bluuebunny/crossref_metadata_2025 huggingface dataset:
RETRACTED: Can consumption of anthocyanin‐rich tomatoes reduce the risk of cardiovascular disease? (Experimental Biology 2014 Abstract Number 829.18)
Authors: Achterfeldt Sebastian , Martin Cathie , Kroon Paul
Published: October 2018

The following abstract which was published originally in 2014 as part of the Experimental Biology 2014 meeting has been voluntarily retracted by the authors, except Sebastian Achterfeldt:

THE FOLLOWING ABSTRACT HAS BEEN RETRACTED

Anthocyanins (ACN) are responsible for the red to dark purple colours in various fruits and vegetables. Epidemiological studies have shown an inverse relationship between consumption of ACN and risk of diseases, particularly cardiovascular diseases (CVD). Supplementation of animal diets with ACN‐rich foods and extracts has been shown to reduce atherosclerosis, improve vascular function and alter gene expression. However, although these studies have provided evidence that anthocyanin‐rich foods can protect against CVD, they do not prove that the anthocyanins are responsible. Therefore, we undertook a unique study using genetically modified anthocyanin‐rich purple tomatoes as the treatment and anthocyanin‐free red tomatoes as the control in a dietary intervention study.ApoE‐/‐ mice (n=20 per group) were fed different doses of purple tomatoes (0, 2.5, 5 or 10% w/w chow) with all groups receiving 10% total tomato. After 17 weeks of intervention, a number of markers of atherosclerosis, inflammation and gene expression were quantified. The data indicate that the anthocyanin‐supplemented diets caused significant reductions in the size of atherosclerotic lesions in the aortic arch, with reductions of up to approximately 40% compared to control for the group fed the highest dose of ACN‐rich tomatoes.These data show that consumption of anthocyanins within a complex plant food matrix causes reductions in the size of atherosclerotic plaques in a mouse model of human atherosclerosis. These findings support the notion that increasing anthocyanin consumption can reduce CVD risk.

Grant Funding Source: Supported by EU FP7 (ATHENA‐245121) and BBSRC (UK).

THE PRECEDING ABSTRACT HAS BEEN RETRACTED

This was published in The FASEB Journal as an abstract only and there is no corresponding full article in the journal.
Nurses Fight for the Right to Vote
Authors: Pollitt Phoebe
Published: October 2018

The Nineteenth Amendment to the U.S. Constitution guarantees women the right to vote. Its ratification in 1920 represented the culmination of a decades-long fight in which thousands of women and men marched, picketed, lobbied, and gave speeches in support of women's suffrage. This article provides a closer look at the lives of four nurse suffragists—Lavinia Lloyd Dock, Mary Bartlett Dixon, Sarah Tarleton Colvin, and Hattie Frances Kruger—who were arrested for their involvement in the women's suffrage movement.
To Be a Nurse
Authors: Kennedy Maureen Shawn
Published: October 2018

What does it really mean?
Study Finds U.S. Immigrant Medical Costs Are Lower Than Thought
Authors: Mechcatie Elizabeth
Published: October 2018

Demographic data suggest recent immigrants are ‘young and robust.’
Patient Dumping Is Still a Problem
Authors: Kritz Fran
Published: October 2018

Nurse-led transitional care may be one solution.
The Integrative Therapy Nurse: A Valuable Player in Symptom Management
Authors: Boyd Hallie
Published: October 2018

With the support of colleagues and hospital management, the author, an RN with board certification in therapeutic massage and bodywork, developed and implemented the role of the integrative therapy nurse on the spinal cord injury and disorders unit at the Minneapolis Veterans Affairs Medical Center. The goal of this initiative was to provide patients with additional nonpharmacologic options for addressing their symptoms through the creation of an integrative therapy nurse role within the existing interdisciplinary team of physicians, NPs, psychologists, registered dieticians, physical therapists, occupational therapists, speech pathologists, and staff nurses. This article outlines the process of creating this role, discusses implications for practice, and reports the outcomes of three years of its implementation. The outcomes of decreased pain and increased relaxation among the veterans who participated in this initiative warrant its further expansion to additional clinical settings.
Art as Sanctuary: A Four-Year Mixed-Methods Evaluation of a Visual Art Course Addressing Uncertainty Through Reflection
Authors: Gowda Deepthiman , Dubroff Rachel , Willieme Anna , Swan-Sein Aubrie , Capello Carol
Published: October 2018

Purpose

Engagement with visual art is a promising modality for addressing issues of uncertainty via reflective practice, one that is being increasingly used in health science education. An elective museum-based course for first-year medical students was created by two medical schools and led by an art educator experienced in medical education. The course, Observation and Uncertainty in Art and Medicine, sought to help students explore experiences of uncertainty and to develop reflective capacity through engagement with visual art.

Method

The course was run and evaluated from 2014 to 2017, with 47 students participating over the 4 years, with 12 students enrolled per year. Before and after the course, students were given the Groningen Reflection Ability Scale (GRAS) for reflective ability, the Tolerance for Ambiguity scale for ambiguity, and Best Intentions Questionnaire for personal bias awareness, and 35 students (74%) completed all of the scales. Focus group interviews and narrative postcourse evaluations were conducted, coded, and thematically analyzed.

Results

Statistically significant improvement was found in GRAS scores. Qualitative themes included student enhancement of observational skills, awareness of the subjectivity and uncertainty of perception, exploration of multiple points of view, and recognition of the course as a place for restoration and connection to classmates.

Conclusions

Incorporating visual art into medical education is an effective pedagogical method for addressing competencies central to training, including observation, reflection, and self-care.
Combining Scores Based on Compensatory and Noncompensatory Scoring Rules to Assess Resident Readiness for Unsupervised Practice: Implications From a National Primary Care Certification Examination in Japan
Authors: Onishi Hirotaka , Park Yoon Soo , Takayanagi Ryo , Fujinuma Yasuki
Published: October 2018

Purpose

Competence decisions in health professions education require combining scores from multiple sources and identifying pass–fail decisions based on noncompensatory (required to pass all subcomponents) and compensatory scoring decisions. This study investigates consequences of combining scores, reliability, and implications for validity using a national examination with subcomponent assessments.

Method

National data were used from three years (2015, 2016, and 2017) of the Japan Primary Care Association Board Certification Examination, with four subcomponent assessments: Clinical Skills Assessment–Integrated Clinical Encounter (CSA-ICE), CSA–Communication and Interpersonal Skills (CSA-CIS), Multiple-Choice Questions (MCQ), and Portfolio. Generalizability theory was used to estimate variance components and reliability. Kane’s composite reliability and kappa decision consistency were used to examine the impact of using compensatory and noncompensatory scoring.

Results

Mean performance (n = 251) on the CSA-ICE, CSA-CIS, MCQ, and Portfolio subcomponent assessments were, respectively, 61% (SD = 11%), 67% (SD = 13%), 74% (SD = 8%), and 65% (SD = 9%); component-specific Φ-coefficient reliability ranged between, respectively, 0.57 and 0.67; 0.50 and 0.60; 0.65 and 0.76; and 0.87 and 0.89. Using a completely noncompensatory scoring approach on all four subcomponents, decision-consistency reliability was 0.33. Fully compensatory scoring yielded reliability of 0.86.

Conclusions

Assessing a range of abilities in making entrustment decisions requires considering the balance of assessment tools measuring distinct but related competencies. These results indicate that noncompensatory pass–fail decision making, which seems more congruent with competency-based education, may lead to much lower reliability than compensatory decision making when several assessment subcomponents are used.
Fatty Infiltration of Cervical Spine Extensor Musculature
Authors: Passias Peter G. , Segreto Frank A. , Bortz Cole A. , Horn Samantha R. , Frangella Nicholas J. , Diebo Bassel G. , Hockley Aaron , Wang Charles , Shepard Nicholas , Lafage Renaud , Lafage Virginie
Published: October 2018

Study Design:

This is a retrospective review of a single surgeon cervical deformity (CD) database.

Objective:

Quantitatively describe the cervical extensor musculature in a CD population, and delineate associations between posterior musculature atrophy and progressive sagittal deformity.

Summary of Background Data:

While fatty infiltration (FI; ie, posterior musculature atrophy) of lumbar extensor musculature has been associated with pain and deformity, little is known of the relationship between FI, CD, cervical sagittal alignment, and functionality.

Methods:

CD patients [TS-CL>20 degrees, C2–C7 Cobb>10 degrees, CL>10 degrees, cervical sagittal vertical axis (cSVA)>4 cm, or chin-brow vertical angle>25 degrees] 18 years old and above, undergoing spinal fusion, with baseline T2-weighted magnetic resonance images were included. FI was assessed using dedicated imaging software at each intervertebral level from C2–C7. FI was gauged as a ratio of fat-free muscle cross-sectional area over total muscle cross-sectional area, with lower values indicating increasing FI. Influence of BL C2–C7 FI on patient-reported outcome measures (PROMs) and alignment was investigated. Multiple linear regression analysis (covariates: age, sex, body mass index, C2–C7 FI ratio) determined predictors of postoperative sagittal alignment and PROMs.

Results:

Thirty-eight patients were included (age: 56.6, sex: 73.7% female, body mass index: 30.1, Charlson Comorbidity Index 0.61). BL deformity presentation: TS–CL 27.4 degrees, CL 2.1 degrees, cSVA: 27.2 mm. Mean baseline C2–C7 FI ratio was 0.65±0.11. Worsening FI was associated with malaligned baseline cSVA (r
s=0.389, P=0.019), T1SS (r
s=0.340, P=0.062), and impaired gait (r
s=0.358, P=0.078). FI was not associated with BL PROMs (P>0.05). Following surgical intervention, regression models determined BL C2–C7 FI ratio as the strongest predictor of 1-year postoperative cSVA (β=−0.482, P=0.007, R
2=0.317). No associations between BL FI and postoperative PROMS or alignment parameters were observed (P>0.05).

Conclusions:

Patients with significant CD demonstrate alterations in the posterior extensor musculature of the cervical spine. Atrophic changes with FI of these muscle groups is associated with worsening CD and is an important predictor of postoperative sagittal alignment.

Level of Evidence:

Level III.
Treatment of Cervical Myelopathy
Authors: Gornet Matthew F. , McConnell Jeffrey R. , Riew K. Daniel , Lanman Todd H. , Burkus J. Kenneth , Hodges Scott D. , Dryer Randall F. , Copay Anne G. , Schranck Francine W.
Published: October 2018

Study Design:

Analysis of 2- and 7-year outcomes from a clinical trial comparing 2-level cervical disk arthroplasty (CDA) to anterior cervical discectomy and fusion (ACDF) in 287 patients with radiculopathy alone, and 110 patients with myelopathy alone or myelopathy with radiculopathy.

Objective:

To compare the long-term safety and effectiveness of CDA for myelopathy versus radiculopathy.

Summary of Background Data:

CDA for myelopathy is safe and effective in short term.

Materials and Methods:

We analyzed Neck Disability Index (NDI), neck/arm pain, SF-36, neurological status, adverse events (AEs), and secondary surgeries at index and adjacent levels.

Results:

All groups improved significantly for NDI, neck/arm pain, and physical component summary (PCS) scores from preoperative to postoperative. CDA Myelopathy versus CDA Radiculopathy: 2- and 7-year improvements were not significantly different. The 7-year score improvements for CDA Myelopathy and CDA Radiculopathy were: NDI (37.8 vs. 35.8, P=0.352), neck pain (12.0 vs. 12.1, P=0.477), arm pain (11.6 vs. 9.6, P=0.480), and PCS (14.1 vs. 13.7, P=0.863). The 2 groups had similar proportions of patients who maintained or improved their neurological status (87.2% vs. 93.5%, P=0.218), similar rates of serious AEs (54.5% vs. 57.5%, P=0.291) and similar rates of secondary surgeries at index (3.7% vs. 4.4%, P=0.839) and adjacent levels (3.7% vs. 7.6%, P=0.367). CDA Myelopathy versus ACDF myelopathy: 2 and 7-year improvements were not significantly different. The 7-year CDA and ACDF score improvements were: NDI (37.8 vs. 31.1, P=0.147), neck pain (12.0 vs. 10.4, P=0.337), arm pain (11.6 vs. 11.4, P=0.791), and PCS (14.1 vs. 11.2, P=0.363). The 2 groups had statistically similar proportions who maintained or improved their neurological status (87.2% vs. 96.2%, P=0.409), statistically similar overall rates of secondary surgeries at the index levels (3.7% vs. 9.4%, P=0.374), and statistically similar rates of secondary surgeries at adjacent levels (3.7% vs. 15.4%, P=0.088). CDA group demonstrated lower rates of serious AEs than ACDF (54.5% vs. 65.9%, P=0.019).

Conclusions:

CDA for myelopathy is a safe and effective long-term treatment.
Hibernoma as an incidental finding in the 18F-FDG PET/CT of a patient with melanoma
Authors: Marcoval Joaquim , Sabaté-Llobera Aida , Bermejo Josep , Fornons-Servent Rosa
Published: October 2018

Despite being benign tumors, hibernomas show intense fluorine-18-fluorodeoxyglucose uptake, as they are derived from brown fat, which is frequently seen as hypermetabolic fatty areas on PET/CT. We present the case of a patient with cutaneous melanoma, diagnosed with a cervical hibernoma mimicking a metastatic lymph node at fluorine-18-fluorodeoxyglucose PET/CT. Being aware of the metabolic behavior and radiologic appearance of this entity may prevent reporting false-positive lesions, especially in an oncologic setting.
Effects of Spaceflight on Cardiovascular Physiology and Health
Authors: Shen Michael , Frishman William H.
Published: October 2018

During spaceflight, the human cardiovascular system undergoes major changes primarily related to the effects of decreased gravitational force, or microgravity, on the human body. These changes present challenges to human adaptation and operation in space. This article reviews the knowledge gained in human experiments in the past half century of spaceflight, and summarizes our knowledge on the effects of short- and long-duration microgravity exposure on cardiovascular physiology and functioning, including fluid redistribution, autonomic reflexes, cardiac parameters, orthostatic intolerance, arrhythmias, aerobic capacity, and cardiac atrophy. This review also discusses current countermeasures for risk reduction during spaceflight, as well as future directions in cardiovascular research in space.
MicroRNA-18a Expression in Female Coronary Heart Disease and Regulatory Mechanism on Endothelial Cell by Targeting Estrogen Receptor
Authors: Yuan Liang , Tang Chunping , Li Dianfu , Yang Zhijian
Published: October 2018

Coronary heart disease (CHD) is a kind of cardiovascular disease, which has been causing mortality around the world for decades. Because symptoms of CHD are different in female and male patients and these symptoms occur much later in female patients, CHD is very likely to be underdiagnosed in women. Thus, it is imperative to explore novel diagnostic method for CHD especially for women. Recently, microRNA-targeted therapy has attracted much attention as a novel therapeutic method. MicroRNAs have been proven as possible markers and targeted agents for diverse diseases. In this article, this study presented an overexpressed miR-18a signature in female CHD patients' peripheral blood. And a strong association of miR-18a with estrogen receptor (ER) expression level was observed. The effects of miR-18a on human umbilical vein endothelial cell proliferation and apoptosis were monitored. The modulatory ability and possible mechanism of miR-18a on ER expression and PI3K/Akt/mTOR pathway was explored by multiple methods. Our study suggested that miR-18a could regulate CHD development through targeting ER. This could provide important information for better understanding of CHD pathology and may offer a promising molecularly targeted method for CHD therapy.
QUANTITATIVE AND QUALITATIVE ANALYSIS OF THE THREE CAPILLARY PLEXUSES AND CHORIOCAPILLARIS IN PATIENTS WITH TYPE 1 AND TYPE 2 DIABETES MELLITUS WITHOUT CLINICAL SIGNS OF DIABETIC RETINOPATHY
Authors: Forte Raimondo , Haulani Hanan , Jürgens Ignasi
Published: October 2018

Purpose:

To separately evaluate the three retinal capillary plexuses and the choriocapillaris in patients with diabetes mellitus (DM) Type 1 and Type 2, without clinical signs of diabetic retinopathy.

Methods:

The study was prospective and cross-sectional. Only patients with age ≤55 years were included. We used a swept-source optical coherence tomography angiography device (Triton; Topcon, Tokyo, Japan) to obtain both quantitative and qualitative analysis of the retinal capillary plexuses (superficial capillary plexus; middle capillary plexus; and deep capillary plexus) and the choriocapillaris.

Results:

We included 17 patients with DM Type 1 (age 34.52 ± 11.05 years, 29 eyes), 17 patients with DM Type 2 (age 48.76 ± 3.26 years, 32 eyes), and 23 healthy control subjects (age 41.82 ± 8.97 years, 43 eyes). When compared with controls, vessel density in the central 1 mm was reduced in both DM Type 1 and DM Type 2 groups in the superficial capillary plexus (P = 0.05 and P = 0.02, respectively), and in DM Type 2 in the deep capillary plexus (P = 0.03). Foveal avascular zone was increased in the middle capillary plexus and deep capillary plexus of DM Type 2 group compared with controls (P = 0.03 and P = 0.02, respectively). Choriocapillary voids were more frequent in DM Type 1 and DM Type 2 compared with controls (P = 0.003 and P < 0.001, respectively).

Conclusion:

Microvascular modifications are present in the three retinal capillary plexuses and the choriocapillaris in both DM Type 1 and DM Type 2 even in the absence of clinical signs of diabetic retinopathy.
PARACENTRAL ACUTE MIDDLE MACULOPATHY ASSOCIATED WITH PHOSPHODIESTERASE-5 INHIBITOR THERAPY
Authors: Sebastiani Stefano , Pellegrini Marco , Giannaccare Giuseppe , Sarraf David
Published: October 2018

Purpose:

To present an atypical case of paracentral acute middle maculopathy occurred upon awakening in the morning within hours after phosphodiesterase-5 (PDE-5) inhibitor consumption at bedtime.

Methods:

Multimodal retinal imaging findings, including fluorescein angiography, spectral domain optical coherence tomography, optical coherence tomography angiography, and microperimetry of a particular case of paracentral acute middle maculopathy lesion that follow the distribution of the cilioretinal artery.

Results:

A 52-year-old healthy man presented with an acute paracentral scotoma in his left eye upon awakening in the morning, after the use of a PDE-5 inhibitor pill the previous night. Spectral domain optical coherence tomography illustrated a hyperreflective band-like lesion at the level of the inner nuclear layer, consistent with a diagnosis of paracentral acute middle maculopathy, along the course of the cilioretinal artery that appeared normally perfused with fluorescein angiography. Optical coherence tomography angiography showed a perfusion deficit and capillary pruning of the retinal deep capillary plexus, with preserved intermediate capillary plexus, that colocalized with the paracentral scotoma confirmed with microperimetry.

Conclusion:

To our knowledge, this is the first report of paracentral acute middle maculopathy after the use of PDE-5 inhibitor. Nocturnal arterial hypotension exacerbated by the vasodilatory effect of the PDE-5 inhibitor may have caused transient cilioretinal artery hypo/nonperfusion and insufficiency. Paracentral acute middle maculopathy may represent the earliest form of ischemia in the central macular region, occurring after a milder vascular insult.
The Effect of Rebamipide Ophthalmic Solution on Cytokine and Mucin Secretion in Culture of Conjunctival Epithelial Cells From the Cu, Zn-Superoxide Dismutase-1 (SOD-1) Knock-Down Mouse
Authors: Ogawa Mamoru , Simsek Cem , Kojima Takashi , Nagata Taeko , Igarashi Ayako , Kawakita Tetsuya , Dogru Murat , Shimazaki Jun , Tsubota Kazuo
Published: October 2018

Objectives:

To evaluate the in vitro effects of 1-mM rebamipide ophthalmic solution on the expression of inflammatory cytokines and MUC5AC in Cu, Zn-superoxide dismutase-1 (SOD-1) knock-down conjunctival epithelium.

Methods:

Conjunctival epithelium from C57BL/6 wild-type mice was cultured and treated with rebamipide ophthalmic solution. Using cytometric bead array, we examined the levels of interleukin-(IL)-6, IL-10, IL-17, monocyte chemoattractant protein-1, interferon-γ (INF-γ), tumor necrosis factor, and IL-12p70 in the culture supernatants. The culture supernatants were obtained from the culture medium of nontreated or SOD-1 knock-down conjunctival epithelium using small interfering RNA (siRNA). In addition, ELISA was performed to ascertain the MUC5AC concentration in the culture medium.

Results:

After rebamipide ophthalmic solution was applied, IL-6 concentration in the supernatants of conjunctival epithelial cells treated with and without siRNA showed a significant timewise decrease from 0 to 24 hr (963±42 to 0.07±0.05 pg/mL and 932±168 to 2.2±0.05 pg/mL, respectively) (P<0.001). Compared with baseline values, MUC5AC concentrations significantly increased 24 hr after rebamipide application to the conjunctival cultures—both with and without SOD-1 siRNA treatment (P<0.05 in both cases).

Conclusions:

Rebamipide seems to increase MUC5AC levels and suppress inflammation by decreasing IL-6 levels in mouse conjunctival epithelial cell cultures. SOD-1 siRNA-treated mouse conjunctival epithelial cell culture is a practical method for investigating changes in mucosa-associated mucins and proinflammatory cytokines in response to therapeutic interventions.
Ocular Surface Stem Cell Transplantation for Treatment of Keratitis–Ichthyosis–Deafness Syndrome
Authors: Cheung Albert Y. , Patel Sunny , Kurji Khaliq H. , Sarnicola Enrica , Eslani Medi , Govil Amit , Holland Edward J.
Published: October 2018

Purpose:

To report our surgical experience with ocular surface stem cell transplantation (OSST) for limbal stem cell deficiency (LSCD) in the setting of keratitis–ichthyosis–deafness (KID) syndrome.

Methods:

Retrospective interventional case series.

Results:

We present 5 eyes of 3 patients with KID syndrome that developed LSCD and underwent OSST. Mean follow-up after OSST was 8.3 ± 4.3 years (range 3.4–11.4 years). Two eyes underwent living-related conjunctival limbal allograft (lr-CLAL), and 3 eyes were treated with keratolimbal allograft (KLAL). Four of the 5 eyes underwent subsequent keratoplasty. Both lr-CLAL eyes maintained a stable ocular surface at final follow-up. Conversely, all KLAL eyes developed a failed surface requiring repeat KLAL surgery. Because of multiple failed KLALs, 1 eye underwent placement of a keratoprosthesis.

Conclusions:

KID syndrome is a rare cause of LSCD. Although OSST can stabilize the surface, long-term treatment of KID syndrome can be challenging. An lr-CLAL may offer further benefit over a KLAL in these eyes because it is HLA- and ABO-matched tissue; it also helps to treat keratoconjunctivitis sicca, often a prominent feature of KID syndrome.
Multicentric Mucinous Adenocarcinoma in the Periorbital Region
Authors: Furst Meredith , Somogyi Marie B. , Vrcek Ivan , Weir Edward , Shore John W.
Published: October 2018

Primary mucinous adenocarcinoma of the skin is an uncommon malignancy in clinical practice, but multicentric presentation of the malignancy is considered even more rare. In this case report, the authors present a 70-year-old woman with multicentric primary mucinous adenocarcinoma of the skin manifesting with 2 separate lesions located on the right eyelid and cheek. Lesion removal and immunohistochemical staining ruled out mucinous adenocarcinoma of the skin secondary to lung or thyroid carcinoma, however, was inconclusive for breast carcinoma. A negative breast examination and mammography determined the lesions were primary mucinous adenocarcinoma of the skin. Lesion removal resulted in a large defect, which was repaired using a tarsoconjunctival flap and right cheek rotational/advancement flap. Six months postoperatively, the patient’s vision returned to baseline with excellent eyelid position and no evidence of local recurrence. Oral consent for the report and photographs was obtained from the patient and filed.
Correction of Recalcitrant Cicatricial Lower Lid Retraction and Entropion With Transverse Tarsotomy and Tarsoconjunctival Flap
Authors: Cho Raymond I.
Published: October 2018

Purpose:

To describe a novel technique to correct cicatricial lower lid entropion and retraction using a transverse lower lid tarsotomy with an interposed tarsoconjunctival flap posterior lamellar spacer.

Methods:

Technique description and retrospective interventional case series.

Results:

Four patients underwent the procedure—two with complications following treatment of sinonasal carcinoma and two with complications following orbital fracture repair. All patients had failed prior posterior lamellar spacer grafts, including donor sclera, dermis-fat graft, and hard palate mucosa. Average time to flap takedown was 20 (11–28) days, with an average follow-up interval of 8.4 (6.2–11.5) months. All patients had resolution of lower lid entropion and significant improvement of lower lid retraction with an average of 2.8 mm (2.0–4.3) of elevation. There were no serious complications, and all patients reported significant improvement in ocular surface symptoms.

Conclusions:

Transverse tarsotomy combined with a tarsoconjunctival flap is effective for the correction of cicatricial lower lid retraction and entropion in eyelids that have failed surgery with traditional posterior lamellar spacer grafts.
Consumers' Association of Hospital Reputation With Healthcare Quality
Authors: Ziemba Justin B. , Arenberg Steven , Reustle Holly , Allaf Mohamad E. , Haldeman Dalal
Published: October 2018

Why consumers consistently rank hospital reputation as one of the most important factors when selecting health care services remains unknown. We hypothesized that this is explained by consumers associating reputation with objective quality. We performed a cross-sectional, US population-based survey of consumers (N = 23,410) exploring this association. A Spearman rank order correlation was used to measure the strength of this relationship. Subgroups of consumers more likely to associate the two was explored with multivariable logistic regression. Consumers commonly agree (56%) that a hospital's reputation is the same as its quality of health care. Consumers also associate hospital reputation with the belief that they will be less like to suffer a complication (ρ = 0.509) or die (ρ = 0.441), although the strength of these relationships were modest (all p < 0.01). Consumers who were male (OR: 0.84), Hispanic (OR: 0.82), African American (OR: 0.86), married (OR: 0.85), self-reported as healthy (OR: 0.67), and had a recent hospitalization (OR: 0.70) were less likely to believe that reputation and quality were equivalent (all p < 0.01). This data suggests that consumers link the construct of hospital reputation with objective health care quality, but this pattern of behavior is of concern, particularly when reputation does not align with objective data.
Preventing Concussions From Foul Tips and Backswings in Professional Baseball: Catchers' Perceptions of and Experiences With Conventional and Hockey-Style Masks
Authors: Green Gary Alan , Porter Keshia Pollack , Conte Stan , Valadka Alex B. , Soloff Lonnie , Curriero Frank C.
Published: October 2018

Objective:

To understand catchers' preferences for mask type and perceptions regarding safety, comfort, and fit, and determine whether mask type is correlated with self-reported concussion and related symptoms after impacts from foul tips or backswings.

Design:

Cross-sectional study.

Setting:

Survey of active baseball catchers.

Participants:

Professional baseball catchers.

Intervention:

From May 1, 2015, to June 30, 2015, an online survey was administered in English and Spanish to all Major and Minor League catchers (n = 836).

Main Outcome Measures:

Survey items addressed the type of mask routinely and previously used (conventional or hockey style); brand and material (steel or titanium); perceptions regarding safety, comfort, and fit; and experiences with concussions.

Results:

The sample consisted of 596 catchers of which 26% reported being diagnosed with a concussion. Some concussions occurred from non-baseball activities, such as car accidents or off the field incidents. For those that occurred playing baseball, 35% resulted from a foul tip. Once catchers entered professional baseball, the use of a conventional mask rose significantly: 71% of catchers reported wearing conventional-style masks, and 30% hockey-style masks at the time the survey was conducted (P < 0.05). Both conventional and hockey-style mask wearers significantly selected hockey-style masks as providing better overall safety and protection than conventional masks (P < 0.05).

Conclusions:

This research supports foul tips as an important cause of concussion in catchers and provides important information about preferences among catchers for masks that are not perceived as the safest and strongest. Future research should supplement these data by conducting laboratory testing to determine which masks are stronger and by collecting qualitative data to explore why some players are more likely to wear a mask type that they perceive as offering less safety or protection.
Risk Factor Analysis of Persistent High-Grade Squamous Intraepithelial Lesion After Loop Electrosurgical Excision Procedure Conization
Authors: Chen Limei , Liu Li , Tao Xiang , Guo Luopei , Zhang Hongwei , Sui Long
Published: October 2018

Objective

The aim of the study was to analyze the clinical outcomes of high-grade squamous intraepithelial lesion (HSIL) 6 months after loop electrosurgical excision procedure (LEEP). We explored the risk factors of persistent cervical HSIL after LEEP and evaluated the methods of follow-up.

Patients and Methods

This retrospective study included women who underwent a LEEP and had a diagnosis of HSIL in their LEEP specimen during 2011 to 2015. The purpose was to determine the risk factors among these women for having persistent HSIL disease at their 6-month follow-up visit. At their follow-up visit, each woman underwent cervical cytology and high-risk human papilloma virus (hrHPV) testing, colposcopy-directed punch biopsy, and/or endocervical curettage.

Results

A total of 3582 women were enrolled. There were 9 cases invasive cervical cancer found and 101 women had persistent HSIL. The persistence rate was higher in women 50 years or older. The circumference, length, and width of LEEP specimens did not differ statistically between the persistent and nonpersistent group. The persistence rate among women with positive LEEP specimen margins was higher than among women with negative margins. Positive endocervical margins were associated with a higher rate of persistence than positive ectocervical margins. Multivariate logistic analysis showed that age, positive margins, abnormal cytology, and positive hrHPV during follow-up were all independent risk factors for persistent HSIL lesions.

Conclusions

Being 50 years or older, positive margins, particularly endocervical margins, and having abnormal cytology and positive hrHPV testing during follow-up were risk factors for persistent HSIL lesions after LEEP conization. Colposcopy plays an indispensable role in the diagnosis of persistent HSIL and progression.
Spinal Surgery With Electrically Evoked Potential Monitoring and Monopolar Electrocautery: Is Prior Removal of a Cochlear Implant Necessary?
Authors: Studer Daniel , Stieger Christof , Reichlin Christoph J. , Terrier Axel , Allum John H.J.
Published: October 2018

Transcranial electric stimulation to generate motor evoked potentials in lower limb muscles is the standard technique used to monitor spinal cord efferent pathways during surgical correction for spinal deformities. Monopolar electrical cauterization is also used by default in the thoracic and lumbar area of the spine during this kind of surgery to prevent major blood loss. Owing to the high levels of current used, both techniques are considered contraindicative if the patient has a cochlear implant (CI). Here, we present a CI patient who underwent corrective spinal fusion surgery for a severe kyphoscoliotic spinal deformity on whom both techniques were used without any negative effects on the CI function. A major improvement in sagittal body balance was achieved with no loss in implant-aided hearing levels. These results add to reports that CI manufactures should review their evidence underlying recommendations that transcranial electric stimulation and upper thoracic monopolar electrical cauterization are high risk for CI users, possibly initiating verification studies.
Unprotected versus protected high-risk percutaneous coronary intervention with the Impella 2.5 in patients with multivessel disease and severely reduced left ventricular function
Authors: Becher Tobias , Eder Frederik , Baumann Stefan , Loßnitzer Dirk , Pollmann Berit , Behnes Michael , Borggrefe Martin , Akin Ibrahim
Published: October 2018

Selecting a revascularization strategy in patients with multivessel disease (MVD) and severely reduced left ventricular ejection fraction (LVEF) remains a challenge. PCI with Impella 2.5 may facilitate high-risk PCI, however long-term results comparing unprotected versus protected PCI are currently unknown. We sought to evaluate the outcome of patients undergoing protected compared to unprotected percutaneous coronary intervention (PCI) in the setting of MVD and severely reduced LVEF.

We included patients with MVD and severely reduced LVEF (≤35%) in this retrospective, single-centre study. Patients that underwent unprotected PCI before the start of a dedicated protected PCI program with Impella 2.5 were compared to patients that were treated with protected PCI after the start of the program. The primary endpoint was defined as major adverse cardiac and cerebrovascular events (MACCE) during a 1-year follow-up. The secondary endpoints consisted of in-hospital MACCE and adverse events.

A total of 61 patients (mean age 70.7 ± 10.9 years, 83.6% male) were included in our study, of which 28 (45.9%) underwent protected PCI. The primary endpoint was reached by 26.7% and did not differ between groups (P = .90). In-hospital MACCE (P = 1.00) and in-hospital adverse events (P = .12) also demonstrated no significant differences. Multivariate logistic regression identified procedural success defined as complete revascularization and absence of in-hospital major clinical complications as protective parameter for MACCE (OR 0.17, 95% CI 0.04–0.70, P = .02).

Patients with MVD and severely depressed LVEF undergoing protected PCI with Impella 2.5 demonstrate similar in-hospital and one-year outcomes compared to unprotected PCI.
Factors predicting adjacent segment disease after anterior cervical discectomy and fusion treating cervical spondylotic myelopathy
Authors: You Jipeng , Tang Xiaohui , Gao Wenshan , Shen Yong , Ding Wen-Yuan , Ren Bao
Published: October 2018

The purpose of this study is to explore perioperative factors predicting symptomatic adjacent segment disease (ASD) after anterior cervical discectomy and fusion (ACDF) for patients with cervical spondylotic myelopathy (CSM) at 5-year follow-up.

This study included 356 patients who underwent ACDF for CSM from Jan.2011 to Jan.2013. Up to Jan. 2018, 39 patients suffered from ASD and 317 did not. Assessments include: age, sex, body mass index (BMI), diabetes, smoking, alcohol, duration of symptoms, preoperative Cobb angle of C2 to 7, T1 slope, C2 to 7 range of motion (C2–7 range of motion [ROM]), C2 to 7 sagittal vertical axis (C2–7 SVA), fusion level involved, superior fusion segment, high signal intensity on T2-WI of magnetic resonance imaging (MRI), preoperative visual analogue scale (VAS)-neck, VAS-Arm, Neck Disability Index (NDI) and Japanese Orthopaedic Association (JOA). Factors were processed by univariate analysis and multivariate linear regression.

Data analyzed by univariate and multivariate analysis shows that age (68.9 years old), duration of symptoms (18.8 months), superior fusion segment, more fusion level involved (2.7), high signal intensity on T2-WI (17 of 39 patients), Cobb angle of C2 to C7 (18.7°), C2 to C7 SVA (31.0 mm), T1 slope (28.4°), preoperative VAS-neck (5.2), VAS-Arm (5.6) and NDI (36.7) in ASD group are significantly higher than those in non-ASD group, however, preoperative JOA (8.2 vs 11.2, P < .001) has an opposite trend in 2 groups.

The rate of ASD after ACDF is 10.9% in 5-year follow up. Patients with cervical sagittal imbalance, advanced age and sever state of CSM, which have a positive relation with ASD before surgery should be paid attention for surgeons.
Rhythmic robotic training enhances motor skills of both rhythmic and discrete upper-limb movements after stroke: a longitudinal pilot study
Authors: Leconte Patricia , Stoquart Gaëtan , Lejeune Thierry , Ronsse Renaud
Published: October 2018

Discrete and rhythmic movements are two fundamental motor primitives being, at least partially, controlled by separate neural circuitries. After a stroke, both primitives may be impaired in the upper limb. Currently, intensive functional movement therapy is recommended after stroke, but it is mainly composed of discrete movements. No recommendation is made for the specific training of rhythmic movements. However, if they form two different primitives, both should receive a specific training to recover the complete motor repertoire, as many daily live movements integrate both of them. This paper reports the effects of a pure unilateral rhythmic movement therapy on motor performance, after stroke. Thirteen patients with chronic stroke participated in this longitudinal pilot study. They were assessed twice before the therapy to validate their chronic state, and twice after the last session to establish the short-term and long-term effects of the therapy. The therapy itself was composed of 12 sessions spread over 1 month. The exercises consisted in performing straight or circular rhythmic movements, while receiving assistance as need through a robotic device. Short-term and long-term improvements were observed in rhythmic movements regarding smoothness, velocity, and harmonicity. More surprisingly, some transfer occurred to the untrained discrete movements. This finding disputes previous studies that reported no transfer from rhythmic to discrete movements with healthy participants.
The Importance of Nurse-Sensitive Outcome Measurements
Authors: Graystone Rebecca
Published: October 2018

Nurse-sensitive patient outcome measurements are critical measures of healthcare quality in the United States. In this column, the director of the Magnet Recognition Program® calls for nurse-sensitive patient outcome measurements to be standardized and developed across all settings where nurses deliver care.
Utility of Combined EZH2, p-ERK1/2, p-STAT, and MYC Expression in the Differential Diagnosis of EZH2-positive Hodgkin Lymphomas and Related Large B-Cell Lymphomas
Authors: Tian Xuejun , Xu Jie , Dorfman David M.
Published: October 2018

EZH2 is a methyltransferase that plays an important tumorigenic role in various neoplasms. We previously found that EZH2 is expressed in a range of aggressive B-cell lymphomas (ABCLs), T-cell lymphomas, and histiocytic neoplasms, with differential expression of intracellular signaling molecules p-ERK, MYC, and p-STAT3, potential regulators of EZH2 expression. We studied EZH2 expression in nodular lymphocyte predominant Hodgkin lymphoma (NLPHL), classic Hodgkin lymphoma (cHL), T-cell/histiocyte-rich large B-cell lymphoma (THRLBCL), and B-cell Lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphomas and classic Hodgkin lymphoma (BCLu-DLBCL/cHL), as well as the coexpression of p-ERK, MYC, and p-STAT3 in these neoplasms. The neoplastic LP cells of NLPHL and Hodgkin/Reed-Sternberg cells of cHL were strongly positive for EZH2, as were the neoplastic cells in THRLBCL and BCLu-DLBCL/cHL. EZH2 expression correlated with proliferation rate, as assessed by Ki-67 staining. LP cells in NLPHL and Hodgkin/Reed-Sternberg cells in cHL were strongly positive for p-ERK, p-STAT3, and MYC, as were the neoplastic cells in THRLBCL and BCLu-DLBCL/cHL, in contrast to the differential expression of these molecules seen in ABCLs. These findings suggest that combined expression of p-ERK, MYC, and p-STAT3 is a useful immunohistochemical pattern for the diagnosis of EZH2-positive Hodgkin lymphomas and related lymphomas, in contrast to ABCLs. Furthermore, the overexpression of EZH2, in association with coexpression of tumorigenic signaling molecules, suggests an oncogenic role for this molecule in the development of Hodgkin lymphomas and related lymphomas. THRLBCL and BCLu-DLBCL/cHL appear to have a mechanism for the regulation of EZH2 expression that is similar to NLPHL and cHL and different from that of ABCLs. In addition, EZH2 and associated signaling cascades may serve as therapeutic targets for the treatment of Hodgkin lymphomas and related lymphomas.
Compendium of Physical Activities Strongly Underestimates the Oxygen Cost During Activities of Daily Living in Stroke Patients
Authors: Compagnat Maxence , Mandigout Stephane , David Romain , Lacroix Justine , Daviet Jean Christophe , Salle Jean Yves
Published: October 2018

Objective

The aim of the study was to measure the metabolic equivalent task when performing physical activities of daily living in poststroke individuals.

Design

Poststroke individuals who were able to walk without human assistance were recruited and asked to perform the following activities of daily living: washing dishes (activity code: 05041 in Ainsworth's compendium), walking at a slow pace of less than 2 mph (activity code: 17151), climbing stairs (activity code: 17133), and walking down stairs (activity code: 17070). The metabolic equivalent task was measured along these activities using a portable breath gas exchange analyzer. The measured values were then compared with Ainsworth's compendium.

Results

Thirty-five participants were included (mean [SD] age = 64.3 [14.3] yrs). The mean (SD) resting metabolic rate was 3.08 (0.79) ml O2 kg−1 min−1. The metabolic equivalent task values were significantly higher than the compendium values: metabolic equivalent task washing dishes = 2.57 (0.96) versus 1.80 for compendium; metabolic equivalent task walking = 4.16 (0.93) versus 2.00 for compendium; metabolic equivalent task climbing stairs = 5.90 (1.43) versus 4.00 for compendium; metabolic equivalent task walking down stairs = 3.29 (0.48) versus 3.50 for compendium.

Conclusions

The metabolic equivalent tasks during activities were higher than Ainsworth's compendium. Stroke individuals are thus exposed to high oxygen requirements when performing activities of daily living, which could have a strong impact on their ability to perform these activities in real life.
The Architecture of Fat Grafting II: Impact of Cannula Diameter
Authors: James Isaac B. , Bourne Debra A. , DiBernardo Gabriella , Wang Sheri S. , Gusenoff Jeffrey A. , Marra Kacey , Rubin J. Peter
Published: October 2018

Background:

Fat grafting has emerged as the treatment of choice for soft-tissue augmentation and reconstruction. Variability of volume retention remains the greatest challenge for this technique, often requiring multiple operations to achieve the desired volume. Graft that is placed greater than 2 mm from the recipient bed will undergo necrosis. Improved understanding of the architecture of fat within the recipient bed is paramount to improving outcomes. The impact of cannula diameter on graft architecture is unknown.

Methods:

Fat was harvested by liposuction and stained with methylene blue. Stained fat was grafted into 4 × 2 × 1-cm sections of excised abdominal tissue with 12-, 14-, 16-, and 19-gauge Coleman cannulas at three different volumes: 0.1, 0.5, and 1.0 cc. Each tissue block was sectioned for stained graft visualization. The diameter of each deposit and percentage with a radius greater than 2 mm were recorded.

Results:

With an injection volume of 0.1 cc, no fat deposits had a radius greater than 2 mm, regardless of cannula size. A graft volume of 0.5 cc created globules greater than 2 mm with larger cannulas (0 percent with 19-gauge, 2.9 percent with 16-gauge, 6.1 percent with 14-gauge, and 4.3 percent with 12-gauge). Injecting 1.0 cc resulted in a significant increase in the percentage of fat parcels expected to undergo central necrosis (16 percent with 19-gauge, 21 percent with 16-gauge, 26 percent with 14-gauge, and 44 percent with 12-gauge).

Conclusions:

Injection cannulas of 14-gauge or larger are more likely to create deposits with dimensions that may be susceptible to central necrosis when injecting 1.0 cc per pass. Smaller cannula sizes or lower volumes per pass should be considered.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, V.
Early Mandibular Distraction in Craniofacial Microsomia and Need for Orthognathic Correction at Skeletal Maturity: A Comparative Long-Term Follow-Up Study
Authors: Zhang Rosaline S. , Lin Lawrence O. , Hoppe Ian C. , Swanson Jordan W. , Taylor Jesse A. , Bartlett Scott P.
Published: October 2018

Background:

Controversy exists regarding the treatment of mandibular hypoplasia in craniofacial microsomia patients, notably the role of mandibular distraction osteogenesis. The authors compared the need for orthognathic surgery in skeletally mature craniofacial microsomia subjects who either did (study group) or did not (control group) undergo early mandibular distraction osteogenesis.

Methods:

A retrospective review was conducted of all craniofacial microsomia patients evaluated between January of 1993 and March of 2017. This study included patients with a Kaban-Pruzansky grade I to III mandible, and who were at least 14 years old at the time of the latest follow-up.

Results:

Thirty-eight subjects met inclusion criteria: 17 who underwent mandibular distraction osteogenesis and 21 who did not (mean age, 18.95 ± 2.82 years versus 17.95 ± 2.14 years, respectively; p = 0.246). The degree of mandibular deformity was matched (distraction, 29.4 percent Kaban-Pruzansky grade IIb and 5.9 percent grade III; no distraction, 23.8 percent grade IIb and 9.5 percent grade III; p = 0.788). No significant difference was noted between the distraction and no-distraction cohorts with regard to need for orthognathic surgery [distraction, n = 10 (58.8 percent); no distraction, n = 8 (38.1 percent); p = 0.203].

Conclusions:

The results seem to suggest that there is no significant difference in orthognathic surgery rates at skeletal maturity between craniofacial microsomia subjects who underwent early mandibular distraction osteogenesis and those who did not. Subjects who undergo distraction may still ultimately require orthognathic surgery to correct facial asymmetry. Additional studies are required to determine the optimal timing and technique of distraction, the importance of orthodontic management during and after distraction, and the early psychosocial benefits of improved facial symmetry.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.