bluuebunny/crossref_metadata_2025 huggingface dataset:
Enhancing stability by penetrating the apophysis of greater trochanter or the posterior neck cortex during titanium elastic nailing of paediatric subtrochanteric femoral fractures in children aged 5–12 years
Authors: Cha Soo Min , Shin Hyun Dae , Joo Yong Bum , Lee Woo Yong
Published: December 2019

We modified the traditional titanium elastic nail (TEN) technique to increase stability, by involving the apophysis of the greater trochanter (GT) and the femoral neck cortex. We report the clinical/radiological outcomes after at least 5 years of follow-up. We prospectively included 17 children aged 5–12 years diagnosed with subtrochanteric femoral fractures between January 2004 and December 2013. Radiological evaluations of bony union, malunion, and limb-length discrepancies (LLDs) were performed at the final follow-up. Clinical outcomes, as revealed by the Flynn scoring system, and the range of hip motion were also recorded. The mean patient age was 8.4 ± 2.0 years. Twelve patients presented with length-stable fractures and the others with unstable fractures. Bony union was evident at a mean of 4.5 months postoperatively. Radiologically, malunion >5° was evident in three patients, but all angles were <10° at the final follow-up. LLDs >1 cm were evident in five patients, but all were <2 cm at the final follow-up. Thirteen patients showed excellent outcomes and 4 had satisfactory outcomes. Complications were apparent in only two patients; both showed only temporary discomfort caused by prominent nails. The range of hip motion was satisfactory in all cases; no difference compared to the contralateral hip was apparent. Finally, the radiological/clinical outcomes did not differ by the fracture stability or pattern. We penetrated the apophysis of the GT and the femoral neck cortex with TENs to further stabilise subtrochanteric femoral fractures. This was a simple procedure that enhanced patient outcomes. Level of evidence: therapeutic level II.
Best Practices for Conducting Interprofessional Team Rounds to Facilitate Performance of the ICU Liberation (ABCDEF) Bundle
Authors: Stollings Joanna L. , Devlin John W. , Lin John C. , Pun Brenda T. , Byrum Diane , Barr Juliana
Published: December 2019

Objectives:

Daily ICU interprofessional team rounds, which incorporate the ICU Liberation (“A” for Assessment, Prevention, and Manage Pain; “B” for Both Spontaneous Awakening Trials and Spontaneous Breathing Trials; “C” for Choice of Analgesia and Sedation; “D” for Delirium Assess, Prevent, and Manage; “E” for Early Mobility and Exercise; “F” for Family Engagement and Empowerment [ABCDEF]) Bundle, support both the care coordination and regular provider communication necessary for Bundle execution. This article describes evidence-based practices for conducting effective interprofessional team rounds in the ICU to improve Bundle performance.

Design:

Best practice synthesis.

Methods:

The authors, each extensively involved in the Society of Critical Care Medicine’s ICU Liberation Campaign, reviewed the pertinent literature to identify how ICU interprofessional team rounds can be optimized to increase ICU Liberation adherence.

Results:

Daily ICU interprofessional team rounds that foster ICU Liberation Bundle use support both care coordination and regular provider communication within and between teams. Evidence-based best practices for conducting effective interprofessional team rounds in the ICU include the optimal structure for ICU interprofessional team rounds; the importance of conducting rounds at patients’ bedside; essential participants in rounds; the inclusion of ICU patients and their families in rounds-based discussions; and incorporation of the Bundle into the Electronic Health Record. Interprofessional team rounds in the ICU ideally employ communication strategies to foster inclusive and supportive behaviors consistent with interprofessional collaboration in the ICU. Patient care discussions during interprofessional team rounds benefit from being patient-centered and goal-oriented. Documentation of ICU Liberation Bundle elements in the Electronic Health Record may help facilitate team communication and decision-making.

Conclusions:

Conducting high-quality interprofessional team rounds in the ICU is a key strategy to support ICU Liberation Bundle use.
Impact of Anticoagulation on Mortality and Resource Utilization Among Critically Ill Patients With Major Bleeding
Authors: Fernando Shannon M. , Mok Garrick , Castellucci Lana A. , Dowlatshahi Dar , Rochwerg Bram , McIsaac Daniel I. , Carrier Marc , Wells Philip S. , Bagshaw Sean M. , Fergusson Dean A. , Tanuseputro Peter , Kyeremanteng Kwadwo
Published: December 2019

Objectives:

Patients with major bleeding are commonly admitted to the ICU. A growing number are on either oral or parenteral anticoagulation, but the impact of anticoagulation on patient outcomes is unknown. We sought to examine this association between anticoagulation therapy and mortality, as well as the independent effects of warfarin compared to direct oral anticoagulants.

Design:

Analysis of a prospectively collected registry (2011–2017) of consecutive ICU patients admitted with major bleeding (as defined by International Society on Thrombosis and Haemostasis clinical criteria).

Setting:

Two hospitals within a single tertiary care level hospital system.

Patients:

We analyzed 1,598 patients identified with major bleeding, of which 245 (15.3%) had been using anticoagulation at the time of ICU admission. Of patients on anticoagulation, 149 were using warfarin, and 60 were using a direct oral anticoagulant.

Interventions:

None.

Measurements and Main Results:

The primary outcome, in-hospital mortality, was analyzed using a multivariable logistic regression model. Patients with anticoagulation-associated major bleeding had higher in-hospital mortality (adjusted odds ratio, 1.49; 95% CI, 1.16–1.92). Among survivors, anticoagulation use was associated with longer median hospital length of stay, and higher mean costs. No differences in hospital mortality were seen between warfarin- and direct oral anticoagulant-associated major bleeding. Patients with warfarin-associated major bleeding had longer median length of stay (11 vs 6 d; p = 0.02), and higher total costs than patients with direct oral anticoagulant-associated major bleeding.

Conclusions:

Among ICU patients admitted with major bleeding, pre-admission anticoagulation use was associated with increased hospital mortality, prolonged length of stay, and higher costs among survivors. As compared to direct oral anticoagulants, patients with warfarin-associated major bleeding had increased length of stay and costs. These findings have important implications in the care of ICU patients with major bleeding.
Hip survival rate in the patients with avascular necrosis of femoral head after transtrochanteric rotational osteotomy: a systematic review and meta-analysis
Authors: Xu Ying-Xing , Ren Yuan-Zhong , Zhao Zhi-Ping , Wang Ying-Zhen , Wang Teng , Li Tao
Published: December 2019

Background:

The clinical outcome of transtrochanteric rotational osteotomy (TRO) for osteonecrosis of the femoral head (ONFH) remains controversial, and the promising clinical results of several Japanese studies could not be reproduced in American and European studies. Trying to solve controversies on TRO for ONFH rising from apparently conflicting studies, a meta-analysis was conducted to assess the 5- and 10-year hip survival rates (with conversion to artificial joint replacement and radiographic failure as endpoints) after TRO.

Methods:

All eligible studies were searched in seven comprehensive databases including PubMed, Web of Science, Embase, Cochrane Library, VIP Database, China Knowledge Resource Integrated Database, and Wan Fang Database prior to June 2019. The outcomes evaluated were 5- and 10-year hip survival rates after TRO. The odds ratio and risk difference for the non-comparative binary data with the 95% confidence intervals (CIs) were calculated for each outcome. The included studies were assessed for methodologic bias and potential reasons for heterogeneity were explored.

Results:

Nineteen studies of TRO for ONFH were eligible for this meta-analysis according to inclusion criteria. Based on the previous report, two calculation methods (Methods 1 and 2) were adopted in this meta-analysis. Furthermore, we performed a sub-group analysis of the 5- and 10-year hip survival rates (Method 1) after TRO for ONFH: Asian sub-population and non-Asian sub-population. Taking conversion to artificial joint replacement as the endpoint, 5- and 10-year hip survival rates (Method 1) after TRO for ONFH in the Asian population were 0.86 (95% CI = 0.82–0.89) and 0.72 (95% CI = 0.65–0.78), respectively, and 5- and 10-year hip survival rates after TRO for ONFH in the non-Asian population were 0.55 (95% CI = 0.43–0.67) and 0.42 (95% CI = 0.28–0.55), respectively. The 5- and 10-year hip survival rates (Method 2) after TRO for ONFH were 0.90 (95% CI = 0.79–0.95) and 0.89 (95% CI = 0.81–0.94), respectively. Taking radiographic failure as the endpoint, 5- and 10-year hip survival rates after TRO for ONFH were 0.70 (95% CI = 0.64–0.76) and 0.53 (95% CI = 0.46–0.61), respectively.

Conclusions:

The 5- and 10-year hip survival rates after TRO for ONFH were satisfactory in the Asian population, and were acceptable in the non-Asian population despite high early failure rates.
Anti-cyclic citrullinated peptide antibody predicts the development of rheumatoid arthritis in patients with undifferentiated arthritis
Authors: Li Chun , Zhang Yan , Song Hui , Gao Jie , Zhao Dong-Bao , Zhu Qi , He Dong-Yi , Wang Li , Li Xiang-Pei , Liu Xu-Dong , Xiao Wei-Guo , Wu Xin-Yu , Wu Hua-Xiang , Tu Wei , Hu Shao-Xian , Wang Xin , Li Zhi-Jun , Lu Zhi-Min , Da Zhan-Yun , Liang Bo , Liu Xiao-Min , Zhao Jin-Wei , Li Ling , Han Feng , Qi Wu-Fang , Wei Wei , Ma Xu , Li Zhen-Bin , Zheng Gui-Min , Zhang Feng-Xiao , Li Yi , Wang You-Lian , Ling Guang-Hui , Chen Jin-Wei , Hou Xiao-Qiang , Zhang Jing , Chen Qing-Ping , Liu Chang-Lian , Zhang Yan , Zeng Jia-Shun , Zou Qing-Hua , Fang Yong-Fei , Su Yin , Li Zhan-Guo
Published: December 2019

Background:

Clinical outcomes of undifferentiated arthritis (UA) are diverse, and only 40% of patients with UA develop rheumatoid arthritis (RA) after 3 years. Discovering predictive markers at disease onset for further intervention is critical. Therefore, our objective was to analyze the clinical outcomes of UA and ascertain the predictors for RA development.

Methods:

We performed a prospective, multi-center study from January 2013 to October 2016 among Chinese patients diagnosed with UA in 22 tertiary-care hospitals. Clinical and serological parameters were obtained at recruitment. Follow-up was undertaken in all patients every 12 weeks for 2 years. Predictive factors of disease progression were identified using multivariate Cox proportional hazards regression.

Results:

A total of 234 patients were recruited in this study, and 17 (7.3%) patients failed to follow up during the study. Among the 217 patients who completed the study, 83 (38.2%) patients went into remission. UA patients who developed RA had a higher rheumatoid factor (RF)-positivity (42.9% vs. 16.8%, χ

2
 
= 8.228, P = 0.008), anti-cyclic citrullinated peptide (CCP) antibody-positivity (66.7% vs. 10.7%, χ

2
 
= 43.897, P < 0.001), and double-positivity rate of RF and anti-CCP antibody (38.1% vs. 4.1%, χ

2
 
= 32.131, P < 0.001) than those who did not. Anti-CCP antibody but not RF was an independent predictor for RA development (hazard ratio 18.017, 95% confidence interval: 5.803–55.938; P < 0.001).

Conclusion:

As an independent predictor of RA, anti-CCP antibody should be tested at disease onset in all patients with UA.
Endoplasmic reticulum stress and destruction of pancreatic β cells in type 1 diabetes
Authors: Cao Zhao-Hui , Wu Zhuan , Hu Cong , Zhang Min , Wang Wu-Zhou , Hu Xiao-Bo
Published: December 2019

Type 1 diabetes (T1D) results from dysfunction of pancreatic islets β cells. Recent studies supported that endoplasmic reticulum (ER) stress takes an important role in pancreatic β cell excessive loss, resulting in T1D. Here, we aimed to review the relationship between ER stress and T1D. Additionally, we also reviewed the potential mechanisms underlying ER stress mediated T1D. Studies have shown that severe ER stress is directly involved in the pancreatic β cells destruction and pathogenesis of T1D. ER stress plays a key part in pancreatic β cells and T1D, which will help in developing new effective therapeutics for T1D.
A Rare Case of Lichen Planus–Like Atopic Dermatitis Involving the Hands
Authors: Saleh Jasmine , Vasicek Brooke , Swan James , Speiser Jodi , Mudaliar Kumaran
Published: December 2019

Lichen planus–like atopic dermatitis clinically mimics lichen planus and can pose a diagnostic challenge. We report a case of a 55-year-old African American woman who developed intensely pruritic papules and plaques on bilateral hands. Histological examination demonstrated acute spongiotic dermatitis with lymphocyte exocytosis into the epidermis. Taken together, a diagnosis of lichen planus–like atopic dermatitis was made. This case serves to highlight that lichen planus–like atopic dermatitis can develop on hands and that it presents as spongiotic dermatitis with lymphocyte exocytosis into the epidermis. Correlating the clinical presentation with histopathological findings will assist in establishing the diagnosis and guiding appropriate management.
Evaluation of Concentration Errors and Inappropriate Dose Tailoring of Tacrolimus Caused by Sampling-Time Deviations in Pediatric Patients With Primary Nephrotic Syndrome
Authors: Wang Junyan , Gao Peng , Zhang Huifen , Hu Yan , Ni Yinghua , Zhu Zhengyi , Zhang Liwen , Wang Huijuan , Yang Jufei , Ji Cai , Wu Miaolian , Huang Lingfei , Fang Luo
Published: December 2019

Background:

Tacrolimus dosing is routinely tailored based on its trough level (C0) drawn by therapeutic drug monitoring in pediatric patients with primary nephrotic syndrome. However, this concentration is often inaccurate owing to inappropriate practice, such as deviation of sampling time (DST). The quantitative relationship between DST and C0 remains unclear.

Methods:

Tacrolimus concentration at nominal sampling times (12 hours after last dose) and 32 deviation scenarios (12 ± 4 hours every 15 minutes) was predicted using a previously validated population pharmacokinetic model based on 162 scenarios of 100 primary nephrotic syndrome patients involved in the population pharmacokinetic model and derived virtual patients. Concentration error (CE) and relative CE (RCE) were evaluated, and the correlation between DST and RCE was evaluated by subgroup analysis using linear regression. Ultimately, the inappropriate dosing possibly misled by incorrect C0 was simulated in a real-patient cohort according to the target range (5–10 ng/mL).

Results:

Approximately 7% of RCE was caused at every 1-hour of DST. DST was the most major contributor of RCE (r = 0.773–0.804). Patients with early sampling, older age, high body weight, high dose, low aspartate transaminase level, high corticosteroid dose, and without combination of azole antifungal agents were revealed to have high RCE. Approximately 7%–36% and 9%–25% of inappropriate dose tailoring may be caused by early and delayed sampling, respectively. In addition, patients with early sampling or high-dose tacrolimus had a higher risk of inappropriate dosing than patients with delayed sampling [hazard ratio = 1.53, 95% confidence interval (CI): 1.03–2.27, P = 0.048], and low-dose tacrolimus (P < 0.0001).

Conclusions:

A moderate bias of concentration and dose tailoring was revealed within 4 hours of DST. In addition, a high risk of bias was found in patients with early sampling and high-dose tacrolimus.
Navigating Insurance Policies in the United States for Gender-affirming Surgery
Authors: Cohen Wess A. , Sangalang Alexa M. , Dalena Margaret M. , Ayyala Haripriya S. , Keith Jonathan D.
Published: December 2019

Background:

Patients with gender dysphoria seeking to undergo gender affirmation surgery are often challenged by lack of insurance coverage. The authors aim to review gender affirmation surgery policies and to highlight discrepancies between qualifying criteria across top insurance companies in the United States.

Methods:

The top 3 insurance companies in each state within the United States were determined by market share. Each insurance policy was analyzed according to coverage for specific “top surgeries” and “bottom surgeries.” Policies were obtained from company-published data and phone calls placed to the insurance provider.

Results:

Of the total 150 insurance companies identified, policies related to gender- affirming surgery were found for 124. Coverage for gender-affirming surgery varies by insurance company, state, and procedure. Most insurance companies, 122 of 124 (98%), covered chest masculinization, but only 25 of 124 (20%) of insurance companies covered nipple-areola complex reconstruction. Additionally, 36 of 124 (29%) insurance companies covered chest feminization. Vaginoplasty is covered by 120 of 124 (97%) insurance companies. Despite high rates of vaginoplasty coverage, vulvoplasty is only covered by 26 of 124 (21%) insurance companies. Phalloplasty and metoidioplasty are covered by 118 of 124 (95%) and 115 of 124 (93%) of insurance companies, respectively. Slightly more than half, 75 of 124 (60%) insurance companies covered penile prosthesis.

Conclusions:

As gender-affirming surgery insurance coverage increases, the policies regarding them remain inconsistent. Standardized policies across insurance companies would further increase access to gender-affirming surgery.
Relationship Between the Problem-Solving Skills and Empathy Skills of Operating Room Nurses
Authors: AY Fatma , POLAT Şehrinaz , KASHIMI Tennur
Published: December 2019

Background

The use of empathy in problem solving and communication is a focus of nursing practice and is of great significance in raising the quality of patient care.

Purpose

The purposes of this study are to investigate the relationship between problem solving and empathy among operating room nurses and to explore the factors that relate to these two competencies.

Methods

This is a cross-sectional, descriptive study. Study data were gathered using a personal information form, the Interpersonal Problem Solving Inventory, and the Basic Empathy Scale (N = 80). Descriptive and comparative statistics were employed to evaluate the study data.

Results

Age, marital status, and career length were not found to affect the subscale scores of cognitive empathy (p > .05). A negative correlation was found between the subscale scores for “diffidence” and “cognitive empathy.” Moreover, the emotional empathy scores of the graduate nurses were higher than those of the master's/doctorate degree nurses to a degree that approached significance (p = .078). Furthermore, emotional empathy levels were found to decrease as the scores for insistent/persistent approach, lack of self-confidence, and educational level increased (p < .05). The descriptive characteristics of the participating nurses were found not to affect their problem-solving skills.

Conclusions/Implications for Practice

Problem solving is a focus of nursing practice and of great importance for raising the quality of patient care. Constructive problem-solving skills affect cognitive empathy skills. Educational level and career length were found to relate negatively and level of self-confidence was found to relate positively with level of cognitive empathy. Finally, lower empathy scores were associated with difficult working conditions in operating rooms, intense stress, and high levels of potential stress-driven conflicts between workers in work settings.
Treatment of obstructive jaundice caused by hepatic artery pseudoaneurysm after liver transplantation
Authors: Gao Weijie , Li Xinyu , Huang Lei
Published: December 2019

Rationale:

Despite vast improvements in technique, several complications still challenge surgeons and medical practitioners alike, including biliary and vascular complications, acute and chronic rejection, and disease recurrence.

Patient concerns:

A 59-year-old man was admitted to hospital on July, 2016. He had hepatitis B cirrhosis related recurrent hepatocellular carcinoma and underwent living donor liver transplantation in our hospital.

Diagnosis:

At the time of admission, the patient's spirit, diet, sleep, normal urine and stool, and weight did not change significantly. The test indicators are as follows: total bilirubin: 100.1 μmol/L, direct bilirubin: 65.0 μmol/L. Emergency CT in the hospital after admission showed that hepatic artery pseudoaneurysm formation after liver transplantation was observed.

Interventions:

This patient underwent minimal invasive endovascular treatment. The demographic, clinical, and laboratory data were collected and reviewed. He was treated successfully by endovascular stent grafting and thrombolytic treatment.

Outcomes:

The blood concentration of tacrolimus (FK506) was 6.3 ng/mL total bilirubin 19.6 μmol/L before discharge. The changing of total bilirubin and direct bilirubin were investigated (Fig. 1). The patient recovered well and was discharged 2 weeks later. The patient is doing well and regularly followed up.

Lessons:

Coil embolization of aneurysmal sac or placement of a stent graft is a minimally invasive alternative to surgery and definitively excludes a bleeding hepatic artery pseudoaneurysm. This technique can be considered as an effective treatment option for hepatic artery pseudoaneurysm instead of a difficult surgical repair.
Recurrent transmural tracheal schwannoma resected by video-assisted thoracoscopic window resection
Authors: Chen Huiguo , Zhang Kai , Bai Mingjun , Li Haifeng , Zhang Jian , Gu Lijia , Wu Weibin
Published: December 2019

Rationale:

Primary schwannoma is extremely rare in the trachea, and its optimal treatment has not yet been established. Previous literature have indicated that traditional resection by thoracotomy is an effective surgical procedure but with huge trauma, and endoscopic excision is a minimally invasive surgical method but with possibility of recurrence. Window resection was usually utilized for selected patients with trachea invasion by thyroid carcinoma, but video-assisted thoracoscopic window resection for trachea schwannoma has not been reported previously.

Patient concerns:

A 23-year-old woman was admitted to hospital due to dyspnea, coughing and wheezing that had persisted for 2 months with aggravation for 1 week.

Diagnoses:

Chest computed tomography (CT) scan revealed a well-circumscribed soft-tissue mass located on the right lateral posterior wall of the trachea. Bronchofibroscopy (BFS) showed a whitish, smooth and round mass with a wide base in the trachea. Immunohistochemical staining demonstrated cells labeled with Vim (+), S-100 (+), SOX-10 (+), SMA (–), CK (–). Histopathological examinations showed that the mass was a schwannoma.

Interventions:

The tumor was nearly completely excised via BFS, but relapsed 2 times at 12 days and 3 weeks after endoscopic resection. Finally, the patient underwent video-assisted thoracoscopic window resection of trachea.

Outcomes:

The patient recovered rapidly and no recurrence was observed over 6 months of follow-up.

Lessons:

The treatment of tracheal schwannoma depends on the characteristics of tumor and the condition of patient. Surgical resection is a preferred alternative for sessile or transmural tumors and recurrence after endoscopic excision. Tracheal window resection by video-assisted thoracoscopy is beneficial for some appropriate patients with a small and sessile tumor.
Massive hemorrhage from an aortoesophageal fistula caused by esophageal stent implantation
Authors: Zhan Yefei , Xu Zhaojun
Published: December 2019

Rationale:

Aortoesophageal fistula (AEF) is the direct communication between the aorta and esophagus, which can cause fatal hemorrhage, and its incidence increased with the use of an esophageal stent (ES).

Patient concerns:

A 79-year-old man was admitted due to hemodynamic shock with massive hematemesis caused by AEF 1 month after the implantation of an ES.

Diagnoses:

Computed tomography angiography visualized an AEF with an ulcer-like projection on the aortic arch where the ES was placed. Angiography of the aorta revealed extravasation of contrast media from the aortic arch into the stented esophagus, which confirmed the diagnosis.

Interventions:

Thoracic endovascular aortic repair (TEVAR) was performed for massive hematemesis caused by ES-related, AEF but did not solve the underlying problem, leading to the second fatal hemorrhage.

Lessons:

TEVAR for the unique treatment of ES-related AEF is feasible in certain cases but may lead to collapse after a specific period.
Optimal duration of mechanical ventilation and influencing factors following mandibular distraction osteogenesis in infants with Pierre Robin sequence
Authors: Zhang Na , Mao Zhe , Cui Yingqiu , Tan Yonghong , Zhang Huanhuan , Ye Xiaoxin , Xu Yingyi
Published: December 2019

Mandibular distraction osteogenesis (MDO) is an effective treatment for tongue-based airway obstruction in infants with severe Pierre Robin sequence (PRS). Most infants receiving MDO require postoperative mechanical ventilation (MV) to assist breathing. Optimal MV time for each individual patient and factors influencing the time must be identified to guide clinical decision-making.

A retrospective analysis was performed on 75 infants with PRS receiving MDO from November 2016 to August 2018. Twenty-six were females and 47 were males. Data extracted from the hospital information system included sex, age, weight, history of preterm labor, preoperative pulmonary infection, laryngomalacia/tracheomalacia, laryngoscope exposure classification, anesthesia duration, operation duration, postoperative treatment site, situation of distraction, postoperative complications and MV duration. Statistical analyses were conducted to investigate the potential associations of these factors with MV time.

Seventy-three PRS syndrome patients received anesthesia for MDO device procedures were considered eligible for study. Patient sex, history of preterm labor, preoperative pulmonary infection, laryngomalacia/tracheomalacia, laryngoscopy exposure difficulty, postoperative treatment site (neonatal or pediatric intensive care unit), ventilator-associated pneumonia, age, weight, anesthesia duration, and operation duration had no significant influence on postsurgical MV time (P > .05). Amount of distraction at the time of extubation had statistically significant influence on postoperative MV time (P < .05). In addition, scatter plots revealed linear relationships between postoperative MV time and amount of distraction at extubation.

According to this analysis, amount of distraction was associated with MV time following MDO for severe PRS and roughly 6 days post-surgery is a generally safe extubation time.
A simple screening score to predict diabetes in cancer patients
Authors: Kim Ji-Su , Ko Sun-Hye , Baeg Myong Ki , Han Kyung-Do
Published: December 2019

Many cancer patients develop diabetes, which may result in reduction of chemotherapy effectiveness and increased infection risk and cardiovascular mortality. Diabetes may also increase the risks of chemotherapy-related toxicity and post-operative mortality, or represent an obstacle to optimal cancer treatment. However, the clinical predictors of diabetes in cancer patients remain largely unknown. Therefore, the aim of our study was to evaluate the risk factors for developing diabetes and construct a nomogram to predict diabetes in cancer patients.

We investigated patients from a national sample cohort obtained from the Korea National Health Insurance Service (KNHIS), which included 2% of the Korean population. Patients who had undergone routine medical evaluation by the KNHIS between 2004 and 2008 and been hospitalized due to cancer (ICD-10 codes C00–97) during the past 3 years were included. After excluding patients with type 2 diabetes and missing data, 10,899 patients were enrolled and followed-up until 2013. A total of 7630 (70%) patients were assigned as the training cohort and used to construct the nomogram which was based on a multivariable logistic regression model. The remaining patients (n = 3269) were used as the validation cohort.

The incidence rate of diabetes was 12.1 per 1000 person-years over a mean follow-up of 6.6 ± 1.8 years. Significant risk factors for developing diabetes were age, sex, obesity, fasting plasma glucose, hypertension, and hypercholesterolmia. A nomogram was constructed using these variables and internally validated. The area under the curve was 0.70 (95% confidence interval, .666-.730, P < .0001) and the calibration plot showed agreement between the actual and nomogram-predicted diabetes probabilities.

The nomogram developed in this study is easy to use and convenient for identifying cancer patients at high-risk for type 2 diabetes, enabling early type 2 diabetes screening and management.
Can we assess the advancements of gallbladder cancer using red blood cell distribution width?
Authors: Xie Youjun , Zhang Lingling , Zhan Lingling
Published: December 2019

Gallbladder cancer (GBC) is a rare biliary malignancy. The relationship between red blood cell distribution width (RDW) and cancer prognosis has been confirmed by many studies, however, the relationship between RDW and gallbladder cancer is rarely reported. Therefore, we aimed to assess the correlation between RDW and the advancements of GBC in this study.

A retrospective study was performed on 108 GBC patients and 119 age and gender-matched individuals who were admitted to the First Affiliated Hospital of Guangxi Medical University from January 2012 to December 2018.

The GBC patients had significantly higher RDW(%) levels compared to the healthy controls group (15.7 ± 2.4 vs 13.5 ± 0.6; P = .000). In addition, GBC patients with stage III+IV had higher levels of RDW(%) than stage I+II (16.1 ± 2.5 vs 14.9 ± 2.0, P = .011). Correlation analysis showed that RDW had positive correlations with TNM stage (correlation coefficient = 0.302, P = .002). The cut-off value of RDW was observed to be 14.5% in patients with GBC (area under the curve = 0.757, 95% confidence interval = 0.677–0.838, P = .000). Univariate logistic regression and multivariate logistic regression analysis showed that RDW was an independent risk factor for GBC lymph node metastasis.

Our results suggest that elevated levels of RDW are independently associated with GBC patients and may serve as potential markers for the advancements of GBC.
Multiple calcaneal fibrous dysplasia
Authors: Ko Jong-Hyun , Park Gun-Joo , Lee Kwang-Bok
Published: December 2019

Rationale:

Fibrous dysplasia (FD) is a benign bone tumor due to developmental failure in the process of primitive bone remodeling to mature lamellar bone. The most common locations of monostotic FD of the extremity bones are the proximal femur, tibia, humerus and the radius. FD in the calcaneus is extremely rare and usually manifests clinically as a single bone lesion. Moreover, no research has reported on multiple lesions in calcaneal FD.

Patient concerns:

We report a 21-year-old man presented to our institution with pain upon walking for 2 months.

Diagnoses:

We diagnosed the patient with multiple calcaneal FD through histologic examination of the excised biopsy that revealed cellular, spindly stroma and woven bone without osteoblastic rimming resembling Chinese characters

Interventions:

Plain X-ray, computed tomography, magnetic resonance imaging and histologic examination. An excisional biopsy with extended curettage and bone grafting with allogenous bone and autogenous bone marrow aspirate concentrate were performed.

Outcomes:

No complications developed after surgery and during serial follow-ups at 3, 6 and 12 months. At a postoperative 12-month follow-up, a plain radiogram showed a well-consolidated bone graft in the lesions.

Lessons:

Calcaneal FD is rare disease entity. This case can help guide clinical decision-making in the future.
Survival without concurrent chemotherapy for locoregionally advanced nasopharyngeal carcinoma treated with induction chemotherapy plus intensity-modulated radiotherapy
Authors: Fangzheng Wang , Chuner Jiang , Haiyan Qin , Quanquan Sun , Zhimin Ye , Tongxin Liu , Jiping Liu , Peng Wu , Kaiyuan Shi , Zhenfu Fu , Yangming Jiang
Published: December 2019

Although induction chemotherapy (IC) combined with intensity-modulated radiotherapy (IMRT) plus concurrent chemotherapy (CC) is the new standard treatment option in locoregionally advanced nasopharyngeal carcinoma (NPC), many patients fail to receive CC. The aim of this study was to investigate long-term survival outcomes and toxicities in these patients who are treated with IC before IMRT without CC.

We retrospectively reviewed 332 untreated, newly diagnosed locoregionally advanced NPC patients who received IC before IMRT alone at our institution from May 2008 through April 2014. The IC was administered every 3 weeks for 1 to 4 cycles. Acute and late radiation-related toxicities were graded according to the acute and late radiation morbidity scoring criteria of the radiation therapy oncology group. The accumulated survival was calculated according to the Kaplan–Meier method. The log-rank test was used to compare the difference in survival.

With a median follow-up duration of 65 months (range: 8–110 months), the 5-year estimated locoregional relapse-free survival, distant metastasis-free survival, progression-free survival (PFS), and overall survival rates were 93.4%, 91.7%, 85.8%, and 82.5%, respectively. Older age and advanced T stage were adverse prognostic factors for overall survival, and the absence of comorbidity was a favorable prognostic factor for PFS. However, acceptable acute complications were observed in these patients.

IC combined with IMRT alone provides promising long-term survival outcomes with manageable toxicities. Therefore, the omission of CC from the standard treatment did not affect survival outcomes.
The association between rs12807809 polymorphism in neurogranin gene and risk of schizophrenia
Authors: Jin Lu , An Zhiguo , Xu Bin , Mu Daibin , Fu Songnian , Hu Hongxing , Shi Yongyong , Luo Xiao , Yi Qizhong
Published: December 2019

Background:

The correlation between single nucleotide polymorphism (SNP) rs12807809 in Neurogranin (NRGN) gene and Schizophrenia (SCZ) was investigated by several studies, whereas the results were conflicting. Thus, we performed the present meta-analysis to combine and analyze the available studies in order to provide a more accurate result on the association of rs12807809 polymorphism in NRGN gene and SCZ vulnerability.

Methods:

A comprehensive retrieval in PubMed, EMBASE, Web of Science, Cochrane Library and Wanfang was performed for relevant studies on the relationship of rs12807809 polymorphism and SCZ. Summary odds ratios (OR) with 95% confidence interval (95% CI) were calculated in allelic, homozygous, heterozygous, dominant and recessive model to appraise the association.

Results:

The meta-analysis included 8 studies containing 12552 SCZ cases and 34783 controls. The results showed a statistically significant correlation between SCZ and rs12807809 polymorphism in overall population in allelic model (OR = 1.10, 95%CI 1.04–1.17). However, subgroup analysis indicated the association only existed in Caucasians but not Asian.

Conclusion:

The results of present meta-analysis suggested significant association between SNP rs12807809 in NRGN gene and SCZ susceptibility in Caucasians but not Asians.
The North American Neuroendocrine Tumor Society Consensus Paper on the Surgical Management of Pancreatic Neuroendocrine Tumors
Authors: Howe James R. , Merchant Nipun B. , Conrad Claudius , Keutgen Xavier M. , Hallet Julie , Drebin Jeffrey A. , Minter Rebecca M. , Lairmore Terry C. , Tseng Jennifer F. , Zeh Herbert J. , Libutti Steven K. , Singh Gagandeep , Lee Jeffrey E. , Hope Thomas A. , Kim Michelle K. , Menda Yusuf , Halfdanarson Thorvardur R. , Chan Jennifer A. , Pommier Rodney F.
Published: December 2019

This manuscript is the result of the North American Neuroendocrine Tumor Society consensus conference on the surgical management of pancreatic neuroendocrine tumors from July 19 to 20, 2018. The group reviewed a series of questions of specific interest to surgeons taking care of patients with pancreatic neuroendocrine tumors, and for each, the available literature was reviewed. What follows are these reviews for each question followed by recommendations of the panel.
Safety of Endoscopic Ultrasound-Guided Fine-Needle Aspiration for Pancreatic Solid Pseudopapillary Neoplasm Before Surgical Resection
Authors: Karsenti David , Caillol Fabrice , Chaput Ulriikka , Perrot Bastien , Koch Stéphane , Vuitton Lucine , Jacques Jérémie , Valats Jean-Christophe , Poincloux Laurent , Subtil Clément , Chabrun Edouard , Williet Nicolas , Vanbiervliet Geoffroy , Belkhodja Hichem , Charachon Antoine , Wangermez Marc , Coron Emmanuel , Cholet Franck , Privat Jocelyn , Le Baleur Yann , Bichard Philippe , Ah Soune Philippe , Lecleire Stéphane , Palazzo Maxime
Published: December 2019

Objectives

The results of only a few endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for pancreatic solid pseudopapillary neoplasm (SPN) have been published, and the safety of the procedure has never been investigated. Our study compared the recurrence rate in patients with and without preoperative EUS-FNA.

Methods

This European multicenter registry-based study was conducted in 22 digestive units, and retrospectively included all patients who underwent complete resection of a pancreatic SPN from 2000 to 2018. Patients with and without initial EUS-FNA were compared, and postsurgery recurrence and the associated risk factors were evaluated.

Results

A complete resection of a pancreatic SPN was performed in 149 patients (133 women, 89%), with a mean age of 34 (standard deviation, 14) years. There were no significant differences between the with (78 patients) and without (71 patients) EUS-FNA groups, except for age and tumor size and location.

Preoperative EUS-FNA allowed pancreatic SPN diagnosis in 63/78 cases (81%). After a mean follow-up of 43 (standard deviation, 36) months, recurrence was noted in 4 patients (2.7%). Preoperative EUS-FNA was not correlated with recurrence, but an older age (P = 0.005) was significant.

Conclusions

Preoperative EUS-FNA does not affect pancreatic SPN recurrence. In this series, old age was significantly correlated with recurrence.
ATM-Mutated Pancreatic Cancer
Authors: Martino Candice , Pandya Deep , Lee Ronald , Levy Gillian , Lo Tammy , Lobo Sandra , Frank Richard C.
Published: December 2019

Metastatic pancreatic cancer (PC) is an aggressive malignancy, with most patients deriving benefit only from first-line chemotherapy. Increasingly, the recommended treatment for those with a germline mutation in a gene involved in homologous recombination repair is with a platinum drug followed by a poly (ADP-ribose) polymerase (poly adenosine phosphate-ribose polymerase [PARP]) inhibitor. Yet, this is based largely on studies of BRCA1/2 or PALB2 mutated PC. We present the case of a 44-year-old woman with ATM-mutated PC who achieved stable disease as the best response to first-line fluorouracil, leucovorin, irinotecan, and oxaliplatin, followed by progression on a PARP inhibitor. In the setting of jaundice, painful hepatomegaly, and a declining performance status, she experienced rapid disease regression with the nonplatinum regimen, gemcitabine plus nab-paclitaxel. Both physical stigmata and abnormal laboratory values resolved, imaging studies showed a reduction in metastases and her performance status returned to normal. Measurement of circulating tumor DNA for KRAS G12R by digital droplet polymerase chain reaction confirmed a deep molecular response. This case highlights that first-line treatment with a platinum-containing regimen followed by PARP inhibition may not be the best choice for individuals with ATM-mutated pancreatic cancer. Additional predictors of treatment response are needed in this setting.
FOXO3a Activation by HDAC Class IIa Inhibition Induces Cell Cycle Arrest in Pancreatic Cancer Cells
Authors: Usami Makoto , Kikuchi Shohei , Takada Kohichi , Ono Michihiro , Sugama Yusuke , Arihara Yohei , Hayasaka Naotaka , Nakamura Hajime , Ikeda Yuuki , Hirakawa Masahiro , Yoshida Makoto , Miyanishi Koji , Kobune Masayoshi , Kato Junji
Published: December 2019

Objectives

Pancreatic cancer (PC) is highly aggressive with multiple oncogenic mutations. The efficacy of current chemotherapy is poor, and new therapeutic targets are needed. The forkhead box (FOX) proteins are multidirectional transcriptional factors strongly implicated in malignancies. Their expression is consistently suppressed by several oncogenic pathways such as PI3K/AKT signaling activated in PC. A recent study showed that class IIa histone deacetylases (HDAC) can act as a transcriptional suppressor. In this study, we hypothesized that HDAC class IIa inhibition would upregulate FOXO3a expression, thereby inducing its transcription-dependent antitumor effects.

Methods

We confirmed the change of FOXO3a expression and the effect of the cell growth inhibition by HDAC class IIa inhibition in AsPC-1 cells. Because FOXO3a is subject to ubiquitylation-mediated proteasome degradation, we examined the synergistic activation of FOXO3a by HDAC class IIa selective inhibitor TMP269 combined with proteasome inhibitor carfilzomib.

Results

We observed that TMP269 induced FOXO3a expression in a dose-dependent manner and inhibited cell growth in AsPC-1 cells. G1/S arrest was observed. FOXO3a expression was further increased and cell growth inhibition was dramatically enhanced by TMP269 combined with carfilzomib.

Conclusions

Dual inhibition of class IIa HDACs and proteasome could be a promising new strategy for modifying FOXO3a activity against PC.
Nuclear Factor-κB Increases Intracellular Calcium by Upregulation of Na+-Ca2+ Exchanger 1 in Cerulein-Induced Acute Pancreatitis
Authors: Chen Yuyang , Li Wanling , Xie Rui , Tang Bo , Xiao YuFeng , Yang Feng , Chen Siyuan , Yu Senyuan , Yang Shiming , Dong Hui , Guo Hong , Liu Jing-Jing
Published: December 2019

Objectives

The mechanisms underlying pathogenesis of acute pancreatitis (AP) are still not completely understood. An early, critical feature of AP is aberrant calcium (Ca2+) signaling, termed Ca2+ overload, within pancreatic acinar cells. This study aimed to develop a model system in rats for AP induction to study the contribution of the Na+-Ca2+ exchanger 1 (NCX1) ion channel in AP pathogenesis.

Methods

To establish a rat model of AP induction, cerulein or l-arginine were intraperitoneally injected and tissue was histologically analyzed by hematoxylin and eosin staining. A cell culture-based model for AP induction was similarly created through cerulein treatment of AR42J cells. Induction of AP was also examined following exposure to the NXC1-targeted inhibitor KB-R7943. The expression of each gene was detected by Western blotting, immunofluorescence, immunohistochemistry, or quantitative reverse transcription polymerase chain reaction. Transcriptional regulation by nuclear factor (NF)-κB was detected using an NCX1 promoter-fusion dual luciferase reporter system. Cytosolic Ca2+ was measured using a fluorescent calcium indicator.

Results

We found that cerulein induced NCX1 expression via activation of nuclear factor NF-κB, which potentially binds to the NCX1 promoter to induce its transcription.

Conclusions

Our findings reveal a regulatory pathway through NF-κB/NCX1 governing Ca2+ overload in AP development, thus providing potential targets for AP treatment.
Applying Motivational Interviewing Strategies to Enhance Organizational Readiness and Facilitate Implementation Efforts
Authors: Arbuckle Melissa R. , Foster Forrest P. , Talley Rachel M. , Covell Nancy H. , Essock Susan M.
Published: December 2019

Motivational interviewing (MI) is an empirically supported clinical method to help individuals make behavioral changes to achieve a personal goal. Through a set of specific techniques, MI helps individuals mobilize their own intrinsic values and goals to explore and resolve ambivalence about change. This article examines how MI-informed approaches can be applied to help staff adopt new evidence-based practices in organizational settings. Although the implementation science literature offers strategies for implementing new practices within organizations, leaders of quality improvement initiatives often encounter ambivalence about change among staff. Implementation approaches that require staff to make substantial changes may be facilitated by drawing from MI strategies. These include building a sense of collaboration from the beginning, eliciting “change talk,” and addressing any ambivalence encountered. Motivational interviewing techniques may be particularly helpful in working with those in a stage of precontemplation (who have yet to see a reason for change) and those who are contemplating change (who see that a problem exists but are ambivalent about change). This article provides examples of how an MI-informed approach can be applied to help facilitate change in staff within organizations that are implementing quality improvement initiatives. These techniques are illustrated using a representative scenario.
A Modified Technique Using Levator Aponeurosis–Müller Muscle–Reinforced Plication for Blepharoptosis Correction
Authors: Cai Jia-qin , Zhu Quan-chao , Ma Jing-jing , Hu Xian , He Gui-juan , Li Hua
Published: December 2019

Background

Blepharoptosis is a common and challenging clinical problem for oculoplastic surgeons, and various surgical techniques have been used to correct ptosis. The aims of this study were to present the clinical results of a modified technique using levator aponeurosis–Müller muscle–reinforced plication for blepharoptosis correction and to demonstrate its advantages over conventional advancement or plication methods.

Methods

This study was conducted in the Plastic Surgery Department of Sir Run Run Shaw Hospital between April 2017 and September 2018. By using this modified technique, the levator-Müller complex was reinforced with a plication suture that pierced under and through the levator-Müller complex, and the posterior and lower part of the levator-Müller complex was advanced to the tarsus, which provided permanent, reliable adhesion. The primary outcome was marginal reflex distance 1 preoperatively and postoperatively. Secondary outcomes were the cosmetic outcome, complications, and operative time.

Results

Eighty-six patients (169 eyelids) underwent this modified surgery. Patients' average age was 26 ± 7.6 years, and the median follow-up was 14 months. The preoperative and postoperative mean marginal reflex distance 1 values were 1.72 ± 0.32 and 3.69 ± 0.28 mm, respectively. The amount of plication ranged from 4 to 15 mm. The overall surgical success rate was 88.17%. Some complications were observed including undercorrection (5.92%), asymmetry (4.73%), lagophthalmos (0.59%), and conjunctival prolapse (0.59%).

Conclusions

The modified technique provided good functional and cosmetic outcomes for blepharoptosis correction by avoiding unpredicted adhesion, and it has its advantages including simplicity, easy adjustment of the eyelid height intraoperatively, minimal edema formation, and high success rate.