bluuebunny/crossref_metadata_2025 huggingface dataset:
Do Positive Anaerobic Culture Results Affect Physicians’ Clinical Management Decisions?
Authors: Bhowmick Tanaya , Varughese Tilly A. , Arakali Schweta , Boruchoff Susan E.
Published: November 2016

Background

Aerobic and anaerobic cultures from body fluids, abscesses, and wounds are ordered routinely. Prior studies have shown that the results of anaerobic blood cultures do not frequently lead to changes in patient management.

Methods

We performed a retrospective chart review to determine whether positive results of anaerobic tissue and fluid cultures (excluding blood) affect physicians’ treatment approaches. Of 3234 anaerobic cultures, 174 unique patient admissions had positive cultures and met inclusion criteria.

Results

Only 18% (n = 31) of patient charts with positive cultures had documented physician acknowledgment (90.3% of acknowledgments by infectious diseases physicians), with 9% (n = 15) leading to change in antibiotic regimens based on results. Seventy percent of all patients received initial empiric antibiotics active against anaerobes. Of the remaining 30% (inappropriate, unknown, or no empiric coverage), 1 regimen change was documented after culture results were known.

Conclusions

Given the lack of management change based on results of anaerobic wound cultures, the value of routine anaerobic culturing is of questionable utility.
Naïveté-Based Discrimination*
Authors: Heidhues Paul , Kőszegi Botond
Published: November 2016

We initiate the study of naïveté-based discrimination, the practice of conditioning offers on external information about consumers’ naïveté. Knowing that a consumer is naive increases a monopolistic or competitive firm's willingness to generate inefficiency to exploit the consumer's mistakes, so naïveté-based discrimination is not Pareto-improving, can be Pareto-damaging, and often lowers total welfare when classical preference-based discrimination does not. Moreover, the effect on total welfare depends on a hitherto unemphasized market feature: the extent to which the exploitation of naive consumers distorts trade with different types of consumers. If the distortion is homogeneous across naive and sophisticated consumers, then under an arguably weak and empirically testable condition, naïveté-based discrimination lowers total welfare. In contrast, if the distortion arises only for trades with sophisticated consumers, then perfect naïveté-based discrimination maximizes social welfare, although imperfect discrimination often lowers welfare. If the distortion arises only for trades with naive consumers, then naïveté-based discrimination has no effect on welfare. We identify applications for each of these cases. In our primary example, a credit market with present-biased borrowers, firms lend more than is socially optimal to increase the amount of interest naive borrowers unexpectedly pay, creating a homogeneous distortion. The condition for naïveté-based discrimination to lower welfare is then weaker than prudence.
Epidemiological Differences Between Localized and Nonlocalized Low Back Pain
Authors: Coggon David , Ntani Georgia , Walker-Bone Karen , Palmer Keith T. , Felli Vanda E. , Harari Raul , Barrero Lope H. , Felknor Sarah A. , Gimeno David , Cattrell Anna , Vargas-Prada Sergio , Bonzini Matteo , Solidaki Eleni , Merisalu Eda , Habib Rima R. , Sadeghian Farideh , Kadir M. Masood , Warnakulasuriya Sudath SP , Matsudaira Ko , Nyantumbu Busisiwe , Sim Malcolm R. , Harcombe Helen , Cox Ken , Sarquis Leila M.M. , Marziale Maria H. , Harari Florencia , Freire Rocio , Harari Natalia , Monroy Magda V. , Quintana Leonardo A. , Rojas Marianela , Harris Elizabeth Clare , Serra Consol , Martinez José Miguel , Delclos George , Benavides Fernando G. , Carugno Michele , Ferrario Marco M. , Pesatori Angela C. , Chatzi Leda , Bitsios Panos , Kogevinas Manolis , Oha Kristel , Freimann Tiina , Sadeghian Ali , Peiris-John Roshini J. , Sathiakumar Nalini , Wickremasinghe A. Rajitha , Yoshimura Noriko , Kelsall Helen L. , Hoe Victor C.W. , Urquhart Donna M. , Derrett Sarah , McBride David , Herbison Peter , Gray Andrew , Salazar Vega Eduardo J.
Published: November 2016

Study Design.

A cross-sectional survey with a longitudinal follow-up.

Objectives.

The aim of this study was to test the hypothesis that pain, which is localized to the low back, differs epidemiologically from that which occurs simultaneously or close in time to pain at other anatomical sites

Summary of Background Data.

Low back pain (LBP) often occurs in combination with other regional pain, with which it shares similar psychological and psychosocial risk factors. However, few previous epidemiological studies of LBP have distinguished pain that is confined to the low back from that which occurs as part of a wider distribution of pain.

Methods.

We analyzed data from CUPID, a cohort study that used baseline and follow-up questionnaires to collect information about musculoskeletal pain, associated disability, and potential risk factors, in 47 occupational groups (office workers, nurses, and others) from 18 countries.

Results.

Among 12,197 subjects at baseline, 609 (4.9%) reported localized LBP in the past month, and 3820 (31.3%) nonlocalized LBP. Nonlocalized LBP was more frequently associated with sciatica in the past month (48.1% vs. 30.0% of cases), occurred on more days in the past month and past year, was more often disabling for everyday activities (64.1% vs. 47.3% of cases), and had more frequently led to medical consultation and sickness absence from work. It was also more often persistent when participants were followed up after a mean of 14 months (65.6% vs. 54.1% of cases). In adjusted Poisson regression analyses, nonlocalized LBP was differentially associated with risk factors, particularly female sex, older age, and somatizing tendency. There were also marked differences in the relative prevalence of localized and nonlocalized LBP by occupational group.

Conclusion.

Future epidemiological studies should distinguish where possible between pain that is limited to the low back and LBP that occurs in association with pain at other anatomical locations.

Level of Evidence: 2
Prognostic Factors, Treatment, and Outcomes in Early Stage, Invasive Papillary Breast Cancer
Authors: Fakhreddine Mohamad H. , Haque Waqar , Ahmed Awad , Schwartz Mary R. , Farach Andrew M. , Paulino Arnold C. , Bonefas Elizabeth , Miltenburg Darlene , Niravath Polly , Butler E. Brian , Teh Bin S.
Published: November 2016

Objectives:

Invasive papillary breast cancer (IPBCA) represents 0.5% of invasive BCA, and is thought to carry a favorable prognosis. This population-based study reports on prognostic factors, treatment, and outcomes of early-stage IPBCA to explore whether there is any evidence to support less aggressive treatment.

Materials and Methods:

IPBCA cases from 1990 to 2009 of the recent Surveillance, Epidemiology, and End Results were analyzed. Inclusion criteria included patients with stage T1-2, N0 IPBCA. Univariate and multivariate analyses were performed using the variables of treatment, stage, race, hormone receptor status, grade (G1-3), and age. Treatment modalities included lumpectomy alone (LA), lumpectomy with radiation treatment (LRT), and mastectomy alone (MA).

Results:

Among 10,485 patients, median follow-up was 56 months. Five and 10-year overall survival (OS) were 93.1% and 76.8%, respectively. Patients treated with LRT had superior mean OS 16.8 versus 14.9 years for MA (P=0.0004) and 14.2 years for LA (P=0.0003). Improved OS also correlated with lower histologic grade (P<0.0001), lower T-stage (P<0.0001), and younger age (P<0.0001). Black patients had the worst OS (12.7 y, P<0.0001).

Conclusions:

LRT is associated with superior OS for early-stage invasive papillary BCA patients, when compared with LA or MA in this population-based study. The findings support the standard of care breast conservation approach for patients with invasive papillary BCA. Other prognostic factors associated with worse OS include increased age, higher T-stage, higher histologic grade, and black race.
Impact of Postoperative Adjuvant Chemotherapy Following Long-course Chemoradiotherapy in Stage II Rectal Cancer
Authors: Loree Jonathan M. , Kennecke Hagen F. , Lee-Ying Richard M. , Goodwin Rachel A. , Powell Erin D. , Tang Patricia A. , Price Hiller Julie A. , Vickers Michael M. , Cheung Winson Y.
Published: November 2016

Objectives:

Use of adjuvant chemotherapy (AC) following neoadjuvant chemoradiation (nCRT) is controversial in rectal cancer (RC). We assessed a multi-institutional database to determine if there was benefit from AC for pathologic stage II RC patients and whether the addition of oxaliplatin to fluoropyrimidine (OXAC) therapy impacted outcomes.

Materials and Methods:

We included patients who underwent nCRT and had pathologic stage II (ypT3/4 ypN0) tumors. Disease-free survival and overall survival were assessed. Multivariate Cox models adjusting for age, sex, Eastern Cooperative Oncology Group, high-risk features (pT4, poor differentiation, <12 nodes removed, lymphovascular/perineural invasion, or obstruction/perforation), and clinical stage were constructed.

Results:

Of 485 patients, 73.6% received AC, of which 25.5% received OXAC. Patients receiving AC were younger (median age 61 vs. 64; P=0.003) and had higher rates of total mesorectal excision (81.5% vs. 78.9%; P=0.049), but had similar high-risk features, performance status, clinical stage, margin status, preoperative carcinoembryonic antigen, and nCRT regimen. In univariate analysis, overall survival was improved with fluoropyrimidine AC compared with no AC or OXAC (P=0.049), but not disease-free survival (P=0.33). In multivariate analysis, any AC, fluoropyrimidine AC, or OXAC did not improve outcomes. After stratifying patients by the presence of high-risk features, elevated carcinoembryonic antigen, margin status, or preoperative clinical stage, we did not identify a group with improved outcomes following AC.

Conclusions:

In this multi-institutional cohort of yp stage II RC patients, we failed to identify a group that derives benefit from AC following nCRT. The addition of oxaliplatin did not appear to improve outcomes when compared with fluoropyrimidine alone.
Clinical Outcomes After Lung Stereotactic Body Radiation Therapy in Patients With or Without a Prior Lung Resection
Authors: Hou Ying , Hermann Gretchen , Lewis John H. , Aerts Hugo J. , Baldini Elizabeth H. , Chen Aileen B. , Colson Yolonda L. , Hacker Fred L. , Killoran Joseph H. , Kozono David E. , Wagar Matthew , Wee Jon O. , Mak Raymond H.
Published: November 2016

Objectives:

Tumor control (TC), toxicity and survival, following stereotactic body radiation therapy (SBRT) were compared between patients with and without a prior lung resection (PLR).

Materials and Methods:

The study is comprised of 130 patients with 141 peripheral tumors treated with SBRT at our institution from 2009 to 2013. Primary TC and lobar control (LC) were defined per RTOG 0236. Toxicity was scored using Common Terminology Criteria for Adverse Events version 4.0. Survival/TC and toxicity were compared between patients with and without PLR using the Kaplan-Meier method and cumulative incidence, respectively. Fine and Gray regression was used for univariable/multivariable analysis for radiation pneumonitis (RP).

Results:

Of the 130 patients with median age 70 years (range, 42 to 93 y), 50 had undergone PLR (median time between PLR and SBRT: 33 mo; range, 1 to 206), including pneumonectomy (12%), lobectomy (46%), wedge resection (42%). With a median follow-up of 21 months in survivors, the PLR group had better TC (1-y 100% vs. 93%; P<0.01) and increased grade ≥2 (RP; 1-y 12% vs. 1%; P<0.01). OS was not significantly different between the 2 groups (1-y 91% vs. 85%; P=0.24). On univariable/multivariable analyses, biologically effective dose was associated with TC (hazard ratios, 0.97; 95% confidence interval, 0.94-0.999; P=0.04). Chemotherapy use was associated with grade ≥2 RP for all patients (hazard ratios, 14.92; 95% confidence interval, 5.68-39.21; P<0.0001) in multivariable analysis. PLR was not associated with increased RP in multivariable analysis.

Conclusions:

Patients with PLR who receive lung SBRT for lung tumors have high local control and relatively low toxicity. SBRT is an excellent option to treat second lung tumors or pulmonary metastases in patients with PLR.
The Relation of White-on-White Standard Automated Perimetry, Short Wavelength Perimetry, and Optic Coherence Tomography Parameters in Ocular Hypertension
Authors: Başkan Ceyda , Köz Özlem G. , Duman Rahmi , Gökçe Sabite E. , Yarangümeli Ahmet A. , Kural Gülcan
Published: November 2016

Purpose:

The purpose of this study is to examine the demographics, clinical properties, and the relation between white-on-white standard automated perimetry (SAP), short wavelength automated perimetry (SWAP), and optical coherence tomographic (OCT) parameters of patients with ocular hypertension.

Materials and Methods:

Sixty-one eyes of 61 patients diagnosed with ocular hypertension in the Ankara Numune Education and Research Hospital ophthalmology unit between January 2010 and January 2011 were included in this study. All patients underwent SAP and SWAP tests with the Humphrey visual field analyser using the 30.2 full-threshold test. Retinal nerve fiber layers (RNFL) and optic nerve heads of patients were evaluated with Stratus OCT.

Results:

Positive correlation was detected between SAP pattern standard deviation value and average intraocular pressure (P=0.017), maximum intraocular pressure (P=0.009), and vertical cup to disc (C/D) ratio (P=0.009). Positive correlation between SWAP median deviation value with inferior (P=0.032), nasal (P=0.005), 6 o’clock quadrant RNFL thickness (P=0.028), and I
max/T
avg ratio (P=0.023) and negative correlation with S
max/N
avg ratio (P=0.005) were detected. There was no correlation between central corneal thickness and peripapillary RNFL thicknesses (P>0.05).

Conclusions:

There was no relation between SAP median deviation, pattern standard deviation values and RNFL thicknesses and optic disc parameters of the OCT. By contrast significant correlation between several SWAP parameters and OCT parameters were detected. SWAP appeared to outperform achromatic SAP when the same 30-2 method was used.
Type IIIb Endoleak Associated with an Infected Thoracoabdominal Endograft
Authors: Orr Nathan T. , Winkler Michael A. , Xenos Eleftherios S.
Published: November 2016

We present a 63-year-old male patient who presented with vague abdominal pain after an endoluminal thoracoabdominal aneurysm repair. He was found to have an infected endograft and an associated type IIIb endoleak. We believe that the infection contributed to the fabric degradation along the endograft and resulted in an expanding endoleak. Graft explantation was not performed because of the patient's multiple comorbidities, and the endoleak was treated with an additional stent graft and suppressive antibiotics. Endograft infection may lead to endograft degradation and associated leak. Therefore, an infectious etiology, although rare, should be considered when evaluating a delayed type IIIb endoleak.
Pseudoaneurysm as a Late Complication of Hybrid Aortic Arch Repair
Authors: Rosu Cristian , Beaulieu Nicolas , Cartier Raymond , Demers Philippe
Published: November 2016

Hybrid aortic arch repair is increasingly used for the management of aortic arch aneurysm. Pseudoaneurysm is a newly described late complication of this procedure. A 57-year-old man underwent emergent supra-aortic debranching and aortic arch stent grafting after rupture of an arch aneurysm. Three years later, the patient presented with a pseudoaneurysm at the junction between the stent graft's proximal landing zone and the origin of the debranching graft. At reoperative repair, the proximal stent graft had eroded through the aortic wall at the junction of the endograft proximal landing zone and the proximal anastomosis of the debranching graft. The presence of a dilated, fragile ascending aorta at the initial procedure seemed to be a risk factor for development of the pseudoaneurysm. Replacement of the ascending aorta combined with supra-aortic debranching has become an accepted strategy in hybrid arch repair to establish a suitable landing zone for the endograft.
Adenoma Detection is Increased in the Setting of Melanosis Coli
Authors: Blackett John W. , Rosenberg Richard , Mahadev Srihari , Green Peter H.R. , Lebwohl Benjamin
Published: November 2016

Goals:

To compare the adenoma detection rate (ADR) during colonoscopy in patients with melanosis coli against matched controls without melanosis.

Background:

Melanosis coli is a colonoscopic finding in which the colon wall appears darkly pigmented, most often due to extended laxative use, and is considered benign. The pigmentation spares adenomas, which should therefore be more readily detectable in melanosis coli.

Study:

We identified all patients with melanosis on colonoscopy at our institution over a 5-year period. We matched each patient with 2 controls by age, gender, and endoscopist. We compared the prevalence of adenomas between groups, and used multivariable analysis, adjusting for procedure indication and bowel preparation quality, to determine the independent association of melanosis with adenoma detection.

Results:

At least 1 adenoma was detected in 34.7% of melanosis patients and 26.5% of controls [odds ratio (OR)=1.52; 95% confidence interval (CI), 1.04-2.24; P=0.03]. On multivariable analysis, the presence of melanosis remained associated with increased adenoma detection (OR=1.56; 95% CI, 1.05-2.33; P=0.03). Melanosis patients were more likely to have an adenoma ≤5 mm (OR=1.62; 95% CI, 1.04-2.51; P=0.03), but not adenomas 6 to 9 mm or ≥10 mm.

Conclusions:

Melanosis coli is associated with a significant increase in ADR during colonoscopy compared with controls. The increased visibility of adenomas given their contrast with the pigmented background is a likely explanation. Future efforts to identify bowel preparation agents that can induce a similar effect could improve ADRs during colonoscopy.
Gastrointestinal hormones and the gut connectome
Authors: Ye Lihua , Liddle Rodger A.
Published: November 2016

Purpose of review

Provision of adequate nutrients by the gut is essential for survival and essential behaviors are linked to the proper ingestion and digestion of food. Recently, a new neural connection has been reported between sensory cells of the gut epithelium and the nervous system that mediates signals from the gut to the brain.

Recent findings

This review describes how the gut senses its environment, relays those signals to the brain, and how the brain influences the gut.

This gut–brain connection provides a pathway for how the body handles food.
Understanding Treatment Disconnect and Mortality Trends in Renal Cell Carcinoma Using Tumor Registry Data
Authors: Smaldone Marc C. , Egleston Brian , Hollingsworth John M. , Hollenbeck Brent K. , Miller David C. , Morgan Todd M. , Kim Simon P. , Malhotra Aseem , Handorf Elizabeth , Wong Yu-Ning , Uzzo Robert G. , Kutikov Alexander
Published: November 2016

Background and Objectives:

The paradoxical rise in overall and cancer-specific mortality despite increased detection and treatment of renal cell carcinoma (RCC) is termed “treatment disconnect.” We reassess this phenomenon by evaluating impact of missing data and rising incidence on mortality trends.

Research Design, Subjects, and Measures:

Using Surveillance, Epidemiology, and End Results data, we identified patients with RCC diagnosis from 1973 to 2011. We estimated mortality rates by tumor size after accounting for lags from diagnosis to death using multiple imputations for missing data from 1983. Mortality rates were estimated irrespective of tumor size after adjustment for prior cumulative incidence using ridge regression.

Results:

A total of 78,891 patients met inclusion criteria. Of 70,212 patients diagnosed since 1983, 10.4% had missing data. Significant attenuation in cancer-specific mortality was noted from 1983 to 2011 when comparing observed with imputed rates: Δobs0.05 versus Δimp0.10 (P=0.001, <2 cm tumors); Δobs0.29 versus Δimp0.18 (P=0.005, 2–4 cm tumors); Δobs0.46 versus Δimp–0.20 (P<0.001, 4–7 cm tumors); Δobs0.93 versus Δimp–0.15 (P<0.001, >7 cm tumors). Holding incidence of RCC constant to 2011 rates, temporal increase in overall mortality for all patients was attenuated (P<0.001) when comparing observed estimates (3.9–6.8) with 2011 adjusted estimates (5.9–7.1), suggesting that rapidly rising incidence may influence reported overall mortality trends. These findings were supported by assessment of mortality to incidence ratio trends.

Conclusions:

Missing data and rising incidence may contribute substantially to the “treatment disconnect” phenomenon when examining mortality rates in RCC using tumor registry data. Caution is advised when basing clinical and policy decisions on these data.
Knowledge as a Predictor of Insurance Coverage Under the Affordable Care Act
Authors: Hoerl Maximiliane , Wuppermann Amelie , Barcellos Silvia H. , Bauhoff Sebastian , Winter Joachim K. , Carman Katherine G.
Published: November 2016

Background:

The Affordable Care Act established policy mechanisms to increase health insurance coverage in the United States. While insurance coverage has increased, 10%–15% of the US population remains uninsured.

Objectives:

To assess whether health insurance literacy and financial literacy predict being uninsured, covered by Medicaid, or covered by Marketplace insurance, holding demographic characteristics, attitudes toward risk, and political affiliation constant.

Research Design:

Analysis of longitudinal data from fall 2013 and spring 2015 including financial and health insurance literacy and key covariates collected in 2013.

Subjects:

A total of 2742 US residents ages 18–64, 525 uninsured in fall 2013, participating in the RAND American Life Panel, a nationally representative internet panel.

Measures:

Self-reported health insurance status and type as of spring 2015.

Results:

Among the uninsured in 2013, higher financial and health insurance literacy were associated with greater probability of being insured in 2015. For a typical uninsured individual in 2013, the probability of being insured in 2015 was 8.3 percentage points higher with high compared with low financial literacy, and 9.2 percentage points higher with high compared with low health insurance literacy. For the general population, those with high financial and health insurance literacy were more likely to obtain insurance through Medicaid or the Marketplaces compared with being uninsured. The magnitude of coefficients for these predictors was similar to that of commonly used demographic covariates.

Conclusions:

A lack of understanding about health insurance concepts and financial illiteracy predict who remains uninsured. Outreach and consumer-education programs should consider these characteristics.
The role of sinus surgery in sleep outcomes
Authors: Alt Jeremiah A. , Orb Quinn , Orlandi Richard R.
Published: November 2016

Purpose of review

Poor sleep is associated with reduced health, increased morbidity, and increased mortality.

Recent findings

Chronic rhinosinusitis (CRS) is one of the most prevalent chronic diseases in the United States, affecting up to 16% of the U.S. population. It has been linked to poor sleep with up to 75% of patients with CRS reporting reduced sleep. Yet there has been little examining the improvement in sleep following surgical treatment of patients with CRS.

In this review, we examine the current knowledge on the association between sleep and CRS as well as review the current data examining the role of sinus surgery. After a structured literature search, we conclude that an evolving body of research demonstrates that sleep is compromised in the majority of patients with CRS. Following surgical treatment of CRS, there is a significant improvement in reported sleep quality that is correlated with subsequent improvement in disease-specific quality of life. Furthermore, we acknowledge that additional research characterizing both objective and subjective measures of sleep following surgical treatment is still needed. Additional investigation is required to better elucidate the underlying pathophysiology of the relationship between sleep dysfunction and CRS.
Impact of Breast Milk, Respiratory Insufficiency, and Gastroesophageal Reflux Disease on Enteral Feeding in Infants With Omphalocele
Authors: Haug Shelly , St. Peter Shawn , Ramlogan Sandhya , Goff Donna , Thorpe Donna , Hopper Andrew , Baerg Joanne
Published: November 2016

Objectives:

The aim of this study was to document the process of achieving full enteral feeding in infants with omphalocele and to identify factors that affect feeding success.

Methods:

After institutional review board approval (study no. 5100169), 123 infants with omphalocele, born between 1993 and 2011 were reviewed. Mortalities were excluded. All survivors had complete follow‐up. Variables suspected to impact enteral feeding in infants with non‐giant versus giant omphalocele were compared. Independent t test, Mann‐Whitney, and χ2 test were used. Regression evaluated for variable independence.

Results:

Of 123 infants with omphalocele, 97 (79%) survived, 62/97 (64%) had non‐giant, and 35/97 (36%) giant omphalocele. For survivors, the mean gestational age was 37 ± 4 weeks with median follow‐up of 4.4 years (range: 1.4–7.4 years). The median time to full feeds was 4 days (range: 0–85 days) for non‐giant versus 8 days (range: 1–96 days) for giant, a significant difference (P < 0.01). Breast milk significantly decreased time to full feeds independent of omphalocele size. Giant omphalocele infants had a significantly higher incidence of respiratory insufficiency at birth (P < 0.01) and sac rupture (P = 0.02), but fewer chromosomal anomalies (P = 0.04). Respiratory insufficiency at birth (P < 0.01) and gastroesophageal reflux disease (P < 0.01) independently delayed feeding in omphalocele infants.

Conclusions:

Infants with non‐giant omphalocele can achieve full enteral feeds within the first week of life, but giant omphalocele infants require significantly more time. Breast milk independently promotes feeding success whereas gastroesophageal reflux disease and respiratory insufficiency at birth independently delay feeding in infants with omphalocele.
Paraneoplastic Galactorrhea in Childhood T-ALL: An Evaluation of Tumor-derived Prolactin
Authors: Grimes Allison , Mirkheshti Nooshin , Chatterjee Bandana , Tomlinson Gail , Assanasen Chatchawin
Published: November 2016

T-cell acute lymphoblastic leukemia (T-ALL) comprises 15% of childhood leukemia. Although multiagent pulse chemotherapy has improved event-free survival in recent decades, the lack of reliable prognosticators and high rate of relapse remain a challenge. Described is a novel discovery of tumor-derived hyperprolactinemia in childhood T-ALL through a case associated with paraneoplastic galactorrhea. Prolactin production by tumor cells, although a rare phenomenon, is previously demonstrated in several adult cancers and 2 pediatric malignancies with unknown implications. This is the first report demonstrating tumor-derived prolactin in pediatric T-ALL and offers potential as a disease marker and therapeutic drug target.
Breast Metastases in Children and Adolescents With Rhabdomyosarcoma: A Large Single-Institution Experience and Literature Review
Authors: Kebudi Rejin , Koc Begum S. , Gorgun Omer , Celik Alaaddin , Kebudi Abut , Darendeliler Emin
Published: November 2016

Introduction:

Breast metastasis is rare in childhood malignancies. Soft tissue sarcomas, especially rhabdomyosarcomas (RMS), and hematologic neoplasms, such as lymphomas, are the most common tumors that metastasize to the breast, albeit rare.

Materials and Methods:

All cases with breast metastasis within a cohort of 200 RMS patients followed in our institution during 1990 to 2014 were assessed retrospectively and the literature was reviewed.

Results:

There were 3 adolescent female patients with breast metastasis. All had alveolar histology. The primary tumors were in the parameningeal sites, extremities, and the perineum, respectively. Two patients had breast metastasis at diagnosis, and 1 during follow-up. In 1 breast lesion, there was a complete response to chemotherapy, and in another there was no response to chemotherapy, and the patient underwent radical mastectomy. In the third patient, there was partial response, and lesions progressed. All patients died with recurrent/progressive disease, 2 with no recurrence in the breast. In the English literature, there are 70 cases including our cases. All but 1 involve female patients, all adolescents, most have alveolar histology and poor prognosis. All had chemotherapy, whereas some had surgery and/or radiotherapy for local treatment.

Conclusion:

Breast metastasis should be considered in adolescent female patients with RMS. Optimal management is not clear. Besides chemotherapy, mastectomy and radiotherapy should be considered on a case basis.
Favorable Response to Sirolimus in a Child With Blue Rubber Bleb Nevus Syndrome in the Gastrointestinal Tract
Authors: Ünlüsoy Aksu Aysel , Sari Sinan , Eğritaş Gürkan Ödül , Dalgiç Buket
Published: November 2016

Recently, sirolimus was demonstrated to be effective in treating vascular lesions and lessening the frequency of bleeding and secondary iron deficiency anemia. We present a child with blue rubber bleb nevus syndrome who had prolonged history of iron deficiency anemia secondary to unrecognized gastrointestinal bleeding. Treatment with propranolol, omeprazole and iron had failed. After 2.5 months of sirolimus therapy (trough levels 1 to 5 ng/mL), his hemoglobin concentration improved into the normal range and remained stable. Vascular malformations on both the patient’s tongue and in the fundus of his stomach shrank within 5 months of the initiation of sirolimus. In gastrointestinal involvement of blue rubber bleb nevus syndrome sirolimus was found to be effective even in the tongue’s vascular lesions.
Decrease of Cardiac Base Rotation in 2D Speckle Tracking Indicates Drug-induced Cardiomyopathy After Chemotherapy in Children With Cancer
Authors: Yanagimoto Kosuke , Okamoto Yasuhiro , Kodama Yuichi , Nishikawa Takuro , Tanabe Takayuki , Kawano Yoshifumi
Published: November 2016

Drug-induced cardiomyopathy can be life-threatening in patients with cancer. Our objective was to explore early detection of drug-induced cardiomyopathy in children with cancer. We enrolled pediatric outpatients diagnosed with cancer between 2012 and 2013. In addition, we recruited pediatric outpatients in good general condition without cardiac disease or cancer, as controls. We measured the serum levels of biomarkers and performed chest radiography, electrocardiography, and ultrasound cardiography (UCG). We analyzed left ventricular (LV) torsion and torsion-related parameters using 2-dimensional (2D) speckle tracking on UCG. In total, 35 pediatric patients were enrolled. All patients showed negative findings for plasma troponin T, radiography, and electrocardiography. During 2D speckle tracking, 9 patients were excluded due to inappropriate dynamic echo images. We compared UCG findings between 26 patients and 16 controls. Although there was no difference in ejection fraction between patients and controls, peak LV torsion tended to be lower in patients than in controls, and the absolute basal rotation value at the timing of peak LV torsion was significantly lower in patients than in controls. In conclusion, a decrease of basal rotation in 2D speckle tracking might indicate the initial changes leading to myocardial disorder after chemotherapy.
Identification of High-risk Cryptic CRLF2 Rearrangements in B-Cell Acute Lymphoblastic Leukemia Utilizing an FGFR3/IGH Dual-Color Dual-Fusion DNA Probe Set
Authors: Robin Adam J. , Peterson Jess F. , Grignon John W. , Gheorghe Gabriela , Burke Michael J. , vanTuinen Peter
Published: November 2016

B-cell acute lymphoblastic leukemia (B-ALL) is the most common childhood malignancy with gene rearrangements involving the IGH locus occurring in ∼5% of cases. Fluorescence in situ hybridization (FISH) probes targeting the IGH locus are not included in the standard children’s oncology group (COG) fluorescence in situ hybridization panel. At our institute, we incorporated the use of FGFR3/IGH dual-color dual-fusion DNA probes for confirmation of aneuploidy 4 and 14 in diagnostic B-ALL specimens. Subsequently we have identified 4 B-ALL cases with cryptic CRLF2-IGH translocations that would otherwise have gone undetected. Detection of genetic alterations in B-ALL, such as CRLF2 rearrangements, may enhance patient risk stratification and therapy options in pediatric B-ALL.
Comparison of Clinical Features and Outcomes in Patients With Bilateral Versus Unilateral Adrenal Neuroblastoma
Authors: Dinh Tu , Truong Bao , Matthay Katherine K. , DuBois Steven G.
Published: November 2016

Background:

While nearly half of cases of neuroblastoma arise in one of the adrenal glands, bilateral origin is rare. We aimed to compare clinical characteristics and outcomes between patients with bilateral versus unilateral adrenal neuroblastoma.

Procedure:

We utilized the Surveillance, Epidemiology, and End Results database to identify patients with bilateral and unilateral adrenal neuroblastoma from 1973 to 2012. We used Fisher exact tests to compare demographics and clinical features between groups. We used Kaplan-Meier methods to describe the 5-year overall survival rate for these 2 groups. We conducted a literature review to complement the Surveillance, Epidemiology, and End Results data.

Results:

Of 1617 patients in the cohort, 1585 (98%) had unilateral disease and 32 (2%) had bilateral disease. Compared with patients with unilateral disease, a significantly greater proportion of patients with bilateral disease was below 1 year of age (53.1% vs. 31.8%; P=0.01) and had distant metastasis at diagnosis (90.6% vs. 69.0%; P=0.006). The 5-year overall survival rate for patients diagnosed with bilateral disease was 70.5% (95% confidence interval, 45.1%-85.8%), compared with 62.4% (95% confidence interval, 59.7%-65%) for patients with unilateral disease (P=0.26).

Conclusions:

Compared with patients with unilateral disease, patients with bilateral adrenal neuroblastoma are younger, more likely to have distant metastasis, and have a favorable outcome.
Prolonged Isotretinoin in Ultra High-Risk Neuroblastoma
Authors: Cash Thomas , Alazraki Adina , Qayed Muna , Katzenstein Howard M.
Published: November 2016

Patients with high-risk neuroblastoma remain a therapeutic challenge with significant numbers of patients failing to respond sufficiently to initial therapy. These patients with poor response to induction are considered as ultra high-risk and are in need of novel treatment strategies. Isotretinoin is part of the standard of care treatment for patients with high-risk disease who undergo high-dose chemotherapy with autologous stem cell rescue although some have questioned the optimal administration schedule. Prolonged use of isotretinoin was well tolerated and may have contributed to long-term survival in a group of patients with ultra high-risk neuroblastoma.
Successful Treatment of a Complex Vascular Malformation With Sirolimus and Surgical Resection
Authors: Goldenberg Dov C. , Carvas Marcelo , Adams Denise , Giannotti Marcelo , Gemperli Rolf
Published: November 2016

Management of complex vascular malformation represents a challenge as it may include a wide variety of options such as embolization, laser therapy, sclerotherapy, and surgical resection but may lead to significant morbidity and is associated with high recurrence rates. In extreme and/or recurrent cases, successful use of sirolimus has been described. We report a case of large unresectable complex venous malformation treated with oral sirolimus for 24 months. Therapy was well tolerated. Patient had substantial improvement in symptoms and shrinkage of the lesion. The Medical Therapy made excision of the malformation possible and patient had a successful surgical procedure. This report provides further evidence that sirolimus should be considered as part of the armamentarium in the management of these rare conditions.
The Effects of Mind Subtraction Meditation on Breast Cancer Survivors’ Psychological and Spiritual Well-being and Sleep Quality
Authors: Yun Mi Ra , Song Misoon , Jung Kyung-Hae , Yu Boas J. , Lee Kyung Jae
Published: November 2016

Background:

Most breast cancer survivors experience psychological and spiritual distress, including depression, anxiety, perceived stress, and loss of meaningfulness in life. This distress can negatively impact physical health, quality of life, and quality of sleep.

Objective:

The aim of this study was to compare and examine the effectiveness of mind subtraction meditation (MSM) and a self-management education (SME) group on breast cancer survivors.

Methods:

A randomized controlled trial was conducted with South Korean female breast cancer survivors (stages I-III). Self-reported questionnaires were administered to both MSM group (n = 22) and SME group (n = 24) to measure psychological and spiritual well-being, as well as quality of sleep.

Results:

Compared with the SME group, the MSM group reported a significant decrease in depression (P = .034), anxiety (P = .036), and perceived stress (P = .009) and an increase in quality of life (P < .001), satisfaction with life (P < .001), posttraumatic growth (P = .007), and quality of sleep (P = .010).

Conclusions:

Mind subtraction meditation may have positive therapeutic effects among breast cancer survivors. This meditation program may be useful to manage psychological and spiritual distress, as well as improve quality of life and sleep, in clinical settings among breast cancer survivors.

Implications for Practice:

This study demonstrated the clinical effectiveness and the feasibility of applying the MSM method to breast cancer survivors. The participants had a high attendance rate in the program, which speaks to the likelihood of the applicability of the meditation program on an outpatient basis.
Sudden Cardiac Death
Authors: Ifteni Petru , Barabas Barna , Gavris Claudia , Moga Marius , Burtea Victoria , Dracea Laura
Published: November 2016

Background

Sudden cardiac death (SCD) is a sudden unexpected event, from a cardiac cause, that occurs in less than 1 hour after the symptom onset in a person without any previous condition that would seem fatal or who was seen without any symptoms 24 hours before being found dead.

Objective

The aims of the study were to describe the features of SCD in Brasov County, Romania (400,000 inhabitants) according to local forensic department autopsy files.

Methods

We retrospectively chart reviewed a number of 7200 autopsy reports between 2001 and 2015 to identify cases of SCD. Data included cause of death, demographics, location of the event, prior known illnesses, as well as psychiatric comorbidities.

Results

Of 7200 autopsies effectuated during the 15-year period, we excluded 276 cases with incomplete data. The rest of the 6924 cases included 3000 autopsies (43.3%) of individuals with a violent death: accidents, suicides, and homicides. In 3924 cases (56.7%), the death was nonviolent. Of 3924 nonviolent deaths, based on the registry of Forensic department, we identified 1085 cases of SCD (749 males [69%]; mean age, 56 ± 17.4 years).

Conclusion

Sudden death with a cardiac etiology remained a major cause of unexpected end of life in the vast majority of cases autopsied during the study period.
Hydrophilic Polymer–associated Ischemic Enterocolitis
Authors: Chavez Jesus A. , Chen Wei , Frankel Wendy L. , Arnold Christina A.
Published: November 2016

Hydrophilic polymer coating of medical devices serves to lubricate the device and prevent device-related complications. The coating can be mechanically disrupted and result in downstream injury via presumed thromboembolism. This process has been reported in the brain, heart, lung, and skin, and has been replicated through animal studies and in vitro histologic processing of the polymer coating. We report the first description of hydrophilic polymer–associated ischemic enterocolitis in a series of 7 specimens (small bowel=2, colon=4, aortic thrombus=1) from 3 patients. We report a 4% incidence among all patients with an ischemic bowel resection between April 29, 2014 and August 8, 2016. All patients developed bowel ischemia within 1 day of aortic repair, and all bowel resection specimens showed polymers, mainly in the submucosal vessels in areas of extensive ischemia. The polymers appeared as basophilic, intravascular, serpiginous structures. In a patient who developed acute paralysis after the aortic repair, identical polymers were identified in the aortic thrombus and the ischemic bowel segment. We demonstrate that the polymers display an altered morphology over time and with various graft types, and that the degrading polymers are associated with a foreign body giant cell reaction. Special stains can aid in diagnosis, with the polymers turquoise on a colloidal iron stain, pink on von Kossa and mucicarmine stains, and pale blue on trichrome. Clinical follow-up was available up to 115 weeks: 1 patient died, and 2 are alive and well. In summary, we report a new diagnostic entity to be considered in the differential diagnosis of iatrogenic ischemic injuries in the gastrointestinal tract. Awareness of this entity is important to elucidate the cause of ischemia and to prevent misdiagnosis of the polymers and their associated giant cell reaction as a parasitic infection, granulomatous vasculitis, sarcoidosis, and idiopathic inflammatory bowel disease.
Atypical Notochordal Cell Tumors
Authors: Carter Jodi M. , Wenger Doris E. , Rose Peter S. , Inwards Carrie Y.
Published: November 2016

By the current WHO classification, benign notochordal cell tumor (BNCT) and chordoma comprise the entire spectrum of notochordal-derived tumors. They have defined radiologic and histologic criteria, and differ considerably in management and clinical outcome. Chordomas are malignant tumors; they show progressive, destructive growth and have the capacity for metastasis. In contrast, BNCT are benign and show limited intraosseous growth. Patients with BNCT can be managed with serial imaging or conservative excision, whereas patients with spinal/sacral chordomas typically undergo radical en bloc resection often with adjuvant therapy and significant morbidity. As such, the distinction between BNCT and chordoma is critically important. We have seen 4 unusual notochordal tumors with radiologic and/or histologic features that defy classification as either BNCT or chordoma. Cases occurred in 4 adults (53 to 83 y), and involved the lumbar spine (N=2) and sacrum (N=2). Three cases had subtle radiologic features of cortical permeation with minimal soft tissue extension. All 4 cases had the characteristic histologic features of BNCT; however, 2 cases also had focal myxoid change. Three patients were followed with serial imaging (follow-up range, 26 to 120 mo); 2 showed no disease progression and 1 had a 10-year cumulative interval growth of 3.7 mm. One patient underwent sacrectomy. The tumor was examined in toto and had the characteristic histologic features of BNCT, with the exception of minimal soft tissue extension. On the basis of these observations, we propose a provisional designation of atypical notochordal cell tumors (ANCT) be used for the subset of notochordal-derived tumors that fail to fulfill current diagnostic criteria for either BNCT or chordoma. We would argue that designating these atypical notochordal tumors as chordoma precipitates potentially overly aggressive surgical management. Patients with ANCT may be better managed by close observation and serial imaging. Additional studies with more cases and longer clinical follow-up should clarify the relationship of ANCT to BNCT and chordoma.
Lyme neuroborreliosis
Authors: Koedel Uwe , Pfister Hans-Walter
Published: November 2016

Purpose of review

Lyme disease is a multistage and multisystem disease. Neurological manifestations [termed Lyme neuroborreliosis (LNB)] occur in about 10% of patients with Lyme disease. Diagnostics and treatment of early and late LNB are widely established. However, the management of persistent symptoms is still fraught with controversies, and therefore is the focus of this review.

Recent findings

The incidence of Lyme disease seems to be much higher than previously assumed. Laboratory methods (namely serological tests) are essential for diagnosing LNB, but only when performed according to the guidelines of scientific medical societies. Most patients treated for LNB have good outcomes. However, some patients remain with nonspecific symptoms despite conventional therapy, a syndrome called posttreatment Lyme disease syndrome (PTLDS). IDSA has provided a formal definition of PTLDS, but its pathogenesis and even its existence remains to be clarified. Of note, there is evidence that these patients do not suffer from persistent Borrelia burgdorferi infection and do not benefit from additional antibiotic therapy.

Acute and late LNB are well established disorders. The existence of PTLDS as a disease entity is still unclear and needs further investigation. Unorthodox alternative therapies advertised to patients with Lyme disease on the Internet are not proven to be effective and well tolerated.
The Potential Value of β-Amyloid Imaging for the Diagnosis and Management of Dementia
Authors: Zhong Yue , Karlawish Jason , Johnson Meridith K. , Neumann Peter J. , Cohen Joshua T.
Published: November 2016

We assessed the potential influence of β-amyloid imaging on clinician diagnoses and management of patients with memory loss. We surveyed 315 clinicians, assigning each a vignette describing a hypothetical patient with symptoms of unexplained mild cognitive impairment, possible Alzheimer disease (AD), or young-onset dementia. Vignettes reported “positive,” “negative,” or no β-amyloid imaging information. We assessed imaging’s influence on diagnosis (AD contribution to symptoms), diagnostic confidence, and patient management. Compared with clinicians receiving no imaging, clinicians given positive imaging results more often attributed symptoms to AD [odds ratio (OR)=5.91; 95% confidence interval (CI), 1.25-27.97]; clinicians given negative imaging were less likely (OR=0.10; 95% CI, 0.04-0.21). Clinicians identifying AD as contributing to symptoms more often recommended acetylcholinesterase inhibitor (AChEI) (OR=18.59; 95% CI, 6.86-50.36) and N-methyl-d-aspartate receptor antagonists (OR=3.63; 95% CI, 1.78-7.39). We found that negative imaging reduced AChEI recommendations. Positive imaging reduced recommendation of β-amyloid imaging for future patients. In conclusion, β-amyloid imaging can influence diagnosis, prescriptions, and patient management.