bluuebunny/crossref_metadata_2025 huggingface dataset:
LAMOST J011939.222−012150.45: The most barium-enhanced CEMP-s turnoff star
Authors: Zhang Shilin , Li Haining , Zhao Gang , Aoki Wako , Matsuno Tadafumi
Published: July 2019

We have performed chemical abundance analyses for a newly discovered metal-poor turn-off star (Teff = 6276 K, log g = 3.93, [Fe$/$H] = −2.93), LAMOST J011939.222−012150.45, based on high-resolution and high signal-to-noise ratio spectra in both optical and near-UV obtained by Subaru. Abundances have been derived for 20 elements, including 11 light elements such as C, N, Na, Mg, etc., and 9 neutron-capture elements from Sr to Pb. This object is a carbon-enhanced metal-poor star with a large carbon excess of [C$/$Fe] = +2.26. LAMOST J011939.222−012150.45 shows extreme enhancement in s-process elements, especially for Ba, La, and Pb ([Ba$/$Fe] = +3.16 ± 0.18, [La$/$Fe] = +2.29 ± 0.24, [Pb$/$Fe] = +3.38 ± 0.12). A very clear radial velocity variation has also been detected, providing evidence of the existence of a companion. Interestingly, even without any scaling, the observed abundance pattern from light to heavy neutron-capture elements agrees well with predictions of accretion from a companion asymptotic giant branch (AGB) star. Considering the evolutionary status of this object, its surface material is very likely to be completely accreted from its AGB companion and has been preserved until today.
Improving on nature’s shortcomings: evolving a lipase for increased lipolytic activity, expression and thermostability
Authors: Alfaro-Chávez Ana L , Liu Jian-Wei , Porter Joanne L , Goldman Adrian , Ollis David L
Published: July 2019

An enzyme must be soluble, stable, active and easy to produce to be useful in industrial applications. Not all enzymes possess these attributes. We set out to determine how many changes are required to convert an enzyme with poor properties into one that has useful properties. Lipase Lip3 from Drosophila melanogaster had been previously optimised for expression in Escherichia coli. The expression levels were good, but Lip3 was mainly insoluble with poor activity. Directed evolution was used to identify variants with enhanced activity along with improved solubility. Five variants and the wild-type (wt) enzyme were purified and characterised. The yield of the wt enzyme was just 2.2 mg/L of culture, while a variant, produced under the same conditions, gave 351 mg. The improvement of activity of the best variant was 200 times higher than that of the wt when the crude lysates were analysed using pNP-C8, but with purified protein, the improvement observed was 1.5 times higher. This means that most of the increase of activity is due to increase in solubility and stability. All the purified variants showed increased thermal stability compared with the wt enzyme that had a T1/2 of 37°C, while the mutant with P291L of 42.2°C and the mutant R7_47D with five mutations had a value of 52.9°C, corresponding to an improvement of 16°C. The improved variants had between five and nine changes compared with the wt enzyme. There were four changes that were found in all 30 final round variants for which sequences were obtained; three of these changes were found in the substrate-binding domain.
Hedging Climate Change News
Authors: Engle Robert F , Giglio Stefano , Kelly Bryan , Lee Heebum , Stroebel Johannes
Published: July 2019

We propose and implement a procedure to dynamically hedge climate change risk. We extract innovations from climate news series that we construct through textual analysis of newspapers. We then use a mimicking portfolio approach to build climate change hedge portfolios. We discipline the exercise by using third-party ESG scores of firms to model their climate risk exposures. We show that this approach yields parsimonious and industry-balanced portfolios that perform well in hedging innovations in climate news both in sample and out of sample. We discuss multiple directions for future research on financial approaches to managing climate risk.
The role of non-pharmacological interventions in the management of rheumatoid-arthritis-related fatigue
Authors: Cramp Fiona
Published: July 2019

Non-pharmacological interventions may be beneficial in the management of rheumatoid arthritis related fatigue. A narrative review was undertaken, with a focus upon research published in the past 6 years. Seven studies were identified, four focusing upon physical activity, two on psychosocial interventions and one that investigated aromatherapy and reflexology. Findings supported previous evidence that physical activity and psychosocial interventions have potential to produce small to moderate reductions in fatigue related to rheumatoid arthritis. Reflexology and aromatherapy interventions also appeared promising. Limitations to the evidence included lack of consistency in fatigue measurement, and minimal data on long-term outcomes and cost effectiveness. The wide range of physical activity interventions prevent specific recommendations. For psychosocial interventions the strongest evidence is for group-based cognitive behavioural approaches. There was lack of consideration given to fatigue mechanisms and intervention design. Due to the complexity of fatigue, future research exploring personalized approaches is warranted.
Relationship of sensation seeking with the neural correlates of appetitive conditioning
Authors: Tapia León Isabell , Kruse Onno , Stark Rudolf , Klucken Tim
Published: July 2019

Previous research has linked sensation seeking with a heightened risk for drug abuse and other risk-taking behavior. As appetitive conditioning presents a model for the etiology and maintenance of addictive behavior, investigating sensation seeking in a classical conditioning paradigm might elucidate possible pathways toward addiction within this model. Furthermore, the theoretical concept underlying sensation seeking proposes a negative relationship between reward processing and sensation seeking in only moderately arousing situations, which has been neglected by previous research.

This study aimed to investigate this inverse relationship in moderately stimulating situations entailing reward processing using functional magnetic resonance imaging. Subjects (N = 38) participated in a classical conditioning paradigm in which a neutral stimulus (CS+) was repeatedly paired with a monetary reward, while another neutral stimulus (CS−) was not.

Imaging results revealed a negative relationship between sensation seeking and neural responses in the insula, amygdala and nucleus accumbens during the early phase and in the dorsal anterior cingulate cortex during the late phase of conditioning. These findings suggest reduced reward learning and consequently diminished processing of outcome expectancy in appetitive conditioning in subjects with high sensation seeking scores. The results are discussed with respect to clinical implications.
Vesicular Antipsychotic Drug Release Evokes an Extra Phase of Dopamine Transmission
Authors: Walters Seth H , Levitan Edwin S
Published: July 2019

Many psychiatric drugs are weak bases that accumulate in and are released from synaptic vesicles, but the functional impact of vesicular drug release is largely unknown. Here, we examine the effect of vesicular release of the anxiolytic antipsychotic drug cyamemazine on electrically evoked striatal dopamine responses with fast scan cyclic voltammetry. Remarkably, in the presence of nanomolar extracellular cyamemazine, vesicular cyamemazine release in the brain slice can increase dopamine responses 30-fold. Kinetic analysis and multiple stimulation experiments show that this occurs by inducing delayed emptying of the releasable dopamine pool. Also consistent with increased dopamine release, an antagonist (dihydro-β-erythroidine) implicates nicotinic acetylcholine receptors, which can directly cause dopamine release, in the vesicular cyamemazine effect. Therefore, vesicular release of cyamemazine can dramatically enhance dopaminergic synaptic transmission, possibly by recruiting an excitatory cholinergic input to induce an extra phase of release. More generally, this study suggests that synaptic drug release following vesicular accumulation by acidic trapping can expand psychiatric drug pharmacodynamics.
When is it appropriate to withhold a trust deed from a beneficiary? Disclosure of trust documents in the New Zealand Supreme Court
Authors: Thompson Stephanie
Published: July 2019

Disputes over beneficiaries’ access to trust documents are increasingly common, particularly as a prelude to hostile litigation. This article examines one of the latest offerings on this subject, Erceg v Erceg [2017] NZSC 28, in which the New Zealand Supreme Court refused to permit a discretionary beneficiary access to trust deeds. The extreme facts of Erceg demonstrate the importance of courts and trustees retaining a discretion to refuse disclosure of even basic trust documents. The decision also clarifies several points of principle about the court’s supervisory jurisdiction, and gives detailed consideration to the factors the court should take into account.
Lamivudine vs placebo or no treatment in preventing the transmission of hepatitis B virus during pregnancy: a systematic review and meta-analysis
Authors: Zhao Peng , Qian Xueqian , Su Chang , Yang Xiaofu , Bai Xiaoxia
Published: July 2019

Background

Hepatitis B virus (HBV) infection is a severe health problem, especially in developing countries. Almost 45% of the population lives in highly endemic areas, where the most common form of transmission is mother to child transmission (MTCT). Administration of antiviral therapy has been established. Nevertheless, its efficacy still remains controversial.

Methods

We conducted the current study to fully evaluate the effectiveness of lamivudine in preventing the MTCT of HBV based on randomized controlled trials (RCTs). Four English electronic databases and four Chinese electronic databases were searched from the inception of each database to 26 September 2017. Studies were included if they (1) were human RCT studies, (2) indicated exposure to lamivudine, (3) explicitly indicated control to placebo or no treatment, (4) indicated the participants were pregnant women infected with HBVand (5) compared the outcome of interest as the MTCT. Extracted data were tabulated and analyzed using Review Manager.

Results

Eleven RCTs were included and analyzed. Compared with controls (placebo or no treatment), lamivudine significantly reduced the probability of MTCT, as indicated by newborn HBsAg seropositivity (RR=0.44, 95% CI 0.26 to 0.74, I2=41%), HBeAg seropositivity (RR=0.66, 95% CI 0.36 to 1.19, I2=0%) and HBV DNA seropositivity (RR=0.29, 95% CI 0.18 to 0.4`6, I2=0%) within 24 h after birth. Similar results were noted pertaining to infant HBsAg seropositivity and HBV DNA seropositivity within 6–7 and 12 mo.

Conclusions

Lamivudine can significantly reduce the MTCT of HBsAg and HBV DNA of neonates during the third trimester of pregnancy without severe adverse events.
Identifying Loci Conferring Resistance to Leaf and Stripe Rusts in a Spring Wheat Population (Triticum aestivum) via Genome-Wide Association Mapping
Authors: Liu Weizhen , Kolmer James , Rynearson Sheri , Chen Xianming , Gao Liangliang , Anderson James A. , Turner M. Kathryn , Pumphrey Michael
Published: July 2019

A previous genome-wide association study (GWAS) for leaf rust (caused by Puccinia triticina) resistance identified 46 resistance quantitative trait loci (QTL) in an elite spring wheat leaf rust resistance diversity panel. With the aim of characterizing the pleiotropic resistance sources to both leaf rust and stripe rust (caused by P. striiformis f. sp. tritici), stripe rust responses were tested in five U.S. environments at the adult-plant stage and to five U.S. races at the seedling stage. The data revealed balanced phenotypic distributions in this population except for the seedling response to P. striiformis f. sp. tritici race PSTv-37. GWAS for stripe rust resistance discovered a total of 21 QTL significantly associated with all-stage or field resistance on chromosomes 1B, 1D, 2B, 3B, 4A, 5A, 5B, 5D, 6A, 6B, 7A, and 7B. Previously documented pleiotropic resistance genes Yr18/Lr34 and Yr46/Lr67 and tightly linked genes Yr17-Lr37 and Yr30-Sr2-Lr27 were also detected in this population. In addition, stripe rust resistance QTL Yrswp-2B.1, Yrswp-3B, and Yrswp-7B colocated with leaf rust resistance loci 2B_3, 3B_t2, and 7B_4, respectively. Haplotype analysis uncovered that Yrswp-3B and 3B_t2 were either tightly linked genes or the same gene for resistance to both stripe and leaf rusts. Single nucleotide polymorphism markers IWB35950, IWB74350, and IWB72134 for the 3B QTL conferring resistance to both rusts should be useful in incorporating the resistance allele(s) in new cultivars.
Does Disordered Sleep Moderate the Relationship Between Pain, Disability and Downstream Health Care Utilization in Patients With Low Back Pain?
Authors: Rhon Daniel I. , O’Hagan Edel , Mysliwiec Vincent , Lentz Trevor A.
Published: July 2019

Study Design.

Prospective cohort.

Objective.

The purpose of this study was to evaluate the influence of disordered sleep on the relationship between pain and health care utilization (HCU) and pain-related disability and HCU in individuals with low back pain (LBP).

Summary of Background Data.

Disordered sleep and pain influence LBP outcomes, but their relationship with health care seeking after an episode of LBP has not been investigated and could help identify who is at risk for long-term medical care.

Methods.

This study included patients with LBP participating in a self-management class at a large US military hospital between March 1, 2010 and December 4, 2012. Pain intensity, disability (Oswestry Disability Index), and sleepiness (Epworth Sleepiness Scale) were captured at baseline. Medical visits for a sleep disorder in the 12 months before the class and LBP-related healthcare utilization for the 12 months following the class were abstracted from the Military Health System Data Repository. Separate multivariate analyses evaluating pain intensity and disability as predictors of HCU were developed, with sleepiness and the presence of a sleep disorder as potential moderators. Analyses were adjusted for age, sex, history of back pain, and mental health comorbidities.

Results.

A total of 757 consecutive participants were included, with 195 (26.8%) diagnosed with a subsequent sleep disorder. Sleepiness was not a significant predictor of HCU. The main effects of disability, pain intensity, and presence of a sleep disorder were significant across all analyses, with higher disability, pain intensity, and presence of a sleep disorder associated with higher predicted visits and costs for LBP. The presence of a sleep disorder was not a significant moderator in any model.

Conclusion.

Higher pain intensity and disability predicted higher pain-related HCU in the year following a LBP self-management class. The presence of a sleep disorder diagnosis, as recorded in medical records, had a significant independent effect on LBP-related health care visits and costs beyond the influences of pain intensity, disability, and other key demographic and health-related characteristics, but did not moderate these relationships.

Level of Evidence: 3
Predictors of Infliximab Trough Concentrations in Inflammatory Bowel Disease Patients Using a Repeated-Measures Design
Authors: Santacana Eugènia , Rodríguez-Alonso Lorena , Padullés Ariadna , Guardiola Jordi , Bas Jordi , Rodríguez-Moranta Francisco , Serra Katja , Morandeira Francisco , Colom Helena , Padullés Núria
Published: July 2019

Background and aims:

Treating patients based on a treat-to-trough approach has been shown to be a cost-effective strategy for inflammatory bowel disease (IBD) patients who have become unresponsive to infliximab (IFX). However, the documented evidence for this is limited, and some controversy remains regarding the use of routine proactive therapeutic drug monitoring (TDM). To support routine TDM of IFX and regimen optimization in IBD patients, more in-depth knowledge of the covariates that affect the pharmacokinetic (PK) variability of IFX is needed. The aim of this study was to identify the characteristics of the patient, disease, and treatments that influence IFX PK and exposure in our cohort of IBD patients using a repeated-measures design.

Methods:

We performed a prospective observational study of adult IBD patients who received IFX between July 2013 and March 2017. We obtained repeated IFX trough concentration (Cmin) measurements and implemented a previously described population pharmacokinetic model to estimate individual clearance (CL). From the individual primary parameters, the area under the curve (AUC), half-life (t1/2), and central elimination rate constant (K10) were estimated. We performed a repeated-measures analysis to evaluate whether patient characteristics, disease status, concomitant immunosuppressive therapy, and immunogenicity are associated with IFX Cmin and PK parameters.

Results:

We collected 429 Cmin measurements from 112 patients. The median of the Cmin values was 3.62 mg/L (1.47–6.02). Antibodies to IFX (ATI) were detected in 14 patients. The predicted median AUC was 28,421 mg/h/L (22,336–36,903). The median individual predicted CL, K10, and t1/2 values were 4.77 mL/kg/day (3.88–5.90), 0.09 days−1 (0.08–0.12), and 12.22 days (9.49–14.87), respectively. IFX Cmin, AUC, CL, and K10 were significantly influenced by ATI and serum albumin concentrations. Moreover, body weight was significantly associated with AUC, CL, and K10. Patients receiving concurrent immunosuppressive therapy had higher Cmin and AUC values and lower CL and K10 values than those treated with IFX monotherapy. We also observed high intrapatient variability in Cmin values during the study period.

Conclusions:

In this repeated-measures study in a population of IBD patients, we observed significant associations between ATI, serum albumin concentration, concomitant immunosuppressive therapy, body weight and gender, and IFX Cmin, and CL. The high PK variability observed in this study supports the need for proactive TDM to optimize the use of IFX as early as possible in IBD patients.
Latissimus Dorsi Myocutaneous Flap in Immediate Reconstruction after Salvage Mastectomy Post-Lumpectomy and Radiation Therapy
Authors: Cattelani Leonardo , Spotti Annamaria , Pedrazzi Giuseppe , Arcuri Maria F. , Gussago Francesca , Polotto Susanna
Published: July 2019

Background:

Breast reconstruction after salvage mastectomy (SM) for recurrent cancer represents a challenge in preradiated patients due to the increased complication rate. Latissimus dorsi myocutaneous flap (LDMF) represents a good reconstructive option due to its versatility, safety, and adaptability.

Methods:

Fifty-nine patients treated in the Breast Surgery Unit at the University Hospital of Parma (Italy) between January 2010 and December 2017 for ipsilateral breast recurrent cancer, previously treated by partial mastectomy plus whole-breast radiation therapy, were analyzed. They underwent SM and immediate reconstruction with implant-assisted pedicled LDMF. We registered local treatment, oncologic characteristics, complications, capsular contracture rate, DASH test, and BREAST-Q scores.

Results:

Mean implant volume was 403 g (range 135–650 g). Contralateral operations were 16/59 (27.1%). We obtained complete postoperative pain control in most cases with paracetamol. Medium hospital stay was 2.8 days. We registered 3.4% major complications and 6.8% minor ones. Mean follow-up was 26.65 months (range 3–91.9 months). DASH questionnaire evidenced no disability for 71.19% of patients and minimum disability for 28.81% of them. BREAST-Q Aesthetic Questionnaire obtained 92.72%. No patient developed Baker III or IV capsular contracture.

Conclusions:

LDMF with implant is a reliable and safe procedure for 1-step breast reconstruction after SM for recurrent cancer in radiated breast. It entails a low rate of major complications, achieving stable and pleasant results without significant upper limb functional impairment, also for elderly women and larger breasts. Thus, a definite role is yet predictable for this flap in the setting of SM in all cases not suitable for free-flap reconstruction.
Prevalence of Depression and Its Influence on the Quality of Life of Jordanians Living in Residential Care Facilities
Authors: AL-AMER Rasmieh , SUBIH Maha , ALDARAAWI Hanan , RANDALL Sue , OTHMAN Wafaa Mousa Mustafa , SALAMONSON Yenna
Published: July 2019

Background

As a third-world country experiencing a rise in the elderly population and changes to traditional family structures, improving psychological health is critical to improving quality of life (QoL) in the older adults living in residential care facilities in Jordan.

Purpose

This study aimed to (a) estimate the prevalence of depression among nursing home (NH) residents in Jordan; (b) measure perceived QoL in these NH residents in the dimensions of mobility, self-care, usual activity, pain and discomfort, and anxiety/depression; and (c) assess the influence of depression on each of these QoL dimensions.

Methods

This cross-sectional study recruited a convenience sample of 155 participants living in a residential care facility in Jordan. The instruments used included a sociodemographic and clinical questionnaire, the Mini-Mental State Examination, a Geriatric Depression Scale (GDS), and the EuroQol, which is a five-dimension, five-level questionnaire. The data were presented as means, standard deviations, and percentages as well as adjusted odds ratios (AORs) with 95% confidence intervals (CIs).

Results

A high prevalence of depression was found in the study population, with 72.3% having a score between 6 and 9 on the GDS, which is suggestive of depression. Moreover, 18.1% scored ≥ 10 on the GDS, which is indicative of a nearly continual state of depression. With regard to the QoL dimensions, 84.5% of the participants reported experiencing pain, 81.9% reported anxiety/depression, 80.6% reported problems performing usual activities, 75.5% reported problems with self-care, and 63.2% reported mobility difficulties. Pain, anxiety, and depression were found to be significantly associated with level of depression (AOR = 2.78 and 95% CI [1.18, 6.57], AOR = 5.81 and 95% CI [2.14, 15.78], and AOR = 4.75 and 95% CI [1.87, 12.07], respectively).

Conclusions

Depression is common among NH residents in Jordan and is associated significantly with poor QoL. This study yielded empirical data that may be used to develop strategies to enhance or promote the mental health status and QoL of NH residents in Jordan.
Implementation of a Health Literacy Universal Toolkit to Improve Postdischarge Care at an Urban Trauma Center
Authors: Nowak Theresa J.
Published: July 2019

Topic:

Low health literacy impacts the financial burden of hospitals up to $238 billion annually. A trauma center located on the East Coast implemented a Transitional Care Management (TCM) model targeting individuals at risk for readmission, but not every patient receives this service.

Purpose:

A gap analysis of the facility's discharge process identified a deficit in the formal evaluation of health literacy upon discharge. The purpose of this project was to implement a Health Literacy Universal Toolkit to assess and improve medication education for low literacy patients. Included in the toolkit were the Rapid Estimate of Adult Literacy in Medicine Short Form (REALM-SF), an evidence-based health literacy screening tool, and 2 interventions, additional education on their inpatient or discharge medication list, and a Brown Bag Medicine Review of medications at a postdischarge clinic appointment.

Conclusion:

Seventy-one patients were screened using the REALM-SF. Sixty-two percent (n = 44) of patients scored at a high school reading level, 30% (n = 21) scored at a seventh- to eighth-grade reading level, and 8% (n = 6) scored at or below a sixth-grade reading level. Eight percent of patients scored as having low health literacy, 30% scored as having marginal health literacy, and 62% scored as having adequate health literacy. Twenty patients received additional medication education with My Medicines Form or a Brown Bag Medicine Review.

Key Points:

Regardless of literacy level, patients appreciated the additional medication education interventions. Health care providers should observe universal health literacy precautions regardless of literacy level.
Comparisons of Trauma Outcomes and Injury Severity Score
Authors: Elgin Lisa B. , Appel Susan J. , Grisham Donna , Dunlap Sarah
Published: July 2019

Trauma is a global health problem and a leading cause of mortality. One of the major predictors of trauma mortality is the Injury Severity Score (ISS). Theoretically, as the ISS increases, the probability of survival decreases; ISS = 75 is considered to be not survivable. Studies have shown that some deaths are preventable and some potentially preventable. Hemorrhagic shock is a potentially preventable cause of trauma mortality. A retrospective database review was conducted of the Mississippi Trauma Registry and point-by-serial correlational analyses were conducted to determine the direction of any significant relations between blood product usage, traditional vital signs, and shock index. Pearson correlation, logistic regressions, and odds ratio calculation results revealed that shock index can signal impending hemorrhagic compromise better than traditional vital signs; thus, facilitating early intervention, specifically, as heart rate and shock index increase, the use of blood products increases, and as blood pressure increases, the use of blood products decreases. Independent t tests for shock index and ISS revealed significant differences in the means with relationship to the subgroups “Dead” and “Alive.” Higher ISS were found to correlate with higher shock indices. Evaluation of ISS and survivability demonstrates that ISS = 75 is survivable and should not lead one to reflexively assume otherwise. A total mortality finding of only 1.58% (n = 2,010) was unexpected but very encouraging.
Trauma Response Nurse: Bringing Critical Care Experience and Continuity to Early Trauma Care
Authors: Liu Susan I. , Curren Jeffrey , Leahy Nicole E. , Sobocinski Kathryn , Zambardino Danielle , Shikar Morgan M. , Vasquez Christel , Miluszusky Brian , Winchell Robert J.
Published: July 2019

Multitrauma patients can benefit significantly from specialized care. Prior to mid-2016, this hospital's trauma team did not include a surgical intensive care unit (SICU) nurse. As the value of bringing this expertise to the patient upon arrival was realized, the role of the trauma response nurse (TRN) was developed. The TRN role was designed to provide a dedicated SICU nurse to care for trauma patients from emergency department (ED) arrival through disposition. The integration of the TRN role into the trauma team sought to improve quality and safety, as well as communication and collaboration, and enhance continuity of care. The primary responsibilities of the TRN were to assist with clinical interventions, transport patients fromthe ED to tests and procedures, and assume care through disposition. Additional TRN duties included education, community outreach, and performance improvement. TRNs now respond to all trauma activations that occur on weekday day shift. This role has improved collaboration between nursing disciplines, improved the overall function of the trauma team, and enhanced the safety of trauma patients during transport. TRNs make valuable contributions to the education and outreach missions of the trauma program and ensure that patients are receiving the highest level of trauma care.
Implementation of a Vascular Access Team to Reduce Central Line Usage and Prevent Central Line-Associated Bloodstream Infections
Authors: Savage Thomas J. , Lynch Amanda D. , Oddera Stacey E.
Published: July 2019

Central line-associated bloodstream infections (CLABSIs) account for one-third of all hospital-acquired infections and can cost the health care system between $21,000 and $100,000 per infection. A dedicated vascular access team (VAT) can help develop, implement, and standardize policies and procedures for central line usage that address insertion, maintenance, and removal as well as educate nursing staff and physicians. This article presents how 1 hospital developed a VAT and implemented evidence-based guidelines. Central line utilization decreased by 45.2%, and CLABSI incidence decreased by 90%. The results of the study demonstrated that a reduced utilization of central lines minimized the risk of patients developing a CLABSI.
Best Practices to Decrease Infusion-Associated Medication Errors
Authors: Wolf Zane Robinson , Hughes Ronda G.
Published: July 2019

Infusion-associated medication errors have the potential to cause the greatest patient harm. A 21-year review of errors and near-miss reports from a national medication error-reporting program found that infusion-associated medication errors resulted in the identification of numerous best practices that support patient safety. A content analysis revealed that most errors involved improper dosage, mistaken drug choice, knowledge-based mistakes, skill-based slips, and memory lapses. The multifaceted nature of administering medications via infusions was highlighted. Opportunities for improvements include best practices such as developing learning cultures and reinforcing the independent double-check process on medications. Staff will likely benefit from education on specific medications, prescription details, and smart pump technology.
Investigating the Relationship Between Weight-Related Self-Stigma and Mental Health for Overweight/Obese Children in Hong Kong
Authors: Chan Ka Lam , Lee Clara S.C. , Cheng Cho Man , Hui Lok Yiu , So Wan Tung , Yu Tik Shun , Lin Chung-Ying
Published: July 2019

This study aimed to test the differences of weight-related self-stigma and mental health conditions between overweight (OW) and non-OW children in Hong Kong. The correlations between weight-related self-stigma and mental health conditions were also investigated. Children aged 8 to 12 years (n = 367; 198 boys) completed questionnaires on weight-related self-stigma (Weight Bias Internalization Scale [WBIS] and Weight Self-Stigma Questionnaire [WSSQ]) and mental health conditions (Brief Symptom Rating Scale-5 [BSRS-5]). Compared with non-OW children (n = 241; 143 boys), OW children (n = 114; 55 boys) had higher weight-related self-stigma in the WBIS (26.49 ± 8.68 vs. 21.58 ± 7.54; p < 0.001) and WSSQ scores (26.36 ± 8.98 vs. 21.91 ± 8.71; p < 0.001). No significant difference was found between OW and non-OW children in mental health conditions as reflected by the BSRS-5 score (4.29 ± 4.35 vs. 4.44 ± 4.16; p = 0.761). BSRS-5 was significantly associated with the WBIS. OW children tended to have a higher level of self-stigma; those having a higher level of weight-related self-stigma presented with more mental health problems.
18F-FDG PET/CT in Oral Cuniculatum Carcinoma
Authors: Dejust Sebastien , El Farsaoui Khadija , Bellefqih Sara , Lalire Paul , Morland David
Published: July 2019

A 69-year-old woman was referred for initial staging of an oral cavity mass. 18F-FDG PET/CT displayed a homogeneous intense uptake of the 50-mm left hemipalatal mass with local extension to the dental arcade and maxillary sinus. Infracentimetric bilateral cervical nodes with faint uptake were also detected, contrasting with the usual presentation of other head and neck squamous cell carcinoma. Biopsy concluded to a rare head and neck squamous cell carcinoma subtype: oral cuniculatum carcinoma (OCC). After radiotherapy, 18F-FDG PET/CT showed metabolic complete response. Our case describing specifically the metabolic characteristics of OCC and radiotherapy evaluation for this rare tumor.
68Ga-PSMA-617 Compared With 68Ga-RM2 and 18F-FCholine PET/CT for the Initial Staging of High-Risk Prostate Cancer
Authors: Schollhammer Romain , de Clermont Gallerande Henri , Robert Grégoire , Yacoub Mokrane , Vimont Delphine , Hindié Elif , Fernandez Philippe , Morgat Clément
Published: July 2019

68Ga-labeled prostate-specific membrane antigen inhibitors and 68Ga-labeled gastrin-releasing peptide receptor antagonists showed interesting results for staging biochemically recurrent prostate cancer. In this case, 68Ga–prostate-specific membrane antigen-617 PET/CT, 68Ga-RM2 PET/CT, and 18F-choline PET/CT were performed in a patient (66-year-old man, prostate-specific antigen = 6.7 ng/mL) with biopsy-proven Gleason 9 (5 + 4) prostate cancer, candidate for radical prostatectomy and lymph node dissection.
Isolated Muscular Sarcoidosis Revealed by Hypercalcemia and 18F-FDG PET/CT
Authors: Dhomps Anthony , Foret Thibault , Streichenberger Nathalie , Skanjeti Andrea , Tordo Jeremie
Published: July 2019

A 43-year-old woman, with previous history of renal lithiasis, was admitted on an emergency for severe hypercalcemia fortuitously discovered in a context of rapidly progressive kidney failure. An 18F-FDG PET/CT performed to rule out underlying malignancy revealed an intense diffuse and isolated muscular FDG uptake with fascia infiltration on the CT finding. A muscular biopsy was performed and demonstrated a non-necrosing granuloma with multinucleated giant cells consistent with muscular sarcoidosis. A corticotherapy was started with a rapid normalization of serum calcium level. The follow-up 18F-FDG PET/CT 4 months later showed a complete response of the sarcoidosis myositis.
Isolated Involvement of Prostate Gland by Immunoglobulin G4–Related Disease Diagnosed With the Help of FDG PET/CT
Authors: Vankadari Kousik , Mittal Bhagwant Rai , Kumar Rajender , Singh Harmandeep , Bhattacharya Anish , Kochhar Rakesh
Published: July 2019

Immunoglobulin G4 (IgG4)–related disease is known to mimic multiple malignancies and always poses a diagnostic challenge. We report a case of a 20-year-old young man, who presented with unexplained recurrent episodes of fever and pain abdomen. 18F-FDG PET/CT revealed intense focal FDG avidity in the prostate. On further workup, he had an elevated serum IgG4 level, and a clinical diagnosis of immunoglobulin G4–related disease was kept. A follow-up FDG PET/CT after glucocorticoid therapy revealed resolution of FDG avidity in the prostate with fall in serum IgG4 levels, hence confirming a diagnosis of atypical immunoglobulin G4–related disease involving isolated prostate gland.
18F-Fluciclovine Uptake in Celiac Ganglia
Authors: Wo Sean , Matesan Manuela Cristina
Published: July 2019

We present 4 cases of patients who underwent 18F-fluciclovine PET for prostate cancer demonstrating physiologic uptake in the celiac ganglia, which could be mistaken for metastatic lymphadenopathy if the celiac ganglia have a nodular configuration and uptake higher than bone marrow. Uptake in celiac, cervical, and sacral ganglia has been reported previously as an important pitfall in 68Ga-PSMA-HBED-CC PET for prostate cancer. In our patients, only celiac ganglion uptake was visualized. Advances in PET scanner technology may cause physiologic uptake of 18F-fluciclovine in celiac ganglia to become more visually distinguishable from muscular uptake in adjacent diaphragmatic crura.
Prognostic Value of Maximum Standardized Uptake Value in 68Ga-Somatostatin Receptor Positron Emission Tomography for Neuroendocrine Tumors
Authors: Lee Dong Yun , Kim Yong-il
Published: July 2019

Purpose

Somatostatin receptor (SSTR) PET has become a mainstay in the diagnosis of neuroendocrine tumors (NETs) and for selecting patients for SSTR-based therapy; however, no consensus has yet been reached in terms of prognosis. A systematic review and meta-analysis was performed on the prognostic value of the maximum standardized uptake value (SUVmax) for 68Ga-SSTR PET in patients with NETs.

Patients and Methods

We performed a systematic search using the following keywords: PET, SSTR, NET, and prognosis. The inclusion criteria were the use of 68Ga-SSTR PET as an imaging tool, studies limited to NETs, studies that reported progression-free survival (PFS) and/or overall survival (OS), and studies that included SUVmax as a prognostic parameter. The effect of SUVmax on PFS and OS was measured in terms of the hazard ratio (HR).

Results

Eight eligible studies with 474 patients were finally included and analyzed. The combined HR of SUVmax on PFS was 2.31 with significance (95% confidence interval [CI], 1.34–4.00; P = 0.003). The trim and fill adjusted analysis for SUVmax on PFS demonstrated the combined HR as 1.81 with significance (95% CI, 1.11–2.95; P = 0.017), as the publication bias was found (Egger P = 0.004). The combined HR of SUVmax on OS was 2.97 with significance (95% CI, 1.71–5.15; P = 0.0001), without publication bias (Egger P = 0.929). The subgroup analysis revealed that well-differentiated NETs (grade 1 or 2) on PFS showed significance (P = 0.03); however, all grades of NETs (including grade 3) on PFS did not reach significance (P = 0.11). Tumor site and type of radiotracer did not affect the prognostic value of SUVmax.

Conclusions

Low SUVmax of 68Ga-SSTR PET was associated with a worse prognosis for PFS and OS in patients with NETs. Well-differentiated NETs had more prognostic value compared with all grades of NETs. The SUVmax of 68Ga-SSTR PET could be used as an objective prognosis predictor.
Clinical Utility of 18F-Florbetaben PET for Detecting Amyloidosis Associated With Multiple Myeloma
Authors: Seo Minjung , Cha Hee Jeong , Kim Misung , Park Sang Hyuk , Lim Ji Hun , Choi Yunsuk , Lee Yoo Jin , Park Seol Hoon , Jo Jae-Cheol
Published: July 2019

Purpose

The aims of this study were to evaluate the diagnostic performance of 18F-florbetaben PET/CT for detecting amyloid deposits in patients with multiple myeloma (MM) and to identify the optimal PET analysis method.

Methods

Fourteen patients with MM were prospectively enrolled (6 with amyloidosis, 8 control subjects). Dynamic imaging of the kidneys was performed for 20 minutes, and the retention ratio was obtained. At 90 minutes after injection, PET was performed. All images were assessed qualitatively and quantitatively, and the SUVmax, SUVmean, and SUVratio were obtained. Variables were compared between the amyloidosis group and the control group. Amyloid deposition was confirmed according to international consensus guidelines.

Results

Tracer uptake was abnormal in all patients with amyloidosis. The visual detection rate was excellent (100%) in the heart, stomach, and tongue but limited in the kidneys (50%) and poor (0%) in the esophagus, liver, and colon. 18F-florbetaben PET/CT identified 13 unexpected cases of abnormal uptake, confirming further amyloid deposition. Both spherical and manual volumes of interest showed similar diagnostic performance when evaluating amyloidosis in target organs. There was no significant difference in diagnostic performance between the SUVmax, SUVmean, and SUVratio.

Conclusions

18F-florbetaben PET/CT can accurately detect systemic amyloid deposits in patients with MM. 18F-florbetaben PET/CT was particularly useful in the heart, stomach, and tongue but of limited value in the esophagus, liver, and colon. 18F-florbetaben PET/CT can provide clinical information on organ involvement and could replace pathologic examination for diagnosis of amyloidosis in the future.
A Prospective Head-to-Head Comparison of 18F-Fluciclovine With 68Ga-PSMA-11 in Biochemical Recurrence of Prostate Cancer in PET/CT
Authors: Pernthaler Birgit , Kulnik Roman , Gstettner Christian , Salamon Spela , Aigner Reingard M. , Kvaternik Herbert
Published: July 2019

Purpose

One of the major challenges for all imaging modalities is accurate detection of prostate cancer (PCa) recurrence. Beyond the established 68Ga-PSMA, a novel promising PET tracer in PCa imaging is 18F-fluciclovine. For evaluating the advantages and disadvantages and the comparability, we conducted a prospective head-to-head comparison on 18F-fluciclovine and 68Ga-PSMA-11 in patients with biochemical recurrence of PCa.

Methods

58 patients with biochemical recurrence of PCa after definitive primary therapy were included. Both scans were performed within a time window of mean 9.4 days. All scans were visually analyzed independently on a patient-, region- and lesion-based analysis. All the examinations were performed in the same medical department using identical scanners at any time.

Results

The overall detection rate for PCa recurrence was 79.3% in 18F-fluciclovine and 82.8% in 68Ga-PSMA-11 (P = 0.64). Local recurrence was detected in 37.9% on 18F-fluciclovine and in 27.6% on 68Ga-PSMA-11 (P = 0.03). Local pelvic lymph node recurrence was detected on 18F-fluciclovine versus 68Ga-PSMA-11 in 46.6% versus 50%, in extrapelvic lymph node metastases in 41.4% versus 51.7% and in bone metastases in 25.9% versus 36.2%. Lesion-based analysis showed identical findings in local pelvic lymph nodes in 39.7%, in extrapelvic lymph nodes in 22.4%, and in bone metastases in 13.8%.

Conclusions

The advantage of 18F-fluciclovine is detecting curable localized disease in close anatomical relation to the urinary bladder, whereas 68Ga-PSMA-11 fails because of accumulation of activity in the urinary bladder. 18F-fluciclovine is almost equivalent to 68Ga-PSMA-11 in detecting distant metastases of PCa recurrence.
Effects of the Poly(ADP-Ribose) Polymerase Inhibitor Olaparib in Cerulein-Induced Pancreatitis
Authors: Ahmad Akbar , Haas De Mello Aline , Szczesny Bartosz , Törö Gábor , Marcatti Michela , Druzhyna Nadiya , Liaudet Lucas , Tarantini Stefano , Salomao Reinaldo , Garcia Soriano Francisco , Szabo Csaba
Published: July 2019

Objective:

Activation of the constitutive nuclear and mitochondrial enzyme poly (ADP-ribose) polymerase (PARP) has been implicated in the pathogenesis of cell dysfunction, inflammation, and organ failure in various forms of critical illness. The objective of our study was to evaluate the efficacy and safety of the clinically approved PARP inhibitor olaparib in an experimental model of pancreatitis in vivo and in a pancreatic cell line subjected to oxidative stress in vitro. The preclinical studies were complemented with analysis of clinical samples to detect PARP activation in pancreatitis.

Methods:

Mice were subjected to cerulein-induced pancreatitis; circulating mediators and circulating organ injury markers; pancreatic myeloperoxidase and malondialdehyde levels were measured and histology of the pancreas was assessed. In human pancreatic duct epithelial cells (HPDE) subjected to oxidative stress, PARP activation was measured by PAR Western blotting and cell viability and DNA integrity were quantified. In clinical samples, PARP activation was assessed by PAR (the enzymatic product of PARP) immunohistochemistry.

Results:

In male mice subjected to pancreatitis, olaparib (3 mg/kg i.p.) improved pancreatic function: it reduced pancreatic myeloperoxidase and malondialdehyde levels, attenuated the plasma amylase levels, and improved the histological picture of the pancreas. It also attenuated the plasma levels of pro-inflammatory mediators (TNF-α, IL-1β, IL-2, IL-4, IL-6, IL-12, IP-10, KC) but not MCP-1, RANTES, or the anti-inflammatory cytokine IL-10. Finally, it prevented the slight, but significant increase in plasma blood urea nitrogen level, suggesting improved renal function. The protective effect of olaparib was also confirmed in female mice. In HPDE cells subjected to oxidative stress olaparib (1 μM) inhibited PARP activity, protected against the loss of cell viability, and prevented the loss of cellular NAD+ levels. Olaparib, at 1μM to 30 μM did not have any adverse effects on DNA integrity. In human pancreatic samples from patients who died of pancreatitis, increased accumulation of PAR was demonstrated.

Conclusion:

Olaparib improves organ function and tempers the hyperinflammatory response in pancreatitis. It also protects against pancreatic cell injury in vitro without adversely affecting DNA integrity. Repurposing and eventual clinical introduction of this clinically approved PARP inhibitor may be warranted for the experimental therapy of pancreatitis.
Influence of Oral Antibiotics Following Discharge on Organ Space Infections in Children With Complicated Appendicitis
Authors: Anandalwar Seema P. , Graham Dionne A. , Kashtan Mark A. , Hills-Dunlap Jonathan L. , Rangel Shawn J.
Published: July 2019

Objective:

To compare postdischarge rates of organ space infections (OSI) in children with complicated appendicitis between those receiving and not receiving oral antibiotics (OA) following discharge.

Summary Background Data:

Existing data regarding the clinical utility of extending antibiotic treatment following discharge in children with complicated appendicitis are limited.

Methods:

Retrospective cohort study of children ages 3 to 18 years undergoing appendectomy for complicated appendicitis from January 2013 to June 2015 across 17 hospitals participating in the NSQIP-Pediatric Appendectomy Pilot Collaborative (n = 711). Multivariable mixed-effects regression was used to compare postdischarge OSI rates between patients discharged with and without OA after propensity matching on demographic characteristics and disease severity. A subgroup analysis was performed for high-severity patients (multiple intraoperative findings of complicated disease or length of stay≥6 d).

Results:

The overall rates of OA utilization and OSI following discharge were 57.0% (hospital range: 3–100%) and 5.2% (range: 0–16.7%), respectively. In the propensity-matched analysis of the entire cohort, use of OA was associated with a 38% reduction in the odds of OSI following discharge compared with children not discharged on OA (4.2% vs. 6.6%, OR 0.62 [0.29, 1.31], P = 0.21). In the high-severity matched cohort (n = 324, 46%), use of OA was associated with a 61% reduction in the odds of OSI following discharge (4.3% vs 10.5%; OR 0.39 [0.15, 0.96], P = 0.04).

Conclusions:

Use of oral antibiotics following discharge may decrease organ space infections in children with complicated appendicitis, and those presenting with high-severity disease may be most likely to benefit.
Resection of Cavity Shave Margins in Stage 0–III Breast Cancer Patients Undergoing Breast Conserving Surgery
Authors: Dupont Elisabeth , Tsangaris Theodore , Garcia-Cantu Carlos , Howard-McNatt Marissa , Chiba Akiko , Berger Adam C. , Levine Edward A. , Gass Jennifer S. , Gallagher Kristalyn , Lum Sharon S. , Martinez Ricardo D. , Willis Alliric I. , Pandya Sonali V. , Brown Eric A. , Fenton Andrew , Mendiola Amanda , Murray Mary , Solomon Naveenraj L. , Senthil Maheswari , Ollila David W. , Edmonson David , Lazar Melissa , Namm Jukes P. , Li Fangyong , Butler Meghan , McGowan Noreen E. , Herrera Maria E. , Avitan Yoana P. , Yoder Brian , Walters Laura L. , McPartland Tara , Chagpar Anees B.
Published: July 2019

Objective:

Single-center studies have demonstrated that resection of cavity shave margins (CSM) halves the rate of positive margins and re-excision in breast cancer patients undergoing partial mastectomy (PM). We sought to determine if these findings were externally generalizable across practice settings.

Methods:

In this multicenter randomized controlled trial occurring in 9 centers across the United States, stage 0–III breast cancer patients undergoing PM were randomly assigned to either have resection of CSM (“shave” group) or not (“no shave” group). Randomization occurred intraoperatively, after the surgeon had completed their standard PM. Primary outcome measures were positive margin and re-excision rates.

Results:

Between July 28, 2016 and April 13, 2018, 400 patients were enrolled in this trial. Four patients (2 in each arm) did not meet inclusion criteria after randomization, leaving 396 patients for analysis: 196 in the “shave” group and 200 to the “no shave” group. Median patient age was 65 years (range; 29–94). Groups were well matched at baseline for demographic and clinicopathologic factors. Prior to randomization, positive margin rates were similar in the “shave” and “no shave” groups (76/196 (38.8%) vs. 72/200 (36.0%), respectively, P = 0.604). After randomization, those in the “shave” group were significantly less likely than those in the “no shave” group to have positive margins (19/196 (9.7%) vs. 72/200 (36.0%), P < 0.001), and to require re-excision or mastectomy for margin clearance (17/196 (8.7%) vs. 47/200 (23.5%), P < 0.001).

Conclusion:

Resection of CSM significantly reduces positive margin and re-excision rates in patients undergoing PM.