bluuebunny/crossref_metadata_2025 huggingface dataset:
ACRE: Absolute concentration robustness exploration in module-based combinatorial networks
Authors: Kuwahara Hiroyuki , Umarov Ramzan , Almasri Islam , Gao Xin
Published: March 2017

To engineer cells for industrial-scale application, a deep understanding of how to design molecular control mechanisms to tightly maintain functional stability under various fluctuations is crucial. Absolute concentration robustness (ACR) is a category of robustness in reaction network models in which the steady-state concentration of a molecular species is guaranteed to be invariant even with perturbations in the other molecular species in the network. Here, we introduce a software tool, absolute concentration robustness explorer (ACRE), which efficiently explores combinatorial biochemical networks for the ACR property. ACRE has a user-friendly interface, and it can facilitate efficient analysis of key structural features that guarantee the presence and the absence of the ACR property from combinatorial networks. Such analysis is expected to be useful in synthetic biology as it can increase our understanding of how to design molecular mechanisms to tightly control the concentration of molecular species. ACRE is freely available at https://github.com/ramzan1990/ACRE.
Making Management Skills a Core Component of Medical Education
Authors: Myers Christopher G. , Pronovost Peter J.
Published: March 2017

Physicians are being called upon to engage in greater leadership and management in increasingly complex and dynamic health care organizations. Yet, management skills are largely undeveloped in medical education. Without formal management training in the medical curriculum, physicians are left to cultivate their leadership and management abilities through a haphazard array of training programs or simply through trial and error, with consequences that may range from frustration among staff to reduced quality of care and increased risk of patient harm. To address this issue, the authors posit that medical education needs a more systematic focus on topics related to management and organization, such as individual decision making, interpersonal communication, team knowledge sharing, and organizational culture. They encourage medical schools to partner with business school faculty or other organizational scholars to offer a “Management 101” course in the medical curriculum to provide physicians-in-training with an understanding of these topics and raise the quality of physician leadership and management in modern health care organizations.
Biomechanical Evaluation of the Depth of Resection During Femoral Neck Osteoplasty for Anterior Impingement Following Slipped Capital Femoral Epiphysis
Authors: Dale Kevin M. , Burns Geoffrey T. , Li Ying
Published: March 2017

Background:

Femoroacetabular impingement as a result of slipped capital femoral epiphysis (SCFE) has been treated traditionally with a proximal femoral osteotomy, but open and arthroscopic femoral osteoplasty is becoming increasingly popular. Cam lesions result from excess bone primarily at the anterolateral femoral head-neck junction. SCFEs result from posterior and inferior slippage of the femoral epiphysis, causing the metaphysis to move anteriorly. This study’s purpose was to compare fourth-generation sawbones standard femurs with SCFE femurs to determine whether bone resection from the anterior metaphysis results in similar biomechanical properties.

Methods:

A custom fourth-generation composite SCFE sawbone was created with a 30-degree slip angle. Control group consisted of fourth-generation composite standard nondeformed medium femurs. The femoral neck at the head-neck junction was divided into 4 quadrants. All resections were done in the anterolateral quadrant. Twenty SCFE sawbones and 20 standard sawbones were divided into 4 subgroups based on resection depths of 0%, 10%, 30%, and 50% of the metaphysis at the head-neck junction. After resection, all proximal femurs were loaded to failure in an Instron testing machine to determine the ultimate load to failure, stiffness, and energy to failure.

Results:

The standard femurs were significantly stronger than the SCFE femurs (P<0.001) and the strength of the femurs decreased significantly as the resection amount increased (P<0.001). Similarly, the standard femurs withstood significantly more energy before failing than the SCFE femurs (P<0.001) and the energy to failure decreased significantly with varying resection amounts (P<0.001).

Conclusions:

SCFE femurs demonstrate a significant reduction in strength and energy to failure after osteoplasty compared with nondeformed femurs in a sawbone model. Strength and energy to failure are inversely proportional to the depth of bone resection.

Clinical Relevance:

Aggressive femoral neck osteoplasty for treatment of a SCFE deformity may lead to increased risk of fracture. Further studies are necessary to determine the safe depth of resection in a clinical setting.
Usage of Chewing Gum in Posterior Spinal Fusion Surgery for Adolescent Idiopathic Scoliosis
Authors: Chan Chris Yin Wei , Chiu Chee Kidd , Lee Chee Kean , Gani Siti Mariam Abd , Mohamad Siti Mariam , Hasan Mohd Shahnaz , Kwan Mun Keong
Published: March 2017

Study Design.

Randomized controlled trial.

Objective.

The present study investigated the effectiveness of chewing gum on promoting faster bowel function and its ability to hasten recovery for patients with adolescent idiopathic scoliosis (AIS) after posterior spinal fusion (PSF) surgery.

Summary of Background Data.

Sham feeding with chewing gum had been reported to reduce the incidence of postoperative ileus by accelerating recovery of bowel function.

Methods.

We prospectively recruited and randomized 60 patients with AIS scheduled for PSF surgery into treatment (chewing gum) and control group. The patient-controlled anesthesia usage, wound pain score, abdominal pain score, nausea score, and abdominal girth were assessed and recorded at 12, 24, 36, 48, and 60 hours postoperatively. The timing for the first fluid intake, first oral intake, sitting up, walking, first flatus after surgery, first bowel opening after surgery, and duration of hospital stay were also assessed and recorded.

Results.

We found that there were no significant differences (P > 0.05) in patient-controlled anesthesia usage, wound pain score, abdominal pain score, nausea score, and abdominal girth between treatment (chewing gum) and control groups. We also found that there were no significant difference (P > 0.05) in postoperative recovery parameters, which were the first fluid intake, first oral intake, sitting up after surgery, walking after surgery, first flatus after surgery, first bowel opening after surgery, and duration of hospital stay between both groups. The wound pain was the worst at 12 hours postoperatively, which progressively improved in both groups. The abdominal pain progressively worsened to the highest score at 48 hours in the treatment group and 36 hours in the control group before improving after that. The pattern of severity and recovery of wound pain and abdominal pain was different.

Conclusion.

We found that chewing gum did not significantly reduce the abdominal pain, promote faster bowel function, or hasten patient recovery.

Level of Evidence: 1
Mass Spectrometry Imaging Can Distinguish on a Proteomic Level Between Proliferative Nodules Within a Benign Congenital Nevus and Malignant Melanoma
Authors: Lazova Rossitza , Yang Zhe , El Habr Constantin , Lim Young , Choate Keith Adam , Seeley Erin H. , Caprioli Richard M. , Yangqun Li
Published: March 2017

Histopathological interpretation of proliferative nodules occurring in association with congenital melanocytic nevi can be very challenging due to their similarities with congenital malignant melanoma and malignant melanoma arising in association with congenital nevi. We hereby report a diagnostically challenging case of congenital melanocytic nevus with proliferative nodules and ulcerations, which was originally misdiagnosed as congenital malignant melanoma. Subsequent histopathological examination in consultation by one of the authors (R.L.) and mass spectrometry imaging analysis rendered a diagnosis of congenital melanocytic nevus with proliferative nodules. In this case, mass spectrometry imaging, a novel method capable of distinguishing benign from malignant melanocytic lesions on a proteomic level, was instrumental in making the diagnosis of a benign nevus. We emphasize the importance of this method as an ancillary tool in the diagnosis of difficult melanocytic lesions.
Vibration Anesthesia for Pain Reduction During Intralesional Steroid Injection for Keloid Treatment
Authors: Park Kui Young , Lee Yohan , Hong Ji Yeon , Chung Won Soon , Kim Myeung Nam , Kim Beom Joon
Published: March 2017

BACKGROUND

Patients suffer significant pain during intralesional steroid injection treatment for keloids and hypertrophic scars. Vibration anesthesia has been shown to effectively and safely alleviate pain sensations, likely by reducing pain transmission from peripheral receptors to the brain.

OBJECTIVE

The objective was to evaluate the efficacy, safety, and patient satisfaction associated with vibration anesthesia for reducing pain during intralesional corticosteroid injection.

METHODS

The authors recruited 40 patients with 58 keloids who were scheduled to undergo intralesional triamcinolone acetonide (TA) injections. Half of each keloid was injected with concomitant vibration anesthesia, whereas the other half was injected without vibration anesthesia. Pain experienced by patients during both procedures was assessed according to visual analog scale (VAS) score. The authors also assessed procedure safety.

RESULTS

The mean VAS score during intralesional TA injection therapy without vibration was 5.88 ± 2.34. By contrast, the same patients yielded a mean VAS score during intralesional TA injection therapy with vibration of 3.28 ± 1.85; the difference between the mean scores was significant (p < .05). Thirty-nine (97.5%) patients tolerated this therapy well.

CONCLUSION

Vibration anesthesia is a promising option for reducing pain during keloid treatment with intralesional steroid injection.
ULTRAWIDEFIELD AUTOFLUORESENCE IN ABCA4 STARGARDT DISEASE
Authors: Klufas Michael A. , Tsui Irena , Sadda SriniVas R. , Hosseini Hamid , Schwartz Steven D.
Published: March 2017

Purpose:

To report the ultrawidefield fundus autofluorescence (UWF-FAF) patterns in ABC4A Stargardt disease.

Methods:

A retrospective cohort study of patients with a clinical diagnosis of Stargardt disease, confirmed ABCA4 genotype, and ultrawidefield fundus autofluorescence imaging using an Optos P200Tx. Four independent graders evaluated the images. Ultrawidefield fundus autofluorescence images were evaluated for the presence of posterior pole and peripheral findings, and were classified into one of three types (Type I: lesions confined to the macula with no peripheral findings; Type II: macular atrophy with flecks only in the periphery; Type III: macular atrophy and varying degrees of peripheral atrophy).

Results:

Ultrawidefield fundus autofluorescence was performed on 58 eyes of 29 patients. Reviews of images revealed the presence of peripheral (outside the 55° view of standard nonwidefield FAF imaging) alterations on UWF-FAF in 76% of eyes. Overall, the UWF-FAF pattern was classified as Type I in 24% eyes (14/58), Type II in 24% (14/58), and Type III in 52% (30/58). The most common genetic mutations were c.2588G>C (6/29 patients, 20.7%), and c.5882G>A (5/29 patients, 17.2%).

Conclusion:

Ultrawidefield fundus autofluorescence reveals peripheral changes in the majority of patients with Stargardt disease. Peripheral FAF changes may have implications for diagnosis, prognosis, and management of individual patients with Stargardt disease.
Adapting a Developmental Screening Measure
Authors: Chen Chieh-Yu , Chen Ching-I , Squires Jane , Bian Xiaoyan , Heo Kay H. , Filgueiras Alberto , Kalinina Svetlana , Samarina Larissa , Ermolaeva Evgeniya , Xie Huichao , Yu Ting-Ying , Wu Pei-Fang , Landeira-Fernandez Jesus
Published: March 2017

Ages & Stages Questionnaires: Social–Emotional (ASQ:SE) is a widely used screening instrument for detecting social–emotional difficulties in infants and young children. To use a screening instrument across cultures and countries, it is necessary to identify potential item-level biases and ensure item equivalence. This study investigated the cultural equity of the 60-month interval of the ASQ:SE by examining whether the items functioned differently in the original English version compared with 5 adapted translated versions (i.e., Korean, Portuguese, Russian, Simplified Chinese, and Traditional Chinese), as well as exploring cultural considerations resulting from identified differences. The research team analyzed differential item functioning (DIF) in a total of 25,042 sixty-month ASQ:SE questionnaires drawn from extant data sets of 6 different language versions. Results indicated that a large portion of items were identified with DIF, suggesting that when participating parents/caregivers rated the social–emotional competence of their children, diverse cultural values, beliefs, and expectations affected their responses. This study provides implications for professionals and developers when using translated/adapted instruments in diverse cultures.
Childcare Providers' Use of Practices to Promote Young Children's Social–Emotional Competence
Authors: Steed Elizabeth A. , Roach Andrew T.
Published: March 2017

Findings are presented regarding childcare providers' use of evidence-based strategies to promote preschoolers' social–emotional competence in 38 urban childcare classrooms. Descriptive results from classroom observations and childcare teachers' interviews indicated that in the absence of training, childcare teaching staff implemented few of these strategies. Teachers also reported a lack of infrastructure elements such as professional development, a leadership team, data-based tools for decision making, and monetary resources that are associated with the adoption and sustained use of strategies. Findings are described and recommendations are presented to support implementation of practices associated with young children's social–emotional competence in childcare settings.
Intention to Use mHealth in Older Adults With Heart Failure
Authors: Cajita Maan Isabella , Hodgson Nancy A. , Budhathoki Chakra , Han Hae-Ra
Published: March 2017

Background:

mHealth, or the use of mobile technology in healthcare, is becoming increasingly common. In heart failure (HF), mHealth has been associated with improved self-management and quality of life. However, it is known that older adults continue to lag behind their younger counterparts when it comes to mobile technology adoption.

Objective:

The primary aim of this study was to examine factors that influence intention to use mHealth among older adults with HF.

Methods:

An adapted Technology Acceptance Model was used to guide this cross-sectional, correlational study. Convenience sampling was used to identify participants from a large university hospital and online.

Results:

A total of 129 older adults with HF participated in the study. Social influence (β = 0.17, P = .010), perceived ease of use (β = 0.16, P < .001), and perceived usefulness (β = 0.33, P < .001) were significantly associated with intention to use mHealth even after controlling for potential confounders (age, gender, race, education, income, and smartphone use). Perceived financial cost and eHealth literacy were not significantly associated with intention to use mHealth.

Conclusions:

Researchers should consider using the participatory approach in developing their interventions to ensure that their mHealth-based interventions will not only address the patient’s HF self-management needs but also be easy enough to use even for those who are less technology savvy.
Mucous Membrane Pemphigoid Causing Central Airway Obstruction
Authors: Jalil Bilal A. , Abdou Yara G. , Rosen Stephanie A. , Dammad Tarek
Published: March 2017

Mucous membrane pemphigoid (MMP) is a rare variant of the skin disease pemphigoid, which predominantly involves the mucous membranes. This rare autoimmune disease that infrequently affects the respiratory tract is characterized by subepithelial blister formation that may result in scarring. Immunopathologic examination of mucous membranes reveals the deposition of immunoglobulins and complement within the subepithelial basement membrane. We describe a patient with undiagnosed MMP, with a near-fatal presentation of central airway obstruction causing acute respiratory distress. The patient was successfully treated with emergent rigid bronchoscopic resection of a ball valve-like endotracheal mass, and diagnosed with a rare variant of pemphigoid disease, MMP. The patient was treated with mycophenolate and was clinically in remission, with bronchoscopically stable lesions at 1 year of follow-up.
Update on the risks of benign adrenocortical incidentalomas
Authors: Di Dalmazi Guido
Published: March 2017

Purpose of review

Recent studies highlighted the association between adrenocortical incidentalomas and several comorbidities. This review summarizes the most recent evidence showing the potential risks related to adrenocortical tumors classified as nonfunctioning adrenal incidentalomas (NFAIs) or associated with clinically autonomous cortisol secretion (ACS).

Recent findings

Alterations in glucose metabolism are a common finding in patients with ACS (30% of the cases). As shown in nonrandomized trials, surgical treatment may improve or cure diabetes in 52% of patients. Cross-sectional studies showed that NFAIs are also associated with insulin resistance. In a recent long-term retrospective study, patients with NFAI were at increased risk of developing prediabetes/diabetes during follow-up. Similarly, a prospective study showed that the incidence of prediabetes was higher also in tumors converting from NFAI to ACS. Patients with ACS are at increased risk of cardiovascular events and related mortality. Some cardiovascular markers were altered in patients with NFAI, even if a cause–effect relationship is not readily evident. Finally, 13% of NFAIs have increased risk of developing ACS during long-term follow-up.

Patients with NFAI are at increased risk of developing alterations of glucose metabolism, whereas those with ACS or NFAI who converted to ACS over time are at risk for cardiovascular diseases.
Role of targeted biopsy under magnifying endoscopy with narrow band imaging may be not necessary: a prospective diagnostic accuracy study
Authors: Zhang Qing-Wei , Zhou Ying , Zhang Jing-Jing , Li Hai-Yan , Song Jie-Ying , Ge Zhi-Zheng , Li Xiao-Bo
Published: March 2017

Background and aims

Targeted biopsy under the guidance of magnifying endoscopy with narrow band imaging (ME-NBI) has higher accuracy than endoscopic forceps biopsy (EFB) in the differential diagnosis of cancerous lesions from noncancerous lesions. The aims of this study were to validate diagnostic efficacy of targeted biopsy under the guidance of ME-NBI (MNTB) and further evaluate whether it is necessary to perform MNTB when combined with ME-NBI.

Methods

This study prospectively analyzed 211 gastric lesions of suspected cancerous tissues. The sensitivity, specificity, positive predictive value, and negative predictive value of EFB, ME-NBI, MNTB, EFB plus ME-NBI, and MNTB plus ME-NBI for the diagnosis of cancerous lesions were determined, respectively. The accuracy, sensitivity, specificity of EFB and MNTB, EFB plus ME-NBI, and MNTB plus ME-NBI were also compared, respectively.

Results

The accuracy, sensitivity, and specificity with 95% confidence intervals were 68.2% (61.4–74.4%), 62.3% (54.1–69.9%), 84.2% (71.6–92.1%) for EFB, 75.4% (68.9–80.9%), 72.7% (64.9–79.4%), 82.5% (69.6–90.8%) for MNTB, 76.8% (70.4–82.2%), 73.4% (65.5–80.0%), 86.0% (73.7–93.3%) for ME-NBI, 82.0% (76.0–86.8%), 85.7% (79.0–90.6%), 71.9% (58.3–82.6%) for EFB plus ME-NBI, 84.8% (79.1–89.3%), 89.6% (83.4–93.8%), and 71.9% (58.3–82.6%) for MNTB plus ME-NBI, respectively. The sensitivity of MNTB was significantly higher than that of EFB (P=0.048). There was no significant difference in the sensitivity (P=0.307), specificity (P=1.000), and accuracy (P=0.337) between EFB plus ME-NBI and MNTB plus ME-NBI.

Conclusion

Although MNTB has a higher diagnostic efficacy than EFB in the diagnosis of cancerous lesions, it may be not necessary to perform MNTB when combined with ME-NBI.
Continuous Intravenous Milrinone Therapy in Pediatric Outpatients
Authors: Curley Michelle , Liebers Jill , Maynard Roy
Published: March 2017

Milrinone is a phosphodiesterase 3 inhibitor with both positive inotropic and vasodilator properties. Administered as a continuous infusion, milrinone is indicated for the short-term treatment of patients with acute decompensated heart failure. Despite limited data supporting long-term milrinone therapy in adults with congestive heart failure, children managed as outpatients may benefit from continuous milrinone as a treatment for cardiac dysfunction, as a destination therapy for cardiac transplant, or as palliative therapy for cardiomyopathy. The aim of this article is to review the medical literature and describe a home infusion company's experience with pediatric outpatient milrinone therapy.
Heparin-Induced Thrombocytopenia
Authors: Frazer Cynthia A.
Published: March 2017

Heparin-induced thrombocytopenia (HIT) is an immune-mediated complication of heparin therapy. The use of heparin to flush some vascular access devices makes HIT a concern for infusion nurses. This article reviews the risk factors for, pathophysiology of, and management of HIT.
Performance Assessment of Epidermal Growth Factor Receptor Gene Sequencing According to Sample Size in Daily Practice Conditions
Authors: García Alejandro , Lorente Constanza , Cuello María T. , dos Santos Mariana , Elsner Boris , Avagnina Alejandra , Denninghoff Valeria
Published: March 2017

Lung carcinoma is the main cause of cancer death worldwide. Adenocarcinoma molecular biomarkers have been discovered, and targeted therapies have been developed with encouraging results. The epidermal growth factor receptor gene is one of these biomarkers. Exons 18 to 21 should be studied in patients with advanced adenocarcinoma, who are candidates for treatment with tyrosine kinase inhibitors. The objective was to compare the performance of the determination in large and small samples in daily practice conditions, trying to adjust to published consensus guidelines. A retrospective observational study of 141 cases was carried out, with exons 19 and 21 sequencing. Sample size (small vs. large), including number of satisfactory polymerase chain reaction (PCR), sequencing, deletions, and mutations, were evaluated. In small biopsies, sample type, fragment number, and percentage of tumor per sample were analyzed. The results shown 114/141 (80.8) cases that met selection criteria; 60/114 (53%) were large (surgical) and 54/114 (47%) were small samples (19/54 endoscopic, 17/54 fine needle aspiration clots, 4/54 lymph nodes, 14/54 core and other). All large samples were satisfactory PCR, 56/60 (93%) satisfactory sequencing, and 12/56 (21%) had deletions in exon 19. Small samples were satisfactory PCRs in 50/54 (93%) cases, and satisfactory sequencing in 35/50 (65%), 8/35 (23%) showed alterations in exon 19, and 1/35 (3%) in exon 21. In conclusion, the proportion of samples unfit for the study of the epidermal growth factor receptor gene mutational status increased from 7% in large samples to 35% in small ones. Nineteen small samples were inconclusive, with cell blocks predominating, 10/19 (53%).
Interleukin (IL)-1, 4, 6, 7, 8, 10 Appearance in Congenital Intra-Abdominal Adhesions in Children Under 1 Year of Age
Authors: Junga Anna , Pilmane Māra , Ābola Zane , Volrāts Olafs
Published: March 2017

Several cytokines have been studied for their potential role in adhesion formation. Regulatory role between the cytokine pathways has not yet to be defined. This study was designed to investigate the relation between proinflammatory and anti-inflammatory cytokines in congenital intra-abdominal adhesions. Tissue samples used for research were obtained from abdominal surgery due to obstructive gut malrotation and several additional pathologies (rectal atresia without perforation, omphalocele). All tissue specimens were stained with hematoxylin and eosin and by immunohistochemistry for interleukin-1 (IL-1), IL-4, IL-6, IL-7, IL-8, and IL-10. The number of immunoreactive structures was graded semiquantitatively. Occasionally to moderate number of IL-1, IL-4, and IL-8 positive inflammatory cells and fibroblasts were observed in tissue. Few to moderate connective tissue cells contained IL-6, but moderate to numerous—IL-7 and IL-10. Statistically significant correlation was found between IL-7 and IL-1 (r
s=0.471, P=0.001), IL-4 (r
s=0.491, P<0.001), IL-8 (r
s=0.440, P=0.001), IL-10 (r
s=0.433, P=0.002). The relatively common finding of IL-6 in adhesions points out the relevance of lymphocyte balance regulation of an ongoing inflammation and regenerative processes. The coherence between the inflammation mediator IL-7 and other proinflammatory/anti-inflammatory cytokines suggests about activation of macrophages and chronic inflammatory aggregate formation. The essential IL-10 and less distinct IL-1 findings in the adhesion material points out strong local defense reactions.
The Role of Mutation Rates of GNAQ or GNA11 in Cases of Uveal Melanoma in Japan
Authors: Ominato Jun , Fukuchi Takeo , Sato Ayako , Yamaguchi Naoyuki , Kobayashi Kazue , Cho Hiroyuki , Oyama Tokuhide , Ajioka Yoichi
Published: March 2017

GNAQ and GNA11 mutations are thought to be important for the tumorigenesis of uveal melanoma. Although previous studies have reported on mutation rates in cases of uveal melanoma, presently, no such report for the Japanese population exists. In this study, we examined the frequency of GNAQ and GNA11 somatic mutations in cases of uveal melanoma in Japan and their relationship with clinicopathologic features or Ki-67-positive cell rates (Ki-67 labeling index: Ki-67 LI) using immunofluorescence methods. The study involved 19 cases of uveal melanoma. We extracted the template DNA from formalin-fixed, paraffin-embedded specimens using a DNA extraction kit. We amplified the DNA sequences of GNAQ and GNA11 using polymerase chain reaction and analyzed mutations by direct sequencing. We evaluated Ki-67 LI using immunofluorescence methods. The frequencies of GNAQ and GNA11 somatic mutations were 26.3% (5/19) and 31.6% (6/19), respectively. The GNAQ and GNA11 mutations were mutually exclusive, as indicated in previous reports. The frequency of GNA11 mutations was significantly higher in epithelioid cells; however, no significant association between GNAQ mutations and cell type was evident, and there was no significant difference in Ki-67 LI between the mutation-positive and mutation-negative tumors. GNAQ and GNA11 mutations were identified in cases of uveal melanoma in Japan, although at lower frequencies than in white counterparts. The mutation frequency of GNA11 was significantly higher in epithelioid cells.
Pediatric Cystic Nephroma Is Morphologically, Immunohistochemically, and Genetically Distinct From Adult Cystic Nephroma
Authors: Li Yunjie , Pawel Bruce R. , Hill Dana A. , Epstein Jonathan I. , Argani Pedram
Published: March 2017

The term cystic nephroma has traditionally been used to refer to 2 neoplasms, a lesion in adults that is now thought to be part of the spectrum of mixed epithelial stromal tumor (MEST) and a pediatric lesion that has been associated with mutations in the DICER1 gene. A direct detailed morphologic, immunohistochemical, and genetic comparison of these 2 lesions has not been performed. In this study, we compare the morphologic features, immunoreactivity for estrogen receptor and inhibin, and DICER1 genetic status of 12 adult cystic nephroma/MEST (median age 50.5 y, all females) and 7 pediatric cystic nephroma (median age 1.3 y, male:female=6:1). Both lesions (11 of 12 adult cases, 6 of 7 pediatric cases) frequently demonstrated subepithelial accentuation of stromal cellularity, though the increased cellularity frequently included inflammatory cells in the pediatric cases. All adult and pediatric cases labeled for estrogen receptor; however, whereas most (83%) of adult cases labeled for inhibin at least focally, no pediatric case labeled for inhibin. Most adult cases (58%) demonstrated wavy, ropy collagen in association with cellular stroma, whereas this was not found in pediatric cases. 86% of pediatric cases demonstrated DICER1 mutations, whereas only 1 of 10 adult cases demonstrated a DICER1 mutation. In summary, although cellular stroma and estrogen receptor immunoreactivity are commonly present in both adult and pediatric cystic nephroma, ropy collagen and inhibin immunoreactivity are far more common in adult cystic nephroma/MEST, whereas DICER1 mutations are far more prevalent in pediatric cystic nephroma. These results support the current World Health Organization Classification’s separation of adult and pediatric cystic nephromas as distinct entities.
The Use of Ancillary Stains in the Diagnosis of Barrett Esophagus and Barrett Esophagus–associated Dysplasia
Authors: Srivastava Amitabh , Appelman Henry , Goldsmith Jeffrey D. , Davison Jon M. , Hart John , Krasinskas Alyssa M.
Published: March 2017

Barrett esophagus (BE) is a known risk factor for the development of esophageal adenocarcinoma. Pathologists play a critical role in confirming the diagnosis of BE and BE-associated dysplasia. As these diagnoses are not always straightforward on routine hematoxylin and eosin–stained slides, numerous ancillary stains have been used in an attempt to help pathologists confirm the diagnosis. On the basis of an in-depth review of the literature, the Rodger C. Haggitt Gastrointestinal Pathology Society provides recommendations regarding the use of ancillary stains in the diagnosis of BE and BE-associated dysplasia. Because goblet cells are almost always identifiable on routine hematoxylin and eosin–stained sections, there is insufficient evidence to justify reflexive use of Alcian blue (at pH 2.5) and/or periodic-acid Schiff stains on all esophageal biopsies to diagnose BE. In addition, the use of mucin glycoprotein immunostains and markers of intestinal phenotype (CDX2, Das-1, villin, Hep Par 1, and SOX9) are not indicated to aid in the diagnosis of BE at this time. A diagnosis of dysplasia in BE remains a morphologic diagnosis, and hence, ancillary stains are not recommended for diagnosing dysplasia. Although p53 is a promising marker for identifying high-risk BE patients, it is not recommended for routine use at present; additional studies are needed to address questions regarding case selection, interpretation, integration with morphologic diagnosis, and impact on clinical outcome. We hope that this review and our recommendations will provide helpful information to pathologists, gastroenterologists, and others involved in the evaluation of patients with BE and BE-associated dysplasia.
Pathophysiology of the Gut and the Microbiome in the Host Response
Authors: Lyons John D. , Coopersmith Craig M.
Published: March 2017

Objective:

To describe and summarize the data supporting the gut as the motor driving critical illness and multiple organ dysfunction syndrome presented at the National Institute of Child Health and Human Development MODS Workshop (March 26–27, 2015).

Data Sources:

Summary of workshop keynote presentation.

Study Selection:

Not applicable.

Data Extraction:

Presented by an expert in the field, the data assessing the role of gastrointestinal dysfunction driving critical illness were described with a focus on identifying knowledge gaps and research priorities.

Data Synthesis:

Summary of presentation and discussion supported and supplemented by relevant literature.

Conclusions:

The understanding of gut dysfunction in critical illness has evolved greatly over time, and the gut is now often considered as the “motor” of critical illness. The association of the gut with critical illness is supported by both animal models and clinical studies. Initially, the association between gut dysfunction and critical illness focused primarily on bacterial translocation into the bloodstream. However, that work has evolved to include other gut-derived products causing distant injury via other routes (e.g., lymphatics). Additionally, alterations in the gut epithelium may be associated with critical illness and influence outcomes. Gut epithelial apoptosis, intestinal hyperpermeability, and perturbations in the intestinal mucus layer have all been associated with critical illness. Finally, there is growing evidence that the intestinal microbiome plays a crucial role in mediating pathology in critical illness. Further research is needed to better understand the role of each of these mechanisms and their contribution to multiple organ dysfunction syndrome in children.
Monitoring Severity of Multiple Organ Dysfunction Syndrome: New and Progressive Multiple Organ Dysfunction Syndrome, Scoring Systems
Authors: Typpo Katri V. , Lacroix Jacques R.
Published: March 2017

Objective:

To describe the diagnostic criteria of new and progressive multiple organ dysfunction syndrome and scoring systems that might be used to assess and monitor the severity and progression of multiple organ dysfunction syndrome in children presented as part of the Eunice Kennedy Shriver National Institute of Child Health and Human Development MODS Workshop (March 26–27, 2015).

Data Sources:

Literature review, research data, and expert opinion.

Study Selection:

Not applicable.

Data Extraction:

Moderated by an experienced expert from the field, issues relevant to the monitoring of the severity of multiple organ dysfunction syndrome including new and progressive multiple organ dysfunction syndrome and scoring systems were presented, discussed, and debated with a focus on identifying knowledge gaps and research priorities.

Data Synthesis:

Summary of presentations and discussion supported and supplemented by relevant literature.

Conclusions:

Many sets of diagnostic criteria of multiple organ dysfunction syndrome are presently available. All are useful, but their diagnostic and predictive value can be improved. Several types of diagnostic criteria are candidates to describe the severity and to monitor the progression of cases of multiple organ dysfunction syndrome, which include existing scores of organ dysfunction: Pediatric Logistic Organ Dysfunction, version 2, daily Pediatric Logistic Organ Dysfunction, version 2, organ failure-free days, etc. If a new set of diagnostic criteria of multiple organ dysfunction syndrome is created, its value must be validated. Furthermore, the epidemiology of multiple organ dysfunction syndrome based on these new diagnostic criteria must be compared with the epidemiology found with the preexisting sets of diagnostic criteria. The reliability as well as the added values of additional or new candidate markers of organ dysfunction and multiple organ dysfunction syndrome severity must be studied and compared.
Pediatric Multiple Organ Dysfunction Syndrome: Promising Therapies
Authors: Doctor Allan , Zimmerman Jerry , Agus Michael , Rajasekaran Surender , Bubeck Wardenburg Juliane , Fortenberry James , Zajicek Anne , Mairson Emma , Typpo Katri
Published: March 2017

Objective:

To describe the state of the science, identify knowledge gaps, and offer potential future research questions regarding promising therapies for children with multiple organ dysfunction syndrome presented during the Eunice Kennedy Shriver National Institute of Child Health and Human Development Workshop on Pediatric Multiple Organ Dysfunction Syndrome (March 26–27, 2015).

Data Sources:

Literature review, research data, and expert opinion.

Study Selection:

Not applicable.

Data Extraction:

Moderated by an expert from the field, issues relevant to the association of multiple organ dysfunction syndrome with a variety of conditions were presented, discussed, and debated with a focus on identifying knowledge gaps and research priorities.

Data Synthesis:

Summary of presentations and discussion supported and supplemented by relevant literature.

Conclusions:

Among critically ill children, multiple organ dysfunction syndrome is relatively common and associated with significant morbidity and mortality. For outcomes to improve, effective therapies aimed at preventing and treating this condition must be discovered and rigorously evaluated. In this article, a number of potential opportunities to enhance current care are highlighted including the need for a better understanding of the pharmacokinetics and pharmacodynamics of medications, the effect of early and optimized nutrition, and the impact of effective glucose control in the setting of multiple organ dysfunction syndrome. Additionally, a handful of the promising therapies either currently being implemented or developed are described. These include extracorporeal therapies, anticytokine therapies, antitoxin treatments, antioxidant approaches, and multiple forms of exogenous steroids. For the field to advance, promising therapies and other therapies must be assessed in rigorous manner and implemented accordingly.
Evaluating the Impact of the Healthy Beginnings System of Care Model on Pediatric Emergency Department Utilization
Authors: Tan Cheryl H. , Gazmararian Julie
Published: March 2017

Objective

The aim of this study was to evaluate whether enrollment in the Healthy Beginnings System of Care (SOC) model is associated with a decrease in emergency department (ED) visits among children aged 6 months to 5.5 years.

Methods

A retrospective, longitudinal study of ED utilization was conducted among children enrolled in the Healthy Beginnings SOC model between February 2011 and May 2013. Using medical records obtained from a children’s hospital in Atlanta, the rate of ED visits per quarter was examined as the main outcome. A multilevel, multivariate Poisson model, with family- and child-level random effects, compared ED utilization rates before and after enrollment. Adjusted rate ratios and 95% confidence intervals were calculated after controlling for sociodemographic confounders.

Results

The effect of SOC enrollment on the rate of ED visits differed by income level of the primary parent. The rate of ED visits after enrollment was not significantly different than the rate of ED visits before enrollment for children whose primary parent had an annual income of less than $5000 (P = 0.298), $20,000 to $29,999 (P = 0.199), or $30,000 or more (P = 0.117). However, for the children whose primary parent’s annual income was $5000 to $19,999, the rate of ED visits after enrollment was significantly higher than the rate of ED visits before enrollment (adjusted rate ratio, 1.48; 95% confidence interval, 1.17–1.87).

Conclusions

Enrollment in the SOC model does not appear to decrease the rate of ED visits among enrolled children. Additional strategies, such as education sessions on ED utilization, are needed to reduce the rate of ED utilization among SOC-enrolled children.
Laryngeal Injury in a Male Lacrosse Player
Authors: Murtagh-Kurowski Eileen , Gittelman Michael A. , Arjmand Ellis
Published: March 2017

Lacrosse has become increasingly popular among US children and teens. Because a lacrosse ball can serve as a projectile, neck injuries, although uncommon, can cause a severe and long-lasting injury. We report the case of a 16-year-old adolescent who experienced direct neck trauma while playing lacrosse. The clinical presentation, treatment strategies, and intubation considerations are reviewed. Finally, a call to action to prevent future, similar injuries is discussed.
Informing the Design of a New Pragmatic Registry to Stimulate Near Miss Reporting in Ambulatory Care
Authors: Pfoh Elizabeth R. , Engineer Lilly , Singh Hardeep , Hall Laura Lee , Fried Ethan D. , Berger Zackary , Wu Albert W.
Published: March 2017

Objective

Ambulatory care safety is of emerging concern, especially in light of recent studies related to diagnostic errors and health information technology-related safety. Safety reporting systems in outpatient care must address the top safety concerns and be practical and simple to use. A registry that can identify common near misses in ambulatory care can be useful to facilitate safety improvements. We reviewed the literature on medical errors in the ambulatory setting to inform the design of a registry for collecting near miss incidents.

Methods

This narrative review included articles from PubMed that were: 1) original research; 2) discussed near misses or adverse events in the ambulatory setting; 3) relevant to US health care; and 4) published between 2002 and 2013. After full text review, 38 studies were searched for information on near misses and associated factors. Additionally, we used expert opinion and current inpatient near miss registries to inform registry development.

Results

Studies included a variety of safety issues including diagnostic errors, treatment or management-related errors, communication errors, environmental/structural hazards, and health information technology (health IT)–related concerns. The registry, based on the results of the review, updates previous work by including specific sections for errors associated with diagnosis, communication, and environment structure and incorporates specific questions about the role of health information technology.

Conclusions

Through use of this registry or future registries that incorporate newly identified categories, near misses in the ambulatory setting can be accurately captured, and that information can be used to improve patient safety.
Medication Safety in Two Intensive Care Units of a Community Teaching Hospital After Electronic Health Record Implementation: Sociotechnical and Human Factors Engineering Considerations
Authors: Carayon Pascale , Wetterneck Tosha B. , Cartmill Randi , Blosky Mary Ann , Brown Roger , Hoonakker Peter , Kim Robert , Kukreja Sandeep , Johnson Mark , Paris Bonnie L. , Wood Kenneth E. , Walker James M.
Published: March 2017

Objective

The aim of the study was to assess the impact of Electronic Health Record (EHR) implementation on medication safety in two intensive care units (ICUs).

Methods

Using a prospective pre-post design, we assessed 1254 consecutive admissions to two ICUs before and after an EHR implementation. Each medication event was evaluated with regard to medication error (error type, medication-management stage) and impact on patient (severity of potential or actual harm).

Results

We identified 4063 medication-related events either pre-implementation (2074 events) or post-implementation (1989 events). Although the overall potential for harm due to medication errors decreased post-implementation only 2 of the 3 error rates were significantly lower post-implementation. After EHR implementation, we observed reductions in rates of medication errors per admission at the stages of transcription (0.13–0, P < 0.001), dispensing (0.49–0.16, P < 0.001), and administration (0.83–0.56, P = 0.011). Within the ordering stage, 4 error types decreased post-implementation (orders with omitted information, error-prone abbreviations, illegible orders, failure to renew orders) and 4 error types increased post-implementation (orders of wrong drug, orders containing a wrong start or stop time, duplicate orders, orders with inappropriate or wrong information). Within the administration stage, we observed a reduction of late administrations and increases in omitted administrations and incorrect documentation.

Conclusions

Electronic Health Record implementation in two ICUs was associated with both improvement and worsening in rates of specific error types. Further safety improvements require a nuanced understanding of how various error types are influenced by the technology and the sociotechnical work system of the technology implementation. Recommendations based on human factors engineering principles are provided for reducing medication errors.
Trends in Fellowship Training for Female Pelvic Medicine and Reconstructive Surgery
Authors: Lake AeuMuro G. , Rickey Leslie M.
Published: March 2017

Objective

The aim of this study was to characterize distinguishing features among gynecology, urology, and combined female pelvic medicine and reconstructive surgery (FPMRS) fellowship programs and practices.

Methods

A 32-item Web-based survey was sent to fellowship directors of FPMRS programs accredited by the Accreditation Council for Graduate Medical Education. The survey assessed the structure of the fellowship, as well as the degree to which gynecology and urology are integrated into the fellowship training. In addition to descriptive statistics, Fisher exact test and Mann-Whitney U test were used for statistical analysis.

Results

Forty-one program directors (PDs) completed the survey for a 76% response rate. Of the respondents, 78% were gynecologists, and 22% were urologists. Sixty-five percent of the respondents considered their program gynecology based, 7.5% considered their program urology based, 22.5% considered their program fully integrated (urology and gynecology equal sharing), and 5% have separate tracks for urology fellows and gynecology fellows. Sixty-one percent of the programs accept both urology and gynecology fellows in their fellowship programs. Approximately two thirds of the PDs are happy with the fellowship model at their institution, whereas the remaining one third would like greater integration of gynecology and urology in fellowship training. Almost 90% of the respondents felt that there were benefits to an integrated program. The top benefits were reported as more exchange of information, better relationships, more comprehensive training, exposure to different treatment approaches, and improved care for women. For those PDs who desire a more integrated program, the top barriers listed were departmental competition/politics, lack of formally trained urology faculty, and expense.

Conclusions

There are several FPMRS fellowship models. A significant proportion of PDs would like a more integrated fellowship program, and an overwhelming majority note benefits for themselves and their fellows that result from increased contact with a diverse FPMRS faculty.
Grasping with a soft glove: intrinsic impedance control in pneumatic actuators
Authors: Paoletti P. , Jones G. W. , Mahadevan L.
Published: March 2017

The interaction of a robotic manipulator with unknown soft objects represents a significant challenge for traditional robotic platforms because of the difficulty in controlling the grasping force between a soft object and a stiff manipulator. Soft robotic actuators inspired by elephant trunks, octopus limbs and muscular hydrostats are suggestive of ways to overcome this fundamental difficulty. In particular, the large intrinsic compliance of soft manipulators such as ‘pneu-nets’—pneumatically actuated elastomeric structures—makes them ideal for applications that require interactions with an uncertain mechanical and geometrical environment. Using a simple theoretical model, we show how the geometric and material nonlinearities inherent in the passive mechanical response of such devices can be used to grasp soft objects using force control, and stiff objects using position control, without any need for active sensing or feedback control. Our study is suggestive of a general principle for designing actuators with autonomous intrinsic impedance control.
Computational optical palpation: a finite-element approach to micro-scale tactile imaging using a compliant sensor
Authors: Wijesinghe Philip , Sampson David D. , Kennedy Brendan F.
Published: March 2017

High-resolution tactile imaging, superior to the sense of touch, has potential for future biomedical applications such as robotic surgery. In this paper, we propose a tactile imaging method, termed computational optical palpation, based on measuring the change in thickness of a thin, compliant layer with optical coherence tomography and calculating tactile stress using finite-element analysis. We demonstrate our method on test targets and on freshly excised human breast fibroadenoma, demonstrating a resolution of up to 15–25 µm and a field of view of up to 7 mm. Our method is open source and readily adaptable to other imaging modalities, such as ultrasonography and confocal microscopy.