bluuebunny/crossref_metadata_2025 huggingface dataset:
Simulation Training for Operative Vaginal Delivery Among Obstetrics and Gynecology Residents
Authors: Bligard Katherine H. , Lipsey Kim L. , Young Omar M.
Published: October 2019

OBJECTIVE:

To perform a systematic review of the literature on the effect of simulation training of operative vaginal delivery on learner technique and knowledge, operator comfort, and patient-centered outcomes.

DATA SOURCES:

MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, ERIC, The Cochrane Library, and ClinicalTrials.gov were searched from inception through April 2017. The search criteria used MeSH terms (“simulation training,” “high fidelity simulation training,” “teaching,” “obstetrical extraction,” “obstetrical forceps,” “vaginal delivery,” “clinical competence,” and “internship and residency”).

METHODS OF STUDY SELECTION:

A total of 30,813 articles were reviewed for inclusion. Studies detailing operative vaginal delivery simulation using forceps or vacuums and reporting health care provider or patient outcomes were eligible.

TABULATION, INTEGRATION, AND RESULTS:

All studies were independently reviewed by two investigators for inclusion. Only eight articles assessed the effect of simulation on trainee skill and comfort or patient outcomes and were included. Four were pretest–posttest studies, two were cross-sectional studies, one was a case–control study, and one was a cohort study. No randomized trials were identified. Simulation was associated with improved forceps placement accuracy and generated force during extraction, as well as increased operator knowledge and comfort with operative vaginal delivery. Additionally, simulation had no association with forceps failure rates, but there was an association with decreased rates of maternal lacerations and neonatal injury. The quality of the included studies was assessed with the Medical Education Research Study Quality Instrument, with a median score of 9.75 (range 9.0–13.5), indicating low-to-moderate quality.

CONCLUSION:

The available evidence suggests that improved technique, comfort, knowledge, and patient outcomes are associated with operative vaginal delivery simulation, but additional studies are required to further characterize such benefits for both forceps and vacuum.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO, CRD42018087343.
Common and rare forms of vasculitis associated with Sjögren's syndrome
Authors: Argyropoulou Ourania D. , Tzioufas Athanasios G.
Published: October 2019

Purpose of review

Although uncommon, systemic vasculitis is one of the most severe extraglandular manifestations of primary Sjögren's syndrome (pSS) accounting for the increased morbidity and mortality of the disease. This review aims to describe major previous and recent reports regarding the clinical presentation, prognosis and treatment of systemic vasculitis associated with pSS.

Recent findings

Both older and recent pSS cohort studies performed over the past several and recent years, have clearly shown that cryoglobulinaemic vasculitis is the most frequent type of systemic vasculitis accompanying pSS. Antineutrophil cytoplasmic antibody-associated, large and medium vessel vasculitis are described only in sporadic cases. In addition to the overt clinical manifestations of cryoglobulinaemic vasculitis, type II cryoglobulinaemia, glomerulonephritis and purpura have been correlated with increased risk for B-cell non-Hodgkin lymphoma (NHL) in pSS.

pSS is characterized by autoreactive B and T-cell infiltrates around the epithelial structures of the affected organs, as well as, B-cell hyperreactivity. The latter, is attested by the increased production of autoantibodies, directed against many different organ and nonorgan self-antigens. Vasculitis is a significant and potentially life-threatening complication of the disease depending on the size, localization, histologic type and the pathogenetic mechanisms of the inflammatory process. The potentially irreversible tissue damage, as well as the increased risk for NHL development, prompts the need for early diagnosis and treatment of cryoglobulinaemic vasculitis in pSS.
Unpicking observational relationships between hip shape and osteoarthritis: hype or hope?
Authors: Faber Benjamin G. , Frysz Monika , Tobias Jon H.
Published: October 2019

Purpose of review

To review recent findings concerning the observational relationship between hip shape and hip osteoarthritis (HOA) and their shared genetic influences, and the potential for clinical application.

Recent findings

Recent observational studies have strengthened the evidence that specific shape deformities, such as cam and acetabular dysplasia, are related to HOA. Statistical shape modelling has emerged as a method to measure hip shape holistically, with the added advantage that this can be applied to dual X-ray absorptiometry scan images. This has led to several additional aspects of hip shape variation being identified, such as a wider femoral neck and larger lesser trochanter, in association with HOA. Furthermore, this method has formed the basis of genetic studies identifying novel genetic influences on hip shape, several of which are shared with known genetic risk factors for HOA.

Shared genetic influences of hip shape and HOA raise the possibility that hip shape plays a casual role in the development of HOA, justifying preventive approaches aiming to combat these adverse consequences.
Delay in Flap Coverage Past 7 Days Increases Complications for Open Tibia Fractures: A Cohort Study of 140 North American Trauma Centers
Authors: Pincus Daniel , Byrne James P. , Nathens Avery B. , Miller Anna N. , Wolinsky Philip R. , Wasserstein David , Ravi Bheeshma , Jenkinson Richard J.
Published: October 2019

Objectives:

To measure time to flap coverage after open tibia fractures and assess whether delays are associated with inpatient complications.

Design:

Retrospective cohort study.

Setting:

One forty level I and II trauma centers in Canada and the United States.

Patients/Participants:

Adult patients (≥16 years) undergoing surgery for (1) an open tibia (including ankle) fracture and (2) a soft-tissue flap during their index admission between January 1, 2012, and December 31, 2015, were eligible for inclusion.

Exposure:

Time from hospital arrival to definitive flap coverage (in days).

Main outcome measurements:

The primary outcome was a composite of the following complications occurring during the index admission: (1) deep infection, (2) osteomyelitis, and/or (3) amputation. The primary analysis compared complications between early and delayed coverage groups (≤7 and >7 days, respectively) after matching on propensity scores. We also used logistic regression with time to flap coverage as a continuous variable to examine the impact of the duration of delay on complications.

Results:

There were 672 patients at 140 centers included. Of these, 412 (61.3%) had delayed coverage (>7 days). Delayed coverage was associated with a significant increase in complications during the index admission after matching (16.7% vs. 6.2%, P < 0.001, number needed to harm = 10). Each additional week of delay was associated with an approximate 40% increased adjusted risk of complications (adjusted odds ratio 1.44, 95% confidence interval 1.13–1.82, for each week coverage was delayed, P = 0.003).

Conclusion:

This is the first multicenter study of flap coverage for tibia fractures in North America. Complications rose significantly when flap coverage was delayed beyond 7 days, consistent with current guideline recommendations. Because the majority of patients did not have coverage within this timeframe, initiatives are required to improve care for patients with these injuries.

Level of Evidence:

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Underlying Mental Illness and Psychosocial Factors Are Predictors of Poor Outcomes After Proximal Humerus Repair
Authors: Belayneh Rebekah , Haglin Jack , Lott Ariana , Kugelman David , Konda Sanjit , Egol Kenneth A.
Published: October 2019

Objectives:

(1) To assess the correlation of psychosocial factors and long-term outcomes of proximal humerus fractures all in surgical repair; (2) to identify specific psychosocial factors with favorable and unfavorable outcomes; and (3) to assess the correlation between DSM-V mental health diagnoses and long-term Disabilities of Arm, Shoulder, and Hand (DASH) scores.

Design:

Prospective cohort study.

Setting:

Academic medical center.

Patients:

Patients were screened and identified on presentation to the emergency department or in the clinical office for inclusion in an institutional review board–approved registry. One hundred eighty-five proximal humerus fractures of 247 met inclusion criteria.

Intervention:

Surgical repair of proximal humerus fractures.

Main Outcome Measure:

All patients were prospectively followed up and assessed for clinical and functional outcomes at latest follow-up visit (mean = 24.8 months) using the DASH questionnaires along with ranges of motion and pain level. Psychosocial factors at 3 months were obtained from the DASH survey.

Results:

Concomitant diagnosis of depressed mood (P = 0.001), anxiety (P < 0.0005), low energy level (P = 0.003), and fatigue (P = 0.001) correlated significantly with poorer outcome. All 6 psychosocial factors correlated directly and significantly with pain at latest follow-up (P < 0.0005). Multiple regression analysis revealed that the strongest predictor of the overall DASH score was the extent of interference with social life (P = 0.001).

Conclusion:

Analysis demonstrated that psychological and social factors at 3 months postoperatively have a strong correlation with negative long-term (>1 year) outcomes after proximal humerus fixation. Clinicians may offer psychological support and encourage social support to these patients postoperatively to improve pain and treatment outcomes.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Complications and Mortality Rates Following Surgical Management of Extradural Spine Tumors in New York State
Authors: Williams Devin M. , Thirukumaran Caroline P. , oses Jalea T. , Mesfin Addisu
Published: October 2019

Study Design.

Database analysis.

Objective.

To evaluate complications and mortality in patients undergoing surgical management of extradural spinal tumors in New York State.

Summary of Background Data.

Metastatic spine surgery has a high rate of complications but most studies are limited to single institutions.

Methods.

The Statewide Planning and Research Cooperative System was used to identify patients with extradural spinal tumors undergoing surgery in New York State from 2006 to 2015. Bivariate and multivariate logistic regression analyses were used to estimate outcomes.

Results.

Four thousand seven hundred sixty-seven patients were identified, the majority of patients were male and white a median age of 61. The complication rate was 17.6% and the mortality rate within 30 days of discharge was 12.2%. Multivariate analysis showed the odds of complications were higher in males compared with females (odds ratio [OR]: 1.27; 95% confidence interval [CI]: 1.05–1.52, P = 0.01), and patients on Medicaid compared with patients on private insurance (OR: 1.42; 95% CI: 1.03–1.96, P = 0.03). Analysis of hospital characteristics showed lower volume hospitals (OR 1.48; 95% CI: 1.03–2.13, P value = 0.03), and teaching hospitals (OR: 1.47; 95% CI: 1.03–2.09, P = 0.04), have higher odds of complications compared with high-volume hospitals and nonteaching hospitals. Multivariate analysis showed higher odds of mortality within 30 days of discharge in patients of older age (OR: 1.02; 95% CI: 1.01–1.03, P value = 0.001), low-volume hospitals compared with high-volume hospitals (OR: 1.36; 95% CI: 1.09–1.79, P value = 0.02), hospitals with low bed size compared with high bed size (OR: 1.43; 95% CI: 1.12–1.83, P value = 0.01), and urban hospitals compared with rural hospitals (OR: 3.04; 95% CI: 2.03–4.56, P value = 0.001).

Conclusion.

Low-volume hospitals are associated with complications and mortality in patients with metastatic spine disease.

Level of Evidence: 3
Conservative Versus Operative Treatment of Stable Thoracolumbar Burst Fractures in Neurologically Intact Patients
Authors: Pehlivanoglu Tuna , Akgul Turgut , Bayram Serkan , Meric Emre , Ozdemir Mustafa , Korkmaz Murat , Sar Cuneyt
Published: October 2019

Study Design.

Nonrandomized, retrospective, comparative, and single-center trial.

Objective.

The aim of this study is to compare the long-term clinical and radiographic results of thoracolumbar burst fractures in neurologically intact patients, treated surgically or nonsurgically with the aim to optimize their management.

Summary of Background Data.

There is an ongoing controversy regarding the treatment of thoracolumbar burst fractures (TLBF) (A3, A4) in neurologically intact patients. Surgical treatment as well as conservative treatment methods are advised to this specific group of patients, while contrasting results exist in the literature.

Methods.

Forty-five neurologically intact patients with TLBF (A3 or A4) (2010–2016) were included. Twenty-one patients with a mean age of 34.3 and a mean follow-up period of 63.1 months were treated surgically with short segment posterior fixation (group 1), while 24 patients with a mean age of 45.7 and a mean follow-up period of 67.1 months were treated conservatively (group 2) with thoracolumbosacral orthesis.

Results.

At the final follow-up groups 1 and 2 had an average segmental kyphosis of 4.09°/11.65° (P = 0.027), an average loss of kyphosis of 2.04°/4.03° (P = 0.038), an average loss of anterior/posterior vertebral body height of %12.89/%2.84/%17.94/%7.62 (P = 0.027/ P = 0.03), a median JOA score of (16.6/16.75) (P = 0.198), a median ODI score of (11.7/12.1) (P = 0.25), a median VAS score of (1.9/2.3) (P = 0.3), SF-36 PCS of (56.74/56.67) (P = 0.25), SF-36 MCS of (55.47/55.5) (P = 0.3), mean durations of hospital stay of 9–11 days (P = 0.3), respectively.

Conclusion.

While there is an ongoing controversy regarding the management of stable thoracolumbar burst fractures in neurologically intact patients in the literature, this study concluded that surgical management of stable thoracolumbar burst fractures in neurologically intact patients provided better radiolographic outcomes, despite the result, that the difference between surgically and nonsurgically treated patients in terms of clinical outcome parameters and quality of life was not statistically significant.

Level of Evidence: 3
Quantifying the Impact of Common Feeding Interventions on Nutritive Sucking Performance Using a Commercially Available Smart Bottle
Authors: Capilouto Gilson J. , Cunningham Tommy J. , Desai Nirmala
Published: October 2019

An estimated 25% to 40% of infants experience difficulties with learning to breast- or bottle-feed. Yet, guidelines and evidence-based support for common feeding practices are limited. The objective of this case report was to quantify the impact of feeding interventions on nutritive sucking performance after discharge in an outpatient setting. This observational case series involved 2 infants. To determine the impact of cumulative interventions, pre- and postintervention effect sizes were calculated. Sucking performance metrics of interest included nipple movement peak sucking amplitude, duration, frequency, and smoothness. Interventions included positional changes and changes in nipple flow rate, among others. For both infants, cumulative interventions had the greatest impact on suck frequency; postintervention, infants were able to increase their rate of nutritive sucking per burst. Other aspects of sucking performance were differentially impacted for each baby. Researchers agree that neonatal and infant feeding has been understudied and that the evidence for common interventions needs to be strengthened. We have demonstrated the implementation of readily available technology that can be used to quantify the direct impact of any intervention on actual sucking performance. In doing so, we can individualize care to support skill development and improve outcomes for infants at risk for ongoing feeding challenges.
Certified Nurse-Midwives' Experiences With Provision of Prenatal Genetic Screening
Authors: Dettwyler Shenin A. , Zielinski Ruth E. , Yashar Beverly M.
Published: October 2019

Prenatal genetic screening (GS) for the most common autosomal aneuploidies encompasses maternal serum screening (MSS) and noninvasive prenatal testing (NIPT, or cell-free fetal DNA testing). In the United States, most maternity care is provided by obstetrician-gynecologists; however, women are increasingly utilizing the services of certified nurse-midwives (CNMs). Currently, limited research exists on midwives' experiences with providing prenatal GS. Therefore, the purpose of this study was to explore CNMs' experiences in providing prenatal GS. A semistructured guide focused on MSS and NIPT was used to interview a convenience sample of 13 CNMs. Results were coded and analyzed using grounded theory to elicit overarching themes. Results were organized into 6 themes describing CNMs' prenatal GS provision: (1) clinical protocols; (2) patient education; (3) patient-CNM shared decision-making process; (4) testing initiation; (5) results delivery; and (6) follow-up coordination. Key influences on midwives' perspectives on offering prenatal GS included a noninterventionist approach to pregnancy and past experiences with false-positive MSS results. Participants had an understanding of prenatal GS that was appropriate to midwifery scope of practice. Results indicate that NIPT utilization is compatible with the midwifery philosophy of noninterventionism, although midwives had limited experiences with NIPT to date.
Discovering metformin-induced vitamin B12 deficiency in patients with type 2 diabetes in primary care
Authors: Herbert Laura , Ribar Alicia , Mitchell Sheryl , Phillips Cynthia
Published: October 2019

Background:

Although metformin is the preferred initial pharmacological choice in type 2 diabetes, there is evidence that reveals a link between metformin use and vitamin B12 deficiency. The American Diabetes Association (ADA) has recently recommended periodic measurement of B12 levels for all patients on metformin.

Local problem:

Medical record data collected for the preintervention period showed that only 5% (n = 23) of patients diagnosed with diabetes and on metformin had B12 levels checked at an internal medicine primary care practice.

Methods:

This was a quasi-experimental project of preintervention and postintervention design using a checklist containing important measures of diabetes control. The project sample population consisted of data of adults with type 2 diabetes aged 18 years and older who were prescribed metformin in the previous year at the primary care practice.

Interventions:

The intervention focused on revising an existing diabetes measures checklist to include a prompt for an annual measurement of B12 levels.

Results:

There was significant improvement in monitoring vitamin B12 levels and discovery of low vitamin B12 levels. These data show that the number of B12 levels checked increased from 23 during the preintervention to 155 during the intervention (p ≤ 0.0000).

Conclusions:

This project supports a conclusion that including a prompt to check B12 levels to an existing checklist increases B12 monitoring in this patient population. Results may encourage other providers to follow the ADA guidelines for monitoring vitamin B12 levels for patients taking metformin.
Participation in a nurse practitioner fellowship to instill greater confidence, job satisfaction, and increased job retention
Authors: Bryant Shari , Parker Karen
Published: October 2019

The Institute of Medicine's The Future of Nursing report recommended the extension of nurse practitioner (NP) fellowship programs to highlight and assess competencies after completion of licensure. The initiative, “Participation in a nurse practitioner fellowship to instill greater confidence, job satisfaction, and increased job retention as nurse practitioners promptly transition from novice to expert clinician,” evaluated NP satisfaction between NPs who had not completed a fellowship versus NPs who had participated in a fellowship. Transition of an NP was evaluated through the Misener Nurse Practitioner Job Satisfaction Scale via 258 NPs through Emory Healthcare, MD Anderson, DNP discussion groups, and Show Me Your Stethoscope from social media. A series of independent t-tests were performed to determine statistical significance. The results of the analyses found that individuals who had participated in an NP fellowship had significantly higher scores on a sense of value for “what you do,” monetary bonuses, and compensation for services outside of normal duties and obtained statistical significance. Owing to the positive trends of the surveys, continuation of NP fellowships is recommended for a successful NP role transition to develop clinical growth, retention, leadership skills, and ultimately an expert clinician.
Understanding the Dizziness Handicap Inventory (DHI): A Cross Sectional Analysis of Symptom Factors That Contribute to DHI Variance
Authors: Formeister Eric J. , Krauter Roseanne , Kirk Laura , Zhu Tian Ran , Rizk Habib G. , Sharon Jeffrey D.
Published: October 2019

Objective:

The Dizziness Handicap Inventory (DHI) is the most commonly used quality of life measure for vestibular disorders. However, there is wide variability in scores, and little is known about which variables contribute to dizziness-related quality of life. Our goal was to investigate the key demographic and symptom-related factors to that account for DHI variance.

Study Design:

Cross-sectional survey.

Setting:

Tertiary referral center.

Patients:

Adult patients presenting to a dizziness clinic.

Main Outcome Measure:

DHI variance explained by multiple linear regression.

Results:

Seventy subjects were included in our study. We performed univariate analyses on numerous demographic and dizziness-related factors, and constructed a multivariate model based on explaining the highest variance in the data with the least number of independent variables. Several validated quality of life and mental health survey scores (SF-36—quality of life; PHQ-9—depression; and GAD-7—anxiety) were significantly correlated with higher DHI scores. Additional factors, including the number of dizzy days per month, the number of dizziness descriptors (spinning, lightheadedness, disequilibrium, etc.), and the number of dizziness triggers (loud sounds, stress, riding in a car, etc.), were all significantly associated with higher DHI scores; a multiple linear regression model showed that these three aforementioned factors combined accounted for 56% of the variability in the DHI scores (p < 0.0001). Adding an index of depression, as measured by the PHQ-9, increased the adjusted R2 to 64% (p < 0.0001).

Conclusions:

DHI score variability is explained by mental health and quality-of-life measures in addition to the daily burden of dizziness.
The Prevalence of Lean/Nonobese Nonalcoholic Fatty Liver Disease
Authors: Shi Yiwen , Wang Qianyi , Sun Yameng , Zhao Xinyan , Kong Yuanyuan , Ou Xiaojuan , Jia Jidong , Wu Shanshan , You Hong
Published: October 2019

Background and Aim:

The prevalence of lean/nonobese nonalcoholic fatty liver disease (NAFLD) ranges widely in studies. Thus, here, we aimed to perform a meta-analysis on NAFLD prevalence in the lean or nonobese population to give clarity.

Materials and Methods:

PubMed, Embase, and the Cochrane Library databases were systematically searched to identify studies reporting NAFLD prevalence in the lean/nonobese population. Lean or nonobese was defined by body mass index cutoffs reported by authors in original studies. NAFLD prevalence based on community, population, or health checkups was combined with random-effect model after logit transformation. Subgroup analysis and meta-regression were further performed to investigate the heterogenicity.

Results:

A total of 45 studies were enrolled in the final analysis, with 55,936 lean/nonobese subjects included, among whom 7351 NAFLD patients were diagnosed. Overall, the pooled NAFLD prevalence of the lean or nonobese population was 10.2% (95% confidence interval: 7.6%-13.6%) and 15.7% (95% confidence interval: 12.5%-19.6%), respectively. Compared with western studies, the NAFLD prevalence in the lean or nonobese population was lower in eastern studies. In addition, the NAFLD prevalence in both the lean and nonobese population showed a general upward trend during recent years. The prevalence was similar in community-based and health checkup–based studies. Lean/nonobese NAFLD patients had significantly lower rates of hypertension, lower uric acid and fasting plasma glucose, and a higher level of high-density lipoprotein than nonlean/obese patients.

Conclusions:

The prevalence of NAFLD in the lean/nonobese population is not rare in either the western or eastern regions of the world. This meta-analysis of prevalence assessment and clinical characteristics should enable higher confidence in more specific interventions and health care standards for these patients.
Evaluation of the use of photobiomodulation following the placement of elastomeric separators
Authors: Ortega Silvana Machado , Gonçalves Marcela Leticia Leal , da Silva Tamiris , Horliana Anna Carolina Ratto Tempestini , Motta Lara Jansiski , Altavista Olga Maria , Olivan Silvia Regina , Santos Ana Eliza Castanho Garrini dos , Martimbianco Ana Luiza Cabrera , Mesquita-Ferrari Raquel Agnelli , Fernandes Kristianne Porta Santos , Bussadori Sandra Kalil
Published: October 2019

Background:

Pain stemming from the placement of elastomeric separators and the exchanging of wires and accessories is the greatest reason for abandoning orthodontic treatment. Indeed, discomfort related to treatment exerts a negative impact on quality of life due to the difficulty chewing and biting. This paper proposes a study to evaluate the analgesic effects of photomiobodulation (PBM) on individuals undergoing orthodontic treatment.

Methods:

The sample will be composed of 72 individuals who receiving elastomeric separators on the mesial and distal faces of the maxillary first molars. The patients will be randomly allocated to 2 groups: an experimental group irradiated with low-level laser and a sham group submitted to simulated laser irradiation. Upon the placement of the separators, the experimental group will receive a single application of PBM on the mesial and distal cervical portion and apical third of the molars. Perceived pain will be analyzed after one hour using the visual analog scale in both groups. Samples will be taken of the gingival crevice with absorbent paper for 30 seconds for the analysis of cytokines using ELISA and the results of the 2 groups will be compared. The patients will sign a statement of informed consent. Statistical analysis will be performed with the Student's t test and analysis of variance (ANOVA).

Discussion:

The expectation is that the patients in the irradiated group will have a lower perception of pain and lower quantity of cytokines compared to those in the sham group. The purpose of the study is to establish an effective method for PBM with the use of low-level infrared laser (Ga-Al-As with a wavelength of 808 nm and output power of 100 mW) for reductions in pain and inflammatory cytokines related to orthodontic treatment.

Trial registration:

This protocol was registered in ClinicalTrial.gov, under number NCT03939988. It was first posted and last updated in May 6, 2019.
Yoga and schizophrenia—a comprehensive assessment of neuroplasticity
Authors: Varambally Shivarama , Venkatasubramanian Ganesan , Govindaraj Ramajayam , Shivakumar Venkataram , Mullapudi Thrinath , Christopher Rita , Debnath Monojit , Philip Mariamma , Bharath Rose Dawn , Gangadhar BN
Published: October 2019

Introduction:

Schizophrenia is one of the most severe mental disorders with a prevalence of about 1% and a leading cause of disability among young adults. Pharmacotherapy is the mainstay in the management of schizophrenia. However, even with the best of medication, several problems like refractoriness, negative symptoms, frequent relapses, and cognitive impairments persist.

Methods:

This is a randomized-controlled clinical study including patients from an urban tertiary hospital and a semi-urban community center, with a between-group, repeated-measures, longitudinal design. This study will recruit 160 patients with DSM 5 diagnosis of schizophrenia who are on stable medication for a minimum of 6 weeks; they will be randomly assigned into 2 arms viz., yoga therapy (YT), and treatment-as-usual (TAU) with 80 patients in each arm. Participants will undergo Clinical, Laboratory, and Radiological assessments at baseline and at intervals of 1 month, 3 months, and 6 months from the baseline. It is hypothesized that yoga will improve psychopathology and emotion processing, increase serum brain derived neurotrophic factor (BDNF) and plasma oxytocin levels and effect changes in cerebral activation in areas of the brain associated with schizophrenia.

Discussion:

This study aims to measure the efficacy of a Yoga-based intervention as an adjunct in patients with schizophrenia as well as the mechanisms of these effects.

Trial registration: Registered retrospectively with Clinical Trial Registry – India (CTRI) with registration number CTRI/2017/08/009219.
Five years of follow-up of immediate quadriparesis caused by a large calcified mass in the ligamentum flavum
Authors: Cao Yafei , Li Heng , Liu Weidong , Yu Weiji , Gao Kun
Published: October 2019

Introduction:

Calcification of ligamentum flavum (CLF) is an important cause of spinal stenosis and spinal cord compression. CLF does not usually induce immediate quadriparesis. Here we describe a rare case of immediate quadriparesis due to a large calcified mass containing liquids in the ligamentum flavum, which was easily confused with gout crystals.

Patient concerns:

A 74-year-old Asian male felt progressive bilateral arm and leg weakness. On the fourth day, acute quadriparesis occurred.

Diagnosis:

Coronal and sagittal computerized tomography (CT) and magnetic resonance imaging (MRI) showed a large circular mass in the left posterior part of the cervical 3/4 spinal canal, protruding into the canal, and occupying one-half of the spinal canal.

Interventions:

Emergency laminectomy was performed at C3/4 level. The huge cyst was excised and 1 ml of white viscous liquid flowed out.

Outcomes:

After operation, CT and MRI showed a full laminectomy of C3/4 and complete decompression of the cervical spinal cord. Hematoxylin-eosin (HE) staining showed that large amounts of calcium was deposited around cystic tissues. Five-year follow-up after laminectomy showed good recovery.

Conclusion:

This case of immediate quadriparesis, caused by a large calcified mass containing fluid, is very rare. It should be at the earliest stage of calcification. Laminectomy is an effective treatment. This calcification was deceptive and was easily confused with gout crystals. It can help to understand the exact pathophysiology of CLF.
Lymphovenous anastomosis for the treatment of persistent congenital chylothorax in a low-birth-weight infant
Authors: Hayashida Kenji , Yamakawa Sho , Shirakami Eri
Published: October 2019

Rationale:

Chylothorax remains a poorly understood phenomenon, and no optimal treatment or guidelines have been established. This is the first report of treating congenital chylothorax and lymphedema in a low-birth-weight infant by lymphovenous anastomosis (LVA).

Patient concerns:

We report a case of successful LVA for persistent congenital chylothorax and lymphedema resistant to other conservative therapies.

Diagnosis:

The diagnosis of chylothorax was confirmed by the predominance of lymphocytes in the pleural fluid draining from the chest tube. In addition, the infant developed oliguria and generalized lymphedema.

Interventions:

LVA under local anesthesia combined with light sedation was performed at his medial thighs and left upper arm.

Outcomes:

Although his subcutaneous edema markedly improved, the decrease in chest tube drainage was gradual. No additional treatment was required.

Lessons:

LVA is of considerable value as a surgical treatment option in the setting of persistent congenital chylothorax and lymphedema, because LVA is a less invasive procedure.
Aberrant hTERT promoter methylation predicts prognosis in Chinese patients with acral and mucosal melanoma
Authors: Xu Haixia , Wang Weijia , Zhao Juan , Li Tingting , Kang Xiaojing
Published: October 2019

Background:

To evaluate the methylation levels of human telomerase reverse transcriptase (hTERT) promoter three CpG island (CGIs) regions and its prognostic impact in Chinese patients with acral and mucosal melanoma.

Methods:

Bioinformatics software was used to analyze hTERT gene promoter. Fresh frozen tissues were taken from 14 patients with melanoma (6 acral melanoma and 8 mucosal melanoma) and 14 pigmented nevus as control subjects (14 acral pigmented nevus). Bisulfite sequencing PCR (BSP) combined TA clone sequencing was used to assess the methylation levels of hTERT promoter CGIs regions. The relative expression level of hTERT mRNA was measured by quantitative real-time polymerase chain reaction (qRT-PCR).

Results:

CGIs-1 (-1392–-1098 bp), CGIs-2 (-945–-669 bp), and CGIs-3 (-445–-48 bp) were selected for our study. Our results indicated that the methylation levels of hTERT promotor CGIs regions in melanoma were greater than pigmented nevus (CGIs-1: 69.3 ± 18.7% vs 46.8 ± 20.4%, t = 3.048 P = .005; CGIs-2: 73.8 ± 14.7% vs 55.6 ± 16.0%, t = 3.120 P = .004; CGIs-3: 5.8 ± 2.2% vs 2.2 ± 1.3%, t = 5.164 P < .001). The relative expression level of hTERT in melanoma was greater than in pigmented nevus (50.39 ± 9.16 vs 26.10 ± 7.25, t = 7.778, P < .001). Linear regression analysis showed that the methylation level of CGIs-2 in melanoma was positively correlated with the relative expression level of hTERT mRNA (R2 = .490, F = 13.478, P = .003). Combined with the analysis of clinicopathological features, the methylation level of CGIs-2 in melanoma with lymph node metastasis was greater than in melanoma without lymph node metastasis, and the methylation level of CGIs-2 increased with TNM staging.

Conclusion:

CGIs-2 methylation level was associated with the relative expression level of hTERT mRNA, lymph node metastasis and TNM staging, suggesting that CGIs-2 hypermethylation might be used to evaluate the prognosis in Chinese patients with acral and mucosal melanoma.
Association between dietary iron intake and the prevalence of nonalcoholic fatty liver disease
Authors: Yang Zidan , Wu Jing , Li Xiaoxiao , Xie Dongxing , Wang Yilun , Yang Tubao
Published: October 2019

The aim was to test the association between dietary iron intake and the prevalence of nonalcoholic fatty liver disease (NAFLD) in a large sample of middle-aged and elderly Chinese population.

The data included in this analysis were collected from a population-based cross-sectional study, that is, the Xiangya Hospital Health Management Center Study. Dietary iron intake was assessed using a validated semiquantitative food frequency questionnaire. The relationship between dietary iron intake and the prevalence of NAFLD was examined using logistic and spline regressions.

A cross-sectional study including 5445 subjects was conducted. The prevalence of NAFLD was 36.9%. Compared with the lowest quintile, the energy-adjusted odds ratios (ORs) of NAFLD were 1.33 (95% confidence interval [CI]: 1.07–1.64), 1.80 (95% CI: 1.41–2.29) and 2.11 (95% CI: 1.60–2.80) in the 3rd, 4th, and 5th quintile of iron intake, respectively (P-value for trend <.001). In addition, dietary iron intake was positively associated with the OR of NAFLD in a dose–response relationship manner (test for trend P < .001). However, after stratifying the data by gender, such association only remained in the male, but not in the female population. With adjustment of additional potential confounders, the results did not change materially.

Subjects with higher dietary iron intake were subject to a higher prevalence of NAFLD in a dose–response relationship manner. However, such association probably only exists in males, but not in females.
A test for treatment effects in randomized controlled trials, harnessing the power of ultrahigh dimensional big data
Authors: Lee Wen-Chung , Lin Jui-Hsiang
Published: October 2019

Background:

The randomized controlled trial (RCT) is the gold-standard research design in biomedicine. However, practical concerns often limit the sample size, n, the number of patients in a RCT. We aim to show that the power of a RCT can be increased by increasing p, the number of baseline covariates (sex, age, socio-demographic, genomic, and clinical profiles et al, of the patients) collected in the RCT (referred to as the ‘dimension’).

Methods:

The conventional test for treatment effects is based on testing the ‘crude null’ that the outcomes of the subjects are of no difference between the two arms of a RCT. We propose a ‘high-dimensional test’ which is based on testing the ‘sharp null’ that the experimental intervention has no treatment effect whatsoever, for patients of any covariate profile.

Results:

Using computer simulations, we show that the high-dimensional test can become very powerful in detecting treatment effects for very large p, but not so for small or moderate p. Using a real dataset, we demonstrate that the P value of the high-dimensional test decreases as the number of baseline covariates increases, though it is still not significant.

Conclusion:

In this big-data era, pushing p of a RCT to the millions, billions, or even trillions may someday become feasible. And the high-dimensional test proposed in this study can become very powerful in detecting treatment effects.
Timescale of tumor volume of a young breast cancer patient with luminal B subtype
Authors: Mao Xiaoyun , Zhou Ming , Fan Chuifeng , Chen Bo , Jin Feng
Published: October 2019

Rationale:

It is largely unknown about the tumor growth of breast cancer naturally. We devised and analyzed an appropriate mathematical tool of the equations that describe how fast tumors grow without treatment on the basis of the ellipsoid shape of solid breast cancer.

Patient concerns:

A 31-year-old woman presented with a painless palpable lump in her left breast for 5 months.

Diagnosis:

Infiltrated ductal breast cancer (histologic grade II) of luminal B

Interventions:

The patient did not receive any therapy due to her private reasons for 2 years, the analysis of the tumor volume growth was done regarding the growth rate of the tumor in the absence of intervention.

Outcomes:

After 2 years of diagnosis of breast cancer, the tumor mass occupied the whole left breast with skin implanted and nipple abnormality. As this case indicated that the tumor's early growth rate was very slow. When the tumor volume reached 300 cm3, its fast growth began without treatment. Later growth approached the maximum, when the tumor volume was more than 800 cm3.

Lessons:

The tumor growth is segmental without therapy. Early diagnosis and treatment is the key to good prognosis for every breast cancer patient.
Adenosquamous carcinoma development as a recurrence of squamous cell carcinoma in the oral floor
Authors: Eguchi Takanori , Basugi Akihiko , Kanai Ikuyo , Miyata Yukinaga , Suzuki Takamasa , Hamada Yoshiki
Published: October 2019

Rationale:

Oral adenosquamous carcinoma (ASC) is rare and its origins are controversial. We here present a patient with oral ASC that developed after surgery for oral squamous cell carcinoma (SCC).

Patient concerns:

A 70-year-old man with SCC on the oral floor underwent surgical resection. However, the enlarged ulcer presented on the oral floor 9 month after surgery.

Diagnoses:

The biopsy of the ulcer revealed a SCC. Imaging examinations detected enhancement of a large lesion expanded to the tongue, but no evidence of regional lymph node or distant metastasis was shown. Based on these results, local recurrence of the cancer was diagnosed (cT4aN0M0).

Interventions:

The surgery for the recurrent tumor was performed.

Outcomes:

The pathological examination of the surgical specimen indicated recurrent tumor was ASC. Thus, histopathological and immunohistochemical analyses of both the initial SCC and the subsequent ASC were performed in an attempt to explore the origin of the ASC. As the results, pathological review of both tumors suggested the subsequent ASC was developed from the tumor cells with adenoid phenotype in the initial SCC.

Lessons:

This report suggests that the oral ASC was origin from the oral SCC, which can contribute to new knowledge for pathogenesis of oral cancer.
Community Socioeconomic Deprivation and Nonalcoholic Fatty Liver Disease Severity
Authors: Orkin Sarah , Brokamp Cole , Yodoshi Toshifumi , Trout Andrew T. , Liu Chunyan , Meryum Syeda , Taylor Stuart , Wolfe Christopher , Sheridan Rachel , Seth Aradhna , Bhuiyan Mohammad Alfrad Nobel , Ley Sanita , Arce‐Clachar Ana Catalina , Bramlage Kristin , Kahn Robert , Xanthakos Stavra , Beck Andrew F. , Mouzaki Marialena
Published: October 2019

Background and Objectives:

Nonalcoholic fatty liver disease (NAFLD) is linked to obesity. Obesity is associated with lower socioeconomic status (SES). An independent link between pediatric NAFLD and SES has not been elucidated. The objective of this study was to evaluate the distribution of socioeconomic deprivation, measured using an area‐level proxy, in pediatric patients with known NAFLD and to determine whether deprivation is associated with liver disease severity.

Methods:

Retrospective study of patients <21 years with NAFLD, followed from 2009 to 2018. The patients’ addresses were mapped to census tracts, which were then linked to the community deprivation index (CDI; range 0‐‐1, higher values indicating higher deprivation, calculated from six SES‐related variables available publicly in US Census databases).

Results:

Two cohorts were evaluated; 1 with MRI (magnetic resonance imaging) and/or MRE (magnetic resonance elastography) findings indicative of NAFLD (n = 334), and another with biopsy‐confirmed NAFLD (n = 245). In the MRI and histology cohorts, the majority were boys (66%), non‐Hispanic (77%–78%), severely obese (79%–80%), and publicly insured (55%–56%, respectively). The median CDI for both groups was 0.36 (range 0.15–0.85). In both cohorts, patients living above the median CDI were more likely to be younger at initial presentation, time of MRI, and time of liver biopsy. MRI‐measured fat fraction and liver stiffness, as well as histologic characteristics were not different between the high‐ and low‐deprivation groups.

Conclusions:

Children with NAFLD were found across the spectrum of deprivation. Although children from more deprived neighborhoods present at a younger age, they exhibit the same degree of NAFLD severity as their peers from less deprived areas.
Translation and Validation of the Arabic Version of the Caring Nurse-Patient Interaction Scale–Patient Version (CNPI-23P)
Authors: Abu Sharour Loai
Published: October 2019

Background

Importantly, little is known about the cancer patients’ perceptions about nurses’ caring behaviors in Arab countries (Jordan specifically). This is mainly related to a lack of short Arabic instruments that measure nurse-patient interaction from a caring perspective.

Objective

To translate and validate an Arabic version of the Caring Nurse-Patient Interaction Scale–Patient Version (CNPI-23P).

Methods

The CNPI-23 was translated into Arabic using Brislin’s model of translation. A cross-cultural adaptation and psychometric testing were used to collect the data from patients with cancer through a self-administered questionnaire, which included the Arabic version of CNPI-23P and demographic characteristics. Descriptive statistics, inferential statistics, and exploratory factor analysis were used.

Results

One hundred fifty patients were recruited. A content validity involving experts and 20 patients indicated that the statements were clear, understandable, and in logical and easy order. Reliability analysis of CNPI-23P subscales ranged between 0.71 to 0.91 and 0.95 for the total Arabic version of CNPI-23P. Results of the exploratory factor analysis showed that the 23-item scale score reflecting 4 caring domains with Kaiser-Meyer-Olkin was 0.896, and Bartlett test of sphericity was significant (P < .001).

Conclusion

The Arabic version of CNPI-23P is reliable and valid and can be used in research, clinical, and educational settings in Arabic countries.

Implications for Practice

The Arabic version of CNPI-23P may increase our understanding of cancer patients’ perceptions about nurses’ caring behaviors in Arab countries.
Graduate Leadership Education for Nurse Leaders—Needed Now More Than Ever
Authors: Fennimore Laura , Warshawsky Nora
Published: October 2019

The American Association of Colleges of Nursing recently reinforced that as nurses seek to expand their expertise in healthcare delivery they should seek graduate education. Today's healthcare systems are growing in complexity and require greater knowledge to “revolutionize healthcare.” This column presents the case to support graduate leadership education for nurse managers followed by recommendations for practice.
Building a Practice-Focused Academic-Practice Partnership
Authors: Dols Jean Dowling , Hoke Mary M. , Allen David
Published: October 2019

A practice-focused academic-practice partnership merging the strengths and resources of 2 faith-based community organizations built evidence-based practice, nursing research, and innovative nursing programs. The unique partnership emphasizing quality care and patient outcomes resulted in hospital-acquired infection reduction, interventional research reducing readmissions, clinical redesign, increased percentage of bachelor's degree–prepared nurses, and dissemination through publication and presentation. Key elements to partnership success were shared mission and vision, program oversight, strong contract, and annual plans with specific measurable outcomes.
Comparative Study of Myxofibrosarcoma With Undifferentiated Pleomorphic Sarcoma
Authors: Yoshimoto Masato , Yamada Yuichi , Ishihara Shin , Kohashi Kenichi , Toda Yu , Ito Yoshihiro , Yamamoto Hidetaka , Furue Masutaka , Nakashima Yasuharu , Oda Yoshinao
Published: October 2019

Myxofibrosarcoma (MFS) is a malignant fibroblastic/myofibroblastic neoplasm with the prominent myxoid area. It has the clinical features of frequent local recurrence and occasional distant metastasis. Morphologically, MFS is occasionally difficult to distinguish from undifferentiated pleomorphic sarcoma (UPS), especially in the case of high-grade MFS. Here, we reviewed clinical and histologic data of 162 MFS cases and 43 UPS cases. MFS was distinguished from UPS with the criterion of 10% myxoid area as a cutoff value. Overall, 52 MFS (34.4%) and 9 UPS (20.9%) cases showed local recurrence, 18 MFS (12.2%) and 19 UPS (44.2%) cases developed distant metastasis, and 13 MFS (9.5%) and 14 UPS (32.6%) cases resulted in tumor-related death. Statistically, MFS had a better prognosis than UPS. Moreover, MFS with less myxoid area had a tendency to present a poorer prognosis. FNCLCC grade was a statistically significant prognostic factor (distant metastasis: P=0.0021, tumor-related death: P=0.0021). Cellularity and nuclear atypia had only a statistical tendency for associations with a poorer prognosis. The overall survival rate of MFS after transformation into a UPS-like condition (<10% myxoid area) was close to that of UPS. It was suggested that MFS is a biologically distinct tumor from UPS, and MFS with less myxoid area had a tendency to present a poorer prognosis. We considered that evaluation of the amount of myxoid area, cellularity, and nuclear atypia may be important as prognostic predictors. MFS may become similar to histologic malignancy of UPS in terms of morphology and biology via local recurrence.