bluuebunny/crossref_metadata_2025 huggingface dataset:
First Reported Human Cases of Leptospirosis in the United States Virgin Islands in the Aftermath of Hurricanes Irma and Maria, September–November 2017
Authors: Marinova-Petkova Atanaska , Guendel Irene , Strysko Jonathan P , Ekpo Lisa LaPlace , Galloway Renee , Yoder Jonathan , Kahler Amy , Artus Aileen , Hoffmaster Alex R , Bower William A , Walke Henry , Ellis Brett R , Hunte-Ceasar Tai , Ellis Esther M , Schafer Ilana J
Published: June 2019

Objective

Following Hurricanes Irma and Maria, the first case of human leptospirosis ever identified in the US Virgin Islands (USVI) was reported to the Virgin Islands Department of Health. Leptospirosis is a potentially fatal bacterial disease caused by Leptospira species found in animal urine and urine-contaminated water and soil. Outbreaks can occur following extreme weather events.

Method

Additional cases of leptospirosis were identified in the 2.5 months post-hurricanes by reviewing emergency department (ED) records from territorial hospitals for patients demonstrating leptospirosis-consistent symptoms, testing symptomatic patients previously enrolled in the USVI arbovirus surveillance system (VIASS), and adding leptospirosis testing prospectively to VIASS. Available patient sera underwent local rapid diagnostic testing for anti-Leptospira IgM followed by confirmatory microscopic agglutination testing at the US Centers for Disease Control and Prevention. Water was collected from cisterns with epidemiologic links to confirmed cases and tested by real-time PCR (qPCR) for pathogenic Leptospira spp.

Results

Sixteen retrospectively identified symptomatic patients were enrolled in VIASS; 15 with available samples tested negative. Based on review of 5226 ED charts, 6 patients were further investigated; of these, 5 were tested of which 1 was positive. Prospective leptospirosis surveillance tested 57 additional patients; of these, 1 was positive. Water from 1 of 5 tested cisterns was found positive by qPCR.

Conclusions

This investigation documents the first 3 cases of leptospirosis reported in the USVI and demonstrates how VIASS successfully was adapted to establish leptospirosis surveillance. Contaminated cistern water was identified as a potential source for Leptospira spp. transmission, highlighting the need for additional post-hurricane remediation and disinfection guidance.
Career Risk and Market Discipline in Asset Management
Authors: Ellul Andrew , Pagano Marco , Scognamiglio Annalisa
Published: June 2019

We establish that the labor market helps discipline asset managers via the impact of fund liquidations on their careers. Using hand-collected data on 1,948 professionals, we find that top managers working for funds liquidated after persistently poor relative performance suffer demotion coupled with a significant loss in imputed compensation. Scarring effects are absent when liquidations are preceded by normal relative performance or involve mid-level employees. Seen through the lens of a model with moral hazard and adverse selection, these scarring effects can be ascribed to a drop in asset managers’ reputation. The findings suggest that performance-induced liquidations supplement compensation-based incentives.

Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
Cross-species convergence in pupillary response: understanding human anxiety via non-human primate amygdala lesion
Authors: Pagliaccio David , Pine Daniel S , Leibenluft Ellen , Dal Monte O , Averbeck Bruno B , Costa Vincent D
Published: June 2019

Few studies have used matched affective paradigms to compare humans and non-human primates. In monkeys with amygdala lesions and youth with anxiety disorders, we examined cross-species pupillary responses during a saccade-based, affective attentional capture task. Given evidence of enhanced amygdala function in anxiety, we hypothesized that opposite patterns would emerge in lesioned monkeys and anxious participants. A total of 53 unmedicated youths (27 anxious, 26 healthy) and 8 adult male rhesus monkeys (Macaca mulatta) completed matched behavioral paradigms. Four monkeys received bilateral excitotoxic amygdala lesions and four served as unoperated controls. Compared to healthy youth, anxious youth exhibited increased pupillary constriction in response to emotional and non-emotional distractors (F(1,48) = 6.28, P = 0.02, η2p = 0.12). Pupillary response was associated significantly with anxiety symptoms severity (F(1,48) = 5.59, P = 0.02, η2p = 0.10). As hypothesized, lesioned monkeys exhibited the opposite pattern i.e. decreased pupillary constriction in response to distractors, compared to unoperated control monkeys (F(1,32) = 24.22, P < 0.001, η2 = 0.33). Amygdala lesioned monkeys and youth with anxiety disorders show opposite patterns of pupil constriction in the context of an affective distractor task. Such findings suggest the presence of altered amygdala circuitry functioning in anxiety. Future lesion and human neuroimaging work might examine the way in which specific amygdala sub-nuclei and downstream circuits mediate these effects.
Global implications for offshore financial centres and companies in the wake of EU requirements for economic substance
Authors: Anderson Kerry
Published: June 2019

The first quarter of 2019 has seen the passage of economic substance legislation in most offshore financial jurisdictions. This article examines the implications of the adaptation of the legislation, focusing on the British Virgin Islands, the Cayman Islands, and Jersey.
From impact factors to real impact: translating evidence on lifestyle interventions into routine mental health care
Authors: Deenik Jeroen , Czosnek Louise , Teasdale Scott B , Stubbs Brendon , Firth Joseph , Schuch Felipe B , Tenback Diederik E , van Harten Peter N , Tak Erwin C P M , Lederman Oscar , Ward Philip B , Hendriksen Ingrid J M , Vancampfort Davy , Rosenbaum Simon
Published: June 2019

The scandal of premature mortality in people with serious mental illness is well established. Despite an increase in studies evaluating the efficacy of lifestyle interventions, translating this evidence into routine clinical care and policies is challenging, in part due to limited effectiveness or implementation research. We highlight the challenge of implementation that is increasingly recognized in clinical practice, advocate for adopting implementation science to study the implementation and systematic update of effective interventions in practice and policy, and provide directions for future research.
Anterolateral thigh measurements by ultrasound in neonates and young infants to ensure safe intramuscular injections during vaccination in low- and middle-income countries
Authors: Bhowmick Rohit , Bharti Bhavneet , Kumar Praveen , Saxena Akshay K , Bharti Sahul
Published: June 2019

Background

Use of same length needle for intramuscularly administered vaccines had been reported to cause under-and over-penetration among infants due to their different body weights and underlying variations in the fat and muscle thickness. Normative data regarding thigh compartment thickness are, however, lacking among neonates and infants aged ≤12 weeks particularly in low- and middle-incoming countries with high burden of low birth weight/growth restricted infants.

Methods

Present study investigated skin to muscle and skin to bone (STBD) distances of anterolateral thigh of babies (n = 300) aged ≤12 weeks (1–80 days) with different weight groups (<3 kg, 3–4 kg and >4 kg) by ultrasonography during their intramuscular vaccinations.

Results

Overall, mean [standard deviation (SD)] STBD was 17.04 (2.66) mm with range of 10.60–23.30 mm. Stratifying by current body weight, mean (SD) STBD in infants weighing less than 3 kg was 14.39 (1.23) mm. For infants weighing between 3–4 kg and >4 kg, the mean (SD) STBD were 16.69 (1.43) mm and 17.04 (2.66) mm, respectively. Estimated safety (no risk of over-penetration) of 16 mm was observed in 57.33% (172) infants whereas 25 mm needle had 100% over-penetration risk in the study cohort. Current body weight of infants was a significant predictor of safe injection [area under the receiver operating characteristic (ROC) curve 0.95; 95% CI 0.92–0.97].

Conclusions

Our study offers objective normative measurements of anterolateral thigh for safe intramuscular vaccination in young infants especially for low birth weight and growth restricted infants in low- and middle-income countries.
Investigating the Causal Mechanisms of Symptom Recovery in Chronic Whiplash-associated Disorders Using Bayesian Networks
Authors: Liew Bernard X.W. , Scutari Marco , Peolsson Anneli , Peterson Gunnel , Ludvigsson Maria L. , Falla Deborah
Published: June 2019

Objectives:

The present study’s objective was to understand the causal mechanisms underpinning the recovery of individuals with whiplash-associated disorders (WAD). We applied Bayesian Networks (BN) to answer 2 study aims: (1) to identify the causal mechanism(s) of recovery underpinning neck-specific exercise (NSE), and (2) quantify if the cyclical pathway of the fear-avoidance model (FAM) is supported by the present data.

Materials and Methods:

We analyzed a prospective cohort data set of 216 individuals with chronic WAD. Fifteen variables were used to build a BN model: treatment group (NSE with or without a behavioral approach, or general physical activity), muscle endurance, range of motion, hand strength, neck proprioception, pain catastrophizing, fear, anxiety, depression, self-efficacy, perceived work ability, disability, pain intensity, sex, and follow-up time.

Results:

The BN model showed that neck pain reduction rate was greater after NSE compared with physical activity prescription (β=0.59 points per month [P<0.001]) only in the presence of 2 mediators: global neck muscle endurance and perceived work ability. We also found the following pathway of variables that constituted the FAM: anxiety, followed by depressive symptoms, fear, catastrophizing, self-efficacy, and consequently pain.

Conclusions:

We uncovered 2 mediators that explained the mechanisms of effect behind NSE, and proposed an alternative FAM pathway. The present study is the first to apply BN modelling to understand the causal mechanisms of recovery in WAD. In doing so, it is anticipated that such analytical methods could increase the precision of treatment of individuals with chronic WAD.
Pediatric ACL Tears: Natural History
Authors: Dingel Aleksei , Aoyama Julien , Ganley Ted , Shea Kevin
Published: June 2019

Background:

Increased participation in youth sports is associated with increased rates of anterior cruciate ligament (ACL) tears in the skeletally immature. Historically, ACL reconstruction was avoided in the skeletally immature, or delayed until skeletal maturity, to avoid physeal injury and growth disturbance. Current practices and meta-analyses support early ACL reconstruction in some groups, to allow for return to activities and to avoid delayed cartilage/meniscus injury.

Purpose:

The purpose of this article was to report on the natural history of ACL injuries in the skeletally immature.

Methods:

A review of published literature on pediatric, skeletally immature ACL tears and conservative, nonoperative treatment was conducted via Pubmed articles published from 1970 to 2018. The search criteria included the key terms “anterior cruciate ligament,” “pediatric” and/or “adolescent,” and “conservative” and/or “nonoperative treatment.” A PRISMA workflow was used to narrow down the articles to those relevant to our analysis and available in full text format.

Results:

Multiple articles on the nonoperative treatment of the ACL showed secondary meniscal and cartilage damage at the time of follow-up. Some articles showed no difference between the rates of secondary injuries between the surgical and nonsurgical treatment groups; however, the nonsurgical treatment groups were often on significant activity modification. Some articles concluded that nonoperative treatment of the ACL tear may be appropriate in low risk, lower level activity patients, and those that will comply with activity restrictions. Even with bracing and PT programs, active athletes treated without surgery appear to have a concerning rate of secondary meniscus injury after the primary ACL injury event.

Conclusions:

The natural history of the ACL tear shows nonoperative treatment for the skeletally immature may be a viable treatment pathway for those who are able to comply with the physical activity restrictions. For the general population of young, active adolescents, an ACL injury treated nonoperatively often leads to secondary meniscal and/or cartilage damage, which may lead to knee degeneration and functional instability.
The Natural History of Meniscus Tears
Authors: Chambers Henry G. , Chambers Reid C.
Published: June 2019

Background:

In order to determine whether treatments are effective in the treatment of meniscus tears, it is first necessary to understand the natural history of meniscus tears. The purpose of this paper is to review the literature to ascertain the natural history of meniscus tears in children and adolescents.

Methods:

A search of the Pubmed and Embase databases was performed using the search terms “meniscus tears,” “natural history of meniscus tears,” “knee meniscus,” “discoid meniscus,” and “natural history of discoid meniscus tears.”

Results:

A total of 2567 articles on meniscus tears, 28 articles on natural history of meniscus tears, 8065 articles on “menisci,” 396 articles on “discoid meniscus,” and only 2 on the “natural history of discoid meniscus” were found. After reviewing the titles of these articles and reviewing the abstracts of 237 articles, it was clear that there was little true long-term natural history data of untreated meniscus tears nor whether treating meniscus tears altered the natural history. Twenty-five articles were chosen as there was some mention of natural history in their studies.

Conclusions:

There are few long-term data on untreated meniscal tears or discoid meniscus, or tears in children and adolescents. The literature suggests that there is a higher incidence of chondral injury and subsequent osteoarthritis, but there are many confounding variables which are not controlled for in these relatively short-term papers.
Patient Activation is Not Associated With Postoperative Outcomes Following Anterior Cervical Discectomy and Fusion
Authors: Patel Dil V. , Yoo Joon S. , Block Andrew M. , Karmarkar Sailee S. , Lamoutte Eric H. , Singh Kern
Published: June 2019

Study Design:

This was a retrospective study.

Objective:

To determine whether an association exists between preoperative patient activation, as measured by the 10-Item Patient Activation Measure (PAM-10), and postoperative outcomes following anterior cervical discectomy and fusion (ACDF).

Summary of Background Data:

Patient motivation in maintaining positive health behaviors, a concept known as patient activation, has been established as an indicator for improvement in pain, disability, and physical function after surgery. However, no studies examine the effect of preoperative patient activation scores on outcomes following ACDF.

Methods:

A prospectively maintained database was retrospectively reviewed and included patients that had a primary, 1–3 level ACDF for degenerative pathology. Patients were categorized into 3 subgroups according to their preoperative PAM-10 scores as follows: “low PAM” (bottom quartile), “moderate PAM” (second and third quartile), and “high PAM” (top quartile). Demographics and perioperative characteristics were recorded. Patient-reported outcomes including Neck Disability Index, 12-Item Short-Form Physical Component Score (SF-12 PCS), and Visual Analogue Scale (VAS) neck and arm pain were collected preoperatively and at 6-week, 3-month, 6-month, and 12-month postoperative follow-up.

Results:

A total of 64 patients were included in this analysis. Patients were stratified by their PAM scores as follows: 25 had a low PAM score, 19 had a moderate PAM score, and 20 had a high PAM score. There was no difference in inpatient VAS pain scores or narcotic consumption. In addition, there was no difference in improvement in VAS neck pain, VAS arm pain, Neck Disability Index, and SF-12 PCS among subgroups at all postoperative follow-ups.

Conclusions:

Although PAM has been associated with better postoperative recovery in lumbar spine patients and other orthopedic surgeries, our investigation suggests that preoperative PAM assessments are not an effective method to predict postoperative outcomes following an ACDF.
How Well Represented Are Women Orthopaedic Surgeons and Residents on Major Orthopaedic Editorial Boards and Publications?
Authors: Rynecki Nicole D. , Krell Ethan S. , Potter James S. , Ranpura Akash , Beebe Kathleen S.
Published: June 2019

Background

Recent studies indicate that women are substantially underrepresented as orthopaedic surgeons and residents compared with other specialties in medicine and medical school. The reasons for this are multifactorial and not completely understood, but previous studies suggest that women may be attracted to fields in which they have female role models. Given that women interested in academia and research may use female editorship and authorship as a proxy for female representation in orthopaedic surgery, we wanted to examine the proportion of women represented in orthopaedic journals and determine if it reflects the distribution of women in orthopaedic surgery as a field. We further wanted to understand if this representation has changed over time in the setting of a slowly shifting gender landscape within orthopaedic surgery.

Questions/purposes

(1) How are women orthopaedic surgeons and residents represented in orthopaedic journals compared with men? (2) Have these proportions changed in the past two decades in light of relatively new efforts to recruit women to the field of orthopaedic surgery?

Methods

The gender composition of editorial boards and first and last authors were obtained from the 1997, 2007, and 2017 volumes of the following journals: The Journal of Bone & Joint Surgery (JBJS), the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), and Clinical Orthopaedics and Related Research® (CORR®). Gender neutral names were searched to obtain a picture to ensure proper tallies.

Results

The total combined amount of women first and last authors increased from 88 of 1450 (6%) in 1997 to 152 of 1912 (8%) in 2007 to 723 of 5391 (13%) in 2017. Similarly, three of 113 (3%) editorial board members were women in 1997, three of 105 (3%) were women in 2007 and 10 of 107 (9%) editors were women in 2017. Of note, 0 out of 9 editors-in-chief were women.

Conclusions

Based on the current percentage of women orthopaedic surgeons and residents, women are represented equally or in greater numbers as editors and authors in JAAOS, JBJS, and CORR. This may be in part due to women orthopaedic surgeons entering academic medicine at a greater rate than males.

Clinical Relevance

Orthopaedic surgeons serving as mentors to prospective female applicants can cite female representation on editorial boards and as authors as an example of gender parity in the field. Additionally, active orthopaedic surgeons who are women interested in these leadership positions should be encouraged that these opportunities exist, regardless of gender.
Compliance with daily, home-based collection of urinary biospecimens in a prospective, preconception cohort
Authors: Cox Kyley J. , Stanford Joseph B. , Blackburn Brenna E. , Porucznik Christina A.
Published: June 2019

Background:

Exposures in the periconceptional environment may impact fertility and future health. Assessing time-varying exposures during the periconceptional window requires identifying approximate fertile windows around ovulation. In this prospective cohort study, we instructed women in daily cervical fluid observation and interpretation to identify incipient ovulation; they used this information to time daily urine collection for both partners. Timing and completeness of collection were compared to expert review.

Methods:

One hundred seventy couples planning pregnancy enrolled from community volunteers from 2011 to 2015; women were taught the Peak Day method to identify fertile windows. Both partners collected daily urine specimens from the first day of fertile-quality fluid (estimator of the beginning of fertile window). Men discontinued on the estimated day of ovulation/conception +2 days; women continued through the onset of next menses, or positive pregnancy test at estimated day of ovulation/conception +18 days. We compared dates from samples with participants’ fertility charts to determine proportion correctly collected. Also, expert reviewers judged on which days urine should have been collected, determining investigator-identified sampling days.

Results:

One hundred sixty-nine couples submitted 6,118 urine samples from 284 cycles. Reviewers and participants agreed in 87% of cycles for the date of the beginning of the fertile window ±3 days (65% exact-day agreement); agreement on ovulation date, ±3 days, was 93% (75% exact-day agreement). Five thousand three hundred twenty-nine female samples were expected based on investigator-identified sampling days, and 4,546 were collected, of which 82% were correctly collected on expected days. Fifty-nine percent of male samples were correctly collected relative to investigator-identified sampling days.

Conclusions:

Intensively-scheduled, biologically-triggered, at-home biospecimen collection can successfully be targeted to the periconceptional window and completed in a longitudinal cohort study.
Prosthetic Joint Infection of the Knee Due to Mycobacterium tuberculosis
Authors: Al Soub Hussam , Yacoub Nada , Al Soub Deema
Published: June 2019

Background

Tuberculous prosthetic joint infection is a rare but serious complication of joint replacement surgery. We report a case of tuberculous prosthetic knee joint infection and review similar cases reported in the literature. The aims of this study were to alert physicians to this rare complication and review the experience of others to improve diagnosis and outcome of this serious complication.

Methods

We report a case and review the literature of all published cases of tuberculous prosthetic knee joint infections in the period between 1950 and 2017.

Results

We found 36 cases reported in the literature, which brings the total number of cases including ours to 37. Majority of cases were reported after the year 2000 and predominantly affecting elderly with a median age of 71 years. Clinical manifestations are nonspecific, with pain and swelling being the most common presenting symptoms (70.5% and 67.5%, respectively). Diagnosis was established by culture or histopathology, which were diagnostic in 89% and 39% of cases, respectively. Management requires the use of antituberculous medication and in some patients in addition surgery. In 35% of patients, medical therapy alone was successful. A 12-month duration of antituberculous drugs is adequate. The outcome is favorable, with survival in 89% of patients.

Conclusions

Tuberculous infection of prosthetic knee joint is a rare but serious complication of total knee replacement surgery. Treatment with antituberculous drugs and surgery in some patients results in favorable outcome.
Risk Factors for Knee Osteoarthritis in Retired Professional Footballers: A Cross-Sectional Study
Authors: Parekh Sanjay M. , Fernandes Gwen S. , Moses Jonathan P. , Fuller Colin W. , Scammell Brigitte E. , Batt Mark E. , Zhang Weiya , Doherty Michael
Published: June 2019

Objective:

To determine risk factors for 3 knee osteoarthritis (KOA) outcomes, knee pain (KP), radiographic KOA (RKOA), and total knee replacement (TKR) in professional footballers.

Design:

This was a cross-sectional study involving a postal questionnaire, followed by radiographic assessment in a subcohort of responders.

Settings and Participants:

Four thousand seven hundred seventy-five questionnaires were sent to retired professional footballers, who had played in the English football league, and 1207 responded. Of these, 470 underwent knee radiographs.

Assessment of Risk Factors:

Potential factors include age, body mass index (BMI), knee alignment, a history of football-related knee injury, and training hours (during career) were collected through the questionnaire.

Main Outcome Measures:

Knee osteoarthritis outcomes were current KP (pain for most days of the previous month), TKR (self-reported), and RKOA (observed through radiographs).

Results:

Football-related injury was the strongest risk factor for KP [adjusted odds ratio (aOR), 4.22; 95% confidence interval (CI), 3.26-5.48], RKOA [aOR, 2.88; 95% CI, 1.81-4.59], and TKR [aOR, 4.83; 95% CI, 2.87-8.13]. Footballers had a 7% increased risk of RKOA for every 1000 hours trained. Although age and gout were associated with all 3 KOA outcomes, BMI, nodal osteoarthritis (OA), a family history of OA, knee malalignment, and 2D:4D ratio were associated with one or another of these 3 KOA outcomes.

Conclusion:

This study is the first to examine KOA risk factors in retired professional footballers. The study has identified several risk factors, both specific (eg, knee injury and training dose) and nonspecific (eg, age and gout) to footballers. This may be used to develop prevention strategies to reduce the risk of KOA in professional footballers after retirement.
Acute lymphoblastic leukemia with pancreas involvement in an adult patient mimicking pancreatic tumor
Authors: Wang Yinghao , Zhang Xuzhao , Dong Linping , Tang Kezhong , Fang Heqing , Tang Zhe , Zhang Bo
Published: June 2019

Rationale:

Acute lymphoblastic leukemia (ALL) is a malignant disease originating from abnormal proliferation of B or T lymphocytes in bone marrow (BM). Invasion of the pancreas is extremely rare in adults.

Patient concerns:

In this article, we report a case presenting that ALL invades the pancreas, as well as liver, kidney, and duodenum detected by magnetic resonance image. The patient was misdiagnosed as pancreatic tumor at initial since hemogram was unremarkable.

Diagnoses:

The diagnosis of ALL was established based on the endoscopic ultrasonography-guided fine-needle aspiration and bone marrow examination, showing BCR/ABL gene positive.

Interventions:

The patient was actively treated with chemotherapy. Hematological remission was obtained and the lesions in the pancreas disappeared.

Outcomes:

The patient finally died of complication from fungal pneumonia and central nervous system involvement 12 months after diagnosis.

Lessons:

Under the context of infection, persistent or intermittent fever and complete blood count are not significant prognoses of pancreatic involvement for adult with ALL. We hope that this case will help hepatobiliary and pancreatic surgeon to be aware of this kind of disease as pancreatic carcinoma and pancreas involvement by ALL have totally different treatment strategy.
Preoperative assessment of complicated appendicitis through stress reaction and clinical manifestations
Authors: Kang Chun-Bo , Li Wen-Qiang , Zheng Jian-Wei , Li Xiao-Wei , Lin Da-Peng , Chen Xiu-Feng , Wang De-Zhong , Yao Nan , Liu Xue-Kai , Qu Jun
Published: June 2019

This study assessed the severity of the disease through the preoperative clinical manifestations and inflammatory reaction indicators of acute appendicitis, and established a score table to predict complicated appendicitis (CA).

The clinical data of 238 patients with acute appendicitis in our hospital were retrospectively analyzed, which included 18 patients with acute simple appendicitis (7.6%), 170 patients with acute purulent appendicitis (72.0%), and 48 patients with acute gangrene and perforation (20.3%). The clinical manifestations and inflammatory reaction indicators were analyzed by univariate logistic regression. Multivariate logistic regression analysis was performed to screen out the independent risk factors of CA. Theβcoefficients of independent risk factors entering the multivariate model were assigned by rounding, and the total score was the sum of values of all factors. Finally, verification and analysis were performed for the predictive model, and the operating characteristic curve (ROC) curve was drawn. Then, the area under the curve (AUC) was compared with the THRIVE scale, and the Hosmer–Lemeshow method was used to evaluate whether the model fitted well.

The multivariate logistic regression analysis of independent risk factors was performed, and the values were rounded to the variable assignment based on theβcoefficient values. The plotted ROC and AUC was calculated as 0.857 (P < .001). Using the Hosmer–Lemeshow method, theX2-value was 12.430, suggesting that the prediction model fitted well.

The scoring system can quickly determine whether this is a CA, allowing for an earlier and correct diagnosis and treatment. Furthermore, the scoring system was convenient, economical, and affordable. Moreover, it is easy to popularized and promote.
Impact of human immunodeficiency virus infection on mortality of patients who acquired healthcare associated-infection in critical care unit
Authors: Castro-Lima Victor Augusto Camarinha de , Borges Igor C. , Joelsons Daniel , Sales Vivian V.T. , Guimaraes Thais , Ho Yeh Li , Costa Silvia F. , Moura Maria Luisa N.
Published: June 2019

To evaluate 30-day mortality in human immunodeficiency virus (HIV) and non-HIV patients who acquired a healthcare-associated infection (HAI) while in an intensive care unit (ICU), and to describe the epidemiological and microbiological features of HAI in a population with HIV.

This was a retrospective cohort study that evaluated patients who acquired HAI during their stay in an Infectious Diseases ICU from July 2013 to December 2017 at a teaching hospital in Brazil.

Data were obtained from hospital infection control committee reports and medical records. Statistical analysis was performed using SPSS and a multivariate model was used to evaluate risk factors associated with 30-day mortality. Epidemiological, clinical, and microbiological characteristics of HAI in HIV and non-HIV patients and 30-day mortality were also evaluated.

Among 1045 patients, 77 (25 HIV, 52 non-HIV) patients acquired 106 HAI (31 HIV, 75 non-HIV patients). HIV patients were younger (45 vs 58 years, P = .002) and had more respiratory distress than non-HIV patients (60.0% vs 34.6%, P = .035). A high 30-day mortality was observed and there was no difference between groups (HIV, 52.0% vs non-HIV, 54.9%; P = .812). Ventilator-associated pneumonia (VAP) was more frequent in the HIV group compared with the non-HIV group (45.2% vs 26.7%, P = .063), with a predominance of Gram-negative organisms. Gram-positive agents were the most frequent cause of catheter associated-bloodstream infections in HIV patients. Although there was a high frequency of HAI caused by multidrug-resistant organisms (MDRO), no difference was observed between the groups (HIV, 77.8% vs non-HIV, 64.3%; P = .214). Age was the only independent factor associated with 30-day mortality (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.01–1.1, P = .017), while diabetes mellitus (OR: 3.64, 95% CI: 0.84–15.8, P = .085) and the Sequential Organ-Failure Assessment (SOFA) score (OR: 1.16, 95% CI: 0.99–1.37, P = .071) had a tendency to be associated with death.

HIV infection was not associated with a higher 30-day mortality in critical care patients with a HAI. Age was the only independent risk factor associated with death. VAP was more frequent in HIV patients, probably because of the higher frequency of respiratory conditions at admission, with a predominance of Gram-negative organisms.
Safety of combining vascular endothelial growth factor receptor tyrosine-kinase inhibitors with chemotherapy in patients with advanced non–small-cell lung cancer
Authors: Lv Wen-wen , Zhang Jin-jie , Zhou Xiao-long , Song Zheng , Wei Chuan-mei
Published: June 2019

Background:

Vascular endothelial growth factor receptor-tyrosine kinase inhibitors (VEGFR-TKIs) have been developed for targeted therapies in non–small-cell lung cancer (NSCLC); moreover, some drug-related toxic reactions among cancer patients have been reported. A meta-analysis of randomized controlled trials (RCTs) to definite the incidence and the risk of grade ≥3 adverse events (AEs), serious and fatal AEs (SAEs and FAEs), with VEGFR-TKIs in advanced/metastatic NSCLC patients was performed.

Methods:

A comprehensive literature search was conducted for the clinical trials published up to December 2017. Qualified studies allotted patients with advanced/metastatic NSCLC to receive either chemotherapy alone or in combination with VEGFR-TKIs. Data were extracted by 2 authors.

Results:

Eighteen RCTs of VEGFR-TKIs plus chemotherapy, involving 8461 advanced NSCLC patients were included. The proportion of patients with grade ≥3 AEs was increased with the addition of VEGFR-TKIs (relative risk, 1.35; 95% confidence interval [CI] 1.19–1.52; incidence, 68.1% vs 50.1%; P < .001). The most common grade ≥3 AEs was neutropenia (24.9% vs 15.4%, P < .001). Addition of VEGFR-TKIs was also related to the increased risk of SAEs (relative risk, 1.34; 95% CI 1.14–1.56; incidence, 37.8% vs 27.9%; P < .001) and FAEs (relative risk, 2.16, 95% CI 1.47–3.19; incidence, 3.4% vs 1.8%). Subgroup analysis suggested there was no difference in the rates of SAEs and FAEs in the second-line settings. No evidence of bias was found between the literatures. The study was registered with PROSPERO (CRD42018099654).

Conclusions:

In comparison with chemotherapy alone, the addition of VEGFR-TKIs in advanced NSCLC patients was related to the increased risk of grades ≥3 AEs, SAEs, and FAEs, especially in the first-line settings. Physicians should be aware of some specific grade ≥3 adverse effect, especially haematologic adverse events, and it is also necessary to monitor cancer patients receiving VEGFR-TKIs.
Central retinal venous occlusion in a child with hyperhomocysteinemia
Authors: Liu Zhengfeng , Pan Xuemei , Jiang Wenjun , Bi Hongsheng
Published: June 2019

Rationale:

To report a rare case of 8-year-old girl patient with central retinal venous occlusion (CRVO) with hyperhomocysteinemia.

Patient concerns:

The patient had a 2-year history on painless visual loss in the left eye.

Diagnoses:

All examination results were within normal limits except plasma homocysteine (HCY). Fluorescein angiography (FA) confirmed peripheral capillary non-perfusion (CNP) in the left eye, and OCT showed macular edema. The girl patient was diagnosed as CRVO.

Interventions:

Based on all of the test results, laser photocoagulation was performed at peripheral capillary non-perfusion (NP). Ranibizumab was injected into virtreous cavity to reduce the macular edema. Oral folic acid, vitamin B12, and vitamin B6 were performed to the girl.

Outcomes:

After 13 months, the girl visual acuity recovered to 20/100 in the left eye.

Lessons:

All eye examinations should be performed in young patients, and they should undergo treatments immediately after is diagnosed as CRVO.
38-year-old woman with nasal congestion
Authors: Xiao Zhixian , Zhou Li , Xu Lian , Liang Fangqi , Tian Li , Jiang Luyun , Ren Guowei , Deng Jianhong
Published: June 2019

Introduction:

Benign fibrous histiocytoma (BFH) is a mesenchymal tumor composed of fibroblasts and histiocytes, which normally occurs in the bone tissue and/or the skin of the limbs. BFH of the nasal septum is rare worldwide.

Patient concerns:

A 38-year-old female patient attended our clinic with congestion in her right nasal cavity.

Diagnoses:

Endoscopic examination revealed a mass within the right nasal passage. Immunohistochemical staining demonstrated cells labeled with VIM (+), CD68PGM1 (+), CD34 (–), Actin (–), PCK (–), EMA (–), Desmin (–), SMA (–), S-100 (–), P63 (–), ALK-1 (–), beta-catenia (+), and KI67 (+). Clinical and histopathological examinations showed that the mass was a septum-originated BFH.

Interventions:

For the treatment of BFH of the nasal septum, the mass was removed endoscopically using a transnasal approach.

Outcomes:

No recurrence was observed over 30 months of follow-up.

Conclusion:

To prevent the recurrence wide local resection with histological clear margin and long-term follow-up with an endoscope are necessary.
The dominant models of KCNJ11 E23K and KCNMB1 E65K are associated with essential hypertension (EH) in Asian
Authors: Zhancheng Wang , Wenhui Ji , Yun Jiang , Lingli Wang , Huijun Huang , Yan Shen , Jin Li
Published: June 2019

Background:

The K+ channel, subfamily J, member-11 (KCNJ11) E23K and β1 subunit of large-conductance Ca2+-activated K+ channel (KCNMB1) E65K polymorphisms were shown to be associated with the risk of essential hypertension (EH). However, the results were inconclusive with relatively small sample size. Thus, we carried out a meta-analysis to investigate the genetic association between KCNJ11 E23K and KCNMB1 E65K polymorphisms and essential hypertension risk.

Methods:

Relative studies were collected using PubMed, Web of Science, the Cochrane Library databases, Chinese National Knowledge Infrastructure and Embase databases. Pooled odds ratios with 95% confidence intervals were used to assess the strength of associations.

Results:

The dominant models of KCNJ11 E23K (P = .006, OR [95%CI] = 0.45 [0.25, 0.79]) and KCNMB1 E65K (P = .04, OR [95%CI] = 0.91 [0.83, 1.00]) were significantly associated with essential hypertension risk. No significant association was detected between the allelic and recessive models of KCNJ11 E23K and KCNMB1 E65K and the susceptibility of EH. Subgroup analysis stratified by ethnicity showed that the dominant model of KCNMB1 E65K was associated with EH risk in Asian population (P = .003, OR [95%CI] = 0.83 [0.74, 0.94]), but not in Caucasian (P = .74, OR [95%CI] = 1.02 [0.89, 1.18]).

Conclusions:

The dominant model of KCNJ11 E23K and KCNMB1 E65K might be susceptible factors for essential hypertension. To confirm this result, large-scale case-control studies with more subjects are necessary.
Primary pulmonary artery sarcoma with deep vein thrombosis
Authors: Li Xin , Qi Quan , Liang Fuxiang , Zhang Xuxia , Dong Shuai , Song Bing
Published: June 2019

Rationale:

Pulmonary artery sarcomas (PAS) are easily misdiagnosed as thromboembolic disease of pulmonary arteries, because of rarity and presenting with nonspecific signs, symptoms, or imaging findings.

Patient concerns:

A 26-year-old man was admitted to the department of invasive technology with fever and dyspnea. Blood tests showed inflammatory activity, a slight increase of D-dimer and Fibrin Degradation Product. A chest enhanced computed tomography (CT) scanning revealed multiple filling defects occurred in the main trunk of both pulmonary arteries and branches of the left pulmonary artery

Diagnoses:

It was initially diagnosed with pulmonary embolism (PE) and deep vein thrombosis (DVT), but was eventually diagnosed with pulmonary artery sarcoma that was confirmed by biopsy.

Interventions:

The transcatheter thrombolysis therapy, inferior vena cava filter implantation, and operation were performed.

Outcomes:

The Organized mass was removed by the operation and was pathologically diagnosed as pulmonary artery sarcoma, the patient received postoperative chemotherapy according to the recommendation of oncology department.

Lessons:

Coagulation markers have been reported to differentiate PAS from PE, but this case suggested that PAS can be associated with DVT and abnormal coagulation-fibrinolysis system.
Partial anomalous pulmonary venous connection associated with hemoptysis
Authors: Li ChengCheng , Teng Peng , Yang Yanyan , Ni Yiming , Ma Liang
Published: June 2019

Rationale:

Partial anomalous pulmonary venous connection (PAPVC) is a rare congenital anomaly characterized by the failure of fusion of embryologic pulmonary venous system with left atrium.

Patient Concerns:

A 45-year-old male patient with PAPVC who was hospitalized because of mild hemoptysis. Images showed the anomalous vein originated from the left upper pulmonary vein and flowed into the left brachiocephalic vein. No other underlying causes for hemoptysis were detected.

Diagnosis:

After multi-disciplinary discussion, the patient was diagnosed as PAPVC of left upper pulmonary vein draining into the left brachiocephalic vein with intact atrial septum.

Interventions:

Although surgical correction of PAPVC was feasible, left upper lobectomy was performed as the definitive treatment for both hemoptysis and PAPVC.

Outcomes:

The patient had an uneventful postoperative hospital course and was followed up for nearly 2 years without recurrence of hemoptysis.

Lessons:

PAPVC is associated with atrial septal defect in 80% to 90% of cases while isolated PAPVC with intact atrial septum is an extremely rare entity. We present a rare isolated PAPVC patient with hemoptysis. To our best knowledge, PAPVC associated with hemoptysis has never been reported before.
Variations of plasma D-dimer level at various points of normal pregnancy and its trends in complicated pregnancies
Authors: Baboolall Uttam , Zha Ying , Gong Xun , Deng Dong Rui , Qiao Fuyuan , Liu Haiyi
Published: June 2019

D-Dimer (DD) is the smallest fragment of plasmin-mediated cleavage of fibrin. There is a progressive increase in DD concentration with advancing gestation in normal pregnancies, making the upper limit of 0.5 μg/ml used in non-pregnant population an unfavorable marker during pregnancy. Coagulation and fibrinolysis parameters are also markedly disturbed in pregnancies complicated by various pathologies.

We designed this retrospective observational cohort study to investigate the trimester specific reference range for DD throughout normal pregnancy, and to compare the distribution of DD in third trimester healthy pregnancies and those complicated by preeclampsia (PE), severe preeclampsia (SPE), gestational diabetes mellitus (GDM), premature rupture of membranes (PROM) and preterm premature rupture of membranes (PPROM). In addition, we aimed to determine the diagnostic value of DD in PE and SPE.

In this retrospective observational cohort study, 250 normal and 178 complicated pregnancies were included. Normal pregnancies included 88-first trimester, 101-second trimester and 61-third trimester pregnancies. Complicated pregnancy included 34 PE, 44 SPE, 32 GDM, 33 PROM, and 35 PPROM cases during the third trimester. Predefined exclusion criteria were used.

The period of gestation (POG) accounted for 41.9% of the variance in DD, with strong correlation between the POG and DD. The trimester specific reference intervals were computed. The distribution for severe preeclampsia was statistically different compared to other categories in the third trimester. This exceptional distribution led to the generation of a receiver operating characteristic (ROC) curve with an area under curve of 0.828, attesting its possible role in predicting severe preeclampsia.

We determined trimester specific reference intervals of DD. The role of DD has been explored, and it may be of diagnostic value in severe preeclampsia.
Invasive candidiasis
Authors: Rodrigues Luiza Souza , Motta Fabio Araujo , Picharski Gledson Luiz , Vasconcelos Thaís Muniz , Riccieri Marinei Campos , Dalla-Costa Libera Maria
Published: June 2019

Background:

Invasive candidiasis (IC) is a major cause of morbimortality in children. Previous studies described the clinical characteristics and risk factors for this infection; however, limited data are available on the predictors of mortality in these patients. In this context, we evaluated the risk factors associated with death due to IC in a pediatric tertiary care hospital in South of Brazil.

Methods:

This is a retrospective, cross-sectional, observational, and analytical study of a series of pediatric patients with clinical and laboratory diagnosis of IC from March 2014 to September 2017. Univariate and multivariate analysis were performed to estimate the association between the characteristics of the patients and death.

Results:

A total of 94 cases of IC were included. The incidence was 1.13 cases per 1000 patients/d, with a mortality rate of 14%. There was a predominance of non-albicansCandida(71.3%) in IC cases and, although there is no species difference in mortality rates, biofilm formation was associated with increased mortality. Clinical characteristics such as male sex, stay in the intensive care unit, and thrombocytopenia; comorbidities such as cardiological disease and renal insufficiency; and risks such as mechanical ventilation and dialysis were associated with increased mortality.

Conclusion:

Data from this study suggest that biofilm formation byCandidasp. is associated with increased mortality, and this is the first study to correlate the male sex and cardiological disease as risk factors for death in pediatric IC patients.
Multivariate analysis of incision infection after posterior lumbar surgery in diabetic patients
Authors: Peng Wang , Liang Yan , Lu Tao , Li Miao , Li Dong-Sheng , Du Kai-Hui , Wu Jian-Huang
Published: June 2019

Background:

Patients requiring posterior lumbar surgery have increased annually. Incision infection after lumbar surgery has serious consequences for patients. However, data on the related factors of incision infection after lumbar surgery in diabetic patients are limited. Therefore, this study aimed to analyze diabetic patients who underwent lumbar surgery and to explore the risk factors of perioperative incision infection to provide a scientific basis for perioperative intervention of lumbar spine surgery and reduce risk of incision infection in such patients.

Methods:

We retrospectively reviewed data of diabetic patients who underwent posterior lumbar surgery from 2011 to 2016. A total of 523 diabetic patients undergoing posterior lumbar surgery were analyzed for the influence of various risk factors on postoperative incision infection. Univariate and multivariate logistic regression was performed. The test level was α=.05, and P < .05 was considered statistically significant.

Results:

In the past 6 years, among the 523 diabetic patients, the incidence of incision infection after posterior lumbar surgery was approximately 7.1%, of which the shallow incision infection rate was 4.2% and the deep incision infection rate was 2.9%. Incision infection of posterior lumbar surgery in diabetic patients is related to smoking, preoperative glycosylated hemoglobin A1c, postoperative albumin (Alb), surgical segment, operation time, and intraoperative blood loss, especially on postoperative fasting blood glucose, postoperative postprandial blood glucose, local subcutaneous fat thickness, and operation sequence (odds ratio >5.00). Meanwhile, sex, age, body mass index (BMI), preoperative Alb, and newly diagnosed diabetes were not highly correlated with incision infection after posterior lumbar surgery.

Conclusion:

Local subcutaneous fat thickness is a better indicator for predicting incision infection compared with BMI. In diabetic patients undergoing lumbar surgery, actively controlling blood glucose fluctuations, restoring normal diet early after surgery, and optimizing surgical procedures to reduce trauma and operative time can effectively reduce the risk of infection after posterior lumbar surgery.