bluuebunny/crossref_metadata_2025 huggingface dataset:
The Third Class
Authors: Rogers Holly , Maytan Margaret
Published: September 2019

The third class follows the same structure as the previous classes. In this chapter, as with the others, there is a script for the opening short meditation. This is followed by typical student comments from check-in. The mindfulness skill taught in this class is guided imagery. The skill is introduced, and then there is a script developed by the Center for Mind–Body Medicine. The final guided meditation, also scripted, focuses on working with thoughts and learning how to label them. There are closing comments, and frequently asked questions are at the end. The questions and answers encompass the experience of meditation, the gratitude part of their meditation log, use of the gatha, anxiety about meditation, and difficulties developing a regular meditation practice.
Refusing Offers to Use Substances
Authors: Daley Dennis C. , Douaihy Antoine
Published: September 2019

Social pressures are the second most common relapse precipitant after negative emotional states. Clients who are not prepared to resist pressures to use are more vulnerable to relapse. Direct social pressures include situations in which others offer the client substances. Pressure may vary from mild to extreme, in which another person tries hard to influence the client to use. The objectives of this chapter are to help the client identify direct and indirect social pressures (people, places, events, social and work situations) to use alcohol, tobacco, or other drugs; to identify feelings experienced during social pressure situations (e.g., anger, anxiety, excitement); to identify thoughts experienced during social pressure situations (e.g., wanting to fit in, wanting to be normal, thinking substance use can be limited or controlled); and to identify strategies to avoid high-risk people, places, situations, and events and to cope with social pressures that cannot be avoided.
Treatment of Co-occurring Psychiatric Disorders
Authors: Daley Dennis C. , Douaihy Antoine
Published: September 2019

Effective treatment of clients with co-occurring disorders (CODs) requires the practitioner to be familiar with the continuum of care so that clients become engaged in services needed to address their disorders and related problems. Evidence suggests that clients receiving integrated treatment have higher rates of treatment adherence and improved clinical outcomes, particularly those with more persistent and chronic forms of psychiatric disorders. Therefore, it is best to provide integrated care that focuses on both types of disorders, regardless of whether the client is in an inpatient, residential, or ambulatory treatment setting. Given that clients with CODs have higher rates of problems with treatment adherence compared to those with a single type of disorder, this chapter reviews strategies to improve adherence. It also delineates recovery issues in the domains of physical/lifestyle, psychological, behavioral/cognitive, family/interpersonal/social, and personal growth/maintenance. The authors stress the potential helpfulness of mutual support programs and discuss clinical challenges such as suicide, violence, HIV/AIDS, and hepatitis C.
Genetic Counseling in the Genomic Era
Authors: Biesecker Barbara B. , Peters Kathryn F. , Resta Robert
Published: September 2019

The nature and scope of genetic counseling is continuing to evolve in the face of the expanding application of new genetic testing technologies like exome and genome sequencing. This creates a new set of challenges for determining the role of genetic counselors and genetic counseling in the delivery of genetic services. Genetic counselors may shift from being gatekeepers to genetic testing to interpreters of complex genetic test results. While this may require learning new biomedical information, the application of basic counseling skills will continue to be critical to service delivery. While testing has become more sophisticated and complex, it still comes down to families and patients trying to integrate genetic information into their lives in meaningful ways. This has, on one level, not changed for at least the last half-century.
Confidentiality and Privilege
Authors: Konrad S. Shane , Bath Eraka
Published: September 2019

Chapter 1 looks at legal cases relevant to some of the most important tenets of psychiatric practice - confidentiality and privilege. Both involve the protection, and limits to that protection, of information communicated during mental health treatment. Cases described here include In re Lifschutz, Doe v. Roe, Whalen v. Roe, In re Zuniga, State v. Andring, Commonwealth v. Kobrin, Menendez v. Superior Court and Jaffee v. Redmond.
Autoimmunity and the endocrine system
Authors: Spickett Gavin
Published: September 2019

This chapter covers autoimmune thyroid diseases, the classifications of diabetes mellitus, the immunological complications of insulin therapy, and various autoimmune polyglandular syndromes. Cushing’s syndrome, pernicious anaemia, immunological infertility, and POEMS syndrome are also featured.
Autoimmunity affecting the nervous system
Authors: Spickett Gavin
Published: September 2019

This chapter covers a range of autoimmune conditions affecting the nervous system. It describes the presentation, immunogenetics, immunopathology, related autoantibodies, treatment, and testing for each example. It also covers the demyelinating diseases (including MS, Guillian-Barré Syndrome, and uncommon variants), neuropathies, and autoimmunity in other neurological diseases.
Immunochemistry
Authors: Spickett Gavin
Published: September 2019

This chapter covers the basic techniques used in immunochemistry, including electrophoresis, immunoelectrophoresis, immunofixation, isoelectric focusing, and immunoblotting. It then specifies the units, normal ranges, test principles, and indications for over 50 immunological tests.
Cellular investigations
Authors: Spickett Gavin
Published: September 2019

This chapter covers cellular investigations, including identification of cell surface phenotype, intracellular proteins, cellular function, secreted products, and abnormal constituents. Techniques are described, along with principles for testing and interpretation of the results.
Large deletions and untargeted substitutions induced by abasic site analog on leading versus lagging strand templates in human cells
Authors: Suzuki Tetsuya , Katayama Yuri , Komatsu Yasuo , Kamiya Hiroyuki
Published: September 2019

The tetrahydrofuran-type abasic site analog (THF) induces large deletion mutations in human cells. To compare the large deletions induced by THF on leading and lagging strand templates, plasmid DNAs bearing the analog at a specific position outside the supF gene were introduced into human U2OS cells. The replicated DNAs recovered from the transfected cells were electroporated into an Escherichia coli indicator strain. THF on the lagging strand template produced more supF mutants than THF on the leading strand template. This unequal mutagenicity was due to the higher frequencies of not only large deletions but also untargeted base substitutions induced in the gene. These results suggested that both types of mutations occur more frequently when abasic sites are formed on the lagging strand template.
Multimodal Magnetic Resonance Imaging reveals alterations of sensorimotor circuits in restless legs syndrome
Authors: Stefani Ambra , Mitterling Thomas , Heidbreder Anna , Steiger Ruth , Kremser Christian , Frauscher Birgit , Gizewski Elke R , Poewe Werner , Högl Birgit , Scherfler Christoph
Published: September 2019

Study Objectives

Integrated information on brain microstructural integrity and iron storage and its impact on the morphometric profile is not available in restless legs syndrome (RLS). We applied multimodal magnetic resonance imaging (MRI) including diffusion tensor imaging, the transverse relaxation rate (R2*), a marker for iron storage, as well as gray and white matter volume measures to characterize RLS-related MRI signal distribution patterns and to analyze their associations with clinical parameters.

Methods

Eighty-seven patients with RLS (mean age 51, range 20–72 years; disease duration, mean 13 years, range 1–46 years, of those untreated n = 30) and 87 healthy control subjects, individually matched for age and gender, were investigated with multimodal 3T MRI.

Results

Volume of the white matter compartment adjacent to the post- and precentral cortex and fractional anisotropy (FA) of the frontopontine tract were both significantly reduced in RLS compared to healthy controls, and these alterations were associated with disease duration (r = 0.25, p = 0.025 and r = 0.23, p = 0.037, respectively). Corresponding gray matter volume increases of the right primary motor cortex in RLS (p < 0.001) were negatively correlated with the right FA signal of the frontopontine tract (r = −0.22; p < 0.05). Iron content evaluated with R2* was reduced in the putamen as well as in temporal and occipital compartments of the RLS cohort compared to the control group (p < 0.01).

Conclusions

Multimodal MRI identified progressing white matter decline of key somatosensory circuits that may underlie the perception of sensory leg discomfort. Increases of gray matter volume of the premotor cortex are likely to be a consequence of functional neuronal reorganization.
Long noncoding RNA SMAD5‐AS1 acts as a microRNA‐106a‐5p sponge to promote epithelial mesenchymal transition in nasopharyngeal carcinoma
Authors: Zheng Ying‐Juan , Zhao Jing‐Yi , Liang Tian‐Song , Wang Ping , Wang Juan , Yang Dao‐Ke , Liu Zhang‐Suo
Published: September 2019

Nasopharyngeal carcinoma (NPC) is a malignant epithelial cancer of the head and neck with high prevalence in southern China, which is accompanied by notable invasiveness and metastasis. Long noncoding RNAs (lncRNAs) participate in the progression of various cancers including NPC. Microarray‐based analysis identified highly expressed lncRNA mothers against decapentaplegic homolog 5 (SMAD5)‐antisense RNA 1 (AS1) related to NPC. Interestingly, it is found that SMAD5‐AS1 competitively bound to microRNA (miR)‐106a‐5p to regulate SMAD5. Herein, the study aimed to clarify the role of SMAD5‐AS1/miR‐106a‐5p/SMAD5 axis in the process of epithelial mesenchymal transition (EMT) in NPC. SMAD5‐AS1 was highly expressed and miR‐106a‐5p was poorly expressed in NPC tissues and cell lines. The NPC cells were treated with a series of small interfering RNAs, mimics, or inhibitors to explore the effects of SMAD5‐AS1, SMAD5, and miR‐106a‐5p on EMT, cell proliferation, migration, and invasion in NPC. Of note, SMAD5‐AS1 silencing or miR‐106a‐5p overexpression reduced expression of N‐cadherin, matrix metallopeptidase 9, Snail, and Vimentin while elevating E‐cadherin expression, thus inhibiting EMT, cell proliferation, migration, and invasion in NPC by down‐regulation of SMAD5. Moreover, SMAD5 silencing could reduce the ability of EMT induced by SMAD5‐AS1 up‐regulation. SMAD5‐AS1 silencing or miR‐106a‐5p elevation inhibited tumorigenesis in nude mice. Taken together, SMAD5‐AS1 silencing suppressed EMT, cell proliferation, migration, and invasion in NPC by elevating miR‐106a‐5p to down‐regulate SMAD5, which provided a novel therapeutic target for NPC treatment.—Zheng, Y.‐J., Zhao, J.‐Y., Liang, T.‐S., Wang, P., Wang, J., Yang, D.‐K., Liu, Z.‐S. Long noncoding RNA SMAD5‐AS1 acts as a microRNA‐106a‐5p sponge to promote epithelial mesenchymal transition in nasopharyngeal carcinoma. FASEB J. 33, 12915–12928 (2019). www.fasebj.org
III–1 The Benefit of LIPUS After Tibial Condylar Valgus Osteotomy (TCVO)
Authors: Nishii Yukinobu , Kinugasa Kiyoto
Published: September 2019

Objective:

The purpose of this study is to investigate the benefit of LIPUS after Tibial Condylar Valgus Osteotomy (TCVO) for the osteoarthritis of the knee joint.

Materials and Methods:

This is retrospective study and the population of the study is 12 cases after TCVO with same locking plate and same artificial bone graft. Seven cases were treated LIPUS after TCVO (L group), and five cases were no LIPUS (NL group). Comparison was made of the period until bone fusion in L group and the NL group. The judgement of bone fusion was that the gap of the most proximal part of the osteotomy is no longer visible in the simple X-ray image.

Results:

The average of age was 63 (58–69) year old in L group, and 67 (59–76) year old in NL group. There was no significant difference in age between L group and the NL group. The average of the time of bone fusion was 73.6 (62–85) days in L group, and 95.0 (84–114) days in NL group. There were significant differences in the time of bone fusion between L group and the NL group (P < 0.05: Mann Whitney U test).

Discussion:

Usefulness of LIPUS after TCVO has been suggested in this study, although there is a limit to having a small number of surveys. There is a variation in the gap of the osteotomy, the time of bone fusion may be different depending on the size of the gap. There is a need to investigate the difference due to the treatment site of LIPUS.
A Prospective Analysis of Motor and Cognitive Skill Retention in Novice Learners of Point of Care Ultrasound
Authors: Rappaport Charles A. , McConomy Bryan C. , Arnold Nicholas R. , Vose Aaron T. , Schmidt Gregory A. , Nassar Boulos
Published: September 2019

Objectives:

To identify the time at which point of care ultrasound static image recognition and image acquisition skills decay in novice learners.

Setting:

The University of Iowa Hospitals and Clinics.

Subjects:

Twenty-four subjects (23 first-year medical students and one first-year physician assistant student).

Design:

The subjects completed an initial didactic and hands-on session with immediate testing of learned image acquisition and static image identification skills.

Interventions:

Retesting occurred at 1, 4, and 8 weeks after the initial training session with no retraining in between. Image acquisition skills were obtained on the same healthy male volunteers, and the students were given no immediate feedback on their performance. The image identification skills were assessed with a 10 question test at each follow-up session.

Measurements and Main Results:

For pleural ultrasound by 4 weeks, there was a significant decline of the ability to identify A-lines (p = 0.0065). For pleural image acquisition, there was no significant decline in the ability to demonstrate lung sliding. Conversely, cardiac image recognition did not significantly decline throughout the study, while the ability to demonstrate cardiac images at 4 weeks (parasternal short axis view) did (p = 0.0008).

Conclusions:

Motor and cognitive skills decay at different times for pleural and cardiac images. Future ultrasound curricula should retrain skills at a maximum of 8 weeks from initial training. They should focus more on didactic sessions related to image identification for pleural images, and more hands-on image acquisition training for cardiac images, which represents a novel finding.
Incidence and Outcomes of Sepsis in Korea: A Nationwide Cohort Study From 2007 to 2016
Authors: Oh Seung-Young , Cho Songhee , Kim Ga Hee , Jang Eun Jin , Choi Seongmi , Lee Hannah , Ryu Ho Geol
Published: September 2019

Objectives:

This study aimed to estimate the incidence and clinical outcomes of sepsis in Korea from 2007 to 2016.

Design:

Retrospective observational study.

Setting:

Nationwide study with population-based healthcare reimbursement claims database.

Patients:

Using data from the National Health Insurance Service of Korea, patients who were hospitalized with a diagnosis of sepsis from 2007 to 2016 were analyzed. The incidence of sepsis was calculated using mid-year census population and analyzed according to year, age, and sex. The Elixhauser Comorbidity Index score was calculated to adjust for the impact of comorbidities on clinical outcome. In-hospital mortality, hospital length of stay, ICU admission rates, and risk factors for in-hospital mortality were also analyzed.

Interventions:

None.

Measurements and Main Results:

The incidence of sepsis increased from 173.8 per 100,000 population in 2007 to 233.6 per 100,000 population in 2016. In-hospital mortality decreased from 30.9% in 2007 to 22.6% in 2016 (p < 0.0001). From 2007 to 2016, hospital length of stay and ICU admission rates associated with sepsis decreased from 26.0 ± 33.5 days to 21.3 ± 24.4 days (p < 0.0001) and from 16.2% to 12.7% (p < 0.0001), respectively. Male sex, age greater than 50 years, Elixhauser Comorbidity Index greater than 10, and mechanical ventilation were identified as risk factors for in-hospital mortality after adjusting for baseline characteristics.

Conclusions:

The incidence of sepsis in Korea increased from 2007 to 2016, while the associated in-hospital mortality, hospital length of stay, and ICU admission rates decreased.
The Prognostic Role of Pretreatment Neutrophil to Lymphocyte Ratio (NLR) in Malignant Adrenal Lesions Treated With Stereotactic Body Radiation Therapy (SBRT)
Authors: Mills Matthew N. , Reddy Abhinav V. , Richardson Logan , Richardson K. Martin , Kersh Charles R.
Published: September 2019

Objective:

The objective of this study was to evaluate a single institution’s experience with stereotactic body radiotherapy (SBRT) in treating malignant adrenal lesions, as well as the prognostic value of systemic inflammation biomarkers.

Materials and Methods:

From November 2007 to February 2018, 27 patients with malignant adrenal lesions received 31 SBRT treatments. Outcomes, measured from the date of SBRT, included overall survival (OS), local control (LC), and freedom from progression. Cox proportional hazard model was utilized to identify potential prognostic factors. Tumor response was assessed with PET Response Evaluation Criteria In Solid Tumors (PERCIST)/Response Evaluation Criteria in Solid Tumors (RECIST) criteria. Acute toxicity was evaluated with the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.03 criteria.

Results:

Median follow-up for all patients was 8 months. The complete response, partial response, stable disease, and progressive disease rates were 59%, 9%, 32%, and 0%, respectively. One-year LC, OS, and freedom from progression were 77.7%, 38.0%, and 10.0%, respectively. There was a trend toward significance upon multivariate analysis for pretreatment neutrophil to lymphocyte ratio >4.1 to predict inferior OS (adjusted hazard ratio=3.29,P=0.09, 1-year OS: 11% vs. 80%). There were 3 cases (10%) complicated by grade 2 acute toxicity, including nausea and fatigue. There was 1 grade 5 toxicity, as 1 case was complicated by a fatal gastric ulcer occurring 3 months after SBRT to the left adrenal gland (112.5 BED10).

Conclusions:

These results support the limited existing literature, demonstrating that SBRT provides adequate LC for adrenal lesions with minimal toxicity. Pretreatment neutrophil to lymphocyte ratio may serve as a prognostic factor in these patients.
Tube Shunt Revision With Excision of Fibrotic Capsule Using Mitomycin C With and Without Ologen—a Collagen Matrix Implant: A 3-Year Follow-up Study
Authors: Salimi Ali , Kovalyuk Natalya , Harasymowycz Paul J.
Published: September 2019

Precis:

Tube revision with capsule excision in failed glaucoma drainage devices (GDDs) has good medium-term success effectively reducing the intraocular pressure (IOP) and medication burden. Implantation of Ologen may limit the complications, particularly erosion.

Purpose:

To evaluate the 36-month outcomes of tube shunt revision with capsule excision using Mitomycin C (MMC) versus MMC with Ologen—a collagen matrix implant.

Materials and Methods:

Twenty-three eyes with failed GDD underwent tube revision with fibrotic capsule excision. 12 of them received a MMC application whereas the other 11 also received an Ologen implant. Qualified success, changes in IOP, medication burden, and complication rates were evaluated and compared.

Results:

Three years post-revision, qualified success for the whole cohort was 58% with no significant difference between the MMC group (52%) and MMC+Ologen group (67%; P=0.606). Mean survival time for each group was 27.4 and 29.8 months, respectively. With no intergroup differences through 3 years, capsule excision leads to a significant decrease in IOP from 28.6±6.5 to 15.1±4.3 mm Hg (47% reduction) and in antiglaucoma medications, from 3.6±1.2 to 2.5±1.3 mm Hg (30% reduction; P<0.001). Complication rates were significantly lower in the MMC+Ologen group (27%) compared with the MMC group (75%; P=0.022). Plate erosion happened in 25% of the eyes in the MMC group which required excision of the tube and plate, but no such complication was observed in the MMC+Ologen group.

Conclusions:

Revision of a failed tube shunt by excision of the encapsulated bleb offers good medium-term outcomes by reducing the IOP and glaucoma medications. Although the addition of Ologen did not affect the medium-term success, IOP, or medication burden, its implantation yielded significantly lower complication rates.
The Chinese Glaucoma Study Consortium for Patients With Glaucoma: Design, Rationale and Baseline Patient Characteristics
Authors: Zhang Hui , Jia Hongyan , Duan Xiaoming , Li Liang , Wang Hui , Wu Jian , Hu Jianping , Cao Kai , Zhao Aiping , Liang Jing , Song Jing , Qiao Chunyan , Wang Ningli
Published: September 2019

Precis:

Chinese Glaucoma Study Consortium (CGSC) as the first nationwide glaucoma registry in China, we describe its design, rationale, the geographic distribution of the hospitals, and baseline patient characteristics.

Aim:

As a leading cause of blindness in China, glaucoma affects 2% to 4% of adults over the age of 40 and will become increasingly prevalent as the population ages. At the national level, there are few reports on the current medical practice for glaucoma patients. CGSC will be considered as the first nationwide glaucoma registry in China. Here we describe its design, rationale, the geographic distribution of the hospitals, and baseline patient characteristics.

Methods:

From December 21, 2015 to September 9, 2018, CGSC recruited patients with the diagnoses of primary angle-closure suspect, primary angle-closure, primary angle-closure glaucoma, acute primary angle closure, primary open-angle glaucoma (POAG), pigmentary glaucoma (PG), and pseudoexfoliative glaucoma (PXG) from 111 hospitals covering 67 cities from 22 provinces, 4 municipalities, and 5 autonomous regions in mainland China. Clinical data were collected using an Electronic Data Capture System designed by Tongren hospital and Gauss informed Ltd. Blood samples were collected from every patient for further genetic analysis.

Results:

Medical records of 10,892 patients were collected, of which 5762 patients have complete information. The average age of those with complete information (n=5762) was 62.05±11.26 years old, and 35.25% were males. Primary angle-closure disease, including primary angle-closure suspect/primary angle-closure/primary angle-closure glaucoma/acute primary angle closure, was predominant (4588, 79.63%), and the distribution for others is as follows: POAG (1116, 19.37%), PXG (41, 0.71%) and PG (17, 0.30%). A total of 16,684 blood samples were collected, of which 9917 (82.68%) were primary angle-closure disease, 1987 (16.57%) were POAG, 69 (0.58%) were PXG, 22 (0.18%) were PG, and 4689 were normal controls.

Conclusions:

The CGSC is the first national-level glaucoma registry study in China. Clinical data and blood samples will provide the opportunity to study the epidemiology of glaucoma in Chinese hospitals, to evaluate the level of medical diagnosis and treatment of glaucoma in China, and to identify the susceptibility loci for glaucoma.
Identification of Norovirus and Human Parechovirus in Patients With Hand, Foot and Mouth Disease Syndrome
Authors: Li Kun , Lin Xian-Dan , Chen Yi-Ping , Liu Qi , Wang Wen , Plyusnin Alexander , Zhang Yong-Zhen
Published: September 2019

Background:

Hand, foot and mouth disease (HFMD) is caused mostly by enteroviruses. However, other viral agents also can cause similar syndromes, and hence, the infections they cause are often misdiagnosed clinically. To determine non-enterovirus etiologic agents in HFMD-like cases, we screened enterovirus-negative samples collected from the patients who were clinically diagnosed as HFMD in China.

Methods:

Two hundred enterovirus-negative samples were collected previously in Wenzhou city of Zhejiang province, China. Both high throughput sequencing and RT-PCR were used to screen viral agents. In addition, their clinical features were analyzed.

Results:

Norovirus (NoV) and human parechovirus (HPeV) were identified from 22 (11.00%) and 9 (4.50%) samples, respectively. In addition, the complete genome sequences were recovered from 4 NoV-positive samples, and the VP1/3Dpol gene sequences were recovered from 5 HPeV-positive samples. Phylogenetic analyses of the NoV sequences revealed that they were closely related to those circulated in other regions of China. Notably, 4 genotypes of HPeVs, including HPeV-1, HPeV-4, HPeV-5 and HPeV-14, were found, indicating high genetic diversity of the virus. Frequent recombination between various genotypes was also observed in the HPeVs. Although most of the patients presented with the clinical features of HFMD, 4 patients infected with NoV GII.4 and 3 patients infected with HPeV-1 (1) and HPeV-4 (2) were characterized with diarrhea. Finally, tonsillitis, convulsion and granulocytopenia were observed in 1 NoV GII.4 patient, while liver dysfunction was found in 1 NoV GII.17 patient.

Conclusions:

These data reveal the variety of agents in the cases clinically diagnosed as HFMD.
Prevalence, Clinical Features and Antibiotic Susceptibility of Group A Streptococcal Skin Infections in School Children in Urban Western and Northern Uganda
Authors: Chang Aileen Y. , Scheel Amy , Dewyer Alyssa , Hovis Ian W. , Sarnacki Rachel , Aliku Twalib , Okello Emmy , Bwanga Freddie , Sable Craig , Maurer Toby A. , Beaton Andrea Z.
Published: September 2019

Background:

Group A Streptococcus (GAS) skin infections can lead to invasive sepsis, poststreptococcal glomerulonephritis, and potentially rheumatic heart disease (RHD). Within a study to identify predisposing factors of RHD in Ugandan schoolchildren, we determined the prevalence of skin infections and assessed the clinical features and antibiotic susceptibility of GAS skin infection.

Methods:

Cross-sectional study conducted at 3 urban primary schools in Western and Northern Uganda in March 2017. A dermatologist rendered clinical diagnoses and obtained a skin swab specimen from lesions with signs of bacterial infection. Beta-hemolytic colonies underwent Lancefield grouping, species identification by polymerase chain reaction and antimicrobial susceptibility testing.

Results:

From 3265 schoolchildren, we observed 32% with ≥1 fungal, 1.8% with ≥1 bacterial, 0.9% with ≥1 viral, and 0.2% with ≥1 ectoparasitic infection. Of 79, 25 (32%) specimens were GAS-positive, of which one-third demonstrated tetracycline resistance. Of 17 impetigo cases, 13 (76%) were located on the leg/foot and 3 (18%) on the head/neck. Prevalence of GAS skin infection was 0.8% (25 of 3265). In Northern Uganda, where subclinical definite RHD prevalence is 1.1%, GAS skin infection prevalence was 1.2% (4 of 343) and 0.9% (3 of 352).

Conclusion:

This study identifies tetracycline-resistant GAS in Ugandan communities, suggests modified skin examination of exposed anatomic locations may be appropriate for population-based GAS skin infection studies, and underscores need for clear case definitions of GAS skin infection. Future studies are needed to evaluate the role of GAS skin infection in development of RHD in Ugandan communities.
Serum Vitamin D Deficiency Is an Independent Risk Factor for Thyroid Eye Disease
Authors: Heisel Curtis J. , Riddering Alixandra L. , Andrews Christopher A. , Kahana Alon
Published: September 2019

Thyroid eye disease is an inflammatory orbitopathy associated with Graves disease. Vitamin D is a known immune system regulator. The authors show that vitamin D deficiency is associated with the development of thyroid eye disease.

Purpose:

Thyroid eye disease (TED) is an inflammatory orbitopathy with significant impact on visual function and quality of life. Although studies have shown that patients who are deficient in vitamin D are more likely to develop autoimmune conditions, there are no studies demonstrating a definitive correlation between serum 25-hydroxyvitamin D (25(OH)D) deficiency and an increased risk of TED.

Methods:

This retrospective case–control study compared serum 25(OH)D levels among 4 groups: 1) Graves disease (GD) patients with TED (n = 89); 2) GD patients without TED (n = 89); and healthy control patients matched to 3) the TED group (n = 356); and 4) the GD group (n = 356). The authors compared 25(OH)D level in the TED group measured within 1 year of TED diagnosis to the most recently measured 25(OH)D level in the GD group using Student t test of the log transformation of serum levels. Linear regression was used to control for other risk factors. Thyroid eye disease patients and GD patients were compared separately to their matched healthy control patients with linear mixed models.

Results:

Thyroid eye disease patients displayed significantly lower serum 25(OH)D levels than GD patients (24.8 ± 13.2 ng/ml vs. 29.4 ± 13.3 ng/ml; p = 0.006). Controlling for smoking status and previous radioactive iodine treatment did not affect this statistically significant difference.

Conclusions:

Low serum vitamin D is associated with TED diagnosis. Assessing and supplementing vitamin D levels may be an important addition to the early management of GD patients. Future research should include longitudinal studies and prospective clinical trials to further explore the mechanism responsible for the observed association.
Measles re-emerges and recommendation of vaccination
Authors: Chen Hui-Lan , Tang Ren-Bin
Published: September 2019

Measles is a highly infectious viral illness and is one of the world’s most contagious diseases that can affect all people if they have not been vaccinated or have not had it before. Before measles vaccine became available in 1963, major epidemic occurred approximately every 2 to 3 years and thus 99% of the people were thought to have been infected naturally with measles virus and got immune for life. In 2000, measles was declared eliminated from the United States, and yet 1215 cases have been reported from 30 states as of August 22, 2019. Currently, there are several large measles outbreaks universally, and some people who were not immune and they need to get their measles, mumps, rubella (MMR) vaccine to prevent measles outbreaks. As vaccination coverage increases, the average age of measles infection can change to adolescents and young adults. In addition, the protective antibodies derived from vaccination might decrease gradually, and the risk of measles infection in young adults is increasing regardless of international travelling.
Development and Evaluation of a Simulation-Based Acute Care Course in a Physical Therapist Education Program
Authors: Silberman Nicki , Litwin Bini , Fernandez-Fernandez Alicia , Dornbaum Martin , Ng Grace
Published: September 2019

Introduction.

Delivery of acute care content in physical therapist (PT) education programs varies greatly. A new course included a series of 6 progressively complex, high fidelity, immersive acute care simulation-based learning experiences (SBLEs) using standardized patients. The primary purpose of this study was to examine the students' perceived value of the SBLEs in relationship to their acute care clinical experiences (CEs). Self-efficacy and clinical performance were also measured to further evaluate course outcomes.

Participants.

Students completing acute care CEs were recruited from 3 consecutive cohorts of a Doctor of Physical Therapy (DPT) program. The control group completed the curriculum before implementing the new course. The experimental groups participated in the first and second years of the course, respectively.

Methods.

A total of 60 students across the 3 cohorts completed the study. Experimental groups completed the course before their acute care CE. Focus groups were conducted to explore student perspectives with both experimental groups on completion of their respective CEs. Self-efficacy was assessed using the Acute Care Confidence Survey before the course, after course completion, and midterm of the CE. Clinical performance was evaluated using the PT Clinical Performance Instrument rating scale at both midterm and final of the CE.

Results.

Qualitative analysis revealed 2 main themes: (1) SBLEs foster self-efficacy in application of the 3 domains of learning and (2) students develop a wider perspective of the dynamic professional roles of the acute care PT. Self-efficacy significantly increased, and there was an upward trend, although no significant difference, in clinical performance for students who completed the course.

Conclusions.

Student performance in the acute care setting was positively influenced by a series of SBLEs. A simulation-based acute care course can be effectively incorporated into a DPT curriculum to foster student's professional identity in multiple domains.
Use of technology to increase physical activity in female veterans and soldiers aged 19–64 years
Authors: Riordan Joan K. , Alexander Susan , Montgomery Ida S.
Published: September 2019

Background and purpose:

Heart disease is the leading cause of mortality for American women, claiming 289,753 lives annually. Research has show that female veterans are more sedentary after separating from service and that mobile apps can assist in increasing physical activity. The purposes of this study were to: 1) implement a mobile application to increase physical activity, 2) compare the exercise data, and 3) determine the sustainability of using a mobile application in female active duty soldiers, military retirees, and veterans with prior service.

Methods:

A convenience sample of 30 participants, aged 19–64 years, was recruited from the Womack Army Medical Center, Fort Bragg, North Carolina. Active duty soldiers, retired military, and family members are eligible for care at Womack. Six of the participants with prior military service are spouses of active duty and retired military and were included in the sample. The participants documented the type of physical activity and amount of time exercised over 12 weeks using the closed discussion group. Clinically significant differences were demonstrated in individual averages of minutes exercised per week in the group of veterans (n = 4; Z = −0.944, p = .345, r = 0.3) and active duty group (n = 5; Z = −1.826, p = .068, r = 0.65).

Conclusions:

The study did not demonstrate a statistically significant increase in physical activity using technology.

Implications for practice:

Mobile technology provides nurse practitioners with tools to empower patients. The use of technology to increase physical activity is relatively new and continues to evolve.
Post-hysterectomy rare collision vulva tumor with long-term human papilloma virus infection composed of squamous cell carcinoma of the labia major and adenosquamous carcinoma of bartholin gland
Authors: Yang Fan , Li HongYi , Qi Xiaorong , Bian Ce
Published: September 2019

Rationale:

Post-hysterectomy collision tumors of the vulva has rarely been reported. Though long-term HPV infection may induce vulva tumor, but the relationship between HPV infection and collision vulva tumor is not clear. And there are no clear rules of the post-hysterectomy cancer surveillance for human papilloma virus (HPV) long-term infections. So here we first report a case of post-hysterectomy rare collision vulva tumor with long-term HPV infection composed of squamous cell carcinoma of the labia major and adenosquamous carcinoma of bartholin gland and hope to bring new direction to our future research.

Patient concerns:

A 48-year-old woman with long-term HPV infection, 3 years after hysterectomy, gravida 3, para 2, was admitted to our hospital with complaints of a 4-month history of an itching vulva ulceration. An anabrosis was located on the surface of the solid mass of the bartholin gland at the posterior part of the right labium and the right inguinal lymph nodes were palpable. Result of the incisional biopsy of the ulcer area at local hospital was atypical squamous cells couldn’t exclude high-grade squamous intraepithelial lesion (ASC-H). Subsequently more authoritative pathological consultation results suggested squamous cell carcinoma of the vulva.

Diagnoses:

Post-hysterectomy collision vulva tumor with long-term HPV infection composed of squamous cell carcinoma of the labia major and adenosquamous carcinoma of bartholin gland.

Interventions:

The extensive excision of the vulva, bilateral inguinal lymph nodes dissection, and local skin flap transposition surgeon was done to this patient. The final certificate diagnosis was: vulvar tumor T1bM0N0 composed of squamous cell carcinoma of the labia major and adenosquamous carcinoma of bartholin gland; HPV infection; post hysterectomy, and bilateral salpingectomy.

Outcomes:

The patient recovered well after surgery, and consequently received 6 courses of TC (paclitaxel + carboplatin) chemotherapy, and 9 months and 13 days followed up. So far patient recorded as complete response (CR).

Lessons:

Collision vulva tumor occurred post-hysterectomy is extremely rare. It is most likely related to long-term HPV infection, which suggests us should to modify the manner of the post-hysterectomy cancer surveillance for HPV long-term infections. For patients with high-risk HPV infection, even if the cytology results are negative, we may should perform colposcopy and vulva biopsy more positively to prevent the disease from progressing into cancer. And the pathogenesis of relationship between HPV infection and collision vulva tumor is still need further investigation.
Phacoemulsification in bilateral anterior lenticonus in Alport syndrome
Authors: Sedaghat Mohammad-Reza , Momeni-Moghaddam Hamed , Haghighi Batool , Moshirfar Majid
Published: September 2019

Rationale:

To report the visual status and results of phacoemulsification cataract surgery in a young patient with Alport syndrome associated with bilateral anterior lenticonus. The milestone of this report is the use of anterior segment optical coherence tomography (AS-OCT) to confirm the central protrusion of the anterior surface of the crystalline lens.

Patient concerns:

A 23-year-old young woman presented with severe progressive visual loss in both eyes, which started several years ago.

Diagnoses:

Refractive status was indicative of high myopia with astigmatism and vision was not improved with optimal correction to better than 0.1 in the right eye and 0.2 in the left eye (visual acuities given in decimal notation). Slit-lamp examination showed transparent cornea, anterior lenticonus and posterior sub-capsular cataract in both eyes. The classical appearance of oil droplet was evident using retro-illumination on the slit lamp.

Interventions:

The natural lenses were replaced with intraocular lens (IOL).

Outcomes:

An excellent refractive status achieved associated with an uncorrected distance visual acuity 0.9 and 0.8 in the right and left eye, respectively.

Lessons:

AS-OCT is a valuable device for confirming the budging of the anterior crystalline lens surface.
Swallowing apraxia in a patient with recurrent ischemic strokes
Authors: Yun Yeo Joon , Na Yong Jae , Han Seung Hoon
Published: September 2019

Rationale:

Swallowing apraxia is defined as dysfunction in oral phase caused by the deficit in the coordination of tongue, lip, and chin movements, without motor weakness, sensory loss, and cognitive decline and has not been reported yet.

Patient concerns:

A 69-year-old male with personal medical history of ischemic stroke about 10 years ago newly developed right striatocapular infarction. He had a problem in the oral phase of swallowing after recurrent ischemic strokes.

Diagnoses:

He was diagnosed as swallowing apraxia via bed side examination and videofluoroscopic swallowing study.

Intervention:

Videofluoroscopic swallowing study was done in this case.

Outcomes:

Symptoms and findings of VFSS were not improved after 2 months treatment.

Lessons:

This case implies that a clinician should be alert to swallowing apraxia as a possible cause when a patient with recurrent strokes complains of oral phase dysfunction of swallowing and considers proper diagnostic option such as videofluoroscopic swallowing study.
Plasma levels of soluble programmed death ligand 1 (sPD-L1) in WHO II/III nasopharyngeal carcinoma (NPC)
Authors: Yang Jia , Hu Man , Bai Xinbin , Ding Xingchen , Xie Li , Ma Ji , Fan Bingjie , Yu Jinming
Published: September 2019

Plasma levels of soluble PD-L1 (sPD-L1) have been reported to be an independent prognostic factor in many malignant tumors. The expression of sPD-L1 in nasopharyngeal carcinoma (NPC) has not been reported. The purpose of this study was to evaluate the expression of sPD-L1 and analyze its correlation with clinical characteristics in patients with NPC.

Thirty-five patients with stage I-IVa NPC were included. Plasma samples were obtained pretreatment. The sPD-L1 concentrations were measured by enzyme-linked immunosorbent assay (ELISA). The correlations of sPD-L1 expression with clinical parameters and laboratory data were analyzed.

sPD-L1 was detected in 35 plasma samples, the mean sPD-L1 concentration was 45.47 pg/ml. sPD-L1 was significantly higher in stage III-IVa (50.76 ± 28.15 pg/ml) compared to stage I-II (19.87 ± 11.38 pg/ml) (t = 2.618, P = .013). sPD-L1 was also higher in stage N2–3 (52.03 ± 28.98 pg/ml) than that in N0–1 (32.88 ± 23.75 pg/ml) (t = 2.096, P = .046). Univariate analysis identified that sPD-L1 level positively correlated with clinical stage (r = 0.495, P = .002) and N stage (r = 0.34, P = .046). Multivariate analysis showed the clinical stage was an independent factor affecting sPD-L1 expression.

This is the first report to detect sPD-L1 in NPC. The study indicated sPD-L1 is quantifiable, convenient and easy to obtain. sPD-L1 may serve as a useful biomarker for evaluating tumor progression and therapeutic efficacy of NPC.
Efficacy of montelukast for the treatment of pediatric allergic purpura
Authors: Bai Li-ping , Yu Jing , Sun Ya-xin , Wang Jiu-mei
Published: September 2019

Background:

This study aims to evaluate the efficacy and safety of montelukast for the treatment of patients with pediatric allergic purpura (PAP).

Methods:

We will retrieve the following electronic databases from inception to the present: MEDILINE, Embase, CENTRAL, CINAHL, AMED, Chinese Biomedical Literature Database, China National Knowledge Infrastructure Database, Wanfang, and VIP database without language limitation. Two authors will carry out study selection, data extraction, and quality evaluation independently. RevMan V5.3 software will be used for statistical software.

Results:

This study will summarize high-quality evidence-based medicine to evaluate the efficacy and safety of montelukast for the treatment of PAP.

Conclusion:

This study will provide strong evidence to determine whether montelukast is an effective and safety treatment for PAP.

Systematic review registration:

PROSPERO CRD42019145472.
Efficacy of ventilator for patients with atelectasis
Authors: Wang Zhi-Guo , Sun Jian-Rong , Sha Hai-Wang
Published: September 2019

Background:

This study aims to assess the efficacy and safety of ventilator for the treatment of atelectasis.

Methods:

We will search Cochrane Library, MEDLINE, EMBASE, CINAHL, EBSCO, Chinese database Chinese Biomedical Literature Database, China National Knowledge Infrastructure, and Wanfang data from inceptions to June 30, 2019 without language limitations. We will include randomized controlled trials (RCTs) of ventilator on evaluating the efficacy and safety of ventilator for atelectasis. We will use Cochrane risk of bias tool to assess the methodological quality for all included RCTs. RevMan 5.3 software will be used for statistical analysis.

Results:

The primary outcome is lung function. The secondary outcomes comprise of airway pressure, mean arterial pressure, arterial blood gas, heart rate, respiratory rate, oxygen saturation, and adverse events.

Conclusion:

The findings of this study will provide most recent evidence of ventilator for the treatment of atelectasis.

Systematic review registration:

PROSPERO CRD42019139329.
Impact of ultrasound diagnosis for chronic pelvic pain
Authors: Wang Xiao-hui , Xu Jing-jun , Yang Guang , Xin Tian-you
Published: September 2019

Background:

This study aims to assess the impact of ultrasound diagnosis in patients with chronic pelvic pain (CPP).

Methods:

We will carry out a comprehensive electronic search from the databases below: PUBMED, EMBASE, Cochrane Library, PSYCINFO, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, and WANGFANG databases from inception to July 1, 2019. The case-controlled studies focusing on impact of ultrasound diagnosis for patients CPP will be included in this study. Two authors will independently conduct all study selection, data collection, and risk of bias assessment. The risk of bias assessment will be assessed using Quality Assessment of Diagnostic Accuracy Studies tool. We will apply RevMan V.5.3 software and Stata V.12.0 software for data pooling and statistical analysis.

Results:

This study will present pooled effect estimates regarding the impact of ultrasound diagnosis for CPP by assessing sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of ultrasound to determine the diagnostic accuracy of ultrasound diagnosis for CPP.

Conclusion:

This study will provide modest evidence for the diagnostic accuracy of ultrasound in patients with CPP.

Systematic review registration:

PROSPERO CRD42019142799.
Impact of ultrasound angiography combined with fine needle aspiration for the diagnosis of thyroid nodules
Authors: Wang Jing , Bai Xiao-Gang , Liu Zhe
Published: September 2019

Background:

This study aims to systematically investigate the impact of ultrasound angiography (UA) combined with fine needle aspiration (FNA) for the diagnosis of thyroid nodules (TNs).

Methods:

The following electronic databases will be searched: MEDLINE, EMBASE, Cochrane Library, PsycINFO, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. We will search them from their inceptions to the present without language limitations. We will consider all case–controlled studies on investigating the impact of diagnosis UA combined FNA for TNs. We will apply Quality Assessment of Diagnostic Accuracy Studies tool to assess methodological quality for all eligible studies.

Results:

In this study, outcomes consist of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio. All these outcomes will be analyzed to evaluate the diagnostic accuracy of UA combined with FNA for TNs.

Conclusion:

This study will provide evidence of the diagnostic accuracy of UA combined with FNA for TNs.

Systematic review registration:

PROSPERO CRD42019138884.