bluuebunny/crossref_metadata_2025 huggingface dataset:
Repeated Intravenous Lidocaine Infusions for Patients with Fibromyalgia: Higher Doses of Lidocaine Have a Stronger and Longer-Lasting Effect on Pain Reduction
Authors: Wilderman Igor , Pugacheva Olga , Perelman Vsevolod (Sev) , Wansbrough Michael C T , Voznyak Yuri , Zolnierczyk Lukasz
Published: September 2019

Objectives

To determine the effect of escalating doses of lidocaine infusion with or without added magnesium on pain levels and the duration of pain relief in patients with fibromyalgia (FM).

Methods

A retrospective chart review of 74 patients diagnosed with FM who underwent at least three escalating doses of intravenous (IV) lidocaine infusions (5 mg/kg of body weight, 7.5 mg/kg, and 7.5 mg/kg of lidocaine + 2.5 g of magnesium sulfate) was conducted. Each patient’s subjective impression of change in pain intensity and duration of pain relief after each treatment was recorded, along with an 11-point numeric rating scale (NRS) for pain intensity, immediately before and after each infusion.

Results

Short-term lidocaine analgesia was evaluated by the reduction in NRS pain score according to the patients reported pre- (immediately before treatment) and post-treatment (immediately after treatment) values. There was a statistical difference in the NRS score reduction between doses 5 mg/kg and 7.5 mg/kg of lidocaine (P = 0.009). Long-term analgesia was evaluated at follow-up visits by the patient’s subjective impression of change in pain intensity and duration of pain relief. There was a statistical difference in the percentage of pain relief and the mean duration of pain relief between the treatments with 5 mg/kg and 7.5 mg/kg of lidocaine (P = 0.007 and P = 0.003). Although there was a trend of greater response to magnesium sulfate as a beneficial adjunct to the lidocaine infusion, we were unable to find a statistically significant difference for any of the variables studied.

Conclusions

This study demonstrated that escalating doses of IV lidocaine to 7.5 mg/kg safely and effectively reduced the pain with prolonged effect in a significant number of patients diagnosed with fibromyalgia. Larger, prospective clinical studies are required to confirm this finding.
Exploring Variation in Police Perceptions of De-Escalation: Do Officer Characteristics Matter?
Authors: White Michael D , Mora Victor , Orosco Carlena
Published: September 2019

Though de-escalation has become popular in policing, there is very little research on the topic. We know virtually nothing about what it is, whether it works, or even how officers perceive de-escalation. The authors surveyed over 100 officers in the Tempe (AZ) Police Department regarding their perceptions of de-escalation, including tactics used to peacefully resolve potentially violent encounters, the frequency of use, and their perceptions of de-escalation training. We examine perceptions overall, as well as by officer race/ethnicity and sex. Findings suggest that officers view de-escalation through a lens defined by their authority and officer safety. They use certain tactics multiple times each shift. Officers are open to de-escalation training but are skeptical about its impact on citizen encounters. Lastly, minority and female officers use certain tactics more often than white male officers. The article concludes with a discussion of the implications for the larger debate on de-escalation in policing.
CHARACTERISATION AND EVALUATION OF AL2O3:C-BASED OPTICALLY STIMULATED LUMINESCENT DOSEMETER SYSTEM FOR DIAGNOSTIC X-RAYS: PERSONAL AND IN VIVO DOSIMETRY
Authors: Wong J H D , Bakhsh M , Cheah Y Y , Jong W L , Khor J S , Ng K H
Published: September 2019

This study characterises and evaluates an Al2O3:C-based optically stimulated luminescent dosemeter (OSLD) system, commercially known as the nanoDot™ dosemeter and the InLight® microStar reader, for personal and in vivo dose measurements in diagnostic radiology. The system characteristics, such as dose linearity, reader accuracy, reproducibility, batch homogeneity, energy dependence and signal stability, were explored. The suitability of the nanoDot™ dosemeters was evaluated by measuring the depth dose curve, in vivo dose measurement and image perturbation. The nanoDot™ dosemeters were observed to produce a linear dose with ±2.8% coefficient variation. Significant batch inhomogeneity (8.3%) was observed. A slight energy dependence (±6.1%) was observed between 60 and 140 kVp. The InLight® microStar reader demonstrated good accuracy and a reproducibility of ±2%. The depth dose curve measured using nanoDot™ dosemeters showed slightly lower responses than Monte Carlo simulation results. The total uncertainty for a single dose measurement using this system was 11%, but it could be reduced to 9.2% when energy dependence correction was applied.
A Trusts Act for New Zealand
Authors: Cone Geoffrey , Shan Claudia , Barber Simon
Published: September 2019

There has been a seismic overhaul of trust law in New Zealand, culminating in the Trustee Act 1956 being replaced by the Trusts Act 2019. The latter reflects modern trust practice and its key features include clarifying the powers, duties, roles and requirements of trust participants, and streamlining various processes. In this article, we focus on a number of these features, with a particular focus on practical insights on the improvements and advantages of New Zealand trust law for domestic as well as international practitioners, settlors, beneficiaries and protectors alike.
A Comparative Genomic Analysis of the Barley PathogenPyrenophora teresf.teresIdentifies Subtelomeric Regions as Drivers of Virulence
Authors: Wyatt Nathan A. , Richards Jonathan K. , Brueggeman Robert S. , Friesen Timothy L.
Published: September 2019

Pyrenophora teres f. teres causes net form net blotch of barley and is an economically important pathogen throughout the world. However, P. teres f. teres is lacking in the genomic resources necessary to characterize the mechanisms of virulence. Recently a high-quality reference genome was generated for P. teres f. teres isolate 0-1. Here, we present the reference quality sequence and annotation of four new isolates and we use the five available P. teres f. teres genomes for an in-depth comparison, resulting in the generation of hypotheses pertaining to the potential mechanisms and evolution of virulence. Comparative analyses were performed between all five P. teres f. teres genomes, examining genomic organization, structural variations, and core and accessory genomic content, specifically focusing on the genomic characterization of known virulence loci and the localization of genes predicted to encode secreted and effector proteins. We showed that 14 of 15 currently published virulence quantitative trait loci (QTL) span accessory genomic regions, consistent with these accessory regions being important drivers of host adaptation. Additionally, these accessory genomic regions were frequently found in subtelomeric regions of chromosomes, with 10 of the 14 accessory region QTL localizing to subtelomeric regions. Comparative analysis of the subtelomeric regions of P. teres f. teres chromosomes revealed translocation events in which homology was detected between nonhomologous chromosomes at a significantly higher rate than the rest of the genome. These results indicate that the subtelomeric accessory genomic compartments not only harbor most of the known virulence loci but, also, that these regions have the capacity to rapidly evolve.
Antimycotal Activity ofCollimonasIsolates and Synergy-Based Biological Control of Fusarium Wilt of Tomato
Authors: Doan Hung K. , Maharaj Nilesh N. , Kelly Kaitlyn N. , Miyao Eugene M. , Davis R. Michael , Leveau Johan H. J.
Published: September 2019

In a continued effort to discover microorganisms with plant-protective properties, we characterized a collection of bacterial isolates from multiple geographic origins and belonging to the genus Collimonas, for their ability to inhibit in vitro the growth of a wide range of plant-pathogenic fungi and oomycetes. Isolate Collimonas arenae Cal35 showed the greatest all-round performance and was the single-best inhibitor of several of the tested pathogens, including Fusarium oxysporum f. sp. lycopersici, the causal agent of Fusarium wilt of tomato. In greenhouse trials, neither C. arenae Cal35 nor the control treatment, i.e., the commercially available Bacillus-based biofungicide Serenade Soil, was able to prevent symptom formation on tomato plants challenged with F. oxysporum f. sp. lycopersici. However, a mixture of Cal35 and Serenade Soil (referred to as Collinade) significantly reduced vascular discoloration and F. oxysporum f. sp. lycopersici-induced loss of shoot dry weight. In replicated field experiments, a Collinade application reduced vascular symptoms as well as the relative abundance of F. oxysporum in the root endosphere of F. oxysporum f. sp. lycopersici-challenged plants. We discuss the emerging property of “biocombicontrol” by Collimonas and Bacillus in the context of synergy-based formulations for the protection of crops against pathogens.
Assessing the Impact on Virus Transmission and Insect Vector Behavior of a Viral Mixed Infection in Melon
Authors: Domingo-Calap Maria Luisa , Moreno Ana Beatriz , Díaz Pendón Juan Antonio , Moreno Aranzazu , Fereres Alberto , López-Moya Juan José
Published: September 2019

Mixed viral infections in plants are common, and can result in synergistic or antagonistic interactions. Except in complex diseases with severe symptoms, mixed infections frequently remain unnoticed, and their impact on insect vector transmission is largely unknown. In this study, we considered mixed infections of two unrelated viruses commonly found in melon plants, the crinivirus cucurbit yellow stunting disorder virus (CYSDV) and the potyvirus watermelon mosaic virus (WMV), and evaluated their vector transmission by whiteflies and aphids, respectively. Their dynamics of accumulation was analyzed until 60 days postinoculation (dpi) in mixed-infected plants, documenting reduced titers of WMV and much higher titers of CYSDV compared with single infections. At 24 dpi, corresponding to the peak of CYSDV accumulation, similar whitefly transmission rates were obtained when comparing either individual or mixed-infected plants as CYSDV sources, although its secondary dissemination was slightly biased toward plants previously infected with WMV, regardless of the source plant. However, at later time points, mixed-infected plants partially recovered from the initially severe symptoms, and CYSDV transmission became significantly higher. Interestingly, aphid transmission rates both at early and late time points were unaltered when WMV was acquired from mixed-infected plants despite its reduced accumulation. This lack of correlation between WMV accumulation and transmission could result from compensatory effects observed in the analysis of the aphid feeding behavior by electrical penetration graphs. Thus, our results showed that mixed-infected plants could provide advantages for both viruses, directly favoring CYSDV dissemination while maintaining WMV transmission.
Genome Sequence Resource for Spiroplasma citri, Strain CC-2, Associated with Citrus Stubborn Disease in California
Authors: Yokomi Raymond , Chen Jianchi , Rattner Rachel , Selvaraj Vijayanandraj , Maheshwari Yogita , Osman Fatima , Pagliaccia Deborah , Vidalakis Georgios
Published: September 2019

Spiroplasma citri is a bacterium that causes stubborn disease of citrus and infects other crops, ornamentals, and weeds. It is transmitted by leafhoppers in a circulative manner. Due to limited sequence data on S. citri, the bacterium was isolated from naturally infected Chinese cabbage grown on a farm in Fresno County, CA. DNA from S. citri CC-2 was extracted from a pure culture in LD8 and subjected to PacBio sequencing. Four contigs were obtained with a single circular chromosome of 1,709,192 bp and three plasmids of 40,210, 39,313, and 2,921 bp in size. The genome developed herein extends the sequence database of S. citri and is the first whole-genome sequence record of S. citri from California.
Heart disease prevention in women
Authors: Wood Jennie , Gordon Patricia
Published: September 2019

More women die from heart disease than any other illness. This article focuses on risk factors and their prevalence in women along with strategies for preventing this disease. Armed with this information, the NP can play a major role in preventing cardiovascular deaths in women.
Prepregnancy Genetic Carrier Screening in Recipients of Hematopoietic Stem Cell Transplants
Authors: Aluko Ashley , Seidler Emily , Penzias Alan
Published: September 2019

BACKGROUND:

Genetic carrier screening of individuals with a history of hematopoietic stem cell (HSC) transplant is not always straightforward.

CASE:

We present the case of a couple who underwent prepregnancy genetic screening before fertility treatment. The genetics laboratory flagged the male partner's blood sample because there was a discrepancy between the sex of the patient and the sex chromosome markers, ultimately leading to the discovery of a prior HSC transplant.

CONCLUSION:

A history of HSC transplant may confound results of serum-based genetic carrier screening. Hematopoietic stem cell transplant recipients are at risk for misinterpreted genetic carrier screening because the results of such screening may not actually be reflective of their own DNA.
Prospective Evaluation of Maternal Sleep Position Through 30 Weeks of Gestation and Adverse Pregnancy Outcomes
Authors: Silver Robert M. , Hunter Shannon , Reddy Uma M. , Facco Francesca , Gibbins Karen J. , Grobman William A. , Mercer Brian M. , Haas David M. , Simhan Hyagriv N. , Parry Samuel , Wapner Ronald J. , Louis Judette , Chung Judith M. , Pien Grace , Schubert Frank P. , Saade George R. , Zee Phyllis , Redline Susan , Parker Corette B. ,   for the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (NuMoM2b) Study
Published: September 2019

OBJECTIVE:

To examine the relationship between prospectively assessed maternal sleep position and subsequent adverse pregnancy outcomes.

METHODS:

This was a secondary analysis of a prospective observational multicenter cohort study of nulliparous women with singleton gestations who were enrolled between October 2010 and May 2014. Participants had three study visits that were not part of clinical care. They prospectively completed in-depth sleep questionnaires between 6 0/7 and 13 6/7 weeks of gestation and 22 0/7 and 29 6/7 weeks of gestation, the first and third study visits. A subset of women also underwent level 3 home sleep tests using the Embletta Gold device. The primary outcome was a composite of adverse pregnancy outcomes such as stillbirth, a small-for-gestational-age newborn, and gestational hypertensive disorders.

RESULTS:

A total of 8,706 (of 10,038) women had data from at least one sleep questionnaire and for pregnancy outcomes, and they comprised the population for this analysis. The primary outcome occurred in 1,903 pregnancies (22%). There was no association between reported non–left lateral or supine sleep during the last week of the first visit (adjusted odds ratio [aOR] 1.00 [95% CI 0.89–1.14]) or third visit (aOR 0.99 [95% CI 0.89–1.11] and the composite or any individual outcome, except for an apparent protective effect for stillbirth at the third visit (aOR 0.27 (95% CI 0.09–0.75). Women with objectively measured supine sleep position for at least 50% of the time were no more likely than those in the supine position 50% or less of the time to have the composite adverse outcome.

CONCLUSIONS:

Going to sleep in the supine or right lateral position, as self-reported before the development of pregnancy outcome and objectively assessed through 30 weeks of gestation, was not associated with an increased risk of stillbirth, a small-for-gestational-age newborn, or gestational hypertensive disorders.
Disseminated Intravascular Coagulation and Hemorrhage After Dilation and Evacuation Abortion for Fetal Death
Authors: Kerns Jennifer L. , Ti Angeline , Aksel Sarp , Lederle Lauren , Sokoloff Abby , Steinauer Jody
Published: September 2019

OBJECTIVE:

To examine the association between fetal death and risk of hemorrhage and disseminated intravascular coagulation (DIC) among women undergoing dilation and evacuation (D&E) procedures.

METHODS:

We conducted a retrospective cohort study of all D&Es at one academic abortion clinic in San Francisco between 2009 and 2013. We abstracted data on fetal death status, demographic characteristics, and complications including hemorrhage and DIC. We examined the risk of hemorrhage and DIC among women with fetal death compared with those without. We conducted unadjusted and adjusted analyses for the outcomes of hemorrhage, DIC, and any complication.

RESULTS:

Among 92 cases of D&E for fetal death and 4,428 cases of D&E for other reasons, hemorrhage occurred in 10% and 7%, respectively (P=.28), and DIC occurred in 2.0% and 0.2% of the fetal death and nonfetal death cohorts (P<.001). In adjusted analysis, fetal death was associated with 2.9 times higher odds of hemorrhage (95% CI 1.4–6.0). In an unadjusted analysis, fetal death was associated with 12.3 times higher odds of DIC (95% CI 2.6–58.6) and 3.0 times higher odds of any complication (95% CI 1.6–5.9).

CONCLUSION:

Women undergoing D&E for fetal death are far more likely to experience DIC and hemorrhage than are women without fetal death, yet the absolute risk is low (2%). Although D&E providers should be prepared for DIC and hemorrhage, we do not recommend any specific preoperative preparation because the vast majority of D&E abortions for fetal death are uncomplicated.
Barriers to Evidence-Based Transgender Care
Authors: Reilly Zachary P. , Fruhauf Timothee F. , Martin Stephen J.
Published: September 2019

Reversal of gender-discriminatory insurance coverage policies has led to a substantial increase in access to gender-affirming surgical care in the United States over the past 20 years. Although the evidence supports the safety, feasibility, and medical necessity of gender-affirming hysterectomy and oophorectomy, there are currently no evidence-based guidelines to define optimal care surrounding many aspects of these surgeries. This commentary reviews the evidence supporting the safety, feasibility, and route of hysterectomy and oophorectomy for transgender men, the benefits and risks of oophorectomy in cisgender women and their extrapolation to transgender men, and the effects of testosterone supplementation in transgender men with and without ovaries. In addition, this article highlights the data gaps surrounding whether oophorectomy should be performed at the time of hysterectomy. Oophorectomy in cisgender women is associated with negative outcomes such as an increase in cardiovascular events and all-cause mortality, most likely attributable to attenuated estrogen levels. There are insufficient outcomes data regarding oophorectomy in transgender men to make the same inference about potential morbidity and mortality. Areas for future research to elucidate best practices are identified in the context of the increasing number of gender-affirming surgeries. As physicians, it is our duty to provide transgender patients with evidence-based recommendations on gynecologic gender-affirming care and to avoid any potential harm.
A Postpartum Remote Hypertension Monitoring Protocol Implemented at the Hospital Level
Authors: Hauspurg Alisse , Lemon Lara S. , Quinn Beth A. , Binstock Anna , Larkin Jacob , Beigi Richard H. , Watson Andrew R. , Simhan Hyagriv N.
Published: September 2019

OBJECTIVE:

To evaluate the feasibility, acceptability, and compliance of a remote blood pressure monitoring protocol implemented as a quality improvement measure at the hospital level for management of hypertension in postpartum women after hospital discharge.

METHODS:

This is an ongoing quality improvement project that included women admitted to the postpartum unit of a single tertiary care hospital. We designed nursing call center-driven blood pressure management and treatment algorithms, which were initiated after hospital discharge until 6 weeks postpartum. Women are eligible to participate if they have a diagnosis of chronic hypertension, superimposed preeclampsia, gestational hypertension, preeclampsia, or postpartum hypertension and have access to a text messaging-enabled smartphone device. After identification by an obstetric care provider, women are enrolled into the program, which is automatically indicated in the electronic medical record. Maternal, obstetric, and sociodemographic data were obtained from the electronic medical record.

RESULTS:

Between February 2018 and January 2019, we enrolled 499 patients. Here we report on the first 409 enrolled patients. Participants include 168 (41%) with gestational hypertension, 179 (44%) with preeclampsia with no history of chronic hypertension, 49 (12%) with chronic hypertension with superimposed preeclampsia, and 13 (3%) with postpartum preeclampsia. One hundred seventy-one (42%) participants had antihypertensives initiated or titrated through the program. Three hundred forty women (83%) continued the program beyond 3 weeks postpartum, and 360 (88%) attended an in-person 6-week postpartum visit. Two hundred thirty-five out of 250 women who completed a postprogram survey (94%) reported satisfaction with the program.

CONCLUSION:

In this study, we detail results from an ongoing remote blood pressure monitoring program. We demonstrate high compliance, retention, and patient satisfaction with the program. This is a feasible, scalable remote monitoring program connected to the electronic medical record.
Comparison between the Pavlik harness and the Tübingen hip flexion splint for the early treatment of developmental dysplasia of the hip
Authors: Ran Lin , Chen Huimin , Pan Yuancheng , Lin Qingjian , Canavese Federico , Chen Shunyou
Published: September 2019

The Pavlik harness and the Tübingen hip flexion splint (Tübingen hip flexion splint) are two effective options for the early management of patients younger than 6 months of age with developmental dysplasia of the hip (DDH). The main objective of this study was to evaluate the clinical and radiological outcomes of patients younger than 6 months of age with type IIb to IV DDH managed by Pavlik harness or Tübingen hip flexion splint. The Pavlik harness and Tübingen hip flexion splint groups were comparable regarding the affected side (P = 0.09), Graf grade (P = 0.635), and age at initial treatment (P = 0.77). Overall, failure rates were 12 and 33% in Pavlik harness (4/33 hips) and Tübingen hip flexion splint groups (14/43 hips), respectively (P = 0.038). No cases of avascular necrosis (AVN) were found in either group. In the Tübingen hip flexion splint group, the failure rate was significantly higher in bilateral cases (66.6%; P = 0.004), in severe forms (Graf grade IV hips; P ≤ 0.0001), and in patients with lower age at initial treatment (67.7 ± 39.3 days; P = 0.005). The average follow-up time was 30.35 ± 3.58 months (range: 24–36). At the last follow-up visit, no statistically significant differences were found between the Pavlik harness and Tübingen hip flexion splint groups regarding the acetabular index (t = 0.632; P = 0.53) or center-edge angle (Z = −0.303; P = 0.762). Our study showed that both the brace treatments for DDH in children younger than 6 months of age were effective and well tolerated. However, Tübingen hip flexion splint should not be used in patients with severe forms of DDH (Graf grade IV hips).
Recovery Process After Anterior Cervical Decompression in Patients With Cervical Spondylotic Myelopathy With Different Natural History
Authors: Li Peng , Zhang Haoping , Cheng Huijuan , Meng Fanshuai , Li Junwei
Published: September 2019

Study Design:

An observational prospective cohort study.

Objective:

To investigate the influence of natural history on the recovery of patients with cervical spondylotic myelopathy (CSM) after anterior cervical decompression.

Summary of Background Data:

The natural history of CSM has not been clearly elucidated, it remains unclear whether the natural history of CSM is associated with the recovery process after surgical treatment.

Materials and Methods:

Patients with CSM (n=117) after anterior cervical decompression were stratified variously on the basis of natural history features. Baseline and postoperative neurological functions were rated using the Japanese Orthopaedic Association (JOA) and patient-based self-evaluation (PBSE) scores. The minimum and maximum recovery times for sensory function, and motor functions of the upper and lower extremities were analyzed separately at time points 1–60 months after surgery.

Results:

In all patients, the postoperative JOA and PBSE scores were significantly improved relative to baseline, in which sensory function recovered most quickly, followed by upper-extremity and lower-extremity motor functions. However, when compared with patients whose first symptom onset at the lower extremity, patients with the first onset at the upper extremity required less time to recover lower-extremity motor function, but more time to recover upper-extremity motor function. Patients with rapid progression had significantly lower preoperative and final JOA and PBSE scores compared with patients whose progression was steady or stepwise. Patients with preoperative symptoms ≥1 year had longer recovery time and poorer functional outcomes compared with those symptoms <1 year.

Conclusions:

In patients with CSM, the location of first symptom onset, progressive velocity of symptom, and duration of preoperative symptoms significantly influenced the recovery process after anterior cervical decompression.

Level of Evidence:

Level 2—observational prospective study.
Comparison of the Effects of Milrinone, Sodium Nitroprusside, and Nitroglycerine for Induced Hypotension in Elderly Patients Undergoing Spine Surgery
Authors: Huh Jaewon , Chung Hyewon , Hwang Wonjung
Published: September 2019

Background:

The use of induced hypotension is limited because of concerns about hypoperfusion to major organs in elderly patients. The aim of this study was to compare the effects of milrinone with those of other vasodilating hypotensive agents on induced hypotension in elderly patients undergoing spine surgery.

Methods:

In total, 60 patients older than 60 years who underwent lumbar fusion surgeries were randomized to groups M (milrinone), S (sodium nitroprusside), and N (nitroglycerine). The study drug was infused after perivertebral muscle retraction until complete interbody fusion occurred. The infusion dose was adjusted to achieve a fall of 30% in systolic blood pressure or mean blood pressure to 60 to 65 mm Hg. Intraoperative blood loss, grade of the surgical field, and urine output were recorded.

Results:

Intraoperative blood loss per fused spine level was 288.5±94.4 mL in group M, 399.8±60.3 mL in group S, and 367.0±122.5 mL in group N (P=0.002). The grade of the surgical field was similar among the 3 groups (P=0.439). Hourly urine output was 1.4±0.5 mL in group M, 0.7±0.3 mL in group S, and 0.9±0.4 mL in group N (P<0.001).

Conclusions:

The use of milrinone for induced hypotension led to less intraoperative blood loss and higher urine output than the use of sodium nitroprusside or nitroglycerine in elderly patients undergoing spine surgery.
Patterns of Care and Survival in Elderly Patients With Locally Advanced Soft Tissue Sarcoma
Authors: Greto Daniela , Saieva Calogero , Loi Mauro , Desideri Isacco , Delli Paoli Camilla , Lo Russo Monica , Pezzulla Donato , Teriaca Maria A. , Lucidi Sara , Visani Luca , Terziani Francesca , Olmetto Emanuela , Becherini Carlotta , Bonomo Pierluigi , Francolini Giulio , Campanacci Domenico A. , Scoccianti Guido , Livi Lorenzo
Published: September 2019

Objectives:

The aim of this study was to analyze patterns of care in elderly soft tissue sarcoma (STS) patients and their impact on clinical outcome and treatment-related toxicity.

Materials and Methods:

We retrospectively collected data of >65-year-old patients diagnosed with locally advanced STS between 1991 and 2017 in a single institution.

Results:

The study included 111 patients: 105 (94.6%) patients underwent surgery, associated with preoperative (n=19, 17.1%) or postoperative radiotherapy (n=72, 64.8%). Anthracycline-based chemotherapy was prescribed in 41.4% of patients (n=46). Acute grade ≥3 postoperative radiotherapy–related radiation dermatitis and all grades of chemotherapy-induced neutropenia were significantly correlated to age >80 years (P=0.02) and >70 years (P=0.045), respectively. The mean follow-up was 4.1 years (range, 0.1 to 17.7). Three-year and 5-year local recurrence–free survival were 80.3% and 75.7%, respectively; neither treatment-related nor patient-related characteristics affected local recurrence. Three-year and 5-year distant relapse–free survival were 59.6% and 44.6%, respectively. On multivariate Cox regression, undifferentiated pleomorphic sarcoma histology and Charlson Comorbidity Index >7 were independent factors associated with distant relapse–free survival (P=0.026 and P=0.0001). Overall survival was 62% and 46.6% at 3 and 5 years, respectively. On multivariate Cox regression, surgery and Charlson Comorbidity Index <7 were independent factors associated with overall survival (P=0.006 and P=0.0001).

Conclusions:

In this study, elderly STS patients receiving a tailored treatment encompassing surgery, radiotherapy, and/or chemotherapy obtained an improved outcome, although caution is advised because of increased toxicity in relation to age. Comorbidities should be considered to offer the best treatment option to this frail patient population.
Spectrum of Melanocytic Proliferation/Differentiation in a Large Series of Cutaneous Neurofibromas: An Under-Recognized Histopathologic Phenomenon and Potential Clue for Neurofibromatosis Type 1
Authors: Ntala Chara , Biswas Asok
Published: September 2019

Aims:

Neurofibromas (NFs) and melanocytic nevi share a common neuroectodermal origin and may occasionally show overlapping morphological features. The objective of this study was to assess the prevalence and spectrum of melanocytic proliferation/differentiation in NFs and also to test the hypothesis whether detection of this feature could be used as a potential clue for neurofibromatosis type 1 (NF-1).

Methods:

This was a retrospective study of 229 syndromic and 239 sporadic cutaneous NFs. Each case was assessed for an associated melanocytic component, both within the tumor and the overlying epidermis. Melan A immunohistochemistry was used in selected cases to further characterize this feature, particularly in diffuse NFs.

Results:

An associated melanocytic component was detected in 77/229 syndromic and 12/239 sporadic cases (P < 0.00001). This was in the form of a junctional proliferation (lentiginous melanocytic hyperplasia or junctional nevus) or dermal differentiation (diffuse spindle cell or dermal nests of pigmented epithelioid melanocytes).

Conclusions:

Our study affirms that the spectrum of melanocytic proliferation/differentiation in NFs is broad and probably under-recognized. Awareness of this phenomenon is critical to avoid misdiagnosis of some diffuse NFs as primary melanocytic tumors, for example, desmoplastic melanomas. Given the strong link between dermal melanocytic differentiation and syndromic NFs, its detection could potentially serve as a useful clue for NF-1 in an appropriate clinical context.
Effect of hyperbaric oxygen on chemotherapy-induced neuropathy in male and female rats
Authors: Brewer Abigail L. , Shirachi Donald Y. , Quock Raymond M. , Craft Rebecca M.
Published: September 2019

Chemotherapeutic agents can cause peripheral neuropathy, a deleterious side effect of cancer treatment. Hyperbaric oxygen (HBO2) treatment has shown great potential for decreasing pain in numerous clinical pain conditions and in preclinical studies. This study was designed to test whether HBO2 might also be useful for treating chemotherapy-induced peripheral neuropathy. Male and female Sprague–Dawley rats were injected with 1 mg/kg paclitaxel or vehicle every other day for 7 days to induce allodynia, followed by either one single, or four daily 60-min exposures to HBO2 or room air. Mechanical and cold allodynia as well as locomotor behavior and body weight were assessed intermittently for several weeks. Estrous cycling was also tracked in female rats. Paclitaxel caused pronounced mechanical allodynia in both sexes that was completely reversed by either one or four treatments of HBO2. Females in all treatment groups showed greater cold acetone scores than males, and acetone scores were not reliably reduced by HBO2 treatment. Neither paclitaxel nor HBO2 treatment altered locomotor behavior or estrous cycling. We conclude that HBO2 treatment was highly effective at reducing mechanical allodynia in paclitaxel-treated rats without affecting weight gain, locomotion, or estrous cycling, suggesting that HBO2 may be effective for treating chemotherapy-induced neuropathic pain without producing significant side effects.
Mentoplasty with Customized Guides and Plates Using 3D Technology: a More Precise and Safer Technique
Authors: Arcas Antoni , Vendrell Gerard , Cuesta Frank , Bermejo Laura
Published: September 2019

Mentoplasty or genioplasty is a common operation to enhance function and appearance of the chin, which has major impact on character impressions and facial beauty. With the advent of new 3D technologies, the technique can be performed using customized guides and plates (with 3D planning and printing), addressing the drawbacks of the procedure, making it minimally invasive, safe, very accurate, and predictable. In this article, we describe a surgical technique using customized surgical guides and plates and performed under local anesthesia and oral sedation, with a surgical time of approximately 45 minutes. The video includes a 3D animation of customized mentoplasty and a recording of real procedures for chin augmentation using customized guides and plates, with use of a minimally invasive approach.
Immediate and Delayed Reconstruction after Excision of Axillary Hidradenitis Suppurativa Using a Propeller Flap
Authors: Elboraey Mohamed A. , Alali Ahmad B. , Alkandari Qutaibah A.
Published: September 2019

Background:

The chronic inflammatory skin condition hidradenitis suppurativa (acne inversa), characterized by hair follicle or apocrine gland infection, causes recurrent superficial nodules and abscesses in axillary, mammary, and perianal regions. Chronic reoccurrence results in fistula formation, causing scarring and fibrosis. Surgical excision of affected skin tissue with adequate free margins is the gold standard treatment to prevent recurrence. This case series describes 6 cases of radical excision of localized axillary hidradenitis suppurativa, with immediate or delayed perforator-based propeller flap defect closure.

Methods:

All patients presenting for surgical treatment of hidradenitis suppurativa between 2016 and 2018 were identified from the hospital database. Only patients with hidradenitis suppurativa confined to the axilla were included. Patients with simple abscess incisions, recurrence after previous grafting/flap surgery, and extension of the disease outside the axilla region were excluded. Patient demographics, size of defect, complications, time of follow-up, recurrences, and level of patient satisfaction were documented.

Results:

Six patients with localized axillary hidradenitis suppurativa were identified, with 8 propeller flap surgeries performed. Defect size was assessed by pathologic examination of excised specimens, ranging from 11–18 cm × 6–14 cm × 0.5–2 cm (length × width × depth). Seven of the eight wounds healed primarily. Functional and aesthetic results were satisfactory and there were no recurrences. The only observed complication was venous congestion following 1 flap procedure.

Conclusion:

These findings confirm that the propeller flap procedure can be effective for immediate or delayed defect closure after radical excision of localized axillary hidradenitis suppurativa, providing that no perifocal signs of infection are present after debridement.
Augmented blood pressure variability following continuous infusion of noradrenaline in rats
Authors: Jiang Danfeng , Kawagoe Yukiko , Asada Yujiro , Kitamura Kazuo , Kato Johji
Published: September 2019

Objective:

Augmented blood pressure (BP) variability has been shown to be associated with cardiovascular diseases. Activity of the sympathetic nervous system is an important determinant factor of the 24-h profile of BP variability, although it is unknown whether persistent adrenergic activation causes augmented BP variability or not. Here we report that continuous infusion of noradrenalin augments 24-h BP variability in rats.

Methods:

Nine-week-old male Wistar rats were continuously infused with subcutaneous 30 μg/h noradrenalin, 150 μg/h of the α1-adrenergic agonist phenylephrine, or 30 μg/h of the β-agonist isoproterenol, for 14 days. Noradrenalin-infused rats were also administered either oral 5 mg/day prazosin or 50 mg/day atenolol during the infusion period. BP variability was evaluated before and after 7 and 14 days of the infusion, using a coefficient of variation of BP recorded every 15 min under an unrestrained condition via an abdominal aortic catheter by a radiotelemetry system.

Results:

Continuous infusion of noradrenalin significantly increased 24-h BP variability at 7 and 14 days, slightly elevating BP levels, while this increase in BP variability was partially attenuated by prazosin, but not by atenolol. Continuous infusion of phenylephrine augmented BP variability, but isoproterenol had no effect on the variability.

Conclusion:

Continuous infusion of noradrenalin augmented 24-h BP variability partly through an α1-adrenergic receptor-mediated mechanism in rats, suggesting that the noradrenalin-infused rat is an animal model of augmented BP variability induced by persistent adrenergic activation.
A medical student’s reflection on intercalation: Retracted
Authors: Janmohamed Imran K.
Published: September 2019

This article is a reflection inspired by my experience intercalating over the past academic year. While the benefits of obtaining an additional degree are widely acknowledged in terms of career progression, medical students remain hesitant when considering intercalation. This article aims to highlight the benefits of intercalation within academic and nonacademic spheres and shed insight into some aspects not commonly recognized.
Husbands’ and wives’ discordant self-reports on couple-level variables: implications for data analysis
Authors: Amorim Mariana , Silva Susana , Severo Milton , Kelly-Irving Michelle , Samorinha Catarina , Alves Elisabete
Published: September 2019

Background:

Using the couple as unit of analysis raises methodological challenges. This study aims to discuss the appropriate proxy to use in statistical analyses when couples provide discordant answers on the following couple-level variables: household monthly income and length of marital relationship.

Methods:

During 12 months (July 2013–June 2014), parents of very preterm infants admitted at all level III Neonatal Intensive Care Units of the North of Portugal were consecutively and systematically invited to participate in this study. Mothers and fathers were surveyed separately, 15 to 22 days after birth. In the current analysis, 82 couples living in the same household were included. A socioeconomic position factor score was computed through a principal component analysis. To seek the most appropriate proxy of the couple's value, the association between the individual answers and the summary measures of couple-level variables, and the factor's score was estimated using generalized linear models.

Results:

Almost 40% of couples gave discordant answers about household monthly income [weighted kappa = 0.68 (95% confidence interval: 0.58–0.79)], with no association with sex. Approximately 19% of couples disagreed regarding the length of marital relationship [weighted kappa = 0.95 (95% confidence interval: 0.92–0.98)], with men declaring longer relationships. No associations were observed between women's and men's answers or the summary measures with the socioeconomic position score.

Conclusions:

Suggestions regarding how to handle the methodological problems related with spousal discrepancies include the collection of individual variables through separate interviews alongside couple-level variables using joint interviews.
The human leukocyte antigen and genetic susceptibility in human diseases
Authors: Gao Jinping , Zhu Caihong , Zhu Zhengwei , Tang Lili , Liu Lu , Wen Leilei , Sun Liangdan
Published: September 2019

The human leukocyte antigen (HLA) complex is involved in immunity, belongs to a highly polymorphic family of genes, and is found in a disease-associated region of the human genome. The HLA region of the genome has been associated with more than hundreds of diseases, including autoimmune diseases, cancer, and infectious diseases. Because of its extensive linkage disequilibrium, HLA represents one of the most attractive and valuable regions that have been discovered in numerous feasibility studies. However, despite its critical role, attempts to apply comprehensive and traditional strategies towards the characterization of the HLA locus have been limited. The recent development of genotyping arrays and sequencing technologies has resulted in the development of technologies that are capable of addressing the extreme polymorphism nature of HLA. In this review, we summarized the current approaches being used to capture, sequence, and analyze HLA genes and loci. In addition, we discussed the new methodologies being used for these applications, including HLA genotyping, population genetics, and disease-association studies.
Customizing Trauma Nursing Education to Incorporate All Departments: A Cost-Effective Way to Educate Nurses From Every Trauma-Associated Unit
Authors: Gautreaux Katherine , Reeves Christi , Abela Karla
Published: September 2019

Trauma education is crucial for optimizing the outcomes of trauma patients. Available trauma nursing education courses are not inclusive of all areas that a trauma patient may interact with but are targeted toward subsets of nurses who care for trauma patients. In addition, these courses can be costly for organizations and often divert resources away from departments for several days. We identified a need for convenient, cost-effective trauma nursing education delivered such that all nursing units that care for trauma patients would benefit. Based on data collected from needs assessments and literature reviews, content experts from many specialties developed and delivered content via interactive lectures, discussion panel, large group activities, case studies, and skills stations. Four internal courses were offered in 2018 with a total of 141 attendees. This resulted in cost savings of up to $86,715 when compared to external trauma courses. Attendees rated the courses very good or excellent (84.00%–95.23%). On average, 99.59% of the activity learning objectives were met, and 91.42% of learners intended to make changes to professional practice. Engaging key resources within an organization to deploy an internal approach to trauma nursing education can be valuable, cost-effective, and accessible to a broader nursing audience, inclusive of all units that care for trauma patients.
Female Suffering After Blunt Trauma and the Need to be Cared for and Cared About
Authors: Filhour Louis D.
Published: September 2019

Using a phenomenological design, the researcher repeated a previous study of males, this time exploring the question of what is the experience of suffering voiced by female patients 6–12 months after hospitalization for blunt trauma. Eleven female volunteers were interviewed and asked questions about how they suffered, what made their suffering more or less bearable, and how they were transformed through their suffering. Like the males, female participants experienced changes in patterns resulting in perceptions of suffering. Participants reported mostly experiencing physical, emotional, and social forms of suffering, whereas fewer participants experienced economic and spiritual suffering. Experiences of suffering resulted from the threat to their sense of wholeness because of their injuries. Intrinsic and extrinsic factors made participants' suffering more or less bearable as they regained or revised their shattered wholeness. Positive attitude and motivation were significant intrinsic factors, whereas quality supportive care was the most significant extrinsic factor. Feeling cared about emotionally was as important as feeling cared for physically in helping participants better bear their suffering. Poor quality care was a significant negative extrinsic factor resulting in suffering being made more unbearable. Through their experiences of suffering and finding meaning in that suffering, participants were transformed, amending their previous state and resulting in a new state of wholeness. Knowledge gained through this phenomenological study may help nurses understand suffering and guide their care and caring to alleviate it or make it more bearable.
Stressful Life Events Moderate the Relationship Between Changes in Symptom Severity and Health-related Quality of Life in Patients With Irritable Bowel Syndrome
Authors: Dong Yuanjun , Baumeister David , Berens Sabrina , Eich Wolfgang , Tesarz Jonas
Published: September 2019

Objectives:

The relationship between changes in symptom severity and health-related quality of life (HRQOL), which may be impacted by stressful life events, in irritable bowel syndrome (IBS), is unclear. Therefore, we investigated the relationship between changes in symptom severity and HRQOL and examined the moderating role of stressful life events in patients with IBS.

Methods:

This study is part of a cohort follow-up study on psychological factors in patients with IBS in tertiary care, and it included 158 patients. In addition to symptom severity and HRQOL, stressful life events were assessed by the Social Readjustment Rating Scale (SRRS). The relationship between symptom severity and HRQOL and the moderating role of stressful life events (in the 12 mo before the follow-up assessment) were analyzed.

Results:

The majority of participants had moderate levels of stressful life events (41.8%), followed by those who had mild levels (39.2%) and severe levels (19.0%) of stressful life events. Symptom severity could predict HRQOL, and the relationship between symptom severity and HRQOL was affected by the level of stressful life events. Compared with mild levels of stressful life events, a severe level of stressful life events significantly affected the relationship between changes in symptom severity and HRQOL (Z=−3.048, P<0.01). A similar result was found when comparing moderate and severe levels of stressful life events (Z=−1.810, P<0.10).

Conclusions:

The study demonstrated that symptom severity predicted HRQOL during the progression of IBS and that stressful life events moderated the impact of symptom severity on HRQOL. The more stressful life events an IBS patient experiences, the less predictable the relationship is between changes in symptom severity and HRQOL.