bluuebunny/crossref_metadata_2025 huggingface dataset:
Mechanical Aspects of Intervertebral Disc Injury and Implications on Biomechanics
Authors: Desmoulin Geoffrey Thor , Pradhan Vikram , Milner Theodore Edgar
Published: October 2019

Study Design.

This article comprises a review of the literature.

Objective.

The purpose of this study was to elucidate the different types of structural failures exhibited in intervertebral discs (IVDs), summarize their potential causes with respect to mechanical loading conditions and the consequences on cell homeostasis and biomechanics.

Summary of Background Data.

Many studies have been performed to gain insight into how discogenic back pain progresses in humans both in vitro and in vivo as well as in animal disc models. However, there is a major need to summarize the common factors which initiate the structural failures observed in IVDs and the typical biomechanical changes. This work could help in developing mechanisms aiming to restore the biochemical and biomechanical balance of IVDs.

Methods.

The different types of structural failures encountered in IVDs were reviewed from published literature. The types of mechanical loading causing these injuries and their physiological and biomechanical consequences were then summarized and linked to ongoing research in this area.

Results.

The most prominent structural failures associated with IVDs are annulus tears, disc prolapse, endplate damage, disc narrowing, radial bulging, and osteophyte formation in the vertebrae. IVDs were found to be vulnerable to compression, flexion, axial rotation, and complex loading mechanisms through single impact, cyclical, and continuous loading. However, chronic loadings had a more damaging impact on the spine. Significant consequences include imbalance of metabolic enzymes and growth factors, alteration in stress profiles of IVDs and a decrease in mechanical stiffness resulting in impaired biomechanics of the spine.

Conclusion.

The mode of loading has an important impact on the severity and nature of failures seen in IVDs and the resulting consequences to biomechanics. However, further research is necessary to better understand to the mechanisms that link injury to degeneration and regeneration of IVD tissues.

Level of Evidence: 3
Gender-Associated Differences in Sacral Morphology Do Not Affect Feasibility Rates of Transsacral Screw Insertion. Radioanatomic Investigation Based on Pelvic Cross-sectional Imaging of 200 Individuals
Authors: Balling Horst
Published: October 2019

Study Design.

Retrospective radioanatomic single-center cohort study.

Objective.

To investigate sex-specific differences in transsacral corridor dimensions, determine feasibility rates of transsacral screw placement without extended safety zones around planned screw positions, and develop an index defining sacral dysmorphism (SD) irrespective of transsacral corridor diameters.

Summary of Background Data.

Previously reported SD definitions used radiologically identifiable pelvic characteristics or predefined minimum diameter thresholds of transsacral corridors in the upper sacral segment including safety zones for screw placement. Technical progress of surgical 3D image guidance improved sacral screw insertion accuracy questioning established minimum diameter threshold–based SD definitions.

Methods.

Datasets from cross-sectional pelvic imaging of 100 women and 100 men presenting to a general hospital from July 2018 through August 2018 were included in a database to evaluate transsacral trajectory rates, and dimensions of transsacral corridor lengths, widths (TSCWs), and heights (TSCHs) in sacral segments I to III (S1–3). SD was assumed, if no transsacral trajectory was found in S1 with a corridor diameter of at least 7.5 mm.

Results.

Women presented significantly higher rates of transsacral trajectories in the inferior sector of S1 (P = 0.03), and larger transsacral corridor lengths in S2 (superior sector, P = 0.045), and S3 (central position, P = 0.02). In men, significantly higher feasibility rates were found for the placement of two transsacral screws in S2 (P = 0.0002), and singular screws in S3 (P = 0.006), with larger S1- (P = 0.0002), and central S2-TSCWs (P = 0.006). SD was prevalent in 17% of women, and 16% of men (P = 0.85). Calculating TSCW ratios of S1 and S2 was significantly indicative for SD at values below a threshold of 0.8 in women (P < 0.00001), and men (P = 0.0004).

Conclusion.

SD is independent of sex despite significant differences in sacral morphology. An index defining SD irrespective of absolute transsacral corridor dimensions is presented to reliably differentiate dysmorphic from nondysmorphic sacra in women and men.

Level of Evidence: 2
Differences Between Mothers' and Fathers' Perception of Their Adolescents' Pain Before and After Parent Training Through The Comfort Ability Pain Management Program
Authors: Donado Carolina , Turrisi Taylor , Wihak Tessa , Coakley Rachael B.
Published: October 2019

Objective:

To evaluate differences in how mothers and fathers perceive and respond to their adolescents' chronic pain before and after The Comfort Ability Program (CAP), a 1-day cognitive-behavioral intervention, and to compare outcomes between mother-father dyads and mothers who attended the intervention alone.

Methods:

Parents completed the Pain Catastrophizing Scale (PCS) and Helping for Health Inventory (HHI) at baseline (preintervention) and at 1 week, 1 month, and 3 months after intervention. Confirmatory factor analyses evaluated construct validity and invariances of the scales. Paired t tests compared scores between mothers and fathers. Unpaired t tests compared mother-father dyads (n = 33) and mothers who attended the intervention alone (n = 73).

Results:

PCS baseline showed significant construct instability between maternal and paternal interpretations. However, 1 week after intervention, construct stability improved between parents. On the PCS and HHI, in which lower scores represent more adaptive parenting behaviors, fathers scored significantly lower than mothers at baseline (PCS: 22.6 [7.7] vs 28.0 [11.4], p value = 0.033; HHI: 16.0 [8.1] vs 20.6 [9.6], p value = 0.029). At 3 months after intervention, PCS scores for both mothers and fathers significantly decreased from baseline (mothers: p value = 0.009; fathers: p value = 0.052) and converged (mothers: 18.6 [11.2] vs fathers: 18.3 [13.2]; p value = 0.786). Mother and father HHI scores were significantly lower at 3 months than baseline (mothers: 13.2 [9.5], p value = 0.005; fathers: 15.0 [12.7], p value = 0.017), although improvement of construct stability between parents was less evident.

Conclusion:

Findings suggest that mothers and fathers may differentially perceive and respond to their adolescents' pain and that CAP parent-training intervention may help align their thinking. The results further demonstrate that both parents make adaptive changes after intervention, reinforcing the value of including both parents in pediatric treatment for chronic pain.
Q Fever and Kingella kingae Endocarditis in a Toddler: A Rare Coinfection Case
Authors: Kagan Shelly , Levy Itzhak , Ashkenazi-Hoffnung Liat , Lowenthal Alex , Goldstein Robert E. , Landau Daniel , Scheuerman Oded
Published: October 2019

A toddler after tetralogy of Fallot graft repair in infancy was diagnosed with endocarditis. Blood cultures were positive for Kingella kingae and serology was positive Coxiella burnetii. He was treated medically and surgically. A postoperative specimen polymerase chain reaction confirmed a coinfection. A comprehensive patient history was imperative for identification of an unlikely infection at this age.
Assessing the content specificity of interpretation biases in community adolescents with persistent and interfering pain
Authors: Lau Jennifer Y.F. , Badaoui Maryam , Meehan Alan J. , Heathcote Lauren C. , Barker Edward D. , Rimes Katharine A.
Published: October 2019

The tendency to select threatening over benign interpretations of ambiguous bodily sensations and cues characterises young people with chronic pain. However, previous studies disagree over whether these biases extend to nonbodily harm situations such as social evaluation. Understanding the content of these biases is crucial to the development of pain management strategies seeking to modify such biases. Two hundred forty-three young people aged 16 to 19 years completed an expanded version of the Adolescent Interpretation of Bodily Threat task. Using a factor-analytic approach, we removed items that did not consistently associate with bodily harm or social evaluation. Next, we examined whether the variance underlying negative and benign interpretations of bodily harm and social evaluation situations were best represented as a common factor (ie, one-factor model), 2 distinct factors (ie, 2-factor model), or one common and 2 distinct factors (ie, 2-factor bifactor model) in all adolescents. We then compared youth with and without persistent and impairing pain on factor scores derived from the best-fitting model. Although negative interpretations of bodily harm and social evaluation situations emerged as distinct factors, benign interpretations across situations were best captured by a common factor and 2 situation-specific factors (ie, bifactor model). Group comparisons showed that young people with moderate-to-high pain interference were more likely to endorse negative interpretations across all situations, and less likely to manifest a general benign interpretational style, than youth without interfering pain, although some of these group differences were explained by co-occurring anxiety and depressive symptoms. Replication of these findings is needed.
A somatosensory cortex input to the caudal dorsolateral striatum controls comorbid anxiety in persistent pain
Authors: Jin Yan , Meng Qian , Mei Lisheng , Zhou Wenjie , Zhu Xia , Mao Yu , Xie Wen , Zhang Xulai , Luo Min-Hua , Tao Wenjuan , Wang Haitao , Li Jie , Li Juan , Li Xiangyao , Zhang Zhi
Published: October 2019

Chronic pain and anxiety symptoms are frequently encountered clinically, but the neural circuit mechanisms underlying the comorbid anxiety symptoms in pain (CASP) in context of chronic pain remain unclear. Using viral neuronal tracing in mice, we identified a previously unknown pathway whereby glutamatergic neurons from layer 5 of the hindlimb primary somatosensory cortex (S1) (GluS1), a well-known brain region involved in pain processing, project to GABAergic neurons in the caudal dorsolateral striatum (GABAcDLS). In a persistent inflammatory pain model induced by complete Freund's adjuvant injection, enhanced excitation of the GluS1→GABAcDLS pathway was found in mice exhibiting CASP. Reversing this pathway using chemogenetic or optogenetic approaches alleviated CASP. In addition, the optical activation of GluS1 terminals in the cDLS produced anxiety-like behaviors in naive mice. Overall, the current study demonstrates the putative importance of a novel GluS1→GABAcDLS pathway in controlling at least some aspects of CASP.
Characteristics of Physician Assistant Students Planning to Work in Primary Care: A National Study
Authors: Larson Eric H. , Frogner Bianca K.
Published: October 2019

Purpose

While the number of physician assistants (PAs) participating in the primary care workforce continues to rise, the proportion of PAs practicing in primary care rather than other specialties has decreased. The purpose of this study was to identify the characteristics of matriculating PA students planning to enter primary care specialties and compare them with students planning on entering other specialties.

Methods

Data from the Physician Assistant Education Association Matriculating Student Survey (MSS) from 2013 and 2014 were analyzed. In a series of bivariate analyses, demographic characteristics, educational backgrounds, clinical experiences, and practice expectations of students intending to enter primary care practice were compared with those of their counterparts who did not intend to enter primary care. Logistic regression was used to assess the overall importance of demographic, background, and practice expectations variables on practice intentions.

Results

A total of 9283 students responded to the MSS from 2013 and 2014. More than half (58.3%) stated an intention to practice in primary care upon graduation. Those students were more likely than their counterparts to be married, to be Hispanic or Asian, and to have participated in community service prior to starting PA training. They were also less likely to view high income as essential to their careers and more likely to view practicing in rural or underserved areas favorably.

Conclusions

The findings of this study could be used to identify student characteristics associated with an interest in primary care and could contribute to more successful student recruitment and PA curriculum design, especially for PA training programs with a mission focused on producing primary care PAs.
Benign Paroxysmal Positional Vertigo in the Elderly: A Single-center Experience
Authors: Nahm HyunJoo , Han Kyujin , Shin Jung Eun , Kim Chang-Hee
Published: October 2019

Objectives:

Dizziness and balance problems are common in the elderly, and benign paroxysmal positional vertigo (BPPV) is one of the most common causes of dizziness. The aim of this study is to investigate the subtype distribution of geriatric BPPV in a single tertiary referral center, and compare the treatment efficacy according to the subtype of BPPV.

Study Design:

Retrospective study.

Setting:

Tertiary referral academic center.

Patients:

The consecutive 316 elderly patients diagnosed with BPPV between March 2013 and March 2019 were included.

Main Outcome Measures:

Using a head-roll and Dix-Hallpike tests, subtype of BPPV was determined. Once the diagnosis of BPPV was made, patients were treated by its corresponding canalith repositioning maneuver (CRM).

Results:

Among 316 elderly patients with BPPV, 143 patients (45%) were diagnosed with posterior semicircular canal BPPV, 46 patients (15%) were diagnosed with lateral semicircular canal (LSCC) canalolithiasis, 126 patients (40%) were diagnosed with LSCC cupulolithiasis, and 1 patient (0%) was diagnosed with anterior semicircular canal BPPV. While 66 and 63% of the patients with posterior semicircular canal BPPV and LSCC canalolithiasis recovered after one session of CRM, only 32% of the patients with LSCC cupulolithiasis recovered after one session of CRM.

Conclusion:

The proportion of LSCC cupulolithiasis was higher in the elderly, and treatment efficacy by CRM is lower in LSCC cupulolithiasis than other subtypes of BPPV. High prevalence of LSCC cupulolithiasis may be explained by a delay between onset of BPPV and patient's presentation to the tertiary referral hospital or pathophysiology of ageotropic positional nystagmus other than otoconial attachment on the LSCC cupula in the elderly.
Rate of Initial Hearing Loss During Early Observation Predicts Time to Non-Serviceable Hearing in Patients With Conservatively Managed Sporadic Vestibular Schwannoma
Authors: Carlson Matthew L. , Dowling Eric M. , Lohse Christine M. , O’Connell Brendan P. , Driscoll Colin L. W. , Haynes David S. , Link Michael J. , Hunter Jacob B.
Published: October 2019

Objective:

To date, prediction models for estimating risk of acquiring non-serviceable hearing in subjects with observed vestibular schwannoma (VS) have evaluated outcomes primarily based on features at initial diagnosis. Herein, we evaluate the association of rate of hearing decline during the initial period of observation with time to non-serviceable hearing. If significant, rate of hearing decline may inform decision making after an introductory period of observation.

Setting:

Two tertiary care centers.

Patients:

VS patients with serviceable hearing who underwent at least three audiograms and two magnetic resonance imaging (MRI) studies before intervention or being lost to follow-up. The rate of change in pure-tone average (PTA) and word recognition score (WRS) was calculated as the score from the second audiogram minus the score from the first audiogram, divided by the duration in months between the two.

Main Outcome Measure(s):

Serviceable hearing, defined as PTA ≤50 dB HL and WRS ≥50%.

Results:

Among 266 patients meeting inclusion criteria, 52 developed non-serviceable hearing at last follow-up. Kaplan–Meier estimated rates of maintaining serviceable hearing (95% CI; number still at risk) at 1, 3, 5, 7, and 10 years were 97% (95–100; 206), 78% (72–85; 98), 68% (60–77; 39), 60% (50–73; 17), and 44% (29–67; 2), respectively. In a univariable setting, each 1 dB increase per month in the rate of initial PTA change was associated with a 96% increased likelihood of acquiring non-serviceable hearing (hazard ratio [HR] 1.96; 95% CI 1.44–2.68; p < 0.001). Each 1% increase per month in the rate of initial WRS change was associated with a decreased likelihood of acquiring non-serviceable hearing (hazard ratio [HR] 0.79; 95% confidence interval [CI] 0.66–0.94; p = 0.009). After multivariable adjustment, both rate of PTA change (HR 2.42; 95% CI 1.72–3.41; p < 0.001) and rate of WRS change (HR 0.81; 95% CI 0.67–0.99; p = 0.043) remained statistically significantly associated with time to non-serviceable hearing.

Conclusion:

Rate of early PTA and WRS decline during the initial period of observation are significantly associated with time to development of non-serviceable hearing. This information may facilitate accurate patient counseling and inform decision-making regarding prospective disease management.
Transcanal Endoscopic Ear Surgery for Congenital Middle Ear Anomalies
Authors: Ito Tsukasa , Kubota Toshinori , Furukawa Takatoshi , Matsui Hirooki , Futai Kazunori , Kakehata Seiji
Published: October 2019

Objective:

To demonstrate the efficacy of transcanal endoscopic ear surgery (TEES) for congenital middle ear anomalies.

Study Design:

Retrospective case review.

Setting:

Tertiary referral center.

Patients:

Twenty-one patients ranging in age from 4 to 62 years old (median: 15 yr) who underwent TEES between 2011 and 2017 were compared with 19 patients ranging in age from 3 to 49 years old (median: 11 yr) who underwent microscopic ear surgery (MES) between 2000 and 2011.

Intervention:

Ossiculoplasty or stapes surgeries were performed with TEES or MES. TEES was performed using a rigid endoscope with an outer diameter of 2.7-mm coupled with a full high-definition video system. MES was performed via a transcanal approach with a retroauricular incision.

Main Outcome Measure:

Middle ear anomaly classification, operating time, and hearing outcomes based on the American Academy of Otolaryngology and Head and Neck Surgery criteria were evaluated and compared between the TEES and MES groups.

Results:

For Teunissen and Cremers class III anomalies, defined as ossicular chain malformations with a mobile stapes footplate, postoperative air-bone gap closure to 10 dB or less was achieved in 50% of the TEES group and 47% of the MES group. Postoperative air-bone gap closure to 20 dB or less was achieved in 86% of the TEES group and 100% of the MES group. No significant difference was found in the operating time between the two groups. All MES procedures required a retroauricular incision.

Conclusion:

Our results indicate that TEES has similar auditory outcomes compared with MES while avoiding a retroauricular incision.
Evaluation of Cochlear Duct Length Measurements From a 3D Analytical Cochlear Model Using Synchrotron Radiation Phase-Contrast Imaging
Authors: Helpard Luke W. , Rohani Seyed A. , Ladak Hanif M. , Agrawal Sumit K.
Published: October 2019

Hypothesis:

Evaluating the accuracy of cochlear duct length (CDL) measurements from a published three-dimensional (3D) analytical cochlear model using Synchrotron Radiation Phase–Contrast Imaging (SR-PCI) data will help determine its clinical applicability and allow for model adjustments to increase accuracy.

Background:

Accurate CDL determination can aid in cochlear implant sizing for full coverage and frequency map programming, which has the potential to improve hearing outcomes in patients. To overcome problems with the currently available techniques for CDL determination, a novel 3D analytical cochlear model, dependent on four basal turn distances, was proposed in the literature.

Methods:

SR-PCI data from 11 cadaveric human cochleae were used to obtain reference measurements. CDL values generated by the analytical cochlear model were evaluated in two conditions: when the number of cochlear turns (NCT) were automatically predicted based on the four input distances, and when the NCT were manually specified based on SR-PCI data.

Results:

When the analytical cochlear model automatically predicted the NCT, the mean absolute error was 2.6 ± 1.6 mm, with only 27% (3/11) of the samples having an error in the clinically acceptable range of ±1.5 mm. When the NCT were manually specified based on SR-PCI data, the mean absolute error was reduced to 1.0 ± 0.6 mm, with 73% (8/11) of the samples having a clinically acceptable error.

Conclusion:

The 3D analytical cochlear model introduced in the literature is effective at modeling the 3D geometry of individual cochleae, however tuning in the NCT estimation is required.
NF2-Related Intravestibular Schwannomas: Long-Term Outcomes of Cochlear Implantation
Authors: Jia Huan , Nguyen Yann , Hochet Baptiste , Smail Mustapha , Mosnier Isabelle , Wu Hao , Sterkers Olivier , Kalamarides Michel , Bernardeschi Daniele
Published: October 2019

Objective:

Intravestibular schwannomas (IVS) are uncommon tumors in Neurofibromatosis type 2 (NF2) and are mainly associated with multiple internal auditory meatus (IAM) and cerebellopontine angle (CPA) tumors. They usually induce profound hearing loss which can be rehabilitated by cochlear implantation (CI). The aim of this study was to analyze the long-term outcomes of CI during the unpredictable evolution of NF2 disease.

Study Design:

Retrospective case review.

Setting:

Tertiary referral center.

Patients:

Three adults with neurofibromatosis type 2 and intravestibular schwannomas, and who were cochlear implant recipients.

Interventions:

Periodic radiologic follow-up, tumor resection, and hearing rehabilitation.

Main Outcome Measures:

Audiological evolution, tumor evolution, surgical outcome, cochlear implant outcome.

Results:

Three NF2 patients (mean age at diagnosis, 26.3 ± 3.2 yr) were identified with IVS in the period between 2000 and 2017. IVS were first observed by serial MRI and profound hearing loss occurred in this ear after 4 ± 1.5 years of follow-up. IVS were removed via a translabyrinthine approach, and ipsilateral cochlear implantations were simultaneously performed. In two patients, large contralateral CPA tumors had previously been removed without hearing preservation, whereas in the third patient, a small, growing contralateral VS was excised via a retrosigmoid approach 6 months after IVS removal/cochlear implantation with serviceable hearing preservation. In all cases, CI provided good hearing outcomes. In two cases, hearing outcomes were even better for more than 5 years when ipsilateral intracanalicular vestibular schwannomas were removed in either the same or subsequent procedures.

Conclusions:

Rehabilitation of hearing with CI provides a favorable long-term outcome in patients with NF2-related IVS which could be altered by the occurrence of other intracanalicular and/or CPA NF2-related tumors.
Investigating the influence of LCT rs3754689 polymorphism on inhibitor development in Iranian and Afghan patients with severe hemophilia A
Authors: Bahrami Zadegan Sobhan , Mousavi Sayed H. , Damavandi Narges , Samiee Aref Mohammad H. , Zeinali Sirous
Published: October 2019

Development of alloantibodies against factor VIII (FVIII) in patients with severe hemophilia A is the main complication of FVIII replacement therapy. There are many studies indicating several genetic factors associated with inhibitor development. A recent study showed that there is a correlation between the risk of inhibitor development and LCT rs3754689 polymorphism among Italian hemophilia A patients. The aim of this study was to speculate whether LCT rs3754689 polymorphism is correlated to inhibitor development in Afghan and Iranian patients. In addition, we assessed the association of F8 gene mutations and inhibitor development in Iranian patients. This case–control study was conducted on 33 severe hemophilia A patients with inhibitor and 119 samples without inhibitor. Genotyping was performed by Sanger sequencing, inverse and multiplex PCR. According to the obtained data, we found a significant correlation between LCT rs3754689 polymorphism and the risk of inhibitor development in Afghan patients (observed risk, 0.11; 95% confidence interval, 0.01–0.88; P = 0.012). Among Iranian patients, rs3754689 polymorphism showed no significant association with inhibitor development against FVIII (P > 0.05). However, we found a significant correlation between the risk of inhibitor formation and large deletions and nonsense mutations in F8 gene among Iranian patients (observed risk, 7.25; 95% confidence interval, 1.93–27.18; P = 0.003). Lack of association of rs3754689 polymorphism in Iranian population shows the various effects of genetic markers in different populations. More studies in different ethnicities or larger sample sizes are recommended.
Helicobacter pylori Infection and the Development of Advanced Colorectal Neoplasia
Authors: Ryoo Si Kyong , Kim Tae Jun , Kim Eun Ran , Hong Sung Noh , Kim Young-Ho , Chang Dong Kyung
Published: October 2019

Background:

An association between Helicobacter pylori infection and colorectal neoplasia has been reported in cross-sectional studies.

Goals:

We examined the association between H. pylori infection and the development of advanced colorectal neoplasia (AN) in a screening cohort.

Study:

We identified 3753 adults, who underwent screening and subsequent surveillance colonoscopies. The primary outcome was the development of metachronous AN, as confirmed by surveillance colonoscopy. H. pylori infection status was assessed by an H. pylori-specific immunoglobulin G antibody test. Sensitivity analysis was also performed by H. pylori infection status on the basis of histology.

Results:

During a median follow-up of 41 months, the incidence of AN was 3.2% and 1.7% in participants with and without H. pylori infection, respectively. In multivariable analysis adjusted for age, body mass index, smoking status, alcohol intake, family history of colorectal cancer, and baseline adenoma characteristics, the hazard ratio [95% confidence interval (CI)] for metachronous AN was 1.74 (1.11-2.73) in participants with H. pylori seropositivity, compared with those without H. pylori seropositivity. The association was consistent with H. pylori infection status on the basis of histology (adjusted hazard ratio, 3.51; 95% CI, 1.64-7.51). In the subgroup analysis, the positive association was observed in both no-adenoma and adenoma removal subgroups.

Conclusions:

In a cohort study, H. pylori infection was associated with an increased risk of AN development. This association was consistent in both the serological and histologic assessment of H. pylori infection. Prospective studies are necessary to determine whether H. pylori eradication can reduce the risk of colorectal neoplasia.
Prognostic significance of middle paraesophageal lymph node metastasis in resectable esophageal squamous cell carcinoma
Authors: Hong Huang , Jie Hou , Liyu Rao , Zerui Chen , Borong Shu , Hongwei Liang
Published: October 2019

Lymph node metastasis (LNM) of esophageal squamous cell carcinoma (ESCC) has important prognostic significance. In this study, we examined the correlations between lymph node metastatic sites and prognosis in patients with resectable ESCC.

A total of 960 patients who received curative esophagectomy with systemic lymphadenectomy between 1996 and 2014 were included in the retrospective analysis. The Kaplan-Meier method and log-rank test were used to perform the survival analysis. The prognostic significance of LNM site was evaluated by Cox regression analysis.

The LNM in middle paraesophageal (P < .001), subcarinal (P < .001), lower paraesophageal (P < .001), recurrent laryngeal nerve (P = .012), paratracheal (P = .014), and perigastric (P < .001) sites were associated with poor prognosis in univariate analysis. In multivariate analysis, only middle paraesophageal LNM (MPLNM, P = .017; HR, 1.33; 95%CI, 1.05–1.67) was the independent factor for worse prognosis. Additionally, patients with MPLNM had a lower 5-year survival rate (15.6%) than those with LNM at other sites. Furthermore, upper or middle tumor location and relatively late pN stage were associated with increased risk of MPLNM.

Our findings suggested MPLNM could be a characteristic indicating the worst prognosis. Preoperative examinations should identify the existences of MPLNM, especially on patients with risk factors. And patients with MPLNM should be considered for more aggressive multidisciplinary therapies.
Evidence of altered cardiac autonomic regulation in myalgic encephalomyelitis/chronic fatigue syndrome
Authors: Nelson Maximillian J. , Bahl Jasvir S. , Buckley Jonathan D. , Thomson Rebecca L. , Davison Kade
Published: October 2019

Background:

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a complex condition with no reliable diagnostic biomarkers. Studies have shown evidence of autonomic dysfunction in patients with ME/CFS, but results have been equivocal. Heart rate (HR) parameters can reflect changes in autonomic function in healthy individuals; however, this has not been thoroughly evaluated in ME/CFS.

Methods:

A systematic database search for case-control literature was performed. Meta-analysis was performed to determine differences in HR parameters between ME/CFS patients and controls.

Results:

Sixty-four articles were included in the systematic review. HR parameters assessed in ME/CFS patients and controls were grouped into ten categories: resting HR (RHR), maximal HR (HRmax), HR during submaximal exercise, HR response to head-up tilt testing (HRtilt), resting HR variability (HRVrest), HR variability during head-up tilt testing (HRVtilt), orthostatic HR response (HROR), HR during mental task(s) (HRmentaltask), daily average HR (HRdailyaverage), and HR recovery (HRR) Meta-analysis revealed RHR (MD ± 95% CI = 4.14 ± 1.38, P < .001), HRtilt (SMD ± 95% CI = 0.92 ± 0.24, P < .001), HROR (0.50 ± 0.27, P < .001), and the ratio of low frequency power to high frequency power of HRVrest (0.39 ± 0.22, P < .001) were higher in ME/CFS patients compared to controls, while HRmax (MD ± 95% CI = –13.81 ± 4.15, P < .001), HR at anaerobic threshold (SMD ± 95% CI = –0.44 ± 0.30, P = 0.005) and the high frequency portion of HRVrest (–0.34 ± 0.22, P = .002) were lower in ME/CFS patients.

Conclusions:

The differences in HR parameters identified by the meta-analysis indicate that ME/CFS patients have altered autonomic cardiac regulation when compared to healthy controls. These alterations in HR parameters may be symptomatic of the condition.
Palliative and Hospice Care in Correctional Facilities
Authors: Burles Meridith , Holtslander Lorraine , Peternelj-Taylor Cindy
Published: October 2019

Background

The need for palliative and hospice care for persons with life-limiting conditions who are incarcerated is increasingly common in correctional facilities worldwide.

Objective

Through a family nursing lens, we critically analyze the unique challenges experienced by those requiring palliative care while incarcerated. Key concerns and implications for nursing are illustrated through the discussion of a representative case scenario.

Methods

The case scenario was developed based on the findings of a scoping review of academic and gray literature (such as policy documents and editorials) about palliative, hospice, and end-of-life care in corrections.

Results

The case scenario highlights multilevel barriers that were identified, including the individual, relational, institutional, and sociocultural contexts of palliative care in correctional facilities. Evidence is presented of how integration of a family nursing perspective can enhance specialized palliative and hospice care services in correctional settings.

Conclusions

By applying a family nursing approach, nurses practicing with correctional populations can ensure persons with life-limiting illnesses are not denied their right to appropriate end-of-life care by playing a key role in addressing barriers to palliative and hospice care access in corrections. Specific attention to relational issues and holistic care can contribute to enhanced palliative and hospice care, greater dignity in dying, and improved family and peer outcomes, which have benefits for individuals, families, communities, and society.

Implications for Practice

Through the case scenario, we illustrate real issues emerging in correctional contexts and offer evidence of how family nursing relational principles can be applied to promote adequate palliative and hospice care.
Work Values of Generation Z Nurses
Authors: Hampton Debra , Welsh Darlene
Published: October 2019

OBJECTIVES

To determine the work values of Generation Z nurses, a new generation in the current workforce.

BACKGROUND

A new generation of nurses is now part of the nursing workforce. Generation Z nurses, born in 1995 (aged ≤24 years), will bring new expectations and ideals about life and work into healthcare work settings.

METHODS

A descriptive, cross-sectional survey design was used to assess the work values of traditional baccalaureate Generation Z nursing students using the Lyons Work Values Survey.

RESULTS

The work value component ranked most important by participants was social/altruistic, followed by instrumental/extrinsic, cognitive/intrinsic, and prestige.

CONCLUSION

Helping people and having a job that is interesting and engaging while also offering job security and good benefits were the most important future Generation Z nurse work values.
Patient Deterioration Simulation Education and New Graduate Nurses’ Self-Confidence and Competence
Authors: Norris Heather , New Keri , Hinsberg Francis
Published: October 2019

A rural community hospital provided a pilot patient deterioration simulation education for new graduate nurses in an attempt to advance the utilization of an existing rapid response team. Pre- and post-intervention self-confidence scores demonstrated a large effect size and a clinically significant eta squared value (.48). The participants successfully completed most of the simulation competencies. This pilot project supports further studies exploring new graduate nurses’ self-confidence levels and competency performance with patient deterioration simulation education.
Epidemiological Impact of Expedited Partner Therapy for Men Who Have Sex With Men: A Modeling Study
Authors: Weiss Kevin M. , Jones Jeb S. , Katz David A. , Gift Thomas L. , Bernstein Kyle , Workowski Kimberly , Rosenberg Eli S. , Jenness Samuel M.
Published: October 2019

Background

Expedited partner therapy (EPT) is an intervention for patients with gonorrhea or chlamydia, providing index patients with prescriptions or medication to give to their partners. Expedited partner therapy is recommended for heterosexuals but not for men who have sex with men (MSM), partially due to concerns about overtreatment of uninfected partners and missed opportunities for human immunodeficiency virus (HIV) diagnosis.

Methods

We extended our stochastic network-based mathematical model of HIV, gonorrhea, and chlamydia among MSM to include EPT. The EPT implementation was simulated for 10 years. Counterfactual scenarios varied EPT coverage, provision, uptake, and partnership window duration. We estimated sexually transmitted infection (STI) incidence, proportion of infections averted, and process outcomes under each scenario.

Results

Delivery of EPT to 20% of eligible MSM index patients (coverage) reduced cumulative STI incidence by 27% (interquartile range, 13%–39%) over 10 years compared with current estimated STI screening levels. A 20% increase in providing medication to non–index partners (provision) averted 32% (interquartile range, 20%–41%) of STI infections compared with estimated STI screening levels. When targeted by partnership type, EPT solely to casual partners maximized the population-level infections averted. The proportion of partners given medication who had no current STI varied from 52% to 63%, depending on coverage level. The proportion of partners given medication with undiagnosed HIV infection was 4% across scenarios.

Conclusions

Expedited partner therapy could reduce bacterial STI incidence for MSM. However, this intervention could result in missed opportunities for HIV/STI prevention and a substantial increase in use of antimicrobials by STI-uninfected MSM, raising concerns about cost and antimicrobial resistance.
Probable Posttraumatic Stress Disorder and Lower Respiratory Symptoms Among Rescue/Recovery Workers and Community Members After the 9/11 World Trade Center Attacks—A Longitudinal Mediation Analysis
Authors: Wyka Katarzyna , Friedman Stephen M. , Jordan Hannah T.
Published: October 2019

Objective

Posttraumatic stress disorder (PTSD) and lower respiratory symptoms (LRS) often coexist among survivors of the September 11, 2001 (9/11) World Trade Center (WTC) attacks. Research in police and nontraditional responders suggests that PTSD mediates the relationship between 9/11 physical exposures and LRS, but not vice versa. We replicated these findings in WTC rescue/recovery workers (R/R workers), extended them to exposed community members, and explored the interplay between both physical and psychological 9/11 exposures, probable PTSD, and LRS over a 10-year follow-up.

Methods

Participants were 12,398 R/R workers and 12,745 community members assessed in three WTC Health Registry surveys (2003–2004, 2006–2007, and 2011–2012). LRS and 9/11 exposures were self-reported. Probable PTSD was defined as a PTSD Checklist score ≥44.

Results

Probable PTSD predicted LRS (R/R workers: β = 0.88–0.98,p< .001; community members: β = 0.67–0.86,p< .001) and LRS predicted PTSD (R/R workers: β = 0.83–0.91,p< .001; community members: β = 0.68–0.75,p< .001) at follow-ups, adjusting for prior symptoms and covariates. In both R/R workers and community members, probable PTSD mediated the relationship between 9/11 physical exposures (dust cloud, long duration of work) and LRS (indirect effects,p= .001–.006), and LRS mediated the physical exposure-PTSD relationship (indirect effects,p= .001–.006). In R/R workers, probable PTSD mediated the psychological exposure (losing friends or loved ones, witnessing horrific events)–LRS relationship (indirect effect,p< .001), but LRS did not mediate the psychological exposure-PTSD relationship (indirect effect,p= .332). In community members, high 9/11 psychological exposure predicted both probable PTSD and LRS at follow-ups; probable PTSD mediated the psychological exposure-LRS relationship (indirect effect,p< .001), and LRS mediated the psychological exposure-PTSD relationship (indirect effect,p= .001).

Conclusions

Probable PTSD and LRS each mediated the other, with subtle differences between R/R workers and community members. A diagnosis of either should trigger assessment for the other; treatment should be carefully coordinated.
Genetic clustering analysis for HIV infection among MSM in Nigeria: implications for intervention
Authors: Li Yuruo , Liu Hongjie , Ramadhani Habib O. , Ndembi Nicaise , Crowell Trevor A. , Kijak Gustavo , Robb Merlin L. , Ake Julie A. , Kokogho Afoke , Nowak Rebecca G. , Gaydos Charlotte , Baral Stefan D. , Volz Erik , Tovanabutra Sodsai , Charurat Man
Published: October 2019

Background:

The HIV epidemic continues to grow among MSM in countries across sub-Saharan Africa including Nigeria. To inform prevention efforts, we used a phylogenetic cluster method to characterize HIV genetic clusters and factors associated with cluster formation among MSM living with HIV in Nigeria.

Methods:

We analyzed HIV-1 pol sequences from 417 MSM living with HIV enrolled in the TRUST/RV368 cohort between 2013 and 2017 in Abuja and Lagos, Nigeria. A genetically linked cluster was defined among participants whose sequences had pairwise genetic distance of 1.5% or less. Binary and multinomial logistic regressions were used to estimate adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for factors associated with HIV genetic cluster membership and size.

Results:

Among 417 MSM living with HIV, 153 (36.7%) were genetically linked. Participants with higher viral load (AOR = 1.72 95% CI: 1.04–2.86), no female partners (AOR = 3.66; 95% CI: 1.97–6.08), and self-identified as male sex (compared with self-identified as bigender) (AOR = 3.42; 95% CI: 1.08–10.78) had higher odds of being in a genetic cluster. Compared with unlinked participants, MSM who had high school education (AOR = 23.84; 95% CI: 2.66–213.49), were employed (AOR = 3.41; 95% CI: 1.89–10.70), had bacterial sexually transmitted infections (AOR = 3.98; 95% CI: 0.89–17.22) and were not taking antiretroviral therapy (AOR = 6.61; 95% CI: 2.25–19.37) had higher odds of being in a large cluster (size > 4).

Conclusion:

Comprehensive HIV prevention packages should include behavioral and biological components, including early diagnosis and treatment of both HIV and bacterial sexually transmitted infections to optimally reduce the risk of HIV transmission and acquisition.
Comparison of Orbital Preadipocyte Adipogenesis Between Pediatric and Adult Graves Ophthalmopathy
Authors: Choi Hee Young , Jung Jae Ho , Ahn Jung Hyo
Published: October 2019

To investigate the difference of adipogenesis in orbital preadipocytes between pediatric and adult Graves ophthalmopathy (GO) under lipopolysaccharide (LPS)-induced inflammation in vitro.

Orbital preadipocytes from pediatric and adult GO patients during eyelid or orbital surgery were cultured. The orbital preadipocytes in pediatric and adult GO were divided into group A and group B. In group A, pediatric and adult orbital preadipocytes were differentiated in adipogenesis media without LPS intervention, respectively. In group B, pediatric and adult orbital preadipocytes were incubated in culture medium containing 1 mg/L LPS for 48 hours before stimulation to differentiate into mature adipocytes in adipogenesis media. The expressions of adipogenic transcription factors, PPAR-γ and C/EBP-α, were determined by real-time polymerase chain reaction on day 7. On day 14, the cells were stained with oil red O to observe the intracellular lipid accumulation.

In group A without LPS intervention, the pediatric orbital preadipocytes showed increased expression of PPAR-γ, C/EBP-α, and intracellular lipids accumulation than the adult orbital preadipocytes. In a group B with LPS intervention, both pediatric and adult preadipocytes showed higher rates of adipogenesis than in group A. Additionally, the increase in adipogenesis was greater in the pediatric preadipocytes.

The pediatric orbital preadipocytes demonstrated increased adipogenesis than adult preadipocytes in GO without LPS-induced inflammation. Adipogenesis of the pediatric orbital preadipocytes was more affected and upregulated as compared to that of the adult preadipocytes by LPS-induced inflammation.
The Role of Transoral Robotic Surgery for Parapharyngeal Space: Experience of a Tertiary Center
Authors: Chu Francesco , De Berardinis Rita , Tagliabue Marta , Zorzi Stefano , Bandi Francesco , Ansarin Mohssen
Published: October 2019

The parapharyngeal space (PPS) is an anatomically and functionally complex region of the craniofacial district. Tumors that originate from this region are rare, and surgery is currently the best practice in the vast majority of cases with different surgical approaches being reported in the literature. Recently, mini-invasive robotic/endoscopic techniques have begun to emerge as effective alternatives in selected cases. In this work, we retrospectively analyzed 17 patients affected by PPS tumors, and managed by transoral robotic surgery (TORS) as a therapeutic or diagnostic procedure. TORS was used alone or combined with a transcervical approach for huge lesions of the PPS, at risk of fragmentation (curative intent). TORS also permitted biopsies of unknown lesions of the PPS to be conducted (diagnostic intent) otherwise unreachable without performing a mandibulotomy. All patients treated with curative intent benefited from radical surgery. No major complications were observed, and tumor fragmentation occurred only in 2 of 17 patients (11.8%). All patients receiving TORS with diagnostic intent were successfully referred to nonsurgical treatments based on the final histhopathological findings. This work also demonstrated TORS to be effective and safe on a larger group of patients compared to our preliminary study in 2016. TORS provides good oncological and functional outcomes when used with curative intent and is an effective diagnostic tool in cases of suspicious lesions of the PPS.
Langerhans Cell Histiocytosis in an Adult: A Discussion of Epidemiology and Treatment Options
Authors: El-Arab Kaley K. , Luedke Alexis Inge , Julian Bao-Quynh Thuy , Ferrauiola Julie , Miller Frank Raymond , Wang Howard Tz-ho
Published: October 2019

Langerhans cell histiocytosis (LCH) is a rare disorder defined by the abnormal proliferation of Langerhans cells. While LCH can present at any age, it is classically described as a pediatric condition, and is therefore overlooked in the adult patient. Additionally, depending on tumor burden and location, LCH can manifest with a host of oral and systemic symptoms which further confuses the clinical presentation and ultimate diagnosis.

The authors present a unique report of an elderly Hispanic male diagnosed with mandibular LCH who sought primary tumor excision after neoadjuvant chemotherapy. In this study, a fibula-free flap was used for subsequent reconstruction.

The purpose of the study is 2-fold: to highlight the variability of LCH in both patient symptomatology and demographics, as well as the role of plastic reconstructive surgery in definitive LCH management, particularly in the setting of single system unifocal disease.
The Possible Role of Color Doppler and Pulse Wave Doppler Ultrasound in the Diagnosis of Cutaneous Lymphangioma Circumscriptum
Authors: Sun Yang , Su Jing , Li Shan-Shan , Cui Li-Gang
Published: October 2019

Cutaneous lymphangioma circumscriptum (CLC) is an uncommon congenital lymphatic malformation. Its dermoscopic features have been reported, however, if blood has infiltrated the lacunas, a pink hue overwhelms the lacunar structures, rendering dermoscopic features indistinguishable. In addition, dermoscopy cannot assess the subcutaneous extent of the lesion before surgery. The high-frequency array transducer Sonography with a high-frequency transducer is excellent in its resolution to evaluate skin lesions and is unaffected by infiltration of blood. Here, the authors report the use of ultrasound (color Doppler and pulse wave Doppler) for the diagnosis and management of CLC.

An 18-year-old man presented 10 years previously with an asymptomatic 0.5 × 0.7 cm cluster of dark reddish vesicular lesions on his buttock. The lesions had recently increased in size and number. There was associated pachyderma. The lesions were hyperechoic and well defined on grayscale ultrasound and hypervascular on color Doppler ultrasound. Cluster cystics of lymphatic spaces were found throughout the whole dermis, especially in the papillary dermis. The lymphatic channels extended downwards to the reticular dermis and the superficial layer of the subcutaneous tissue. The pathological findings revealed lymphangiomas invading the subcutaneous tissue. The flat endothelial cells were partly positive for D2-40, which is a marker of lymphatic endothelial cells. Ultrasound was able to delineate the margins of the lesions. Diagnosis of CLC using preoperative color Doppler and pulse wave Doppler could reduce unnecessary repeated pre- and postoperative biopsies.