bluuebunny/crossref_metadata_2025 huggingface dataset:
17. Angiolymphoid hyperplasia with eosinophilia mimicking temporal arteritis
Authors: Ansari Ghazal , Pakozdi Angela , Etomi Oseme
Published: September 2019

Introduction

A 32-year-old man presented to rheumatology clinic with a 2-year history of progressively worsening right temporal headache, a painful hard lump on his right temple and pre-auricular tenderness not responding to conventional analgesics. Patient denied any jaw and tongue claudication. His vision was not compromised and patient denied weight loss, night sweats and arthralgia. He was fit and well otherwise.

Case description

Examination revealed a pulsatile mass with a length of 1 cm along the superficial temporal artery. Temporal artery ultrasound revealed lump corresponds to the superficial artery with thickened wall and halo formation raising the possibility of temporal arteritis. MRI head scan suggested inflammation of the superficial temporal artery.

Discussion

Because of the atypical features of young age and normal inflammatory markers, corticosteroid treatment was not commenced. A temporal artery biopsy showed no evidence of vasculitis, but revealed reactive lymphoid follicles with eosinophil infiltrates in the surrounding soft tissue. The diagnosis of angiolymphoid hyperplasia with eosinophilia (ALHE) was made. The patient’s headaches have completely resolved after the temporal biopsy. Unfortunately, three months later the lump and the headaches recurred. The symptoms improved with topical tacrolimus 0.1% ointment and he underwent for complete surgical excision of the lump. Patient is asymptomatic and remained well.

Key learning points

We present a case of angiolymphoid hyperplasia with eosinophilia which can mimic temporal arteritis presentation as in our case and has totally different approach to management.  ALHE, which is a benign, locally proliferative condition with predilection to the periauricular and scalp area with no definitive treatment however, complete excision can be curative. It may recur in up to one-third of cases in the absence of complete surgical excision as in our patient.

Conflict of interest

The authors declare no conflicts of interest.
3. Dermatomyositis and underlying bilateral benign endometrioma
Authors: Parker Lucy , Soliotis Fotini
Published: September 2019

Introduction

The link between ovarian malignancy and paraneoplastic dermatomyositis is well established. Association with underlying benign ovarian pathology is much less certain, with only scarce case report evidence available. This represents the first case of dermatomyositis with associated bilateral ovarian chocolate cysts.

Case description

A 45-year-old female presented with classical features of dermatomyositis, with a background of hypertension and non-alcoholic fatty liver disease. She had proximal limb weakness, neck flexor weakness, dysphagia and dysphonia, accompanied by a scaly, erythematous rash over her face, chest, abdomen and lateral thighs. Serum creatine kinase (CK) at presentation was 4923 IU/L. An MRI scan of her thighs showed widespread muscle oedema affecting both legs and the pelvis, including the quadriceps, iliacus and psoas muscles. A punch biopsy of the skin on her thigh showed only post inflammatory pigmentation. Lung volumes were reduced (FEV1 69% predicted). Video fluoroscopy confirmed moderate-severe pharyngeal stage dysphagia. CT scan of the chest, abdomen and pelvis revealed enlarged, unilocular cysts in each ovary, the right cyst measuring 7 cm and the left, 5 cm in maximal diameter. Subsequent transvaginal ultrasound confirmed bilateral unilocular, thick walled cysts with a ground-glass appearance, which would be consistent with benign endometriomas. A further interval ultrasound after 1 month showed no change in their appearance or size. Serum CA125 was 104 kU/L.

The patient was treated with 3 pulses of 1g intravenous (IV) methylprednisolone, followed by 2 courses of IV immunoglobulin 2g/kg over 5 days. This was followed by a gradually reducing course of oral prednisolone, starting at 50mg OD PO alongside 15mg weekly of oral methotrexate. She has responded well to treatment, with near normalisation of her objective manual muscle testing scores and normalisation of the serum CK value. Surgery is now planned for a total abdominal hysterectomy and bilateral oophorectomy.

Discussion

Extensive investigation has not demonstrated any other underlying malignancy to account for the development of dermatomyositis. Initial limited and unsustained clinical response to IV methylprednisolone prompted further treatment with IV immunoglobulin. Surgical histology results are now awaited to confirm the suspected diagnosis. It will be very interesting to see if surgical removal of the cysts has any impact on the clinical manifestation of disease.

Key learning points

Benign ovarian pathology should not be dismissed as a potential underlying mechanism for development of dermatomyositis.

Conflicts of interest

The authors have declared no conflicts of interest.
Social jetlag is associated with an increased likelihood of having depressive symptoms among the Japanese working population: the Furukawa Nutrition and Health Study
Authors: Islam Zobida , Hu Huanhuan , Akter Shamima , Kuwahara Keisuke , Kochi Takeshi , Eguchi Masafumi , Kurotani Kayo , Nanri Akiko , Kabe Isamu , Mizoue Tetsuya
Published: September 2019

Study Objectives

Social jetlag, a mismatch between biological and social timing, has been reported to be associated with depressive symptoms among general population. However, evidence on this association is lacking among non-shift workers, who are under pressure to adapt themselves to a work schedule. We investigated the cross-sectional association of social jetlag with depressive symptoms among Japanese non-shift workers.

Methods

This study included 1,404 employees, aged 18–78 years, who completed a study questionnaire at a periodic health checkup. Social jetlag was calculated as the absolute value of the difference in the midpoint of sleep times between weekdays and weekends. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Multivariable logistic regression was used to estimate the odds ratio (OR) with adjustments for potential confounders including diet and chronotype.

Results

Of the study participants, 63.5%, 28.4%, and 8.1% had less than 1 hour, 1 to less than 2 hours, and at least 2 hours of social jetlag, respectively. Greater social jetlag was significantly associated with an increased likelihood of having depressive symptoms. The multivariable-adjusted OR (95% confidence interval) were 1.30 (0.95 to 1.78) and 2.14 (1.26–3.62) for 1 to less than 2 hour and at least 2 hours compared to less than 1 hour of social jetlag. The association between social jetlag and depressive symptoms appeared to be linear, according to restricted cubic spline regression.

Conclusion

Results suggest that greater social jetlag is associated with an increased likelihood of having depressive symptoms among non-shift workers.
The Automated and Electric Vehicles Act 2018 Part 1 and Beyond: A Critical Review
Authors: Marson James , Ferris Katy , Dickinson Jill
Published: September 2019

On 19 July 2018, the Automated and Electric Vehicles Act 2018 (AEVA) received Royal Assent. As motor vehicles are becoming increasingly technologically based, with driving aids having taken over many of the more mundane (and possibly dangerous) aspects of driving from the driver, it is imperative that legislation keeps pace to determine the responsibilities of the parties. Motor insurance provides protection for those involved with vehicles and who may suffer harm, injury, and loss due to the negligence of the actors. This is most frequently driver error, but may also include manufacturing defects, which result in deaths and less serious injuries. It is also here where the intersection between torts and insurance laws needs careful management. It would be particularly unfair to ask drivers or third-party victims of motor vehicle accidents to seek redress from a manufacturer for losses incurred during the actions of an autonomous vehicle. Consumer law has historically removed this burden from affected consumers and it is entirely sensible for the law to protect individuals in an emerging field—and perhaps even more so given the trajectory of vehicles with driver-enabled qualities and the numbers of vehicles currently featuring such innovations. Yet, the AEVA consists of aspects which are troubling in respect of the motor insurance industry’s dominance of this market, the application of compulsory insurance, and exclusions and limitations to responsibility which expose policy holders and victims to EU-breaching levels of risk.
Social Support, Quality of Services, and Job Satisfaction: Empirical Evidence from Palestinian Social Workers
Authors: Safadi Najwa Sado
Published: September 2019

This study examines the predictors of job satisfaction among public sector social workers in occupied Palestinian territories. Using a quantitative design, data were collected in summer of 2016 through a paper-based, self-administered questionnaire (N = 237). Using hierarchical multiple regression, the three models explained 15 percent to 32 percent of the variance in job satisfaction. In the final model, coefficient indicated that monthly income, contract work status, service orientation, and supervisory support are related to job satisfaction. Respondents with more children and lower salaries showed lower levels of job satisfaction. Respondents who are working as temporary contract workers, who have positive attitudes toward the social work profession, and who have positive attitudes toward supervisory support are more likely to be satisfied with their job. Implications for administrative practice and policy are presented.
I–2 Systemic Effect of LIPUS on B-TCP-(tri-calcium-phosphate) Ceramic Discs Subcutaneously Implanted in the Dorsal Aspect of Rat
Authors: Hidaka Kouki , Mikuni-Takagaki Yuko , Fujita Maiko , Seki Azusa , Ito Yoshihiro , Kumagai Ken , Takeuchi Ryohei
Published: September 2019

Objective:

It is essential to have sufficient numbers of cells for bone regeneration. We previously reported that LIPUS exposure to rodent fractured femurs or sockets of extracted teeth recruited cells from sites remote to the lesion through peripheral blood vessels (Kumagai, Takeuchi et al, J Orthop Res 2012 and Hidaka et al, Int J Anal Bio-Sci 2015). In the present study, we tried to show LIPUS exerted its anabolic action systemically on tricalcium phosphate (β-TCP) discs implanted in the back of rats, which were not directly treated with LIPUS.

Materials and Methods:

Four pairs of male Sprague Dawley rats were operated on as previously described. A week later, 3 β-TCP discs were implanted in the dorsal aspect of sham operated control rats and the experimental rats. On and following the day of implantation, the 2 discs closer to the rat head only in one of the pair were exposed to LIPUS every 24 hours for 2 weeks as described.

Results and Discussion:

Except in one rat, which showed enlarged spleen and adrenal body, no abnormality was found. Body weight, histology, and transfer of injected fluorescence-conjugated protein from one to the other rat suggested the operation was successful. In the β-TCP discs of LIPUS-untreated side rats, we observed invaded cells and blood vessels present in numbers between those of the LIPUS-exposed and the control rats. Real-time PCR and immunohistochemistry analysis also showed consistent results. Given these findings, the systemic effect of LIPUS may be more influential than we used to assume.
II–1 Compliance With Treatment Using Low-Intensity Pulsed Ultrasound (LIPUS): Comparison Between Fresh Fracture and Delayed Union Groups
Authors: Nakajima Daisuke , Uchiyama Yoshiyasu , Kobayashi Yuka , Watanabe Masahiko
Published: September 2019

Objective:

Since treatment with low-intensity pulsed ultrasound (LIPUS) is performed by patients themselves, patient's compliance with the treatment may be a problem. In this study, we investigated the differences in patients compliance to LIPUS due to differences in the timing of the introduction of LIPUS (fresh fracture group vs. delayed union group).

Subjects and Methods:

Of 367 patients who used LIPUS at 3 Tokai University Hospitals between May 2010 and November 2017, 283 patients (male: 186, female: 97) who were able to be followed until completion of the LIPUS treatment were selected as the subjects. The patients were divided into 2 groups: a fresh fracture group (159 patients) in which LIPUS was introduced within 3 months after the injury and a delayed union group (124 patients) in which LIPUS was introduced 3 months or later after the injury. The compliance rate (the number of days using LIPUS/number of days on which the device was lent × 100), duration of LIPUS use, and pseudarthrosis formation rate were evaluated as indices of the patients' compliance to LIPUS treatment. For statistical comparisons of the 2 groups, χ2 test or Mann–Whitney U-test were used and P-values < 0.05 were regarded as significant.

Results:

The LIPUS compliance rates were 67.7 ± 20.1 and 69.8 ± 21.0% in the fresh fracture and delayed union groups, respectively, showing no significant difference. The durations of LIPUS use were 130 ± 64 and 161 ± 86 days, respectively, showing that it was used for a more prolonged duration in the latter group (P = 0.004). The pseudarthrosis formation rates were 5.0% (8 cases) and 5.6% (7 cases), respectively, showing no significant difference between the 2 groups.

Discussion:

The relationships between low LIPUS compliance rate, prolongation of the duration of use and lower patient age have been reported previously. However, this study clarified that the duration of LIPUS use was also extended as the introduction of LIPUS was delayed. However, the pseudarthrosis formation rate did not increase in the delayed union group and had no major influence on compliance.
Camps for Children with Cancer and Their Families: A Systematic Review of Psychosocial and Physical Impacts
Authors: Kelada Lauren , Wakefield Claire Elizabeth , Cruz Silva Maria C. , Signorelli Christina
Published: September 2019

Objective:

Camps for children with cancer and their families aim to promote positive psychosocial and physical outcomes for attendees. However, evidence for this is inconsistent, and previous reviews have not delineated between camps for children (patient/survivors and siblings) and family camps (including parents/guardians). Such understanding is necessary to understand the evidence-based benefits of each type of camp. Our systematic review summarizes the findings and limitations of the recent literature for children's camps and family camps.

Methods:

We searched MEDLINE/PubMed, PsycINFO, Social Work Abstracts, and Google Scholar for relevant articles published between 2013 and 2018.

Results:

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol, we included 19 articles (from 15 studies) in the review. Evidence for the impact of camps was mixed. All articles reported positive outcomes, yet 3 quantitative articles also reported nonsignificant changes. Camps for children (representing 2151 children with cancer/survivors) appeared to facilitate social skills, self-esteem, and physical activity. Family camps (representing 96 families) may provide families the opportunity to reconnect. Both types of camp provide attendees with social support and fun/respite. In 2 qualitative articles, some parents attending family camps reported tension between families of children on treatment and bereaved families. The literature is limited by small sample sizes and the lack of multisite, longitudinal, and controlled study designs.

Conclusion:

The recent literature provides evidence for some positive, short-term psychosocial and physical outcomes of camps. Future research should use rigorous quasiexperimental designs and should assess the long-term impact of camp attendance.
Profiles and Predictors of Infant Sleep Problems Across the First Year
Authors: Cook Fallon , Conway Laura , Gartland Deirdre , Giallo Rebecca , Keys Elizabeth , Brown Stephanie
Published: September 2019

Objective:

To identify profiles and predictors of maternal-reported infant sleep problems across the first postnatal year.

Methods:

Survey data examining maternal mental and physical health, intimate partner violence (IPV), and infant sleep problems and night waking were gathered from a cohort of 1,460 nulliparous women at 15 weeks' gestation and when their infants were 3, 6, 9, and 12 months old.

Results:

Latent class analysis revealed 5 profiles of infant sleep problems, including those who had few problems (24.7%), persistent moderate problems (27.3%), increased problems at 6 months (10.8%), increased problems at 9 months (17.8%), and persistent severe problems (19.4%). Persistent severe infant sleep problems were associated with prepartum and postpartum maternal depression (adjusted odds ratio [AOR] 2.13, 95% confidence interval [CI] 1.35–3.34, p < 0.01; AOR 2.52, 95% CI 1.64–3.87, p < 0.001, respectively), poorer prepartum and postpartum perception of health (adjusted mean difference [AMD] 23.48, 95% CI 24.9 to 22.1, p < 0.01; AMD 23.78, 95% CI 25.2 to 22.4, p < 0.001, respectively), increased postpartum anxiety (AOR 2.22, 95% CI 1.26–3.90, p < 0.01), and increased prevalence of IPV in the first year postpartum (AOR 1.86, 95% CI 1.20–2.87, p < 0.01).

Conclusion:

Poorer prepartum and postpartum maternal mental and physical health, and IPV, were associated with maternal report of persistent severe infant sleep problems. Women experiencing prenatal physical and mental health difficulties may benefit from advice on managing infant sleep and settling. Health professionals working with unsettled infants must be equipped to enquire about and respond appropriately to disclosures of IPV.
Simulation in Cleft Surgery
Authors: Kantar Rami S. , Alfonso Allyson R. , Ramly Elie P. , Diaz-Siso J. Rodrigo , Breugem Corstiaan C. , Flores Roberto L.
Published: September 2019

Background:

A number of digital and haptic simulators have been developed to address challenges facing cleft surgery education. However, to date, a comprehensive review of available simulators has yet to be performed. Our goal is to appraise cleft surgery simulators that have been described to date, their role within a simulation-based educational strategy, the costs associated with their use, and data supporting or refuting their utility.

Methods:

The following PubMed literature search strategies were used: “Cleft AND Simulation,” “Cleft Surgery AND Simulation,” “Cleft Lip AND Simulation,” “Cleft Palate AND Simulation.” Only English language articles up to May 1, 2019, were included. Simulation phases of learning were classified based on our previously proposed model for simulation training.

Results:

A total of 22 articles were included in this study. Within identified articles, 11 (50%) were strictly descriptive of simulator features, whereas the remaining 11 (50%) evaluated specific outcomes pertinent to the use of cleft surgery simulators. The 22 included articles described 16 cleft surgery simulators. Out of these 16 cleft surgery simulators, 7 (43.8%) were high fidelity haptic simulators, 5 (31.2%) were low fidelity haptic simulators, and 4 (25.0%) were digital simulators. The cost to simulator user ranged from freely available up to $300.

Conclusions:

Cleft surgery simulators vary considerably in their features, purpose, cost, availability, and scientific evidence in support of their use. Future multi-institutional collaborative initiatives should focus on demonstrating the efficacy of current cleft simulators and developing standardized assessment scales.
Donor Site Morbidity in Phalloplasty Reconstructions: Outcomes of the Radial Forearm Free Flap
Authors: Kovar Alexandra , Choi Susie , Iorio Matthew L.
Published: September 2019

Background:

The radial artery forearm free flap (RFFF) is the workhorse technique for phallus reconstruction. The RFFF provides good cosmesis and potential sensory recovery. However, the donor site is large in comparison to other applications of the RFFF which may increase the potential for donor site morbidity, such as nerve injury, delayed wound healing, and decreased hand strength. This study systematically reviewed the current literature to assess the donor site morbidity associated with RFFF phalloplasty (RFFFP).

Methods:

A systematic review utilizing Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines was completed of the current literature pertaining to donor site morbidity after RFFFP. Two investigators independently reviewed the literature to determine eligibility for inclusion. Two hundred sixty-seven studies were reviewed and 10 were included in the final analysis after application of exclusion criteria.

Results:

Nine hundred forty flap reconstructions were identified. Gender affirming surgery was the indication in 77.7% (n = 730) of patients. The overall donor site complication rate was 7.9% (n = 74). Skin graft failure occurred in 41 patients (4.5%) and was the most frequent complication. Donor site infection (n = 3, 15.8%), hematoma (n = 1, 0.8%), neuroma (n = 1, 10%), compartment syndrome (n = 1, 0.8%), decreased strength or sensation (n = 15, 4.9%), lymphedema or limb swelling (n = 10, 3.9%), and contracture (n = 2, 6.5%) were also found.

Conclusions:

The most common donor site complication after RFFFP is skin graft failure. Decreased forearm sensation and strength affected a significant proportion of patients within each reported cohort. Prospective studies should continue to evaluate donor site morbidity with objective measures, such as grip strength evaluation, and long-term follow-up for vascular changes following radial artery harvest.
A Novel Mangled Upper Extremity Injury Assessment Score
Authors: Savetsky Ira L. , Aschen Seth Z. , Salibian Ara A. , Howard Katherine , Lee Z-Hye , Frangos Spiros G. , Thanik Vishal D.
Published: September 2019

Background:

Managing mangled upper extremity injuries is a challenging problem because multiple tissue components including soft tissue, muscle, tendon, bone, nerves, and vessels are involved. The complexity of these injuries has hindered the development of accurate scoring systems and treatment algorithms.

Methods:

Patients with mangled upper extremities presenting to a metropolitan level 1 trauma center in New York City over a 10-year period were identified. A mangled upper extremity was defined as any injury to ≥3 tissue components involving the extremity proximal to the digit.

Results:

The injuries and outcomes of 76 patients were evaluated and used to create a Mangled Upper Extremity Score (MUES). One point was assigned for each of the following injury characteristics: patient age >40, fasciotomy needed, bony fixation required, bony defect present, revascularization required, crush injury mechanism, degloving or avulsion injury present, and a soft tissue defect >50 cm2. The MUES correlated with the number of complications (P value = 1.96 × 10−7) and length of hospital stay (P value = 3.95 × 10−7). Next, a Mangled Extremity Severity Score (MESS) equivalent was calculated for each patient. There was no correlation between the MESS and the number of complications (P value = 0.92) or length of hospital stay (P value = 0.35).

Conclusions:

Existing extremity scoring systems, including the MESS, are not reliable in predicting the success of limb salvage attempts or outcomes of mangled upper extremity injuries. The MUES developed in this study correlates significantly with important outcome measures including the number of hospital complications and length of hospital stay.
Structure-function Relationship in Advanced Glaucoma After Reaching the RNFL Floor
Authors: Sung Mi Sun , Heo Hwan , Park Sang Woo
Published: September 2019

Précis:

Although the circumpapillary retinal nerve fiber layer (cpRNFL) reached the measurement floor, the nasal macular region is important for assessing central visual function in advanced glaucoma.

Purpose:

To investigate the relationship between the central visual field (VF) and macular parameters obtained from spectral-domain optical coherence tomography (SD-OCT) in patients with advanced glaucoma that reached the cpRNFL thickness measurement floor and to determine whether the structural changes measured by SD-OCT are useful for estimating the functional status in these patients.

Methods:

A total of 68 eyes from 68 patients with advanced glaucoma were included. Only eyes having an average cpRNFL thickness of ≤57 μm that reached the measurement floor were included. Macular imaging using Cirrus SD-OCT and 10-2 Humphrey VF was performed. The VF mean deviation was converted to a linear scale using unlogged 1/Lambert values. The relationships between the central VF and various macular parameters were determined.

Results:

Patients had a mean VF mean deviation of −20.69 dB and an average cpRNFL thickness of 51.76±3.61 μm. Correlations between the VF and all cpRNFL thickness parameters were not significant. However, significant correlations were found between the central VF and superonasal macular ganglion cell-inner plexiform layer thickness (r=0.334; P=0.003), inner nasal macular thickness (r=0.301; P=0.013), and outer nasal macular thickness (r=0.331; P=0.007).

Conclusions:

Even after the cpRNFL had reached the measurement floor, several macular parameters showed a statistically significant relationship with functional status in VF. In particular, the assessment of structural changes in the nasal macular region may be important in determining the central VF in advanced glaucoma.
Quality of Life in Thyroid Eye Disease: A Systematic Review
Authors: Lee Tze Howe Brandon , Sundar Gangadhara
Published: September 2019

Purpose:

The aim of this systematic review is to provide 1) an understanding of the components of quality of life (QOL) questionnaires and 2) an up-to-date insight of the types of QOL questionnaires available, strengths and limitations based on current literature.

Methods:

A literature search was conducted from 18 to 21 of February 2019 using 6 major databases: Cochrane Library, Ovid Medline, PubMed, Scopus, Taylor and Francis, and Web of Science. All papers were skimmed by title and abstract to determine whether the paper fulfilled the screening criteria. In cases of uncertainty, the paper was read in totality to justify its inclusion. After that, duplicates were eliminated and the remainder was subjected to a second set of inclusion and exclusion criteria before finalizing the list of included studies.

Results:

An initial search returned with 402 studies, which were subsequently filtered using prespecified criteria to 27 studies to collate information regarding questionnaires assessing QOL of thyroid eye disease patients.

Conclusions:

The QOL of thyroid eye disease patients is best assessed using disease-specific questionnaires. Among the different types of questionnaires, the Graves Ophthalmopathy Quality of Life (GO-QOL) questionnaire is preferred due to its’ ability to explore QOL in-depth and proven efficacy in many countries after cultural adaptation at the expense of time. Single-item questionnaires like the Thyroid Eye Disease Quality of Life (TED-QOL) are more suitable as screening tools in busy metropolitan settings while semi-structured interviews are important in developing new ways of assessing the QOL of thyroid eye disease patients.
Pediatric nurse practitioner's perceived organizational support in academic and nonacademic institutions
Authors: Kleinert Dorothy , Johnson Janet , Webel Allison R. , Fitzpatrick Joyce
Published: September 2019

Background:

The role of the pediatric nurse practitioner (PNP) has changed since its inception over 50 years ago. Pediatric nurse practitioner practice has evolved from providing outpatient primary care to children to providing complex care in the acute practice environment.

Purpose:

The purpose of this study was to describe whether a difference existed in perceptions of organizational support (POS) of PNPs working in academic and nonacademic institutions and to describe the differences between PNP reporting structures and POS.

Methods:

A quantitative cross-sectional design was used with a convenience sample (n = 86) of PNPs from the membership list of the Pediatric Nurse Credentialing Board (PNCB). A formal written request was sent to the PNCB to access their membership after which institutional review board approval was obtained from Case Western Reserve University. Participants received an online cover letter with links to the surveys to be completed. The PNPs were asked to complete a demographic/institution characteristic survey and Eisenberger Perceived Organizational Support Survey (POS).

Results:

More than 63% of the PNPs participating in this national survey, practicing in both academic and nonacademic affiliated hospitals, had positive perceptions of organizational support. No differences were found between the academic and the nonacademic affiliations.

Implications for practice:

Because PNPs are integral to the provision of care to children, providing opportunities for PNPs to continue to enhance their clinical skills and practice to the full extent of their scope of practice will only enhance their perceptions of organizational support. This dynamic creates a win-win for the PNP, the institution, the patients they care for, and the US health care system.
Ecological interactions in asthma: from environment to microbiota and immune responses
Authors: Kozik Ariangela , Huang Yvonne J.
Published: September 2019

Purpose of review

Asthma is a heterogeneous condition shaped not only by genetics but also host conditioning by environmental factors. Recognizing the ecological context of microbe-immune interactions across environments and body sites is a necessary step toward better understanding how human microbiota influence or drive the pathogenesis and pathophysiology of asthma in its various presentations.

Recent findings

There is increasing evidence of a critical role for microbiota in asthma pathogenesis and outcomes across various body compartments, including the upper and lower airways, and gut. We discuss recent studies from this area including: development of a method to quantify microbial farm-effect in nonfarm environments, relationships between environmental microbial exposures and asthma prevalence across different geographies, microbiome-mediated responses to ozone, and microbiome-immune interactions within and across body compartments. Beyond bacteria, recent reports of asthma-associated differences in archaea and fungal organisms also are highlighted.

Collective evidence warrants application of an ecological framework to advance mechanistic insights into microbiota-immune interactions in asthma. This is necessary to achieve goals of developing successful therapeutic interventions targeting modification of microbiomes.
Comparison of mortality and complications between bilateral simultaneous and staged total hip arthroplasty
Authors: Huang Liangku , Xu Tao , Li Peng , Xu Yuben , Xia Lei , Zhao Zandong
Published: September 2019

Background:

Total hip arthroplasty (THA) relieves pain and restores function in patients with severe rheumatoid arthritis and osteoarthritis. Over the past few decades, several authors have attempted to assess the efficacy and safety of simultaneous bilateral THA compared with staged bilateral THA. The purpose of this meta-analysis is to compare the mortalities and complications between simultaneous bilateral THA and staged bilateral THA.

Methods:

A literature search to identify eligible studies was undertaken to identify all relevant articles published until August 2018. We included studies that compared simultaneous bilateral THA and staged bilateral THA and their effects on mortality and complications. The outcomes included mortality, the occurrence of deep venous thrombosis (DVT), the occurrence of pulmonary embolism (PE), respiratory complications, cardiovascular complications, digestive system complications and the occurrence of dislocation. Stata 12.0 was used for the meta-analysis.

Results:

Nineteen studies involving 59,257 patients were identified; among them, 16,758 patients were selected for treatment with simultaneous bilateral THA, and 42,499 patients were chosen for the purpose of staged bilateral THA. The meta-analysis results demonstrated that there was no significant difference between simultaneous bilateral THA and staged bilateral THA in terms of mortality (risk ratio [RR] = 1.15, 95% CI = 0.76, 1.74; P = .520). Compared with staged bilateral THA, simultaneous bilateral THA was associated with a reduction in the occurrence of DVT, PE and respiratory complications (P < .05). There were no significant differences in the cardiovascular complications, digestive system complications or the occurrence of dislocation and infection (P = .057).

Conclusions:

We observed that the prevalence of DVT, PE and respiratory complications was considerably lower with the use of simultaneous bilateral THA than with the use of staged bilateral THA. Thus, simultaneous bilateral THA is a considerably safer procedure than staged bilateral THA in selected THA patients.
Evaluation of halitosis in adult patients after treatment with photodynamic therapy associated with periodontal treatment
Authors: Romero Sergio dos Santos , Schalch Tânia Oppido , do Vale Katia Llanos , Ando Ellen Sayuri , Mayer Marcia Pinto Alves , Feniar Joanna Paula Gaba , Fernandes Kristianne Porta Santos , Bussadori Sandra Kalil , Motta Lara Jansiski , Negreiros Renata Matalon , Tempestini Horliana Anna Carolina Ratto
Published: September 2019

Rationale:

Halitosis is an unpleasant odor that emanates from the mouth. Studies show halitosis returns in a week, after treatment with PDT. Probably, bacteria living in the periodontal sulcus could recolonize the dorsum of the tongue. Until nowadays, there are no study in adult population that associates halitosis and periodontal treatment with follow-up evaluation. The aim of this randomized, controlled, single-blinded clinical trial is to treat oral halitosis in healthy adults with photodynamic therapy (PDT), associated with periodontal treatment and follow them up for 3 months.

Patient concerns:

the concerns assessments will be done over the study using anamnesis interviews and specific questionnaire.

Diagnoses:

halitosis will be evaluated by OralChroma.

Interventions:

The participants (n = 40) with halitosis will be randomized into 2 groups: G1-treatment with PDT (n = 20) or G2-cleaning of the tongue with a tongue scraper (n = 20).

Outcomes:

Halitosis will be evaluated by measuring volatile sulfur compounds using gas chromatography. After the treatments, a second evaluation will be performed, along with a microbiological analysis (RT-PCR) for the identification of the bacteria T. denticola. The assessment of halitosis and the microbiological analysis will be repeated. After that, patients will receive periodontal treatment. The participants will return after 1 week and 3 months for an additional evaluation. Quality of life will be measured by Oral Health Impact Profile questionnaire (OHIP-14).

Lessons:

This protocol will determine the effectiveness of phototherapy regarding the reduction of halitosis in adults. clinicaltrials.gov NCT 03996915.

Ethics and dissemination:

This protocol received approval from the Human Research Ethics Committee of Universidade Nove de Julho (certificate number: 3.257.104). The data will be published in a peer-reviewed periodical.
Radiological and clinical findings in sclerosing adenosis of the breast
Authors: Tan Hongna , Zhang Huiyu , Lei Zhidan , Fu Fangfang , Wang Meiyun
Published: September 2019

To study the imaging and clinical features of breast sclerosing adenosis (SA), and to enhance the recognition of this disease, as well as to help the clinic to give a correct diagnosis.

Imaging findings were retrospectively reviewed in 47 women with SA lesions confirmed by pathology (including 39 cases of mammography, 40 cases of ultrasound [US], and 34 cases magnetic resonance imaging [MRI]).

Of 47 patients confirmed with SA, 18 cases were pure SA, and 29 cases coexist with other proliferative lesions and malignancies; the maximum diameter of SA lesions was 0.5 to 3.5 cm with an average of 1.6 cm. On the mammogram of 39 SA cases, the percentage of architectural distortion, calcifications, mass/nodular, asymmetric density, and mass combining with calcifications were 30.8%, 23.1%, 17.9%, 12.8%, and 7.7%, respectively; and 3 cases had no abnormal findings. On the sonogram (excluding 5 normal finding cases), the majority of lesions showed regular shaped (57.1%), well defined margined (60.0%), heterogenous low echoed (71.4%) nodulus. 85.3% lesions showed high signal on T2-weighted images, and all lesions were enhanced markedly, including 82.4% lesions appearing mass-like enhancement (17 star-shaped enhanced masses included); and the percentage of the time-signal intensity curve in type 1, type 2, and type 3 were 52.9%, 41.2%, and 5.9%, respectively. If the category breast imaging-reporting and data system ≥4b was considered to be a suspicious malignant lesion, the misdiagnostic rates of mammography, US, and MRI would be 17.9%, 17.5%, and 35.3%, respectively.

The SA lesions are small and can occur with other diseases histologically. The majority of SA lesions showed distortion or calcifications on mammograms, low echo-level nodules with heterogenous echo on US and mass-like lesion with or without star shape on enhanced MRI.
Once-weekly bortezomib had similar effectiveness and lower thrombocytopenia occurrence compared with twice-weekly bortezomib regimen in treating patients with newly diagnosed multiple myeloma in China
Authors: Yao Rongxin , Hu Xudong , Zhou Shuping , Zhang Qianying , Huang He , Sun Ni , Guo Wenjian , Yu Kang , Lin Ying
Published: September 2019

The study aims to examine the treatment effect and adverse reactions of patients with newly diagnosed MM receiving different bortezomib-based regimens.

This was a retrospective study of patients with newly diagnosed MM and who were treated with bortezomib-based combined chemotherapy at the Department of Hematology of the 2 affiliated hospitals of Wenzhou Medical University between July 2009 and May 2016. Cox proportion hazard multivariate analyses were carried out to assess the differences in treatment effect and adverse events between standard (1.3 mg/m2 on days 1, 4, 8, 11) and weekly (1.6 mg/m2 on days 1, 8, 15) cohorts, as well as the differences between intravenous injection and subcutaneous injection therapy. Progression-free survival (PFS) and overall survival (OS) were assessed using Kaplan–Meier method and the log-rank test.

Among the 117 patients, 78 patients were treated with bortezomib standard therapy and 39 patients were treated with bortezomib weekly therapy (all with intravenous injection). In all patients, the treatment strategy was not independently associated with PFS or OS. The patients in the weekly therapy group had less thrombocytopenia events than those in the standard therapy group. The subcutaneous route had similar treatment effect as the intravenous route, but the incidence of peripheral neuropathy was lower.

The once-weekly bortezomib regimen was similar in effectiveness to standard therapy in treating patients with newly diagnosed MM, but the incidence of thrombocytopenia was lower with the weekly regimen compared with the standard regimen.
A persistent primitive hypoglossal artery-posterior inferior cerebellar artery convergence aneurysm treated by stent-assisted coil embolization
Authors: Zeng Shi , Yang Donghong , Yang Huajiang , Xu Lun-Shan , Xu Min-Hui
Published: September 2019

Rationale:

Persistent primitive hypoglossal artery (PPHA) is often associated with intracranial anomalies such as aneurysms. Surgical treatment of aneurysms on the PPHA is challenging due to that the posterior circulation depends solely on PPHA.

Patient concerns:

A case of an 83-year-old woman with a large aneurysm on PPHA presented with vertigo was reported.

Diagnosis:

Three-dimensional angiogram revealed a wide-neck aneurysm on the PPHA.

Interventions:

The aneurysm was successfully treated using a novel low-profile visualized intraluminal support stent-assisted coiling technique.

Outcomes:

No complications occurred during the procedure. The final angiogram confirmed the patency of the posterior inferior cerebellar artery and the parent artery and its distal branches.

Lessons:

Our case suggests that stent-assisted coil embolization is safe and effective for the treatment of aneurysms on the PPHA.
Association between interleukin-6 gene polymorphisms and febrile seizure risk
Authors: Chen Qingling , Li Mengmeng , Zhang Xin , Zhang Xinyue , Zhong Rui , Lin Weihong
Published: September 2019

Background:

The association between plasma interleukin-6 (IL-6) levels and the development of febrile seizures (FS) has been reported in multiple previous studies, which showed significantly higher serum IL-6 levels in FS patients than in control patients. However, the mechanism underlying this association remains unclear. One previous study indicated an increased frequency of the −174 GG and −597 GG genotypes in FS patients. Although IL-6 gene polymorphisms may be associated with FS risk, this association remains a matter of debate.

Objective

Considering the lack of meta-analyses addressing the possible association between IL-6 gene polymorphisms and the risk of FS, we aimed to perform a meta-analysis to determine the association of IL-6 gene polymorphisms (−572, −174, −597) with the risk of FS.

Methods

We conducted a systematic literature search in the PubMed, EMBASE, and WANFANG databases to collect eligible articles. The associations of IL-6 gene polymorphisms with FS risk were evaluated by calculating the pooled odds ratios and 95% confidence intervals. The dominant, recessive, heterozygous, homozygous, and allele genetic models were used to calculate the combined ORs.

Results

Our meta-analysis showed that IL-6 (−572, −174, −597) polymorphisms were significantly associated with susceptibility to FS.

Conclusion:

This study provided knowledge regarding the association of IL-6 (572, 174, 597) polymorphisms with susceptibility to FS. The T allele and TT genotype may be associated with an increased risk for FS.
Development and validation of a SEER-based prognostic nomogram for patients with bone metastatic prostate cancer
Authors: Hou Guangdong , Zheng Yu , Wei Di , Li Xi’an , Wang Fuli , Tian Jingyang , Zhang Geng , Yan Fei , Zhu Zheng , Meng Ping , Yuan Jiarui , Gao Ming , Li Zhibin , Zhang Bin , Xing Zibao , Yuan Jianlin
Published: September 2019

Controversies exist between the previous two prognostic nomograms for patients with bone metastatic prostate cancer (PCa), and a nomogram applied to western patients has yet to be established. Thus, we aimed to build a reliable and generic nomogram to individualize prognosis.

The independent prognostic factors were identified in a retrospective study of 1556 patients with bone metastatic PCa registered in the Surveillance, Epidemiology and End Results (SEER) database. Besides, the prognostic nomogram was developed using R software according to the result of multivariable Cox regression analysis. Then, the discriminative ability of the nomogram was assessed by analyses of receiver operating characteristic curves (ROC curves). We also performed 1-, 2-, and 3-year calibrations of the nomogram by comparing the predicted survival to the observed survival. Furthermore, the model was externally validated using the data of 711 patients diagnosed at different times enrolled in the SEER database.

Age ≥70 years, Gleason score ≥8, PSA value of 201 to 900 ng/ml, stage T4, stage N1, with liver metastases, and Asian/Pacific ethnicity were identified as independent prognostic factors. In the primary cohort, 1-, 2-, and 3-year area under the ROC curve (AUC) of the nomogram for predicting cancer-specific survival (CSS) were 0.71, 0.70, and 0.70, respectively. Besides 1-, 2-, and 3-year AUC were 0.70, 0.68, and 0.69, respectively, in the external validation cohort. Moreover, calibration curves presented perfect agreements between the nomogram-predicted and actual 1-, 2-, and 3-year CSS rate in both the primary and external validation cohorts. In other words, our nomogram has great predictive accuracy and reliability in predicting 1-, 2-, and 3-year CSS for patients with bone metastatic prostate cancer.

This study established and validated a prognostic nomogram applied to not only Asian patients but western patients with bone metastatic PCa, which will be useful for patients’ counseling and clinical trial designing.
HE4 as a biomarker for diagnosis of lung cancer
Authors: He Yong-Peng , Li Li-Xian , Tang Jia-Xi , Yi Lin , Zhao Yi , Zhang Hai-Wei , Wu Zhi-Juan , Lei Hai-Ke , Yu Hui-Qing , Nian Wei-Qi , Gan Lin
Published: September 2019

Background:

The aim of our study was to assess the value of serum human epididymis protein 4 (HE4) to diagnose lung cancer and provide reliable scientific conclusions to guide clinical practice.

Methods:

A systematic search of the PubMed, EMBASE, Cochrane Library, Chinese National Knowledge Infrastructure, Chinese Biomedical Literature, and WANFANG databases was conducted to identify all studies examining serum HE4 in the diagnosis of lung cancer published up to June, 2017. The Quality Assessment of Diagnostic Accuracy Studies tool was used to evaluate the methodological quality of each trial. The meta-analysis was performed using STATA software and Review Manager 5.3.

Results:

There were 21 studies involving 1883 cases and 1696 controls included in our meta-analysis. The pooled sensitivity and specificity of HE4 for diagnosing lung cancer were 0.73 (95% confidence interval [CI] 0.68–0.78) and 0.86 (95% CI 0.81–0.91), respectively. The positive likelihood ratio and negative likelihood ratio were 5.4 (95% CI 3.8–7.5) and 0.31 (95% CI 0.26–0.37), respectively. The diagnostic odds ratio was 17 (95% CI 12–26). The area under the curve of the summary receiver-operating characteristic curve was 0.86 (95% CI 0.83–0.89). Race, assay method, type of cancer, sample size, and publication date might be sources of heterogeneity in our meta-analysis. Subgroup analyses showed that the sensitivity in Caucasians was higher than that in Asians (0.81, 95% CI 0.71–0.91; and 0.71, 95% CI 0.66–0.77, respectively), but the specificity in Asians was better than that in Caucasians (0.87, 95% CI 0.81–0.92; and 0.85, 95% CI 0.73–0.97, respectively). The chemiluminescent microparticle immunoassay had the highest sensitivity, with 0.79 (95% CI 0.73–0.97), and the enzyme-linked immunosorbent assay had the highest specificity, with 0.87 (95% CI 0.79–0.94). HE4 had high diagnostic efficacy when screening for small cell lung cancer with the highest specificity (0.90, 95% CI 0.77–1.00).

Conclusions:

HE4 is a relatively promising and effective biomarker for the diagnosis of lung cancer. Furthermore, given the limitations of our study, additional large-scale and well-designed studies are needed in the future.