the Hand scoring system averaged 18.2 points, and the results were excellent in 1 case and good in 5.

Conclusions

Transposition of duplicated thumb can provide durable functional and cosmetic results for Rotterdam types IV and VI with asymmetric radial polydactyly in which neither thumb has adequate distal and proximal components.
Enrichment of Cytomegalovirus-induced NKG2C+ Natural Killer Cells in the Lung Allograft
Authors: Harpur Christopher M. , Stankovic Sanda , Kanagarajah Abbie , Widjaja Jacqueline M.L. , Levvey Bronwyn J. , Cristiano Yvonne , Snell Greg I. , Brooks Andrew G. , Westall Glen P. , Sullivan Lucy C.
Published: November 2018

Background.

In lung transplant recipients, immunosuppressive medications result in impaired antiviral immunity and a propensity for cytomegalovirus (CMV) reactivation within the lung allograft. Natural killer (NK) cells play a key role in immunity to CMV, with an increase in the proportion of NK cells expressing activating CD94-NKG2C receptors in the blood being a strong correlate of CMV infection. Whether a similar increase in NKG2C+ NK cells occurs in lung transplant recipients following CMV reactivation in the allograft and if such cells contribute to viral control remains unclear.

Methods.

In this pilot study, we longitudinally assessed the frequency and phenotype of NKG2C+ NK cells in the blood and bronchoalveolar lavage (BAL) of lung transplant recipients and stratified recipients based on their risk of developing CMV disease.

Results.

We observed an increase in the proportion of NKG2C+ NK cells in the blood and BAL of CMV high-risk patients, coincident with both the cessation of antiviral prophylaxis and subsequent detection of actively replicating CMV in the blood and lung allograft. Additionally, these NKG2C+ NK cells expressed killer-cell immunoglobulin-like receptors distinct from those of other NK subsets and BAL NKG2C+ NK cells possessed an activated phenotype. Finally, the frequency of NKG2C+ NK cells in the BAL may be inversely correlated with CMV blood titers.

Conclusions.

Monitoring the phenotype of NK cells postlung transplant may be a useful biomarker for monitoring patient levels of CMV immunity.