bluuebunny/crossref_metadata_2025 huggingface dataset:
Successive clinical application of vitamin D and bumetanide in children with autism spectrum disorder
Authors: Feng Jun-Yan , Li Hong-Hua , Wang Bing , Shan Ling , Jia Fei-Yong
Published: January 2020

Rationale:

Autism spectrum disorder (ASD) is a common neurodevelopmental disorder caused by complex interactions between genetic and environmental factors. Recent studies suggest that Vitamin D3 or bumetanide therapy may improve the core symptoms of ASD in some individuals. However, there are no guidelines that provide clinicians with evidence-based treatment regimens for the use of these therapies in ASD.

Patient concerns:

A 30-month-old female was referred to our department because she did not respond when her name was called.

Diagnosis:

The patient was diagnosed with ASD by a team of autism experts according to American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria.

Interventions:

The patient was administered Vitamin D3 150,000 IU intramuscularly once a month and Vitamin D3 800 IU orally each day. After 6 months, Vitamin D3 supplementation was discontinued because of lack of effectiveness. Subsequently, oral bumetanide 0.5 mg twice daily was initiated.

Outcomes:

The patient's symptoms remained unchanged after 6 months of Vitamin D3 supplementation, and her serum 25 (OH) D levels had reached 52.4 ng/mL. At the parent's request, Vitamin D3 supplementation was discontinued because of lack of effectiveness. Thereafter, bumetanide was initiated. After 1 month of bumetanide, the patient's Childhood Autism Rating Scale score was 26, which is below the cutoff score for ASD. This case report suggests that Vitamin D3 and bumetanide target different mechanisms in the pathogenesis of ASD.

Lessons:

Based on these observations, we discuss three possible scenarios for Vitamin D3 supplementation and propose that bumetanide should be initiated if Vitamin D3 supplementation is ineffective (identifier ChiCTR-CCC-13004498).
Health outcome prediction using multiple perturbations
Authors: Lee Wen-Chung
Published: January 2020

Public health workers and medical practitioners are frequently required to make predictions regarding various health outcomes. However, a prediction with nearly 100% certainty is seldom possible.

If a person has a health outcome of concern or is in the process of developing the outcome, many attributes of that person may undergo subtle changes—the perturbations. We propose a method, namely “prediction using multiple perturbations” and investigate its asymptotic properties when the number of attributes tends to infinity. This is a proof-of-concept study.

The proposed method can predict the health outcome of a person to near certainty if personal data with billions or trillions of attributes can be collected and 4 conditions (described subsequently in this paper) are met.

Collecting personal data with billions or trillions of attributes may someday become possible in the current era of big data. If such information can be obtained, theoretically we can predict the health outcome of a person to near certainty.
Transcriptome analyses identify hub genes and potential mechanisms in adenoid cystic carcinoma
Authors: Liu Hong-Bing , Huang Guan-Jiang , Luo Meng-Si
Published: January 2020

Adenoid cystic carcinoma (ACC) is one of the most frequent malignancies of salivary glands. The objective of this study was to identify key genes and potential mechanisms during ACC samples.

The gene expression profiles of GSE88804 data set were downloaded from Gene Expression Omnibus. The GSE88804 data set contained 22 samples, including 15 ACC samples and 7 normal salivary gland tissues. The gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were constructed, and protein–protein interaction network of differentially expressed genes (DEGs) was performed by Cytoscape. The top 10 hub genes were analyzed based on Gene Expression Profiling Interactive Analysis. Then, DEGs between ACC samples and normal salivary gland samples were analyzed by gene set enrichment analysis. Furthermore, miRTarBase and Cytoscape were used for visualization of miRNA-mRNA regulatory network. KEGG pathway analysis was undertaken using DIANA-miRPath v3.0.

In total, 382 DEGs were identified, including 119 upregulated genes and 263 downregulated genes. GO analysis showed that DEGs were mainly enriched in extracellular matrix organization, extracellular matrix, and calcium ion binding. KEGG pathway analysis showed that DEGs were mainly enriched in p53 signaling pathway and salivary secretion. Expression analysis and survival analysis showed that ANLN, CCNB2, CDK1, CENPF, DTL, KIF11, and TOP2A are all highly expressed, which all may be related to poor overall survival. Predicted miRNAs of 7 hub DEGs mainly enriched in proteoglycans in cancer and pathways in cancer.

This study indicated that identified DEGs and hub genes might promote our understanding of molecular mechanisms, which might be used as molecular targets or diagnostic biomarkers for ACC.
Hypoglycemic risk exposures in relation to low serum glucose values in ambulatory patients
Authors: Abusamaan Mohammed S. , Marzinke Mark A. , Ashok Aditya , Carroll Karen , Lane Kyrstin , Jeun Rebecca , Moseley Kendall F. , Carson Kathryn A. , Mathioudakis Nestoras N.
Published: January 2020

This study aimed to correlate hypoglycemic risk exposures (HREs) with low blood glucose value (BGV) in ambulatory patients to inform selection of a glucose critical action value (CAV).

This was a retrospective study of ambulatory patients with at least 1 serum glucose ≤70 mg/dL obtained at 2 laboratories within the Johns Hopkins Health System over 3.8 years. Multivariable logistic regression was used to evaluate association of BGV cut-offs of <60, <54, <50, and <45 mg/dL with HREs. HREs were classified as “high hypoglycemic risk” (HHR), “moderate hypoglycemic risk” (MHR), “low hypoglycemic risk” (LHR), and “no hypoglycemic risk” (NHR).

A total of 5404 patient samples of BG ≤70 mg/dL were analyzed, of which 30.3%, 23.2%, 28.5%, 18.0% occurred in NHR, LHR, MHR, and HHR groups, respectively. An inverse relationship was noted between BGV cut-offs and HHR, but no association was observed for LHR or MHR. After adjusting for age, sex, and race, there was an inverse association between BG thresholds and the odds of HHR. For classification of HHR, BGV cut-offs of <60, <54, <50, and <45 mg/dL correctly classified 71.2%, 69.8%, 68.8%, and 67.2% of BG samples, achieved false-positive rates of 13.6%, 4.7%, 1.7%, and 0.5% and positive likelihood ratios of 3.3, 6.0, 11.2, and 23.4, respectively.

Nearly 70% of low BGVs occurred in patients with at least 1 HRE, but only ∼20% occurred in HHR patients. Given their high positive likelihood ratios, BGVs <54 or <50 mg/dL are reasonable candidates for CAVs that would allow sufficient clinician response time while minimizing false-positive alerts.
Association between changes in QRS width and echocardiographic responses to cardiac resynchronization therapy
Authors: Ma Jing , Liu Yi , Dong Yun , Chen Ming , Xia Lianghua , Xu Min
Published: January 2020

Background:

Numerous studies have illustrated the association of QRS width with the incidence of echocardiographic response to cardiac resynchronization therapy (CRT). This study aimed to summarize the observational studies regarding the magnitude of change in QRS width between responders and nonresponders to CRT.

Methods:

The PubMed, Embase, and the Cochrane Library were systematically searched for relevant studies investigating the changes of QRS width with the incidence of echocardiographic response to CRT from inception till May 2019. The pooled weighted mean difference (WMD) with 95% confidence interval (CI) was calculated through random-effects model.

Results:

Five prospective and 6 retrospective studies with a total of 1524 patients were selected for final analysis. The reduction of QRS width in responders was significantly greater than nonresponders (WMD: –20.54 ms; 95% CI: –26.78 to –14.29; P < .001). Moreover, responders were associated with greater percentage reduction in QRS width when compared with nonresponders (WMD: –8.80%; 95% CI: –13.08 to –4.52; P < .001). Finally, the mean change in QRS width between responders and nonresponders differed when stratified by country, study design, mean age, percentage male, ejection fraction, measuring time of postimplanted QRS, ischemic cardiomyopathy, atrial fibrillation, and study quality.

Conclusions:

These findings indicated that shortening QRS width after CRT device implantation showed association with greater incidence of echocardiographic responses to CRT. Further prospective studies should be conducted to evaluate the prognostic values of QRS width on the incidence of echocardiographic response to CRT.
Pneumocystis pneumonia after use of corticosteroids in a man with severe alcoholic hepatitis
Authors: Chung Min Woo , Kim Uh Jin , Jun Chung Hwan , Cho Sung Bum , Park Seon Young , Park Chang Hwan , Kim Hyun Soo , Choi Sung Kyu , Rew Jong Sun
Published: January 2020

Rationale:

Severe alcoholic hepatitis (AH) has a very high mortality rate. Current guidelines recommend oral corticosteroids as first-line agents in individuals with severe AH to reduce short-term mortality. However, systemic corticosteroids have serious adverse effects. In individuals with AH, infection, which is one of the complications of steroid use, can result in serious outcomes, such as acute-on-chronic liver failure. Pneumocystis pneumonia (PCP) is a life-threatening opportunistic infection which may occur when high-dose corticosteroids are prescribed for more than 1 month. Therefore, when high-dose corticosteroids are used, providing PCP prophylaxis is warranted. Although trimethoprim-sulfamethoxazole (TMP-SMX) is the drug of choice for the prophylaxis of PCP, its hepatotoxicity limits its use in patients with severe AH who are on high-dose corticosteroids. Moreover, there is a lack of consensus on which drugs should be used for PCP prophylaxis in individuals with severe AH who are on glucocorticoid treatment. Herein, we report a case of a 43-year-old male with fatal PCP that occurred after the use of corticosteroids for severe AH.

Patient concerns:

A 43-year-old alcoholic man presented with a hematoma on his right leg. His liver function was poor, and he was he was diagnosed with severe AH and treated with oral corticosteroids for 26 days. After glucocorticoid treatment, he developed a productive cough.

Diagnoses:

A sputum PCR test was positive for Pneumocystis jirovecii.

Interventions:

He was initially treated with TMP-SMX and required artificial ventilation.

Outcomes:

He developed disseminated intravascular coagulation and multi-organ failure, and died 10 days after starting TMP-SMX.

Lessons:

To date, prevention of PCP in individuals with severe AH who are on corticosteroids has been overlooked. This case illustrates the need for prophylaxis of PCP in individuals with severe AH taking corticosteroids.
Effectiveness and safety of warm needle acupuncture on chronic renal failure
Authors: Huang Cihui , Lin Yunxin , Yang Yaqin , Zeng Fangdong , Jiang Huaqing , Lin Ting , Zheng Liang
Published: January 2020

Background:

Warm needle acupuncture (WNA) is an integral part of the acupuncture therapy. Chronic renal failure (CRF) is a common disease, which is a type of kidney disease characterized by a slow and progressive decline in renal function. The clinical practice indicates that WNA has a therapeutic effect on CRF. Therefore, we will provide a protocol to explore the effectiveness and safety of WNA for CRF.

Methods:

We will search the randomized controlled trials literatures of WNA for CRF in 5 English databases (PubMed, Web of Science, EMBASE, the Cochrane Central Register of Controlled Trials [Cochrane Library], and World Health Organization International Clinical Trials Registry Platform) and 4 Chinese databases (Chinese national knowledge infrastructure, Chinese Scientific Journal Database Information, Wanfang Database, and Chinese biomedical literature database). The renal function will be considered as the primary outcome and the secondary outcome will include curative effect, security, syndrome according to standards for assessing traditional Chinese medicine, adverse events caused by WNA, such as dizziness, nausea, vomiting, weariness, and so on. We will use EndnoteX7 software to perform the selection of the studies. And all analyses will be conducted by using RevMan software V5.3.

Result:

This study will provide a rational synthesis of current evidences for WNM on CRF.

Conclusion:

The conclusion of this study will provide evidence to judge the effectiveness and safety of WNA on CRF.

Registration: PROS-PERO CRD42019144530
A cross-sectional study
Authors: Cui Mengzhao , Gang Xiaokun , Wang Gang , Xiao Xianchao , Li Zhuo , Jiang Zongmiao , Wang Guixia
Published: January 2020

Sarcopenia is a geriatric syndrome and it impairs physical function. Patients with type 2 diabetes mellitus (T2DM) are at a higher risk of sarcopenia. The purpose of this study is to explore characteristics of general information and metabolic factors of sarcopenia in patients with T2DM in the northeast of China, and provide information for the prevention and treatment of sarcopenia in clinical practice.

Patients with T2DM aged ≥65 were recruited in Changchun from March 2017 to February 2018. Questionnaires of general information, physical examination, laboratory and imaging examination were conducted. The patients were assigned into sarcopenia group and non-sarcopenia group according to the diagnostic criteria proposed by Asian working group for sarcopenia (AWGS), and the differences between 2 groups were analyzed.

A total of 132 participants were included in this study, of which, 38 (28.8%) were diagnosed with sarcopenia. 94 (71.2%) were with no sarcopenia. Logistic regression analysis showed that age (OR: 1.182, 95%CI: 1.038–1.346), trunk fat mass (TFM) (OR: 1.499, 95%CI: 1.146–1.960) and free thyroxine (FT4) (OR: 1.342, 95%CI: 1.102–1.635) were independent risk factors for sarcopenia. BMI (body mass index) (OR: 0.365, 95%CI: 0.236–0.661), exercise (OR: 0.016, 95%CI: 0.001–0.169), female (OR: 0.000, 95%CI: 0.00–0.012), metformin (OR: 0.159, 95%CI: 0.026–0.967) and TSM (trunk skeletal muscle mass) (OR: 0.395, 95%CI: 0.236–0.661) were protective factors for sarcopenia.

Sarcopenia in patients with T2DM is associated with increased age, increased TFM and increased FT4 level. Regular exercise, female, metformin administrations, high BMI and increased TSM are associated with lower risk of sarcopenia.
Comparison of fractional excretion of electrolytes in patients at different stages of chronic kidney disease
Authors: Hsiao Po-Jen , Liao Chen-Yi , Kao Yung-Hsi , Chan Jenq-Shyong , Lin Yuh-Feng , Chuu Chih-Pin , Chen Jin-Shuen
Published: January 2020

Kidney handling of electrolytes varies in different stages of chronic kidney disease (CKD). Diabetes mellitus (DM) plays an important role in CKD. Fractional excretion (FE) is an important means in clinical practice. The relationship between FE of electrolytes in patients at different stages of CKD is worth further investigating.

We designed a cross-sectional study in 1 teaching hospital, consecutive CKD patients were enrolled between February 2016 and January 2017. Including clinical demographic features, laboratory examination including spot urine electrolytes, blood biochemistries, and relevant medications were determined.

A total of 762 CKD patients completed the study. Of these, 218 (28.6%) had DM. Participants were grouped according to estimated glomerular filtration rate into 7 categories: hyperfiltration (HF), CKD1, CKD2, CKD3a, CKD3b, CKD4, and CKD5. Groups HF, CKD1, 2, 3a, 3b, 4 and 5 contained 83, 143, 192, 94, 82, 82, and 86 patients, respectively. FE of electrolytes tended to increase along with the decline of renal function (CKD1–CKD5) (P < .001). The relationship was similar between the DM and non-DM groups. Diabetic patients demonstrated higher FE of magnesium compared with non-DM subjects at CKD2 and CKD5 (P < .05).

CKD patients showed a progressive increase in the FE of electrolytes; FE of magnesium seemed to increase more among diabetic patients with CKD, and could be a potential predictor of CKD progression.
Risk and treatment of symptomatic epidural hematoma after anterior cervical spine surgery
Authors: Liao Yehui , Tian Yang , Ye Rupei , Tang Chao , Tang Qiang , Ma Fei , Yang Sheng , He Hongchun , Zhong Dejun
Published: January 2020

Symptomatic epidural hematoma (SEH) after anterior cervical spine surgery is very rare, but it has disastrous consequences for the patients. Timely diagnosis and evaluation can effectively reduce the sequelae of neurological deficit in SEH. The purpose of this study was to retrospectively analyze a subset of clinical data of SEH after anterior cervical spine surgery, and to investigate the risk factors and treatment experience of this serious complication.

Neurological deterioration after anterior cervical spine surgery was detected in six patients. Epidural hematoma was confirmed by emergency cervical magnetic resonance imaging (MRI). The patients included five males and one female, with an average age of 56.7 ± 13.1 years (range 42–76 years). Three patients had a history of drinking and/or smoking. All of the patients were treated with nonsteroidal anti-inflammatory drugs (NSAIDs) preoperatively, but without anticoagulant drugs or pre-spinal surgery. The coagulation function was normal in all patients. Except for one patient, who had lower blood pressure (BP) during the operation and higher BP after the operation, the other patients had a normal level of BP during the pre-, intra-, and post-operation periods. The average time was 9.9 ± 6.7 hours (range, 2−19 hours) from the postoperative period to the initial neurological deficit and 6.3 ± 6.0 hours (range, 1.8−16.7 hours) from the initial deterioration to evacuation. Five patients underwent emergency evacuation, and one patient underwent conservative treatment. Four patients who underwent evacuation and one patient who received conservative treatment achieved neurological function recovery with an American Spinal Injury Association (ASIA) grade 2.4 ± 0.9 (range, 2−4 score) score at the last follow-up. One patient with confirmed arterial epidural hemorrhage during the evaluation showed no neurological function recovery at the last follow-up.

Wide exposure of the epidural space and BP level during the perioperative period play an important role in the formation of SEH after anterior cervical spine surgery. Arterial epidural hematoma has serious consequences; therefore, early diagnosis and evaluation play an important role in the recovery from paralysis.
Acupuncture for symptomatic rotator cuff disease
Authors: Choi Seoyoung , Kim Kun Hyung
Published: January 2020

Background:

Rotator cuff disease (RCD) consists of subacromial impingement syndrome, rotator cuff tendinopathy or tendinitis, partial or full rotator cuff tear, calcific tendinitis, and subacromial bursitis. Acupuncture has been suggested as a meaningful nonsurgical intervention for managing shoulder pain and dysfunction. However, previous reviews have not completely addressed the role of acupuncture in the management of RCDs. The objective of this systematic review is to evaluate the effectiveness and safety of acupuncture for managing symptoms in patients with RCD.

Methods:

We will search the following databases from their inception to November 30, 2019: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine (AMED), Physiotherapy Evidence Database (PEDro), 3 Chinese databases (China Academic Journal Full-text Database (CAJ), China Doctoral Dissertations Full-text database and China Masters’ Thesis Full-text Database), 6 Korean databases (Korean studies Information Service System (KISS), National Digital Science Library (NDSL), Research Information Sharing Service (RISS), Korean Medical Database (KMBASE), Korea Institute of Science and Technology Information (KISTI), Oriental Medicine Advanced Searching Integrated System (OASIS)), and 3 trial registries (ClinicalTrials.gov, International Standard Randomized Controlled Trials Number (ISRCTN) Registry, WHO International Clinical Trials Registry Platform (ICTRP)). We will include randomized controlled trials of acupuncture for RCD. There will be no restrictions related to setting or location. The primary outcome is pain intensity and shoulder dysfunction measured on validated scales within 12 weeks. Quality assessment will be performed using the Cochrane risk of bias tool. Dichotomous outcomes will be presented as risk ratios (RR), and continuous outcomes will be presented as weighted or standardized mean differences (SMD). Each outcome will be calculated with 95% confidence intervals.

Discussion:

The updated evidence that would be provided by this review will offer useful information for patients and practitioners, and also have implications for future studies and the development of clinical practice guidelines of RCD.

Registration: Open Science Framework (OSF) Preregistration. 2019, December 5. osf.io/n2e6t
Real-world treatment patterns of renal anemia in hemodialysis patients
Authors: Kim Hyo Jin , Park Ji In , Yoo Kyung Don , Kim Yunmi , Baek Hyunjeong , Kim Sung Ho , Chang Taehoon , Kim Hye Hyeon , Lee Kye Hwa , Hwang Seungsik , Kim Clara Tammy , Koo Hoseok , Kim Ju Han
Published: January 2020

A multicenter cohort study.

The DialysisNet was previously developed for the management of hemodialysis (HD) patients based on the American Society for Testing and Materials Continuity of Care Records by metadata transformation. DialysisNet is a dialysis patient management program created by using the personal health record care platform to overcome the problems of registry studies, in real-time.

Here, we aimed to investigate the pattern of treatment for renal anemia in HD patients using DialysisNet.

We performed a multicenter cohort study among HD patients who were treated at one of the three Korean university-affiliated hospitals from January 2016 to December 2016. Subjects were divided into 4 hemoglobin variability groups by quartiles. The variable anemia treatment pattern was reviewed. To determine renal anemia treatment patterns, we automatically collected information on the practice of anemia treatment patterns such as erythropoietin stimulating agent (ESA) doses and administration frequencies, and targeted hemoglobin maintenance rate. Individual hemoglobin variabilities were expressed as (standard deviations)/(√(n/[n–1]).

The records of 159 patients were analyzed (Hospital A: 35, Hospital B: 21, Hospital C: 103). Mean patients’ age was 65.6 ± 12.8 years, and 61.6% were men. Overall, hemoglobin level was 10.5[7.43;13.93] g/dL. 158 (99.3%) patients were using ESA; and overall, the epoetin alfa dose was 33,000[4000;136,800] U per week. Hemoglobin levels (P = .206) and epoetin alfa doses were similar (P = .924) for patients with different hemoglobin variabilities. The hemoglobin target maintenance rate was lower in the highest hemoglobin variability group than in the lowest variability group (P = .045).

In this study, detailed information on the actual anemia treatment patterns were obtained using the DialysisNet. We expect that DialysisNet will simplify and improve the renal anemia management for both dialysis patients and health care providers.
Non-linear relationship between sleep duration and metabolic syndrome
Authors: Fan Lei , Hao Zilong , Gao Li , Qi Minjie , Feng Shixian , Zhou Gang
Published: January 2020

The aims of this study were to evaluate the prevalence of metabolic syndrome (MetS) and explore the association between sleep duration and MetS. This study enrolled 8 272 adults aged 18 years and older from 6 urban and 8 rural areas during 2013 to 2014in Henan China. Participants were interviewed about demographic characteristics, lifestyle factors and medical history, and physical measurements were performed. The relationships between sleep duration and MetS were evaluated and plotted by Restricted Cubic Spline Regression. The mean age was 51.5 years (SD 14.2) and 4 916 (59.4%) were female. The crude prevalence of MetS was 30.3% and the age-standardized rate was 23.6%. Men were more likely to have MetS than women (P = .01). MetS was positively associated with age, education, smoking, drinking, BMI and sleep duration, and seemed irrelevant to occupation and sedentary behavior. In terms of individual component of MetS, high blood pressure was the most prevalent component for both men and women, while the lowest prevalent was high triglycerides in men and for women was low high-density lipoprotein cholesterol (HDL-C). There was a U-shaped relationship between sleep duration and MetS and its components. Sleep duration <6 hours or >9 hours were associated with higher risk of MetS (OR from 1.10 to 2.15). The MetS was prevalent, and more than half of total adult population was suffering from high blood pressure. Sleep duration may be a determinant of metabolic health. Both short (<6 hours) and long sleep duration (>9 hours) was linked to an increased risk of MetS.
Malignancy rate of Bethesda category III thyroid nodules according to ultrasound risk stratification system and cytological subtype
Authors: Yoo Won Sang , Ahn Hwa Young , Ahn Hye Shin , Chung Yun Jae , Kim Hee Sung , Cho Bo Youn , Seo Mirinae , Moon Jae Hoon , Park Young Joo
Published: January 2020

The risk of malignancy is considered to be 10% to 30% for cases of thyroid nodules with atypia or follicular lesion of undetermined significance (AUS/FLUS). However, only a minority of patients with AUS/FLUS undergo surgery; therefore, the risk of malignancy might be overestimated due to selection bias. To overcome this problem, we categorized cases of thyroid nodules with AUS/FLUS using the ultrasound risk stratification system (US-RSS) to calculate the malignancy rate and identify the patients most suitable for surgical treatment.

In this retrospective observational study, we subcategorized 382 pathologically confirmed thyroid nodules with AUS/FLUS using current US-RSSs (American Thyroid Association, Korean-Thyroid Imaging Report and Data System, American College of Radiology-Thyroid Imaging, Reporting and Data System, European Thyroid Imaging Report and Data System) and calculated the malignancy rate. Additionally, cases of nodules with AUS/FLUS were categorized according to their cytological subtypes, and the malignancy rate was calculated.

Current US-RSSs showed good or moderate agreement among them. The overall malignancy rate for thyroid nodules with AUS/FLUS was 38.7%. On categorization of the nodules with AUS/FLUS, the malignancy rates were found to be 60% to 67.5% for the high suspicion category, 32.2–36.6% for the intermediate suspicion category, and 12.4% to 16.3% for the low suspicion category. The malignancy rate for nodules with cytologic atypia was significantly higher than that for nodules with architectural atypia, especially in the intermediate suspicion category.

Categorization of thyroid nodules with AUS/FLUS using current US-RSSs helps to determine the optimal course of management of patients, especially when combined with cytological subtype characterization.
Development of a Prognostic Score to Predict Mortality in Patients With Pediatric Acute Liver Failure
Authors: Lee Eun Joo , Kim Ju Whi , Moon Jin Soo , Kim Yu Bin , Oh Seak Hee , Kim Kyung Mo , Ko Jae Sung
Published: January 2020

Objectives:

This study aims to develop a new prognostic score based on changes in serial laboratory data from patients with pediatric acute liver failure (PALF).

Methods:

We retrospectively reviewed data on 146 patients with PALF at the Seoul National University Children Hospital (SNUCH) and the Asan Medical Center (AMC). Daily morning laboratory records were obtained for up to 7 days after diagnosis of PALF: total bilirubin (TB) (mg/dL), international normalized ratio for prothrombin time (INR) at enrolment; peak TB, peak INR, peak ammonia (μmol/L); the difference between the peak TB and TB at enrollment (ie, Δpeak TB), the difference between the peak INR and INR at enrollment (ie, Δpeak INR), the maximum change in serial TB (ie, Δdaily TB), the maximum change in serial INR level (ie, Δdaily INR). We assigned nontransplanted patients in SNUCH and AMC to derivation and validation cohorts, respectively.

Results:

Δpeak TB, Δdaily TB, Δpeak INR, and Δdaily INR were significantly higher in the nonsurvival group. We developed a new score that can predict mortality in nontransplanted patients (derivation cohort n = 42, validation cohort n = 33). PALF‐Delta score (PALF‐Ds) = [0.232 × Δpeak TB (mg/dL)] + [2.263 × Δdaily INR] + [0.013 × peak ammonia (μmol/L)] − 4.498. The score yielded AUC 0.918 in the derivation cohort (sensitivity 81%, specificity 91%) and AUC 0.947 in the validation cohort (sensitivity 100%, specificity 89%).

Conclusion:

A prognostic scoring system using the change of TB/INR may be useful for predicting mortality in patients with PALF.
Predictors of Emotional Engagement in Online Graduate Nursing Students
Authors: Kuchinski-Donnelly Darlene , Krouse Anne M.
Published: January 2020

Background

Student engagement, specifically emotional engagement, is a predictor to positive learning outcomes and academic success. Autonomy, competence, and relatedness have been associated with engagement; however, these studies have not been done in nursing.

Purpose

The purpose of this study was to examine if autonomy, competence, and relatedness predicted emotional engagement among graduate nursing students in the online learning environment.

Methods

A descriptive, correlational design was used to determine the levels of and relationships among emotional engagement and autonomy, competence, and relatedness as well as predictors of emotional engagement in students (n = 123) in online nursing programs.

Results

Findings revealed that students were emotionally engaged in their learning, and competence was the only predictor of emotional engagement.

Conclusion

Competency-based learning strategies should be implemented in online learning environments to increase the emotional engagement of graduate nursing students.
Comparison of PD-L1 Expression Using 2 Validated PD-L1 IHC 22C3 pharmDx Methods in Non–Small Cell Lung Cancer in a Routine Hospital Setting
Authors: Skov Birgit G.
Published: January 2020

Concordance between 3 validated, commercial programmed cell death ligand 1 (PD-L1) assays and their associated platforms (PD-L1 IHC 22C3 pharmDx Autostainer Link 48, PD-L1 IHC 28-8 pharmDx Autostainer Link 48, and Ventana SP263) has been demonstrated in non–small cell lung cancer. No comparison studies exist for IHC 22C3 pharmDx on the Dako Omnis platform. PD-L1 scoring can be challenging and time-consuming, but no quantitative data exist. A total of 144 formalin-fixed, paraffin-embedded samples from a routine clinical setting were stained with PD-L1 IHC 22C3 pharmDx on the Autostainer Link 48 and on the Dako Omnis platform. Cytologic and histologic material was assessed by 1 pathologist to evaluate the analytical agreement. The ease of PD-L1 scoring was also evaluated. High agreement of PD-L1 scores was found between PD-L1 IHC 22C3 pharmDx on the Autostainer Link 48 and the Dako Omnis platform, whether applied to histologic or cytologic cell blocks, with an overall agreement of 99% and positive agreement and negative agreement of 95%. An overall 76% of the samples that were difficult to score were in the 1% to 49% Tumor Proportion Score category, with no difference between the platforms. Assessment of PD-L1 expression in non–small cell lung cancer, as measured by PD-L1 IHC 22C3 pharmDx on the Autostainer Link 48 and Dako Omnis platform, is feasible on histologic and cytologic specimens. The very high overall agreement, positive agreement, and negative agreement between the 2 PD-L1 staining platforms was demonstrated. Scoring of samples in the Tumor Proportion Score category 1% to 49% was the most difficult and time-consuming.
Combined Application of Immunohistochemistry and Warthin-Starry Silver Stain on the Pathologic Diagnosis of Cat Scratch Disease
Authors: Peng Jinwu , Fan Zhuoyang , Zheng Hongmei , Lu Junmi , Zhan Yuting
Published: January 2020

Purpose:

Cat scratch disease (CSD) is an infectious disorder caused primarily by the bacterium Bartonella henselae (B. henselae). Immunohistochemistry (IHC) and Warthin-Starry silver stain (WS) are considered to be indispensable to diagnose CSD in combination with morphologic characteristics. In this study, we retrieved and reviewed 46 cases of paraffin-embedded lymphadenitis with histologic and/or clinical suspicion of CSD between 2014 and 2018, and detected B. henselae by IHC and WS, respectively, and evaluated the application significance of IHC and WS for the detection of B. henselae and validated their values in the pathologic diagnosis of CSD.

Materials and Methods:

B. henselae was detected by IHC and WS; validation of 2 methods for detecting B. henselae was evaluated by sensitivity, specificity, false-positive rate, false-negative rate, precision, negative predictive value, and agreement rate.

Results:

Microscopically, suppurative granulomas and/or multiple stellate microabscesses were observed in the accessory cortex of lymph nodes, especially near the subcapsule. Our results showed that 80.4% (37/46) of cases were positive for B. henselae by IHC, manifesting mainly punctuate, granular, or linear to outline the shape of bacteria. However, the positive rate of B. henselae by the WS method was 52.2% (24/46). There was a significant difference between IHC and WS (P=0.023). Moreover, a positive percentage of B. henselae was 97.8% (45/46), which was detected by the combined application of IHC and WS. The combination of IHC and WS exhibited high sensitivity (97.8%) and good agreement rate (86.5%).

Conclusion:

The combined application of the IHC and WS method may have important clinical advantages, which is with the highest sensitivity and agreement rate for pathologic diagnosis of CSD.
Evaluation of Learning Effectiveness After a Simulation-Based Training Pediatric Course for Emergency Physicians
Authors: Ansquer Raihei , Oriot Denis , Ghazali Daniel Aiham
Published: January 2020

Introduction

For emergency physicians, pediatric emergencies represent rare and challenging situations. Simulation-based training (SBT) is increasingly used in medical education and recommended for implementation in the curriculum and postgraduate training.

Objectives

The objective of this study was to explore the self-assessment of emergency physicians' and residents' clinical practice in pediatric emergency care after SBT.

Methods

We surveyed emergency physicians and residents who successfully took a course of Pediatric Emergency Procedures (University of Poitiers, France) between 2010 and 2015. The course included didactics 50% of the time, and simulation the other 50%. According to Kirkpatrick model, 3 levels were approached: satisfaction, learning (knowledge, skills, and attitudes), and changes in clinical practice. The main results are expressed in numbers (percentages).

Results

One hundred percent of the 46 included emergency physicians and residents were satisfied with the course. Sixty-nine percent agreed with the realism of low-fidelity simulation, whereas 22% disagreed. Ninety-six percent agreed with high-fidelity simulator realism. One hundred percent of responders perceived a gain in knowledge, 98% in practical skill, and 83% in improved self-confidence. Among the clinical practice changes, 91% involved anticipation, 81% procedural skills, 92% algorithms, and 79% communication and teamwork. One hundred percent expressed the wish to repeat simulation sessions at a rate of 2 ± 1 sessions per year.

Conclusions

Self-assessment of the Pediatric Emergency Procedures university course was very positive. According to the participants, this type of SBT on very specific pediatric emergency cares should be integrated to the emergency resident's curriculum. As regards pediatric emergency care, particularly dealing with low-volume, high-stake procedures, the participants were favorable to further, more regular simulation training.
Diagnostic Performance of a Staged Pathway for Imaging Acute Appendicitis in Children
Authors: Ahmad Tahani , Khdair Ahmad Fareed , Manson David
Published: January 2020

Introduction

The objective of this work is to assess the performance of our staged diagnostic pathway in the evaluation of suspected appendicitis cases in children. The pathway consisted of clinical assessment by the emergency physician, performing initial ultrasound (US), consultation, and clinical reevaluation by the surgery team followed by a repeat focused US scan in inconclusive cases. Computed tomography (CT) was limited to cases where the repeat US remained inconclusive and the clinical reassessment indicated persistent concerns for appendicitis.

Method

Retrospective review of the electronic medical records of 206 consecutive children who presented to our emergency department with acute abdominal pain and underwent US examination for suspected appendicitis. The imaging findings, management plan, and surgical outcome (in those who underwent surgery) were reviewed. The diagnostic performance of the initial US, repeat US, and the full imaging protocol were evaluated including the negative appendectomy rate (NAR) and the number of CT scans performed.

Results

Of the 206 cases, 73 (35.4%) had appendicitis. Computed tomography was performed in 9 (4.3%) of 206 cases. The US/CT ratio was 23:1. Our approach showed a diagnostic accuracy of 95.6% (197/206), sensitivity of 97.3% (73/75), specificity of 93.7% (124/133), positive predictive value of 89.0% (73/82), and negative predictive value of 98.7% (82/95). The NAR was 2.7% (2/72). The accuracy of the protocol is higher than that of the initial US alone (61.2%; 126/206) and that of the repeat US (84.2%; 16/19).

Conclusion

The strategy of repeating limited focused US followed by CT scan in cases that remain inconclusive has good diagnostic accuracy and reasonable NAR and decreases the number of CT scans.
A Quality Initiative to Decrease Time to Antibiotics in Children with Sickle Cell Disease and Fever
Authors: McKinney Christopher , Caruso-Brown Amy , Montgomery Kathleen , Gillespie Anne , Coughlin Rebecca , Law Dawn , Brouwer Anna , Tytler Lauren , Hilden Joanne , Nuss Rachelle
Published: January 2020

Introduction:

Children with sickle cell disease (SCD) are at increased risk for sepsis secondary to functional asplenia. Timely administration of antibiotics, within 60 minutes of triage, is a national indicator of quality SCD care in the United States. However, there are no reports demonstrating the feasibility of doing so in the outpatient hematology–oncology clinic setting.

Local Problem:

At baseline, in our pediatric hematology–oncology outpatient center, just 10% of children with SCD and fever received timely antibiotics.

Methods:

We implemented a process improvement initiative for children with SCD and fever with the aim of ≥90% receiving timely antibiotics. We enacted interventions focused on general clinic processes from check-in to antibiotics and population-specific interventions, including an intravenous access protocol, notification/communication among staff members, and design of an electronic order set.

Results:

The percentage of children receiving timely antibiotics improved from 10% to 77% with successful maintenance following the interventions. Residual delays are due to nonexpeditious order placement and difficult intravenous access.

Conclusion:

Improving the timely administration of antibiotics in the outpatient hematology–oncology clinic setting for children with SCD and fever is possible. Achieving at least 90% timely antibiotics for children with SCD and fever in the outpatient clinic setting will require ongoing efforts at expeditious order placement and intravenous access.
Brief Report: Accuracy in Self-Report of Viral Suppression Among HIV-Positive Men With HIV-Negative Male Partners
Authors: Stephenson Rob , Bratcher Anna , Mimiaga Matthew J. , Garofalo Robert , Hidalgo Marco A. , Hoehnle Samuel , Sullivan Patrick S.
Published: January 2020

Background:

Among men who have sex with men, there is now clear evidence that the risk of HIV transmission through condomless sex when the HIV-positive partner is virally suppressed is effectively zero. However, an understanding of the accuracy of reporting of viral load among serodiscordant same-sex male couples is missing from the literature.

Setting:

This analysis uses data from the baseline sample of Stronger Together, a randomized controlled efficacy trial of an innovative dyadic intervention to enhance antiretroviral therapy adherence for HIV serodiscordant male couples in 3 US cities (Atlanta, Boston, and Chicago).

Methods:

Biomarker-confirmed and self-reported measures of viral load were used to assess the accuracy of self-report of viral suppression. In this descriptive analysis, the percentage of men who inaccurately reported being virally suppressed is compared across demographic, relationship, and HIV care characteristics.

Results:

Results confirm those of other recent studies that have shown relatively high levels of inaccuracy in reporting of viral suppression. Although 72.5% of men could accurately report their viral load status, 20% reported that they were virally suppressed when they did not have a biomarker-confirmed measure of viral suppression.

Conclusion:

These results highlight the need to provide interventions to men who have sex with men living with HIV to support access to care and ensure current knowledge of viral load and to continue to support primary prevention of HIV through condom use and pre-exposure prophylaxis. For couples, particularly serodiscordant male couples, interventions that can teach the couple how to collaborate to achieve and maintain viral suppression for the positive partner are an urgent and pragmatic programmatic priority that can equip couples with the knowledge required to correctly implement U = U strategies.
Why do Thoracic Radiologists Need to Know About Cultural Competence (and What Is it Anyway)?
Authors: Noble Anita , Shaham Dorith
Published: January 2020

Thoracic radiologists meet patients when performing procedures such as transthoracic computed tomography–guided biopsy and during shared decision-making required for lung cancer screening. Both patients and thoracic radiologists are influenced by their cultures, which affect their health care interactions. While culture may relate to religion or ethnicity of individuals, it also includes multiple additional characteristics such as gender, socioeconomic status, sexual orientation, education, occupation, age, disability, and more. Patients from different cultures undergo similar medical procedures; however, care must be tailored according to the cultural and linguistic needs of each patient. Cultural competence allows all patients, from the same or different culture as the thoracic radiologist, to receive care that is tailored to the patient’s cultural and linguistic needs. Cultural competence includes concepts such as cultural awareness, linguistic competence, and health literacy as well as avoiding bias and stereotyping. Culturally competent care requires appropriate services for interpretation, relating to spoken language, and translation, related to written reports and documents. The implications of not providing adequate interpretation and translation services include the inability to take an accurate health history and patient inability to understand the informed consent forms. Thoracic radiologic services should have culturally competent practices in place at every step of the care, starting from the first phone call when patients are making an appointment. This will allow patients to receive care that is culturally and linguistically appropriate and lead to better satisfaction and outcomes.
Relationships Between Abdominal Pain and Fatigue With Psychological Distress as a Mediator in Women With Irritable Bowel Syndrome
Authors: Han Claire J. , Jarrett Monica E. , Heitkemper Margaret M.
Published: January 2020

Women with irritable bowel syndrome often report fatigue, along with abdominal pain and psychological distress (i.e., depression and anxiety). There is little information about the relationships among these symptoms. Using a secondary data analysis (N = 356), we examined the relationship between abdominal pain and fatigue and whether psychological distress mediates the effect of abdominal pain on fatigue in both across women and within woman with irritable bowel syndrome. Data gathered through a 28-day diary were analyzed with linear regressions. The across-women and within-woman relationships among same-day abdominal pain, fatigue, and psychological distress were examined. Within-woman relationships were also examined for directionality among symptoms (i.e., prior-day abdominal pain predicts next-day fatigue and prior-day fatigue predicts next-day abdominal pain). In across-women and within-woman analyses on the same day, abdominal pain and fatigue were positively correlated. In within-woman analyses, abdominal pain predicted next-day fatigue, but fatigue did not predict next-day pain. In across-women and within-woman analyses, psychological distress partially mediated the effects of abdominal pain on fatigue. Symptom management incorporating strategies to decrease both abdominal pain and psychological distress are likely to reduce fatigue. Nursing interventions, such as self-management skills to reduce abdominal pain and psychological distress, may have the added benefit of reducing fatigue in irritable bowel syndrome.
The Past as Seen by Women and Men With Alzheimer Disease
Authors: El Haj Mohamad , Boutoleau-Bretonnière Claire , Gallouj Karim
Published: January 2020

Background:

Although there is a large body of research demonstrating the negative effects of Alzheimer disease (AD) on autobiographical memory (ie, memory of personal information), little is known about sex differences in autobiographical retrieval in AD.

Methods:

We addressed this issue by inviting patients with AD and healthy control participants to retrieve autobiographical memories and analyzed them with regard to specificity, subjective experience (ie, time travel, emotion, and visual imagery), and retrieval time.

Results:

Analyses demonstrated no significant differences between women and men with AD with regard to autobiographical specificity, time travel, visual imagery, or retrieval time. However, the higher emotional value was attributed to memories by women with AD than by men with AD.

Discussion:

AD seems to equally affect the ability of women and men with AD to construct specific autobiographical memories, to mentally travel in time to relive these memories, to construct mental visual images during memory retrieval, and to organize and monitor search processes, as the latter are mirrored by retrieval time. However, women with AD seem to attribute greater emotional value to autobiographical memories than men with AD.