bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Factors Influencing the Outcomes of an Acellular Dermal Matrix for Skin Cancer Treatment: A Retrospective Study
Authors: Ferrari Barbara , Reggiani Camilla , Francomano Mariangela , Bellini Pierantonio , Ferrari Federica , Giacomelli Luca , Mannocci Alice , Magnoni Cristina
Published: June 2020

OBJECTIVE

To evaluate the efficacy and safety of a biologically engineered dermal matrix used in reconstructive surgery after skin tumor resection, focusing on the frequency of successful grafting and identifying potential factors influencing treatment outcomes.

DESIGN AND PARTICIPANTS

This retrospective analysis involved consecutive patients diagnosed with skin cancer in any area of the body and for which treatment with a dermal skin template was recommended as alternative to traditional surgery.

MAIN OUTCOME MEASURES

Percentage of successful grafting and the patient and tumor characteristics influencing treatment outcome via univariate analysis.

MAIN RESULTS

A total of 302 patients were included. Surgical reconstruction with the matrix was effective in 88.9% of the patients within 21 days of surgery. Notably, the matrix was successful regardless of tumor location, type, or size. Infection was the only variable significantly associated with graft failure (P < .001).

CONCLUSIONS

The studied dermal matrix provides an efficient alternative to traditional reconstructive surgery in patients who present specific comorbidities or risk factors. The only variable significantly associated with graft failure was infection, which should be properly controlled through appropriate treatment.
Sonority-Related Novel Word Learning Ability of Children With Cochlear Implants With Optimal Oral Language Exposure
Authors: Hamza Yasmeen , Okalidou Areti , Dierckx Ann , van Wieringen Astrid
Published: June 2020

Objectives:

The present study investigated how children with cochlear implants (CIs), with optimal exposure to oral language, perform on sonority-related novel word learning tasks. By optimal oral language exposure, we refer to bilateral cochlear implantation below the age of 2 years. Sonority is the relative perceptual prominence/loudness of speech sounds of the same length, stress, and pitch. The present study is guided by a previous study that investigated the sonority-related novel word learning ability of a group of children with CIs, in the Greek language, of which the majority were implanted beyond the age of 2 unilaterally.

Design:

A case-control study with 15 Dutch-speaking participants in each of the three groups, i.e., children with CIs, normal-hearing children (NHC), and normal-hearing adults, was conducted using a sonority-related novel “CVC” word learning task. All children with CIs are implanted before the age of 2 years with preimplant hearing aids. Thirteen out of the 15 children had bilateral CIs. The CVC words were constructed according to four sonority conditions, where N is nonsonorous and S is a sonorous phoneme: NSN, NSS, SSN, and SSS. Outcome measures were accuracy and reaction times (RTs). In addition, the Peabody picture vocabulary test and the digit span forward test were administered to the children.

Results:

There were no statistical differences in accuracy or RTs between the children groups on the overall score and across the different conditions. However, children with CIs, unlike NHC, scored statistically less accurately and with longer RTs relative to normal-hearing adults, on the overall task. Within-group comparisons showed that none of the groups performed statistically differently on any of the conditions. The NHC showed higher receptive vocabulary scores relative to children with CIs. In addition, the group of children with CIs entailed a statistically significantly higher number of children with “weak” short-term memory.

Conclusions:

Children with CIs who have optimal oral language exposure showed age-appropriate sonority-related novel word learning abilities and strategies relative to their NH peers. However, children with CIs continue to show lower receptive vocabulary scores than NHC, despite the equivalent novel word learning ability. This suggests that children with CIs may have difficulties in retaining newly learned words. Future work should look into possible causes of the gap in performance. This would eventually aid in rehabilitation tailored to the needs of the individual.
Aberrant reactive aldehyde detoxification by aldehyde dehydrogenase-2 influences endometriosis development and pain-associated behaviors
Authors: McAllister Stacy L. , Sinharoy Pritam , Vasu Megana , Gross Eric R.
Published: June 2020

Endometriosis affects ∼176 million women worldwide, yet on average, women experience pain ∼10 years from symptom onset before being properly diagnosed. Standard treatments (drugs or surgery) often fail to provide long-term pain relief. Elevated levels of reactive aldehydes such as 4-hydroxynonenal (4-HNE) have been implicated in the peritoneal fluid of women with endometriosis and upon accumulation, reactive aldehydes can form protein-adducts and/or generate pain. A key enzyme in detoxifying reactive aldehydes to less reactive forms is the mitochondrial enzyme aldehyde dehydrogenase-2 (ALDH2). Here, we tested the hypothesis that aberrant reactive aldehyde detoxification by ALDH2 underlies endometriosis and its associated pain. We determined, in the eutopic and ectopic endometrium of women with severe (stage IV) peritoneal endometriosis, that ALDH2 enzyme activity was decreased, which was associated with decreased ALDH2 expression and increased 4-HNE adduct formation compared to the eutopic endometrium of controls in the proliferative phase. Using a rodent model of endometriosis and an ALDH2*2 knock-in mouse with decreased ALDH2 activity, we determined that increasing ALDH2 activity with the enzyme activator Alda-1 could prevent endometriosis lesion development as well as alleviate pain-associated behaviors in proestrus. Overall, our findings suggest that targeting the ALDH2 enzyme in endometriosis may lead to better treatment strategies and in the proliferative phase, that increased 4-HNE adduct formation within the endometrium may serve as a less invasive diagnostic biomarker to reduce years of suffering in women.
Neuronal/astrocytic expression of chemokine (C-C motif) ligand 2 is associated with monocyte/macrophage recruitment in male chronic pelvic pain
Authors: Liu Zhiqiang , Murphy Stephen F. , Wong Larry , Schaeffer Anthony J. , Thumbikat Praveen
Published: June 2020

Chronic pelvic pain syndrome is a multisymptom syndrome with unknown etiology. The experimental autoimmune prostatitis (EAP) mouse model of chronic pelvic pain syndrome is associated with immune cell infiltration into the prostate, expression of C-C chemokine ligand 2 (CCL2), and neuroinflammation in the spinal cord. Here, we studied CCL2 expression in tissues along the nociceptive pathway and its association with neuroimmune cells during pain development. Examination of prostate tissues at days 14 and 28 after EAP induction revealed CCL2 expression was increased in epithelial cells and was associated with increased numbers of macrophages lying in close apposition to PGP9.5-positive afferent neuronal fibers. C-C Chemokine ligand 2 immunoreactivity was elevated to a similar degree in the dorsal root ganglia at day 14 and day 28. D14 of EAP was associated with elevated IBA1+ cells in the dorsal root ganglia that were not evident at D28. Adoptive transfer of green fluorescent protein+ leukocytes into EAP mice demonstrated monocytes are capable of infiltrating the spinal cord from peripheral blood with what seemed to be a proinflammatory phenotype. In the lower dorsal spinal cord, CCL2 expression localized to NeuN expressing neurons and GFAP-expressing astrocytes. Myeloid derived cell infiltration into the spinal cord in EAP was observed in the L6-S2 dorsal horn. Myeloid-derived CD45+ IBA1+ cells were localized with IBA1+ TMEM199+ microglia in the dorsal horn of the spinal cord in EAP, with intimate association of the 2 cell types suggesting cell–cell interactions. Finally, intrathecal administration of liposomal clodronate ameliorated pelvic pain symptoms, suggesting a mechanistic role for macrophages and microglia in chronic pelvic pain.
Respiratory Disorders Resulting From Exposure to Low Concentrations of Ammonia
Authors: Mahdinia Mohsen , Adeli Seyyed Hassan , Mohammadbeigi Abolfazl , Heidari Hamidreza , Ghamari Farhad , Soltanzadeh Ahmad
Published: June 2020

Objective:

This study aimed to investigate respiratory disorders associated with exposure to low concentrations of ammonia.

Method:

This cohort study was conducted on 122 industrial workers. Data gathering were based on the officially registered data, the NMAM 6016 and the American Thoracic Society and European Respiratory Society protocols.

Results:

The prevalence rate of respiratory disorders significantly increased in the exposure group over 5 years (P < 0.05). The frequencies of these symptoms in the exposure group were significantly higher than non-exposure group (P < 0.05). Respiratory functions were decrease significantly in the exposure group and were lower than non-exposure group (P < 0.05). Exposure and the amount of exposure to ammonia had a significant relationship with respiratory disorders and respiratory functions (P < 0.05).

Conclusion:

Exposure to ammonia lower than threshold limit value (TLV), can act as a risk factor of respiratory disorders.
Defining Excellence in Physical Therapist Education: A Comparison of 2 Theoretical Perspectives
Authors: Jette Diane U. , Brechter Jacklyn H. , Heath Amy E. , Tschoepe Barbara
Published: June 2020

Background and Purpose.

Defining excellence and assessing quality in physical therapist education are challenging for many reasons, including the variable nature of curricular approaches, program structure and settings, teaching approaches, and institutional culture. In addition, the stakeholders differ depending on the unique program mission or outcome one considers. Thus, there are tensions about measuring inputs, processes, or outcomes, using quantitative versus qualitative data, and the value of program diversity. Recently, 2 approaches to measuring physical therapist education program excellence have been reported in the literature. Although these studies were not connected, the foundations of each suggest some unifying core concepts. This paper evaluates the 2 approaches to assessing program excellence, comparing clusters and attributes of the Engagement Theory of Program Quality applied by the American Council of Academic Physical Therapy task force for benchmarking excellence with the dimensions and elements for education reform proposed by the study of Excellence and Innovation in Physical Therapist Education.

Position and Rationale.

The Engagement Theory of Program Quality is a generic model designed to assess graduate programs, whereas the theoretical model proposed by the study of Excellence and Innovation in Physical Therapist Education is specific to physical therapist education. The models, however, demonstrate considerable correspondence, suggesting that excellence in graduate programs in higher education has common roots regardless of type of program.

Discussion and Conclusion.

There is clear convergence of major constructs across the 2 theoretical models. The most salient commonalities include the emphases on shared vision; leadership; collaborative relationships/partnerships; adequate resources to support students, faculty, and infrastructure; and the capacity for transformation of the people and institutions involved in the educational endeavor. These commonalities suggest a basis for initial consensus of a professional shared vision, as well as the foundation for further efforts at defining excellence and developing structures and processes for appraising quality in physical therapist education programs. We urge development of a culture of assessment to move our physical therapist education programs closer to achieving excellence.
Is the blood pressure different between the paralyzed and unaffected arms or legs?
Authors: Tao Liang , Tang Min , Peng Hai-ping , Gu Meng-bi , Zhang Hua-zhong , Zhou Guang , Su Hai
Published: June 2020

Objectives

To investigate whether the blood pressure (BP) levels are similar between the paralyzed and unaffected arms or legs.

Methods

This study enrolled 236 post-stroke patients with hemiplegic paralysis. Simultaneous four-limb BP was measured using four automatic BP devices for three times, and the average was used as final value. The inter-arm difference (IAD) and inter-ankle difference (IAND) were the BP difference between the arms or ankles, respectively. The difference between maximal BP reading and minimal BP reading was calculated as △BP to reflect the variation of three BP readings.

Results

The paralyzed arm had similar mean SBP (134.8 ± 18.7 vs. 135.1 ± 19.0 mmHg, NS) and DBP (79.5 ± 11.3 vs 78.1 ± 10.4 mmHg, NS) levels as compared with the unaffected arm. Similarly, the mean ankle SBP (143.6 ± 19.1 vs. 143.7 ± 18.6 mmHg, NS) and DBP (77.9 ± 17.7 vs. 75.8 ± 11.1 mmHg, NS) in the paralyzed legs were also similar to those in the unaffected legs. The detection rate of systolic IAD ≥10 mmHg was 5.9% and that for systolic IAND ≥15 mmHg was 20.3%. Meanwhile, △SBP levels were similar between two arms or ankles.

Conclusion

In the post-stroke patients with hemiplegic paralysis, the SBP and DBP levels of the paralyzed and unaffected arms or ankles were similar.
The impact of primary biliary cholangitis on non-alcoholic fatty liver disease
Authors: Iluz-Freundlich Daniel , Uhanova Julia , Grubert Van Iderstine Micah , Minuk Gerald Y.
Published: June 2020

Background

The impact of chronic cholestatic liver diseases such as primary biliary cholangitis (PBC) on non-alcoholic fatty liver disease (NAFLD) has yet to be described.

Objectives

To document and compare the severity and course of liver disease in patients with NAFLD/PBC versus NAFLD alone.

Methods

In this retrospective, case-control study 68 adult NAFLD/PBC patients were matched 1:2 for age and sex with 136 NAFLD alone patients. Disease activity and severity were documented by serum aminotransferases, albumin, bilirubin and international normalized ratio (INR) values and hepatic fibrosis by Fib-4 and aspartate aminotransferase/platelet ratio indices (APRI).

Results

On presentation (baseline), NAFLD/PBC patients had similar serum aminotransferase, albumin and bilirubin levels but lower INR values than NAFLD alone patients. Fib-4 and APRI levels were similar. Despite longer follow-up (favouring more advanced disease) in NAFLD/PBC patients, serum aminotransferases and bilirubin values were similar but albumin and INR levels significantly lower in NAFLD/PBC versus NAFLD alone patients at the end of follow-up. NAFLD/PBC patients also had significantly lower and less worsening of Fib-4 values at the end of follow-up. Transition from intermediate Fib-4 levels to those compatible with no or limited fibrosis was higher in NAFLD/PBC patients.

Conclusion

These findings suggest PBC does not adversely affect the severity or course of NAFLD.
The Malnutrition Universal Screening Tool can predict malnutrition in patients with esophageal achalasia
Authors: Milito Pamela , Aquilino Krizia , Lazzari Veronica , Boveri Sara , Munizio Nadia , Ogliari Cristina , Asti Emanuele , Bonavina Luigi
Published: June 2020

Background:

At present, little research has been done to clarify why some achalasia patients do not lose weight or are even obese and to investigate their nutritional status. The aim of this study was to identify predictive factors of malnutrition in these patients and to assess their response to treatment.

Methods:

We conducted a retrospective cohort study on consecutive patients referred to a tertiary-care center for laparoscopic or endoscopic treatment of achalasia. Demographics, anthropometric variables, presenting symptoms, and results of the objective investigation were recorded on a prospectively collected database. The severity of symptoms and the nutritional risk were assessed by the Eckardt score and the Malnutrition Universal Screening Tool (MUST), respectively, before and after treatment.

Results.

Between 2013 and 2019, 171 patients met the study inclusion criteria. There were 87 (50.9%) male and the median age was 53.0 (39–66) years. The median Eckardt score was 6 (interquartile range 3). Based on the MUST score, 121 (70.8%) patients were classified at moderate/high risk of malnutrition. Of these, 93 (76.9%) were overweight or obese. Compared to low-risk group, predictive factors of moderate/high risk of malnutrition were higher Eckardt score [odds ratio (OR) 1.63; 95% CI, 1.35–1.99], more severe dysphagia (OR 2.68, 95% CI, 1.66–4.30), and greater absolute weight loss (OR 2.37; 95% CI, 1.77–3.17). The latter was the only independent predictive factor of malnutrition (OR 2.54; 95% CI, 1.69–3.82). After treatment, the measured MUST score was 0 in 96% of patients.

Conclusions:

Over 70% of achalasia patients were at moderate/high risk of malnutrition. These individuals may benefit from a perioperative multidisciplinary approach including dietary intervention to stabilize weight and improve their nutritional status.
The burden of Clostridioides difficile infection in patients with history of liver transplant and during index admission
Authors: Wijarnpreecha Karn , Aby Elizabeth S. , Kim Donghee , Ungprasert Patompong , Cheungpasitporn Wisit , Thongprayoon Charat , Lukens Frank J. , Harnois Denise M. , Kröner Paul T.
Published: June 2020

Background/objectives

Liver transplant recipients have an increased risk of Clostridioides difficile infection (CDI) which associated with higher morbidity and mortality. CDI in liver transplant has been argued to increase hospital costs, charges, and length of stay (LOS) in small studies. However, no recent nationwide analysis determines these outcomes.

Methods

This is a retrospective cohort study using the National Inpatient Sample 2016. All patients with ICD10CM diagnostic codes for CDI were included. The cohort was stratified for the history of liver transplant and liver transplant index admission. The primary outcome was the odds of CDI in both patient cohorts to patients without liver transplant. Secondary outcomes were inpatient morbidity, mortality, resource utilization, colectomy rates, LOS, and total hospital costs and charges.

Results

A total of 360 364 patients with CDI were identified, 1665 had a history of liver transplant and 155 had liver transplant during that admission. Patients with a history of liver transplant had increased odds of CDI compared to patients with no history of liver transplant (adjusted odds ratio 2.78; 95% confidence interval, 2.44–3.16). Patients with CDI had greater odds of shock, acute kidney injury, ICU stay, organ failure and significantly higher costs, charges and LOS.

Conclusions

Patients with a history of liver transplant increased odds of CDI. CDI with history of liver transplant and the index admission for liver transplant had higher odds of morbidity and resource utilization. Clinicians must maintain a high index of suspicion for CDI for early diagnosis and appropriate initiation of treatment.
The diagnostic accuracy of ascitic calprotectin for the early diagnosis of spontaneous bacterial peritonitis: systematic review and meta-analysis
Authors: Hadjivasilis Alexandros , Tzanis Alexander , Ioakim Kalliopi J. , Poupoutsi Ioanna , Agouridis Aris P. , Kouis Panayiotis
Published: June 2020

Spontaneous bacterial peritonitis (SBP) is a common complication in patients with cirrhosis and has an incidence of up to 30% in hospitalized patients. Importantly, it may raise their mortality rate up to 30%. Hence, a delayed diagnosis is associated with poor prognosis. This systematic review aims to assess the diagnostic accuracy of ascitic fluid calprotectin for the early diagnosis of SBP in patients with ascites. This study was conducted in accordance with the PRISMA statement. A systematic literature search was conducted from inception to February 2020 in the following electronic bibliographic databases: MEDLINE, Scopus, The Cochrane Library and OpenGrey. Quality Assessment of Diagnostic Accuracy Studies tool was used to assess risk of bias. Ten studies were included in the qualitative and quantitative synthesis. Hierarchical summary receiver operating characteristic curves were plotted and the summary sensitivity of a positive ascitic fluid calprotectin assessment to detect SBP was 93% [95% confidence interval (CI) 90–95%] while the summary specificity was 89% (95% CI 80–95%), irrespectively of the method used. The positive likelihood ratio and negative likelihood ratio of the test were 8.7 (95% CI 4.4–17.1) and 0.08 (85% CI 0.06–0.12). All studies showed positive correlation between ascitic calprotectin and polymorphonuclear (PMN) leukocyte count. Ascitic calprotectin appears to be an excellent alternative to PMN leucocyte count of ≥250 cells/mm3 for the diagnosis of SBP with much faster time to diagnosis. Owing to its substantially high negative predictive value, the test can accurately exclude SBP avoiding unnecessary antibiotics in suspected patients.
Nomogram for Estimating Overall Survival in Patients With Metastatic Pancreatic Cancer
Authors: Goldstein David , Von Hoff Daniel D. , Chiorean E. Gabriela , Reni Michele , Tabernero Josep , Ramanathan Ramesh K. , Botteman Marc , Aly Abdalla , Margunato-Debay Sandra , Lu Brian , Louis Chrystal U. , McGovern Desmond , Lee Chee Khoon
Published: June 2020

Objectives

This analysis investigated nomogram use to evaluate metastatic pancreatic cancer prognosis.

Methods

Thirty-four baseline factors were examined in the Metastatic Pancreatic Adenocarcinoma Clinical Trial (MPACT) (nab-paclitaxel plus gemcitabine vs gemcitabine) data set. Factors significantly (P < 0.1) associated with overall survival (OS) in a univariable model or with known clinical relevance were tested further. In a multivariable model, factors associated with OS (P < 0.1) were selected to generate the primary nomogram, which was internally validated using bootstrapping, a concordance index, and calibration plots.

Results

Using data from 861 patients, 6 factors were retained (multivariable analysis): neutrophil-lymphocyte ratio, albumin level, Karnofsky performance status, sum of longest diameter of target lesions, presence of liver metastases, and previous Whipple procedure. The nomogram distinguished low-, medium-, and high-risk groups (concordance index, 0.67; 95% confidence interval, 0.65–0.69; median OS, 11.7, 8.0, and 3.3 months, respectively).

Conclusions

This nomogram may guide estimates of the range of OS outcomes and contribute to patient stratification in future prospective metastatic pancreatic cancer trials; however, external validation is required to improve estimate reliability and applicability to a general patient population. Caution should be exercised in interpreting these results for treatment decisions: patient characteristics could differ from those included in the nomogram development.
Serum Anti-p53 Antibody Can Serve as a Predictive Marker for Histological Grade of Intraductal Papillary Mucinous Neoplasms of the Pancreas
Authors: Hata Tatsuo , Mizuma Masamichi , Motoi Fuyuhiko , Iseki Masahiro , Omori Yuko , Hayashi Hiroki , Nakagawa Kei , Morikawa Takanori , Kamei Takashi , Naitoh Takeshi , Furukawa Toru , Unno Michiaki
Published: June 2020

Objective

The aim of the study was to clarify the diagnostic impact of measuring serum anti-p53 antibody (S-p53Ab) in predicting the histological grades of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas.

Methods

We compared the measured values and positive prevalence of S-p53Ab across the different histological grades of 111 resected IPMN cases. We also evaluated the TP53 alterations using immunohistochemistry and next-generation sequencing.

Results

Serum anti-p53 antibody were detected in 6 of 111 cases, all of their histological grades were high-grade dysplasia (HGD) and invasive carcinoma (INV). Positive prevalence of S-p53Ab was higher in cases with INV (4/35 cases, 11.4%) than those with HGD (2/38 cases, 5.3%), whereas S-p53Abs were undetectable in cases with low-grade dysplasia. Measured S-p53Ab values were not correlated with either carcinoembryonic antigen (CEA) or carbohydrate antigen 19-9 (CA 19-9). In 4 of 6 S-p53Ab-positive cases, the TP53 alterations—somatic pathogenic mutations or aberrant immunoreactivity—were identified in their IPMN lesions. A combination assay of S-p53Ab, CEA, and CA 19-9 revealed a 38.4% sensitivity and 81.6% specificity for predicting HGD/INV.

Conclusions

Serum anti-p53 antibody can serve as a surrogate marker for TP53 alterations and help predict the presence of HGD/INV in cases with IPMN, in combination with CEA and CA 19-9.
Comparing Pathology Report Quality Indicators in 2 Distinct Whipple Resection Specimen Protocols
Authors: DeCoste Ryan , McDonell Laura M. , Uzans Drea , Molinari Michele , Huang Weei-Yuarn
Published: June 2020

Objectives

Pancreaticoduodenectomy specimens are complex, with varying gross examination techniques. In 2012, our institution began using axial sectioning. We sought to determine if this resulted in more complete pathology reporting.

Methods

Quality indicators were analyzed for pathology reports from 2 cohorts: 2001 to 2009 grossed traditionally and 2012 to 2017 using an axial technique (n = 81 and 51). Continuous and categorical data were compared using 2-tailed t test and Fisher exact test, respectively.

Results

The later cohort exhibited increased reporting of stage, lymphovascular invasion, margins/surfaces, mean number of lymph nodes, and mean number of slides (P < 0.01). No differences were seen in reporting of size, grade, or perineural invasion. In the later cohort, superior mesenteric vein/portal vein surface was positive in 17 cases (33%), showing strong correlation with superior mesenteric artery/uncinate margin involvement (13/17 cases; P = 0.0001). There was a higher rate of lymph node positivity (86% vs 65%, P < 0.01) in the later cohort.

Conclusions

There is a trend toward higher-quality pathology reports in 2012 to 2017. A possible drawback of the axial approach is increased histopathology slides. Potential additional contributors include College of American Pathologists protocols, increasing subspecialty practice, and updates to the American Joint Committee on Cancer staging criteria.
Intraoperative Ultrasound Elastography Is Useful for Determining the Pancreatic Texture and Predicting Pancreatic Fistula After Pancreaticoduodenectomy
Authors: Kawabata Yusuke , Okada Toshihiro , Iijima Hiroko , Yoshida Masahiro , Iwama Hideaki , Xu Jinyang , Hatano Etsuro , Fujimoto Jiro , Suzumura Kazuhiro
Published: June 2020

Objectives

Pancreatic fistula (PF) is one of the most common complications after pancreaticoduodenectomy (PD). The soft pancreatic texture is known to be an important predictive factor for PF after PD. However, its evaluation is dependent on the sense of touch by the operator during operation, thus not objective. The aim of this study was to investigate the relationship between mean elasticity via intraoperative ultrasound elastography and histological pancreatic hardness, as well as predictive factor of PF after PD.

Methods

Forty-eight patients who underwent ultrasound elastography during PD and had pancreatic parenchyma histologically evaluated were included.

Results

Pancreatic fistula was noted in 20 patients. There were significant differences in the histological pancreatic fibrosis rate between soft pancreas group (8.2%) and hard pancreas group (28.4%, P < 0.05) and in the mean elasticity between soft pancreas group (1.94 m/s) and hard pancreas group (3.17 m/s, P < 0.05). The mean elasticity was significantly correlated with pancreatic fibrosis rate (P < 0.05). A multivariate analysis revealed that the mean elasticity of less than 2.2 m/s was a significant predictor of PF after PD (P = 0.003).

Conclusions

Intraoperative ultrasound elastography could predict pancreatic texture objectively. The mean elasticity of less than 2.2 m/s was a significant predictor of PF after PD.
Radiation as a Single-Modality Treatment in Localized Pancreatic Cancer
Authors: Shaib Walid L. , Zakka Katerina , Shahin Asser A. , Yared Fares , Switchenko Jeffrey M. , Wu Christina , Akce Mehmet , Alese Olatunji B. , Patel Pretesh R. , Mcdonald Mark , El-Rayes Bassel F.
Published: June 2020

Objectives

Locally advanced pancreatic cancer (LAPC) is managed with multimodality therapy. We aim to evaluate the outcome of single-modality radiation therapy for LAPC.

Methods

Locally advanced pancreatic cancer patients were identified between 2004 and 2013 using the National Cancer Database excluding patients who received chemotherapy or surgery.

Results

A total of 6590 patients were included. The mean age was 73.5 (range, 28–90) years, 83.2% were white, and 54.4% were female. Tumors of 4 cm or greater (>T3 stage) accounted for 52.7%. The median radiation dose was 39.6 Gy. Stereotactic body radiation (SBRT) delivered to 64 patients and external-beam/intensity modulated radiotherapy in 416 patients. Radiation therapy was associated with improved overall survival (OS) compared with no treatment in univariate and multivariable analyses. The medians OS for patients who received SBRT, external-beam/intensity modulated radiotherapy, or no radiation were 8.6, 6.7, and 3.4 months, respectively (P < 0.001). There is a significant difference in 12-month OS for the SBRT cohort (31.9%; 95% confidence interval [CI], 20.9%–43.5%) compared with patients who received no radiation (15.1%; 95% CI, 14.2%–16.0%), and on multivariable analysis (hazard ratio, 0.50; 95% CI, 0.38–0.65; P < 0.001).

Conclusions

The current study suggests potential benefit for radiation therapy alone in comparison with no treatment in LAPC.
Helicobacter pylori Infection in Pediatric Patients Living in Europe
Authors: Kori Michal , Le Thi Thu Giang , Werkstetter Katharina , Sustmann Andrea , Bontems Patrick , Lopes Ana Isabel , Oleastro Monica , Iwanczak Barbara , Kalach Nicolas , Misak Zrinjka , Cabral José , Homan Matjaž , Cilleruelo Pascual Maria Luz , Pehlivanoglu Ender , Casswall Thomas , Urruzuno Pedro , Martinez Gomez Maria José , Papadopoulou Alexandra , Roma Eleftheria , Dolinsek Jernej , Rogalidou Maria , Urbonas Vaidotas , Chong Sonny , Kindermann Angelika , Miele Erasmo , Rea Francesca , Cseh Áron , Koletzko Sibylle ,   Helicobacter pylori Working Group of ESPGHAN
Published: June 2020

Objectives:

The aim of the study was to assess clinical presentation, endoscopic findings, antibiotic susceptibility and treatment success of Helicobacter pylori (H. pylori) infected pediatric patients.

Methods:

Between 2013 and 2016, 23 pediatric hospitals from 17 countries prospectively submitted data on consecutive H. pylori‐infected (culture positive) patients to the EuroPedHP‐Registry.

Results:

Of 1333 patients recruited (55.1% girls, median age 12.6 years), 1168 (87.6%) were therapy naïve (group A) and 165 (12.4%) had failed treatment (group B). Patients resided in North/Western (29.6%), Southern (34.1%) and Eastern Europe (23.0%), or Israel/Turkey (13.4%). Main indications for endoscopy were abdominal pain or dyspepsia (81.2%, 1078/1328). Antral nodularity was reported in 77.8% (1031/1326) of patients, gastric or duodenal ulcers and erosions in 5.1% and 12.8%, respectively. Primary resistance to clarithromycin (CLA) and metronidazole (MET) occurred in 25% and 21%, respectively, and increased after failed therapy. Bacterial strains were fully susceptible in 60.5% of group A, but in only 27.4% of group B. Primary CLA resistance was higher in Southern and Eastern Europe (adjusted odds ratio [ORadj] = 3.44, 95% confidence interval [CI] 2.22–5.32, P < 0.001 and 2.62, 95% CI: 1.63–4.22, P < 0.001, respectively) compared with Northern/Western Europe. Children born outside Europe showed higher primary MET resistance (ORadj = 3.81, 95% CI: 2.25–6.45, P < 0.001). Treatment success in group A reached only 79.8% (568/712) with 7 to 14 days triple therapy tailored to antibiotic susceptibility.

Conclusions:

Peptic ulcers are rare in dyspeptic H. pylori‐infected children. Primary resistance to CLA and MET is markedly dependent on geographical regions of birth and residence. The ongoing survey will show whether implementation of the updated ESPGHAN/NASPGHAN guidelines will improve the eradication success.
Predictors of Posttraumatic Stress Disorder, Anxiety, and Depression Symptoms in Survivors of Torture Living in the United States
Authors: Tran Ann , Brickman Sophie , Jordan Joshua , Samuelson Kristin W.
Published: June 2020

A constellation of psychosocial factors contributes to the complex trauma symptoms that survivors of torture may experience. We examined the roles of pretrauma, peritrauma, and postmigration factors as predictors of posttraumatic stress disorder, depression, and anxiety in a sample of 101 culturally heterogeneous torture survivors residing in the United States. Predictors included demographic variables (sex, education, marital status), peritrauma torture type variables generated by principal components analysis (PCA), and postmigration variables (employment status, legal immigration status, and family separation). Of the torture factors identified through PCA (torture inflicted on the self and torture inflicted on family members), torture inflicted on the self significantly predicted anxiety. Undocumented legal status and female sex were related to poorer psychological outcomes. Results highlight the importance of considering postmigration factors, specifically legal status, rather than elements of the torture experience itself, in the delivery of trauma-informed psychological interventions and policy development for survivors of torture.
Child Abuse Response Simulation for Advanced Practice Nursing Students
Authors: McClure Natasha , Nelson Brittany , Anderson Margaret , Donnell Carrie , Knox Danielle
Published: June 2020

Purpose

The purpose of this project was for advanced practice nursing students to gain experience taking a history from a parent or caregiver and communicating the treatment plan for an infant in which child abuse is suspected.

Project

Fifty-three students participated in a 1:1 simulated encounter with a standardized patient acting as the mother of an infant with a leg injury that reportedly resulted from a fall from the couch. Students received feedback from the standardized patient via an assessment tool and debriefed with faculty immediately after the simulation.

Outcome

All students demonstrated empathy, acknowledged the mother's emotions, and communicated the concern for abuse. Additionally, all students explained the x-ray findings, need for hospital admission, and referral to investigative agency for further evaluation.

Conclusion

Simulations designed to provide advanced practice nursing students with experience interviewing a parent and responding in the case of suspected child abuse are an important method of preparing them for initial clinical encounters.
Mitochondrial Dysregulation in Sepsis
Authors: Graham Julie-Kathryn , Stacy Kathleen
Published: June 2020

Background

Until 2016, the condition Sepsis was widely understood to be the systemic immune response syndrome in the presence or suspicion of an infectious source. Systemic immune response syndrome, an adaptive response, has been repeatedly demonstrated to lack specificity for sepsis. The current definition of sepsis describes a dysregulated host response to infection, yet the dysregulated nature of the response has yet to be defined. Successful recognition and management of sepsis are critically dependent on understanding and operationalizing the definition of sepsis.

Objective

The authors sought to review the current literature on sepsis and its relationship to oxygen downregulation within the mitochondria along the electron transport chain.

Methods

Articles retrieved from databases PubMed and CINAHL, pertaining to human cells, post 2001, in English, original experimental, quasi-experimental, or cohort design. Articles were selected and retrieved by the first author and synthesized by both authors.

Results

The 10 articles included in the review were all bench science cellular studies. They demonstrated consistent, statistically significant differences when investigating mitochondrial oxygen downregulation in sepsis versus control, offering strong, statistically significant support for the hypothesis of mitochondrial dysregulation in the septic host.

Conclusions

The evidence makes a compelling case for mitochondrial dysregulation to inform the current definition of sepsis as a dysregulated host response. As the evidence points to a linear, progressive time/exposure-dependent disruption in oxygen downregulation in sepsis at the cellular level, it lends credence to the recommendations for early intervention and its relationship with survivability. Time is not on the side of the individual with sepsis.
An Unusual Cervical Injury Caused by Accidental Electrical Burns
Authors: Mosbahi Amal , Majdoub Wael , Sriha Badreddine , Turki Elyes
Published: June 2020

High-voltage electrocution is mostly unintentional, and it is associated with significant morbidity and mortality due to severe tissue damages. The present report describes an atypical electrocution with multiple victims and a fatal outcome of a 48-year-old man due to unusual neck injuries caused by accidental electrical burns.
Fatal Intracerebral Hemorrhage During “Muay Thai” in a 21-Year-Old Man With Undiagnosed Acute Myeloid Leukemia
Authors: Caputo Fiorella , Barranco Rosario , Fraternali Orcioni Giulio , Frigiolini Francesca Maria Elena , Ventura Francesco
Published: June 2020

Acute myeloid leukemia (AML) is characterized by the rapid growth of abnormal white blood cells in the bone marrow that interferes with the production of normal blood cells. This disease is burdened by a high risk of bleeding complications involving central nervous system hemorrhages, purpura, gingival bleeding, and gastrointestinal bleeding. In this article, the authors report a case of a fatal intracerebral hemorrhage in a 21-year-old man who was affected by an undiagnosed AML. The subject practiced a combat sport (Muay Thai), and 2 days before his last training, he was involved in a fight where the aggressor punched him in the face; however, after the fight, he did not claim of any symptoms. The current case highlights the importance of the role of the forensic pathologist because only through a careful and complete circumstantial, autoptic, and histological analysis it is possible to date the origin of a cerebral hemorrhage and establish whether it is spontaneous or posttraumatic in subjects with undiagnosed preexisting diseases. Through an integrated study, it is also important to date the lesion and identify the traumatic event responsible of the bleeding. Finally, this case has a relevant clinical importance relatively to sports medicine, where it would be appropriate that athletes undergo blood test as a preventive measure. In fact, in presence of an acute hematological disease, such as AML, even mild traumatic injuries may be fatal.
Implementing Deep Learning Algorithms in Anatomic Pathology Using Open-source Deep Learning Libraries
Authors: McAlpine Ewen , Michelow Pamela
Published: June 2020

The application of artificial intelligence technologies to anatomic pathology has the potential to transform the practice of pathology, but, despite this, many pathologists are unfamiliar with how these models are created, trained, and evaluated. In addition, many pathologists may feel that they do not possess the necessary skills to allow them to embark on research into this field. This article aims to act as an introductory tutorial to illustrate how to create, train, and evaluate simple artificial learning models (neural networks) on histopathology data sets in the programming language Python using the popular freely available, open-source libraries Keras, TensorFlow, PyTorch, and Detecto. Furthermore, it aims to introduce pathologists to commonly used terms and concepts used in artificial intelligence.
Diagnostic Discordance in Pediatric Critical Care Transport
Authors: Noje Corina , Costabile Philomena M. , Henderson Eric , O'Donnell Erin , Bhatia Pooja , Singh Sarabdeep , Hattab Mohammad W. , Anders Jennifer F. , Klein Bruce L.
Published: June 2020

Objectives

The aims of the study were to describe diagnostic discordance rates at our pediatric tertiary care center between the reason for transfer of critically ill/injured children (determined by the referring institution) and the inpatient admission diagnosis (determined by our accepting institution), to identify potential factors associated with discordance, and to determine its impact on patient outcomes.

Methods

We conducted a retrospective chart review of all critically ill/injured children transferred to the Johns Hopkins Children's Center between July 1, 2017, and June 30, 2018. All patients whose initial inpatient disposition was the pediatric intensive care unit were included.

Results

Six hundred forty-three children (median age, 51 months) from 57 institutions (median pediatric capability level: 3) met inclusion criteria: 46.8% were transported during nighttime, 86.5% by ground, and 21.2% accompanied by a physician. Nearly half (43.4%) had respiratory admission diagnoses. The rest included surgical/neurosurgical (14.2%), neurologic (11.2%), cardiovascular/shock (8.7%), endocrine (8.2%), infectious disease (6.8%), poisoning (3.1%), hematology-oncology (2.2%), gastrointestinal/metabolic (1.9%), and renal (0.3%). Forty-six (7.2%) had referral-to-admission diagnostic discordance: 25 of 46 had discordance across different diagnostic groups and 21 of 46 had clinically significant discordance within the same diagnostic group. The discordant group had higher need for respiratory support titration in transport (43.9% vs 27.9%, p = 0.02); more invasive procedures and vasopressor needs during the day of admission (26.1% vs 11.6%, P = 0.008; 19.6% vs 7%, P = 0.006); and longer intensive care unit (ICU) and hospital stays (5 vs 2 days; 11 vs 3 days, P < 0.001). When compared with respiratory admission diagnoses, patients with cardiovascular/shock and neurologic diagnoses were more likely to have discordant diagnoses (odds ratio [95% confidence interval], 13.24 [5.41–35.05]; 6.47 [2.48–17.75], P < 0.001).

Conclusions

Seven percent of our critically ill/injured pediatric cohort had clinically significant referral-to-admission diagnostic discordance. Patients with cardiovascular/shock and neurologic diagnoses were particularly at risk. Those with discordant diagnoses had more in-transit events; a higher need for ICU interventions postadmission; and significantly longer ICU stays and hospitalizations, deserving further investigation.
POCUS Case Review
Authors: Malik Rabia , Chen Lei , Riera Antonio
Published: June 2020

We report a case of a 16-year-old adolescent girl who presented to the pediatric emergency department for worsening abdominal pain and vomiting and had significant weight loss over the previous 4 months. Point-of-care ultrasound was used to assess for signs of superior mesenteric artery syndrome.
Acute Care Utilization and Health Care Expenditures in Medicaid‐Enrolled Children
Authors: Masonbrink Abbey R. , Richardson Troy , Goyal Monika K. , Hall Matt , Reed Jennifer L. , Alpern Elizabeth R. , Samuels-Kalow Margaret E. , Neuman Mark I.
Published: June 2020

Objectives

Although recent health care reform efforts have focused on minimizing high cost health care utilization, the relationship between acute care use and health care expenditures among certain vulnerable populations such as Medicaid-insured children remains poorly understood. We sought to evaluate the association between acute care utilization and health care expenditures and to identify characteristics associated with high spending.

Methods

We performed a retrospective cohort study of Medicaid-enrolled children 1–21 years old from 1/1/2016 to 12/31/2016. Children were categorized by acute care use (including emergency department and urgent care visits) as 0, 1, 2, 3, and 4 or more visits. Our main outcomes were annualized spending, total per-member-per-year spending, and acute care-related per-member-per-year spending.

Results

There were 5.1 million Medicaid-enrolled children that comprised the study cohort, accounting for US $32.6 billion in total spending. Children with 4 or more acute care visits were more likely to be younger than 2 years or older than 14 years, female, and have a chronic condition. Children with 4 or more acute care visits consisted of only 4% of the cohort but accounted for 15% (US $4.7 billion) of the total spending. Increasing acute care visits were associated with increasing total annualized spending in adjusted analyses (P < 0.001). This association was disproportionately observed in older age groups and children without chronic medical conditions.

Conclusions

Medicaid spending for children increases with increasing acute care use; this trend was disproportionately observed in older age groups and children without chronic medical conditions. Improved understanding of factors contributing to frequent acute care utilization and disproportionate spending is needed to potentially reduce unnecessary health care costs in these pediatric populations.
The COVID-19 Pandemic: Crisis Management for Plastic Surgeons
Authors: Hollier Larry H. , Tanna Neil , Kasabian Armen K. , Abu-Ghname Amjed , Davis Matthew J. , Gibstein Alexander , Reece Edward M.
Published: June 2020

The worldwide outbreak of coronavirus disease 2019 (COVID-19) has forced health care systems across the United States to undertake broad restructuring to address the ongoing crisis. The framework of crisis management can assist plastic surgeons navigate the dynamic environment of the COVID-19 pandemic. This article outlines crisis management tools at a number of different levels, from hospital-wide to plastic surgeon–specific, and it offers a practical discussion of the coronavirus situation as it affects plastic surgeons. Although there are innumerable ways that this virus is currently changing plastic surgeons’ practices, it is crucial to remember that these changes are temporary, and they will be best met by being confronted head-on.
Mindfulness-Based Interventions for the Improvement of Well-Being in People With Multiple Sclerosis: A Systematic Review and Meta-Analysis
Authors: Carletto Sara , Cavalera Cesare , Sadowski Isabel , Rovaris Marco , Borghi Martina , Khoury Bassam , Ostacoli Luca , Pagnini Francesco
Published: June 2020

Objective

The study aims to meta-analytically review studies about the effects of mindfulness-based interventions (MBIs) on well-being of people with multiple sclerosis (MS).

Methods

Seven electronic databases were searched from June 2018 to September 2018. A systematic review and a meta-analysis were conducted.

Results

Twenty-one studies were included in qualitative synthesis, and 10 studies were included in meta-analysis. MBIs are effective with an overall moderate effect size (Hedges' g = 0.70) in improving well-being in people with MS, with lasting effects at the follow-up (g = 0.55). In particular, MBIs demonstrated to highly reduce stress (g = 1.07) and to improve depression and anxiety symptoms with a moderate to large effect at postintervention (g = 0.77 and g = 0.63, respectively).

Conclusions

MBIs represent a valid and effective mind-body intervention to improve the well-being of patients with MS. Further studies should investigate which components of MBIs could be more beneficial for patients with progressive MS.

PROSPERO registration

CRD42018099704.