bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Outcomes of Patients With Unresectable Cholangiocarcinoma Treated With Proton Beam Therapy
Authors: Hung Sheng-Ping , Huang Bing-Shen , Hsieh Cheng-En , Lee Ching-Hsin , Tsang Ngan-Ming , Chang Joseph Tung-Chieh , Chen Jen-Shi , Chou Wen-Chi , Tseng Jeng-Hwei , Hong Ji-Hong
Published: November 2019

Objective:

To investigate the clinical outcomes and failure patterns of patients with unresectable cholangiocarcinoma (CC) who had been treated with proton beam therapy (PBT).

Methods:

The authors retrospectively examined 30 patients with unresectable CC who had undergone PBT between November 2015 and December 2017. Survival curves were plotted with the Kaplan-Meier method. Independent predictors of survival were identified by multivariate Cox proportional hazard regression analyses. Complications were assessed using the Common Terminology Criteria for Adverse Events v4.0.

Results:

The median tumor size was 7 cm. Seventeen patients (56.7%) had regional lymph node metastases. The median radiation dose was 72.6 cobalt gray equivalents, and 23 patients (76.7%) received concurrent chemotherapy. The 1-year local control, regional control, and distant metastases-free rates were 88%, 86%, and 68%, respectively. The median overall survival and progression-free survival were 19.3 and 10.4 months, respectively. The median jaundice-free survival was 13 months, with a 1-year biliary tract infection (BTI)-free rate of 58%. Patients who received concurrent chemotherapy had a better median progression-free survival (12.1 vs. 4.7 mo). The most common form of acute toxicity from PBT was acute skin reactions which were rarely severe (grade III: 7% of patients). Three and 2 patients had grade III-IV toxicities and radiation-induced liver disease. There were no deaths caused by PBT or concurrent chemotherapy.

Conclusions:

PBT is clinically useful in patients with unresectable CC, even in the presence of large tumors or regional nodal metastases. Its use may induce durable symptom relief, without increasing acute or late toxicity.
An Epidemiological Study of Chinese Children with Developmental Dyslexia
Authors: Cai Lei , Chen Yuxia , Hu Xiaoyun , Guo Yangfeng , Zhao Xiaoli , Sun Tao , Wu Yujia , Li Xiuhong
Published: November 2019

Objective:

The epidemiological studies of Chinese developmental dyslexia (DD) in China are still limited. The current study aimed to investigate the prevalence rate, risk factors, and psychiatric comorbidities of Chinese DD in Guangzhou, a city in South China.

Method:

A total of 1661 students from second to fifth grades were recruited. The dyslexic students were identified by evaluating learning disability through the Pupil Rating Scale–Revised Screening for Learning Disability (PRS) scale by the head teachers and word recognition through the standard test. Students with a PRS score of <65 received the Raven’s test, and those with intelligence quotient scores below 80 in the Raven’s test were excluded. Psychiatric comorbidities were assessed by the Strength and Difficulties Questionnaire completed by parents.

Results:

The prevalence rate of Chinese DD was 4.9% in Guangzhou city. There were significant differences in gender, the paternal educational level, and reading experience before the age of 6 years between the DD group and the non-DD group. Male gender (odds ratio [OR] = 4.17), low paternal educational level (p = 0.045), and lack of reading experience before the age of 6 years (OR = 1.99) were the risk factors for DD. The DD cases had a higher risk of hyperactivity and inattention (OR = 3.21).

Conclusion:

This study showed that the prevalence rate of DD was 4.9% in Guangzhou city. Male gender, low paternal educational level, and lack of reading experience before the age of 6 years were the risk factors for Chinese DD. The high comorbidity rate of hyperactivity and inattention in the Chinese DD population needs further evaluation.
Trends in Cancer Incidence Among American Indians and Alaska Natives and Non-Hispanic Whites in the United States, 1999–2015
Authors: Gopalani Sameer V. , Janitz Amanda E. , Martinez Sydney A. , Gutman Pamela , Khan Sohail , Campbell Janis E.
Published: November 2019

Background:

Female breast, prostate, lung, and colorectal cancers are the leading incident cancers among American Indian and Alaska Native (AI/AN) and non-Hispanic White (NHW) persons in the United States. To understand racial differences, we assessed incidence rates, analyzed trends, and examined geographic variation in incidence by Indian Health Service regions.

Methods:

To assess differences in incidence, we used age-adjusted incidence rates to calculate rate ratios (RRs) and 95% confidence intervals (CIs). Using joinpoint regression, we analyzed incidence trends over time for the four leading cancers from 1999 to 2015.

Results:

For all four cancers, overall and age-specific incidence rates were lower among AI/ANs than NHWs. By Indian Health Service regions, incidence rates for lung cancer were higher among AI/ANs than NHWs in Alaska (RR: 1.46; 95% CI: 1.37, 1.56) and Northern (RR: 1.29; 95% CI: 1.25, 1.33) and Southern (RR: 1.06; 95% CI: 1.03, 1.09) Plains. Similarly, colorectal cancer incidence rates were higher in AI/ANs than NHWs in Alaska (RR: 2.29; 95% CI: 2.14, 2.45) and Northern (RR: 1.04; 95% CI: 1.00, 1.09) and Southern (RR: 1.11; 95% CI: 1.07, 1.15) Plains. Also, AI/AN women in Alaska had a higher incidence rate for breast cancer than NHW women (RR: 1.05; 95% CI: 1.05, 1.20). From 1999 to 2015, incidence rates for all four cancers decreased in NHWs, but only rates for prostate (average annual percent change: –4.70) and colorectal (average annual percent change: –1.80) cancers decreased considerably in AI/ANs.

Conclusion:

Findings from this study highlight the racial and regional differences in cancer incidence.
Long-term Exposure to Neighborhood Deprivation and Intimate Partner Violence Among Women: A UK Birth Cohort Study
Authors: Yakubovich Alexa R. , Heron Jon , Feder Gene , Fraser Abigail , Humphreys David K.
Published: November 2019

Background:

Intimate partner violence is the most common form of violence perpetrated against women. To our knowledge, the effect of neighborhood disadvantage on intimate partner violence against women has never been investigated prospectively outside the United States.

Methods:

We used data from the Avon Longitudinal Study of Parents and Children in the United Kingdom, which followed our target sample, 7,219 women, from birth and their mothers (from pregnancy). At age 21, 2,128 participants self-reported the frequency of experiencing physical, psychological, or sexual intimate partner violence since age 18. Participants’ exposure to neighborhood-level deprivation and family-level socioeconomic characteristics (e.g., income) were measured at 10 time points from baseline (gestation) until children were 18 years old. We estimated the effect of cumulative exposure to greater neighborhood-level deprivation on the risk of experiencing intimate partner violence using marginal structural models with stabilized inverse probability weights, accounting for time-varying confounding by socioeconomic indicators and sample attrition.

Results:

A one-unit increase in cumulative exposure to more severe neighborhood deprivation was associated with a 62% increase in participants’ frequency of experiencing intimate partner violence (95% confidence interval 11%, 237%) and 36% increase in their risk of experiencing any intimate partner violence (95% confidence interval 1%, 85%).

Conclusions:

In our study, cumulative exposure to greater neighborhood deprivation over the first 18 years of life was associated with women’s increased risk of experiencing intimate partner violence in early adulthood. Future studies should test this association across contexts, including underlying mechanisms, and evaluate preventive strategies that target structural disparities.
Preventing Ovarian Cancer in High-risk Women: One Surgery at a Time
Authors: SWANSON CASEY L. , BAKKUM-GAMEZ JAMIE N.
Published: November 2019

Eleven genes have been identified that increase the lifetime risk of developing ovarian cancer. The cumulative cancer risk of ovarian cancer varies with the mutation type and age. Ovarian cancer risk management options include surgical risk reduction with salpingo-oophorectomy and a newer step-wise approach with interval salpingectomy and delayed oophorectomy. Women should be counseled on the pros and cons of hysterectomy in the setting of reducing the risk of other cancers; eliminating the risk of endometrial cancer in Lynch Syndrome, potential risk of serous/serous-like endometrial cancer in BRCA1 carriers, and elimination of progestogen therapy that may increase breast cancer risk.
Diagnostic Reference Levels, Deterministic and Stochastic Risks in Pediatric Interventional Cardiology Procedures
Authors: Rizk Chadia , Fares Georges , Vanhavere Filip , Saliba Zakhia , Farah Jad
Published: November 2019

To establish diagnostic reference levels (DRLs) and investigate deterministic and stochastic risks in pediatric interventional cardiology (IC) procedures. Exposure parameters were retrospectively reviewed for 373 patients treated between May 2016 and November 2018 at a single specialized hospital. Weight specific DRLs were derived for pediatric IC procedures. Additionally, peak skin dose (Dskin,max) was measured using thermoluminescent dosimeters for a sample of 7 diagnostic and 43 therapeutic procedures. Finally, using PCXMC software, organ doses were computed and the risk of exposure-induced cancer death (REID) was estimated using the risk models of the Biological Effects of Ionizing Radiation VII committee. DRLs for ventricular septal defect (VSD) occlusions, lacking in the literature, in terms of air kerma at patient entrance reference point (388 and 629 mGy) and total air kerma-area product (28 and 61 Gycm2) were proposed for patients weight-groups 5 − < 15 kg and 15 − < 30 kg, respectively. The mean (range) Dskin,max was 15 (1–30) mGy and 94 (1–491) mGy for diagnostic and therapeutic procedures, respectively. Meanwhile, VSD occlusion involved the highest organ doses where the lungs, liver, stomach, and breasts mean doses were 57, 37, 6, and 10 mGy, respectively, and the associated REID were 0.5% and 0.3% in female and male patients, respectively. DRLs were proposed for pediatric IC procedures; these will help optimize patient exposure. Dskin,max values were lower than the 2 Gy threshold for skin injuries. Pediatric organ doses and the REID were the highest during VSD occlusion and may be critical for repetitive procedures.
EN-FACE OPTICAL COHERENCE TOMOGRAPHY IN PATIENTS WITH EPIRETINAL MEMBRANE
Authors: Bae Kunho , Choi Jae Hwan , Kim Kyung Tae , Kang Se Woong
Published: November 2019

Purpose:

To evaluate the correlation between en-face optical coherence tomography (OCT) parameters and functional outcomes before and after idiopathic epiretinal membrane (ERM) surgery.

Methods:

This retrospective cohort study involved 80 eyes from 80 patients who underwent surgery for idiopathic ERM. Best-corrected visual acuity, metamorphopsia assessment (M-score), and OCT were assessed before surgery and six months after. The adhesive zone (A-zone) and retinal fold, a novel en-face OCT parameter reflecting inner retinal layer changes, were evaluated. Correlations between the area of A-zone and the number of retinal folds on en-face OCT images and other B-scan OCT parameters were evaluated regarding visual outcomes before and after ERM surgery.

Results:

The defect size of the ellipsoid zone, interdigitation zone, and external limiting membrane were significantly correlated with preoperative and postoperative 6-month best-corrected visual acuity (all P < 0.05). The central foveal thickness, A-zone area, number of marginal retinal folds, and fovea involvement in the A-zone were correlated with the preoperative and postoperative 6-month M-score (all P < 0.05). The A-zone area was significantly associated with the preoperative and postoperative 6-month M-score in a multiple linear regression model (P < 0.001, P = 0.008, respectively), and the number of marginal retinal folds was significantly associated with the preoperative M-score (P < 0.001) and marginally significantly with the postoperative 6-month M-score (P = 0.106).

Conclusion:

The A-zone area and the number of marginal retinal folds were significantly associated with the M-score before and after ERM surgery. These novel en-face OCT parameters can serve as a novel surrogate tool for predicting the functional outcomes in idiopathic ERM.
Brain signatures of threat–safety discrimination in adolescent chronic pain
Authors: Heathcote Lauren C. , Timmers Inge , Kronman Corey A. , Mahmud Farah , Hernandez J. Maya , Bentley Jason , Youssef Andrew M. , Pine Daniel S. , Borsook David , Simons Laura E.
Published: November 2019

Approximately 1.7 million youth suffer from debilitating chronic pain in the US alone, conferring risk of continued pain in adulthood. Aberrations in threat–safety (T–S) discrimination are proposed to contribute to pain chronicity in adults and youth by interacting with pain-related distress. Yet, few studies have examined the neural circuitry underlying T–S discrimination in patients with chronic pain or how T–S discrimination relates to pain-related distress. In this study, 91 adolescents (10-24 years; 78 females) including 30 chronic pain patients with high pain-related distress, 29 chronic pain patients with low pain-related distress, and 32 healthy peers without chronic pain completed a developmentally appropriate T–S learning paradigm. We measured self-reported fear, psychophysiology (skin conductance response), and functional magnetic resonance imaging responses (N = 72 after functional magnetic resonance imaging exclusions). After controlling for age and anxiety symptoms, patients with high pain-related distress showed altered self-reported fear and frontolimbic activity in response to learned threat and safety cues compared with both patients with low pain-related distress and healthy controls. Specifically, adolescent patients with high pain-related distress reported elevated fear and showed elevated limbic (hippocampus and amygdala) activation in response to a learned threat cue (CS+). In addition, they showed decreased frontal (vmPFC) activation and aberrant frontolimbic connectivity in response to a learned safety cue (CS−). Patients with low pain-related distress and healthy controls appeared strikingly similar across brain and behavior. These findings indicate that altered T–S discrimination, mediated by frontolimbic activation and connectivity, may be one mechanism maintaining pain chronicity in adolescents with high levels of pain-related distress.
Graded chronic pain scale revised: mild, bothersome, and high-impact chronic pain
Authors: Von Korff Michael , DeBar Lynn L. , Krebs Erin E. , Kerns Robert D. , Deyo Richard A. , Keefe Francis J.
Published: November 2019

Drawing on advances in chronic pain metrics, a simplified Graded Chronic Pain Scale-Revised was developed to differentiate mild, bothersome, and high-impact chronic pain. Graded Chronic Pain Scale-Revised was validated among adult enrollees of 2 health plans (N = 2021). In this population, the prevalence of chronic pain (pain present most or every day, prior 3 months) was 40.5%: 15.4% with mild chronic pain (lower pain intensity and interference); 10.1% bothersome chronic pain (moderate to severe pain intensity with lower interference with life activities); and 15.0% high-impact chronic pain (sustained pain-related activity limitations). Persons with mild chronic pain vs those without chronic pain showed small differences on 10 health status indicators (unfavorable health perceptions, activity limitations, and receiving long-term opioid therapy), with nonsignificant differences for 7 of 10 indicators. Persons with bothersome vs mild chronic pain differed significantly on 6 of 10 indicators (eg, negative pain coping beliefs, psychological distress, unfavorable health perceptions, and pain-related interference with overall activities). Persons with high-impact chronic pain differed significantly from those with mild chronic pain on all 10 indicators. Persons with high-impact chronic pain, relative to those with bothersome chronic pain, were more likely to have substantial activity limitations (significant differences for 4 of 5 disability indicators) and more often received long-term opioid therapy. Graded Chronic Pain Scale-Revised strongly predicted 5 activity-limitation indicators with area under receiver operating characteristic curve coefficients of 0.76 to 0.89. We conclude that the 5-item Graded Chronic Pain Scale-Revised and its scoring rules provide a brief, simple, and valid method for assessing chronic pain.
Elder Abuse in American Indian Communities: An Integrative Review
Authors: Crowder Jolie , Burnett Camille , Laughon Kathryn , Dreisbach Caitlin
Published: November 2019

Background

American Indian elders have one of the lowest life expectancies in the United States. Disproportionate disease burden, socioeconomic disparities, and higher rates of violence across the lifespan are thought to contribute to higher rates of elder abuse. Elder abuse and higher rates of trauma exposure are linked with adverse outcomes.

Methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines informed the methodology and assessment of the literature on elder abuse among American Indians.

Results

Of the nine studies published in the last 30 years, rates of elder abuse varied by study, location, and tribal affiliation from 4.3% to 45.9%. Large studies with comparison populations found higher rates for American Indians. There was a consensus for three risk factors: substance abuse, mental health problems, and caregiving issues. Importance of tribal norms, the notion of respect conferred to elders, and the concept of acculturation were major culturally relevant themes. Perceived tribal norms and strengths, for example, respect for elders, were at odds with abuse experiences, particularly financial exploitation and neglect. Historical trauma, shame, and fear impacted reporting. There was little consistency in study designs, most were qualitative or mixed methods, samples were small, there was no common measurement tool or time frame for abuse, and there was only one intervention study.

Implications

High rates of abuse suggest healthcare providers should be encouraged to screen and intervene despite the lack of empirical evidence. Providers should not assume that traditional culturally ascribed strengths, such as honor and respect for elders, provide any degree of protection against elder abuse.
A Rehabilitation Framework for Children Living With HIV in South Africa: Reaching Consensus for a Resource-Poor Community
Authors: Maddocks Stacy , Hanass-Hancock Jill , Cobbing Saul , Chetty Verusia
Published: November 2019

Although rehabilitation frameworks for adults living with HIV are developing steadily, interventions to ensure the integration of rehabilitation into the routine care of children living with HIV-related disabilities lags. We sought to explore perceptions of, and gain expert consensus on, a rehabilitation framework for children living with HIV. Experts in HIV pediatric care in South Africa engaged in a Delphi survey, based on findings from a context-specific rehabilitation framework for adults. Consensus was determined by an a priori threshold of 80% agreement and an interquartile range of 1 or lower on criteria to be included as essential or useful in the framework. Experts agreed that enhancing access to patient-centered care through decentralization and training of health care and community care workers in the use of disability screening tools at each point of care needed to be included in the framework. Strengthening multiprofessional team collaboration was also seen as fundamental.
Bending Work Time: Curvilinear Relationship Between Working Time Dimensions and Psychological and Somatic Symptoms
Authors: Tanskanen Jussi
Published: November 2019

Objectives:

Study examines the curvilinear associations of working time dimensions (working hours, time pressure, work schedules, and control of work time and pace) on psychological and somatic symptoms.

Methods:

Representative Finnish Quality-of-Work-Life Surveys conducted in 2003, 2008, and 2013 were restricted to those (N = 11,165) regularly working over 10 h/wk with more than 1-year tenure in their job. Generalized additive models were utilized in analysis.

Results:

Working hours had U-shaped relationships with psychosomatic symptoms, while time pressure had a threshold effect. Work pace control had linear effect. The effects of work time control and work schedules were insignificant. There were interaction effects between working time dimensions.

Conclusions:

Organizations should acknowledge the dynamics of working time dimensions. Notably, time pressure has a hazardous relation to psychosomatic symptoms, but working pace control can buffer the negative effect.
Empowering the novice family nurse practitioner: Promoting readiness to practice through immersion in an innovative educational strategy
Authors: Finneran Janet M. , Kreye Judy M.
Published: November 2019

The demand for primary care providers in the United States is on the rise with projected shortages by the year 2025. The number of primary care nurse practitioners (NPs) is expected to nearly double from 2013 to 2025 in an effort to respond to the growing demand for primary care services both regionally and nationally. Nurse practitioners are key to addressing the current and future shortage of health care providers, especially in primary care. However, novice NPs face a significant challenge when transitioning from the registered nurse role to the advanced practice role, which can affect job satisfaction and retention. The purpose of this project is to assess the implementation of a structured Clinical Transition Program (CTP) embedded within a family NP (FNP) educational program as a learning strategy to strengthen readiness to practice and promote successful role transition in the novice FNP graduate. The CTP includes primary care clinical placements as well as specialty clinical rotations and intentional clinical placements in varied settings, including those in rural and underserved areas. Participation in the program had a positive effect on perceived readiness to practice for students at graduation and 9 months after graduation. Nurse educators, armed with the knowledge of the importance of successful role transition for the new NP, must continue to develop, implement, and assess educational opportunities that promote and support readiness to practice within existing NP programs.
Comparison of Disease-related Knowledge of Patients With Inflammatory Bowel Disease Between the West and the East Using an Updated Questionnaire (IBD-KNOW)
Authors: Kim Jin Yong , Yoon Hyuk , Hwang Jun Seong , Yang Suk-Kyun , Park Sang Hyoung , Loftus Edward V.
Published: November 2019

Goals:

The study aimed to compare the level and characteristics of disease-related knowledge of patients with inflammatory bowel disease (IBD) between the West and the East using an international version of a questionnaire regarding knowledge of inflammatory bowel disease (IBD-KNOW).

Background:

The authors recently developed a new questionnaire regarding IBD-KNOW, which showed excellent test characteristics in Korea.

Study:

The IBD-KNOW questionnaire was administered to 100 patients with IBD from tertiary referral hospitals in the United States and Korea. Scores were calculated and compared between US and Korean patients, and factors associated with high scores were analyzed.

Results:

A total of 196 (100 US and 96 Korean) patients with IBD completed the questionnaires. Analysis of the baseline characteristics revealed that male sex, smoking status, disease duration, history of IBD-related operations, family history of IBD, and use of corticosteroids or biologics were significantly different between US and Korean patients. The mean IBD-KNOW score was higher in US patients than in Korean patients (14.8 vs. 11.3; P<0.001). Multivariate analyses showed that a high IBD-KNOW score (top 25%) was associated with a positive family history of IBD (odds ratio, 2.90; P=0.025) in US patients with IBD and with the use of biologics (odds ratio, 3.65; P=0.008) in Korean patients with IBD.

Conclusions:

The IBD-KNOW questionnaire, an updated assessment tool of IBD-related knowledge, is simple, reliable, and available in various patient populations. IBD-KNOW can be used to identify the factors affecting the level of IBD-related knowledge to improve the quality of care in patients with IBD through a personalized approach.
Effectiveness comparisons of acupuncture for diabetic nephropathy proteinuria
Authors: Miao Yao-Dong , Gu Wen-Yuan , Liu Zhi-Qiang , Ma Yun-Tao , Deng Sheng
Published: November 2019

Introduction:

Diabetic nephropathy (DN) is one of the microvascular complications of diabetes (DM). Proteinuria is the most important clinical feature of DN and an independent risk factor for the progression of DN. Therefore, reducing urinary protein is the primary goal of DN treatment. Acupuncture has long been widely used in the treatment of DN. Therefore, this paper conducted a meta-analysis of the clinical efficacy of acupuncture in the treatment of DN proteinuria, in order to comprehensively analyze the role of acupuncture in the treatment of DN.

Methods and analysis:

We will search for PubMed, Cochrane Library, AMED, EMbase, WorldSciNet; Nature, Science online and China Journal Full-text Database (CNKI), China Biomedical Literature CD-ROM Database (CBM), and related randomized controlled trials included in the China Resources Database. The time is limited from the construction of the library to September 2019.We will use the criteria provided by Cochrane 5.1.0 for quality assessment and risk assessment of the included studies, and use the Revman 5.3 and Stata13.0 software for meta-analysis of the effectiveness, recurrence rate, and symptom scores of DN proteinuria.

Ethics and dissemination:

This systematic review will evaluate the efficacy and safety of acupuncture for DN proteinuria. Because all of the data used in this systematic review and meta-analysis has been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process Trial.

Trial registration number: PROSPERO CRD42019139705
Undetectable proviral deoxyribonucleic acid in an adolescent perinatally infected with human immunodeficiency virus-1C and on long-term antiretroviral therapy resulted in viral rebound following antiretroviral therapy termination
Authors: Koofhethile Catherine Kegakilwe , Moyo Sikhulile , Kotokwe Kenanao Peggy , Mokgethi Patrick , Muchoba Lorato , Mokgweetsi Selebogo , Gaolathe Tendani , Makhema Joseph , Shapiro Roger , Lockman Shahin , Kanki Phyllis , Essex M. , Gaseitsiwe Simani , de Oliveira Tulio , Novitsky Vladimir
Published: November 2019

Rationale:

Early initiation of antiretroviral therapy (ART) leads to long-term viral suppression, reduces proviral reservoir size, and prolongs time to rebound. Since human immunodeficiency virus (HIV) is a lifelong disease, diagnostic monitoring after confirmed infection is typically not performed; therefore, little is known about the impact of early initiation and long-term ART on the sensitivity of assays that detect HIV antibodies and viral nucleic acid in children and adolescents.

Patient concerns:

Here we report 1 case of diagnosed and confirmed perinatal HIV-1C infection with longstanding viral suppression, who subsequently had a negative HIV-1 deoxyribonucleic acid (DNA) test, undetectable antibodies to HIV-1, and high CD4+ T cell count after 14 years of ART.

Diagnosis:

The patient was diagnosed with HIV in 2002 at 1 and 2 months of age using DNA polymerase chain reaction. At 8 months old, his viral load was 1210 HIV ribonucleic acid (RNA) copies/mL and CD4 T cell count was 3768 cells/mm3.

Intervention:

At the age of 9 months, highly active antiretroviral therapy comprising of zidovudine, nevirapine, and lamivudine was initiated. The patient remained on this treatment for 14 years 11 months and was virally suppressed.

Outcomes:

At the age of 14 years 4 months, the participant decided to visit a local voluntary HIV testing center, where a rapid HIV test came out negative and the viral load was undetectable (<400 HIV-1 RNA copies/mL). These results led to termination of ART which led to viral rebound within 9 months.

Lessons:

As more people with early HIV infection initiate early ART in the context of “Test and Treat all” recommendations, aspects of this report may become more commonplace, with both clinical and public health implications. If the possibility of functional cure (or false-positive diagnosis) is being considered, decisions to terminate ART should be made cautiously and with expert guidance, and may benefit from highly sensitive quantification of the proviral reservoir.
Chromosomal copy number variations in products of conception from spontaneous abortion by next-generation sequencing technology
Authors: Dai Rulin , Xi Qi , Wang Ruixue , Zhang Hongguo , Jiang Yuting , Li Leilei , Liu Ruizhi
Published: November 2019

Fetal chromosomal abnormalities are considered to be the main cause of spontaneous abortion (SA). We aimed to determine the differences in the rates and numbers of chromosomal abnormalities between samples from women with a history of one versus more than one SA as well as between samples from first- and second-trimester SAs in women from Northeast China.

In total, 1210 products of conception (POCs) from patients with a history of one or more SAs were examined. Of these 1210 samples, 434 were from women with a history of 1 SA, and 776 were from women with a history of more than 1 SA. Additionally, 1071 samples were from the first trimester, 118 were from the second trimester, and 21 were from the third trimester. We identified chromosomal abnormalities by next-generation sequencing (NGS) technology. Among the 1210 POCs in women with SA, 607 (50.17%) had fetal chromosomal abnormalities. There were no significant differences in the rates of chromosomal abnormalities according to the abortion frequency. However, first-trimester SA had a significantly higher percentage of fetal chromosomal abnormalities than second-trimester SA (P < .05). Among 663 chromosomal abnormalities, 633 abnormalities occurred in first-trimester SA; the most frequent karyotype was trisomy 16 (14.38%), followed by monosomy X (13.27%), trisomy 22 (7.90%), and trisomy 15 (5.37%). Thirty abnormalities occurred in second-trimester SA; the most frequent karyotype was trisomy 18 (26.67%), followed by monosomy X (16.67%), trisomy 21 (13.33%), and trisomy 13 (10.00%). No chromosomal abnormalities occurred in the third trimester.

These findings indicate the importance of determining the genetic cause of abortion in patients with a history of SA. We also identified a trend suggesting that the percentage of fetal chromosomal abnormalities is significantly higher in first- than second-trimester SA. The detection rate of chromosomal abnormalities in POCs from SA can be increased by NGS, which is beneficial for couples with recurrent miscarriages and offers better genetic counseling in the clinical setting.
Molecular expression profiles of selected microRNAs in colorectal adenocarcinoma in patients from south-eastern part of Romania
Authors: Brînzan Costel , Aşchie Mariana , Matei Elena , Mitroi Anca , Cozaru Georgeta
Published: November 2019

MicroRNAs (miRNAs) are endogenous, non-coding class of RNAs with functions in the regulation of genes expressions. Dysregulated expressions of miRNAs play important roles in carcinogenesis and cancer progression by targeting various oncogenes and tumor-suppressor genes. miRNAs represent a new field for molecular diagnosis and prognosis of colorectal cancer (CRC) due to their high tissue specificity, their stability, and their dysregulated expression in tumor development.

This study aimed to investigate using the qRT-PCR method the expression profile and prognostic value of 11 mature miRNAs in a cohort of 82 Romanian patients diagnosed with CRC. The relationship between the expression levels of selected miRNAs and clinicopathologic features were evaluated using ANOVA and Pearson test. In addition, the receiver operating characteristic (ROC) and area under the curve (AUC) were used to assess the diagnostic values of the miRNAs to discriminate cancerous from non-cancerous states of the samples.

The expression levels of miR-30c, miR-144, miR-375, miR-214, and miR-195 in CRC tissue were significantly downregulated (all P < .05; Paired T-Test) than that in normal adjacent tissue sample (NATS), while the expression of miR-141, miR-182, miR-183, miR-21, and miR-370 in CRC tissue were significantly upregulated (all P < .001) than that in NATS. Moreover, the expression levels of miR-182, miR-183, miR-141, and miR-21 were demonstrated to be associated with a gradual increase in fold change expression with depth of tumor invasion (all P < .05), lymph node invasion (all P < .001), and maximal increase with distant metastasis (all P < .001). Moreover, the analysis of ROC curves revealed that AUC (95% CI) of miR-182, miR-183, miR-141, and miR-21 in diagnosis of CRC was 0.76 (0.66–0.87), 0.85 (0.78–0.94), 0.77 (0.62–0.92), 0.83 (0.73–0.90), respectively. The univariate and multivariate Cox-proportional hazard regression for all variables revealed that the nodal status, distant metastasis, miR-21, miR-141, miR-182, and miR-183 were independent prognostic markers of CRC.

In conclusion, altered expressions of miR-21, miR-141, miR-182, and miR-183 in CRC varies at different stages of CRC development and may serve as potential diagnosis molecular biomarkers in Romanian patients with CRC. Further investigations are needed to confirm our findings.
Histamine H2 antagonists for functional dyspepsia
Authors: Li Juanjuan , Wang Fengyun , Lv Lin , Xu Lin , Zeng Enjin , Tang Xudong
Published: November 2019

Background:

Functional dyspepsia (FD) is a prevalent gastrointestinal disorder. Histamine H2 antagonists (H2RAs) are the pharmacological treatment option for FD, but no potent evidence has been found for the efficacy of these drugs in the condition. Therefore, this systematic review protocol aims to examine the efficacy and safety of H2RAs in the treatment of FD.

Methods:

We will perform a systematic search in the following electronic databases: the Cochrane Central Register of Controlled Trials (to October 2019), MEDLINE (OvidSP; to October 2019), EMBASE (OvidSP; to October 2019). Only randomized clinical trials (RCTs) comparing any H2RA with placebo for the treatment of FD will be included. The primary outcome will be an improvement in global symptoms of dyspepsia. Study selection, data extraction, and study quality will be performed by 2 independent reviewers. Dichotomous data will be presented as a risk ratio (RR) with 95% confidence intervals (CI), and continuous data as mean difference (MD) or standardized MD (SMD) with 95% CI. RevMan v.5.3 software will be used for all statistical analyses.

Results:

This study will provide a high-quality synthesis to examine the role of H2RAs in FD as reflected by the improvement of global symptoms of dyspepsia, quality of life scores, and adverse events.

Conclusion:

This systematic review will provide updated evidence to judge whether H2RAs are of benefit in FD.
Sclerosing stromal tumor of the ovary in a postmenopausal woman with estrogen excess
Authors: Zhao Zhiyi , Yan Li , Lv Hongtao , Liu Hongtao , Rong Fengnian
Published: November 2019

Rationale:

Sclerosing stromal tumor (SST) of the ovary is rare. We describe the first case of ovarian SST with estrogen excess with both clinical and serological evidence in a postmenopausal woman.

Patient concerns:

A 70-year-old female who referred menopause 14 years ago was admitted with postmenopausal bleeding for 3 months. Ultrasonography revealed thickened endometrium of 6 mm and no adnexal masses. An elevated serum estradiol level of 49.78 ng/L was revealed in laboratory examination with normal ranges less than 27.25 ng/L in postmenopausal women.

Diagnoses:

The final histology diagnosis is SST of left ovary and endometrial hyperplasia with polyps.

Interventions:

Laparoscopic hysterectomy and bilateral salpingo-oophorectomy were performed and a solid tumor with a diameter of 3 cm × 2 cm from the left ovary was found intraoperatively.

Outcomes:

Three days after removal of the tumor, the serum estrogen level was decreased to normal which indicated the estrogen activity of the tumor.

Lessons:

To the best of our knowledge, it is the first reported case of ovarian SST with estrogen excess with both clinical and serological evidence. The present case illustrates the necessity to consider the rare possibility of ovarian SST as a cause for estrogen excess leading to postmenopausal bleeding. Hormonal evaluation (estrogens, androgens) should be considered in women with postmenopausal bleeding regardless of imaging examination.
IL-35 and IL-18 Serum Levels in Children With Acute Lymphoblastic Leukemia: The Relationship With Prognostic Factors
Authors: Solati Hossein , Zareinejad Mohammadrasul , Ghavami Alireza , Ghasemi Zahra , Amirghofran Zahra
Published: November 2019

Acute lymphoblastic leukemia (ALL) is the most common type of cancer among children. In this study, we investigated the serum levels of interleukin (IL)-35 and IL-18 in children with ALL to compare with healthy subjects and find their relationship with prognostic factors and response to therapy. IL-35 and IL-18 serum concentrations in 40 children diagnosed with ALL and 35 age-matched and sex-matched healthy children were measured using ELISA. The association between cytokine levels and patients’ clinical and laboratory data were determined. A significant difference was found in IL-35 serum levels between the patients (3.6±1.5 ng/mL) and controls (2.5±1.8 ng/mL) (P=0.007). No significant difference in IL-18 serum levels between these groups was observed. A positive correlation between IL-35 and IL-18 levels was detected (P=0.001). The authors found that patients with lower platelet count had higher IL-35 concentration (P=0.003). By considering a cut-off value of 6.21 ng/mL (mean±2SD of controls) for IL-35, it was found that white blood cell (WBC) count was higher in patients with IL-35 >6.21 ng/mL (P=0.016), and the majority of these patients had T-ALL (P=0.01). Although the mean overall survival in patients with IL-35 >6.21 ng/mL was shorter (937±381 d) than in those with IL-35 ≤6.21 ng/mL (1567±103 d), but the result was not significant (P=0.1, log-rank test). The IL-18 level was associated with a lower hemoglobin level (P=0.027). These data suggested a role for IL-35 in ALL development. The significant relation of IL-35 to white blood cells and platelet counts may imply a possible influence of IL-35 on ALL prognosis.
Effects of transcutaneous electrical nerve stimulation on physical symptoms in advanced cancer patients receiving palliative care
Authors: Nakano Jiro , Ishii Koji , Fukushima Takuya , Ishii Shun , Ueno Kazumi , Matsuura Emi , Hashizume Kaori , Morishita Satoru , Tanaka Koji , Kusuba Yoko
Published: November 2019

Transcutaneous electrical nerve stimulation (TENS) is primarily used for pain, but might be useful for various other physical symptoms, including nausea, fatigue, dyspnea, and constipation. However, few studies have used TENS for treating the physical symptoms of patients with advanced cancer. In this crossover trial, we assess the effects of TENS on pain and other physical symptoms in 20 in-patients with advanced cancer receiving palliative care. For 5-day phases between wash out periods of 5 days, patients received TENS or non-TENS. TENS was delivered at four points: the center of the back for mainly nausea and dyspnea, on the back at the same dermatomal level as the origin of the pain (100 Hz), and on both ankle joints for constipation (10 Hz). The intensity of pain and the total opioid dose used during phases were recorded. Physical symptoms were evaluated using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 15 Palliative Care (QLQ-C15-PAL). Hematological and biochemical data were recorded before and after the TENS phase. The average pain and total number of opioid rescue doses were significantly reduced by TENS. TENS tended to improve nausea and appetite loss, but not constipation. There were no effects on hematological and biochemical parameters. Use of TENS could safely improve pain, nausea, and appetite loss in patients with advanced cancer. Although it cannot be used as a substitute for opioids and other pharmaceutical treatment, it may be useful to support palliative care.
Thromboprophylaxis an update of current practice
Authors: Ricci William M. , Broekhuyse Henry , Keating John F. , Teague David C. , White Timothy O.
Published: November 2019

Diagnosis, prophylaxis, and management of venous thromboembolism (VTE) in patients with fractures remain a highly controversial topic with little consensus in clinical practice or the literature. The following manuscript represents a summary of evidence presented at the 2017 OTA Annual Meeting Symposium; “Thromboprophylaxis an Update of Current Practice: Can We Reach A Consensus?” The need for prophylaxis in pelvic and acetabular fracture patients; the existing body of evidence related to VTE, pulmonary embolism (PE), and prophylaxis for patients with fractures about the knee; current evidence in Edinburgh Scotland, regarding VTE prophylaxis in patients with isolated ankle fractures and the risk of VTE in patients with a hip fracture are topics that are addressed. The reader will benefit from the wisdom of this compilation of global contributions on thromboprophylaxis.
The Relationship Between Multiple Sclerosis Symptom Severity Measures and Performance on Driving Variability Metrics in a Virtual Reality Simulator
Authors: Raphail Ann-Marie A. , Vickers Kayci L. , Leist Thomas P. , Schultheis Maria T.
Published: November 2019

Objective

Driving ability can be compromised in individuals with multiple sclerosis (MS); however, the progressive nature of multiple sclerosis makes it difficult for clinicians to assess when performance on functional tasks, such as driving, has started to decline. The aim of the study was to evaluate the relationship between two measures of multiple sclerosis severity, the Expanded Disability Status Scale and the Multiple Sclerosis Functional Composite, and minor driving errors in a virtual reality driving simulator.

Design

Symptom severity was measured in 31 active drivers with multiple sclerosis using the Expanded Disability Status Scale and Multiple Sclerosis Functional Composite. Driving performance was measured using a standardized virtual reality driving simulator route. Executive functioning, a cognitive function commonly related to driving, was evaluated using the Trail Making Test B.

Results

Greater impairment on the Multiple Sclerosis Functional Composite was related to increased difficulty maintaining lane positioning (r = −0.49, P = 0.01) and poorer executive functioning (r = −0.52, P < 0.01). In contrast, the Expanded Disability Status Scale was not related to either measure.

Conclusions

These findings suggest that poorer performance on the Multiple Sclerosis Functional Composite, and not the Expanded Disability Status Scale, may indicate vulnerability to minor driving errors as an early sign of driving compromise. The use of screening tools, such as the Multiple Sclerosis Functional Composite, could help clinicians identify increased driving risk and consider comprehensive driving evaluations earlier, before a major driving violation or accident occurs.

To Claim CME Credits

Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME

CME Objectives

Upon completion of this article, the reader should be able to: (1) Describe the relationship between symptom severity and driving performance in a virtual reality driving simulator, and how the relationship may vary based on which symptom severity measure is used; (2) Identify nuanced differences between two commonly used multiple sclerosis (MS) symptom severity measures when assessing functional abilities such as driving; and (3) Utilize symptom severity screeners that can assist in monitoring symptom progression and assessing whether further driving evaluation is needed.

Level

Advanced.

Accreditation

The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Management of Teeth in the Line of Mandibular Angle Fractures Treated with Open Reduction and Internal Fixation: A Systematic Review and Meta-Analysis
Authors: Khavanin Nima , Jazayeri Hossein , Xu Thomas , Pedreira Rachel , Lopez Joseph , Reddy Sashank , Shamliyan Tatyana , Peacock Zachary S. , Dorafshar Amir H.
Published: November 2019

Background:

Mandibular angle fractures are common and frequently involve a tooth in the fracture line. Despite trends toward more conservative indications for tooth extraction during open repair, the literature remains heterogeneous. This review aims to ascertain the effect of tooth extraction/retention on patient outcomes following mandible open reduction and internal fixation and to evaluate the evidence surrounding indications for extraction.

Methods:

PubMed, EMBASE, the Cochrane Library, Elsevier text mining tool database, and clinicaltrials.gov were queried through March of 2018 for English language publication on adults with traumatic mandibular fractures. The review protocol was not registered online. Quality of evidence was assigned using the Grading of Recommendations Assessment, Development and Evaluation methodology. Meta-analyses were performed when definitions of outcomes were deemed similar.

Results:

Overall, 26 of 1212 identified studies met inclusion criteria. Indications for tooth extraction and rates of extraction varied considerably across studies. The quality of evidence was low or very low for all outcomes. Tooth retention was associated with lower overall complications (OR, 0.54; 95 percent CI, 0.37 to 0.79), major complications requiring readmission or reoperation (OR, 0.47; 95 percent CI, 0.24 to 0.92), and malocclusion (OR, 0.56; 95 percent CI, 0.32 to 0.97); there was no difference in wound issues or nonunion. Removal of asymptomatic teeth was associated with inferior alveolar nerve injury (39.4 percent versus 16.1 percent).

Conclusions:

The literature is limited by retrospective study deign and poor follow-up; however, when indicated, tooth extraction is not associated with an increased risk of infection or nonunion. Removal of asymptomatic teeth was associated with a risk of inferior alveolar nerve injury. Additional high-quality studies are needed to evaluate potentially expanded indications for tooth extraction.