bluuebunny/crossref_metadata_2025 huggingface dataset:
Lifetime risk of knee and hip replacement following a diagnosis of RA: findings from a cohort of 13 961 patients from England
Authors: Burn Edward , Edwards Christopher J , Murray David W , Silman Alan , Cooper Cyrus , Arden Nigel K , Pinedo-Villanueva Rafael , Prieto-Alhambra Daniel
Published: March 2019

Objective

To estimate the lifetime risk of knee and hip replacement following a diagnosis of RA.

Methods

The analysis was undertaken using routinely collected data from the English NHS. Diagnosis of RA was identified using primary care records, with knee and hip replacement observed in linked hospital records. Parametric survival models were fitted for up to 15 years of follow-up, with age, sex, Charlson comorbidity score, socioeconomic status, BMI and smoking status included as explanatory variables. A decision model was used to combine and extrapolate survival models to estimate lifetime risk.

Results

The number of individuals with a diagnosis of RA and included in the study was 13 961. Lifetime risk of knee replacement and hip replacement was estimated to be 22% (95% CI: 16, 29%) and 17% (95% CI: 11, 26%) following a diagnosis of RA for the average patient profile (non-smoking women aged 64 with no other comorbidities, BMI of 27 and in the top socioeconomic quintile). Risks were higher for younger patients.

Conclusion

The lifetime risk of knee and hip replacement for individuals with a diagnosis of RA is approximately double that of the general population. These findings allow for a better understanding of long-term prognosis and healthcare resource use, and highlight the importance of timely diagnosis and effective treatment.
“Learning the Lingo”: A Grounded Theory Study of Telephone Talk in Clinical Education
Authors: Eppich Walter J. , Dornan Tim , Rethans Jan-Joost , Teunissen Pim W.
Published: March 2019

Purpose

Workplace-learning literature has focused on doing, but clinical practice also involves talking. Clinicians talk not only with patients but also about patients with other health professionals, frequently by telephone. The authors examined how the underexplored activity of work-related telephone talk influences physicians’ clinical education.

Method

Using constructivist grounded theory methodology, the authors conducted 17 semistructured interviews with physicians-in-training from various specialties and training levels from two U.S. academic health centers between 2015 and 2017. They collected and analyzed data iteratively using constant comparison to identify themes and explore their relationships. They used theoretical sampling in later stages until sufficiency was achieved.

Results

Residents and fellows reported speaking via telephone regularly to facilitate patient care and needing to tailor their talk to the goal(s) of the conversation and their conversation partners. Three common conversational situations highlighted the interplay of patient care context and conversation and created productive conversational tensions that influenced learning positively: experiencing and dealing with (1) power differentials, (2) pushback, and (3) uncertainty.

Conclusions

Telephone talk contributes to postgraduate clinical education. Through telephone talk, physicians-in-training learn how to talk; they also learn through talk that is mediated by productive conversational tensions. These tensions motivate them to modify their behavior to minimize future tensions. When physicians-in-training improve how they talk, they become better advocates for their patients and more effective at promoting patient care. Preparing residents to deal with power differentials, pushback, and uncertainty in telephone talk could support their learning from this ubiquitous workplace activity.
Words Matter
Authors: Thurman Whitney A. , Johnson Karen E. , Sumpter Danica F.
Published: March 2019

In health care, as in society, racism operates on multiple levels and contributes greatly to health and social inequities experienced by black Americans. In addressing racism, however, health care has primarily focused on interpersonal racism rather than institutionalized forms of racism that are deeply entrenched and contribute to racial inequities in health. In order to meaningfully address health inequities, health care must extend its focus beyond the interpersonal level. The purpose of this integrative literature review is to identify how and to what extent peer-reviewed nursing literature and professional nursing organizations have explicitly addressed institutionalized racism. A systematic search of relevant nursing literature published since 2008 yielded 29 journal articles that focused on black Americans' experience of institutionalized racism in health and health care; the articles explicitly named racism as institutionalized, institutional, systemic, systematic, or structural. This review summarizes author-identified implications of institutionalized racism for nursing education, research, and practice, and offers suggestions for use by the nursing profession to dismantle racist policies, practices, and structures.
Risk of Invasive Anal Cancer in HIV-Infected Patients With High-Grade Anal Dysplasia: A Population-Based Cohort Study
Authors: Arens Yotam , Gaisa Michael , Goldstone Stephen E. , Liu Yuxin , Wisnivesky Juan , Sigel Carlie S. , Swartz Talia H. , Sigel Keith
Published: March 2019

BACKGROUND:

The progression rate and predictors of anal dysplastic lesions to squamous cell carcinoma of the anus remain unclear. Characterizing these parameters may help refine anal cancer screening guidelines.

OBJECTIVE:

This study aimed to determine the rate of progression of high-grade anal dysplasia to invasive carcinoma in HIV-infected persons.

DESIGN:

Using the Surveillance, Epidemiology, and End Results database linked to Medicare claims from 2000 to 2011, we identified HIV-infected subjects with incident anal intraepithelial neoplasia III. To estimate the rate of progression of anal intraepithelial neoplasia III to invasive cancer, we calculated the cumulative incidence of anal cancer in this cohort. We then fitted Poisson models to evaluate the potential risk factors for incident anal cancer.

SETTINGS:

This is a population-based study.

PATIENTS:

Included were 592 HIV-infected subjects with incident anal intraepithelial neoplasia III.

MAIN OUTCOME MEASURES:

The primary outcome measured was incident squamous cell carcinoma of the anus.

RESULTS:

Study subjects were largely male (95%) with a median age of 45.7 years. Within the median follow-up period of 69 months, 33 subjects progressed to anal cancer. The incidence of anal cancer was 1.2% (95% CI, 0.7%–2.5%) and 5.7% (95% CI, 4.0%–8.1%) at 1 and 5 years, following a diagnosis of anal intraepithelial neoplasia III. Risk of progression did not differ by anal intraepithelial neoplasia III treatment status. On unadjusted analysis, black race (p = 0.02) and a history of anogenital condylomata (p = 0.03) were associated with an increased risk of anal cancer incidence, whereas prior anal cytology screening was associated with a decreased risk (p = 0.04).

LIMITATIONS:

The identification of some incident cancer episodes used surrogate measures.

CONCLUSIONS:

In our population-based cohort of HIV-infected subjects with long-term follow-up, the risk of progression from anal intraepithelial neoplasia III to anal squamous cell carcinoma was higher than reported in other studies and was not associated with the receipt of anal intraepithelial neoplasia III treatment. See Video Abstract at http://links.lww.com/DCR/A933.
Defining Fistular Patterns in Hidradenitis Suppurativa: Impact on the Management
Authors: Martorell Antonio , Giovanardi Giulia , Gomez-Palencia Pilar , Sanz-Motilva Virginia
Published: March 2019

BACKGROUND

Recent studies suggest that there are different fistular subtypes in hidradenitis suppurativa (HS) patients who are associated with variable therapeutic outcomes.

OBJECTIVE

To describe clinical and ultrasound features that characterize the different fistular patterns in HS and to evaluate the response to medical therapies.

METHODS

A retrospective study developed by a well-recognized center specialized in HS analyzing both clinical and ultrasound (US) aspects of fistular structures in HS patients was performed. Medical therapy response was evaluated through follow-up visits at Week 24.

RESULTS

A total of 117 fistulas detected in the skin of 40 patients were evaluated. Four different types of fistulas were described: dermal fistula (Type A), dermoepidermal fistula (Type B), complex fistula (Type C), and subcutaneous fistula (Type D). Fistulas Type A and B showed a complete resolution after 6 months of different medical therapies in up to 95% and 65% of cases, respectively. Contrary to this, fistulas Type C and D showed no significant response after a medical intervention.

CONCLUSION

The US evaluation seems to play an important role to define these important structures that will help the clinician in elaborating a personalized combined medical and surgical management of the HS patient.
New Technologies in Rhinoplasty: A Comprehensive Workflow for Computer-assisted Planning and Execution
Authors: Willaert Robin V. , Opdenakker Yasmin , Sun Yi , Politis Constantinus , Vermeersch Hubert
Published: March 2019

Rhinoplasty in facial cleft patients is among the most challenging types of reconstructive facial surgery due to its variability. Advances in 3-dimensional imaging enable improved preoperative assessment in rhinoplasty. In complex cases with bony support irregularities and asymmetry, it is rational to initiate planning with reconstruction of the aberrant substructure (ie, “bottom-up” planning) rather than starting the surgical design with soft-tissue morphing.

We present a new comprehensive workflow in which novel advanced technologies are implemented to perform “bottom-up” computer-assisted planning and execution in complex rhinoplasty cases. This workflow enables meticulous planning, use of grafting templates, and 3-dimensional–guided osteotomies with integration of piezotome and intraoperative navigation.

Previous reports separately discuss some of these innovations. However, greater benefit lies in the combination of these techniques, with emphasis on preoperative computer analysis, virtual planning, and transfer to the operation theater.

Surgeons are seeking new ways to enhance minimally invasive approaches and to obtain predictable and favorable clinical results. The presently introduced workflow allows clinicians to plan complex cases in a simple, effective, and safe manner, with the combination of different techniques to produce consistent results.
Spreader Graft Easy and Stable Fixation
Authors: Durán-Vega Héctor César , Regalado-Briz Arturo
Published: March 2019

The original spreader graft described by Sheen was dissecting a sub perichondrial flap along the anterior edge of the septum and inserting the grafts in place and occasionally, fixing them with a mattress suture. Although it has been done usually with mattress suture, it has some disadvantages as the instability of the graft while it is being fixated and others. We present a different fixation method with a simple running suture instead.
Intramasseteric Schwannoma Derived from the Masseteric Nerve
Authors: Matsumine Hajime , Sasaki Ryo , Fujii Kaori , Sakurai Hiroyuki
Published: March 2019

This report documents the intramasseteric onset of a schwannoma of the masseteric nerve, which is extremely rare. The patient was a 24-year-old woman who noticed an asymptomatic mass in the parotidomasseteric region 1 year before; a soft painless mass located near the angle of the left mandible was observed during the initial examination. No neuropathy, including sensory deficit, facial nerve paralysis, or trismus, was observed. Contrast-enhanced magnetic resonance imaging revealed an isolated neoplastic lesion within the body of the masseter muscle; the lesion exhibited low-signal intensity on coronal T1-weighted imaging and high-signal intensity on T2-weighted imaging with somewhat heterogeneous early uptake of contrast medium. The tumor was resected under general anesthesia and was found to be solid with distinct margins, enclosed within the masseter muscle, and continuous with a branch of the masseter nerve identified using intraoperative electrical stimulation. The lesion was a pale yellow solid mass encapsulated in a smooth membrane measuring 3.2 × 1.7 × 1.6 cm. Histopathological examination revealed a mixture comprising Antoni A pattern with Verocay bodies surrounded by oval nuclei exhibiting nuclear palisading, and an Antoni B pattern with loss of the characteristic cellular arrangement and separation of the cells, creating a more distinct individual tumor cell morphology. The final histopathological diagnosis was schwannoma. No complications, such as trismus or facial nerve paralysis, and no tumor recurrence were observed in the 1 year that has elapsed postoperatively.
Moving From Physician Burnout to Resilience
Authors: SOTILE WAYNE M. , FALLON REBECCA S. , SIMONDS GARY R.
Published: March 2019

We contend that work ambivalence is a key building block in fostering physician burnout and its sequalae, while engagement in meaningful work and receiving family support for that work enhances resilience. No singular approach to curbing burnout in OBGYN physicians has received empirical support. Clinical experience suggests that curbing physician burnout requires a combination of workplace redesigns, positive leadership behaviors, and resilience training that teaches practical applications from the fields of resilience, emotional intelligence, positive psychology, and relationship systems. This paper highlights organizational and leadership interventions that foster physician engagement, and describes how physicians can foster personal and family resilience.
A Systematic Review of the Diagnostic Accuracy of Depression Questionnaires for Cardiac Populations
Authors: González-Roz Alba , Gaalema Diann E. , Pericot-Valverde Irene , Elliott Rebecca J. , Ades Philip A.
Published: March 2019

Purpose:

Depression is overrepresented in patients with cardiovascular disease and increases risk for future cardiac events. Despite this, depression is not routinely assessed within cardiac rehabilitation. This systematic review sought to examine available depression questionnaires to use within the cardiac population. We assessed each instrument in terms of its capability to accurately identify depressed patients and its sensitivity to detect changes in depression after receiving cardiac rehabilitation.

Methods:

Citation searching of previous reviews, MEDLINE, PsycInfo, and PubMed was conducted.

Results:

The Beck Depression Inventory-II (BDI-II) and the Hospital Anxiety and Depression Scale (HADS-D) are among the most widely used questionnaires. Screening questionnaires appear to perform better at accurately identifying depression when using cut scores with high sensitivity and specificity for the cardiac population. The BDI-II and the HADS-D showed the best sensitivity and negative predictive values for detecting depression. The BDI-II, the HADS-D, the Center for Epidemiological Studies—Depression Scale, and the 15-item Geriatric Depression Scale best captured depression changes after cardiac rehabilitation delivery.

Conclusions:

The BDI-II is one of the most validated depression questionnaires within cardiac populations. Health practitioners should consider the BDI-II for depression screening and tracking purposes. In the event of time/cost constraints, a briefer 2-step procedure (the 2-item Patient Health Questionnaire, followed by the BDI-II, if positive) should be adopted. Given the emphasis on cut scores for depression diagnosis and limited available research across cardiac diagnoses, careful interpretation of these results should be done. Thoughtful use of questionnaires can help identify patients in need of referral or further treatment.
Bridging worldviews
Authors: Garman Andrew N. , Standish Melanie P. , Wainio Joyce Anne
Published: March 2019

Background

As the pace of health sector transformation accelerates, the importance of leadership continues to grow across all health professions. Advances in a variety of disciplines can inform effective leadership development. However, at present, most health sector leadership competency models do not incorporate these advances and are instead developed using consensus-based methods within specific professions. An interprofessional approach to leadership competencies could help incorporate these advances and support better interdisciplinary leadership development.

Purpose

This study was pursued to revise and revalidate a widely used health sector leadership competency model and assess its potential for providing greater interoperability across the professions.

Methodology/Approach

Using the National Center for Healthcare Leadership’s interprofessional competency model Version 2.1 as the starting point, we developed a revised and revalidated model in four phases: (a) we completed a future scan using methods described in Garman et al. [Garman, A. N., Johnson, T. J., & Royer, T. (2011). The future of healthcare: Global trends worth watching. Chicago, IL: Health Administration Press.]; (b) we collected behavioral event interview data from pairs of leaders representing different organizational and performance levels, using methods developed by Boyatzis [Boyatzis, R. E. (1982). The competent manager: A model for effective performance. New York, NY: John Wiley & Sons.]; (c) we conducted a validity study via electronic survey of 145 working managers and calculated content validity ratios using methods described by Lawshe [Lawshe, C. H. (1975). A quantitative approach to content validity. Personnel Psychology, 38(4), 563–575.]; and (d) we used natural language processing to assess the extent to which existing leadership models in the health professions will crosswalk to the new model.

Findings

All competencies in the revised model successfully met criteria for validity. The revised model also successfully crosswalked against, on average, 85% of the competencies in the other five health professions leadership models.

Practice Implications

Based on the results of this research, we conclude the revised model can provide a “common language” framework in support of interdisciplinary leadership development. The availability of such a model may also assist human resource and development executives in better aligning learning resources with organizational goals.
Spectrum and Yield to Dose Conversion Coefficients for Beta Skin Doses Linked to the Q System
Authors: Frosio Thomas , Bertreix Philippe , Köster Ulli , Theis Christian , Magistris Matteo
Published: March 2019

Monte Carlo simulations are a state-of-the-art method to calculate dose coefficients and could be used with the Q system for radioactive material packaging. These simulations often take a long time to converge with sufficient precision. Furthermore, if multiple sources have to be taken into account, many weeks of calculations may be needed. In order to reduce the calculation time, this paper proposes a new method based on a transfer function to instantly compute Q values associated with beta skin doses. The method developed in this paper can be applied to compute beta skin dose and easily could be extended to other particles and different depths in organs with various kinds of shielding configurations between source and target.
Primary Open-angle Glaucoma With Initial Visual Field Damage in the Superior and Inferior Hemifields: Comparison in a Population-based Setting
Authors: Iwase Aiko , Araie Makoto
Published: March 2019

Purpose:

To study differences in systemic and ocular factors between eyes with primary open-angle glaucoma (POAG) with an initial visual field defect (VFD) starting in the superior hemifield and those starting in the inferior hemifield in a population-based setting.

Subjects and Methods:

The data were analyzed from eyes with definitive category-1 POAG based on the International Society of Geographic and Epidemiological Ophthalmology criteria with VFD constriction in the superior or inferior hemifield (superior and inferior VFD groups, respectively) found in 2 Japanese population-based glaucoma surveys. The visual fields were tested using the Humphrey Field Analyzer Central 30-2 or 24-2 Swedish Interactive Thresholding Algorithm Standard program.

Results:

Of 336 eyes of 214 patients with POAG with reliable visual fields results, 36 and 37 eyes with 36 and 37 POAG patients were classified into the superior and inferior VFD groups, respectively. The superior VFD group had significantly greater disc ovality, entire and inferior-half β-peripapillary atrophy (PPA) area, and lower mean total deviation value in the corresponding superior hemifield (P=0.004 to 0.048 after Bonferonni correction) than the inferior VFD group. Multivariate logistic regression analysis showed that the superior VFD group was associated with greater ovality, larger β-PPA area, and thinner central cornea thickness (P=0.013 to 0.035).

Conclusions:

In POAG, greater disc ovality and β-PPA and thinner central cornea thickness were associated significantly with the initial VFD starting in the superior hemifield, suggesting some difference in the glaucomatous damaging process between the superior and inferior halves of the disc.
Quantitative Analysis of Retinal and Choroidal Vascular Parameters in Patients With Low Tension Glaucoma
Authors: Tepelus Tudor C. , Song Sheena , Borrelli Enrico , Nittala Muneeswar G. , Baghdasaryan Elmira , Sadda SriniVas R. , Chopra Vikas
Published: March 2019

Précis:

By using OCT-A, we observed a reduction of the superficial macular, peripapillary, and optic nerve, as well as the choriocapillaris in eyes with low tension glaucoma, compared with normal controls.

Purpose:

The purpose of this study was to investigate macular and optic disc vascular parameters in patients with low tension glaucoma (LTG) using optical coherence tomography angiography (OCTA).

Methods:

In this cross-sectional study, images were prospectively acquired from both eyes of 26 patients with clinically diagnosed LTG and 22 age-matched volunteers with normal healthy eyes using the Zeiss swept-source (SS) OCTA (Plex Elite 9000, Carl Zeiss Meditec). Perfusion density (PD) and vessel length density (VLD) within a 5 mm diameter circle centered over the macula and optic nerve head were analyzed.

Results:

The final analysis cohort included 49 eyes with LTG and 40 healthy control eyes. Mean age was 60±10 years in the LTG group and 60±17 years in the control group. The LTG group had a statistically significant reduction in PD of the choriocapillaris (CC) compared with normal controls (71.74±8.37% vs. 80.48±3.84%; P<0.001). There was no statistically significant difference in PD between the LTG and control groups for the superficial vascular plexus (SVP), deep capillary plexus (DCP) or the optic nerve head and peripapillary area (ONH+PP) (P>0.05). The LTG group did show statistically significant reductions in VLD compared with normal controls for the SVP (2083.64±153.76 mm/mm2 vs. 2154.63±144.18 mm/mm2; P=0.03) and ONH + PP (1813.76±271.69 mm/mm2 vs. 1950.23±169.33 mm/mm2; P=0.03), whereas the DCP VD was similar between the 2 groups (P>0.05).

Conclusions:

Eyes with low tension glaucoma seems to show a lower CC perfusion density, as well as a lower SVP and ONH+PP vessel length density compared to normal eyes.
A Quality Improvement Project to Improve Sepsis-Related Outcomes at an Integrated Healthcare System
Authors: Hughes M. Courtney , Roedocker Andrea , Ehli Jessica , Walz Danaka , Froehlich Kim , White Landon , Binder Bill
Published: March 2019

Hospitals are encouraged to take steps to improve outcomes for patients with sepsis, a leading cause of morbidity and mortality. A retrospective analysis examined data (n = 4,475) from three health systems to better determine the impact of a 10-month sepsis quality improvement program that consisted of clinical alerts, audit and feedback, and staff education. Compared with the control group, the intervention group significantly decreased length of stay and costs per stay. The intervention group increased sepsis bundle compliance by more than 40%. A sepsis quality improvement program may improve sepsis health outcomes and decrease costs.
Occupational Stress and Burnout Among Health Care Workers Caring for People Living With HIV in Eswatini
Authors: Bhembe Lomthandazo Queeneth , Tsai Feng-Jen
Published: March 2019

We used the Effort-Reward Imbalance Questionnaire and Copenhagen Burnout Inventory in our cross-sectional study to examine associations between occupational stress and burnout among 368 health care workers (HCW) who cared for people living with HIV (PLWH) in Eswatini. Chi-square and logistic regression analyses were conducted. HCW caring for PLWH reported high efforts, imbalanced effort-reward ratios, overcommitment, and low rewards. Health care managers, physicians, and nurses reported higher work efforts, effort-reward ratios, overcommitment, and personal, work-related, and client-related burnout than laboratory staff or peer counselors. HCW with high work efforts, effort-reward ratios, and overcommitment had significantly higher risks of having personal (odds ratio [OR] = 4.60), work-related (OR = 3.96), and client-related burnout (OR = 2.20). HCW with low rewards had a significant risk of having personal (OR = 3.13) and work-related (OR = 2.08) burnout. Our results suggested the need for policies to reduce work stress for HCW caring for PLWH.
Best practices in care for menopausal patients: 16 years after the Women's Health Initiative
Authors: DeNeui Terri , Berg Judith , Howson Alexandra
Published: March 2019

The Women's Health Initiative (WHI) was a large, randomized clinical trial funded by the National Institutes of Health to determine whether menopause hormone therapy (MHT) prevented heart disease, breast and colorectal cancer, and osteoporotic fractures in postmenopausal women. Two WHI trials were stopped early, and the findings had a profound effect on the clinical practice guidelines related to postmenopausal health. This article provides an overview of the WHI MHT clinical trials and findings, discusses the early stoppage of the trials and subsequent implications, and details the current nomenclature and treatment options for women transitioning through menopause in light of the WHI. This study is based on a comprehensive literature review and an education activity developed by the American Association of Nurse Practitioners. To best serve patients and individualize therapy, clinicians must provide the best estimate of potential risks or benefits to the individual patient. It is important to balance evidence of symptom relief with long-term risks and benefits that fit the patient's characteristics of family and personal health history. Armed with evidence to support various hormonal and non-hormonal options, well-informed clinicians can counsel women about MHT and potentially avoid negative impact on quality of life.
Does treatment of urinary tract infections reflect the antibiotic stewardship program guidelines?
Authors: Bista Bhawana , Champion Jane Dimmitt
Published: March 2019

Protocols are required for antibiotic use for treatment of urinary tract infections (UTIs) in long-term care facilities (LTCFs). This project assessed antibiotic prescribing practices for UTI in three LTCFs to elucidate practice and its relationship to protocols in these settings. A retrospective chart review of UTI cases occurring between February 1, 2017, and July 30, 2017, was conducted to describe provider management in three LTCFs. Sixty-three cases with compelling urinary symptoms potentially suggestive of UTI were included in the review. Urine culture findings indicated that a more than 100,000 CFU/ml colony count was present in 46% (n = 29) of the cases; however, 63.5% (n = 40) of the cases received antibiotics. Eleven cases (17.4%) received antibiotics based on symptoms without UTI diagnosis. Empirical treatment was initiated in 35% (n = 22) of the cases. When urine culture reports were available, previously untreated 28.57% (n = 18) cases received antibiotics for colony counts of >100,000 CFU/ml. Antibiotics were given for colony counts of <100,000 CFU/ml for 17.46% (n = 11) of the cases. Increased urinary frequency or burning on urination (95.23%) and change in behavior (88.9%) were the primary reasons for initiation of urinalysis and urine culture testing. Nurse practitioner implementation of protocols for antibiotic stewardship programs in LTCFs can prevent overprescription for UTI in these facilities.
Primed Left Ventricle Heart Perfusion Creates Physiological Aortic Pressure in Porcine Hearts
Authors: Xin Liming , Yao Weiran , Peng Yan , Lu Pengzhou , Ribeiro Roberto , Wei Bin , Gellner Bryan , Simmons Craig , Zu Jean , Sun Yu , Badiwala Mitesh
Published: March 2019

This article presents a primed left ventricle heart perfusion method to generate physiologic aortic pressure (AoP) and perform functional assessment. Isolated hearts of male Yorkshire pigs were used to study the hemodynamic behaviors of AoPs generated in the primed left ventricle heart perfusion (n = 6) and conventional (zero-loaded left ventricle) Langendorff perfusion (n = 6). The measurement results show that left ventricular pressure generated in the primed left ventricle heart perfusion is a determinant of physiologic AoP (i.e. systolic and diastolic pressures within physiologic range). The aortic pulse pressure (systolic pressure = 124.5 ± 1.7 mm Hg, diastolic pressure = 87.8 ± 0.9 mm Hg, aortic pulse pressure = 36.7 ± 2.6 mm Hg) from the primed left ventricle heart perfusion represents close match with the in vivo physiologic data. The volume in the left ventricle remains constant throughout the primed left ventricle heart perfusion, which allows us to perform isovolumetric left ventricular pressure measurement in ex vivo heart perfusion (EVHP). Left ventricular contractility measurements (maximum and minimum rates of left ventricular pressure change) were derived for cardiac assessment. In summary, the proposed primed left ventricle heart perfusion method is able to create physiologic AoP and enables left ventricular functional assessment in EVHP in porcine hearts.
Gallbladder Polyps
Authors: Demirbaş Fatma , Çaltepe Gönül , Comba Atakan , Bilgin Meltem C. , Eren Esra , Abbasguliyev Hasan , Kalayci Ayhan G.
Published: March 2019

Objective:

Unlike adults, gallbladder polyps (GPs) are rare in childhood. The aim of this study was to evaluate patients with a GP diagnosis.

Methods:

Patients who were diagnosed with GP via ultrasonography from October 2012 to October 2017 were retrospectively evaluated in terms of sociodemographic characteristics and laboratory findings.

Results:

The study included 19 patients diagnosed with GP and followed up in our department. The patients comprised 14 (73.6%) girls with a mean age of 13.9 ± 4.1 years and a mean follow‐up period of 10.2 ± 5.4 months (range, 3–26 months). The most common presenting symptom of the patients (n = 15, 78.9%) for ultrasonography was abdominal pain without biliary symptoms. Location of the polyps was in the corpus in 55% of patients, and either in the fundus (20%) or the neck of the gallbladder (25%). The average diameter of the polyps was 4.5 ± 1.6 mm (range, 2–9 mm). Multiple polyps were observed in 3 patients. No significant change in the number or size of polyps was noted at the end of the follow‐up periods. Cholecystectomy was applied to 1 patient who had >5 polyps with a rapid increase in size, and the pathology report was hamartomatous polyp. There was no remarkable change in the clinical or laboratory findings of other patients during the follow‐up period.

Conclusion:

In this study, GPs could be seen in young children as young as 16 months of age and ultrasonography is sufficient for follow‐up in stable and asymptomatic patients.
Isolated Amylase Deficiency in Children and Its Clinical Implication
Authors: Hopson Puanani , Patel Samit , Bornstein Jeffrey , Mehta Devendra , Horvath Karoly
Published: March 2019

Objectives:

Among the 3 lines of pancreatic enzymes, amylase secretion develops last and it is not detected in duodenal aspirates of infants in the first month after birth. The aim of this study was to assess the prevalence and symptoms of isolated amylase deficiency in children.

Methods:

During a 6‐year period, we performed endoscopic pancreatic function tests (ePFT) in 712 children. Isolated amylase deficiency was defined as activity that was below the third percentile of our referenced population with normal lipase and protease activities.

Results:

Seventy‐two children between age 0.21 and 15.7 years (boys, n = 35) had isolated amylase deficiency. The highest prevalence of isolated amylase deficiency was found in patients less than 6 months of age (52.9%). From 6 months to 1 year of age, the prevalence was 40%. The prevalence gradually decreased until 18 months. Failure to thrive, poor weight gain, diarrhea, and abdominal bloating were the most frequent indications for ePFT. Eleven children had repeat ePFT after initial diagnosis and 6 had normal enzyme activity, whereas 5 had remained amylase‐deficient an average of 1.65 years later.

Conclusions:

The prevalence of selective amylase deficiency was 10.1% in the 712 children who underwent ePFT with the suspicion of malabsorption. Low amylase activity is “physiologic” in infants <6 months of age, however, this study supports that it should be considered in the differential diagnosis in children older than 6 months of age.
Horizontal Transmission of Hepatitis B Virus From Mother to Child Due to Immune Escape Despite Immunoprophylaxis
Authors: Kanji Jamil N. , Penner Robert E.D. , Giles Elizabeth , Goodison Karin , Martin Steven R. , Marinier Eric , Osiowy Carla
Published: March 2019

Hepatitis B virus (HBV) vaccination starting at birth is approximately 95% effective in preventing mother‐to‐child transmission to infants born to HBV‐infected mothers. A higher risk of transmission is associated with birth to a highly viremic mother, often due to transplacental exposure, while later horizontal transmission is much less common, particularly following complete vaccination. This study reports a case of infection in an older child despite appropriate immunoprophylaxis starting at birth and an apparent protective immune response post‐vaccination. Two immune escape mutations within the antigenic determinant of the surface antigen‐coding region were observed in the child's dominant HBV sequence, whereas the maternal HBV variant lacked mutations at both sites. Ultra‐deep sequencing confirmed the presence of 1 mutation at low levels within the maternal HBV quasispecies population, suggesting early exposure to the child followed by viral evolution resulting in immunoprophylaxis escape and chronic infection.
Avoidant/Restrictive Food Intake Disorder in Diet‐treated Children With Eosinophilic Esophagitis
Authors: Robson Jacob , Laborda Trevor , Fitzgerald Susan , Andersen Joseph , Peterson Kathryn , O'Gorman Molly , Guthery Stephen , Bennett‐Murphy Laura
Published: March 2019

Eosinophilic esophagitis (EoE) is an inflammatory condition of the esophagus with rising incidence in children. Owed to potential adverse effects and high costs of EoE medications, strict elimination diets are often employed as a mainstay of long‐term EoE therapy in children. Currently, there are no effective tests to pinpoint food protein triggers in children with EoE. Therefore, EoE elimination diets are often broad (including milk, soy, wheat, egg, fish/shellfish, and nuts) and can greatly alter a child's baseline eating habits. Herein, we describe 2 cases of avoidant/restrictive food intake disorder (ARFID) in children with remitted EoE maintained on an elimination diet. We also present comorbidity data on ARFID and diet‐treated EoE from our pediatric EoE clinic. This is the first report of disordered eating associated with EoE therapy. As EoE is becoming more common, close monitoring of intake and growth in patients treated with elimination diets will be key.
Impact of outpatient pharmacy services collaborating with oncologists at an outpatient clinic for outpatient chemotherapy prescription orders
Authors: Demachi Ken , Suzuki Shinya , Kamata Hayato , Suzuki Hidetaka , Sugama Yuka , Ikegawa Kiwako , Igarashi Takashi , Kawasaki Toshikatsu , Johnson Philip E. , Yamaguchi Masakazu
Published: March 2019

Objectives:

This retrospective study was conducted to evaluate the impact of a service in which clinical pharmacists collaborated with oncologists at an outpatient clinic on chemotherapy order prescriptions and adverse drug reaction management in outpatient cancer chemotherapy.

Methods:

This was a single-center retrospective cohort study. Subjects were patients who received pharmacist services at an outpatient clinic in 6 treatment divisions at the National Cancer Center Hospital East from June to September 2016. Pharmacist interventions were categorized and assessed for impact by 2 pharmacists according to previously published methods.

Results:

The 6 pharmacists worked a total of 1396 hours, providing 1645 pharmacy interventions to 3419 patients. Of the 1645 interventions, 459 interventions (27.9%) involved chemotherapy order prescriptions. The 459 interventions for chemotherapy prescriptions were categorized according to the previously reported categories “drug therapy safety” (n = 330, 71.9%), “other” (n = 91, 19.8%), “drug therapy efficacy” (n = 28, 6.1%), and “drug therapy indication” (n = 10, 2.2%). Of the 91 interventions categorized as “other,” the 2 most frequent types of interventions were “confirmation from pharmacists to oncologists about laboratory test order” (n = 54, 11.7%) and “consultation from oncologists to pharmacists about chemotherapy regimen” (n = 23, 5.0%). Most interventions were identified as having “no error” (n = 369, 80.4%), while 8 interventions (1.8%) were identified as being “potentially lethal” or “serious.” Moreover, 92.8% of interventions were identified as being “extremely significant,” “very significant” or “significant.”

Conclusions:

This study clarified the benefits of outpatient pharmacy services in which pharmacists collaborate with oncologists at an outpatient clinic on outpatient chemotherapy prescription orders.
Do Social and Environmental Factors Affect the Emergency Service Admission Characteristics of Preschool-Aged Pediatric Trauma Patients?
Authors: Gürmen Ekim Saglam , Doğan Serkan , Ocak Tarik
Published: March 2019

Objective

Studies related to the epidemiology of trauma play a major role in determining the health status of the communities living in the vicinity of the centers that they are conducted. We have found no epidemiological study related to emergency service admission conducted only on preschool-aged children in the literature. Our aim was to determine characteristics of trauma in this age group, to analyze encountered trauma types, and to investigate possible associations among epidemiological factors, characteristics of the trauma victims, and trauma itself in pediatric patients admitted to our emergency service.

Methods

We conducted a prospective study with patients aged 66 months and younger, admitted to Emergency Service of Istanbul Kanuni Sultan Suleyman Training and Research Hospital between July 1, 2015, and December 31, 2015. Data related to age, sex, occupational status of parents, number of siblings, Glasgow coma scale score, transport mode, admission time period of the day, general health status, type of trauma, the trauma site, involved body regions, radiologic imaging and laboratory results, consultations, clinical diagnosis and outcome, duration of emergency service stay, and treatment cost were collected and statistically analyzed.

Results

A total of 688 preschool-aged cases were admitted owing to trauma. The major mode of transport was a private vehicle (98.3%), and the major cause was falling (64.0%). The major traumatized body region was head and neck (51.0%), and the major diagnosis was soft tissue trauma (90.1%). The average duration of stay was 122.01 minutes and affected by sibling number, trauma type, and employment status. The total service fee was interrelated with the type of trauma and the site that trauma occurred; it also was strongly correlated with duration of emergency service stay.

Conclusions

Our results suggest that both in-hospital and social/environmental aspects should be improved to reduce the clinical and social burden of trauma.
An Interesting Presentation of Lyme Pseudothrombophlebitis
Authors: Sandelich Stephen , DePiero Andrew
Published: March 2019

An 8-year-old boy presented to the emergency department with swelling and pain of his left knee and calf for approximately 1 week. His examination was significant for moderate knee effusion and swelling of the posterior calf with erythema and warmth of the affected areas. An ultrasound obtained at an outside hospital showed a large heterogeneous mass in the gastrocnemius, and a magnetic resonance imaging revealed a large, heterogeneous, rim-enhancing collection in the medial head of the left gastrocnemius muscle with surrounding myositis involving the gastrocnemius muscle. The child was taken to the operating room by the orthopedic team for drainage and irrigation of the knee effusion and of the collection in the gastrocnemius. The diagnosis of Lyme pseudothrombophlebitis was made through Lyme serology testing of aspirated fluid. He improved after this drainage but required a prolonged antibiotic course.
Elevated Depressive Symptoms Are a Stronger Predictor of Executive Dysfunction in HIV-Infected Women Than in Men
Authors: Rubin Leah H. , Springer Gayle , Martin Eileen M. , Seaberg Eric C. , Sacktor Ned C. , Levine Andrew , Valcour Victor G. , Young Mary A. , Becker James T. , Maki Pauline M. ,   for the Neuropsychology Working Groups of the Women's InterAgency HIV Study and the Multicenter AIDS Cohort Study
Published: March 2019

Background:

HIV-infected (HIV+) women seem to be more vulnerable to neurocognitive impairment (NCI) than HIV+ men, perhaps in part due to mental health factors. We assessed the association between elevated depressive symptoms and NCI among HIV+ and HIV-uninfected (HIV−) women and men.

Setting:

Women's Interagency HIV Study and Multicenter AIDS Cohort Study.

Methods:

Eight hundred fifty-eight HIV+ (429 women; 429 men) and 562 HIV− (281 women; 281 men) completed the Center for Epidemiologic Studies Depression (16 cutoff) Scale and measures of psychomotor speed/attention, executive, and motor function over multiple visits (or time points). Women's Interagency HIV Study and Multicenter AIDS Cohort Study participants were matched according to HIV status, age, race/ethnicity, and education. Generalized linear mixed models were used to examine interactions between biological sex, HIV serostatus, and depression on impairment (T-scores <40) after covariate adjustment.

Results:

Despite a higher frequency of depression among men, the association between depression and executive function differed by sex and HIV serostatus. HIV+ women with depression had 5 times the odds of impairment on a measure of executive control and inhibition versus HIV− depressed women and 3 times the odds of impairment on that measure versus HIV+ depressed men. Regardless of group status, depression was associated with greater impairment on processing speed, executive (mental flexibility), and motor function (P's < 0.05).

Conclusions:

Depression contributes to NCI across a broad range of cognitive domains in HIV+ and HIV− individuals, but HIV+ depressed women show greater vulnerabilities in executive function. Treating depression may help to improve cognition in patients with HIV infection.
Kinetic [18F]-Fluoride of the Knee in Normal Volunteers
Authors: Haddock Bryan , Fan Audrey P. , Jørgensen Niklas R. , Suetta Charlotte , Gold Garry Evan , Kogan Feliks
Published: March 2019

Purpose

[18F]-sodium fluoride ([18F]NaF) is a well-established bone-seeking agent that has shown promise to assess bone turnover in a variety of disorders, but its distribution in healthy knee joints has not been explored. This study aimed to investigate parametric values for [18F]NaF uptake in various bone tissues types of the knee and their spatial distributions.

Methods

Twelve healthy subjects were hand-injected with 92.5 MBq of [18F]NaF and scanned on a 3-T PET/MRI system. Listmode PET data for both knees were acquired for 50 minutes from injection simultaneously with MRI Dixon and angiography data. The image-derived input function was determined from the popliteal artery. Using the Hawkins model, Patlak analysis was performed to obtainKi(Kipat) values and nonlinear regression analysis to obtainKiNLR,K1,k3/(k2+k3), and blood volume. Comparisons for the measured kinetic parameters, SUV, and SUVmax were made between tissue types (subchondral, cortical, and trabecular bone) and between regional subsections of subchondral bone.

Results

Cortical bone had the highest [18F]NaF uptake differing significantly in all measured parameters when compared with trabecular bone and significantly higher SUVmax andK1than subchondral bone. Subchondral bone also had significantly higher SUV, SUVmax, andKithan trabecular bone tissue. Regional differences were observed inK1andk3/(k2+k3) values.

Conclusions

Quantitative [18F]NaF PET is sensitive to variations in bone vascularization and metabolism in the knee joint.
68Ga-DOTA-TATE in Neuroblastoma With Marrow Involvement
Authors: Torun Nese
Published: March 2019

A 22-month-old boy diagnosed with neuroblastoma was evaluated by bone scintigraphy and 123I-metaiodobenzylguanidine scintigraphy, and no metastases to skeletal system was detected. However, plain radiograph and MRI revealed suspected metastatic lesions. The patient was therefore evaluated by 68Ga-DOTA-TATE PET/CT, and 68Ga-DOTA-TATE uptake was observed in multiple bone and bone marrow areas, which were consistent with metastases. Biopsy was taken from the right iliac bone, and the pathological examination of the biopsy specimen was coherent with neuroblastoma invasion.
Retroperitoneal Pelvic Solitary Fibrous Tumor With High Tracer Uptake in 68Ga-DOTATOC PET/CT
Authors: Thuillier Philippe , Risson Jean-Romain , Eusen Yves , Uguen Arnaud , Abgral Ronan
Published: March 2019

We report the case of a 27-year-old woman referred to our department for the characterization of a 7 × 6-cm left ischio-anal fossa mass by Ga-DOTATOC PET/CT. Several diagnoses were previously mentioned, in particular, myxoid sarcoma but also pelvic paraganglioma. Urinary methoxylated derivates and blood chromogranin A tests were negative. PET/CT showed a high Ga-DOTATOC uptake of the mass that was strongly consistent with paraganglioma diagnosis. Histopathological analysis surprisingly revealed a solitary fibrous tumor without aggressive criteria.
Beware of False-Positive FDG PET/CT Interpretations for Presacral Recurrent Rectal Cancer
Authors: Pennings Jan P. , de Haas Robbert J. , de Jong Koert P. , Dierckx Rudi A.J.O. , Kwee Thomas C.
Published: March 2019

FDG PET/CT is considered an accurate method for the detection of recurrent rectal cancer in the pelvis. Excess presacral soft tissue is found in up to half of patients after (chemo)radiation and surgery for rectal cancer, and usually represents fibrosis that is metabolically inactive. However, presacral soft tissue that is FDG avid is generally considered suspicious for recurrent cancer. Nevertheless, FDG avidity in the presacral space not uncommonly proves to be due to benign inflammatory changes, and additional MRI may be diagnostically useful, as demonstrated in the presented 2 cases.