bluuebunny/crossref_metadata_2025 huggingface dataset:
Minimally Invasive Navigated Foraminal Discectomy via Contralateral Approach Using a 3-Dimensional 4K High-Definition Exoscope: 2-Dimensional Operative Video
Authors: Oren Jonathan , Kwan Kevin , Schneider Julia , Levine Mitchell , Langer David
Published: December 2019

This surgical video is the first to demonstrate a novel minimally invasive technique of utilization of surgically navigated foraminal discectomy using a 3-dimensional 4k high-definition exoscope (Sony Olympus). Typical approaches for foraminal disc herniations may involve violation of the facet resulting in subsequent destabilization requiring fusion.
1
Although minimally invasive facet-sparing contralateral techniques have previously been described,
2
there is continued limitations stemming from rudimentary localization with standard fluoroscopy and impaired visualization with the bulky traditional operative microscope.
3
We demonstrate that high-quality real-time navigation is possible using standard Iso-C intraoperative fluoroscopy for 3-dimensional reconstructions, allowing for intraoperative routing. Navigation is particularly advantageous for adjustments in the trajectory of the tubular retractor and for confirmation of complete foraminal decompression. Visualization from the 4k high-definition exoscope also allows for an unparalleled view of the narrow operative corridor and allows for participation from the operative team. Informed consent was obtained from the patient for the surgery in its entirety.
A PHANTOM STUDY SHOWING THE IMPORTANCE OF BREAST SHIELDING DURING HEAD CT
Authors: Zalokar Nika , Mekiš Nejc
Published: December 2019

This study aimed to investigate the dose to the breasts during head computed tomography (CT) if lead shielding is used. The study was performed in two major hospitals using helical and axial protocols on an anthropomorphic phantom. Measurements were performed with and without the use of a lead shield of 0.5 mm equivalent density. The results showed a significant decrease in dose with the lead shielding in both hospitals. During the helical protocol, the use of shielding significantly reduced the dose by 96% in Hospital A and 82% in Hospital B. The dose reduction during axial protocol was also significant: 95% in Hospital A and 86% in Hospital B with lead shielding. Considering the significant dose reduction of 82% up to 96% during this study, we highly recommend the shielding of breasts regardless of the protocol used during head CT examinations.
Old, older, the oldest: red blood cell storage and the potential harm of using older red blood cell concentrates
Authors: Baron David M. , Lei Chong , Berra Lorenzo
Published: December 2019

Purpose of review

Over the last decades, clinical studies have suggested that transfusion of red blood cells (RBCs) might negatively impact patient outcomes. Even though large randomized clinical trials did not show differences in mortality when transfusing fresh versus standard-issue RBC units, data imply that RBCs at the very end of storage could elicit negative effects.

Recent findings

Certain alterations of RBCs during cold storage -- such as an increase of potassium and lactate in the storage solution -- have been discovered a century ago. In recent years, proteomic and metabolomic studies have shed more light into pathophysiological changes of RBCs during storage and have helped to specify the definition of old blood. These advancements are now utilized to increase the quality of stored RBCs and devise therapeutic strategies (e.g. nitric oxide, haptoglobin, or reduction of the iron load) when transfusing old blood.

Further research to improve the quality of RBC units and to study populations potentially at risk is warranted. Until the question whether transfusion of old blood is detrimental for specific patient populations has been answered, a deliberate use of RBC transfusion should be implemented.
Predatory journals and conferences: why fake counts
Authors: Cortegiani Andrea , Manca Andrea , Giarratano Antonino
Published: December 2019

Purpose of review

Predatory publishing poses a serious educational end ethical threat to the credibility of science. The aim of this review is to discuss the main features of this deceptive open-access model, its potential consequences and relevance for the whole scientific community.

Recent findings

Recent reports showed that scholars and clinicians from all research fields, including anesthesiology, are facing an alarming invasion of predatory journals and, more recently, fake conferences. This review discusses key elements of these phenomena and proposes countermeasures to tackle the problem.

Predatory journals and conferences are two sides of the same coin. As here reviewed, their deceptive practices have negative implications for scientists and clinicians, both educational and ethical. These range from publication of experimental data that are unreliable and poorly verified to inflated curricula and ‘doped’ academic careers. Because clinical practice is heavily based on research data, a solution is needed to ultimately ensure patients’ safety.
The Impact of Spatial Distribution of Pain on Long-Term Trajectories for Chronic Pain Outcomes After Intensive Interdisciplinary Pain Treatment
Authors: Williams Sara E. , Homan Kendra J. , Crowley Susan L. , Pruitt David W. , Collins Andrew B. , Deet Emily T. , Samuel Nicole D. , John Abigail , Banner Katherine , Rose John B.
Published: December 2019

Objectives:

Evidence for the effectiveness of intensive interdisciplinary pain treatment (IIPT) for pediatric chronic pain is growing; however, little research has considered factors that contribute to differences in patients’ treatment response. The present study utilized multilevel modeling to examine trajectory of change over time in functional disability from clinic assessment to 6-month follow-up in pediatric patients participating in IIPT, considering spatial distribution of pain, coping efficacy, and pain intensity.

Materials and Methods:

Participants included 110 pediatric patients (M
age=14.65, SD=2.37; localized pain, 27.3%; widespread pain, 72.7%) consecutively admitted into IIPT. Patients completed self-report measures of functional disability, pain intensity, and coping efficacy at pretreatment assessment, admission, weekly during IIPT, discharge, and several follow-ups.

Results:

Analysis identified a model with 3 three-way interactions, including time, time squared, pain intensity, coping efficacy, and pain distribution, on functional disability. The spatial distribution of pain had the greatest impact on treatment trajectory in patients with widespread pain, high pain intensity, and poor coping efficacy; these patients demonstrated greater functional disability compared with patients with localized pain. In addition, patients with widespread pain and poor coping efficacy had the most functional disability across all levels of pain intensity. Patients with localized pain and poor coping efficacy demonstrated initial treatment gains, but evidenced an increase in functional disability at follow-up.

Discussion:

Overall, spatial distribution of pain, coping efficacy, and pain intensity played an important role in patients’ response to treatment. Better understanding of these variables could improve treatment response, particularly for the most severely disabled chronic pain patients.
Physiological Signatures of Brain Death Uncovered by Intracranial Multimodal Neuromonitoring
Authors: Rajagopalan Swarna , Cruz Navarro Jovany , Baghshomali Sanam , Kirschen Matthew , Greer David , Kofke W. Andrew , Balu Ramani
Published: December 2019

Background:

The physiological and neurochemical changes that accompany brain death are not well described.

Materials and Methods:

A retrospective observational study of patients with acute brain injury who underwent intracranial multimodality neuromonitoring between October 2015 and June 2018. Patients were included for analysis either if brain death was diagnosed or refractory intracranial hypertension with persistent equalization of intracranial pressure (ICP) and mean arterial pressure (MAP) developed.

Results:

Of 114 patients who underwent invasive neuromonitoring, 11 cases with MAP/ICP equalization were identified. Of those, 9 were declared brain dead based on accepted national and institutional criteria. An additional 2 cases with MAP/ICP equalization who died after withdrawal of life-sustaining therapies were identified. Of the 11 identified patients, 10 had continuous monitoring data available for analysis. Cerebral microdialysis data were available for 4 patients.

In the 10 cases with available continuous data, ICP/MAP equalization was associated with marked reduction of cerebral blood flow and brain tissue oxygen tension to near zero levels as well as a significant decrease in brain temperature compared with body temperature. In the 4 patients with microdialysis monitoring, ICP/MAP equalization resulted in a near complete depletion of cerebral glucose and pyruvate, as well as a marked rise in cerebral glycerol. Finally, ICP/MAP equalization was accompanied by complete loss of cerebrovascular pressure reactivity, decrease in intracranial pulse pressure, and a paradoxical improvement of ICP waveform morphology.

Conclusions:

A characteristic set of changes in cerebrovascular physiology and neurochemistry occurs during brain death. These changes can be identified by intracranial neuromonitoring.
Seromas Following Pediatric Spinal Deformity Surgery: Is Operative Management Necessary?
Authors: Yu James , Dumaine Anne M. , Poe-Kochert Connie , Thompson George H. , Mistovich R. Justin
Published: December 2019

Background:

Seromas are known complications after pediatric spinal deformity surgery. Although many surgeons perform an early debridement to prevent deep surgical site infections (SSIs), a less invasive approach to seroma management has not been studied. We hypothesized that a conservative approach to seroma management would be safe and yield equivalent outcomes.

Methods:

We performed a retrospective review of patients who developed a postoperative seroma with or without nonpurulent drainage. Inclusion criteria were patients below 21 years who underwent primary posterior spinal fusion from 1996 to 2016 and developed a postoperative wound seroma. Seromas were clinically defined as an afebrile patient with a fluid collection that was soft and nontender to palpation and without induration or erythema. Growing spine surgeries and revision procedures were excluded from this study.

Results:

Twenty-five of 790 total patients with a mean follow-up of 57.8 months (±48.5 mo) developed a seroma. Seromas were identified at a mean of 13.6 days postoperatively and resolved after a mean of 12.2 days following the presentation. Seromas occurred in 12 patients with idiopathic scoliosis, 12 with neuromuscular scoliosis, and 1 patient with Scheuermann kyphosis. All cases were managed conservatively with monitoring of the incision without an operative procedure. In cases of spontaneous drainage, a sterile dressing was applied to the wound and changed as needed until drainage ceased. Two patients underwent bedside needle aspiration and 5 patients received prophylactic antibiotics at the treating surgeon’s discretion. All cases resolved spontaneously without development of an acute SSI. Three cases subsequently developed a late SSI (range, 18 to 38 mo postoperatively). Two had idiopathic scoliosis and 1 had neuromuscular scoliosis. None of these seromas drained spontaneously.

Conclusions:

Conservative management of postoperative seromas after pediatric spinal deformity surgery is appropriate. It is unclear if seromas contributed to the development of the 3 late infections. Further studies are needed regarding the relationship of late infections in seroma patients.

Level of Evidence:

Level IV—case series.
Skin Expansion Due to the Dupuytren Cord Allows to Design Local Flaps to Facilitate Skin Closure in Severe Cases: The 3-flap: Surgical Technique and Clinical Evaluation
Authors: Le Gall Hélène , Dautel Gilles
Published: December 2019

In the serious forms of Dupuytren disease, passive extension during surgery often results in unmasking a loss of skin substance that makes primary closure impossible. Our objective in this study was to describe and assess the therapeutic possibilities of a 3 local flaps surgical approach in serious forms of Dupuytren disease, using the lateral skin expansion because of the cord. A cadaveric study was carried out on 12 adult nonembalmed, fresh frozen hands. For each specimen, a loss of skin substance was simulated on the palmar side of the fifth finger at the level of the proximal digital flexion crease. Coverage involved an incision delineating 3 distinct local flaps: a radially based quadrangular palmar flap, triangular proximally based laterodigital flap, and a distally based triangular web space flap. For a defect reaching up to 40% of the palmar surface of the first phalanx (P1), this 3-flap combination allowed us to fill in skin loss with a tension-free closure. Then we led a clinical study among 10 patients suffering from Dupuytren contracture, Tubiana, and Michon classification stages from II to IV. For those patients who all showed perioperative inadequate skin coverage, we used the 3-flap plasty. No skin necrosis occurred. This reliable technique using a “cascade” of local flaps makes it possible, in serious forms of Dupuytren disease, to both easily access the palmar and digital portions of the cord and to achieve closure.
The Cost of Postoperative Infection Following Orthopaedic Fracture Surgery
Authors: Levy Joseph F. , Castillo Renan C. , Tischler Eric , Huang Yanjie , O’Hara Nathan N.
Published: December 2019

The objective of this paper is to describe the costs associated with postoperative infection following orthopedic fracture surgery. The data provided is based on a narrative review and an analysis of national claims and discharge databases in the United States. The narrative research specifically evaluated the costs associated with postoperative infections following the treatment of proximal femur, tibia, humerus, and ankle fractures. Two US databases were used to estimate the annual incidence of a deep surgical site infection following fracture treatment and the costs associated with that treatment. Previous studies suggest that the cost of treatment for an infected patient is likely to be at least twice the cost of treating an uninfected patient. However, the current literature is limited to small retrospective reviews focused narrowly on the direct health care sector costs of treatment. Further research is required to better estimate the costs of postoperative infection in orthopedic trauma patients, particularly the nonhealth care sector and indirect costs associated with impairment and lost productivity to the patient and caregiver.
A Systematic Approach to Perioperative Smoking Cessation
Authors: Davis James M. , Thomas Leah C. , Dirkes Jillian E.H. , Aronson Solomon
Published: December 2019

Background:

There is compelling evidence that smoking leads to poor postoperative outcomes including increased incidence of wound infection, respiratory infection, sepsis, cardiac arrest, and mortality. There is also compelling evidence that smoking cessation before surgery leads to improved outcomes. A recent meta-analysis found that brief smoking interventions may be insufficient to change postoperative outcomes. However, more intensive evidence-based smoking cessation interventions do improve postoperative outcomes and lead to long-term smoking abstinence. From a healthcare perspective, this raises a question of how to best provide effective perioperative smoking cessation treatment to a population.

Methods:

Duke University Health System recently developed a systematic approach to perioperative smoking cessation. In this report, we outline evidence-based principles for perioperative smoking cessation and describe initial results from a perioperative smoking cessation program.

Results:

In the first 100 days of the Duke Perioperative Smoking Cessation Program, we received 420 referrals. Participants had a mean pack-year history of 50.3 (packs/day×years smoking; SD 32.5), a mean Fagerström Test for Nicotine Dependence score of 4.5 (SD 2.5), and a mean expired breath carbon monoxide of 11.8 (SD 7.5) parts per million. Mean days from initial perioperative smoking cessation visit to surgery was 21.4 (SD 22.3).

Discussion:

This model of perioperative smoking cessation is in the early stages of development; however, evidence-based perioperative smoking cessation services can be effective across a health system.
Favorable Outcomes of a Direct Heart Transplantation Strategy in Selected Patients on Extracorporeal Membrane Oxygenation Support
Authors: Coutance Guillaume , Jacob Nicolas , Demondion Pierre , Nguyen Lee S. , Bouglé Adrien , Bréchot Nicolas , Varnous Shaida , Leprince Pascal , Combes Alain , Lebreton Guillaume
Published: December 2019

Objectives:

Heart transplantation in patients supported by venoarterial extracorporeal membrane oxygenation has been associated with poor prognosis. A specific protocol for extracorporeal membrane oxygenation management encompassing patient selection, implantation strategy, and preoperative and perioperative treatment is applied at our institution. Our aim was to compare posttransplant outcomes of patients supported or not by extracorporeal membrane oxygenation at the time of heart transplantation.

Design:

A large observational single-center retrospective study was conducted. The primary endpoint was overall survival after heart transplantation. Secondary endpoints included death-censored rejection-free survival and the frequency of extracorporeal membrane oxygenation-related complications.

Setting:

One heart transplantation and extracorporeal membrane oxygenation high-volume center.

Patients:

All consecutive patients over 18 years old with a first noncombined heart transplantation performed between 2012 and 2016 were included.

Interventions:

None (retrospective observational study).

Measurements and Main Results:

Among the 415 transplanted patients, 118 (28.4%) were on extracorporeal membrane oxygenation at the time of transplantation (peripheral, 94%; intrathoracic, 6%). Median time on extracorporeal membrane oxygenation before heart transplantation was 9 days (interquartile range, 5–15 d) and median follow-up post heart transplantation was 20.7 months. Posttransplant survival did not differ significantly between the two groups (1-yr survival = 85.5% and 80.7% in extracorporeal membrane oxygenation vs nonextracorporeal membrane oxygenation patients; hazard ratio, 0.69; 95% CI, 0.43–1.11; p = 0.12, respectively). Donor age, body mass index, creatinine clearance, and ischemic time were independently associated with overall mortality, but not extracorporeal membrane oxygenation at the time of heart transplantation. Rejection-free survival also did not significantly differ between groups (hazard ratio, 0.85; 95% CI, 0.60–1.23; p = 0.39). Local wound infection was the most frequent complication after extracorporeal membrane oxygenation (37% of patients).

Conclusions:

With the implementation of a specific protocol, patients bridged to heart transplantation on extracorporeal membrane oxygenation had similar survival compared with those not supported by extracorporeal membrane oxygenation.
Computational analysis of flow cytometry data in hematological malignancies: future clinical practice?
Authors: Duetz Carolien , Bachas Costa , Westers Theresia M. , van de Loosdrecht Arjan A.
Published: December 2019

Purpose of review

This review outlines the advancements that have been made in computational analysis for clinical flow cytometry data in hematological malignancies.

Recent findings

In recent years, computational analysis methods have been applied to clinical flow cytometry data of hematological malignancies with promising results. Most studies combined dimension reduction (principle component analysis) or clustering methods (FlowSOM, generalized mixture models) with machine learning classifiers (support vector machines, random forest). For diagnosis and classification of hematological malignancies, many studies have reported results concordant with manual expert analysis, including B-cell chronic lymphoid leukemia detection and acute leukemia classification. Other studies, e.g. concerning diagnosis of myelodysplastic syndromes and classification of lymphoma, have shown to be able to increase diagnostic accuracy. With respect to treatment response monitoring, studies have focused on, for example, computational minimal residual disease detection in multiple myeloma and posttreatment classification of healthy or diseased in acute myeloid leukemia. The results of these studies are encouraging, although accurate relapse prediction remains challenging. To facilitate clinical implementation, collaboration and (prospective) validation in multicenter setting are necessary.

Computational analysis methods for clinical flow cytometry data hold the potential to increase ease of use, objectivity and accuracy in the clinical work-up of hematological malignancies.
Does a Long-Term Quality and Safety Curriculum for Health Care Professionals Improve Clinical Practice? An Evaluation of Quality Improvement Projects
Authors: van Tuijl Anne A. C. , Calsbeek Hiske , Wollersheim Hub C. , Laan Roland F. J. M. , Fluit Cornelia R. M. G. , van Gurp Petra J.
Published: December 2019

Introduction:

Little is known about the effects on clinical practice of continuing education quality and safety curricula. The aim of this study is to gain insight into learning outcomes on the fourth level of the Kirkpatrick evaluation model for systematically deployed quality improvement projects performed by health care professionals during a Masters in Healthcare Quality and Safety in the Netherlands.

Methods:

The researchers reviewed 35 projects led by health care professionals in 16 different hospitals to determine their scopes and effects. Afterward, professionals took an online survey to determine the extent of their project's sustainability and spread.

Results:

Improving health care safety was the most prevalent quality dimension (n = 11, 31%). A positive change was measured by professionals for 64% (n = 35) of the primary outcomes. Statistical significance was measured in 19 (35%) of the outcomes, of which nine (47%) were found to have a statistically significant effect. A minority of professionals (17%) judged their project as sustained by the department, while some stated that the intervention (37%) or the results of the project (11%) had spread.

Discussion:

Although most projects indicated an improvement in their primary outcomes, only a few resulted in statistically significant changes. Teaching professionals in using evaluation methods that take into account the complex context where these projects are performed and teaching them leadership skills is needed to reduce the likelihood of unmeasured outcomes. Analyzing learning experiences of professionals in performing the project is important to see what they learned from performing quality improvement projects, providing experiences that may lead to sustainable effects in future projects.
Menopause and risk of hip fracture in middle-aged Chinese women: a 10-year follow-up of China Kadoorie Biobank
Authors: Peng Ke , Yao Pang , Kartsonaki Christiana , Yang Ling , Bennett Derrick , Tian Maoyi , Li Liming , Guo Yu , Bian Zheng , Chen Yiping , Chen Zhengming , Ivers Rebecca , Woodward Mark , Clarke Robert
Published: December 2019

Objective:

Bone loss is accelerated after menopause in women, as is the risk of hip fracture, but little is known about the importance of age at menopause, time since menopause, and total reproductive years for risk of hip fracture.

Methods:

Between 2004 and 2008, the China Kadoorie Biobank recruited 125,336 postmenopausal women who had a natural menopause and recorded 1,327 incident cases of hip fracture during the first 10 years of follow-up. Multivariable Cox regression was used to estimate hazard ratios and 95% CIs for incident hip fracture for age at menopause, time since menopause, and total reproductive years.

Results:

The mean (SD) age at menopause was 48.8 (4.0) years. Compared with women who reached menopause before age 53 years, women with a later age at menopause had a 22% (95% CI, 11%-35%) lower risk of hip fracture. Compared with women who were <5 years since menopause, those who were 5 to 9, 10 to 14, 15 to 19, and ≥20 years since menopause had hazard ratios of hip fracture of 1.43 (95% CI, 1.01-2.04), 2.10 (95% CI, 1.71-2.57), 2.50 (95% CI, 2.21-2.83), and 2.33 (95% CI, 1.97-2.75), respectively. Women with a longer (≥36 y) versus shorter (<30 y) duration of total reproductive years had a 19% (95% CI, 9-28) lower risk of hip fracture.

Conclusions:

Women with younger age at menopause, longer interval since menopause, or shorter duration of total reproductive years had the highest risks of hip fracture.
Maintenance Therapy in the Primary Treatment of Epithelial Ovarian Cancer
Authors: AYOUB HADEAL , MCDONALD MEGAN E.
Published: December 2019

Despite aggressive upfront treatment with a combination of surgery and chemotherapy, most women with advanced epithelial malignancy will experience disease recurrence. The goal of treatment in the recurrent setting shifts away from a curative approach towards palliation of symptoms. In an attempt to delay time to first recurrence, the concept of maintenance chemotherapy emerged. This paper reviews the available literature evaluating the use of maintenance chemotherapy in the primary treatment setting and its effect on progression-free survival and overall survival.
A Meta-analysis on the Outcome of Sequential Glaucoma Drainage Implantation
Authors: Yoon Dan , Vajaranant Thasarat
Published: December 2019

Precis:

A meta-analysis shows that second glaucoma drainage implantation can be effective after a failed drainage implant. There is a need for continued glaucoma medications and the risk of corneal decompensation.

Purpose:

Studies on second glaucoma drainage implantation are small and exploratory. We performed a meta-analysis on the efficacy of second glaucoma drainage implantation.

Materials and Methods:

The intraocular pressure (IOP) and the number of glaucoma medications were compared preoperative to postoperative after second drainage implantation. Kaplan-Meier survival curves were aggregated and compared with the survival curve from the Tube versus Trabeculectomy study.

Results:

Nine studies, all retrospective, were included in the meta-analysis. Our results showed that second drainage implantation significantly lowered the IOP and reduced the number of medications. Most patients still required medications for adequate IOP control. Second drainage implants tended to fail earlier than first drainage implants in the Tube versus Trabeculectomy study. The most common complication after second drainage implants was corneal decompensation.

Conclusions:

Second glaucoma drainage implantation can be considered a viable approach after a failed drainage implant, but patients should be counseled on the need for continued medical therapy and the risk of corneal decompensation.
Hypotony Keratopathy Following Trabeculectomy
Authors: Camp Andrew S. , Weinreb Robert N.
Published: December 2019

Precis:

Hypotony keratopathy is a potential complication of hypotony following trabeculectomy and successful treatment depends on increasing intraocular pressure (IOP).

Purpose:

To evaluate corneal decompensation in patients following trabeculectomy with adjuvant mitomycin C (MMC). We propose “hypotony keratopathy” as a descriptive term.

Methods:

Patients with trabeculectomy and follow-up performed by the authors were included in this retrospective single-center study. Patients were included if they had evidence of corneal decompensation (Descemet membrane folds or corneal edema) the following trabeculectomy with MMC with concurrent hypotony. Outcome measures included best-corrected visual acuity, average IOP at time of diagnosis, and changes in central corneal thickness. Clinical outcomes for the treatment of hypotony keratopathy were noted when performed.

Results:

A total of 14 eyes from 12 patients were included in the series. Hypotony developed an average of 5 years after trabeculectomy, and hypotony keratopathy was diagnosed 7.5 years after trabeculectomy. Hypotony keratopathy ranged from nonvisually significant Descemet membrane fold without increased corneal thickness to visually significant corneal edema. Best-corrected visual acuity decreased 0 to 6 Snellen lines after diagnosis of hypotony keratopathy. Lower IOP was associated with increased corneal thickness. Vision improved after trabeculectomy revision (6 eyes) and cataract extraction with an intraocular lens implant (1 eye) but did not improve after Descemet stripping automated endothelial keratoplasty (2 eyes).

Conclusions:

Hypotony keratopathy is a poorly described but potentially treatable complication of trabeculectomy with MMC. Hypotony keratopathy may be related to endothelial dysfunction secondary to hypotony.
Solitary Fibrous Tumor of the Orbit: A Case Series With Clinicopathologic Correlation and Evaluation of STAT6 as a Diagnostic Marker
Authors: Blessing Nathan W. , Bermudez-Magner J. Antonio , Fernandez Maria P. , Rosenberg Andrew E. , Dubovy Sander R. , Johnson Thomas E.
Published: December 2019

Purpose:

To retrospectively describe the clinical characteristics, management, and outcomes of a series of patients with solitary fibrous tumor (SFT) of the orbit and to evaluate signal transducer and activator of transcription 6 (STAT6) as a diagnostic marker.

Methods:

Review of a retrospective, noncomparative, consecutive series of patients treated at a single institution with a histopathologic diagnosis of SFT. Demographic, clinical, and imaging data were collected, and paraffin-embedded tissue sections were stained to evaluate for the presence of STAT6 and other pertinent markers.

Results:

Twenty-one patients were identified. Most presented with painless progressive proptosis or eyelid swelling for less than 6 months. Imaging revealed well-circumscribed, firm, variably vascular contrast-enhancing lesions with low to medium reflectivity on ultrasound. Four tumors were histopathologically malignant. All tumors were primarily excised, and 1 patient required exenteration. Two patients were treated with adjuvant radiation therapy. Six patients had recurrent disease of which 3 underwent repeat excision, and 2 were observed. No metastatic disease or attributable deaths were observed. All lesions with available tissue stained positively for both CD34 and STAT6.

Conclusion:

This is the largest single institution case series of orbital SFT with clinicopathologic correlation and the largest series to confirm the presence of STAT6 in orbital lesions. The management of SFT remains challenging due to unpredictable tumor behavior, and complete excision is the generally recommended treatment. It remains unclear whether a subset of asymptomatic patients with histopathologically benign disease can be durably observed without negative sequelae.
Fluid Infusion Through Chest Tube to Facilitate Pleural Procedures
Authors: Majid Adnan , Rivera Estefania , Sisniega Carlos , Husta Brian , Chee Alex , Parikh Mihir , Holden Van , Kheir Fayez
Published: December 2019

Background:

Most pleural procedures need the presence of a moderate effusion to allow safe access to the pleural space. We propose a technique to allow safe access in patients with a drained pleural space who require further pleural evaluation or treatment during the same hospital stay.

Methods:

This was a retrospective study. All patients who underwent any pleural intervention with a prior infusion of fluid in the pleural space using a pre-existing chest tube (≤14 Fr) were included. Before the pleural intervention, warm saline was infused into the pleural space through the small-bore chest tube until enough fluid was detected on thoracic ultrasound to allow pleural access. Data on patient demographics, indication for the pleural procedure, and patient outcome was analyzed.

Results:

A total of 22 patients with pleural disease underwent definitive pleural procedure facilitated by fluid infusion. Median volume of fluid infused was 1000 mL (850, 1500 mL). The median time between the initial chest tube insertion and the subsequent definitive pleural procedure was 3 days (2, 7 d). All procedures were completed successfully. One patient had a hemothorax secondary to fluid infusion.

Conclusion:

Fluid infusion through a chest tube is a feasible technique for patients that require a pleural procedure and have minimal fluid after initial pleural drainage. This approach may facilitate pleural procedures, reduce incidence of complications, and expedite the diagnosis and treatment of patients with pleural diseases. Pressure infusers should not be used during this procedure as there is a theoretical increased risk of complications.
Gastrectomy Versus Endoscopic Resection for Patients With Early-stage Gastric Adenocarcinoma
Authors: Yang Jiahui , Ren Mudan , Lu Guifang , Liu Huan , Liu Chuan , Wang Wancong , He Shuixiang
Published: December 2019

Background:

This study aimed to compare the long-term results of patients who received these therapies.

Materials and Methods:

The Surveillance, Epidemiology, and End Results (SEER) database was queried in this research for data of patients with early gastric adenocarcinoma who underwent gastrectomy or endoscopic resection from 2007 to 2015. Propensity score matching was selected to generate a balanced cohort. Competing-risk regression analysis was carried out on the matched cohort. Cancer-specific mortality (CSM) and other cause-specific mortality (OCSM) were compared using adjusted subdistribution hazard ratios (SHRs).

Results:

In this study, 2214 patients with 191 underwent endoscopic treatment (ET) and 2023 who underwent surgery were identified. After propensity score matching, 474 patients were included in the analysis. The use of ET increased over time in patients, especially for those with cardia diseases. The ratio of 5-year CSM between ET and gastrectomy groups was 13.12% to 14.24% and the ratio of 5-year OCSM between them was 22.48% versus 14.31%. After adjusting for associated clinicopathologic factors, patients in both groups had similar CSM (SHR=0.87, 95% credible interval: 0.47-1.64, P=0.69) and OCSM (SHR=1.59, 95% credible interval: 0.94-2.68, P=0.08) in multivariable analysis.

Conclusion:

The long-term prognosis appears equivalent t in patients with endoscopic resection and gastrectomy.
Biosynthetic Human Insulin and Insulin Analogs
Authors: Rodbard Helena W. , Rodbard David
Published: December 2019

Background:

Biosynthetic human insulins and analogs have replaced animal insulins and permitted structural modifications to alter the rate of absorption, duration of action, improve reproducibility of effects, and modulate relative efficacy in various target tissues. Several forms of rapidly acting insulins nearly achieve rapid pharmacokinetics and pharmacodynamics similar to first-phase insulin release. There is need for even faster-acting analogs to mimic normal physiology and improve control of postprandial glycemic excursions. Two biosynthetic insulin analogs have sufficiently long duration of action for use as once-daily basal insulins; controversy persists regarding their respective risks of hypoglycemia and relative glycemic variability.

Results:

Basal-bolus therapy and insulin pump therapy, including closed-loop automated insulin delivery, require rapid-acting insulin analogs. The longer acting insulins can provide stable, reproducible basal insulin with reduced rates of hypoglycemia, particularly nocturnal hypoglycemia, greater efficacy in reducing mean glucose and glucose variability while increasing time in glucose target range. Inhalable human insulin provides very rapid action. Premixture of rapid-acting analogs with protamine has been useful for some patients with type 2 diabetes. An insulin analog with preferential efficacy at the liver has been developed and tested clinically but not marketed. Current research is aimed at developing even faster-acting insulin analogs. Long-acting basal insulins coformulated with GLP-1 receptor agonists or with a rapidly acting insulin analog have valuable clinical applications. Excipients, chaperones, local heating of the infusion site, and hyaluronidase have also been used to accelerate the absorption of insulin analogs.

Conclusions:

Biosynthetic human insulins have radically revolutionized management of both type 1 and type 2 diabetes worldwide. The ability to manipulate the structure and formulation of insulin provides for more physiologic pharmacokinetics and pharmacodynamics, enabling improved glycemic control, reduced risk of hypoglycemia, and reduced rates of long-term complications.
A Case of Novel GATA-1 Mutation–positive Transient Abnormal Myelopoiesis With Life-threatening Complications in a Neonate With Down Syndrome
Authors: Sah Ritesh R. , Ray Somosri , Bhatia Prateek , Dhir Shashi K. , Totadri Sidharth , Kumar Narender , Kumar Praveen
Published: December 2019

Transient abnormal myelopoiesis is a transient myeloproliferative disorder seen in ∼15% to 20% of infants with Down syndrome. These infants are usually asymptomatic, requiring only monitoring, but they can have variable severity of symptoms up to multisystemic dysfunction requiring chemotherapy. GATA-1 somatic mutations acquired in utero are pathognomic of this entity and present nearly in all cases. Herein, we present a case of Down syndrome in a neonate who presented within her first week of life with life-threatening features of transient abnormal myelopoiesis requiring chemotherapy support. In addition, next-generation sequencing revealed a small mutant clone (8%) positive for a novel frameshift GATA-1 mutation.
Filament genes and biofilm formation in Streptococcus agalactiae
Authors: Shadbad Mohammad Alipour , Kafil Hossein Samadi , Rezaee Mohammad Ahangarzadeh , Farzami Marjan Rahnamaye , Dehkharghani Alireza Dolatyar , Sadeghi Javid , Gholizadeh Pourya , Aghazadeh Mohammad
Published: December 2019

Streptococcus agalactiae is the prominent cause of bacterial sepsis and meningitis in neonates and is also the contributing agent of a number of serious infections in immunocompromised adults. S. agalactiae run into multiple niches through an infection, suggesting that regulatory mechanisms control the expression of specific virulence factors in this bacterium. Like other Gram-positive bacteria, Group B streptococcus (GBS) can create three-dimensional structures, such as biofilms that can increase their ability to colonize and maintain in the host. Biofilm formation has been investigated by GBS under laboratory conditions and is clearly controlled under environmental conditions. Significantly, antibodies that act against the proteins of the pili can prevent the creation of biofilms. The consequences of biofilm formation in the field of asymptomatic colonization and its dissemination remain invasive and its details are examined. The complex pathway leading to biofilm development in different species of microorganisms involves the contribution of both environmental conditions and genetic factors. Numerous genes or factors have been identified as being essential or required for biofilm formation. Such genes include those that regulate surface-exposed proteins, appendages, such as pili or fimbriae, and extracellular polymeric substance (EPS) matrix materials. Pilus seems to play a key role in adhesion and attachment to host cells both in Gram-negative and Gram-positive pathogens. Their involvement in the transition from planktonic growth to a surface-attached multicellular community has also been demonstrated in many studies. Three different types of pili have been characterized in GBS as potential virulence factors. For example, type 2a pili are involved in biofilm formation.
Peripheral Venipuncture Education Strategies for Nursing Students
Authors: de Souza-Junior Valtuir Duarte , Mendes Isabel Amélia Costa , Marchi-Alves Leila Maria , Jackman Deirdre , Wilson-Keates Barbara , de Godoy Simone
Published: December 2019

This integrative literature review identified strategies to teach peripheral venipuncture to nursing students. The following databases were searched for primary studies: Biblioteca Virtual em Saúde (BVS), PubMed, Web of Science, Education Resources Information Center (ERIC), SCOPUS, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). The final sample was composed of 24 studies. The literature ranged from descriptive studies to controlled clinical trials and methodologic studies to construct products/instruments for teaching peripheral venipuncture. The most frequently identified teaching strategies were theoretical contents taught via theoretical lecture, e-learning courses, video lessons, and demonstration by specialists combined with practical exercises using a mannequin, human arms, and/or haptic devices. Despite the different methods used currently, the best patient outcomes were achieved when the student received the theoretical content in an educational setting before the practical training on a mannequin and/or a virtual simulator.
Challenges Associated With Vascular Access Needs of Patients With Factitious Disorder
Authors: McMillan Janet P.
Published: December 2019

Factitious disorder, formerly known as Munchausen syndrome, is a type of mental illness in which patients fabricate symptoms to gain attention or sympathy. When considering a patient with factitious disorder as a candidate for infusion therapy, the clinician must be aware of the challenges associated with providing an invasive treatment to high-risk patients while promoting safety.
Best Practice for Delivering Small-Volume Intermittent Intravenous Infusions
Authors: Harding Mariann , Stefka Shelly , Bailey Mistey , Morgan Donna , Anderson Aric
Published: December 2019

This study investigated the delivery of small-volume intermittent intravenous (IV) infusions. Laboratory protocol evaluated potential medication loss among 6 administration methods using 50- and 100-mL solutions. Significant variations existed in calculated medication loss depending on administration method and volume. Up to 35% of medication may not be administered due to residual volume, with the greatest percentage associated with 50-mL solutions. Results suggest that intermittent IV infusions should only be delivered as a secondary infusion through a primary infusion administration set with a continuous infusion or an infusion that can flush the administration set at the completion of the secondary infusion.
Protean Manifestations and Diagnostic Challenges Including Discordance Between Electrodiagnostic-Radiologic Studies in Neurolymphomatosis
Authors: Lorance David K. , Allison James B. , Gardner Juli-Anne , Waheed Waqar
Published: December 2019

Introduction:

Malignant lymphocytic infiltration of the central nervous system (CNS) and peripheral nervous system (PNS) is diagnostically challenging and informs treatment and prognosis.

Case Report:

We describe the clinical course of a 49-year-old man with CNS and PNS relapse of mantle cell lymphoma and the diagnostic modalities that enabled the diagnosis of neurolymphomatosis.

Conclusion:

This clinical phenotype reinforces previously reported presentations of neurolymphomatosis and the ability of multimodal diagnostics, when combined with clinical suspicion phenotype, to enable diagnosis of malignant lymphocytic infiltration of the CNS and PNS.
Longitudinal Patterns of Sexually Transmitted Infection Risk Based on Psychological Characteristics and Sexual Behavior in Heterosexual Sexually Transmitted Infection Clinic Visitors
Authors: van Wees Daphne A. , Heijne Janneke C.M. , Basten Maartje , Heijman Titia , de Wit John , Kretzschmar Mirjam E.E. , den Daas Chantal
Published: December 2019

Background

Great heterogeneity in sexually transmitted infections (STI) risk exists, and investigating individual-level characteristics related to changes in STI risk over time might facilitate the development and implementation of effective evidence-based behavior change interventions. The aim of this study was to identify longitudinal patterns of STI risk based on psychological and behavioral characteristics.

Methods

A longitudinal study was conducted among heterosexual STI clinic visitors aged 18 to 24 years. Latent classes based on behavioral and psychological characteristics at baseline, and transitions from 1 latent class to another at 3-week, 6-month, and 1-year follow-up, were identified using latent transition analysis.

Results

Four latent classes were identified that could be differentiated by psychological and behavioral characteristics and STI risk: overall low-risk (10%), insecure high-risk (21%), condom-users (38%), and confident high-risk (31%). Although the majority of the total study population did not move to another latent class over time, the size of the overall low-risk group increased from 10% at baseline to 30% after 1 year. This was mainly due to transitions from the insecure high-risk, condom-users, and confident high-risk class at 3-week follow-up to the overall low-risk class at 6-month follow-up.

Conclusions

Distinct subgroups among heterosexual STI clinic visitors can be differentiated from each other by multiple psychological and behavioral characteristics, and these characteristics reflecting the risk of acquiring STI are consistent over the course of 1 year in most individuals. An integral approach, adapting behavioral interventions to match multiple psychological and behavioral characteristics of high-risk subgroups, might be more effective in controlling STI transmission.
Diabetic Kidney Disease: Past and Present
Authors: Akhtar Mohammed , Taha Noheir M. , Nauman Awais , Mujeeb Imaad B. , Al-Nabet Ajayeb Dakhilalla M.H.
Published: December 2019

Diabetes mellitus (DM) afflicting humans has been recognized as a disease for >3000 years. However, very little was known about its etiology and pathogenesis until about a century ago when increasing knowledge about anatomy and physiology of the human body gradually led to our understanding that the hormone insulin produced by the Islets of Langerhans in the pancreas plays a crucial role in the metabolism of glucose and maintaining the blood sugar level within a normal range. DM is caused by inadequate insulin production (type 1) or insulin resistance (type 2). For thousands of years, DM has been considered as a disease of the kidney; however, with the understanding of the pathogenesis of DM, it became clear that diabetic kidney disease (DKD) is a complication and not a cause of DM. DKD is associated with increased matrix expansion that manifests morphologically as a diffuse or nodular expansion of the mesangium and diffuse thickening of the glomerular and tubular basement membranes. Hyperglycemia plays a crucial role in the development of pathologic changes within the kidney. Once established, DKD usually undergoes a slow but relentless progression to end-stage renal disease. However, recent studies have shown that its progression can be slowed or even reversed by strict control of hyperglycemia. Morphologically, DKD may resemble several other glomerular diseases that must be ruled out before a definitive diagnosis. Patients with DM may also develop nondiabetic glomerular or interstitial diseases with or without DKD. The findings in nephrectomy specimens and the differential diagnoses are presented in detail.