bluuebunny/crossref_metadata_2025 huggingface dataset:
The incidence and distribution of mediastinal lymph node metastasis and its impact on survival in patients with non-small-cell lung cancers 3 cm or less: data from 2292 cases
Authors: Yang Mu-Zi , Hou Xue , Liang Run-Bin , Lai Ren-Chun , Yang Jie , Li Shuo , Long Hao , Fu Jian-Hua , Lin Peng , Wang Xin , Rong Tie-Hua , Yang Hao-Xian
Published: January 2019

OBJECTIVES

Our goal was to investigate the incidence and distribution of mediastinal lymph node metastases (MLNM) in non-small-cell lung cancers (NSCLC) 3 cm or less, with the purpose of guiding mediastinal lymph node dissection.

METHODS

A total of 2292 cases seen between January 2001 and December 2014 were included. These patients were grouped according to the lobes with the primary tumours. The incidence and distribution of pathological MLNM were compared among the groups. The impact of MLNM on overall survival was also compared.

RESULTS

The most common mediastinal metastatic sites for different primary tumour lobes were as follows: right upper lobe, 17.7% (87/492) for level 4R; right middle lobe, 14.9% (28/188) for level 7; right lower lobe, 19.8% (82/414) for level 7; left upper lobe, 18.2% (96/528) for level 5; and left lower lobe, 16.6% (42/253) for level 7. For patients with tumours in the upper lobe, the median survival time was 32 months for those with MLNM in the subcarinal zone or lower zone compared with 83 months for those with MLNM only in the upper zone (P < 0.01). When the tumours were 1 cm or less, the incidence of MLNM to the lower zone for upper lobe tumours and of MLNM to the upper zone for lower lobe tumours was zero.

CONCLUSIONS

Different primary NSCLC lobe locations have a different propensity to be sites of MLNM for those tumours that are 3 cm or less. For tumours no larger than 1 cm, a lower zone mediastinal lymph node dissection might be unnecessary for upper lobe tumours and an upper zone mediastinal lymph node dissection might be unnecessary for lower lobe tumours.
Domesticated escapees on the run: the second-generation monitoring programme reports the numbers and proportions of farmed Atlantic salmon in >200 Norwegian rivers annually
Authors: Glover K A , Urdal K , Næsje T , Skoglund H , Florø-Larsen B , Otterå H , Fiske P , Heino M , Aronsen T , Sægrov H , Diserud O , Barlaup B T , Hindar K , Bakke G , Solberg I , Lo H , Solberg M F , Karlsson S , Skaala Ø , Lamberg A , Kanstad-Hanssen Ø , Muladal R , Skilbrei O T , Wennevik V
Published: January 2019

Norway is the world’s largest producer of farmed Atlantic salmon and is home to ∼400 rivers containing wild salmon populations. Farmed escapees, a reoccurring challenge of all cage-based marine aquaculture, pose a threat to the genetic integrity, productivity, and evolutionary trajectories of wild populations. Escapees have been monitored in Norwegian rivers since 1989, and, a second-generation programme was established in 2014. The new programme includes data from summer angling, autumn angling, broodstock sampling, and snorkelling surveys in >200 rivers, and >25 000 scale samples are analysed annually. In 2014–2017, escapees were observed in two-thirds of rivers surveyed each year, and between 15 and 30 of the rivers had >10% recorded escapees annually. In the period 1989–2017, a reduction in the proportion of escapees in rivers was observed, despite a >6-fold increase in aquaculture production. This reflected improved escape prevention, and possibly changes in production methods that influence post-escape behaviour. On average, populations estimated to experience the greatest genetic introgression from farmed salmon up to 2014 also had the largest proportions of escapees in 2014–2017. Thus, populations already most affected are those at greatest risk of further impacts. These data feed into the annual risk-assessment of Norwegian aquaculture and form the basis for directing mitigation efforts.
Incidental seabird mortality and discarded catches from trawling off far southern Chile (39–57°S)
Authors: Adasme Luis M , Canales Cristian M , Adasme Nicolás A
Published: January 2019

In world fisheries, incidental non target species mortality have turned in a permanent debate issue. Although many studies have dealt with these interactions from a descriptive overview, there is little information based on fishing operations data. One of the most important species that have awakened scientific concern are seabird, being southern Chile one of the areas with the highest levels in this kind of interactions. In order to improve our understanding on these relationships, we analyze records of fishing hauls of industrial trawlers off the coast of Chile between 39 and 57°S. The results showed that incidental seabird mortality appears to be affected mainly by the collisions with net monitoring systems (net-sonde cable), the duration of fishing hauls, the year period, and the fishing zones, these last related to the breeding period and areas of albatross colonies. We indirectly address a probable relationship between seabird mortality and fishing discards, and some hypothesis are proposed to explain the results. Finally, we demonstrated that longer fishing hauls are less efficient for fishing, beside to a high seabird mortality. Our findings suggest mitigation actions that would harmonize fishing activity with the ecosystem, in particular, for trawl fishing management and operations off far southern Chile.
Weakly supervised natural language processing for assessing patient-centered outcome following prostate cancer treatment
Authors: Banerjee Imon , Li Kevin , Seneviratne Martin , Ferrari Michelle , Seto Tina , Brooks James D , Rubin Daniel L , Hernandez-Boussard Tina
Published: January 2019

Background

The population-based assessment of patient-centered outcomes (PCOs) has been limited by the efficient and accurate collection of these data. Natural language processing (NLP) pipelines can determine whether a clinical note within an electronic medical record contains evidence on these data. We present and demonstrate the accuracy of an NLP pipeline that targets to assess the presence, absence, or risk discussion of two important PCOs following prostate cancer treatment: urinary incontinence (UI) and bowel dysfunction (BD).

Methods

We propose a weakly supervised NLP approach which annotates electronic medical record clinical notes without requiring manual chart review. A weighted function of neural word embedding was used to create a sentence-level vector representation of relevant expressions extracted from the clinical notes. Sentence vectors were used as input for a multinomial logistic model, with output being either presence, absence or risk discussion of UI/BD. The classifier was trained based on automated sentence annotation depending only on domain-specific dictionaries (weak supervision).

Results

The model achieved an average F1 score of 0.86 for the sentence-level, three-tier classification task (presence/absence/risk) in both UI and BD. The model also outperformed a pre-existing rule-based model for note-level annotation of UI with significant margin.

Conclusions

We demonstrate a machine learning method to categorize clinical notes based on important PCOs that trains a classifier on sentence vector representations labeled with a domain-specific dictionary, which eliminates the need for manual engineering of linguistic rules or manual chart review for extracting the PCOs. The weakly supervised NLP pipeline showed promising sensitivity and specificity for identifying important PCOs in unstructured clinical text notes compared to rule-based algorithms.

Trial registration

This is a chart review study and approved by Institutional Review Board (IRB).
ROMOP: a light-weight R package for interfacing with OMOP-formatted electronic health record data
Authors: Glicksberg Benjamin S , Oskotsky Boris , Giangreco Nicholas , Thangaraj Phyllis M , Rudrapatna Vivek , Datta Debajyoti , Frazier Remi , Lee Nelson , Larsen Rick , Tatonetti Nicholas P , Butte Atul J
Published: January 2019

Objectives

Electronic health record (EHR) data are increasingly used for biomedical discoveries. The nature of the data, however, requires expertise in both data science and EHR structure. The Observational Medical Outcomes Partnership (OMOP) common data model (CDM) standardizes the language and structure of EHR data to promote interoperability of EHR data for research. While the OMOP CDM is valuable and more attuned to research purposes, it still requires extensive domain knowledge to utilize effectively, potentially limiting more widespread adoption of EHR data for research and quality improvement.

Materials and methods

We have created ROMOP: an R package for direct interfacing with EHR data in the OMOP CDM format.

Results

ROMOP streamlines typical EHR-related data processes. Its functions include exploration of data types, extraction and summarization of patient clinical and demographic data, and patient searches using any CDM vocabulary concept.

Conclusion

ROMOP is freely available under the Massachusetts Institute of Technology (MIT) license and can be obtained from GitHub (http://github.com/BenGlicksberg/ROMOP). We detail instructions for setup and use in the Supplementary Materials. Additionally, we provide a public sandbox server containing synthesized clinical data for users to explore OMOP data and ROMOP (http://romop.ucsf.edu).
Being Hopeful: Exploring the Dynamics of Post-traumatic Growth and Hope in Refugees
Authors: UMER MADEHA , Elliot Dely Lazarte
Published: January 2019

With more than 60 million people across the world displaced from their homes, the refugee crisis has been in the political limelight and prominent in academic conversations. With a focus on the salutogenic rather than the pathological effects of trauma, this research probed beyond refugees’ distressed psychological wellbeing by exploring contributory factors to refugees’ effective resettlement during the post-migration phase. In this small-scale study, participants were purposively selected. The mixed-methods approach led to the assessment of refugees’ post-traumatic growth and a qualitative investigation of their narrative writings on hope. Adopting a psychological lens, the article critically considers Charles Snyder’s theoretical framework on ‘hope’ and its tenets, namely ‘Goals’, ‘Pathways’, ‘Agency’, ‘Barriers’ and ‘Thoughts & Feelings’, by employing it freshly in a new context and extending the framework in light of refugees’ successful adaptation and integration into society. The research findings endorse the value of developing a hopeful disposition as key to refugees’ acculturation, empowerment and post-traumatic growth.
Expression of STAT3-regulated genes in circulating CD4+ T cells discriminates rheumatoid arthritis independently of clinical parameters in early arthritis
Authors: Anderson Amy E , Maney Nicola J , Nair Nisha , Lendrem Dennis W , Skelton Andrew J , Diboll Julie , Brown Philip M , Smith Graham R , Carmody Ruaidhrí J , Barton Anne , Isaacs John D , Pratt Arthur G
Published: January 2019

Objectives

Dysregulated signal transduction and activator of transcription-3 (STAT3) signalling in CD4+ T cells has been proposed as an early pathophysiological event in RA. We sought further evidence for this observation, and to determine its clinical relevance.

Methods

Microarray technology was used to measure gene expression in purified peripheral blood CD4+ T cells from treatment-naïve RA patients and disease controls newly recruited from an early arthritis clinic. Analysis focused on 12 previously proposed transcripts, and concurrent STAT3 pathway activation was determined in the same cells by flow cytometry. A pooled analysis of previous and current gene expression findings incorporated detailed clinical parameters and employed multivariate analysis.

Results

In an independent cohort of 161 patients, expression of 11 of 12 proposed signature genes differed significantly between RA patients and controls, robustly validating the earlier findings. Differential regulation was most pronounced for the STAT3 target genes PIM1, BCL3 and SOCS3 (>1.3-fold difference; P < 0.005), each of whose expression correlated strongly with paired intracellular phospho-STAT3. In a meta-analysis of 279 patients the same three genes accounted for the majority of the signature’s ability to discriminate RA patients, which was found to be independent of age, joint involvement or acute phase response.

Conclusion

The STAT3-mediated dysregulation of BCL3, SOCS3 and PIM1 in circulating CD4+ T cells is a discriminatory feature of early RA that occurs independently of acute phase response. The mechanistic and functional implications of this observation at a cellular level warrant clarification.
When international mobility meets local connections: Evidence from China
Authors: Li Feng , Tang Li
Published: January 2019

Transnational academic mobility has long been championed as positive and worthy of supporting. Yet, little attention has been paid to its joint impact with local connections on the career advancement of established scholars. Utilizing novel curriculum vitae data of 1447 Chang Jiang Scholars, we examine the relationship between academic mobility and the speed of obtaining prestigious academic titles. Our results suggest that local connections accelerate the career development of Chinese scholars, while international academic mobility has a negligible effect or even slows down the speed of late-phase career advancement. Returnee scholars tend to obtain national academic titles within a longer time period compared with their local counterparts. This penalty of international academic mobility also holds for returnees with only overseas PhD training experience and international research visits. Local scientists are more likely than their returnee peers with equivalent ties to have a quicker career trajectory. Policy implications are also discussed.
Advancing Population Health at Academic Medical Centers: A Case Study and Framework for an Emerging Field
Authors: Gourevitch Marc N. , Thorpe Lorna E.
Published: January 2019

The Triple Aim framework for advancing health care transformation elevated population health improvement as a central goal, together with improving patient experiences and reducing costs. Though population health improvement is often viewed in the context of clinical care delivery, broader-reaching approaches that bridge health care delivery, public health, and other sectors to foster area-wide health gains are gathering momentum. Academic medical centers (AMCs) across the United States are poised to play key roles in advancing population health and have begun to structure themselves accordingly. Yet, few frameworks exist to guide these efforts. Here, the authors offer a generalizable approach for AMCs to promote population health across the domains of research, education, and practice. In 2012, NYU School of Medicine, a major AMC dedicated to high-quality care of individual patients, launched an academic Department of Population Health with a strongly applied approach. A rigorous research agenda prioritizes scalable initiatives to improve health and reduce inequities in populations defined by race, ethnicity, geography, and/or other factors. Education targets population-level thinking among future physicians and research leadership among graduate trainees. Four key mission-bridging approaches offer a framework for population health departments in AMCs: engaging community, turning information into insight, transforming health care, and shaping policy. Challenges include tensions between research, practice, and evaluation; navigating funding sources; and sustaining an integrated, interdisciplinary approach. This framework of discipline-bridging, partnership-engaging inquiry, as it diffuses throughout academic medicine, holds great promise for realigning medicine and public health.
A Retrospective Comparative Cohort Study Comparing Temporary Internal Fixation to External Fixation at the First Stage Debridement in the Treatment of Type IIIB Open Diaphyseal Tibial Fractures
Authors: Fowler Timothy , Whitehouse Michael , Riddick Andrew , Khan Umraz , Kelly Michael
Published: January 2019

Objectives:

To compare the rates of deep infection, flap failure, and nonunion after temporary internal fixation (TIF) with temporary external fixation (ex-fix) in the management of Gustilo–Anderson type IIIB open tibia fractures.

Design:

Retrospective comparative cohort study.

Setting:

Level 1 trauma center.

Patients/Participants:

Sixty-four consecutive patients with a Gustilo–Anderson type IIIB open diaphyseal tibia fracture (OTA/AO 42) were treated between May 2014 and May 2016. Forty-seven patients (TIF = 24; ex-fix = 23) met the inclusion criteria and underwent 2-stage reconstruction. Definitive fixation was with an intramedullary nail.

Intervention:

Temporary fracture stabilization at the first-stage debridement was achieved with either TIF with a plate or ex-fix.

Main Outcome Measurement:

The main outcome measure was deep infection.

Results:

There were 4 complications in the ex-fix group (3 infection and 1 nonunion) and 2 complications in the TIF group (1 infection and 1 flap failure). Multiple regression modeling revealed that infection (P = 0.610), nonunion (P = 0.918), and flap failure (P = 0.112) were not significantly associated with the mode of temporary fixation or other demographic and treatment variables. The odds ratio of patients treated with TIF developing an infection compared with those treated with an ex-fix was 0.29 (95% confidence interval, 0.03–3.01).

Conclusions:

TIF of type IIIB open diaphyseal tibial fractures seems to be a safe alternative to conventional external fixation.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Using Historical Variation in Opioid Prescribing Immediately After Fracture Surgery to Guide Maximum Initial Prescriptions
Authors: Bhashyam Abhiram R. , Basilico Matthew , Weaver Michael J. , Harris Mitchel B. , Heng Marilyn
Published: January 2019

Objectives:

Recent studies have advocated for prescription opioid maximums (based on percentage reductions from historical amounts) to reduce excess prescribing. Implementing this in orthopaedic trauma has been difficult, given the injury variety and limited historical data on postoperative prescribing. We report on the initial opioid prescriptions for a large cohort of postoperative, opiate-naive fracture patients and hypothesize that prescribing was associated with fracture location and morphology.

Design:

Retrospective cohort analysis.

Setting:

Two American College of Surgeons Level I trauma centers.

Patients:

Six thousand eight hundred seventy-nine orthopaedic trauma patients treated between 2002 and 2015. Only patients who had a single operatively treated injury and were opiate naive (had not received an opioid prescription in the 6 months before presentation) were included.

Intervention:

Postoperative opioid discharge prescription.

Outcomes:

We analyzed the quantity of initial opioids prescribed in morphine milligram equivalents (MMEs, a standardized unit of opioid dosage used for comparison across opioid types). Fracture location and morphology were classified using the OTA/AO classification.

Results:

Fracture location was an independent predictor of the MME prescribed (P < 0.001). All other fracture locations were prescribed significantly higher MME than distal radius fractures (control group, 150 MME, P < 0.01). There was no difference in MMEs prescribed by articular involvement or degree of comminution.

Conclusions:

We demonstrate significant variation in initial postoperative opioid prescribing to opiate-naive orthopaedic trauma patients by fracture location, but not by fracture morphology. We use these data to propose a guideline based on the OTA/AO fracture classification for the maximum initial prescription of opioids.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
The Role of Computed Tomography and Magnetic Resonance Imaging in the Diagnosis of Pediatric Thoracolumbar Compression Fractures
Authors: Franklin Don B. , Hardaway Austin T. , Sheffer Benjamin W. , Spence David D. , Kelly Derek M. , Muhlbauer Michael S. , Warner William C. , Sawyer Jeffrey R.
Published: January 2019

Background:

Because of concerns about radiation exposure, some centers consider magnetic resonance imaging (MRIs) the preferred imaging modality for pediatric thoracic and/or lumbar compression fractures. The purpose of this study was to evaluate the sensitivity of computed tomography (CT) and MRI in diagnosing thoracolumbar compression fractures and the utility of MRI in their management.

Methods:

Retrospective review identified 52 patients aged 0 to 18 years with 191 thoracic and/or lumbar compression fractures who had both CT and MRI during the initial trauma evaluation. The decision to perform CT and/or MRI was made by the attending pediatric spine surgeon. In all cases the CT scan was performed before the MRI. All imaging studies were reviewed by a board-certified pediatric radiologist and attending pediatric spine surgeon.

Results:

Only 10 patients (19%) had a single-level injury. Of 42 with multiple compression fractures, 34 (81%) had fractures in contiguous levels, and 8 had noncontiguous injuries. Comparing CT and MRI, there was complete agreement in the number and distribution of fractures in 23 patients (44%). MRI identified additional levels of fracture in 15 patients (29%); 14 (27%) had fewer levels fractured on MRI than CT. Only one patient (2%) had fractures seen on MRI after a normal CT scan. Complete correlation between CT and MRI was seen in 59% (17/29) of patients aged 11 to 18 years, compared with 26% (6/23) of patients younger than 11.

Conclusions:

In pediatric patients with mild thoracic or lumbar compression fracture(s), CT scan demonstrates a high sensitivity in determining the presence or absence of a fracture compared with MRI. Although some variability exists between the 2 modalities in the exact number of spinal levels involved, the definitive treatment and outcome were not changed by the addition of MRI. The information that may be obtained from an MRI must be weighed against the increased time and expense of the study, as well as the risks associated with sedation when necessary.

Level of Evidence:

Level II—diagnostic study.
Reliability of Radiographic Assessments of the Hip in Cerebral Palsy
Authors: Shore Benjamin J. , Martinkevich Polina , Riazi Mahdis , Baird Emily , Encisa Clarissa , Willoughby Kate , Narayanan Unni G.
Published: January 2019

Introduction:

Children with cerebral palsy are at risk for progressive hip displacement. Since surveillance for hip displacement uses specific radiographic measurements to guide decision making, it is important to establish the reliability of these measurements, which include Reimer’s migration percentage (MP), acetabular index or acetabular angle (AI or AA), and pelvic obliquity (PO). The purpose of this study was to determine the intraobserver and interobserver reliability of these radiographic measures among an international group of pediatric orthopaedic surgeons participating in the prospective international multicenter Cerebral Palsy Hip Outcomes Project (CHOP) currently underway to evaluate the outcomes of hip interventions in cerebral palsy.

Methods:

Two compact discs (CDs) containing the same 25 anteroposterior pelvis radiographs in Digital Imaging and Communications in Medicine (DICOM) format were provided to participating surgeons at least 2 weeks apart. To reduce the likelihood of recall or any effects of learning or fatigue, the order of the radiographs varied on the 2 CD versions, and participating surgeons received the 2 CDs in random order. The intraclass correlation coefficients (ICCs) were calculated to assess interobserver and intraobserver reliability. Mean absolute differences of hip measurements obtained at 2 time points were also calculated.

Results:

The MP had the highest reliability followed by PO, AI, and AA with a mean intrarater ICC (SD; range) of 0.95 (0.04; 0.84 to 0.98); 0.92 (0.03; 0.85 to 0.97); 0.84 (0.05; 0.75 to 0.92); and 0.82 (0.14; 0.51 to 0.98); respectively. The mean interrater ICC (SD; range) for MP, PO, AI, and AA were 0.94 (0.05; 0.78 to 0.99); 0.90 (0.04; 0.76 to 0.99); 0.79 (0.08; 0.52 to 0.93); and 0.69 (0.23; 0.42 to 0.98) for MP, PO, AI, and AA, respectively. The mean (SD; 95% confidence interval) for the absolute difference between the 2 measurements for the raters was 4.9% (2.9%; 3.4%-6.4%); 3. 8 degrees (1.2 degrees; 3.1-4.5 degrees); 2.6 degrees (1.5 degrees; 1.7-3.5 degrees); and 1.3 degrees (0.3 degrees; 1.29-1.31 degrees) for MP, AI, AA, and PO, respectively.

Conclusions:

MP is a reproducible measure with excellent intrarater and interrater reliability. However, differences in MP of <7% should be treated with caution as these might be a consequence of measurement error. Although we found a high level of intrarater and interrater reliability of the AI, AA, and PO, these measurements are more variable and not ideal for use as discrete outcome measures. Instead, these parameters might be useful for prognostication and decision making when consistent trends are observed longitudinally over time which might be better indications of true change.
Data Omission by Physician Trainees on ICU Rounds*
Authors: Artis Kathryn A. , Bordley James , Mohan Vishnu , Gold Jeffrey A.
Published: January 2019

Objectives:

Incomplete patient data, either due to difficulty gathering and synthesizing or inappropriate data filtering, can lead clinicians to misdiagnosis and medical error. How completely ICU interprofessional rounding teams appraise the patient data set that informs clinical decision-making is unknown. This study measures how frequently physician trainees omit data from prerounding notes (“artifacts”) and verbal presentations during daily rounds.

Design:

Observational study.

Setting:

Tertiary academic medical ICU with an established electronic health record and where physician trainees are the primary presenters during daily rounds.

Subjects:

Presenters (medical student or resident physician), interprofessional rounding team.

Interventions:

None.

Measurements and Main Results:

We quantified the amount and types of patient data omitted from photocopies of physician trainees’ artifacts and audio recordings of oral ICU rounds presentations when compared with source electronic health record data. An audit of 157 patient presentations including 6,055 data elements across nine domains revealed 100% of presentations contained omissions. Overall, 22.9% of data were missing from artifacts and 42.4% from presentations. The interprofessional team supplemented only 4.1% of additional available data. Frequency of trainee data omission varied by data type and sociotechnical factors. The strongest predictor of trainee verbal omissions was a preceding failure to include the data on the artifact. Passive data gathering via electronic health record macros resulted in extremely complete artifacts but paradoxically predicted greater likelihood of verbal omission when compared with manual notation. Interns verbally omitted the most data, whereas medical students omitted the least.

Conclusions:

In an academic rounding model reliant on trainees to preview and select data for presentation during ICU rounds, verbal appraisal of patient data was highly incomplete. Additional trainee oversight and education, improved electronic health record tools, and novel academic rounding paradigms are needed to address this potential source of medical error.
Treatment With Acetylsalicylic Acid Reverses Endotoxin Tolerance in Humans In Vivo: A Randomized Placebo-Controlled Study
Authors: Leijte Guus P. , Kiers Dorien , van der Heijden Wouter , Jansen Aron , Gerretsen Jelle , Boerrigter Verin , Netea Mihai G. , Kox Matthijs , Pickkers Peter
Published: January 2019

Objective:

To investigate immunostimulatory effects of acetylsalicylic acid during experimental human endotoxemia and in sepsis patients.

Design:

Double-blind, randomized, placebo-controlled study in healthy volunteers and ex vivo stimulation experiments using monocytes of septic patients.

Setting:

Intensive care research unit of an university hospital.

Subjects:

Thirty healthy male volunteers and four sepsis patients.

Interventions:

Healthy volunteers were challenged IV with endotoxin twice, at a 1-week interval, with each challenge consisting of a bolus of 1 ng/kg followed by continuous administration of 1 ng/kg/hr during 3 hours. Volunteers were randomized to acetylsalicylic acid prophylaxis (80 mg acetylsalicylic acid daily for a 14-d period, starting 7 d before the first endotoxin challenge), acetylsalicylic acid treatment (80 mg acetylsalicylic acid daily for the 7-d period in-between both endotoxin challenges), or the control group (receiving placebo). Furthermore, monocytes of sepsis patients were incubated with acetylsalicylic acid preexposed platelets and were subsequently stimulated with endotoxin.

Measurements and Main Results:

Acetylsalicylic acid prophylaxis enhanced plasma tumor necrosis factor-α concentrations upon the first endotoxin challenge by 50% compared with the control group (p = 0.02) but did not modulate cytokine responses during the second endotoxin challenge. In contrast, acetylsalicylic acid treatment resulted in enhanced plasma levels of tumor necrosis factor-α (+53%; p = 0.02), interleukin-6 (+91%; p = 0.03), and interleukin-8 (+42%; p = 0.02) upon the second challenge, whereas plasma levels of the key antiinflammatory cytokine interleukin-10 were attenuated (–40%; p = 0.003). This proinflammatory phenotype in the acetylsalicylic acid treatment group was accompanied by a decrease in urinary prostaglandin E metabolite levels (–27% ± 7%; p = 0.01). Ex vivo exposure of platelets to acetylsalicylic acid increased production of tumor necrosis factor-α (+66%) and decreased production of interleukin-10 (–23%) by monocytes of sepsis patients.

Conclusions:

Treatment, but not prophylaxis, with low-dose acetylsalicylic acid, partially reverses endotoxin tolerance in humans in vivo by shifting response toward a proinflammatory phenotype. This acetylsalicylic acid–induced proinflammatory shift was also observed in septic monocytes, signifying that patients suffering from sepsis-induced immunoparalysis might benefit from initiating acetylsalicylic acid treatment.
Extracorporeal Membrane Oxygenation Use in Cardiogenic Shock: Impact of Age on In-Hospital Mortality, Length of Stay, and Costs
Authors: Chung Mabel , Zhao Yuansong , Strom Jordan B. , Shen Changyu , Yeh Robert W.
Published: January 2019

Objectives:

Increasing age is a well-recognized risk factor for in-hospital mortality in patients receiving extracorporeal membrane oxygenation for cardiogenic shock, but the shape of this relationship is unknown. In addition, the impact of age on hospital length of stay, patterns of patient disposition, and costs has been incompletely characterized.

Design:

Retrospective analysis of the National Inpatient Sample.

Setting:

U.S. nonfederal hospitals, years 2004–2016.

Patients:

Adults with cardiogenic shock treated with extracorporeal membrane oxygenation (3,094; weighted national estimate: 15,415).

Interventions:

None.

Measurements and Main Results:

The mean age of extracorporeal membrane oxygenation recipients was 54.8 ± 15.4 years (range, 18–90 yr). Crude in-hospital mortality was 57.7%. Median time-to-death was 8 days (interquartile range, 3–17 d). A linear relationship between age and in-hospital mortality was observed with a 14% increase in the adjusted odds of in-hospital mortality for every 10-year increase in age (adjusted odds ratio, 1.14; 95% CI, 1.08–1.21; p < 0.0001). Thirty-four percent of patients were discharged alive at a median time of 30 days (interquartile range, 19–48 d). The median length of stay and total hospitalization costs were 14 days (interquartile range, [5–29 d]) and $134,573 ($71,782–$239,439), respectively, both of which differed significantly by age group (length of stay range from 17 d [18–49 yr] to 9 d [80–90 yr]; p < 0.0001 and cost range $147,548 [18–49 yr] to $105,350 [80–90 yr]; p < 0.0001).

Conclusions:

Age is linearly associated with increasing in-hospital mortality in individuals receiving extracorporeal membrane oxygenation for cardiogenic shock without evidence of a threshold effect. Median time-to-death is approximately 1 week. One third of patients are discharged from the hospital alive, but the median time-to-discharge is 1 month. Median length of stay ranges from 9 to 17 days depending on age. Hospitalization costs exceed $100,000 in all age groups.
Outcomes in Patients With Metastatic Pancreatic Adenocarcinoma With the Introduction of New Chemotherapeutic Drugs
Authors: Zhang Kevin J. , Dyson Greg , Gatz Joshua L. , Silverman Michael E. , Tesfaye Anteneh A. , Shields Anthony F. , Philip Philip A.
Published: January 2019

Objectives:

Adenocarcinoma of the pancreas represents the third leading cause of cancer-related death in the United States. Drug combinations, FOLFIRINOX (5-FU, leucovorin, irinotecan, and oxaliplatin) and gemcitabine/nab-paclitaxel, showed a clinically meaningful benefit when compared with single-agent gemcitabine in phase III trials. The goal of this study was to investigate whether there was an increase in overall survival (OS) for patients treated for metastatic pancreatic cancer after the introduction of the above regimens.

Materials and Methods:

Patients were grouped into 2 treatment eras that were before and after the introduction of these newer chemotherapeutic regimens; 2006-2010 and 2011-2015, respectively. Baseline demographics and disease-related variables were collected from metastatic pancreatic cancer treated at the Barbara Ann Karmanos Cancer Institute in Detroit, MI.

Results:

When stratified by treatment era, the later era had an improvement in survival (hazard ratio for death of 0.61; P=0.005). Median OS was 8.97 and 9.95 months for the earlier (n=59) versus latter era (n=99), respectively. There was an increase from 28.3% to 38.9% at 12 months between the earlier and later era, an improvement of 37.4%. African Americans had a worse outcome with a hazard ratio of 1.63 (P=0.02) for death. When comparing the eras, Caucasians had a longer median OS in each era in addition to having a greater improvement in median OS between eras.

Conclusions:

There was a modest improvement in median OS between 2006-2010 and 2011-2015 with the introduction of newer chemotherapeutic regimens. However, there has been no significant improvement in outcomes for African Americans or in short-term survival.
Vision Performance and Accommodative/Binocular Function in Children Wearing Prototype Extended Depth-of-Focus Contact Lenses
Authors: Tilia Daniel , Sha Jennifer , Thomas Varghese , Bakaraju Ravi C.
Published: January 2019

Objective:

To assess two prototype contact lenses (CLs) that extend depth of focus through deliberate manipulation of multiple spherical aberration terms (extended depth-of-focus [EDOF]) for visual performance, accommodative and binocular function, and objective static near refraction against a single-vision (SV) CL.

Method:

This was a prospective, randomized, cross-over, single-masked (participant) clinical trial in which 16 myopic children wore 2 prototype CLs (EDOF
L
/EDOF
H
) designed for presbyopes and a SV CL, each for one week. Measurements comprised monocular and binocular high-contrast visual acuity (HCVA: 6 m, 40 cm), binocular low-contrast visual acuity (LCVA: 6 m), contrast sensitivity (CS: 6 m), phorias (3 m, 33 cm), monocular-accommodative facility (33 cm), and objective static refraction (spherical equivalent M) at zero, −3, and −5 D vergences. Measurements were taken 10 min after lens insertion. Subjective response was assessed using take-home questionnaires comprising vision clarity (distance/intermediate/near), vision quality (haloes at night/ghosting), vision stability when moving (playing sport/using stairs), and comfort.

Results:

Single vision was significantly better than both EDOF CLs for monocular HCVA, LCVA, and CS (6 m); vision clarity (distance), ghosting (P≤0.040), and EDOF
L
for binocular HCVA (6 m, P=0.047). M was significantly closer to the ideal objective static refraction at −3 and −5 D vergences (P≤0.004) with both EDOF compared with SV CLs. There were no differences between CLs for any other variable (P≥0.169).

Conclusion:

Extended depth-of-focus CLs caused minimal disruption to the accommodative and binocular system compared with SV CLs when worn by myopic children. Future EDOF designs for children should reduce the difference between SV for distance vision and vision quality while maintaining the same performance for intermediate and near.
Differentiation between hepatic cystic echinococcosis types 1 and simple hepatic cysts
Authors: Ran Bo , Aji Tuerganaili , Jiang Tieming , Zhang Ruiqing , Guo Qiang , Abulizi Abuduaini , Yimiti Yusfu , Wen Hao , Shao Yingmei
Published: January 2019

This study aims to evaluate the clinic value of ultrasound, computed tomography (CT) and serological testing in the differentiation between hepatic Cystic Echinococcosis (CE) types 1 and simple hepatic cysts.

Totally 50 patients with CE Types 1 and 50 patients with simple hepatic cysts were included. All patients examined by ultrasound, CT and serological testing respectively. The receiver operating characteristic (ROC) curve of diagnosis methods was drawn and their sensitivity, specificity, Youden index, positive likelihood ratio, negative likelihood ratio, positive predictive value and negative predictive value were compared. Pathology result was used as golden standard.

The area under ROC curve of ultrasound was 0.97 and of CT and serological testing was 0.79 and 0.71 respectively. The sensitivity of ultrasound in the diagnosis of CE Types 1 was 96.00%, specificity was 98.00%, the positive likelihood ratio was 48.00, and negative likelihood ratio was 0.04. Disease prevalence was 50%, positive predictive value was 97.96%, and negative predictive value was 96.08%. The sensitivity of CT was 80.00%, specificity was 62.00%, positive likelihood ratio was 2.11, and negative likelihood ratio was 0.32. Disease prevalence was 50%, positive predictive value was 67.80%, and negative predictive value was 75.61%. The sensitivity of immunological test was 86.00%, specificity was 72.00%, positive likelihood ratio was 3.07, and negative likelihood ratio was 0.19. Disease prevalence was 50%, positive predictive value was 75.44%, and negative predictive value was 83.72%. Combined ultrasound and immunological test, the sensitivity and the specificity was 82% and 100% respectively. Combined CT and immunological test, the sensitivity the specificity was 70% and 82% respectively.

In the differentiate diagnosis of CE Types 1 and simple hepatic cyst, ultrasound is better than CT with high sensitivity and specificity, therefore recommended. Immunological examination is an important complement to the imaging examination.
A Pilot Randomized Controlled Trial of Transcutaneous Electrical Nerve Stimulation for Patients With Acute Tinnitus
Authors: Li Li , Shi Hao , Wang Min
Published: January 2019

Background:

This pilot study aimed to evaluate the feasibility effectiveness and safety of transcutaneous electrical nerve stimulation (TENS) for patients with acute tinnitus.

Methods:

A total of 46 eligible patients with acute tinnitus were entered and included in this randomized controlled trial. All the included patients were equally and randomly divided into a verum TENS group and a sham TENS group, each group 23 participants. All patients received parenteral intramuscular therapy of 1 ml Vitamin B12 weekly for a total of 4 weeks. In addition, they also underwent verum or sham TENS 30 min daily, 3 times weekly for 4 weeks. The primary efficacy endpoint was measured by the Tinnitus Severity Scale (TSS) and Tinnitus Questionnaire (TQ) sum score. The secondary efficacy endpoints were assessed by the Tinnitus Handicap Inventory (THI), 12-Item Short Form Health Survey (SF-12) questionnaire, and adverse events. All outcome efficacy endpoints were measured at baseline and after 4 weeks of treatment.

Results:

After 4-week treatment, the patients undergoing verum TENS showed statistically efficacy of symptoms relief, as measured by the scales of TSS (P < .01), TQ (P < .01), and THI (P < .01), and improvement of quality of life, as assessed by the SF-12 (P < .01), compared with patients receiving sham TENS. In addition, no adverse events related to the treatment were recorded in either group.

Conclusions:

The results of this study showed that verum TENS may benefit patients with acute tinnitus after 4 weeks of treatment.
Osteitis secondary to BCG vaccine in immunocompetent patients
Authors: Saldaña Napoleón González , Ranero Agustín Rafael De Colsa , Trujillo Diego Mauricio Galvis , Garza Eduardo Arias De la , Tortoriello Ana Isabel Quesada , Ruiz Bárbara Varela , Jurado Rodolfo Rodríguez , Olguín Hugo Juárez , Silva Miroslava Lindoro
Published: January 2019

Rationale:

Osteitis corresponds to a rare but potentially serious complication reported in pediatric population after the application of the Bacillus Calmette-Guerin (BCG) vaccine. In the present study, 3 clinical cases associated with this entity are reported.

Patient concerns:

The 1st case corresponds to a 1-year-old female patient who presented an increase in the volume of the right pelvic limb after BCG application. The second case is a 2-year-old male who began with an increase in volume, overactive gait and pain at the level of the left knee on walking that began after a trauma in the left low limb. The 3rd case corresponds to a 3-year-old patient who started with intense pain and limitation for ambulation.

Diagnosis:

Both the radiographical and histological studies presented data suggestive of infection by Mycobacterium tuberculosis complex, corroborated through biopsy and genotyping analysis with the isolation of Mycobacterium bovis as the causal agent.

Interventions:

The basic treatment scheme was based on Ethambutol, Rifampicin, Pyrazinamide, and Isoniazid. When M. bovis was typified, clarithromycin was added in the treatment.

Outcomes:

Osteitis secondary to BCG vaccine usually has a favorable evolution, especially in immunocompetent patients.

Lessons:

It was possible to confirm the association of BCG vaccine with the clinical picture of the patients who presented improvement after the start of antimicrobial management. Osteitis secondary to BCG vaccine usually presents a favorable evolution, especially in immunocompetent patients; however, the involvement of joint, growth discs and vertebrae increases the risk of presenting long-term sequels.
Association between condom use and perspectives on contraceptive responsibility in different sexual relationships among sexually active college students in China
Authors: Long Lu , Han Yutong , Tong Longxia , Chen Zhenhua
Published: January 2019

China has increasing incidence of unplanned pregnancies among college students these years. Increasing students’ sense of responsibility to protect sexual partners may help reduce the rate of unplanned pregnancies.

A self-administered questionnaire was distributed to students from 3 colleges in Sichuan, China. Among them, 559 of male students and 267 of female students were included in this study. The questionnaire collected participants’ characteristics, usage of condom, and investigated male and female students’ perceptions of who should be responsible for contraception use.

We found that relationship status was closely related to students perceiving responsibility for reproductive health and condom using. Male students who were in casual relationships during their most recent sexual encounter and shared responsibility for contraception were more likely to use condoms than other male students (P < .001). Female students who were in steady relationships during their most recent sexual encounter and shared responsibility for contraception were more likely to use condoms than other female students (P = .007). The multivariate analysis revealed condom use was associated with greater odds of sharing responsibility for contraceptive use in different types of sexual relationships.

Improving students’ attitudes toward responsibility for contraception may increase condom use among students at risk for unplanned pregnancies. Programs providing targeted health education and services may help reduce the rate of unplanned pregnancies among students in China.
Prognostic value of numbers of metastatic lymph node in medullary thyroid carcinoma
Authors: Meng Kexin , Luo Hua , Chen Hailong , Guo Haiwei , Xia Wenjie
Published: January 2019

Lymph node (LN) metastases are widely considered as a vital assessment of disease progression, as well as an essential indicator for biochemical cure of medullary thyroid carcinoma (MTC). Prognostic effect of numbers of metastatic LN has not been fully studied and the optimal cut-point of LN numbers has not been established. This population-based study designed to investigate prognostic value of numbers of positive LN and determinate the prognostic factors.

Data were generated from Surveillance, Epidemiology, and End Results (SEER) database between 1998 and 2013. X-tile program was applied and cut points for division of LN numbers as low-, medium- and high-risk were 0, 1 to 10, and ≥11. The relationship between numbers of metastatic LN, age, tumor size, extent of tumor, and radiotherapy on overall survival (OS) and disease-specific survival (DSS) were evaluated.

A total of 1466 diagnosed primary MTC patients without metastases were eligible for analysis in current study. 945 (64%) patients were classified as no positive LNs, 327 (22%) as 1 to 10 positive LNs, 194 (14%) as ≥11 positive LNs. Patients with older age, tumor size, ≥11 positive LN were associated with unfavorable OS. Those dispensed with radiation had statistically better prognosis than the others. When stratified by age, there was a significant difference in patients ≥45 years within LN categories (log-rank P < .001). When stratified by tumor size, a significant correlation was noted between rising numbers of involved nodes and falling rates of OS in tumor measuring >2cm setting (2–4 cm setting, log-rank P = .003 and >4 cm setting, log-rank P = .014, separately). There was no statistical difference of the area under the curve (AUC) for OS and DSS prediction between LN group and N stage, suggesting the 2 LN systems had the same predictive power for OS and DSS.

Numbers of metastatic LN showed prognostic power in survival analysis and remained an independent survival predictor which can be evaluated in MTC treatment decisions for optimum assessment.
A case report of ocular tuberculosis in a patient with membranous nephropathy
Authors: Yin Xiaofang , Ge Haibo , Miao Ruifen
Published: January 2019

Rationale:

Membranous nephropathy (MN), a chronic kidney disease (CKD), due to hypoproteinemia, malnutrition, anemia, long-term intake of immunosuppressive agents, changes in cellular immune state, and decrease in antimicrobial peptides, is a high risk for Mycobacterium tuberculosis (MTB) infection, which can cause tuberculosis (TB). TB manifests by various clinical symptoms. Ocular symptoms is a rare presentation of TB. Here, we describe a case of ocular tuberculosis in a patient with MN.

Patient concerns:

A 63-year-old man with membranous nephropathy (MN) history presented with ocular symptoms.

Diagnoses:

According to the pathological manifestations of ocular tissue biopsy and a positive polymerase chain reaction (PCR) on samples from sputum and bronchoalveolar lavage fluid (BALF), we elicited a diagnosis of disseminated tuberculosis.

Intervention:

The patient received antituberculous therapy and immunosuppressive therapy.

Outcomes:

The clinical manifestations significantly improved.

Lessons:

Clinicians should be aware of the possibility of TB in cases of immunocompromised patients and perform an appropriate diagnostic work-up for TB.