bluuebunny/crossref_metadata_2025 huggingface dataset:
Associations Between Office Location and Adiposity in Office Workers
Authors: Gay Jennifer L. , Buchner David M.
Published: August 2020

Objective:

Evaluate whether having to walk longer distances to common destinations within office buildings is associated with less adiposity and greater occupational physical activity.

Methods:

Distances between offices and amenities were measured for 108 office-based workers, as was body fat percentage, waist circumference, number of sedentary breaks at work, and duration and intensity of activity at work.

Results:

Being further away from the building entrance was correlated with lower body fat percentage. Greater distance from a participant's office to the copier was associated with smaller waist circumferences. Correlations were found between distance to the bathroom and work activity, and sedentary breaks with distance to the break room and distance from the printer or copier.

Conclusions:

Worksites interested in improving the health of their employees should consider how building design affects occupational physical activity and health.
Precarious Employment as Compared With Unemployment Reduces the Risk of Depression in the Elderly in Korea
Authors: Park Sungjin , Kang Mo-Yeol , Lee June-Hee
Published: August 2020

Objective:

To compare how depression develops in precarious employment and in unemployment, as how precarious jobs impact unemployment-related depression is relatively unknown.

Methods:

Using the 1st to 4th Korean Longitudinal Study of Aging survey data, 5638 older people were analyzed to measure depression incidence in relation to employment status. A Center for Epidemiological Studies-Depression Scale form was chosen to identify depression. Hazard ratios (HRs) and 95% confidence intervals (CIs) were derived from Cox proportional hazards models adjusted for a number of variables.

Results:

Unemployment-related depression risk was significantly higher than for precarious employment. Depression risk was significantly lower for male full-time permanent workers than precarious workers, but was not significantly different in women.

Conclusions:

To prevent the deterioration of mental health in the elderly, an extensive job promotion campaign including precarious work is required.
Quality Assurance During a Global Pandemic
Authors: Jones Ian F. , Lammers Daniel T. , Conner Jeffery R. , Holtestaul Torbjorg A. , Ieronimakis Nicholas , Caretti David , McClellan John M. , Eckert Matthew J. , Bingham Jason R.
Published: August 2020

Objective:

The proliferation of improvised masks during the COVID-19 pandemic has raised questions regarding filter effectiveness and safety. We sought to compare the effectiveness of commonly used improvised filter materials against N95 industry standards.

Methods:

Six different filter materials commonly used in the community were tested using both single- and multi-layer configurations with the TSI 8130 automated filter tester in accordance with National Institute for Occupational Safety and Health (NIOSH) standards for N95 respirators.

Results:

Only three of the tested filter material configurations met N95 parameters with regard to filtration efficiency and pressure drop across the filter material—the: True-high-efficiency particulate air (HEPA) filter, four-layer MERV 13 and 14 HVAC filters.

Conclusions:

Many proposed filter materials for improvised masks do not meet current industry standards and may pose safety and efficacy concerns. Care should be taken when selecting materials for this critical respirator component, particularly for health care workers or others at high risk for pathogen exposure.
Using Ecological Momentary Assessment to Examine the Effects of Duty Status on Acute Stress and Tiredness in Firefighters
Authors: Courtney Jimikaye B. , Lipsey Tiffany , Braun Barry , Henry Kim , Nelson Tracy L. , Li Kaigang
Published: August 2020

Objective:

Characterize firefighters’ acute stress and tiredness by duty status (ie, “off night/day,” “on night/day”).

Methods:

Thirty nine career firefighters completed three, eight-day smartphone-based ecological momentary assessment periods with seven surveys per day assessing stress and tiredness. Mixed-effects location scale models examined duty status effects on stress and tiredness.

Results:

Firefighters’ lowest stress and tiredness levels were when off-duty (β = 16.27 andβ = 24.71, respectively) and their highest levels were when on-duty (β = 24.47 andβ = 32.18, respectively). Within-subject effects of duty status accounted for a larger proportion of variability in stress and tiredness for all duty types, except for stress when “on-duty night/off-duty day.”

Conclusions:

Firefighters had more similar stress and tiredness outcomes when they were on-duty and less similar outcomes when off-duty. This could be due to firefighters having more similar experiences when they are on- versus off-duty.
Clinical Balance Testing to Screen for Patients With Vestibular Disorders: A Retrospective Case-control Study
Authors: Salah Mahadi , Van de Heyning Paul , De Hertogh Willem , Van Rompaey Vincent , Vereeck Luc
Published: August 2020

Objective:

Identify clinical screening tests to proficiently screen for patients with vestibular disorders.

Study design:

Retrospective case-control study.

Setting:

Tertiary referral center.

Patients:

318 healthy individuals and 331 subjects with vestibular disorders.

Interventions:

All subjects performed Romberg and Jendrassic maneuver with eyes closed (ROMJec), standing on foam with eyes open (SOFeo) and eyes closed (SOFec), Tandem Romberg with eyes open (TReo) and eyes closed (TRec), single leg stance with eyes open (SLSeo) and eyes closed (SLSec), Tandem gait (TG) and Timed Up and Go (TUG).

Main outcome measures:

Significant differences in performance on the balance tests.

Results:

For the age-group <40 years, TUG >6 seconds (OR 102.4; p <0.0001) and SLSec <30 seconds (OR 48.0; p <0.0001) proved to be the most predictive combination of testing (AUC 0.9; LR+ 15.8; LR− 0.2), with a positive predictive value (PPV) of 88.4%. For the age-group 40–60, TUG >7 seconds (OR 4.0; p = 0.0107) and TRec <30 seconds (OR 63.1; p < 0.0001) was the most predictive combination of tests (AUC 0.9 LR+ 6.0; LR− 0.1), with a PPV of 93.8%. For the age-group >60 the combination of TUG >8 seconds (OR 17.4; p < 0.0001) and SOFec <30 seconds (OR 10.4; p < 0.0001) was the most predictive (AUC 0.9 LR+ 6.3; LR− 0.2), with a PPV of 84.8%.

Conclusions:

Combinations of clinical tests are proposed to promptly screen for vestibular disorders in specific age groups. To interpret the results for the individual patient, the physician must take the history and the general examination into consideration.
Protein and physical activity in older persons
Authors: Yeung Suey S.Y. , Chan Ruth S.M. , Woo Jean
Published: August 2020

Purpose of review

The aim of this study was to highlight recent evidence on protein requirement and physical activity recommendations in older adults and their interrelationship.

Recent findings

Higher protein intake in older adults is beneficial for better physical function, reduced fracture risk, healthy ageing and lower mortality. However, the association between protein quality and health remains inconsistent. Higher physical activity is associated with a lower risk of physical dependence, frailty, cognitive impairment and mortality. Prospectively increasing or even sustaining physical activity can be protective against adverse health outcomes compared with decreasing physical activity. There is a synergistic protective effect of protein intake and physical activity on health. Data on the bidirectional link between protein intake and physical activity are scarce. Whether increasing physical activity can help to increase energy intake (and thus protein intake) and vice versa require further research.

The key role of protein intake and physical activity in optimizing health in older adults is well established. The synergistic effects of these two modifiable lifestyle factors strengthen the need to consider dietary and physical activity recommendations together. Future research may examine the bidirectional link between diet and physical activity, which could potentially be one of the strategies to increase the uptake of recommendations for protein intake and physical activity in older adults.
Cost-effectiveness of Abdominal Ultrasound Versus Magnetic Resonance Imaging for Pancreatic Cancer Screening in Familial High-Risk Individuals in Japan
Authors: Kowada Akiko
Published: August 2020

Objective

The aim of the study was to assess cost-effectiveness of abdominal ultrasound, magnetic resonance imaging, endoscopic ultrasound, computed tomography, positron emission tomography, and no screening for pancreatic cancer screening in familial high-risk individuals (HRIs).

Methods

We developed decision trees with Markov models for a hypothetical cohort of familial HRIs at the age of 50 year using a healthcare sector perspective and a lifetime horizon. Main outcomes were costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios.

Results

In a base-case analysis, abdominal ultrasound was the most cost-effective (US $11,035, 17.4875 QALYs). Magnetic resonance imaging yielded the best benefits. Cost-effectiveness was sensitive to the incidence of pancreatic cancer. Endoscopic ultrasound was more cost-effective than abdominal ultrasound when the incidence of pancreatic cancer was greater than 0.008 and under 0.016. Magnetic resonance imaging was more cost-effective than endoscopic ultrasound when the incidence of pancreatic cancer was greater than 0.016. Probabilistic sensitivity analysis using Monte-Carlo simulation for 10,000 trials demonstrated that abdominal ultrasound was cost-effective 76% of the time at a willingness-to-pay threshold of US $50,000/QALY gained.

Conclusions

Abdominal ultrasound is the most cost-effective and recommended for pancreatic cancer screening in familial HRIs in Japan. Evaluating the risk of pancreatic cancer among familial HRIs as a target for screening is significant.
Platelet Microparticles Regulate Neutrophil Extracellular Traps in Acute Pancreatitis
Authors: Qi Qinqin , Yang Bin , Li Huihui , Bao Junjun , Li Hongye , Wang Bingbing , Mei Qiao
Published: August 2020

Objective

This study aimed to explore the clinical significance of the increase of platelet microparticles (PMPs) in acute pancreatitis (AP).

Methods

Clinical data and plasma samples from patients with AP were collected, and healthy subjects were controls. The PMPs were detected by flow cytometry; meanwhile, the ability to promote neutrophil extracellular traps (NETs) formation was investigated. Neutrophils from healthy subjects were co-cultured with PMPs from AP patients. The NETs were visualized by confocal laser scanning microscopy. In the supernatant of cell co-culture, myeloperoxidase, neutrophil elastase, and histone H3 were detected by enzyme-linked immunosorbent assay.

Results

Patients with AP had elevated plasma levels of PMPs compared with controls; moreover, there were significantly higher PMPs levels in severe AP than mild AP and moderately severe AP. Healthy subjects' neutrophils were stimulated with PMPs from AP patients to release NETs. It was observed that NETs formed in AP group, but not in the controls. Correspondingly, there were higher levels of myeloperoxidase, neutrophil elastase, and histone H3 in AP group than in controls.

Conclusions

The level of PMPs is a positive correlation with AP severity, which may be related to PMPs-NETs interaction. Platelet microparticles may be a potential predictor of severe AP and promising novel therapeutic target for AP.
IKZF1 rs4132601 and rs11978267 Gene Polymorphisms and Acute Lymphoblastic Leukemia: Relation to Disease Susceptibility and Outcome
Authors: Mosaad Youssef M. , El-Ziny Magdy A. , Darwish Ahmad , Al-Harrass Mohammad , Abdmabood Suzy , Fawzy Iman M. , Sherif Doa M. , Yakoub Mostafa G. , Abdeltawab Hosam
Published: August 2020

(IKZF1) rs4132601 and rs11978267 are common gene polymorphisms and have been associated with the risk of acute lymphoblastic leukemia. However, these associations are less evident in races and/or ethnicities other than European and Hispanic. Therefore, we investigated the association between these single-nucleotide polymorphisms and acute lymphoblastic leukemia susceptibility and disease outcome. Real-time polymerase chain reaction typing was performed for IKZF1 rs4132601 and rs11978267 for 128 pediatric acute lymphoblastic leukemia (pALL), 45 adult acute lymphoblastic leukemia (aALL), and 436 healthy controls. The G allele-containing and G-containing genotypes (GG+GT) of rs4132601 were significantly higher in pALL (P=0.003, odds ratio [OR]=1.65, 0.009, OR=1.42, respectively) and aALL (P=0.016, OR=1.81 and 0.011, OR=1.61, respectively). However, the GG haplotype was associated with the risk of pALL (P=0.044), the GA haplotype was associated with the risk of aALL (P=0.007). In aALL, the GG genotype of rs4132601 was associated with absence of remission and poor overall survival (P=0.003 and 0.041, respectively). The IKZF1 rs4132601 single-nucleotide polymorphism can be considered a susceptibility risk factor for the development of pALL and aALL in the studied cohort of Egyptian patients. The GG genotype of IKZF1 rs4132601 may be a risk factor for poor outcome in aALL patients.
Bleeder With a Clot: Thrombosis Following Treatment of Bleeding in a Child With Severe Hemophilia B
Authors: Goh Mei Ching , Lam Joyce Ching Mei , Tan Ah Moy , Bhattacharyya Rajat
Published: August 2020

A 16-year-old boy with severe hemophilia B and minimal bleeding manifestations in his early childhood presented with gastrointestinal bleeding at 11 years of age. Following administration of prothrombin complex concentrate, he developed peripheral venous thrombosis and cerebral sinovenous thrombosis, posing a management dilemma. His cerebral sinovenous thrombosis resolved spontaneously, proving watchful waiting to be a useful strategy. He developed spontaneous intracranial bleed at 14 years of age for which he was treated with factor IX concentrate and commenced on prophylaxis. We discuss the factors contributing to genotype-phenotype dissonance in severe hemophilia and considerations before commencing prophylaxis in such cases.
Developing a Next-of-Kin Involvement Guide in Cancer Care—Results From a Consensus Process
Authors: Bergerød Inger J. , Braut Geir S. , Fagerdal Birte , Gilje Bjørnar , Wiig Siri
Published: August 2020

Background

In hospital cancer care, there is no set standard for next-of-kin involvement in improving the quality of care and patient safety. There is therefore a growing need for tools and methods that can guide this complex area.

Objective

The aim of this study was to present the results from a consensus-based participatory process of designing a guide for next-of-kin involvement in hospital cancer care.

Method

A consensus process based on a modified Nominal group technique was applied with 20 stakeholder participants from 2 Norwegian university hospitals.

Result

The participants agreed on the 5 most important priorities for hospital cancer care services when involving next-of-kin. The results showed that next-of-kin stakeholders, when proactively involved, are important resources for the patient and healthcare professionals in terms of contribution to quality and safety in hospitals. Suggested means of involving next-of-kin were closer interaction with external support bodies, integration in clinical pathways, adjusted information, and training healthcare professionals.

Conclusion

In this study, we identified topics and elements to include in a next-of-kin involvement guide to support quality and safety in hospital cancer care. The study raises awareness of the complex area of next-of-kin involvement and contributes with theory development and knowledge translation in an involvement guide tailored for use by healthcare professionals and managers in everyday clinical practice.

Implications for Practice

Service providers can use the guide to formulate intentions and make decisions with suggestions and priorities or as a reflexive tool for organizational improvement.
Improving Consumer Assessment of Health Care Providers and Systems Communication Scores in Hospice Care
Authors: Kincaid Rachael Brown
Published: August 2020

Although patient satisfaction scores have been used in the inpatient setting for more than a decade, they are new to the hospice and home care setting. Hospice organizations began tracking Consumer Assessment of Healthcare Providers & Systems (CAHPS) scores in 2017, and beginning in 2019, the scores became accessible by the public. The purpose of this quality improvement project was to determine whether improved communication techniques had a positive effect on CAHPS scores at an outpatient nonprofit hospice organization. The intervention was divided into 2 parts, improving communication among staff and improving education provided to patients and their caregivers. This pilot project was implemented over a 4-month period, and the CAHPS scores were compared with those from the 4 months before preceding implementation.
Firearm Injury From Hunting .30 Caliber Bullet Passing Through an Intermediate Target (Binoculars)
Authors: Smędra Anna , Sidelnik Przemysław , Goryca Wojciech , Berent Jarosław
Published: August 2020

This article presents the results of research relating to the ricocheting of hunting ammunition and the application of these results to the investigation of a specific gunshot death, which occurred during a hunt for boars. The scene and autopsy findings revealed that a bullet had first struck a pair of binoculars around the victim's neck before entering his body. As the investigation proceeded, however, questions were raised as to whether the shot was a direct one or a ricochet. The case was thus referred to forensic medicine experts for their opinion. Experiments were conducted, which demonstrated that, although test ammunition could ricochet, the rebound fragments possessed insufficient kinetic energy to pierce the binoculars. On the basis of the experiments, it was determined that the victim had been killed by a direct shot and that the bullet had pierced the intermediate target of the binoculars before entering his body. The possibility of a ricochet producing the injuries found, that is, the victim being struck with a bullet or fragments rebounding from an obstacle, was considered unlikely.
Cerebral Vascular Thrombosis Associated With Ulcerative Colitis and Primary Sclerosing Cholangitis
Authors: Crook Shannon M. , Quinton Reade A.
Published: August 2020

We report a case of a sudden death of a 23-year-old man with a history of ulcerative colitis and primary sclerosing cholangitis due to cerebral vascular thrombosis. He was found supine in bed with no signs of trauma or drug use. Three days before being found, he had complained of fever and excessive diarrhea. At autopsy, the brain was markedly edematous with diffuse subarachnoid hemorrhage over the left cerebral hemisphere. The vessels at the base of the brain were unremarkable, and there was no significant hemorrhage over the inferior surfaces. On sectioning, clotted blood was identified in the left frontal lobe and lateral ventricles. Microscopically, the left cerebral hemisphere showed extensive intraparenchymal hemorrhage, necrosis, and numerous thrombosed leptomeningeal vessels. Sections of the transverse and descending colon showed changes consistent with the history of ulcerative colitis.

Cerebral venous and sinus thrombosis represents approximately 1% of all strokes and is a known rare complication associated with inflammatory bowel disease (IBD). Symptoms of cerebral venous thrombosis are highly variable and may manifest as headache, focal neurological deficits, seizure, or encephalopathy. In addition to acquired hypercoagulability risk factors patients develop during active disease flares (eg, dehydration), studies suggest that IBD itself represents an independent risk factor for thrombosis. It is important for the forensic pathologist to consider thrombotic complications, particularly those in the cerebral venous system, as potential manifestations of known or undiagnosed IBD.
SHCBP1 Promotes the Progression of Esophageal Squamous Cell Carcinoma Via the TGFβ Pathway
Authors: Ren Chunhong , Zhou Zhengbo , Wang Xiuzhen , Hua Xu , Zou Muping , Zhang Xin
Published: August 2020

Esophageal cancer (EC) is known as a type of common malignant tumor, with the incidence ranking eighth worldwide. Because of the high metastasis of advanced EC, the total survival rate has been quite low. Esophageal squamous cell carcinoma (ESCC) is a main type of EC. Targeted therapy for ESCC has become a new direction; however, newly therapeutic targets are also badly needed. Shc SH2 domain-binding protein (SHCBP1) is located on 16q11.2, which is a downstream protein of the Shc adaptor. SHCBP1 participates in the regulation of several physiological and pathologic processes, such as cytokinesis. Recent studies have found that SHCBP1 was abnormally upregulated in multiple types of tumors, such as breast cancer and liver cancer, and that it affects the proliferation and motility of cancer cells in vitro. However, it remains unclear whether SHCBP1 is related to the progression of EC. Herein, we found the upregulation of SHCBP1 in human EC tissues. Our findings further demonstrated that SHCBP1 expression was related to the clinical features of ESCC patients. We found that SHCBP1 depletion inhibited the proliferation and motility of ESCC cells via the transforming growth factor β pathway and that it suppressed the growth of tumors in mice. We, therefore, concluded that SHCBP1 could serve as a promising EC molecular target.
Adenomatoid Tumor: A Review of Pathology With Focus on Unusual Presentations and Sites, Histogenesis, Differential Diagnosis, and Molecular and Clinical Aspects With a Historic Overview of Its Description
Authors: Karpathiou Georgia , Hiroshima Kenzo , Peoc’h Michel
Published: August 2020

Adenomatoid tumors have been described almost a century ago, and their nature has been the subject of debate for decades. They are tumors of mesothelial origin usually involving the uterus, the Fallopian tubes, and the paratesticular region. Adenomatoid tumors of the adrenal gland, the liver, the extragenital peritoneum, the pleura, and the mediastinum have been rarely reported. They are usually small incidental findings, but large, multicystic and papillary tumors, as well as multiple tumors have been described. Their pathogenesis is related to immunosuppression and to TRAF7 mutations. Despite being benign tumors, there are several macroscopic or clinical aspects that could raise diagnostic difficulties. The aim of this review was to describe the microscopic and macroscopic aspects of adenomatoid tumor with a special focus on its differential diagnosis and pathogenesis and the possible link of adenomatoid tumor with other mesothelial lesions, such as the well-differentiated papillary mesothelioma and the benign multicystic mesothelioma, also known as multilocular peritoneal cysts.
Malignant Mesothelioma of the Peritoneum in Women
Authors: Malpica Anais , Euscher Elizabeth D. , Marques-Piubelli Mario L. , Ferrufino-Schmidt Maria C. , Miranda Roberto N. , Sams Ralph , Royal Richard E. , Raghav Kanwal P.S. , Fournier Keith F. , Ramalingam Preetha
Published: August 2020

Malignant mesothelioma of the peritoneum in women is an uncommon tumor. In this study, we present the clinicopathologic features of 164 such cases seen in our institution over a period of 42 years (1974-2016). Clinical information, pathologic findings, immunohistochemical results, and follow-up were recorded. Hematoxylin and eosin–stained slides were reviewed in all cases. Patients ranged in age from 3 to 85 years, median: 49 years. Most patients presented with abdominal/pelvic pain, although some were asymptomatic, presented with paraneoplastic syndromes or cervical lymphadenopathy. Overall, 9% of patients had a history of direct or indirect exposure to asbestos. In total, 31% and 69% of patients had either a personal or family history of other tumors; most of these tumors are currently recognized as part of a syndrome. Genetic testing information was available in 5 patients: BAP-1 germline mutation (1), type 2 neurofibromatosis (1), Lynch syndrome (1), McCune-Albright syndrome (1), no BAP-1 or TP53 mutation (1). Most cases had gross and microscopic features typical of malignant mesothelioma of the peritoneum in women; however, some had confounding features such as gelatinous appearance, signet ring or clear cells, and well-differentiated papillary mesothelioma-like areas. Calretinin and WT-1 were the markers more frequently expressed, and up to 23% of the cases showed PAX-8 expression. Patients’ treatments predominantly included: chemotherapy, cytoreductive surgery, and hyperthermic intraperitoneal chemotherapy. On multivariate analysis, the predominance of deciduoid cells, nuclear grade 3, and the absence of surgical treatment were associated with worse overall survival (OS). For all patients, the 3- and 5-year OS were 74.3% and 57.4%, respectively. The 3- and 5-year OS for patients treated with cytoreductive surgery, and hyperthermic intraperitoneal chemotherapy were 88.9% and 77.8%, respectively.
Postchemotherapy Histiocyte-rich Pseudotumor Mimicking Residual Lymphoma
Authors: Fang Hong , Chuang Hubert H. , Strati Paolo , Hu Shimin , Shuai Wen , Medeiros L. Jeffrey , Wang Wei
Published: August 2020

Postchemotherapy histiocyte-rich pseudotumor is a rare event in lymphoma patients and can cause elevated metabolic activity on positron emission tomography-computed tomography scan mimicking residual tumor. Here, we reported 11 lymphoma cases showing mass-like lesions with increased fluorodeoxyglucose uptake after chemotherapy. These postchemotherapy lesions occurred in various anatomic sites including spleen, mediastinum, lymph node, and other tissue locations, concerning for refractory or residual lymphoma. Their median size was 2.7 cm (range, 1.4 to 7.7 cm) and the median standardized uptake value on positron emission tomography-computed tomography was 10.6 (range, 5.2 to 13.8). Histologic examination of these lesions demonstrated reactive changes mainly composed of histiocyte-rich proliferation without viable lymphoma. Fat necrosis, cholesterol cleft, and calcium deposit were also commonly observed. After biopsies, 3 patients received additional chemotherapy, 2 had stem cell transplant with adjuvant chemotherapy or radiation, 1 had surgical excision, and the remaining 5 patients did not receive any further treatment. Follow-up imaging studies showed the resolved or decreased fluorodeoxyglucose activities in all patients including those without additional treatments, consistent with benign/reactive nature of these pseudotumor lesions. This study illustrates postchemotherapy mass-like lesions with elevated metabolic activity do not always represent residual disease and provides awareness of correlation between radiologic and histologic features of these lesions to avoid misinterpretation and overtreatment of lymphoma patients after chemotherapy.
Chronic Intervillositis of Unknown Etiology
Authors: Sauvestre Fanny , Mattuizzi Aurélien , Sentilhes Loïc , Poingt Marion , Blanco Patrick , Houssin Clémence , Carles Dominique , Pelluard Fanny , Andre Gwenaëlle , Lazaro Estibaliz
Published: August 2020

Chronic intervillositis of unknown etiology (CIUE) is a rare placental disease characterized by intervillous infiltration of maternal macrophages and associated with poor pregnancy outcomes and a high risk of recurrence in subsequent pregnancies. Its pathophysiology remains unclear and prognostic factors have not yet been established. In addition, clear relationships between the histologic extent of lesions and the severity of perinatal outcomes have not been demonstrated. Our objectives were to validate a CIUE classification system based on the gradation of macrophagic infiltration of the intervillous space, and to attempt to correlate these results with perinatal outcomes. For this multicenter retrospective study, 3 pathologists reviewed all cases diagnosed with “intervillositis” between 1997 and 2018. Confirmed CIUE cases were semiquantitatively graded based on the percentage of macrophagic infiltrate in the intervillous space: grade 1 (5% to 10%), grade 2 (10% to 50%), and grade 3 (>50%). Multiple pregnancies and pregnancies with medical follow-up completed outside of the study centers were excluded. In total, 122 cases of CIUE in 102 patients were included in the study. Microscopic classification based on one criterion was easy to perform, and interobserver correlation was good. Grade 3 infiltration was strongly associated with poor perinatal outcomes and fetal growth restriction (P<0.0001). After delivery, only 16.1% of newborns from the grade 3 CIUE group were alive, compared with 59% from the grade 2 and 86.5% from the grade 1 group (P=0.0002). Recurrence risk was associated with CIUE gradation of the index case (P=0.004), with 95% of recurrent CIUE cases being from patients with grades 2 and 3 CIUE. In this study, conducted with the largest CIUE cohort to date, a classification based only on the degree of macrophagic infiltration of the intervillous space was validated, and this classification was shown to be strongly associated with poor perinatal outcomes and risk of recurrence.
Immunohistochemical Characterization of Giant Cell Tumor of Bone Treated With Denosumab
Authors: Kerr Darcy A. , Brcic Iva , Diaz-Perez Julio A. , Shih Angela , Wilky Breelyn A. , Pretell-Mazzini Juan , Subhawong Ty K. , Nielsen G. Petur , Rosenberg Andrew E.
Published: August 2020

Giant cell tumor of bone is a locally aggressive, rarely metastasizing neoplasm. Evidence suggests that the neoplastic cells may be osteoblastic in differentiation. Standard treatment is surgical removal, but medical therapy with denosumab, an inhibitor of receptor activator of nuclear factor-κβ ligand, has become a component of patient management in select cases. Denosumab-treated giant cell tumor of bone (DT-GCTB) shows drastic morphologic changes including the presence of abundant bone. To further determine the relationship of the neoplastic cells to osteoblast phenotype, we performed a morphologic and immunohistochemical study on a series of DT-GCTB. Cases of DT-GCTB were retrieved from surgical pathology files, available slides were reviewed, and immunohistochemistry for H3.3 G34W, SATB2, and p63 was performed. The cohort included 31 tumors from 30 patients (2:3 male:female), ages 15 to 73 years (median=36 y). The morphology of post–denosumab-treated tumors ranged from tumors composed of an abundant bone matrix with few spindle cells to spindle cell-predominant tumors. Five had focal residual classic CGTB, and 2 manifested mild nuclear atypia. The majority expressed all markers: 86.2% for H3.3 G34W, 96.7% for SATB2, and 100% for p63. All markers stained the various tumor components including spindle cells and the cells on the surface of and within the treated tumor bone matrix. Most markers were also positive in reactive-appearing woven bone adjacent to tumor: 84.6% for H3.3 G34W, 100% for SATB2, and 68% for p63. These findings suggest that denosumab treatment of giant cell tumor of bone results in osteoblastic differentiation with bone production.
Sclerosing Epithelioid Fibrosarcoma
Authors: Warmke Laura M. , Meis Jeanne M.
Published: August 2020

Since its original description in 1995, the concept of sclerosing epithelioid fibrosarcoma (SEF) as a distinctive tumor has evolved in the literature. Subsequent studies suggested that the presence of low grade fibromyxoid sarcoma (LGFMS)-like zones, occasional FUS gene rearrangements, and immunoreactivity for MUC4 all pointed to a close inter-relationship with LGFMS; however, more recent studies showed that SEF is genetically distinct from LGFMS with predominantly EWSR1-CREB3L1 fusion and complex secondary genomic alterations. To better understand the relationship between these tumors, we studied 51 cases of SEF, the largest reported series to date, and directly compared them to a previously published series of LGFMS from the same institution. The male-to-female ratio was 1.4:1 with a median age of 45 years. Tumors occurred primarily in the lower extremity (12), intra-abdominal area/visceral organs (9) and chest wall/paraspinal region (9) with a median size of 8.2 cm. The median follow-up was 49 months in 45 patients: 12 developed local recurrences and 36 developed metastases, mainly to lung and bone. Molecular studies showed EWSR1 gene rearrangement in 13 cases, 3′ deletion of EWSR1 in 6, monosomy for EWSR1 in 2; FUS gene rearrangements in 3; EWSR1-CREB3L1 fusion in 7; EWSR1-CREB3L2 fusion in 1; and YAP1-KMT2A fusion in 2. Overall survival of SEF was significantly less compared with LGFMS (P≤0.0001). These results indicate that SEF is a distinct sarcoma that behaves more aggressively than LGFMS with a shorter survival, higher metastatic rate, and greater propensity to involve deep soft tissue and bone.
Upper Limb Associated Reactions
Authors: Kahn Michelle B. , Williams Gavin , Mentiplay Benjamin F. , Bower Kelly J. , Olver John , Clark Ross A.
Published: August 2020

Objective

The aims of this study were to (1) evaluate the relationships between stationary and dynamic associated reaction (AR) tests in people with acquired brain injury using surface electromyography (sEMG) muscle activity and three-dimensional motion analysis kinematic measures and (2) assess the test-retest reliability of sEMG and seated tests of ARs.

Design

Forty-two adults with acquired brain injury underwent AR testing with seated contralateral maximal voluntary isometric contraction tests and walking (self-selected and fast speeds). Associated reaction measurements included biceps brachii sEMG, elbow goniometry, and three-dimensional motion analysis kinematics during walking. Pearson correlations evaluated the relationships between seated and dynamic walking AR tests and between muscle activity and kinematic measures. Chronic participants were reassessed 1 wk later for reliability.

Results

A strong (r = 0.65) and moderate (r = 0.53) relationship existed for biceps brachii sEMG during seated and walking tests at self-selected and fast walk, respectively. A weak to moderate relationship existed between biceps brachii sEMG and kinematics during walking and between seated and walking measures of ARs (r = 0.23–0.53). All tests had strong to very strong test-retest reliability (intraclass correlation coefficients, >0.78).

Conclusion

Seated contralateral maximal voluntary isometric contraction tests correlate only weakly to moderately with AR walking kinematics and moderately to strongly with biceps brachii activation during walking. Moderate relationships exist between sEMG and kinematics, indicating that they may provide different information for ARs.
Demographics and Durable Medical Equipment Needs of Persons With Disabilities in a Charitable Rehabilitation Clinic
Authors: Martinez Claudia I. , Sanchez Ashley N. , Stampas Argyrios , Woo Jean , Verduzco-Gutierrez Monica
Published: August 2020

This study characterizes the demographics and durable medical equipment needs of persons with disabilities to improve utilization and management of resources at a philanthropic rehabilitation clinic. Paper charts from all encounters between 2013 and 2018 were reviewed. Data collected include sex, age, ethnicity, insurance status, diagnoses, and durable medical equipment requested/received. Paper charts that were incomplete or illegible were excluded. Among 763 individuals, there were 1157 encounters for durable medical equipment requests. Forty-six percent of individuals were uninsured. Thirty-seven percent had federal insurance such as Medicare or Medicaid, and 6% private insurance. Fifty-five percent of individuals were Hispanic, 28% African American, and 14% White. Fifty-six percent of encounters were with individuals with a neurological diagnosis, 18% medical diagnosis, 17% musculoskeletal/autoimmune diagnosis, 6% amputation diagnosis, and 3% cancer diagnosis. Of the 2680 items distributed, 34% were wheelchair parts and repair, 30% personal hygiene/incontinence supplies, 25% mobility equipment, and 11% bathroom equipment. Of the 513 unmet items requested, 49% were mobility equipment, 24% wheelchair parts and repair, 17% personal hygiene/incontinence supplies, and 11% bathroom equipment. More than a third (43%) of durable medical equipment requests were from individuals with either private insurance or federal payers, which implies lack of adequate coverage on durable medical equipment to maintain mobility and independence.
Clinical and Anatomical Considerations for Management of a Complete Tear of the Distal Rectus Femoris Myotendinous Junction
Authors: Holder Eric K. , Rose Alysha , Haims Andrew
Published: August 2020

The knee extensor mechanism is a highly complex multilayered and reinforced structure. Quadriceps muscle injuries are considered to be common, particularly among athletes; however isolated rectus femoris injuries involving the distal myotendinous junction are considered to be exceedingly rare with very few case reports published to date. Thus, the presentation and diagnosis of this injury can be elusive and treatment is nonuniform. There is limited literature published advocating both nonsurgical and surgical management. We illustrate the clinical and radiologic presentation of a traumatic, nonsport-related distal rectus femoris muscle injury treated operatively. The presentation of this injury along with anatomical and clinical considerations is portrayed in detail. This case report contributes to the sparse literature regarding this injury and delineates management considerations.
Shock Severity and Hospital Mortality In Out of Hospital Cardiac Arrest Patients Treated With Targeted Temperature Management
Authors: Tabi Meir , Burstein Barry J. , Ahmed Abdelrahman , Dezfulian Cameron , Kashani Kianoush B. , Jentzer Jacob C.
Published: August 2020

Background:

Shock in patients resuscitated after out of hospital cardiac arrest (OHCA) is associated with an increased risk of mortality. We sought to determine the associations between lactate level, mean arterial pressure (MAP), and vasopressor/inotrope doses with mortality.

Methods:

Retrospective cohort study of adult patients with OHCA of presumed cardiac etiology treated with targeted temperature management (TTM) between December 2005 and September 2016. Multivariable logistic regression was performed to determine predictors of hospital death.

Results:

Among 268 included patients, the median age was 64 (55, 71.8) years, including 27% females. OHCA was witnessed in 89%, OHCA rhythm was shockable in 87%, and bystander CPR was provided in 64%. Vasopressors were required during the first 24 h in 60%. Hospital mortality occurred in 104 (38.8%) patients. Higher initial lactate, peak Vasoactive-Inotropic Score (VIS), and lower mean 24-h MAP were associated with higher hospital mortality (all P < 0.001). After multivariable regression, both higher initial lactate (adjusted OR 1.15 per 1 mmol/L higher, 95% CI 1.00–1.31, P = 0.03) and higher peak VIS (adjusted OR 1.20 per 10 units higher, 95% CI 1.10–1.54, P = 0.003) were associated with higher hospital mortality, but mMAP was not (P = 0.92). However, patients with a mMAP < 70 mm Hg remained at higher risk of hospital mortality after multivariable adjustment (adjusted OR 9.30, 95% CI 1.39–62.02, P = 0.02).

Conclusions:

In patients treated with TTM after OHCA, greater shock severity, as reflected by higher lactate levels, mMAP < 70 mmHg, and higher vasopressor requirements during the first 24 h was associated with an increased rate of hospital mortality.
Fibrinolysis Shutdown and Thrombosis in a COVID-19 ICU
Authors: Creel-Bulos Christina , Auld Sara C. , Caridi-Scheible Mark , Barker Nicholas A. , Friend Sarah , Gaddh Manila , Kempton Christine L. , Maier Cheryl L. , Nahab Fadi , Sniecinski Roman
Published: August 2020

The coronavirus disease (COVID-19) pandemic has threatened millions of lives worldwide with severe systemic inflammation, organ dysfunction, and thromboembolic disease. Within our institution, many critically ill COVID-19-positive patients suffered major thrombotic events, prompting our clinicians to evaluate hypercoagulability outside of traditional coagulation testing.

We determined the prevalence of fibrinolysis shutdown via rotational thromboelastometry (ROTEM, Instrumentation Laboratories, Bedford, Mass) in patients admitted to the intensive care unit over a period of 3 weeks. In 25 patients who had a ROTEM test, we found that 11 (44%) met criteria for fibrinolysis shutdown. Eight of 9 (73%) of the VTE patients met criteria for fibrinolysis shutdown.

Given the high rate of fibrinolysis shutdown in these patients, our data support using viscoelastic testing to evaluate for the presence of impaired fibrinolysis. This may help identify patient subsets who might benefit from the administration of fibrinolytics.
Mid-term Outcomes of Laparoscopic Total Cystectomy Versus Open Surgery for Complicated Liver Hydatid Cysts
Authors: Maitiseyiti Abulaihaiti , Ma Zhigang , Meng Yuan , Tian Guanglei , Kalifu Baheti , Lu Shuang , Chen Xiong
Published: August 2020

Background:

Total cystectomy is a challenging procedure in patients with complicated liver hydatid cysts (HCs). This study aimed to evaluate the feasibility and safety of laparoscopic total cystectomy in patients with complicated liver HCs.

Methods:

Prospectively collected clinical data of 50 consecutive patients, who underwent laparoscopic procedures for complicated liver HCs between January 2017 and January 2019, were retrospectively analyzed. One hundred patients who underwent open procedures were compared with the laparoscopic group in terms of perioperative outcomes during the 1-year follow-up period.

Results:

Conversion to open surgery occurred in 1 (2%) case. The number of single and multiple lesions and the size of HCs were similar between the 2 groups (P>0.05). Sixty-six percent of patients underwent total cystectomy, 10% subtotal cystectomy, and 24% hepatectomy in the laparoscopic group (P>0.05). Decompression and hepatic inflow occlusion were performed in high-risk cases. No differences were noted in average blood loss volume, and transfusion rate between the 2 groups. Postoperative recovery in the laparoscopic group was significantly shorter than that in the open group. There was no difference in the incidence of postoperative complications between the laparoscopic and open groups. No recurrence or death was observed in either group during this period.

Conclusions:

Laparoscopic total cystectomy was a curative and safe surgical approach to the treatment of complicated HC with favorable mid-term outcomes. Subtotal cystectomy combined with decompression is the preferred option for patients with high surgical risk(s). However, long-term outcomes need to be validated in prospective studies with larger sample sizes and prolonged follow-up.
Laparoscopic Complete Mesocolic Excision Versus Noncomplete Mesocolic Excision: A Systematic Review and Meta-analysis
Authors: Dai Qiaoqiong , Tu Shiliang , Dong Quanjin , Chen Bingchen
Published: August 2020

Background:

Complete mesocolic excision (CME) emphasizes sharp dissection along the mesocolon plane and ligation of the supplying vessels at their origin. Although laparoscopic CME is reported to be feasible and safe, the benefit of laparoscopic CME over noncomplete mesocolic excision (NCME) remains unclear. This meta-analysis aimed to compare the safety, quality, and effect of laparoscopic CME with NCME.

Materials and Methods:

A systematic literature search with no limits was performed in PubMed, Embase, and Web of Science on March 27, 2020. Studies comparing laparoscopic CME with NCME were enrolled. Outcomes of interests included intraoperative, pathologic, postoperative, and survival outcomes.

Results:

Seven studies (5 articles and 2 conference abstracts) published between 2015 and 2020 with a total of 1595 patients (742 by CME and 853 by NCME) were enrolled. Compared with NCME, laparoscopic CME was associated with less intraoperative blood loss [P<0.001, weighted mean difference (WMD)=−12.01, 95% confidence interval (CI): −13.56 to −10.45, I
2=44%], more harvested lymph nodes (P<0.001, WMD=6.50, 95% CI: 3.57-9.42, I
2=89%), longer length of specimens (P=0.004, WMD=3.57, 95% CI: 1.12-6.03, I
2=93%), longer distance from tumor to high tie (P<0.001, WMD=1.36, 95% CI: 0.87-1.85, I
2=76%), and longer distance from nearest bowel wall to high tie (P<0.001, WMD=1.36, 95% CI: 0.87-1.85, I
2=85%). No differences were observed in terms of operative time, postoperative complications, wound infection, ileus, proximal, and distal resection margin or disease-free survival between 2 groups.

Conclusions:

The currently limited evidences suggest that laparoscopic CME can slightly decrease intraoperative blood loss and improve specimen quality, but its safety and survival benefits need to be further studied. High-quality evidences are needed before laparoscopic CME can be recommended as the standard procedure for colon cancer surgery.
Magnetic Sphincter Augmentation: Poor Consensus Among Experts Regarding Key Technical Aspects of Implantation
Authors: Leeds Steven G. , Ward Marc A.
Published: August 2020

Background:

Magnetic sphincter augmentation (MSA) of the lower esophageal sphincter is an effective alternative to Nissen fundoplication for the treatment of gastroesophageal reflux disease. Surgeons must be certified in patient selection, adequate mediastinal dissection, device sizing, and device implantation. This certification process is intended to ensure optimal outcomes and patient safety; however, for many key technical aspects of MSA, proper performance has not been clearly defined. The purpose of this study is to determine how often surgical experts agree on the technical aspects of the MSA procedure.

Materials and Methods:

A 12-question survey investigated various technical aspects of the MSA procedure. The survey was sent to all certified MSA surgical proctors. Consensus on individual questions was defined as ≥70% agreement among the responding surgeons.

Results:

The survey was sent to 37 certified MSA surgical proctors, 24 of whom responded (65%). The mean number of MSA procedures performed by the responders was 210. There was consensus on 4 of the 12 questions. The consensus was achieved indicating it is safe for MSA implantation in any size hiatal hernia, and that tension on the hiatal repair is not a factor to implant the MSA device. There was no consensus for 3 mediastinal dissection questions and only consensus on 2 of the 5 questions regarding MSA implantation. Once the device is implanted, there was no consensus for the appearance of the MSA device.

Conclusions:

There is a need for procedure standardization to improve teaching and to maintain excellent efficacy and safety outcomes when the device is used in the community.