bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating the Safety and Efficacy of Intraoperative Enteral Nutrition in Critically Ill Burn Patients: A Systematic Review and Meta-analysis
Authors: Pham Christopher H , Fang Mike , Vrouwe Sebastian Q , Kuza Catherine M , Yenikomshian Haig A , Gillenwater Justin
Published: March 2020

Major burn injuries incite a hypermetabolic response, and the initiation of early enteral nutrition is the standard of care in patients with large burns and contributes to improved outcomes. Perioperative fasting is a common cause of caloric deficits in burn patients and can be obviated with intraoperative enteral nutrition. However, the risks and benefits of this practice are unknown, and there is a concern for aspiration. We conducted a systematic review and meta-analysis to evaluate the safety and efficacy of intraoperative enteral nutrition. We performed a systematic literature search using PubMed, Scopus, and OvidSP MEDLINE databases. We identified studies that evaluated the effects of intraoperative enteral nutrition in adult burn patients compared to those undergoing routine perioperative fasting. We performed a meta-analysis on the incidence of mortality, pneumonia, wound infections, and aspiration in burn patients receiving intraoperative enteral nutrition. We identified seven articles for qualitative review and four for quantitative review (N = 83 patients). There were no statistically significant increases in the risk of mortality (odds ratio [OR] = 1.28, 95% confidence interval [CI]: 0.49, 3.31), wound infections (OR = 0.71, 95% CI: 0.16, 3.24), pneumonia (OR = 2.1, 95% CI: 0.7, 6.1), and aspiration (OR = 1.14, 95% CI: 0.07, 18.75) in patients receiving intraoperative enteral nutrition. Within individual studies, intraoperative enteral nutrition patients received significantly more calories than standard fasting patients. Intraoperative enteral nutrition may increase nutritional intake in burn patients without an increase in complications; however, this is based on limited studies. Randomized controlled trials are needed before recommendations on intraoperative enteral nutrition practice can be made.
Celiac disease: a rare cause of ‘postoperative’ ileoileal intussusception after surgical reduction of ileocolic intussusception in a toddler
Authors: Gawrieh Bardisan , Salhab Nabila , Omran Ammar , Alshehabi Zuheir , Taishori Norma , Ali Wajih
Published: March 2020

Intussusception (IS) is defined as invagination of part of the bowel into an adjacent section of the intestines and is the second most common cause of small bowel obstruction in children. Postoperative ileoileal intussusception after surgical reduction is a special type of ileoileal intussusception and is considered idiopathic. This research paper examines the case of a female Syrian toddler who had been diagnosed with ileoileal intussusception after surgical reduction. Diagnosis of celiac disease was later histopathologically confirmed. Celiac disease (CD) may be the underlying cause for special types of intussusception that may be considered idiopathic, and further investigations, such as endoscopy, should be considered.
Vibration Does Not Affect Short Term Outcomes Following Traumatic Brain Injury in a Porcine Model
Authors: Jung Andrew D , Morris Mackenzie C , Veile Rosalie , Friend Lou Ann , Stevens-Topie Sabre , Cox Daniel D , McGuire Jennifer L , Foreman Brandon , Hartings Jed A , Pritts Timothy A , Makley Amy T , Goodman Michael D
Published: March 2020

Introduction

Traumatic brain injury (TBI) has become increasingly prevalent among the injuries sustained in the military. Many wounded warriors require emergency medical evacuation via helicopter and subsequently fixed wing transport. During aeromedical evacuation, both pilots and patients experience whole body vibration due to engine, rotor, and propeller rotation. The impact of posttraumatic vibration and hypoxia exposure characteristic of the aeromedical evacuation environment on TBI is currently unknown.

Methods

A swine TBI model of controlled cortical impact was utilized. The pigs first underwent TBI or sham injury and were subsequently exposed to vibration or no vibration and hypoxia or normoxia for 2 hours. They were monitored for an additional 4 hours following vibration/hypoxia and blood was drawn at hourly intervals for cytokine and serum biomarker analysis. Continuous physiologic and neurologic monitoring were utilized. Prior to the conclusion of the experiment, the animals underwent brain magnetic resonance imaging. At the end of the study, the brain was extracted for histologic analysis.

Results

Physiologic parameters except for peripheral capillary oxygen saturation (SpO2) were similar between all groups. The hypoxia groups demonstrated the expected decrease in SpO2 and pO2 during the hypoxic period, and this was sustained throughout the study period. The pH, pCO2 and electrolytes were similar among all groups. Neuron specific enolase was increased over time in the TBI group, however it was similar to the sham TBI group at all time points. There were no differences in IL-1β, IL-6, IL-8, TNFα, GFAP, HIF1α, syndecan-1, or S100β serum levels between groups. The mean ICP during cortical impact in the TBI group was 279.8 ± 56.2 mmHg. However, the postinjury ICP was not different between groups at any subsequent time point. Brain tissue oxygenation and perfusion were similar between all groups.

Conclusion

In this novel study evaluating the effect of vibration on short-term outcomes following TBI, we demonstrate that the moderate vibration and hypoxia simulating aeromedical evacuation do not impact short term outcomes following TBI.
Orbitomeningeal Band in Transcavernous Dissection and Anterior Clinoidectomy: 3-Dimensional Operative Video
Authors: Campero Alvaro , Baldoncini Matias , Villalonga Juan F , Sáenz Amparo
Published: March 2020

The orbitomeningeal or meningo-orbital band (MOB) has been described as the most superficial dural band responsible for tethering the frontotemporal basal dura to the periorbita.
1,2
The MBO usually interferes with the surgical approach to the most profound areas of the anterior and middle skull base. It is known that there are no cranial nerves on the lateral surface of the superior orbital fissure; therefore, the neurosurgeon can cut the MOB without causing any neurological deficit and, at the same time, achieving fully exposure of the anterior clinoid process
1-4
and/or the lateral wall of the cavernous sinus.
5

The purpose of this video is to describe the microsurgical anatomy of the MOB and illustrate the technique for its detachment, accompanied by 2 illustrative cases. To achieve this, we use 3-dimensional recordings of 2 cadaveric specimens’ dissections performed by the senior author.

Case 1: 58-yr-old female with left blindness. Magnetic resonance imaging (MRI) shows an anterior and middle skull base lesion with orbital compression.

Case 2: 32-yr-old male presenting with headache and trigeminal neuralgia. The MRI revealed an hourglass-shaped lesion in the posterior and middle fossa. Both patients signed an informed consent and agree with the use of their images for research purposes.

We used a step-by-step approach for an adequate and secure dissection of the MOB highlighting the anatomic structures involved in the process. This approach allows safe and adequate access to the deeper structures of the anterior and middle skull base.
Reconstruction of smeared spectral functions from Euclidean correlation functions
Authors: Bailas Gabriela , Hashimoto Shoji , Ishikawa Tsutomu
Published: March 2020

We propose a method to reconstruct smeared spectral functions from two-point correlation functions measured on the Euclidean lattice. An arbitrary smearing function can be considered as long as it is smooth enough to allow an approximation using Chebyshev polynomials. We test the method with numerical lattice data of charmonium correlators. The method provides a framework to compare lattice calculation with experimental data including excited-state contributions without assuming quark–hadron duality.
Study of Λ-Hypernuclei with Stopped K− Reaction
Authors: Tamura Hirokazu , Hayano Ryugo S. , Outa Haruhiko , Yamazaki Toshimitsu
Published: March 2020

We summarize studies of Λ hypernuclei with stopped K− reaction carried out at KEK. The π− momentum spectra in the (stopped K−, π−) reaction were measured with light nuclear targets (4He, 7Li, 9Be, 12C and 16O). The ground and excited states of Λ4He, Λ12C and Λ16O were identified and their formation probabilities were measured. The branching ratios of π0-mesonic decay of Λ4He, Λ11B and Λ12C were measured for the first time with π0 coincidence. The lifetime of Λ4H was also determined with an improved accuracy. The π− peak intensity from Λ4H→4He+π− decay gave the Λ4H formation probabilities on these targets, where Λ4H is produced as hyperfragment except for the case of the 4He target. Concerning the formation mechanism of hyperfragments and their application to hypernuclear γ-ray spectroscopy, the running experiments and future prospects are also described.
The Titanium-coated PEEK Cage Maintains Better Bone Fusion With the Endplate Than the PEEK Cage 6 Months After PLIF Surgery
Authors: Hasegawa Tomohiko , Ushirozako Hiroki , Shigeto Ebata , Ohba Tetsuro , Oba Hiroki , Mukaiyama Keijiro , Shimizu Satoshi , Yamato Yu , Ide Koichiro , Shibata Yosuke , Ojima Toshiyuki , Takahashi Jun , Haro Hirotaka , Matsuyama Yukihiro
Published: March 2020

Study Design.

A multicenter, randomized, open-label, parallel-group trial.

Objective.

To investigate interbody bone fusion rates in titanium-coated polyetheretherketone (TiPEEK) and polyetheretherketone (PEEK) cages after posterior lumbar interbody fusion (PLIF) surgery.

Summary of Background Data.

Previous clinical studies have not revealed any significant difference in bone fusion rates between TiPEEK and PEEK cages.

Methods.

During one-level PLIF surgery, 149 patients (84 men, 65 women, mean age 67 yr) were randomly allocated to use either a TiPEEK cage (n = 69) or PEEK cage (n = 80). Blinded radiographic evaluations were performed using computed tomography and assessed by modified intention-to-treat analysis in 149 cases and per-protocol analysis in 143 cases who were followed for 12 months. Clinical outcomes were assessed using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire and the Oswestry Disability Index.

Results.

The interbody union rate at 12 months after surgery was 45% owing to a very strict definition of bone fusion. The rates of bone fusion were significantly higher at 4 and 6 months after surgery in the TiPEEK group than in the PEEK group in the unadjusted modified intention-to-treat analysis and were significantly higher at 6 months in the unadjusted per-protocol analysis. Binary logistic regression analysis adjusted for sex, age, body mass index, bone mineral density, and surgical level showed that using a TiPEEK cage (odds ratio, 2.27; 95% confidence interval: 1.09–4.74; P = 0.03) was independently associated with bone fusion at 6 months after surgery. Japanese Orthopaedic Association Back Pain Evaluation Questionnaire and Oswestry Disability Index results improved postoperatively in both groups.

Conclusion.

Using the TiPEEK cage for PLIF enabled the maintenance of better bone fusion to the endplate than using the PEEK cage at 6 months after the surgery. Our findings suggest the possibility of an earlier return to rigorous work or sports by the use of TiPEEK cage.

Level of Evidence: 1
Disk Area Is a More Reliable Measurement Than Anteroposterior Length in the Assessment of Lumbar Disk Herniations
Authors: Gupta Anmol , Upadhyaya Shivam , Yeung Caleb M. , Ostergaard Peter J. , Fogel Harold A. , Cha Thomas , Schwab Joseph , Bono Chris , Hershman Stuart
Published: March 2020

Study Design:

Retrospective study.

Objective:

The goal of this study is to identify and validate the reliability and accuracy of 2 methods used to assess lumbar disk herniations (LDHs): anteroposterior length and cross-sectional area.

Background:

Many clinicians characterize LDHs through the measurement of the anteroposterior length in the axial plane. Radiologists, on the other hand, have utilized software to measure the disk and canal areas to define the injury. In this study, the authors consider the reliability and accuracy of anteroposterior length in comparison with the area.

Methods:

Using International Classification of Diseases, 10th Revision (ICD-10) code M51.26, patients at a single academic medical center who received a diagnosis of primary lumbar radicular pain with subsequent magnetic resonance imaging documentation of a single-level disk herniation in 2015 and 2016 were identified. AGFA-IMPACS software was utilized to make the following measurements: anterior-posterior canal length; anterior-posterior disk length; mid-canal width; mid-disk width; total canal area; total disk area. Data analysis was conducted in SPSS and a 2-tailed reliability analysis using Cronbach alpha as a measure of reliability was obtained.

Results:

A total of 408 patients met the inclusion and exclusion criteria for this study. Sixteen (3.9%) had L3-L4 herniation, 208 had L4-L5 herniation (51.0%), and 184 had L5-S1 herniation (47.5%). The least reliable interobserver metrics, with respective Cronbach alpha values of 0.381 and 0.659, were the linear measurements of mid-disk width and anterior-posterior canal length. Area measurements of the disk and canal areas generated Cronbach alpha values of 0.707 and 0.863. Intraobserver Cronbach alpha values for all measurements, including all areas and lengths, met or exceeded 0.982.

Conclusions:

The cross-sectional area provides a more reliable measurement modality for diskLDHs in comparison to linear measurements. Unlike anteroposterior length, cross-sectional area incorporates the shape of a herniation or canal in its measurement. Thus, it is superior in its characterization LDH particularly in light of its stronger reproducibility.

Level of Evidence:

Level III—retrospective study.
Lumbar Percutaneous Pedicle Screw Breach Rates
Authors: Panchmatia Jaykar R. , Vaccaro Alexander R. , Wang Wenhai , Harris Jonathan A. , Bucklen Brandon S.
Published: March 2020

Study Design:

Cadaveric study.

Summary of Background Data:

Pedicle screw fixation is an established means of stabilizing the thoracic and lumbar spine. However, there are associated complications including pedicle breach which can result in neurological injury, durotomy, vascular injury, and suboptimal fixation.

Objective:

The aim of this study is to determine whether use of a navigated robotic platform results in fewer pedicle breaches and the underlying reasons for any difference in pedicle breach rates.

Materials and Methods:

Ten board-certified neuro- and orthopedic spine surgeons inserted 80 percutaneous lumbar screws in 10 unembalmed human cadavers. Forty screws were inserted using conventional fluoroscopic guidance and 40 were inserted using a navigated robotic platform. None of the participating surgeons had any prior experience with navigated robotic spine surgery. At the end of the study each screw was assessed with a computed tomography scan, plain radiographs and visual inspection to determine the presence or absence of pedicle breaches.

Results:

Forty percent (40%) of screws inserted using conventional fluoroscopic guidance breached compared with 2.5% of screws inserted with robot assistance (P=0.00005). Lateral breaches accounted for 88.2% (15/17) of all breaches. Detailed analysis revealed that the starting point of screws that breached laterally were significantly more lateral than that of the contralateral accurate screw (P=0.016). Pedicle screw diameter, length, and angulation in the transverse plane did not differ significantly between accurate screws and those that breached (P>0.05).

Conclusions:

The use of a navigated robotic platform in the present study resulted in significantly fewer pedicle breaches. This was achieved through correct starting point selection with subsequent safe pedicle screw insertion.
Development of a Web Exercise Video for Nursing Intervention in Outpatients With Low Back Pain
Authors: Park Kyung Hye , Song Mi Ryeong
Published: March 2020

The purpose of this study was to develop a Web exercise video for nursing intervention among outpatients with low back pain by applying the analysis-design-development-implementation-evaluation model to promote continuous exercise. During the analysis phase, we assessed the needs for the lower back exercise video as well as details of the current situations of the participants. Additionally, we investigated the intervention methods that the medical practitioners thought would be helpful in promoting lower back exercise. After the design and development phase, a lower back exercise video of 5 minutes 46 seconds was developed. The main contents in the video were the stretching and flexing exercises of the spine and muscles, including “One knee to chest,” “Both knees to chest,” “Hip bridge,” “Prone position to erect spine,” “Kneeling back extension,” “Kneeling, opposite arm and leg raised,” and “Sitting rotation stretch.” For the implementation and analysis phase, a pilot test was done. The lower back exercise video was posted on the Web site, and participants watched the video and exercised individually. Participants reported that they were able to use the Web video whenever required, and after following the video a few times, they grew accustomed to the practice and were able to perform it repeatedly to help strengthen the lower back. In the future, experimental research is needed to confirm the effectiveness of exercise using Web video.
Tumoral Melanosis in the Setting of Targeted Immunotherapy for Metastatic Melanoma—A Single Institutional Experience and Literature Review
Authors: Jurgens Andrea , Guru Swadha , Guo Ruifeng , Brewer Jerry , Bridges Alina , Jakub James , Comfere Nneka
Published: March 2020

Background:

Tumoral melanosis clinically resembles metastatic melanoma, occurs in the context of regressed disease, and requires evaluation to rule out underlying melanoma and metastatic disease. Histopathology demonstrates a nodular infiltrate of melanophages in the dermis, subcutaneous tissue, deep soft tissue, or lymph nodes in the absence of viable melanocytes. Recent limited reports of tumoral melanosis in the context of immunotherapy with ipilimumab (monoclonal antibody targeting CTLA-4) as well as nivolumab and pembrolizumab (humanized monoclonal antibodies against programmed death 1 receptor) highlight a unique presentation representative of treatment-related tumor regression and an association with a favorable clinical response.

Objective:

To describe our experience with tumoral melanosis in the setting of immunotherapy for metastatic melanoma and elucidate the clinical and histopathological features.

Methods:

Retrospective case series from a single tertiary care institution.

Results:

We describe 10 cases of patients with metastatic melanoma who received treatment with immunotherapy before the development of tumoral melanosis. Length of time between the initiation of therapy and the onset of tumoral melanosis ranged from 2 to 20 months with a mean time of 10 months. At the end of the follow-up period, 8 patients were classified as having a complete or partial response to treatment with immunotherapy. One patient had progression of visceral and cutaneous disease on ipilimumab despite developing tumoral melanosis, and 1 patient had yet to undergo repeat imaging. Furthermore, at the end of follow-up, 3 patients were alive with no evidence of active disease, 5 patients were alive with disease, and 1 patient was deceased, although this patient died of a cardiovascular event unrelated to his underlying melanoma. Of the patients who were classified as alive with disease, 2 patients had minimal remaining disease, and 2 patients had an almost complete response on immunotherapy with recurrence of visceral metastases after immunotherapy was discontinued. One patient developed new peritoneal and cutaneous metastases on pembrolizumab despite development of tumoral melanosis.

Conclusions:

The underlying biologic mechanisms and prognostic implications of tumoral melanosis in the setting of immunotherapy remain to be elucidated. Further prospective studies with a larger cohort and prolonged follow-up are necessary to better understand the incidence, prevalence, and oncologic outcomes in patients with tumoral melanosis who receive immunotherapy.
SOX-10 and S100 Negative Desmoplastic Melanoma: Apropos a Diagnostically Challenging Case
Authors: Kooper-Johnson Sarah , Mahalingam Meera , Loo Daniel S.
Published: March 2020

An 83-year-old man presented with a tumor of the neck, clinically consistent with an epidermal inclusion cyst. Excisional biopsy revealed a deeply infiltrating spindled cell tumor. Immunohistochemical markers for S100, SOX-10, Melan-A, HMB-45, and NK1/C3 were negative. Based on the presence of an area of lentigo maligna and the histologic pattern of the spindle cell component, a diagnosis of desmoplastic melanoma was made despite the absence of immunophenotypic evidence for melanocytic differentiation. To the best of our knowledge, the complete lack of both S100 and SOX-10 makes this tumor an unprecedented case. To avoid ruling out the diagnosis of desmoplastic melanoma prematurely, physicians should be made aware of this possible immunohistochemical profile.
Does a Subset of Localized Chronic Fibrosing Vasculitis Represent Cutaneous Manifestation of IgG4-Related Disease/a Histologic Pattern of IgG4-Related Skin Disease? A Reappraisal of an Enigmatic Pathologic Entity
Authors: Tran Tien Anh
Published: March 2020

Localized chronic fibrosing vasculitis (LCFV) is a rare cutaneous fibroinflammatory and vasculitic process of poorly defined etiology. Furthermore, controversy remains as to whether LCFV represents a primary pathologic process or a histologic pattern. The current case documents a 52-year-old male patient with a scrotal mass and clinical history of a retroperitoneal mass as well as a previously resected tumor of the right submandibular salivary gland displaying morphologic features of eosinophilic angiocentric fibrosis. Histologic examination of the resected scrotal mass revealed a tumefactive lesion characterized by focally storiform fibrosis, obliterative phlebitis, tissue infiltration by IgG4-positive plasma cells, and leukocytoclastic vasculitis. Apart from the leukocytoclastic vasculitis, the scrotal lesion demonstrated characteristic morphologic features of an IgG4-related disease (IgG4-RD). In recognition of the combined histologic findings of both LCFV and IgG4-RD in the scrotal mass, it was postulated that a subset of LCFV cases might represent cutaneous manifestations of IgG4-RD or a new histologic pattern of IgG4-related skin disease (IgG4-RSD). The literature analysis of previously reported LCFV cases appeared to lend credence to this hypothesis. Pathologists should be aware of this new histologic pattern of IgG4-RSD as judicious consideration for additional studies might potentially detect an unexpected systemic IgG4-RD in the patient, particularly in cases of LCFV displaying storiform fibrosis associated with plasma cell infiltrate.
A Clinicopathological Study of 29 Spitzoid Melanocytic Lesions With ALK Fusions, Including Novel Fusion Variants, Accompanied by Fluorescence In Situ Hybridization Analysis for Chromosomal Copy Number Changes, and Both TERT Promoter and Next-Generation Sequencing Mutation Analysis
Authors: Kastnerova Liubov , Martinek Petr , Grossmann Petr , Steiner Petr , Vanecek Tomas , Kyclova Jitka , Ferak Ivan , Zalud Radim , Slehobr Ondrej , Svajdler Peter , Sulc Miroslav , Bradamante Mirna , Banik Martin , Hadravsky Ladislav , Sticova Eva , Hajkova Veronika , Ptakova Nikola , Michal Michal , Kazakov Dmitry V.
Published: March 2020

ALK-fused spitzoid neoplasms represent a distinctive group of melanocytic lesions. To date, few studies addressed genetic and chromosomal alterations in these lesions beyond theALKrearrangements. Our objective was to study genetic alterations, includingALKgene fusions,telomerase reverse transcriptasepromoter (TERT-p) mutations, chromosomal copy number changes, and mutations in other genes. We investigated 29 cases of Spitz lesions (11 Spitz nevi and 18 atypical Spitz tumors), all of which were ALK immunopositive. There were 16 female and 13 male patients, with age ranging from 1 to 43 years (mean, 18.4 years). The most common location was the lower extremity. Microscopically, all neoplasms were polypoid or dome shaped with a plexiform, predominantly dermally located proliferation of fusiform to spindled melanocytes with mild to moderate pleomorphism. The break-apart test forALKwas positive in 17 of 19 studied cases.ALKfusions were detected in 23 of 26 analyzable cases by Archer FusionPlex Solid Tumor Kit. In addition to the previously described rearrangements, 3 novel fusions, namely,KANK1-ALK,MYO5A-ALK, andEEF2-ALK, were found. Fluorescence in situ hybridization for copy number changes yielded one case with the loss ofRREB1among 21 studied cases.TERT-p hotspot mutation was found in 1 of 23 lesions. The mutation analysis of 271 cancer-related genes using Human Comprehensive Cancer Panel was performed in 4 cases and identified in each case mutations in several genes with unknown significance, except for a pathogenic variant in theBLMgene. Our study confirms that mostALKfusion spitzoid neoplasms can be classified as atypical Spitz tumors, which occurs in young patients with acral predilection and extends the spectrum ofALKfusions in spitzoid lesions, including 3 hitherto unreported fusions.TERT-p mutations and chromosomal copy number changes involving 6p25 (RRB1), 11q13 (CCND1), 6p23 (MYB), 9p21 (CDKN2A), and 8q24 (MYC) are rare in these lesions. The significance of mutation in other genes remains unknown.
MACULAR HOLE CLOSURE WITH TOPICAL STEROIDS
Authors: Bonnell Alyssa C. , Prenner Sofia , Weinstein Max S. , Fine Howard F.
Published: March 2020

Background and objective:

To report the outcomes of topical difluprednate 0.05% use in the closure of full-thickness macular holes.

Patients and methods:

Retrospective chart review of 4 patients with full-thickness macular holes who received difluprednate drops 4 times daily for a minimum of 12 weeks. Main outcome measures were macular hole status assessed with optical coherence tomography, visual acuity, intraocular pressure, and complications of treatment.

Results:

All patients had macular hole closure within 12 weeks of difluprednate exposure. Mean time to macular hole closure was 5 weeks (range, 2–12 weeks). Visual acuity improved with macular hole closure. Average baseline visual acuity was 20/42. Average visual acuity after macular hole closure was 20/26 (P = 0.14). Two patients experienced increased intraocular pressure with topical steroid use.

Conclusion:

Exposure to difluprednate in this cohort of patients with full-thickness macular holes was associated with reduced macular edema, macular hole closure, and visual improvement.
Safety of the Polish BCG-10 Vaccine During a Period of BCG Vaccine Shortage: An Australian Experience
Authors: Wong Nicole X. , Buttery Jim , McMinn Alissa , Azhar Zainul , Crawford Nigel W.
Published: March 2020

Bacille Calmete-Guerin vaccine is widely administered to reduce the risk of severe tuberculosis disease in children. Recent global vaccine supply issues have led to the use of alternative products, which may vary in side effect profile. We report on the safety of the Polish (Moreau strain) “Bacille Calmete-Guerin-10” vaccine in an Australian cohort. Using active surveillance, we identified an adverse event rate of 54.6 per 10,000 doses (95% confidence interval: 38.5–75.2), which was comparable to that reported with the Danish Sanofi-Pasteur and Connaught strains.
Digoxin lowers the incidence of prostate cancer: A nationwide population-based study
Authors: Lin Tzu-Ping , Fan Yu-Hua , Chen Yu-Chun , Huang William J.S.
Published: March 2020

Background:

In vitro studies have confirmed that cardiac glycosides can induce apoptosis in both hormone-dependent and -independent prostate cancer (PCa) cell lines. The aim of this study was to investigate the incidence of PCa among patients treated with and without digoxin using a nationwide population-based database in Taiwan.

Methods:

We retrieved data of men aged 30 years or older who were newly diagnosed with heart failure between January 1998 and December 2003 from the National Health Insurance program database in Taiwan. We divided the patients into digoxin users and non-digoxin users. Kaplan-Meier curves and Cox proportional hazard analysis were used to examine the risk of subsequent PCa between the digoxin and non-digoxin groups.

Results:

The mean ± SD follow-up (years) periods in the digoxin and non-digoxin groups were 8.6 ± 1.78 and 8.3 ± 1.75, respectively. The cumulative incidence of PCa during the follow-up period was 3.5% (147/4233) in the non-digoxin group compared with 3.0% (65/2154) in the digoxin group. The log-rank test revealed that the digoxin group had a similar incidence of PCa to the non-digoxin group (p = 0.18). After adjusting for age, benign prostatic hyperplasia, and comorbidities, Cox proportional hazard regression analysis showed that digoxin was associated with a significantly decreased risk of developing PCa (hazard ratio, 0.74; 95% CI, 0.548-0.993; p = 0.045). Moreover, logistic regression analysis showed that the risk of PCa decreased with a longer duration of digoxin use during the study period compared to those who had never used digoxin (p = 0.043).

Conclusion:

The cardiac glycoside digoxin had significant effects on reducing the incidence of PCa in a time-dependent manner. Our findings may imply the potential application of cardiac glycosides in the prevention and management of PCa.
Association Between Work Absence and Health Services Utilization and Costs Among Employed Individuals With Arthritis
Authors: Salkar Monika , Gangan Nilesh , Yang Yi
Published: March 2020

Objective:

To evaluate whether work absence is associated with increased health services utilization and health care costs among employed individuals with arthritis.

Methods:

This was a retrospective cross-sectional study using pooled data from the 2011 to 2015 Medical Expenditure Panel Survey (MEPS). Employed individuals with arthritis were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9) codes and Clinical Classification code. Generalized linear models were used to analyze utilization and costs outcomes.

Results:

Individuals with arthritis who reported work absences had greater odds of having a hospitalization event (odds ratio [OR]: 9.198,P < 0.001), higher number of ambulatory care visits (β = 0.549,P < 0.001), and had higher total health care costs (β = 0.40,P < 0.001) and arthritis-related costs (β = 0.035,P < 0.0002) compared with individuals without work absences.

Conclusion:

Among employed individuals with arthritis, self-reported work absence is associated with significantly higher health care utilization and health care costs.
Genomics, Epigenetics, and Hearing Loss in Neurofibromatosis Type 2
Authors: Dinh Christine T. , Nisenbaum Eric , Chyou Darius , Misztal Carly , Yan Denise , Mittal Rahul , Young Juan , Tekin Mustafa , Telischi Fred , Fernandez-Valle Cristina , Liu Xue-Zhong
Published: March 2020

Objectives:

In this review, we discuss current knowledge about the genetics and epigenetics of vestibular schwannoma (VS) in relation to hearing loss. A multistep and sequential genetic algorithm suitable for the identification of Neurofibromatosis Type 2 (NF2) constitutional and somatic mutations is discussed.

Data Sources, Study Selection:

A review was performed of the English literature from 1990 to 2019 using PubMed regarding genetics and epigenetics of vestibular schwannoma and NF2.

Conclusion:

NF2 is a genetic disorder characterized byNF2mutations that affect the function of a tumor suppressor called merlin. In particular, individuals with NF2 develop bilateral VS that can lead to hearing loss and even deafness. Recent advances in genetic and epigenetic studies have improved our understanding of the genotype–phenotype relationships that affect hearing in NF2 patients. Specific constitutionalNF2mutations including particular truncating, deletion, and missense mutations have been associated with poorer hearing outcomes and more severe clinical manifestations. Epigenetic events, such as DNA methylation and histone modifications, also contribute to the development and progression of hearing loss in NF2 patients. Furthermore, the accumulation of multiple NF2 and non-NF2 genetic and epigenetic abnormalities at the level of the tumor may contribute to worse hearing outcomes. Understanding genetic and epigenetic signatures in individual NF2 patients and particularly in each VS will allow us to develop novel gene therapies and precision medicine algorithms to preserve hearing in NF2 individuals.
Slim, Modiolar Cochlear Implant Electrode: Melbourne Experience and Comparison With the Contour Perimodiolar Electrode
Authors: Shaul Chanan , Weder Stefan , Tari Sylvia , Gerard Jean-Marc , O’Leary Stephen J. , Briggs Robert J.
Published: March 2020

Objective:

To describe the tip fold over rate, scalar localization, and speech perception outcomes of the CI532 Slim Modiolar Electrode.

Patients and Intervention:

All patients receiving the CI532 implant before June 2018.

Main Outcome Measures:

Outcome measures for adults patients include pre- and postoperative speech perception, operative report details, electrode position as determined by X-ray and cone beam computed tomography. Comparison made with previous experience with the Contour perimodiolar electrode (CI512). In the pediatric population tip fold-over rate, measured by intraoperative X-ray, was the exclusive outcome.

Results:

One hundred twenty-five CI532 devices were implanted in adults and 69 in children. Electrode tip fold-over occurred in eight adults cases and none among children (4.1%). Cone beam CT scans of 120 out of 125 adult patients confirmed scala tympani (ST) position in all but one case where the electrode had been placed into scala vestibuli. There were no translocations from ST to scala vestibuli. This compares favorably with the CI512 translocation rate of 17%. Speech perception outcomes demonstrated good performance with mean preop phoneme scores of 16.2% (±13) increasing to 64.2% (±14) and 71.6 (±16) 3 and 12-months postop, respectively. Compared with a matched group of CI512 recipients, CI532 recipient phoneme scores were significantly higher 3 and 12-months postop by 4 and 7%, respectively.

Conclusion:

The slim modiolar, CI532 electrode has provided very reliable ST position with a low rate of tip fold over. A trend toward better speech perception scores in CI532 compared with CI512 was observed.
Can Benign Paroxysmal Positional Vertigo Be Treated in a One Session?
Authors: Pérez-Guillén Vanesa , Franco-Gutiérrez Virginia , Aguilar Maria Teresa Gil- , Zamora Enrique García- , Pérez-Vázquez Paz
Published: March 2020

Objective:

To determine the reliability and safety of posterior canal BPPV (pc-BPPV) treatment with subsequent assessment of the effectiveness of the maneuver in a single session, compared to the classic weekly procedure.

Method:

A prospective study of two randomized groups of unilateral pc-BPPV was performed: a weekly management group (27 patients) and single-session treatment group (26 patients). The number of maneuvers required to clear pc-BPPV, incidence of side effects (re-entries and canal conversions), and recurrence rates were compared.

Results:

There were no statistically significant differences in the number of maneuvers needed to resolve pc-BPPV, the incidence of side effects, or the recurrence rate between the two groups. Two re-entries were diagnosed in the single-session group, and both were easily and successfully treated. Three early recurrences were found in the single-session group and one spontaneous recovery was encountered in the weekly group. Time required to discharge patients to follow-up was significantly reduced in the single-session group.

Conclusion:

Managing pc-BPPV in one session is safe and reliable, resulting in fewer visits to outpatient clinics and optimization of treatment strategies.
Clinical and radiological comparison of 2 level anterior lumbar interbody fusion with posterolateral fusion and percutaneous pedicle screw in elderly patients with osteoporosis
Authors: Lee Dong Geun , Park Choon Keun , Lee Dong Chan
Published: March 2020

Retrospective observational cohort study.

We used observational measures and retrospective chart reviews to compare elderly patients with osteoporosis who underwent multi-level anterior lumbar interbody fusion (ALIF) with either posterolateral fusion (PLF) or percutaneous pedicle screw fixation.

Multi-level ALIF with PLF is used to save the posterior element of the spine and improve fusion rates in elderly patients with osteoporosis. To minimize perioperative invasiveness and improve patients’ postoperative quality of life, we perform minimal percutaneous screw fixation.

Fifty-three elderly patients with osteoporosis who underwent either PLF with open pedicle screw fixation (n = 28) or percutaneous pedicle screw fixation (PPF) (n = 25) for treatment with 2-level ALIF between January 2010 and December 2013 were compared for clinical outcome including operation time, intraoperative and postoperative blood loss, and hospital day and radiological outcome.

Average operation times were significantly shorter and intra- and postoperative blood loss was significantly reduced in the PPF group. There were no significant differences, preoperative and postoperative, in observational measures including visual analog scale, Oswestry disability index, and Rolland-Moris disability. There were no significant differences in the degree of lordosis, changes of motion, or adjacent segmental degeneration. Fusion rates were increased in the PLF group compared to the PPF group 6 months post-surgery, but from 1 year to the last follow-up, the rates were statistically equivalent. There were fewer minor complications in the PPF group, and no major complications at all.

Two-level ALIF with PPF results in shorter operation times, less blood loss and minor complications, and similar fusion rate as 2-level ALIF with PLF. It; therefore, represents an effective method, leading to rapid recovery and less complications in elderly patients with osteoporosis.
Mid-term outcomes of bioresorbable vascular scaffolds vs second-generation drug-eluting stents in patients with acute coronary syndromes
Authors: Ke Junsong , Zhang Hongyu , Huang Jun , Lv Ping , Yan Jumei
Published: March 2020

Background:

Everolimus-eluting bioresorbable vascular scaffolds (BVS), which have the characteristics of scaffold absorption and vascular function recovery, are the latest innovation in the treatment of coronary artery disease. This new concept has become a hot topic in the field of interventional cardiology. Data regarding mid-term clinical outcomes of BVS in acute coronary syndromes are currently scarce. The aim of this systematic review and meta-analysis is to compare mid-term outcome data for BVS and second-generation drug-eluting stents (DES) in the treatment of acute coronary syndromes.

Methods:

We searched PubMed, Embase, the Cochrane Library, Web of Science, and relevant web sites for studies with a follow-up of ≥ 1 years that studied percutaneous coronary interventions with BVS vs second-generation DES in acute coronary syndromes. A meta-analysis was performed with the software RevMan following the standards of the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0.

Results:

Five studies, 2 randomized controlled trials, and 3 observational studies, with a total of 1758 patients (BVS n = 917; DES n = 841) and a median follow-up duration of 24 months, were included. BVS, when compared with DES, resulted in higher rates of target lesion revascularization (TLR) (OR, 2.20; 95% CI, 1.12–3.64; P = .02) and stent/scaffold thrombosis (ST/ScT) (OR = 2.35, 95% CI: 1.13–4.89, P = .02). When TLR due to device thrombosis were excluded, the difference in risk estimates between the 2 groups was no longer significant (OR: 1.67, 95% CI: 0.73–3.82, P = .22). The risk for all-cause death (OR = 1.32 95% CI: 0.61–2.88, P = .48), cardiac death (OR = 1.29, 95% CI: 0.58–2.86 P = .52), target vessel myocardial infarction (OR = 1.50, 95% CI: 0.86–2.61, P = .15), and target lesion failure (OR = 1.34, 95% CI: 0.76–2.35, P = .31) did not differ between BVS and DES groups.

Conclusion:

At mid-term follow-up, BVS had a higher risk of TLR and ST/ScT than the second-generation DES in patients with acute coronary syndromes. ST/ScT was the key factor indicating the decreased safety and effectiveness of BVS relative to DES.
Clinical study on the safety and efficacy of high-dose tigecycline in the elderly patients with multidrug-resistant bacterial infections
Authors: Xia Guolian , Jiang Ronglin
Published: March 2020

Multidrug-resistant bacterial (MDRB) infections have been difficult to treat clinically. Tigecycline (TIG) has several advantages, especially in the treatment of severe infections. Many clinicians have considered increasing the TIG dose to improve the efficacy of this molecule. The safety and efficacy of high-dose TIG in elderly patients with MDRB infections were investigated in this study.

We conducted a retrospective analysis of the elderly patients with MDRB infections who were treated at the First Affiliated Hospital. A total of 106 patients received a conventional dose (CD-TIG group: 50 mg every 12 hours) of TIG and 51 received a high dose (HD-TIG group: 100 mg every 12 hours). The data from all patients were collected for examining the clinical features and performing the microbiological analysis. The safety profile and efficacy of the HD regimen were investigated.

The clinical efficacy and microbiological eradication in the patients with MDRB infection were higher in the HD-TIG group than the CD-TIG group. The independent predictors of clinical cure were the use of TIG at HD (odd ratio [OR], 5.129; 95% confidence interval [CI] [1.890, 13.921]; P = .001) and microbiological eradication (OR, 3.049; 95% CI, [1.251, 7.430]; P = .014). In the ventilator-associated pneumonia (VAP) and bloodstream infection (BSI) subgroups, the sole independent predictor of clinical cure was the HD of TIG, and no significant adverse events were observed. The occurrence of multidrug-resistant Acinetobacter baumannii infection and an MIC value of 1 to 2 g/mL for TIG were independently associated with clinical failure in the VAP subgroup.

HDs of TIG was found to associate with better clinical efficacy and microbiological eradication than its CDs in the elderly patients with MDRB infections. In the VAP and BSIs subgroups, administration of HDs of TIG was associated with better outcomes.
Blumgart method using LAPRA-TY clips facilitates pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy
Authors: Nagakawa Yuichi , Takishita Chie , Hijikata Yosuke , Osakabe Hiroaki , Nishino Hitoe , Akashi Masanori , Nakajima Tetsushi , Shirota Tomoki , Sahara Yatsuka , Hosokawa Yuichi , Ishizaki Tetsuo , Katsumata Kenji , Tsuchida Akihiko
Published: March 2020

The modified Blumgart method for pancreaticojejunostomy has been shown to reduce the rate of postoperative pancreatic fistula (POPF) in open surgery. We describe a modified Blumgart method using LAPRA-TY suture clips to facilitate laparoscopic pancreaticojejunostomy.

We prepared a double-armed 4-0 nonabsorbable monofilament, which was ligated using the LAPRA-TY clip at the tail end, 12-cm in length. Next, the U-suture was placed through the pancreatic stump and the seromuscular layer of the jejunum. We performed duct-to-mucosa suturing with a 5-0 absorbable monofilament. After completing the duct-to-mucosa suturing, as a final step we placed the sutures through the seromuscular layer of the jejunum on the ventral side and tightly secured the thread with the LAPRA-TY clips. We performed laparoscopic Blumgart pancreaticojejunostomy during pancreaticoduodenectomy in 39 patients. We compared the surgical outcomes of 19 patients who underwent Blumgart pancreaticojejunostomy using the LAPRA-TY clips (LAPRA-TY group) with 20 patients undergoing surgery not using the LAPRA-TY clips (conventional group).

The rate of clinically relevant postoperative pancreatic fistula in the LAPRA-TY group was 21.1%, which did not differ significantly from the rate of the conventional group. However, the mean time of pancreaticojejunostomy in the LAPRA-TY group was 56.2 min (range, 39–79 min), which was significantly shorter than that of the conventional group (69.7 min; range, 53–105 min, P < .001).

Although the modified Blumgart pancreaticojejunostomy using LAPRA-TY suture clips did not improve the pancreatic fistula rate, it allowed for shorter operative times. Thus, this procedure lends itself to positive surgical and patient outcomes.
Preventive Health Care Utilization Among Mother-infant Dyads With Medicaid Insurance in the Year Following Birth
Authors: Gregory Emily F. , Passarella Molly , Levine Lisa D. , Fiks Alexader G. , Lorch Scott A.
Published: March 2020

Background:

Following birth, women may access preventive care in adult settings or, with their infants, in pediatric settings. Preventive care can improve future birth outcomes and long-term health, particularly for women with health risks.

Methods:

This cohort study linked mother-infant Medicaid claims from 12 states for 2007–2011 births. Pregnancy claims identified health risk categories: maternal cardiovascular (diabetes, hypertension, pre-eclampsia, obesity), maternal mental health (depression, anxiety), and premature birth. Claims for 1 year following birth identified adult and pediatric preventive visits. Logistic regression assessed the relationship between visits and risks, adjusting for maternal demographics, perinatal health care utilization, year, and state.

Results:

Of 594,888 mother-infant dyads with Medicaid eligibility for 1 year following birth, 36% had health risks. In total, 38% of all dyads, and 33% with health risks, had no adult preventive visits. Dyads had a median of 1 (IQR, 0–2) adult and 3 (IQR, 2–5) pediatric preventive visits. A total of 72% of dyads had more preventive visits in pediatric than adult settings. In regression, preterm birth was associated with lower odds of any adult preventive visits [odds ratio (OR), 0.97; 95% confidence interval (CI), 0.95–0.99], and maternal health risks with higher odds (cardiovascular OR, 1.19; 95% CI, 1.18–1.21; mental health OR, 1.87; 95% CI, 1.84–1.91), compared with dyads without risk.

Conclusions:

Maternal health risks were associated with increased adult preventive visits, but 38% of dyads had no adult preventive visits in the year following birth. Most dyads had more opportunities for preventive care in pediatric settings than adult settings.
Neonatal Autoimmune Lymphoproliferative Syndrome: A Case Report and A Brief Review
Authors: Chandramati Jayasree , Sidharthan Neeraj , Ponthenkandath Sasidharan
Published: March 2020

The authors are reporting a case of autoimmune lymphoproliferative syndrome in a newborn who presented with massive hepatosplenomegaly, thrombocytopenia, and anemia at birth. Antenatal ultrasound revealed a fetus with hepatosplenomegaly. The infant was treated with steroids and sirolimus and is doing well at 4 years of age. This is the first case report of autoimmune lymphoproliferative syndrome presenting as hepatosplenomegaly during fetal life.
Lessons Learned in Implementation of an Expert Nurse Mentor Program
Authors: Kennedy Julie A. , Jenkins Sheryl H. , Novotny Nancy L. , Astroth Kim M. , Woith Wendy M.
Published: March 2020

Experienced critical care nurses have the expertise to respond quickly and appropriately in emergency situations. New graduate nurses, however, typically lack this expertise and may benefit from mentoring as they learn to manage rapidly deteriorating patients. The purpose of this article is to describe the lessons learned during implementation of an Expert Nurse Mentor Program. Nurse educators may benefit from this information as they strive to establish and maintain mentoring programs.