bluuebunny/crossref_metadata_2025 huggingface dataset:
SHORT-TERM OUTCOMES AFTER INTRAVITREAL INJECTIONS OF CONBERCEPT VERSUS RANIBIZUMAB FOR THE TREATMENT OF RETINOPATHY OF PREMATURITY
Authors: Jin Enzhong , Yin Hong , Li Xiaoxin , Zhao Mingwei
Published: July 2017

Purpose:

Intravitreal injection of conbercept (IVC) is the latest applied treatment that could be used in retinopathy of prematurity (ROP) patients. The structural outcomes and recurrence of ROP among patients treated with IVC or intravitreal injection of ranibizumab (IVR) were compared.

Methods:

A consecutive case series of ROP treated with IVC or IVR were retrospectively studied. The primary outcome was treatment success defined as regression of plus disease. The secondary outcomes were recurrence of plus, times of injection, and the final regression of disease.

Results:

A total of 48 eyes (24 patients) with ROP were included. Twenty eyes (10 patients) received IVC, and 28 eyes (14 patients) received IVR. For the IVC group, 18 eyes had Zone II 3+ ROP and 2 eyes had aggressive posterior ROP. Among the 28 eyes treated with IVR, 6 eyes had Zone I 2/3+ ROP, 6 eyes had aggressive posterior ROP, and 16 eyes had Zone II 3+ ROP. For the IVC group, the mean gestational age, birth weight, postmenstrual age at initial treatment, and follow-up period for the infants were 29.49 ± 1.37 weeks, 1,369.0 ± 161.9 g, 38.47 ± 2.72 weeks, and 52.6 ± 21.4 weeks, respectively. And for the infants who received IVR, these were 28.35 ± 1.62 weeks, 1,171.4 ± 279.9 g, 38.53 ± 3.54 weeks, and 42.9 ± 9.8 weeks, respectively. For the IVC group, 17 (85%) of 20 eyes received the injection only once, and the regression of plus disease occurred 4.3 ± 2.08 weeks later. Three eyes (15%) did not healed with one injection received a second IVC, and the regression of plus disease occurred within 3 weeks. For the IVR group, 15/28 (53.6%) eyes received a second IVR. Among them, 10 recurrent eyes and 5 eyes did not recover with one injection. No retinal detachment was observed in both group infants.

Conclusion:

Both conbercept and ranibizumab are effective choice for the treatment of ROP. Conbercept is a novel effective treatment strategy for ROP providing a new treatment option for ophthalmologists.
ARCUATE NERVE FIBER LAYER CHANGES AFTER INTERNAL LIMITING MEMBRANE PEELING IN IDIOPATHIC EPIRETINAL MEMBRANE
Authors: Scupola Andrea , Grimaldi Gabriela , Abed Edoardo , Sammarco Maria G. , Giudiceandrea Andrea , Greco Andrea , Sasso Paola , Blasi Maria A.
Published: July 2017

Purpose:

To analyze the relationship between swelling of the arcuate nerve fiber layer (SANFL) and long-term decrease of retinal nerve fiber layer thickness after internal limiting membrane peeling for idiopathic epiretinal membrane, and to investigate if SANFL is related to a mechanical surgical damage.

Methods:

Prospective, interventional consecutive case series of 46 eyes that underwent combined epiretinal membrane/internal limiting membrane peeling for idiopathic epiretinal membrane. Infrared, blue autofluorescence, color fundus imaging and measurement of retinal nerve fiber layer thickness in six peripapillary sectors by spectral-domain optical coherence tomography were performed preoperatively and at 2 weeks, 1, 3, 6, and 12 months after surgery. The presence of SANFL was checked postoperatively on infrared and blue autofluorescence fundus imaging, and the extent of each SANFL was measured on infrared fundus images.

Results:

Areas of SANFL were identified in 39 eyes (84.8%) at 2-week follow-up. Retinal nerve fiber layer thickness significantly decreased in the temporal sectors at 1, 6, and 12 months (P < 0.0001). The linear extent of SANFL was significantly correlated with the percentage of reduction in retinal nerve fiber layer thickness in the temporal (R2 = 0.45; P < 0.0001) and infero-temporal (R2 = 0.23; P = 0.0008) sectors at 12 months of follow-up. Correspondence between sites of surgical grasping and the points of origin of SANFL was demonstrated on blue autofluorescence fundus images superimposed on intraoperative surgical frames.

Conclusion:

Early postoperative SANFL is correlated with late focal retinal nerve fiber layer thinning in the temporal sectors. Intraoperative surgical grasping seems to be a leading factor for the onset of SANFL.
Technician Consistency in Specular Microscopy Measurements: A “Real-World” Retrospective Analysis of a United States Eye Bank
Authors: Rand Gabriel M. , Kwon Ji Won , Gore Patrick K. , McCartney Mitchell D. , Chuck Roy S.
Published: July 2017

Purpose:

To quantify consistency of endothelial cell density (ECD) measurements among technicians in a single US eye bank operating under typical operating conditions.

Methods:

In this retrospective analysis of 51 microscopy technicians using a semiautomated counting method on 35,067 eyes from July 2007 to May 2015, technician- and date-related marginal ECD effects were calculated using linear regression models. ECD variance was correlated with the number of specular microscopy technicians.

Results:

Technician mean ECDs ranged from 2386 ± 431 to 3005 ± 560 cells/mm2. Nine technicians had statistically and clinically significant marginal effects. Annual mean ECDs adjusted for changes in technicians ranged from 2422 ± 433 to 2644 ± 430 cells/mm2. The period of 2007 to 2009 had statistically and clinically significant marginal effects. There was a nonstatistically significant association between the number of technicians and ECD standard deviation.

Conclusions:

There was significant ECD variability associated with specular microscopy technicians and with the date of measurement. We recommend that eye banks collect data related to laboratory factors that have been shown to influence ECD variability.
Development of a Falls Registry: A Pilot Study
Authors: Berg Gina M. , Carlson Tara , Fairchild Joanne , Edwards Courtney , Sorell Ryan
Published: July 2017

Each year approximately 1 in 4 healthy older adults aged 65+ years and 1 in 2 aged 80+ years living in the community will fall. Fall-related injuries are the leading cause of death and disability and cost the United States approximately $31 billion annually. Currently, no repository of scene data exists that informs prevention programs regarding circumstances that contribute to older adult falls. This was a multicenter (4 sites: Kansas, Maryland, Oregon, and Texas) pilot study consisting of interviews of older (55+ years) patients who had been admitted to a trauma center with fall-related injuries. Questions included information regarding environment, behaviors, injuries, and demographics. Additional information was abstracted from patient medical record: comorbidities, medications, and discharge information. Data are presented descriptively. Forty-nine patients were interviewed: average age was 78 years; White (93.9%); female (53.1%); and most (63.3%) had fallen before. The most commonly reported fall factors and injuries included those occurring at home without agency services (65.0%), on hard flooring (51.1%), with laced shoes (44.2%), and with walkers (36.7%) and contained contusion/open wound of head (61.2%). Survey time was anecdotally estimated at 10–15 min. Preliminary data suggest that prevention efforts should emphasize on educating older adults to focus on ambulation, body position, and use of assistive devices in their daily activities. The development of a systematic and organized registry that documents scene data would inform public health agencies to develop fall prevention programs that promote older adult safety. Furthermore, it would provide a large sample size to test factor associations with injury severity.
Effects of a Systematic Quality Improvement Process to Decrease Complications in Trauma Patients With Prehospital Peripheral Intravenous Access
Authors: Garrett Angie , Drake Stacy A. , Holcomb John B.
Published: July 2017

Peripheral intravenous (PIV) catheterization is commonly performed, and its complications are costly, may result in serious health issues, and may adversely affect patient satisfaction. At our large urban Level I trauma center, we identified a cluster of 7 PIV complications from prehospital insertions in a 5-month period. Several of the patients developed noninfectious as well as infectious, limb-threatening complications requiring aggressive operative intervention. A performance improvement project was chartered to identify the cause of PIV complications and review current nursing practice. The FOCUS-Plan Do Check Act methodology was used to measure and improve practice. With implementation of interventions and outcomes monitoring, no PIV complications were reported for the subsequent 39 consecutive months. Our findings have implications for more controlled studies to establish best practice at other Level I trauma centers across the country.
Delirium in the ICU: What About the Floor?
Authors: Cahill Anthony , Pearcy Christopher , Agrawal Vaidehi , Sladek Phillip , Truitt Michael S.
Published: July 2017

Delirium was first described in the 1800s as acute, fluctuating confusion. Recent studies note an incidence of 15% in adult intensive care unit patients. Here we present the first prospective study to evaluate the incidence and risk factors for delirium in patients admitted to the trauma surgeon (TS) in non-critical care areas (NCCAs). Patients 18 years or older admitted to any TS in the designated NCCA were evaluated and consented for participation over a 3-month period. Participants were screened with the Confusion Assessment Method (CAM) every 12 hr. Those positive for delirium (CAM+) were administered the CAM-Severity. In addition, 69 other previously identified risk factors were evaluated. Over 3 months, 148 patients were evaluated, 12 of whom were CAM+ (8%). Of patients 65 years or older, 21% screened positive for delirium. Age, education level, presence of Foley catheter, respiratory distress, orthopedic operation, and lack of ambulation were risk factors associated with delirium (p < .05). Among all TS patients in the NCCA, we found delirium to be present in 8%. Our nurses identified a 21% incidence of delirium in patients 65 years or older. Given this significant incidence, screening at-risk patients in the NCCA should be considered.
Challenges in the Management of Geriatric Trauma: A Case Report
Authors: Gaebel Ashley , Keiser Megan
Published: July 2017

This article describes geriatric trauma and commonly associated difficulties emphasizing both the epidemiology and assessment of geriatric trauma. There is little data guiding decisions for trauma patients 65 years or older, as there are many unique characteristics to the geriatric population, including comorbidities, medications, and the aging physiology. The geriatric population in the United States has been steadily climbing for the last 20 years and is projected to continue on this trend. Although each patient presents differently, there remains a need for the consistent utilization of standard guidelines to help dictate care for geriatric patients, particularly for patients not receiving care at a trauma center. This review uses a case study about an elderly woman with many comorbidities, followed by a comprehensive discussion of geriatric trauma and the challenges that result from a lack of guideline utilization to direct management.
A Literature Review on Gang Violence
Authors: Kittle Jolene
Published: July 2017

Gangs and gang violence are a concerning cause of preventable injuries and death in the trauma community. The number of gangs and gang members has been on an upward trend since 2003 with an estimated 30,000 gangs in the United States. This includes approximately 850,000 gang members. Trauma centers are in a unique position to participate in the prevention of gang violence. This review compiles current, relevant literature on gangs and gang violence covering the following topics: prevention/intervention, contributing influences, and experiential reflections. The purpose of the literature review is to deepen understanding of gangs and gang violence and potentiate further research in this area in order to help promote successful prevention efforts. Trauma nurses can use this information in developing culturally sensitive, compassionate care and trauma centers will find this useful in the development of injury prevention programs aimed at the reduction of gang and street violence.
The Prognosis of Severe Acute Pancreatitis Varies According to the Segment Presenting With Low Enhanced Pancreatic Parenchyma on Early Contrast-Enhanced Computed Tomography
Authors: Kitamura Katsuya , Horibe Masayasu , Sanui Masamitsu , Sasaki Mitsuhito , Yamamiya Akira , Ishii Yu , Yoshida Hitoshi , Sawano Hirotaka , Goto Takashi , Ikeura Tsukasa , Hamada Tsuyoshi , Oda Takuya , Yasuda Hideto , Ogura Yuki , Miyazaki Dai , Hirose Kaoru , Chiba Nobutaka , Ozaki Tetsu , Yamashita Takahiro , Koinuma Toshitaka , Oshima Taku , Yamamoto Tomonori , Hirota Morihisa , Azumi Yoshinori , Nagata Keiji , Saito Nobuyuki , Sato Mizuki , Miyamoto Kyohei , Iwasaki Eisuke , Kanai Takanori , Mayumi Toshihiko
Published: July 2017

Objective

The aim of this study was to investigate the outcomes of severe acute pancreatitis (SAP) according to the segment presenting with low enhanced pancreatic parenchyma (LEPP) on early contrast-enhanced computed tomography.

Methods

This was a post hoc analysis of a multicenter, retrospective study conducted at 44 institutions in Japan. Patients diagnosed as having SAP according to the Japanese Severity Score between January 2009 and December 2013 were included. We compared the effect of LEPP in each segment on mortality.

Results

A total of 1097 patients were assessed. The numbers of patients with LEPP in the pancreatic head (Ph), body (Pb), or tail (Pt) were 272, 273, and 204 (with some overlaps), respectively. In multivariate analysis, LEPP in Ph and Pt was significantly related to mortality (odds ratio [OR], 1.94; 95% confidence interval [CI], 1.11–3.40 [P < 0.05], for LEPP in Ph; OR, 2.44; 95% CI, 1.27–4.67 [P < 0.05], for LEPP in Pt), but LEPP in Pb was unrelated to mortality (OR, 0.70; 95% CI, 0.35–1.37; P = 0.30).

Conclusions

Presence of LEPP in Ph and Pt on early contrast-enhanced computed tomography was independently associated with increased mortality in SAP. These patients require close observation to ensure timely and adequate intervention.
Celecoxib Oral Administration for Prevention of Post–Endoscopic Retrograde Cholangiopancreatography Pancreatitis
Authors: Kato Kunihiro , Shiba Masatsugu , Kakiya Yuki , Maruyama Hirotsugu , Ominami Masaki , Fukunaga Shusei , Sugimori Satoshi , Nagami Yasuaki , Watanabe Toshio , Tominaga Kazunari , Fujiwara Yasuhiro
Published: July 2017

Objectives

Rectal nonsteroidal anti-inflammatory drugs have reported promising prophylactic activity in post–endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Conversely, cyclooxygenase-2 enzyme has been suggested to contribute to experimental acute pancreatitis. The aim of this study was to evaluate the efficacy of oral administration of celecoxib, a cyclooxygenase-2 inhibitor, for the prevention of PEP.

Methods

We performed a prospective randomized controlled study. Patients who were scheduled to undergo ERCP were randomized to receive either oral 400-mg celecoxib tablets 1 hour before ERCP and saline infusion (celecoxib group) or saline infusion only (control group). The primary outcome measure was the frequency of PEP.

Results

A total of 170 patients were randomized; 85 patients each in the celecoxib group and control group were analyzed. After the procedure, 23 patients (13.5%) developed PEP. There was no difference in the frequency of PEP between the 2 groups (control group vs celecoxib group, 15.3% (13/85) vs 11.7% (10/85); P = 0.65). The severity of PEP, asymptomatic hyperamylasemia, and post-ERCP pain were not significantly different between the 2 groups. There were no adverse events related to celecoxib treatment.

Conclusions

Oral administration of celecoxib had no beneficial preventive effect on PEP.
Surveillance and Outcomes of Nonresected Presumed Branch-Duct Intraductal Papillary Mucinous Neoplasms
Authors: Ooka Kohtaro , Rustagi Tarun , Evans Anna , Farrell James J.
Published: July 2017

Objectives

Guidelines regarding the surveillance of intraductal papillary mucinous neoplasms (IPMNs) are controversial because of uncertain risk of malignancy, agnosticism regarding the use of endoscopic ultrasound, and their recommendation to stop surveillance after 5 years. We present a systematic review and meta-analysis of the risk of malignancy and other end points and estimate the value of endoscopic ultrasound for surveillance.

Methods

We systematically searched MEDLINE for studies with a cohort of patients with presumed branch-duct IPMN who initially were managed nonsurgically. Data regarding study characteristics, surveillance, and outcomes were extracted. Incidence rates of morphologic progression, malignancy, surgery, and death were calculated with a random effects model.

Results

Twenty-four studies with 3440 patients and 13,097 patient-years of follow-up were included. Rates of morphologic progression, surgery, malignancy, and death were 0.0379, 0.0250, 0.0098, and 0.0043 per patient-year, respectively. Endoscopic ultrasound was not associated with significantly different rates of these outcomes.

Conclusions

The risk of malignancy calculated in this study was low and in line with recent systematic reviews. Endoscopic ultrasound does not have marginal use in surveillance. Given the limitations of a systematic review of nonrandomized studies, further studies are needed to determine the optimal surveillance of branch-duct IPMNs.
Effect of Serum Triglycerides on Clinical Outcomes in Acute Pancreatitis
Authors: Sue Laura Y. , Batech Michael , Yadav Dhiraj , Pandol Stephen J. , Blumentals William A. , von Krusenstiern Lenore Soodak , Chen Wansu , Wu Bechien U.
Published: July 2017

Objectives

The aim of this study was to evaluate the effect of serum triglycerides on the development of multiple or persistent organ failure in patients with acute pancreatitis.

Methods

A retrospective cohort study was conducted among patients hospitalized for acute pancreatitis between 2006 and 2013. Triglyceride levels measured before and within 72 hours of admission were compared. In addition, the effect of triglyceride levels on the development of multiple or persistent organ failure during hospitalization for acute pancreatitis was assessed.

Results

Among 2519 patients, 267 patients (10.6%) developed organ failure, of which 75 patients developed multiple system organ failure and 82 patients developed persistent organ failure. Triglyceride levels in patients who developed organ failure were initially much higher than in patients who did not develop organ failure, but by 72 hours into admission, approached levels of patients who did not develop organ failure. Approximately 8% of patients had triglyceride levels greater than 500 mg/dL, the majority of which had similarly high levels before admission.

Conclusions

Increased triglyceride levels were associated with the development of multiple or persistent organ failure among patients hospitalized with acute pancreatitis. Patients with high triglyceride levels at the time of admission were likely to have high triglyceride levels before admission.
Regional Metastatic Behavior of Nonfunctional Pancreatic Neuroendocrine Tumors
Authors: Jutric Zeljka , Grendar Jan , Hoen Helena M. , Cho Sung W. , Cassera Maria A. , Newell Pippa H. , Hammill Chet W. , Hansen Paul D. , Wolf Ronald F.
Published: July 2017

Objectives

Literature addressing the significance of lymph node positivity in the management of nonfunctional pancreatic neuroendocrine tumors (PNETs) is conflicting.

Methods

The National Cancer Data Base was queried for patients who underwent surgical resection of nonfunctional PNETs between 1998 and 2011. Clinical data and overall survival were analyzed using χ2 and Cox proportional hazards regression. Multiple imputation was used as a comparative analysis because of the high number of patients missing data on tumor grade.

Results

Two thousand seven hundred thirty-five patients were identified. The overall incidence of lymph node metastasis was 51%. In the subset of patients with grade 1 tumors less than 1 cm, 24% had positive lymph nodes. Overall median survival for patients with negative lymph nodes was 11 years compared with 8 years for lymph node–positive patients (P < 0.001). On multivariate survival analysis, tumor grade, distant metastases, regional lymph node involvement, positive surgical margins, male sex, and older age were predictive of decreased overall survival.

Conclusions

Lymph node positivity was associated with decreased overall survival. The incidence of lymph node involvement in resected low-grade tumors less than 1 cm is higher than previously reported. Patients selected for resection of PNETs should be offered lymphadenectomy for staging.
Effect of Intravenous Fluids and Analgesia on Dysmotility in Patients With Acute Pancreatitis
Authors: Wu Landy M. , Pendharkar Sayali A. , Asrani Varsha M. , Windsor John A. , Petrov Maxim S.
Published: July 2017

Objectives

Analgesia and intravenous fluid resuscitation are cornerstones of initial patient management in acute pancreatitis (AP). The aim was to investigate the effect of intravenous fluids and analgesia on gastrointestinal motility in the early course of AP.

Methods

Gastrointestinal dysmotility was assessed using the Gastroparesis Cardinal Symptom Index (GCSI). One-way analysis of variance and analysis of covariance were conducted, adjusting for age, sex, body mass index, severity of AP, preexisting diabetes mellitus, and time from first symptom onset to hospital admission.

Results

A total of 108 patients with AP were prospectively enrolled. Opioid analgesia, when compared with nonopioid analgesia, was significantly associated with increase in total GCSI score in both unadjusted and adjusted analyses. There was no significant difference between aggressive and nonaggressive fluid resuscitation in both unadjusted and adjusted analyses. A combination of opioids and any intravenous fluids was associated with a significantly increased total GCSI score compared with opioids and no intravenous fluids in both unadjusted and adjusted analyses. Duration of symptoms was the confounder that significantly affected 6 of 9 studied associations.

Conclusions

Intravenous fluids and analgesia significantly affect motility independent of severity and other covariates. Guidelines on prudent use of opioids and fluids in AP need to be developed, particularly taking into account duration of symptoms from onset to hospitalization.
Treatment Patterns and Burden of Illness in Patients Initiating Targeted Therapy or Chemotherapy for Pancreatic Neuroendocrine Tumors
Authors: Broder Michael S. , Chang Eunice , Reddy Sheila R. , Neary Maureen P.
Published: July 2017

Objective

The aim of this study was to characterize treatment patterns and burden of pancreatic neuroendocrine tumors (PNET).

Methods

Using 2 claims databases, we identified patients with PNET initiating targeted therapy (everolimus, sunitinib) or chemotherapy from 2009 to 2012. The first targeted/cytotoxic therapy was considered index treatment. Treatment patterns were graphically evaluated from index treatment initiation until enrollment or study end, whichever occurred first. Disease burden was examined by index group for first follow-up year.

Results

In treatment pattern analyses (582 newly treated patients with PNET), 72.2% received chemotherapy index treatment, 16.2% everolimus, and 11.7% received sunitinib. Median index treatment duration was 242, 146, and 126 days for everolimus, sunitinib, and cytotoxics (P < 0.01). Sunitinib initiators switched most often followed by everolimus and cytotoxic initiators. In disease burden analyses, 338 patients met inclusion criteria, with mean age of 54.5 (standard deviation, 9.9) years, 45.6% were female, and there were no significant between-group differences. Targeted therapy initiators had more prior somatostatin analog use versus cytotoxics (53.4% vs 25.1%, P < 0.001); 72.5% had comorbidities after treatment initiation; 42.9% had 1 or more inpatient hospitalization; and 47.9% had 1 or more emergency department visit.

Conclusions

Pancreatic neuroendocrine tumor treatment patterns varied; cytotoxics were more often used as early therapy than targeted agents, but for less time. Patients had high health care utilization, irrespective of treatment, potentially from burdensome symptoms and comorbidities.
Validation of the 2012 Fukuoka Consensus Guideline for Intraductal Papillary Mucinous Neoplasm of the Pancreas From a Single Institution Experience
Authors: Yu Songfeng , Takasu Naoki , Watanabe Toshihiro , Fukumoto Tsuyoshi , Okazaki Shinji , Tezuka Koji , Sugawara Shuichiro , Hirai Ichiro , Kimura Wataru
Published: July 2017

Objectives

The 2012 Fukuoka consensus guideline has stratified the risks of malignant intraductal papillary mucinous neoplasm (IPMN) of the pancreas into “high-risk stigmata” (HRS) and “worrisome feature” (WF). This study aimed to evaluate its clinical validity based on a single institution experience.

Methods

Eighty-nine patients who underwent surgical resection with pathological diagnosis of IPMN were retrospectively studied.

Results

High-risk stigmata was significantly correlated with the prevalence of malignant IPMN as compared with WF. The positive predictive values of HRS and WF were 66.7% and 35.7% for branch duct IPMN and 80% and 38.1% for main duct IPMN, respectively. Univariate analysis indicated that all the factors in HRS and WF had statistical significance. Whereas multivariate analysis revealed only enhanced solid component (odds ratio [OR], 50.01; P = 0.008), presence of mural nodule (OR, 73.83; P < 0.001) and lymphadenopathy (OR, 20.85; P = 0.03) were independent predictors. Scoring HRS and WF by different numbers of positive factors resulted in improved predictive value. The area under the curve of HRS score was significantly lower than that of WF or HRS + WF score (0.680 vs 0.900 or 0.902, respectively; P < 0.001).

Conclusions

As supplementary to the 2012 Fukuoka guideline, we suggest that calculating scores of WF and HRS may have superior diagnostic accuracy in predicting malignant IPMN.
Clinical Profile of Pancreatic Cystic Lesions in von Hippel-Lindau Disease
Authors: Sharma Ayush , Mukewar Saurabh , Vege Santhi Swaroop
Published: July 2017

Objectives

Little is known about the association between pancreatic cystic lesions (PCLs) with von Hippel-Lindau disease (VHLD). In this study, we describe the clinical presentation, type of PCLs, and risk for malignancy in PCLs in VHLD.

Methods

Patients given a diagnosis of both VHLD and PCLs were identified from electronic medical records at Mayo Clinic, Rochester, MN, from January 1, 2000, to January 1, 2016. Various demographic, clinical, and radiologic variables were recorded.

Results

Forty-eight patients were identified with PCLs and VHLD. Most were female (73%), and mean (standard deviation) age was 35.9 (14.2) years. Most (92%) were asymptomatic. PCLs included simple cysts (n = 34, 69%), serous cystadenoma (n = 14, 29%), branch duct intraductal papillary neoplasm (n = 5, 10%), and cystic neuroendocrine tumors (n = 2, 4%). Eight (19%) had mixed PCLs. Cyst aspiration was performed in 8 (53%) patients who underwent EUS, and all were negative for malignancy. At a median follow-up of 84 months, no PCL-associated cancers were seen.

Conclusions

Simple cyst is the most common type of PCL found in VHL disease; however, other PCLs were also seen with no malignancy potential. Branch duct intraductal papillary mucinous neoplasms were present in 10%, and this association was not hitherto reported.
Patterns of Care for Locally Advanced Pancreatic Adenocarcinoma Using the National Cancer Database
Authors: Amini Arya , Jones Bernard L. , Stumpf Priscilla , Leong Stephen , Lieu Christopher H. , Weekes Colin , Davis S. Lindsey , Messersmith Wells A. , Purcell William T. , Ghosh Debashis , Schefter Tracey , Goodman Karyn A.
Published: July 2017

Objectives

The role of radiotherapy (RT) in locally advanced pancreatic cancer (LAPC) is uncertain. This study examines patterns of care and survival outcomes of LAPC undergoing chemotherapy alone versus chemotherapy plus RT (C + RT).

Methods

The National Cancer Database was queried for nonmetastatic LAPC patients who received chemotherapy alone or C + RT.

Results

Of the 13,695 patients included, 5306 underwent chemotherapy alone and 4971, C + RT. Use of C + RT declined from 2003 to 2011 (73%–53%), whereas chemotherapy alone increased. Of those receiving RT, rates of intensity-modulated radiotherapy (IMRT) increased (27%–72%), whereas 3-dimensional (3D) RT decreased (73%–28%). Unadjusted 1-year overall survival (OS) was longer for versus chemotherapy (45.6% vs 38.7%), as was 2-year OS (12.9% vs 11.9%) (hazard ratio, 0.88; 0.85–0.91; P < 0.001). Under multivariate analysis, C + RT was associated with improved OS (hazard ratio, 0.84; 0.81–0.87; P < 0.001). On subgroup analysis comparing C + IMRT, C + 3D RT, and chemotherapy alone, 1-year OS was 49.1%, 45.1%, and 38.7%, and 2-year OS was 13.1%, 11.6%, and 11.9% accordingly.

Conclusions

Utilization of RT in LAPC is decreasing, whereas chemotherapy alone is increasing. Of patients undergoing RT, rates of IMRT are increasing. Whereas C + IMRT appeared to be associated with improved OS compared with chemotherapy alone, 3D RT was not.
Association of Waist-Hip Ratio to Sudden Cardiac Death and Severe Coronary Atherosclerosis in Medicolegal Autopsies
Authors: Kocovski Linda , Lee Joshua Dogyeong , Parpia Sameer , Fernandes John , Nair Vidhya
Published: July 2017

Various modifiable and nonmodifiable risk factors, such as abdominal obesity, are known to affect the development of atherosclerotic cardiovascular disease and subsequent sudden cardiac death (SCD). The waist-hip ratio is a surrogate marker of visceral obesity that has been shown in various studies to be a better predictor of cardiovascular risk than the body mass index (BMI), a measurement of generalized obesity. Waist-hip ratio was measured prospectively on medicolegal autopsies performed for 1 year, in addition to standard measurements of BMI and heart weight, and histologic determination of severe coronary atherosclerosis (SCA, coronary artery diameter stenosis >75%). Logistic modeling was performed to determine any association between WHR, BMI, cardiovascular disease risk factors, heart weight, and SCD or SCA. Waist-hip ratio was not shown to be statistically significantly associated with either SCD (P = 0.68) or SCA (P = 0.14). Body mass index was shown to be significantly associated with SCA (P < 0.001), and heart weight was shown to be significantly associated with both SCD and SCA (P < 0.001, both). Waist-hip ratio, as a surrogate marker of central obesity and increased risk of atherosclerotic cardiovascular disease, is shown not to be statistically significantly associated with either SCD or SCA in postmortem cases.
Recurrent BRAF Gene Rearrangements in Myxoinflammatory Fibroblastic Sarcomas, but Not Hemosiderotic Fibrolipomatous Tumors
Authors: Kao Yu-Chien , Ranucci Valentina , Zhang Lei , Sung Yun-Shao , Athanasian Edward A. , Swanson David , Dickson Brendan C. , Antonescu Cristina R.
Published: July 2017

Myxoinflammatory fibroblastic sarcoma (MIFS) is a low grade soft tissue sarcoma with a predilection for acral sites, being associated with a high rate of local recurrence but very infrequent distant metastases. Although a t(1;10) translocation resulting in TGFBR3-MGEA5 fusion has been reported as a recurrent genetic event in MIFS, this abnormality is seen only in a subset of cases. As no studies to date have investigated the spectrum of alternative genetic alterations in TGFBR3-MGEA5 fusion negative MIFS, we undertook a genetic analysis of this particular cohort for further molecular classification. Triggered by an index case occurring in the finger of a 37-year-old female and harboring a novel TOM1L2-BRAF fusion by targeted RNA sequencing we investigated potential recurrent BRAF abnormalities by screening a large group of 19 TGFBR3-MGEA5 fusion negative MIFS by fluorescence in situ hybridization. There were 6 (32%) additional MIFS with BRAF genetic abnormalities, including 5 gene rearrangements and one showing BRAF amplification. Interestingly, VGLL3 amplification, a recurrent genetic abnormality coexisting with t(1;10) in some MIFS, was also detected by fluorescence in situ hybridization in 4/6 (67%) BRAF-rearranged MIFS, but not in the BRAF-amplified case. Up-regulated VGLL3 mRNA expression was also demonstrated in the index case by RNA sequencing. The 7 BRAF-rearranged/amplified MIFS arose in the fingers (n=3), and 1 each in wrist, forearm, foot, and knee, of adult patients (36 to 74 y; M:F=4:3). The histologic spectrum ranged from predominantly solid growth of plump histiocytoid to epithelioid tumor cells with focal myxoid change to a predominantly myxoid background with scattered tumor cells. Varying degree of inflammatory infiltrates and large tumor cells with virocyte-like macronucleoli were observed in most cases. Immunohistochemical stains of phosphorylated ERK, a downstream effector of BRAF activation, were positive in all 4 cases tested (2 diffuse strong, 2 focal strong). Unlike t(1;10), BRAF rearrangements were only found in MIFS but not in 6 hemosiderotic fibrolipomatous tumor (HFLT) lacking TGFBR3-MGEA5 fusions (including 2 pure HFLT, 2 hybrid HFLT-MIFS, and 2 associated with pleomorphic hyalinizing angiectatic tumors).
Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition
Authors: Mehta Nilesh M. , Skillman Heather E. , Irving Sharon Y. , Coss-Bu Jorge A. , Vermilyea Sarah , Farrington Elizabeth Anne , McKeever Liam , Hall Amber M. , Goday Praveen S. , Braunschweig Carol
Published: July 2017

This document represents the first collaboration between two organizations, American Society of Parenteral and Enteral Nutrition and the Society of Critical Care Medicine, to describe best practices in nutrition therapy in critically ill children. The target of these guidelines is intended to be the pediatric (> 1 mo and < 18 yr) critically ill patient expected to require a length of stay greater than 2 or 3 days in a PICU admitting medical, surgical, and cardiac patients. In total, 2,032 citations were scanned for relevance. The PubMed/Medline search resulted in 960 citations for clinical trials and 925 citations for cohort studies. The EMBASE search for clinical trials culled 1,661 citations. In total, the search for clinical trials yielded 1,107 citations, whereas the cohort search yielded 925. After careful review, 16 randomized controlled trials and 37 cohort studies appeared to answer one of the eight preidentified question groups for this guideline. We used the Grading of Recommendations, Assessment, Development and Evaluation criteria to adjust the evidence grade based on assessment of the quality of study design and execution. These guidelines are not intended for neonates or adult patients. The guidelines reiterate the importance of nutritional assessment, particularly the detection of malnourished patients who are most vulnerable and therefore potentially may benefit from timely intervention. There is a need for renewed focus on accurate estimation of energy needs and attention to optimizing protein intake. Indirect calorimetry, where feasible, and cautious use of estimating equations and increased surveillance for unintended caloric underfeeding and overfeeding are recommended. Optimal protein intake and its correlation with clinical outcomes are areas of great interest. The optimal route and timing of nutrient delivery is an area of intense debate and investigations. Enteral nutrition remains the preferred route for nutrient delivery. Several strategies to optimize enteral nutrition during critical illness have emerged. The role of supplemental parenteral nutrition has been highlighted, and a delayed approach appears to be beneficial. Immunonutrition cannot be currently recommended. Overall, the pediatric critical care population is heterogeneous, and a nuanced approach to individualizing nutrition support with the aim of improving clinical outcomes is necessary.
Occupational Safety and Health and Healthy Housing: A Review of Opportunities and Challenges
Authors: Jacobs David E. , Forst Linda
Published: July 2017

Purpose:

Occupational safety and health (OSH) risks in construction of healthy housing (HH) have not been examined and collaboration between HH and OSH professionals is inadequate. The World Health Organization is developing international HH guidelines and the International Labour Organization is working to improve OSH in construction globally.

Methods:

We searched for exemplary reports (including gray literature) on construction hazards; preventive measures for occupants and workers; OSH frameworks, laws, and regulations; definitions; and HH.

Results:

Healthy housing construction typically improves ventilation, moisture and mold, pest control, injury hazards, cleanability, maintenance, accessibility, thermal conditioning, and avoidance of toxic building materials. To date, this work is done without explicit requirements for worker health. Construction is among the most hazardous sectors around the globe, although protective measures are well known, including engineering and administrative controls and provision of personal protective equipment. Residential construction, renovation, repair, and maintenance are fragmented, consisting mostly of small companies without proper OSH training, equipment, and knowledge of HH principles. Residential construction is often undertaken by informal or unauthorized workers, putting them at high risk. Reduced exposure to toxic building materials is an example of a benefit for both workers and occupants if OSH and HH collaboration can be improved. By recognizing that homes under new construction or renovation are both a workplace and a residence, HH and OSH initiatives can apply public health principles to occupants and workers simultaneously. This article publishes key definitions, hazards and interventions common to both fields.

Conclusions:

A global increase in residential construction and renewed global interest in HH poses both risks and opportunities for primary prevention. Policy and practice interventions can benefit the health of occupants and those who work on their homes. Improvements in legislation, regulation, and international frameworks are needed to maximize OSH and HH collaboration and realize significant cobenefits. Occupational safety and health and HH standards should include requirements to protect both workers and occupants. Because homes can also be workplaces, both workers and housing occupants will receive important cobenefits when OSH and HH standards use proven interventions to protect workers and occupants.
Effect of the spider toxin Tx3-3 on spinal processing of sensory information in naive and neuropathic rats: an in vivo electrophysiological study
Authors: Dalmolin Gerusa D. , Bannister Kirsty , Gonçalves Leonor , Sikandar Shafaq , Patel Ryan , Cordeiro Marta do Nascimento , Gomez Marcus Vinícius , Ferreira Juliano , Dickenson Anthony H.
Published: July 2017

Introduction:

Drugs that counteract nociceptive transmission in the spinal dorsal horn preferentially after nerve injury are being pursued as possible neuropathic pain treatments. In a previous behavioural study, the peptide toxin Tx3-3, which blocks P/Q- and R-type voltage-gated calcium channels, was effective in neuropathic pain models.

Objectives:

In the present study, we aimed to investigate the effect of Tx3-3 on dorsal horn neuronal responses in rats under physiological conditions and neuropathic pain condition induced by spinal nerve ligation (SNL).

Methods:

In vivo electrophysiological recordings of dorsal horn neuronal response to electrical and natural (mechanical and thermal) stimuli were made in rats under normal physiological state (naive rats) or after the SNL model of neuropathic pain.

Results:

Tx3-3 (0.3–100 pmol/site) exhibited greater inhibitory effect on electrical-evoked neuronal response of SNL rats than naive rats, inhibiting nociceptive C-fibre and Aδ-fibre responses only in SNL rats. The wind-up of neurones, a measurement of spinal cord hyperexcitability, was also more susceptible to a dose-related inhibition by Tx3-3 after nerve injury. Moreover, Tx3-3 exhibited higher potency to inhibit mechanical- and thermal-evoked neuronal response in conditions of neuropathy.

Conclusion:

Tx3-3 mediated differential inhibitory effect under physiological and neuropathic conditions, exhibiting greater potency in conditions of neuropathic pain.
R0 Versus R1 Resection Matters after Pancreaticoduodenectomy, and Less after Distal or Total Pancreatectomy for Pancreatic Cancer
Authors: Demir Ihsan Ekin , Jäger Carsten , Schlitter A. Melissa , Konukiewitz Björn , Stecher Lynne , Schorn Stephan , Tieftrunk Elke , Scheufele Florian , Calavrezos Lenika , Schirren Rebekka , Esposito Irene , Weichert Wilko , Friess Helmut , Ceyhan Güralp O.
Published: July 2017

Objective:

The aim of this study was to decipher the true importance of R0 versus R1 resection for survival in pancreatic ductal adenocarcinoma (PDAC).

Summary of Background Data:

PDAC is characterized by poor survival, even after curative resection. In many studies, R0 versus R1 does not result in different prognosis and does not affect the postoperative management.

Methods:

Pubmed, Embase, and Cochrane databases were screened for prognostic studies on the association between resection status and survival. Hazard ratios (HRs) were pooled in a meta-analysis. Furthermore, our prospective database was retrospectively screened for curative PDAC resections according to inclusion criteria (n = 254 patients) between July 2007 and October 2014.

Results:

In the meta-analysis, R1 was associated with a decreased overall survival [HR 1.45 (95% confidence interval, 95% CI 1.37–1.52)] and disease-free survival [HR 1.44 (1.30–1.59)] in PDAC when compared with R0. Importantly, this effect held true only for pancreatic head resection both in the meta-analysis [R0 ≥0 mm: HR 1.21 (1.05–1.39) vs R0 ≥1 mm: HR 1.66 (1.46–1.89)] and in our cohort (R0 ≥0 mm: 31.8 vs 14.5 months, P < 0.001; R0 ≥1 mm, 41.2 vs 16.8 months; P < 0.001). Moreover, R1 resections were associated with advanced tumor disease, that is, larger tumor size, lymph node metastases, and extended resections. Multivariable Cox proportional hazard model suggested G3, pN1, tumor size, and R1 (0 mm/1 mm) as independent predictors of overall survival.

Conclusion:

Resection margin is not a valid prognostic marker in publications before 2010 due to heterogeneity of cohorts and lack of standardized histopathological examination. Within standardized pathology protocols, R-status’ prognostic validity may be primarily confined to pancreatic head cancers.
Ten-year Outcomes of a Prospective Randomized Trial of Laparoscopic Gastric Bypass Versus Laparoscopic Gastric Banding
Authors: Nguyen Ninh T. , Kim Eric , Vu Stephen , Phelan Michael
Published: July 2017

Objective:

The primary endpoints of this study were long-term weight loss, morbidity, and changes in comorbidities and quality of life.

Background:

Bariatric surgery is an effective option for the treatment of severe obesity and its related comorbidities. However, few studies have reported on the long-term outcome (>5 yrs) of bariatric surgery.

Methods:

Between 2002 and 2007, 250 patients with a body mass index (BMI) of 35 to 60 kg/m2 were randomly assigned to undergo laparoscopic gastric bypass or laparoscopic gastric banding. After exclusions, 111 patients underwent gastric bypass and 86 patients underwent gastric banding. Factors predictive of improved weight loss were analyzed using multiple logistic regressions.

Results:

At baseline, the mean age was 43 ± 10 years and the mean BMI was 46.5 ± 5.6 kg/m2. At 10-year follow-up, the mean total body weight loss for the entire cohort was −37.5 ± 19.4 kg, −42.4 ± 19.6 kg for gastric bypass versus −27.4 ± 14.5 kg for gastric banding. Late reoperation was significantly higher after gastric banding compared with the gastric bypass group (31.4% vs. 8.1%, respectively, P < 0.01). For the entire cohort, improvement or remission of diabetes occurred in 68%; 61% for hypertension; and 57% for dyslipidemia. The long-term mortality for the entire cohort was 1.0% at a mean follow-up of 9.5 ± 0.4 years. Factors predictive of improved weight loss included the type of operation (ie, gastric bypass), female sex, and the absence of diabetes at baseline. At long-term follow-up, quality of life continues to be improved from baseline for both the groups.

Conclusions:

Bariatric surgery is an effective treatment for severe obesity with durable 10-year weight loss and improvement in comorbidities and quality of life. Compared with gastric banding, gastric bypass was associated with better long-term weight loss, lower rate of late reoperation, and improved remission of comorbidities.
Design and Methods of the Korean Organ Transplantation Registry
Authors: Yang Jaeseok , Jeong Jong Cheol , Lee Joongyub , Kim Young Hoon , Paik Hyo Chae , Kim Jae-Joong , Park Hyun-young , Kim Myoung Soo , Ahn Curie
Published: July 2017

Background

Beneficial aspects of solid organ transplantation, which encompass survival benefit, improved quality of life, and cost efficacy, have been clearly demonstrated. However, regional and ethnic differences require further studies to identify prognostic factors and transplant outcomes against various backgrounds. After previous efforts of a nationwide, retrospective study on the kidney transplant outcomes in Korea, a new prospective-designed version of the Korean Organ Transplantation Registry (KOTRY) was launched in 2014.

Methods

Cohorts of kidney, liver, heart, lung, and pancreas transplantation were developed. Data on demographics, comorbid conditions, laboratory tests, including tissue typing and panel reactive antibody tests, immunosuppressive regimen followed, concentration and dosage of immunosuppressants, allograft rejection type, infectious events, cardiovascular outcomes, malignancies, donor comorbidity, and outcomes of living donors are collected. Longitudinal data collection is based on a regular annual interval, and blood samples are collected before organ transplantation and again at 1 and 3 years posttransplantation. To enhance data quality, a predefined data verification system operates on a Web-based database, and transplant center users receive regular education about updates. Data are cleansed thrice a year, and feedback given to centers about outlier values and missing data. Annual auditing is conducted.

Results

Currently, 59 centers are participating in KOTRY. The estimated annual enrollment is more than 2000 cases.

Conclusions

KOTRY, as a systematic Korean transplant cohort, is expected to provide important information on Asian organ transplantation. The processes used to establish KOTRY provide a good model for launching new nationwide transplant cohort studies.