bluuebunny/crossref_metadata_2025 huggingface dataset:
Corneal Endothelial Morphology and Thickness Alterations in Patients With Severe Obstructive Sleep Apnea–Hypopnea Syndrome
Authors: Chalkiadaki Evangelia , Andreanos Konstantinos , Florou Chrysoula , Droutsas Konstantinos , Maniou Chrysoula , Amfilochiou Anastasia , Georgalas Ilias , Papaconstantinou Dimitrios , Koutsandrea Chrysanthi
Published: June 2020

Purpose:

To investigate central endothelial cell density (ECD), morphology, and central corneal thickness (CCT) in patients newly diagnosed with severe obstructive sleep apnea–hypopnea syndrome (OSAHS) and to determine the correlation between these parameters and OSAHS severity.

Methods:

This prospective, comparative case series was conducted in a university ophthalmology clinic. In total, 51 patients recently diagnosed with severe OSAHS (apnea–hypopnea index above 30) and a paired, age and sex-matched control group of 44 healthy individuals were enrolled. After detailed ophthalmologic examination, specular microscopy measurement was performed for all participants. Central ECD, average cell area, coefficient of variation (CV) of cell area, hexagonal cell appearance ratio (% Hex), and CCT were compared between the groups. The Pearson correlation test was also used to assess the influence of the polysomnographic findings, that is, the proportion of each stage of sleep, apnea–hypopnea index, SpO2, mean and maximum duration of apneas, oxygen desaturation index, and arousal index on corneal endothelial morphometric parameters and CCT.

Results:

A total of 190 eyes were examined: 102 eyes of patients with severe OSAHS and 88 eyes of the control group. The mean ECD, CV, % Hex, and CCT values in the OSAHS group were 2439.25 ± 344.36 cells/mm2, 41.41 ± 11.62, 45.22 ± 7.06%, and 533.88 ± 40.53 μm, respectively. ECD and CCT did not significantly differ between the groups (P = 0.46, P = 0.55, respectively). CV value was significantly higher (P = 0.009), whereas the %Hex was significantly lower (P = 0.01) in the OSAHS group. We observed a significant negative correlation between CCT and REM sleep percentage (P = 0.005).

Conclusions:

Greater pleomorphism and polymegathism of corneal endothelium was found in patients with severe OSAHS when compared with healthy subjects. Low percentage of REM sleep, usually found in patients with OSAHS, may cause an increase in corneal thickness.
Multicenter visual outcomes comparison of 2 trifocal presbyopia-correcting IOLs: 6-month postoperative results
Authors: Lapid-Gortzak Ruth , Bhatt Uday , Sanchez Juan Gonzalo , Guarro Mercè , Hida Wilson Takashi , Bala Chandra , Nosé Ricardo Menon , Rodriguez Alvira Francisco Jose , Martinez Aldo
Published: June 2020

Purpose:

To clinically evaluate visual performance of the AcrySof IQ PanOptix TFNT00 and AT LISA tri 839MP intraocular lenses (IOLs) in binocular visual acuity (VA) and to characterize low-contrast visual performance at 6 months postimplantation.

Setting:

Multicenter, 15 sites.

Design:

Prospective, parallel-group, randomized, double-masked, postmarketing clinical study.

Methods:

Binocular uncorrected distance (UDVA, 4 m), intermediate (UIVA, 60 cm), and near (UNVA, 40 cm) visual acuities and binocular defocus curves were evaluated under photopic lighting conditions. Photopic and mesopic contrast sensitivities with and without glare were assessed.

Results:

The study included 182 subjects (62% women; mean age, 66 ± 9.4 years) who were implanted bilaterally with the TFNT00 IOL (n = 93) or 839MP IOL (n = 89), and binocular VA was evaluated 4 to 6 months (120–180 days) postimplantation. The TFNT00 IOL group showed superior visual outcomes compared with the 839MP IOL group in binocular UIVA (P = .001) and UNVA (P = .003) and noninferior outcomes in UDVA (95% CI, −0.023 to 0.041; upper limit <0.1 logarithm of the minimum angle of resolution [logMAR] [margin of noninferiority]). Mean defocus curve from 0.00 to −3.00 diopter (D) ranged from 0.1 to 0.0 logMAR for both IOLs; better mean VA values (logMAR) were observed in the TFNT00 IOL group between −1.50 and −2.50 D compared with those of the 839MP IOL group. Contrast sensitivity values were similar between the 2 groups in all conditions.

Conclusions:

The results of this study showed improved visual performance at near and intermediate distances with the TFNT00 IOL compared with that of the 839MP IOL.
Modified hydrodissection to prevent intraoperative iris prolapse
Authors: Huynh Michelle L. , Sanders Riley , Sallam Ahmed B.
Published: June 2020

A modified hydrodissection technique to prevent intraoperative iris prolapse is presented. The phacoemulsification tip is inserted into the main ocular incision while hydrodissection is performed through a side-port incision. Placement of the phacoemulsification tip in this location prevents iris prolapse. This technique can be used routinely and might be especially applicable in cases with a high risk for iris prolapse, such as in intraoperative floppy-iris syndrome.
Perceived Control Prevents Perception of Negative Changes in Life as a Result of Caring for a Patient With Heart Failure
Authors: Chung Misook Lee , Liljeroos Maria , Moser Debra K. , Lennie Terry A.
Published: June 2020

Introduction

Family caregivers of patients with heart failure (HF) commonly experience emotional distress and caregiving burden. Despite their caregiving distress, caregivers may experience positive or negative changes in their life compared with before caregiving. Greater perceived control is associated with better health outcomes, but little is known about whether perceived control is related to caregivers' perceptions of positive or negative changes in life, independent of their distress and burden in providing care for patients with HF. The specific aims were to compare emotional distress and caregiving burden between caregivers who perceived positive versus negative changes in life due to caregiving and to examine whether perceived control predicts the perception of positive or negative changes in life while controlling for emotional distress and caregiving burden.

Methods

Primary caregivers of patients with HF (N = 140, 75% women) completed questionnaires about perceived positive or negative changes in life as a result of caregiving, perceived control, depressive symptoms, anxiety, and caregiving burden. Independent t test, χ2, and logistic regressions were used to accomplish specific aims.

Results

Compared with caregivers who reported positive changes in life (42%), caregivers who perceived negative changes in life (58%) had higher levels of depressive symptoms, anxiety, and caregiving burden. Lower level of perceived control was an independent predictor of perceived negative changes in life, controlling for age, gender, depressive symptoms, anxiety, and caregiving burden (odds ratio, 0.89; 95% confidence interval, 0.79–0.99; P = .0038).

Conclusion

Greater perceived control played a protective role for caregivers independent of caregiver burden. Interventions designed to enhance perceived control may improve caregivers' perceptions of changes in their life.
Cost-Effectiveness and Return-on-Investment of the Dynamic Work Intervention Compared With Usual Practice to Reduce Sedentary Behavior
Authors: Ben Ângela J. , Jelsma Judith G.M. , Renaud Lidewij R. , Huysmans Maaike A. , van Nassau Femke , van der Beek Allard J. , van der Ploeg Hidde P. , van Dongen Johanna M. , Bosmans Judith E.
Published: June 2020

Objective:

To assess the cost-effectiveness and return-on-investment (ROI) of the Dynamic Work (DW) Intervention, a worksite intervention aimed at reducing sitting time among office workers.

Methods:

In total, 244 workers were randomized to the intervention or control group. Overall sitting time, standing time, step counts, quality-adjusted life years (QALYs), and costs were measured over 12 months. The cost-effectiveness analysis was performed from the societal perspective and the ROI analysis from the employers’ perspective.

Results:

No significant differences in effects and societal costs were observed between groups. Presenteeism costs were significantly lower in the intervention group. The probability of the intervention being cost-effective was 0.90 at a willingness-to-pay of 20,000€/QALY. The probability of financial savings was 0.86.

Conclusion:

The intervention may be considered cost-effective from the societal perspective depending on the willingness-to-pay. From the employer perspective, the intervention seems cost-beneficial.
Comparison of Measurement Properties of the Mobility Section of the Prosthesis Evaluation Questionnaire on a Visual Analogue Scale and Its Modified Version with Five Response Categories
Authors: Repo Jussi P. , Häkkinen Arja H. , Barner-Rasmussen Ian , Lahdenperä Noora-Ilona , Kautiainen Hannu , Roine Risto P. , Tukiainen Erkki J.
Published: June 2020

Introduction

Two different versions of the Prosthesis Evaluation Questionnaire (PEQ) are available. This study aimed to assess the measurement properties of the original 13-item Mobility Section of the Finnish version of the PEQ on a visual analogue scale (PEQ-VAS, 0–100 points) and its modified 12-item version with five response categories (PEQ-MS12/5, 0–60 points).

Methods

Patients having undergone major lower-limb amputation completed the PEQ, the PEQ-MS12/5, the Locomotor Capabilities Index–5, the Houghton Scale, and the 15D instrument, and answered general health and pain questions on a VAS. Participants who completed the instruments twice in a 2-week interval (n = 117) were included.

Results

Mean (SD) scores of the PEQ-VAS and the PEQ-MS12/5 were 58 (25) and 31 (13) with coefficients of variation of 0.42 and 0.43, respectively. Reproducibility was consistent between the measures. Although Spearman's correlation coefficient was high (r = 0.83) and Kendall's coefficient of concordance was excellent (0.91), differences were noted in score distribution and patient rank correlation. There were similarities and differences in correlations with the other patient-reported instruments.

Conclusions

The original PEQ-VAS Mobility Section and the modified PEQ-MS12/5 have moderate measurement differences; the results are thus not directly comparable. Both measures provide reliable and valid scores, but the modified version is easier to complete and analyze in clinical work.
New Surgical Circulatory Support System Outcomes
Authors: Ramzy Danny , Soltesz Edward , Anderson Mark
Published: June 2020

We report the first U.S. experience of the recently approved micro-axial surgical heart pump for the treatment of ongoing cardiogenic shock following acute myocardial infarction (AMICGS), postcardiotomy cardiogenic shock (PCCS), cardiomyopathy including myocarditis, high-risk percutaneous coronary intervention (HRPCI), and coronary artery bypass surgery (HRCABG). Demographic, procedural, hemodynamic, and outcome data were obtained from the manufacturer’s quality database of all Impella 5.5 implants at three centers. Fifty-five patients underwent an Impella 5.5 implant for cardiomyopathy (45%), AMICGS (29%), PCCS (13%), preop CABG (5%), OPCAB (4%), and other (4%). Thirty-five patients (63.6%) were successfully weaned off device with recovery of native heart function. Eleven patients (20.0%) were bridged to another therapy, two patients (3.6%) expired while on support, and in seven patients (12.7%) care was withdrawn. Overall survival was 83.6%. There were no device-related strokes, hemolysis, or limb ischemia observed. Four patients experienced purge sidearm damage, resulting in a pump stop in two patients. The new micro-axial surgical heart pump demonstrated successful clinical and device performance in providing both full hemodynamic support and ventricular unloading for patients with AMICGS, decompensated cardiomyopathy, and high-risk cardiac procedures. In this early U.S. experience, 83.6% of patients survived to explant with 76.1% of these patients recovering native heart function.
Efficacy of sofosbuvir/velpatasvir/voxilaprevir in direct-acting antiviral experienced patients with hepatitis C virus
Authors: Da Ben L. , Lourdusamy Vennis , Kushner Tatyana , Dieterich Douglas , Saberi Behnam
Published: June 2020

Aims

Report the real-world experience of the efficacy and safety of sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX) in chronic hepatitis C virus (HCV) infected patients who have previously experienced a direct-acting antiviral (DAA) containing regimen.

Methods

Consecutive patients who have previously failed or did not tolerate a DAA containing regimen for chronic HCV who was treated with SOF/VEL/VOX were studied. Baseline clinical and laboratory data including NS5A RAS mutation testing were collected.

Results

SOF/VEL/VOX resulted in an end of treatment undetectable HCV viral load in all patients and a sustained virologic response 12 rate of 100% despite the presence of NS5A RAS mutation, HIV infection, and cirrhosis. Treatment with SOF/VEL/VOX was well tolerated and there were no adverse events.

Conclusions

SOF/VEL/VOX is well tolerated and effective in treating patients who have been exposed to prior DAA therapy outside of clinical trials. SOF/VEL/VOX should be considered as the first-line regimen in HCV infected patients who have experienced prior DAA failure.
Polymorphisms in Toll-like receptors 1, 2, 5, and 10 are associated with predisposition to Helicobacter pylori infection
Authors: Kalkanli Tas Sevgi , Kirkik Duygu , Tanoglu Alpaslan , Kahraman Resul , Ozturk Kubra , Esen Muhammed Fevzi , Coskunpinar Mehmet Ender , Cagiltay Eylem
Published: June 2020

Objective:

Toll-like receptors (TLRs) are significant receptors to the innate immune system which symbolizes a family of pattern recognition receptors. We aimed to investigate associations between rs4833095 polymorphism of TLR1, rs3804099 polymorphism of TLR2, rs5744174 polymorphism of TLR5, and rs10004195 polymorphism of TLR10 in dyspeptic individuals with Helicobacter pylori infection.

Methods:

Genomic DNA was isolated and genotyping of rs4833095 polymorphism in TLR1, rs3804099 polymorphism in TLR2, rs5744174 polymorphism in TLR5, and rs10004195 polymorphism in TLR10 were investigated in 400 individuals (205 in dyspeptic individuals with H. pylori-positive subjects and 195 dyspeptic individuals with H. pylori-negative subjects) by real-time PCR. Statistical analysis was performed by Pearson’s Chi-square test.

Results:

According to our study; rs4833095 polymorphism in TLR1 C allele, rs3804099 polymorphism in TLR2 C allele, rs5744174 polymorphism in TLR5 C allele, and rs10004195 polymorphism in TLR10 A allele increased the risk of H. pylori infection [odds ratio (OR), 2.01; 95% confidence interval (CI), 1.39–3.16; OR, 1.78; 95% CI, 1.19–2.6; OR, 1.87; 95% CI, 1.25–2.78; OR, 2.66; 95% CI, 1.72–4.099, respectively].

Conclusion:

This is the first study that investigates TLRs in H. pylori infection in Turkey. Our findings may support the hypothesis that polymorphisms in certain TLRs may cause a genetic predisposition to H. pylori-related gastric problems.
Immune monitoring of a child with autoimmune hepatitis and type 1 diabetes during COVID-19 infection
Authors: Yuksel Muhammed , Akturk Hacer , Arikan Cigdem
Published: June 2020

Immunocompromised patients may be at increased risk to develop COVID-19 during the 2019 β-coronavirus infection. We present the unique opportunity we had to monitor the liver, IL-6 and immune cell course before, during and after COVID-19 in a boy with autoimmune hepatitis (AIH) and type 1 diabetes (T1D). CD4+ and CD8+ T cells frequencies decreased because of prednisolone, followed by a plateauing increase whereas CD19+CD20+ B cell increased strongly and was unaffected by COVID-19 infection. Moreover, the percentage of activated CD8+ T cells expressing HLA-DR (CD8+HLA-DR+) increased during COVID-19 and subsided after its clearance. Total regulatory T cells (Tregs: CD4+CD25+CD127lowFOXP3+) remained stable. Although activated Tregs (CD4+CD45RA-FOXP3high) strongly increased upon prednisolone, it decreased afterwards. Furthermore, regulatory B cells (Bregs: CD19+CD20+CD24highCD38high) declined sharply owing to prednisolone. Serum IL-6 remained undetectable at all times. We demonstrated for the first time immune monitoring in a child with AIH and T1D before, during and after COVID-19. We hypothesize that continuing with low level of prednisolone without azathioprine may have abrogated activated Tregs, Bregs and IL-6 production and therefore permitting the activation of CD8+ T cells, clearing the virus.
Patients developing inflammatory bowel disease have iron deficiency and lower plasma ferritin years before diagnosis: a nested case-control study
Authors: Widbom Lovisa , Ekblom Kim , Karling Pontus , Hultdin Johan
Published: June 2020

Background

Iron deficiency is common among inflammatory bowel disease (IBD) patients, generally reported without comparisons with controls. The aim of this study was to analyse if iron deficiency was more common among those later developing IBD compared to matched controls in a prospective setting.

Methods

We included 96 healthy subjects later developing IBD and 191 matched controls from the Northern Sweden Health and Disease Study. We analysed iron, ferritin, transferrin, and calculated transferrin saturation in plasma sampled at least 1 year prior to IBD diagnosis. Iron deficiency was defined as plasma ferritin <30 µg/L if C-reactive protein (CRP) was <3 mg/L. When CRP was >3 mg/L, iron deficiency could not be excluded if ferritin was <100 µg/L.

Results

Iron deficiency could not be excluded among more male cases vs controls (25.0% vs 2.2%; P < 0.001), whereas with no differences for women (39.6% vs 35.3%; P = 0.538). Ferritin was lower among male IBD cases (P = 0.001) and for ulcerative colitis (P = 0.016 for males and 0.017 for females), but not for Crohn’s disease. Ferritin was associated with a lower risk for IBD and in the ulcerative colitis subgroup when using sex-based z-scores. Ferritin quartiles 2–4 had a 65% lower odds ratio for all IBD, ulcerative colitis, and Crohn’s disease in multivariable analysis.

Conclusions

Lower ferritin was associated with higher risk for developing IBD in a prospective setting. Iron deficiency was more common among healthy males years later developing IBD compared to matched controls, but not among women.
Diabetes Is Associated With the Metastasis of Pancreatic Neuroendocrine Tumors
Authors: Fan Zhiyao , Gong Yitao , Huang Qiuyi , Yang Chao , Cheng He , Jin Kaizhou , Fan Kun , Ni Quanxing , Yu Xianjun , Luo Guopei , Liu Chen
Published: June 2020

Objectives

Type 2 diabetes mellitus (T2DM) has been associated with several types of cancers, but the role of T2DM in pancreatic neuroendocrine tumors (pNETs) has not been systematically studied.

Methods

In this study, 299 patients with pNETs were recruited, and the clinicopathologic characteristics and prognosis of the diabetic and nondiabetic patients were compared. The association between metformin use and survival was assessed to examine whether metformin impacts the prognosis of pNETs patients.

Results

The prevalence of T2DM in the cohort was 20.7% (n = 62). The proportions of grade 3 tumors, distant metastases, and nerve invasion in pNET patients with T2DM were higher than those in patients without T2DM, and as a result, the survival was worse in patients with T2DM. After adjusting for the tumor stage, diabetic status was not associated with poor survival in the univariate analysis. The results of logistic regression showed that pNET patients with T2DM were at high risk for tumor metastasis (odds ratio [OR], 2.81; P = 0.001), nerve invasion (OR, 2.43; P = 0.029), and grade 3 tumors (OR, 4.97; P = 0.010).

Conclusions

Type 2 diabetes mellitus is associated with pNET metastasis and not an independent risk factor for poor prognosis in pNETs.
Safety and Clinical Outcomes of Using Low–Molecular-Weight Dextran During Islet Autotransplantation in Children
Authors: Ali Hawa M. , Bellin Melena D. , Boucher Alexander A. , Northup Elise F. , Florek Ellen R. , Wilhelm Josh J. , Downs Elissa M. , Schwarzenberg Sarah Jane , Chinnakotla Srinath
Published: June 2020

Objectives

The objective of this study was to evaluate potential safety and clinical benefit of low–molecular-weight dextran (dextran) use in patients undergoing total pancreatectomy with islet auto transplantation (TPIAT).

Methods

We evaluated 124 children undergoing TPIAT at a single institution, either with (n = 72) or without (n = 52) perioperative dextran infusion. Data on islet graft function and postoperative complications were collected through electronic medical records and patient-reported outcomes from research questionnaires.

Results

Islet graft failure was less likely at 1 year (odds ratio, 0.186; 95% confidence interval, 0.04–0.65) and 2 years (odds ratio, 0.063; 95% confidence interval, 0.003–0.35) post-TPIAT in the dextran group. This finding remained significant at 2 years in multivariate logistic regression modeling adjusting for islet mass, body surface area, and sex. Likewise, in multivariate regression, the odds of partial islet graft function were higher at 1 and 2 years in the dextran group. Dextran use was overall safe, although it did lead to a higher incidence of postoperative bleeding requiring blood transfusions (P < 0.001).

Conclusions

These findings suggest that dextran use may increase the likelihood for sustained post-TPIAT islet graft function, potentially mitigating severity of postoperative diabetes for these children.
The Applicability of a Checklist for the Diagnosis and Treatment of Exocrine Pancreatic Insufficiency
Authors: Pezzilli Raffaele , Capurso Gabriele , Falconi Massimo , Frulloni Luca , Macarri Giampiero , Costamagna Guido , Di Leo Alfredo , Salacone Paola , Carroccio Antonio , Zerbi Alessandro
Published: June 2020

Objective

To evaluate a rapid checklist capable of identifying exocrine pancreatic insufficiency in outpatients.

Methods

Prospective observational study of a multicenter cohort.

Results

One hundred and two patients were enrolled; 61.8% of the patients had medically-treated benign or malignant pancreatic disease, and 38.2% had a pancreatic resection. Visual examination of the feces was evaluated in 84 patients and it was related to steatorrhea in 51 patients (50.0%). Receiver operating characteristic curves were evaluated for each symptom or clinical sign and four of them (ie, increase in daily bowel movements, number of bowel movements, fatty stools, >10% weight loss) had a satisfactory area under the curve. At multivariate analysis, fatty stools and >10% weight loss entered into this analysis having an area under the curve of 0.916 (95% confidence interval, 0.851–0.981). At 1 month and at one year of follow-up, the pancreatic enzyme replacement therapy administered showed that pancreatic extracts were able to significantly improve the increase in daily bowel movements, the number of bowel movements, fatty and bulky stools and >10% weight loss.

Conclusion

Both fatty stools and >10% weight loss were able to clinically evaluate steatorrhea, and their improvement was sufficient to evaluate substitution therapy.
Positive Orientation and Health‐related Quality of Life in Adult Patients Born With Anorectal Malformations
Authors: Fernandes Mariana , Aminoff Dalia , Violani Cristiano , Grano Caterina
Published: June 2020

Objectives:

Anorectal malformations (ARMs) are rare congenital colorectal anomalies, which may have a negative impact on health‐related quality of life (HRQoL) due to long‐lasting consequences, like fecal incontinence. The aim of the present study was to test whether a pervasive mode of appraising and viewing life experiences from a positive stance (ie, positivity) mediates the effect of fecal continence on HRQoL.

Methods:

Participants were enrolled from the Italian Association for Anorectal Malformations. Adult patients with ARMs who completed measures of fecal continence (Hirschsprung Disease/Anorectal Malformation Quality of Life Questionnaire), positivity (Life Satisfaction Scale, Rosenberg Self‐esteem Scale, and Life Orientation Test), and mental/physical HRQoL (SF‐36) were included. Data were analyzed using the PROCESS macro for SPSS statistical software (Model 4).

Results:

The study included 66 adult patients with ARMs. Mediated regression analyses showed a significant total effect in which patients with higher fecal continence perceived higher physical (β = 0.210, SE = 0.038, 95% CI [0.133, 0.286]) and mental HRQoL (β = 0.226, SE = 0.056, 95% CI [0.115, 0.338]) than patients with lower fecal continence. The indirect effects were also significant, indicating that positivity mediated the impact of fecal continence on physical (β = 0.026, SE = 0.017, 95% CI [0.002, 0.068]), and mental HRQoL (β = 0.146, SE = 0.058, 95% CI [0.047, 0.275]).

Conclusions:

The findings extend previous literature on ARM patients and additional evidence that an optimistic view of oneself, one's life, and one's future contribute to explain the effects of functional impairments on quality of life.
Outcomes Following Pouch Formation in Paediatric Ulcerative Colitis
Authors: Orlanski‐Meyer Esther , Topf‐Olivestone Chani , Ledder Oren , Dotan Iris , Folmer‐Hansen Lars , Kindermann Angelika , Assa Amit , Kolho Kaija‐Leena , Kolaček Sanja , Carroll Matthew W. , Strisciuglio Caterina , Aloi Marina , Hansen Richard , Navon Dan , Winter Harland S. , Navas‐López Victor M. , de Ridder Lissy , Smets Françoise , Weiss Batia , Turner Dan
Published: June 2020

Introduction:

Contemporary pediatric data on pouch outcomes are sparse, especially in the era of laparoscopic surgeries. We aimed to assess outcomes and predictors in children with ulcerative colitis/inflammatory bowel disease (IBD)‐unclassified who underwent colectomy and ileal pouch‐anal anastomosis.

Methods:

This was a multicenter retrospective cohort study from 17 IBD centers affiliated with the pediatric IBD Porto group of ESPGHAN. An electronic REDcap system was used to collate baseline characteristics, demographic, clinical, management and surgical data, short‐ and long‐term outcomes, and to identify potential predictors of pouch outcome.

Results:

Of the 129 patients included, 86 (67%) developed pouchitis during follow‐up of median 40 months (interquartile range 26–72), of whom 33 (26%) with chronic pouchitis. Patients operated on by surgeons performing <10 pouch surgeries/year had a higher rate of chronic pouchitis (11/27 [41%] vs 8/54 [15%], P = 0.013) on both univariable and multivariable analyses and also associated with time to pouchitis (P = 0.018) and chronic pouchitis (P = 0.020). At last follow‐up, overall pouch performance was rated good/excellent in 86 (74%) patients. Time from colectomy to pouch formation was not associated with pouch outcomes. Despite higher rate of nonsevere surgical complications among children undergoing colectomy at <10 years of age (7/16 [44%] vs 10/92 [11%], P = 0.003), functional outcome and pouchitis rate did not differ.

Conclusions:

Pouchitis rate in children with ulcerative colitis/IBD unclassified is high. Surgeon experience is the major modifiable risk factor for pouch outcome. Our analyses suggest that pouch surgery can also be performed successfully in young children.
Observing the Implementation of Shared Decision-making in Routine Radiotherapy Cancer Nursing
Authors: Efverman Anna , Bergius Axelsson Beata
Published: June 2020

Background

Healthcare professionals have driven decision-making in the past. However, shared decision-making has the potential to increase quality of care.

Objective

To determine to what degree patients undergoing routine pelvic radiotherapy care perceive decision-making as being shared between patient and healthcare professionals.

Methods

This exploratory longitudinal study covered 193 patients undergoing pelvic radiotherapy, mostly women (n = 161 [84%]) treated for a gynecological (n = 132 [68%]) or colorectal (n = 54 [28%]) cancer. We collected data regarding self-perceived level of shared decision-making at the start of radiotherapy and quality of life (QoL) (91%–95% response rate per week) during the radiotherapy period.

Results

The patients reported that they shared the decision-making with the healthcare professionals much (n = 137 [71%]), moderately (n = 33 [17%]), a little (n = 12 [6%]), or not at all (n = 11 [6%]). Male patients (P = .048), patients who did not live with their partner (P = .034), patients with higher education (P = .043), and patients with low functional capacity (P = .018) perceived lower levels of shared decision-making. A higher level of shared decision-making was related to higher QoL at baseline and during the first to third weeks of radiotherapy (P ranged from .001 to .044).

Conclusions

Almost 9 of 10 patients reported that they shared the decision-making moderately or much with the healthcare professionals. The study identified subgroups perceiving lower levels of shared decision-making and found that a higher level of shared decision-making was related to better QoL.

Implications

Healthcare professionals may need to pay extra attention to patients who may perceive that they share decision-making to a low extent.
Predictive Model of Psychological Distress in Patients With Lung Cancer
Authors: Lv Xiao-qing , Wang Bing-qing , Tong Huan-huan , Liu Shan-shan , Tang Hsin-Yi Jean , Hong Jing-fang
Published: June 2020

Background

Patients with lung cancer suffer from significant psychological distress. The underlying theoretical model that may explain what predicts or mediates the degree of psychological distress has not been elucidated.

Objectives

To describe the incidence of psychological distress in patients with lung cancer and to test a predictive theoretical model of psychological distress based on symptom burden, type D personality, social support, and intrusive thoughts.

Methods

Three hundred eighty-nine patients with stages I to IV lung cancer were recruited. Participants completed a battery of scales, including measures of psychological distress, symptom burden, type D personality, perceived social support, intrusive thoughts, and demographic and clinical characteristics. The predictive theoretical model was tested using structural equation modeling.

Results

Experiencing clinically significant psychological distress was reported by 63.75% of participants. Consistent with the social cognitive processing model, symptom burden, type D personality, social support, and intrusive thoughts all significantly and directly predicted the level of psychological distress in patients with lung cancer. Moreover, intrusive thoughts mediated the effects of type D personality and symptom burden on psychological distress; social support and symptom burden mediated the effects of type D personality on psychological distress.

Conclusions

The majority of the participants experienced psychological distress at a clinically significant level. Intrusive thoughts and social support mediated the effects of type D personality and symptom burden on psychological distress.

Implications for Practice

Patients with type D personality and symptom burden should be identified. Interventions for targeting social support and intrusive thoughts might ultimately reduce their psychological distress.
Psychometric Validation of the Chinese Version of the Lymphedema Functioning, Disability, and Health Questionnaire for Upper Limb Lymphedema in Patients With Breast Cancer–Related Lymphedema
Authors: Zhao Huihui , Wu Yanni , Tao Yanling , Zhou Chunlan , De Vrieze Tessa , Li Xiaojin , Chen Liling
Published: June 2020

Background

Breast cancer–related lymphedema (BCRL) has a notable impact on patients’ quality of life. However, no instrument is available to assess the problems in functioning due to BCRL in China.

Objective

The aims of this study were to translate and validate a Chinese version of the Lymphedema Functioning, Disability, and Health Questionnaire for Upper Limb Lymphedema (Lymph-ICF-UL).

Methods

A process of translation and cultural adaptation was conducted based on international standards. The study included 155 patients with BCRL and 90 patients without lymphedema. Psychometric properties that were tested consisted of internal consistency, test-rest reliability, content, construct and discriminant validity.

Results

The Cronbach’s α was .92, and intraclass correlation coefficient was 0.83. Content validity was confirmed by a sufficient content validity index in item level and scale level. Exploratory factor analysis identified 5 factors accounting for 62.44% of the total variance, and confirmatory factor analysis fit indices were acceptable. Convergent validity was supported by a moderate correlation with the 36-item Short-Form Health Survey Questionnaire and relatively weak correlations with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30. There was good divergent validity with all hypotheses evaluating divergent validity were confirmed. Significant differences were found between the lymphedema and nonlymphedema groups.

Conclusion

The Chinese version of the Lymph-ICF-UL is a valid and reliable instrument that can be used in both clinical and scientific settings in China.

Implications

The Chinese version of the Lymph-ICF-UL could be applicable in assessing the impairments in function, activity limitations, and participation restrictions of Chinese patients with BCRL.
Implementing a Transition-to-Practice Program for Novice Clinical Nurse Specialists
Authors: Abel Sarah E. , Carter-Templeton Heather
Published: June 2020

Purpose

The aim of this study was to determine the impact of a transition-to-practice program on job satisfaction among novice clinical nurse specialists (CNSs) in the US Air Force.

Program Description

A needs assessment was conducted among currently practicing Air Force CNSs (n = 30) to establish the necessity for a transition-to-practice program. Newly graduated CNSs (n = 8) were paired with experienced CNS mentors and met every 2 weeks for 2 months to discuss progress on the CNS core competencies. Before beginning the program, mentees self-reported perceptions related to the core competencies. Mentors focused on areas of self-reported low competency. The Nursing Context Index was administered preintervention and postintervention to assess the program's impact on job satisfaction.

Outcomes

Overall job satisfaction among novice CNSs improved from 5.01 to 5.57 (scale, 1-7) after completing the program. Personal satisfaction (4.30-5.63) and satisfaction with professional support (5.28-6.00) showed the greatest improvement out of the 4 elements of job satisfaction evaluated.

Conclusions

Transition-to-practice programs can be beneficial for novice CNSs in establishing their practice. Future studies with larger sample sizes over longer periods of time are necessary to determine the true impact of similar programs.
High Lifetime Prevalence of Syphilis in Men Who Have Sex With Men and Transgender Women Versus Low Lifetime Prevalence in Female Sex Workers in Lima, Peru
Authors: Hung Phoebe , Osias Ethan , Konda Kelika A. , Calvo Gino M. , Reyes-Díaz E. Michael , Vargas Silver K. , Goldbeck Cameron , Caceres Carlos F. , Klausner Jeffrey D.
Published: June 2020

Background

The syphilis epidemic continues to cause substantial morbidity worldwide and is worsening despite ongoing control efforts. Syphilis remains an important public health problem among 3 key populations: men who have sex with men (MSM), transgender women, and female sex workers.

Methods

We conducted a retrospective chart review of patients that received rapid point-of-care treponemal antibody tests from January 2019 to July 2019 in 4 sexually transmitted infection (STI) clinics in Lima, Peru. We assessed patient medical records for human immunodeficiency virus (HIV) infection, history of STIs, as well as sociodemographic and behavioral characteristics. Cross-sectional descriptive analyses were used to determine factors associated with treponemal positivity.

Results

We included 401 patient records in our analyses: 252 MSM, 31 transgender women, and 118 female sex workers. The overall median age of patients was 29.0 years (interquartile range, 24.0–36.0 years). Positivity on the treponemal test was 28.9% (95% confidence interval [CI], 24.3%–33.3%) overall, 37.7% (95% CI, 31.7%–44.0%) for MSM, 54.8% (95% CI, 36.0%–72.7%) for transgender women, and 3.4% (95% CI, 0.9%–8.5%) for female sex workers. In the bivariate analysis, treponemal positivity was also associated with receptive anal sex in the last 6 months in MSM (P < 0.01). Additionally, treponemal positivity increased with age (P = 0.0212) and varied by socioeconomic status (P < 0.01). Multivariate Least Absolute Shrinkage and Selection Operator logistic regression showed that treponemal positivity was highly associated with HIV coinfection (adjusted odds ratio, 5.42) and previous STI other than HIV or syphilis (adjusted odds ratio, 1.54).

Conclusions

A review of the medical records of members of 3 key populations who had recently received a rapid point-of-care treponemal test in Lima, Peru, revealed that lifetime prevalence of syphilis was high among MSM and transgender women, but low among female sex workers. Those results may indicate a need for more frequent, regular testing among MSM and transgender women—possibly in conjunction with HIV testing, and appropriate treatment of those shown to be positive.
Primary Extranodal Classical Hodgkin Lymphoma of the Sphenoid Sinus: A Case Report and Brief Review of the Literature
Authors: Odeyemi Olumide O. , Rosser Julie A.
Published: June 2020

Primary sinonasal lymphoma is a relatively rare disease, particularly in Western societies, and the vast majority of these are non-Hodgkin lymphoma. Classical Hodgkin lymphoma (CHL) characteristically originates in lymph nodes; primary extranodal CHL of the sinonasal tract is extremely rare. We report a case of a 63-year-old woman with primary CHL of the sphenoid sinus. The patient presented to the emergency department with complaints of “flashing light” in both eyes. Magnetic resonance imaging studies revealed a 4.2-cm enhancing mass in the sphenoid sinus. Histologic examination of the sphenoid mass revealed a diffuse mixed inflammatory infiltrate, within which were scattered large atypical cells with enlarged nuclei with irregular nuclear contours and prominent eosinophilic nucleoli, consistent with Hodgkin/Reed-Sternberg cells. Immunohistochemical studies showed the large atypical cells to be positive for CD15 and CD30 and negative for CD20 and CD45. In situ hybridization staining for small Epstein-Barr virus–encoded RNA was also positive in the atypical cells. These findings supported the diagnosis of CHL.
Subspecialty Training
Authors: Brassil Michelle , Gallegos-Kearin Vanessa , Tolchin Dorothy Weiss
Published: June 2020

Physiatrists care for patients and families with complex medical needs, and primary palliative care is an important part of the comprehensive rehabilitation care plan. Palliative care improves patient and family quality of life and reduces healthcare costs. Clinical care guidelines for several physiatry patient populations now include the provision of palliative care.

Current Accreditation Council for Graduate Medical Education physiatry residency program requirements include foundational palliative care skills. Similarly, current clinical palliative care practice guidelines enumerate standards that apply to the rehabilitation setting. However, there is a dearth of literature on the current state of palliative care training within physiatry programs, and hospice and palliative medicine remains one of the least subscribed physiatry subspecialties.

In this article, we describe palliative care, highlight existing literature on palliative care needs within physiatry patient populations, and identify a core physiatry-palliative care skillset. We look both within physiatry and across other specialties to guide recommendations for palliative care education within physiatry residency programs. We also describe opportunities for post–residency fellowship training in hospice and palliative medicine.
Activity of the Quadratus Lumborum and Trunk Muscles Relates to Pelvic Tilt Angle During Pelvic Tilt Exercises
Authors: Oshikawa Tomoki , Adachi Gen , Akuzawa Hiroshi , Okubo Yu , Kaneoka Koji
Published: June 2020

Objective

Pelvic tilt exercises are used clinically to correct lumbopelvic alignment. The anterior and posterior layers of the quadratus lumborum are important for pelvic motor control in the coronal plane. This study aimed to evaluate whether the anterior and posterior activity is related to the pelvic tilt angle during pelvic tilt exercises.

Design

The study design was single-occasion repeated measures in a randomized manner. Twelve healthy men performed the four directions of the pelvic tilt exercises (anterior or posterior pelvic tilt and lateral pelvic elevation on the ipsilateral or contralateral measurement side). The electromyographies of the anterior and posterior were recorded using intramuscular fine-wire electrodes and normalized to isometric peak electromyography.

Results

The activity of the anterior and posterior during lateral pelvic elevation on the ipsilateral measurement side (19.0 ± 16.0 percent of maximal voluntary isometric contraction) was significantly higher than that during other directions of the pelvic tilt exercises (P< 0.01). There was a significant positive correlation between the anterior activity and the maximum change angles of pelvic tilt during lateral pelvic elevation on the ipsilateral measurement side (r= 0.674,P= 0.016).

Conclusions

The anterior activity was related to a large lateral pelvic elevation angle on the ipsilateral side during pelvic tilt exercises.
Attentional Processing and Interpretative Bias in Functional Neurological Disorder
Authors: Keynejad Roxanne C. , Fenby Edward , Pick Susannah , Moss-Morris Rona , Hirsch Colette , Chalder Trudie , Hughes Alicia M. , Nicholson Timothy R.
Published: June 2020

Objective

Altered attentional processing (automatically attending to negative or illness-relevant information) and interpretative biases (interpreting ambiguous information as negative or illness relevant) may be mechanistically involved in functional neurological disorder (FND). Common mechanisms between FND and chronic fatigue syndrome (CFS) have been proposed but not compared experimentally.

Methods

We compared the cognitive task performance of FND, CFS, and healthy control (HC) groups. The tasks assessed attentional bias toward illness-relevant stimuli (visual probe task), attentional control (attention network task), and somatic interpretations (interpretative bias task), alongside self-reported depression, anxiety, fatigue, and general health.

Results

Thirty-seven participants diagnosed with FND, 52 participants diagnosed with CFS, and 51 HC participants were included. Although participants with CFS showed attentional bias for illness-relevant stimuli relative to HC (t = −3.13, p = .002, d = 0.624), individuals with FND did not (t = −1.59, p = .118, d = 0.379). Both the FND (t = 3.08, p = .003, d = 0.759) and CFS (t = 2.74, p = .007, d = 0.548) groups displayed worse attentional control than did the HC group. Similarly, the FND (t = 3.63, p < .001, d = 0.801) and CFS groups (t = 4.58, p < .001, d = 0.909) showed more somatic interpretative bias than did the HC group.

Conclusions

Similar attentional control deficits and somatic interpretative bias in individuals with FND and CFS support potential shared mechanisms underlying symptoms. Interpretative bias toward somatic and illness-relevant stimuli in functional disorders may prove a therapeutic target.
Gentle Touch
Authors: Oztek Murat Alp , Noda Sakura , Beauchemin Emily A. , Otto Randolph K.
Published: June 2020

Pediatric imaging presents unique challenges related to patient anxiety, cooperation, and safety. Techniques to reduce anxiety and patient motion in adults must often be augmented in pediatrics, because it is always mentioned in the field of pediatrics, children are not miniature adults. This article will review methods that can be considered to improve patient experience and cooperation in imaging studies. Such techniques can range from modifications to the scanner suite, different ways of preparing and interacting with children, collaborating with parents for improved patient care, and technical advances such as accelerated acquisition and motion correction to reduce artifact. Special considerations for specific populations including transgender patients, neonates, and pregnant women undergoing fetal imaging will be described. The unique risks of sedation in children will also be briefly reviewed.
Benefits of the Multidisciplinary Approach After Curative Surgery for the Treatment of Scalp Angiosarcoma
Authors: Lee Kyeong-Tae , Moon Jeehyun , Jeong Han-Sin , Lim Ha Seong , Lim So Young
Published: June 2020

Background

Patients with scalp angiosarcoma still present with a dismal prognosis, indicating the need for a multidisciplinary approach. The present study aimed to investigate the treatment outcomes of scalp angiosarcoma with a focus on the effect of radiotherapy and chemotherapy, performed in either an adjuvant or palliative setting, after curative surgical treatment.

Methods

Patients with scalp angiosarcoma without evidence of systemic metastasis who were treated with curative ablative surgery between 2008 and 2018 were assessed. Oncologic outcomes, including recurrence-free survival (RFS) and overall survival (OS), were evaluated.

Results

A total of 23 patients were analyzed. All patients underwent radical resection, most of whom (82.6%) achieved R0 resection. Adjuvant radiotherapy and chemotherapy (all taxane-based) were delivered for 11 and 3 patients, respectively. Recurrence developed in 17 (73.9%) of 23 patients during a mean follow-up period of 18.4 months. The overall 2-year RFS and OS were 15.5% and 44.4%, respectively. Multivariate analysis showed that adjuvant radiotherapy and chemotherapy were associated with a significantly low risk of recurrence. In 17 patients with recurrence, those receiving palliative radiotherapy or chemotherapy had significantly higher OS than those not receiving any treatments. Compared with patients treated during the first half of the study period, those treated during the latter part, who received adjuvant and palliative radiotherapy or chemotherapy more frequently, had significantly favorable OS, with a 2-year OS of 77.8%.

Conclusions

A multidisciplinary approach using radiotherapy and/or chemotherapy combined with curative resection might be associated with better oncologic outcomes in patients with scalp angiosarcoma.
A Rare Cause of Dysphagia: Giant Lipoma in Parapharyngeal Space
Authors: Aslan Mehmet , Ozer Ozturk Ebru , Dogukan Fatih Mert
Published: June 2020

Background:

Parapharyngeal area is one of the most complex areas of head and neck anatomy. Tumors of the parapharyngeal region are very rare among head and neck tumors. Lipomas also constitute a tiny proportion of parapharyngeal tumors so parapharyngeal area lipomas are very rare in the literature. Due to anatomical location, these tumors treatment is challenging.

Clinical Report:

A 20-year-old male patient admitted to our department with complaints of swallowing difficulty and a mass on the right side of the neck. Magnetic resonance imaging was performed, and it was reported as a 6 × 4.5 cm lipoma. He underwent excision of parapharyngeal area lipoma by a transoral approach.

Conclusion:

Parapharyngeal lipomas are very rare, and difficult to diagnose before they turn out symptomatic. The primary treatment approach in tumors of the parapharyngeal area is surgery and the surgical approach should be chosen according to the anatomical location of the lesion.