bluuebunny/crossref_metadata_2025 huggingface dataset:
Portal Vein Thrombosis After Total Pancreatectomy and Islet Autotransplant
Authors: Robbins Alexandria J. , Skube Mariya E. , Bellin Melena D. , Dunn Ty B. , Chapman Scott A. , Berry K. Louise , Lusczek Elizabeth , Beilman Gregory J.
Published: November 2019

Objectives

To determine the rate of portal vein thrombosis (PVT) based on pharmacologic prophylaxis protocol and the impact of PVT on islet graft function after total pancreatectomy with islet autotransplantation (TPIAT).

Methods

We compared the incidence of PVT, postsurgical bleeding, and thrombotic complications in patients undergoing TPIAT between 2001 and 2018 at the University of Minnesota who received either unfractionated heparin (UFH) or enoxaparin for postoperative PVT prophylaxis. Six-month and 1-year graft function was compared between patients who developed PVT and those who did not.

Results

Twelve patients (6.6%) developed a PVT, which resolved by 6 months after TPIAT in 10 patients. There was no statistically significant difference in PVT rate between patients who received UFH or enoxaparin for prophylaxis (P = 0.54). Patients who received enoxaparin developed other thrombotic complications more often (6% vs 0%, P = 0.02). Islet graft function did not differ in patients who developed PVT versus those who did not.

Conclusions

There was no difference between enoxaparin or UFH prophylaxis in preventing PVT, but there may be a higher incidence of other thrombotic complications with enoxaparin. In the setting of routine screening and anticoagulation therapy, PVT is a self-limited process.
Systematic Review and Meta-analysis of Minimally Invasive Pancreatectomies for Solid Pseudopapillary Neoplasms of the Pancreas
Authors: Tan Hwee Leong , Syn Nicholas , Goh Brian K. P.
Published: November 2019

Objectives

We report the first systematic review and meta-analysis on minimally invasive pancreatectomy (MIP) for solid pseudopapillary neoplasms (SPPN) of the pancreas.

Methods

A systematic review of all studies reporting patient characteristics and outcomes of MIP for SPPN was conducted.

Results

We reviewed 27 studies comprising 149 patients with SPPN managed via MIP. Five were comparative retrospective cohort studies, comprising 46 and 60 patients in the minimally-invasive and open groups, respectively. Tumor size was smaller in the minimally-invasive group (mean difference, −2.20; 95% confidence interval (CI), −3.09 to −1.32; P < 0.001). The MI group had lower intraoperative blood loss (mean difference, −180.19; 95% CI, −344.28 to −16.09; P = 0.03) and transfusion requirement (relative risk, 0.24; 95% CI, 0.06–0.94; P = 0.04), and a shorter time to diet (mean difference, −2.99; 95% CI, −3.96 to −2.03; P < 0.001) and length of stay (mean difference, −3.61; 95% CI, −6.98 to −0.24; P = 0.04). There was no significant difference in operating time, margin positivity, postoperative morbidity, and postoperative pancreatic fistula rates.

Conclusions

Minimally invasive pancreatectomy for SPPN is associated with decreased intraoperative blood loss and transfusion requirements and a shorter postoperative time to diet and hospital stay.
Evaluation of Phase II Trial Design in Advanced Pancreatic Cancer
Authors: Tang Monica , Chen Julia , Goldstein David , Links Matthew , Lord Sarah , Marschner Ian , Simes Robert J. , Lee Chee K.
Published: November 2019

Objectives

We evaluated how well phase II trials in locally advanced and metastatic pancreatic cancer (LAMPC) meet current recommendations for trial design.

Methods

We conducted a systematic review of phase II first-line treatment trial for LAMPC. We assessed baseline characteristics, type of comparison, and primary end point to examine adherence to the National Cancer Institute recommendations for trial design.

Results

We identified 148 studies (180 treatment arms, 7505 participants). Forty-seven (32%) studies adhered to none of the 5 evaluated National Cancer Institute recommendations, 62 (42%) followed 1, 31 (21%) followed 2, and 8 (5%) followed 3 recommendations. Studies varied with respect to the proportion of patients with good performance status (range, 0%–80%) and locally advanced disease (range, 14%–100%). Eighty-two (55%) studies concluded that investigational agents should progress to phase III testing; of these, 24 (16%) had documented phase III trials. Three (8%) phase III trials demonstrated clinically meaningful improvements for investigational agents. One of 38 phase II trials that investigated biological investigational agents was enriched for a biomarker.

Conclusions

Phase II trials do not conform well to current recommendations for trial design in LAMPC.
Rising Prevalence of Opioid Use Disorder and Predictors for Opioid Use Disorder Among Hospitalized Patients With Chronic Pancreatitis
Authors: Bilal Mohammad , Chatila Ahmed , Siddiqui Mohamed Tausif , Al-Hanayneh Muhannad , Shah Aun Raza , Desai Madhav , Wadhwa Vaibhav , Parupudi Sreeram , Casey Brenna W. , Krishnan Kumar , Hernandez-Barco Yasmin G.
Published: November 2019

Objectives

We aimed to evaluate the prevalence, impact, and predictors of opioid use disorder (OUD) in hospitalized chronic pancreatitis (CP) patients.

Methods

A retrospective cohort study was performed using the National Inpatient Sample database from 2005 to 2014. Patients with a primary diagnosis of CP and OUD were included. The primary outcome was evaluating the prevalence and trend of OUD in patients hospitalized with CP. Secondary outcomes were to (1) assess the impact of OUD on health care resource utilization and (2) identify predictors of OUD in hospitalized CP patients.

Results

A total of 176,857 CP patients were included, and OUD was present in 3.8% of patients. The prevalence of OUD in CP doubled between 2005 and 2014. Patients with CP who had OUD were found to have higher mean length of stay (adjusted mean difference, 1.2 days; P < 0.001) and hospitalization costs (adjusted mean difference, US $1936; P < 0.001). Independent predictors of OUD in CP patients were obesity, presence of depression, and increased severity of illness.

Conclusions

Opioid use disorder–related diagnoses are increasing among CP patients and are associated with increased health care resource utilization. Our study identifies patients at high-risk for OUD whose pain should be carefully managed.
Reducing Pancreatic Fibrosis Using Antioxidant Therapy Targeting Nrf2 Antioxidant Pathway
Authors: Kojayan Greg Garo , Alizadeh Reza Fazl , Li Shiri , Ichii Hirohito
Published: November 2019

Chronic pancreatitis is the progressive inflammation of the pancreas resulting in the irreversible damage of pancreatic structure and function by means of fibrosis. Chronic pancreatitis is most commonly caused by alcohol consumption, although the direct molecular etiology is unknown. Recent studies suggest oxidative stress as a catalyst for pancreatic stellate cell activation leading to the deposition of collagenous extracellular matrix causing pancreatic fibrosis. We review the effect of oxidative stress on pancreatic fibrogenesis and indicate the molecular pathways involved in preventing oxidant-related cell damage. Likewise, we summarize existing antioxidative therapies for chronic pancreatitis and discuss a novel nuclear factor erythroid 2–related factor 2 activator, dimethyl fumarate, and its potential to reduce fibrogenesis by downregulating pancreatic stellate cell activation.
Activation of the Nuclear Factor-kappa B Signaling Pathway Damages the Epithelial Barrier in the Human Pancreatic Ductal Adenocarcinoma Cell Line HPAF-II
Authors: Su Zhou , Gong Yahui , Yang Huiying , Deng Dehai , Liang Zhihai
Published: November 2019

Objectives

Injury of the pancreatic duct epithelial barrier plays a critical role in the development of acute pancreatitis. The activity of the nuclear factor-kappa B (NF-κB) pathway is involved in the disruption of the pancreatic duct epithelial barrier. This study investigated how NF-κB impacts the dysfunction of the pancreatic duct epithelial barrier.

Methods

A human pancreatic ductal adenocarcinoma cell line was treated with tumor necrosis factor-alpha (TNF-α) and pyrrolidine dithiocarbamate. The expression levels of p65 and p-p65 were detected to evaluate NF-κB activity. Tricellulin (TRIC) expression levels were measured to assess the change in tight junction (TJ)-related proteins. The expression and localization of myosin light chain kinase (MLCK) were investigated. The structure of TJs and monolayer permeability were also examined.

Results

NF-κB was activated by TNF-α and suppressed by pyrrolidine dithiocarbamate. Activation of NF-κB upregulated the expression levels of TRIC and MLCK. Broadened TJs were observed after NF-κB was activated. Lower monolayer permeability was observed when NF-κB was suppressed.

Conclusions

Activation of the NF-κB pathway induced by TNF-α leads to increased TRIC and MLCK expression, resulting in broadened TJs and high permeability, which contribute to damage to the pancreatic duct epithelial barrier.
Adrenal Insufficiency in Children With Eosinophilic Esophagitis Treated With Topical Corticosteroids
Authors: Bose Paroma , Kumar Sanjay , Nebesio Todd D. , Li Chuwen , Hon Emily C. , Atkins Dan , Furuta Glenn T. , Gupta Sandeep K.
Published: November 2019

Objectives:

The aim of the study was to identify practices of gastroenterologists screening for adrenal insufficiency (AI) and report prevalence of AI in children with eosinophilic esophagitis (EoE) treated with topical corticosteroids (TCS); compare serum dehydroepiandrosterone sulfate (DHEA‐S) levels to morning serum cortisol (MSC) levels as screening tool for AI.

Methods:

A multipart study was conducted. In part 1, a survey about screening practices for AI in children with EoE on TCS was sent to gastroenterologists belonging to a PedsGI listserv and to EoE consortia. In part 2, children with EoE on TCS for ≥6 months were prospectively screened for AI with MSC levels. For subjects with a MSC level of <10 μg/dL, a repeat MSC level and/or confirmatory adrenocorticotropic hormone (ACTH) stimulation testing was offered. AI was defined by peak serum cortisol level <18 μg/dL. In part 3, DHEA‐S levels were drawn with MSC levels.

Results:

Seven percent (16/238) of gastroenterologists screened for AI. Providers in EoE consortia were more likely to screen than nonconsortia providers [9/21(43%) vs 7/217(3%); P = 0.0001]. Thirty‐seven children were prospectively screened for AI, and 51% (19/37) had a low MSC level. Ten patients had a low‐dose ACTH stimulation test (LDST) after 1 or more low MSC levels. Five percent (2/37) of patients were diagnosed with AI. DHEA‐S and MSC levels had a moderate correlation (rs = 0.44, P = 0.03).

Conclusions:

Gastroenterologists belonging to EoE consortia were more likely to screen for AI. Prevalence of AI in our prospective cohort was 5%. DHEA‐S has a moderate correlation with MSC levels, but more data is required to assess utility as a screening tool for AI.
Differentiation of Colonic Inflammatory Bowel Disease
Authors: Dhaliwal Jasbir , Siddiqui Iram , Muir Jennifer , Rinawi Firas , Church Peter C. , Walters Thomas D. , Griffiths Anne M.
Published: November 2019

Objectives:

Differentiation of Crohn disease (CD) from ulcerative colitis (UC) is challenging when inflammation is predominantly colonic. The paediatric inflammatory bowel disease (PIBD) classes algorithm was developed to bring consistency to labelling, but used physician‐assigned diagnosis as the criterion standard. We aimed to reassess the PIBD classes using pathology of subsequently resected colon as the criterion standard.

Method:

Single‐centre study of patients diagnosed with colonic IBD between 2002 and 2017 and subsequently treated with colectomy. Baseline pretreatment data were reviewed and the PIBD classes algorithm was independently applied by 2 reviewers to assign a label of UC/IBD‐unclassified (IBD‐U)/colonic‐CD. Concordance between the algorithm‐based, precolectomy clinical, and pathologic examination of resected colon diagnosis were assessed. Changes in diagnosis during postcolectomy follow‐up were recorded.

Results:

Sixty‐two children underwent colectomy for medically refractory colonic IBD. Diagnosis based on pathologic review of resected colon CD:4;UC:56;IBDU:2. The clinical, PIBD classes algorithm, and colectomy diagnoses were concordant in 51 of 62 patients (81%, Fleiss kappa 0.48). Precolectomy clinical diagnosis was concordant with colectomy diagnosis in 58 of 62 patients (94%, weighted‐kappa 0.65). The PIBD classes label was concordant with colectomy diagnosis in 51 of 62 patients (82%, weighted‐kappa 0.38); resected colon pathology was typical of UC in 6 patients with PIBD classes label of IBD‐U based on single class 2 feature and in 3 with PIBD classes label of CD based on single class 1 feature.

Conclusions:

Concordance of PIBD classes algorithm diagnosis applied before colectomy with a diagnostic label based on pathologic examination of a subsequently resected colon is only fair. Caution is needed in stringent application of colonic CD and IBD‐U labels based on presence of single feature.
Autoimmune Gastritis in Pediatrics
Authors: Mitsinikos Tania , Shillingford Nick , Cynamon Harry , Bhardwaj Vrinda
Published: November 2019

Objectives:

To bring heightened awareness to a condition, autoimmune gastritis (AIG), which is a well‐established entity in adults; however, rarely described in pediatrics. Currently, the literature describes AIG in pediatric patients who also suffer from other autoimmune disorders, which precedes the diagnosis of AIG, and often presents with unexplained anemia. Additionally, there have been case reports describing patients with immunodeficiencies and AIG, which progress to gastric adenocarcinoma. AIG is a histopathologic diagnosis, demonstrating chronic inflammatory process with loss of parietal cells with or without intestinal metaplasia and enterochromaffin‐like cell hyperplasia. Management of these patients includes nutritional replacement as well as routine surveillance endoscopy with biopsy in search of metaplastic and dysplastic changes.

Methods:

We queried the pathology database at Children's Hospital Los Angeles (CHLA) for cases with a final diagnosis of AIG and for those with a differential diagnosis that includes AIG in the diagnostic comment. All cases that were identified were selected as long as they did not only meet the histopathologic criteria, but also the biochemical criteria for this condition.

Results:

Of the 3 patients, 2 were referred to gastroenterology for the evaluation of iron‐deficiency anemia in the context of diabetes mellitus and Addison's disease; and diabetes mellitus and Hashimoto's thyroiditis. AIG was confirmed on the biopsies, which showed a reduction in parietal cell mass, pseudopyloric metaplasia and enterochromafin‐like cell hyperplasia. Both patients were treated with iron replacement therapy. The third patient presented with symptomatic anemia and diagnosed with pernicious anemia without other autoimmune disorders. She was successfully treated with oral vitamin supplementation. In this case, serial gastric biopsies demonstrated stable intestinal metaplasia without evidence of dysplasia.

Conclusion:

Although AIG is rare in children, pediatric gastroenterologists and pathologists should have a heightened suspicion for this entity in those patients with a history of autoimmune disorders and/or pernicious anemia.
Urgent Proton Beam Therapy With Interinstitutional Transfer for Patients With Intracranial Rhabdomyosarcoma: Report of 3 Cases
Authors: Inaba Masako , Nakao Tomohei , Hosaka Sho , Suzuki Ryoko , Fukushima Hiroko , Yamaki Yuni , Saito Takashi , Sakashita Shingo , Noguchi Masayuki , Minami Manabu , Masumoto Tomohiko , Mizumoto Masashi , Sakurai Hideyuki , Fukushima Takashi , Takada Hidetoshi
Published: November 2019

A number of cases have been reported in recent years regarding the use of proton beam therapy to mitigate adverse events affecting important cranial organs in cases of rhabdomyosarcoma at parameningeal sites. However, few reports have described the use of proton beam therapy as urgent radiotherapy for parameningeal rhabdomyosarcoma with intracranial extension. We treated 3 patients diagnosed with parameningeal rhabdomyosarcoma extending into the cranium who were assessed at other hospitals as suitable for urgent radiotherapy and transferred to our hospital for proton beam therapy. These patients comprised 2 boys and 1 girl 6 to 12 years of age at diagnosis, and proton beam therapy was started on days 5, 11, and 23 after diagnosis, respectively. Patients with parameningeal rhabdomyosarcoma extending into the cranium can be transferred to institutions equipped to perform proton beam therapy. To minimize the interval to starting therapy, medical information should be shared with institutions capable of providing such therapy as soon as the possibility of intracranial soft-tissue sarcoma is recognized. Proton beam therapy is 1 option for radiotherapy in cases of intracranial rhabdomyosarcoma.
Discontinuation of Imatinib in a Child With Chronic Myeloid Leukemia
Authors: Jeyaraman Preethi , Naithani Rahul
Published: November 2019

Chronic myeloid leukemia (CML) has different disease biology with a more aggressive clinical course in children. Achieving treatment-free remission is the ideal goal for the pediatric CML population to avoid long-term toxicities of tyrosine kinase inhibitors. Here, we present our experience of stopping Imatinib in a pediatric patient of CML who had excessive weight gain with Imatinib. He is currently maintaining treatment-free remission for 15 months after stopping therapy at the time of last follow-up. The patient also had normalization of body mass index with the stopping of Imatinib.
Cold External Temperatures and Sickle Cell Morbidity in Children: A Retrospective Analysis
Authors: Wachnian Cielle , Tompkins Nicholas , Corriveau-Bourque Catherine , Belletrutti Mark , Bruce Aisha A.K.
Published: November 2019

Background:

Genetic and environmental factors affect the occurrence of vaso-occlusive crises (VOCs) in patients with sickle cell disease (SCD). Research provides inconsistent evidence on how environmental temperature affects SCD. Edmonton, Alberta, has an increasing SCD population and is the northern-most city in North America with a population of over a million.

Objective:

The objective of this study was to identify whether pediatric patients with SCD experience increased morbidity in cold external temperatures.

Materials and Methods:

This study was a retrospective case series. Emergency visits, phone calls, and admission data for VOC in children were recorded from July 2011 to June 2016. Temperatures were recorded and statistically analyzed using descriptive statistics, to determine the relation to VOC.

Results:

A total of 118 patients with 257 VOC events were reviewed. When analyzing the mean, minimum, and change in temperatures at presentation, the largest percentage of VOC events occurred at mild to moderate temperatures. Temperature data at 24 and 48 hours before the presentation had similar results. When accounting for the relative frequency of extreme weather days, there are increased VOC events with temperature fluctuations >20°C.

Conclusions:

There was no correlation between mean and minimum temperature change. Fluctuation in temperature of >20°C was associated with increased relative VOC frequency, suggesting that large temperature variability should be avoided in SCD, but a prospective study is required to determine causality.
Is Hemoglobin D Trait Hematologically Silent: Comparison With Healthy Controls and β-thalassemia Carriers
Authors: Aslan Deniz
Published: November 2019

Hemoglobin D-Los Angeles, a recessively inherited hemoglobin variant, has been introduced as hematologically silent in the heterozygous state. However, as its compound heterozygosity with other hemoglobinopathies may lead to a severe clinical phenotype, with hemoglobin S being the most serious, the detection of carriers is important. To clarify the hematologic picture, we assessed erythrocyte parameters in D carriers and compared values in healthy controls and β-thalassemia carriers. Although values in D carriers, in the absence of confounding factors, significantly differed from thalassemia carriers (P<0.05 for all), they were not similar to healthy controls. Microcytosis (absent in healthy controls) (mean corpuscular volume: 80.7 vs. 83.5 fL, P=0.038) and erythrocytosis (6 times more than in healthy controls) (red blood cell: 5.2 vs. 4.7×1012/L, P=0.002) were detected, making questionable the true silence of the D trait.
Burkitt Lymphoma Presenting as Acute Pancreatitis: Report of 3 Cases and Review of the Literature
Authors: Lee Anselm Chi-Wai , Li Chak-Ho
Published: November 2019

Acute pancreatitis is a rare presentation in Burkitt lymphoma (BL) and may lead to delayed medical or unnecessary surgical treatment. Three cases of BL presenting as acute pancreatitis in the authors’ institutions were described. Similar cases reported in the medical literature were collected and described along with the authors’ cases. There were 12 cases described in the medical literature and hence a total of 15 cases of BL presenting as acute pancreatitis. Fourteen cases were the first diagnosis, and the other presented at lymphoma relapse. Twelve cases occurred in children under 15 years. Twelve patients had extrapancreatic disease. Three children were treated with surgery before diagnosis. Two patients died. Six of the remaining had adequate follow-up and were surviving in remission 8 months to 16 years after diagnosis. Lymphoma should be included in the differential diagnosis of acute pancreatitis in children. Acute pancreatitis in combination with malignant infiltration on imaging is highly suggestive of BL, especially in the jaundiced child.
Prednisolone Prophase for a Week Versus Upfront Multiagent Chemotherapy in Childhood Acute Lymphoblastic Leukemia: An Analysis With Reference to Induction Mortality in a Developing Country
Authors: Jabbar Naeem , Mansoor Neelum , Nadeem Kishwer , Maqsood, MSc Sidra , Butt Zainab , Ashraf Shamvil
Published: November 2019

In childhood acute lymphoblastic leukemia, high treatment-related mortality, especially in the induction phase of treatment, is a major challenge for developing countries. The reasons are multifactorial, including a late presentation with higher disease burden, malnourishment, and limited support services. These factors may aggravate the toxic effects of upfront multiagent chemotherapy in terms of severe neutropenic sepsis and tumor lysis. Therefore, instead of upfront chemotherapy, we offered prednisolone prophase for 1 week with the objective of balancing the antileukemic versus the toxic effect of treatment. The data of 538 patients who received induction with this approach (cohort B) are compared for induction mortality with previous records of 438 patients (cohort A) treated with upfront chemotherapy. In the presence of similar clinical characteristics including age, sex, risk group, and phenotype in both cohorts, a significant difference was found in overall induction mortality of 9% in cohort B versus 14% in cohort A (P<0.05). This difference was also significant in the high-risk and T-cell phenotype, which strengthens our hypothesis that patients with higher burden of disease may experience more fatal toxic effects with upfront intensive chemotherapy. Therefore, we suggest that the prednisolone prophase approach is beneficial to control the disease with less severe toxic effects in our settings.
Oral Corticosteroid Therapy as an Adjuvant Treatment for Acute Bleeding in Hemophilia Patients With High Titer Inhibitors
Authors: Cacciotti Chantel , Chan Anthony , Bhatt Mihir
Published: November 2019

Treatment options exist for patients with severe hemophilia and high titer factor VIII inhibitors but is often inadequate. Few studies have been conducted to evaluate the utility of short-term corticosteroid therapy for improvement in bleeding complications and temporary or sustained resolution of inhibitors in these patients. We describe 2 patients with acute muscular hematomas successfully treated with 4 to 5 days of oral adjuvant corticosteroid therapy resulting in improvement in their acute bleeds and temporary reduction of inhibitors. Thus, the addition of corticosteroids to traditional therapy of hemophilia with inhibitors may be beneficial in some patients. In those with impending compartment syndrome steroids may improve edema and bleeding symptoms preventing the need for surgical interventions.
A Pediatric Case Report of Epstein-Barr Virus–associated Hemophagocytic Lymphohistiocytosis With Pericardial Effusion and Multiple Coronary Artery Aneurysms
Authors: Sun Guilian , Yao Fang , Yang Zhiliang
Published: November 2019

Pediatric coronary artery aneurysms (CAAs) are mainly detected in Kawasaki disease and in chronic active Epstein-Barr virus (EBV) infection sometimes, and cardiac complications are rare in viral-associated hemophagocytic lymphohistiocytosis (HLH) patients. Here, we report a pediatric case of EBV-associated HLH with pericardial effusion and multiple CAAs, whereas the patient did not fulfill the diagnostic criteria of Kawasaki disease or chronic active EBV. The case indicates that CAAs may occur in EBV-HLH. Specifically, in a patient with a long-term fever and a high EBV DNA copy number, the detection of cardiac complications may help signal the possible occurrence of HLH, and CAAs may affect the prognosis for high risk of cardiac events.
PICU Admission Rates in Pediatric Cancer and Hematopoietic Stem Cell Transplant Patients Receiving High-flow Nasal Cannula Oxygen Therapy on the General Ward
Authors: van Dorst Mila , van Gestel Josephus P.J. , van Grotel Martine , Versluijs Birgitta , van den Heuvel-Eibrink Marry M. , Nijman Joppe , Wösten-van Asperen Roelie M.
Published: November 2019

The use of high-flow nasal cannula (HFNC) oxygen therapy is growing as an alternative to standard oxygen. However, its use in patients treated for malignancies, including hematopoietic stem cell transplantation (HSCT) patients, is controversial. In this retrospective cohort study, we assessed outcomes of pediatric cancer and HSCT patients (including nonmalignant indications) with acute hypoxemic respiratory failure treated with HFNC on the ward. Among 39 patients included in the study, 53 episodes of HFNC treatment were analyzed. Of these episodes, 18 (34%) failed and patients required subsequently pediatric intensive care unit (PICU) admission. A significant median higher C reactive protein (175 [range, 72 to 308] vs. 80 [13.5 to 187.8] mg/dL; P=0.006) and higher Bedside Pediatric Early Warning Score (PEWS) 1 to 4 hours after initiation of HFNC (10.1±0.8 vs. 7.1±0.4; P=0.001) was found in the failure group compared with the nonfailure group. Among the 18 patients admitted to PICU, 14 (78%) needed intubation. Five (28%) patients died during their PICU admission. In summary, one third of the pediatric cancer and HSCT patients receiving HFNC on the ward eventually required PICU admission of which 78% were intubated. C reactive protein and BedsidePEWS 1 to 4 hours after initiation of HFNC were significantly associated with the need for PICU admission. However, no firm conclusion can be drawn whether HFNC treatment should actually be initiated in the ward in this vulnerable patient population. Larger, prospective studies are needed to evaluate the most appropriate treatment and setting (PICU or general ward) for these patients.
Systolic Heart Failure
Authors: Capriotti Teri , Ashline Breanna
Published: November 2019

Heart failure (HF) is a significant public health problem that is projected to increase in prevalence in the next 20 years due to a growing aged population and improved survival after acute cardiac events. The American College of Cardiology (2019) defines HF as a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill or eject blood. In systolic HF, the left ventricular muscle has diminished contractility and ejection fraction is less than 40%. This article will review the pathophysiology and treatment of HF. Implications for home care clinicians are discussed.
Home Care Nurses' Perspectives Regarding Health Information Management Among Older Adults
Authors: Kang Youjeong , Taylor Jean O. , Osterhage Katie , Turner Anne M.
Published: November 2019

Aging is associated with comorbidities and increased utilization of healthcare services, which results in a large amount of personal health information (PHI) to manage. Older adults often have difficulty managing this increased load of health information. Although many home healthcare nurses (HCNs) provide assistance to older adults after discharge from medical facilities, little is known about HCNs' experiences with older adults regarding the management and transfer of PHI in their homes. The purpose of this qualitative study was to 1) determine how HCNs obtain and provide health information, 2) describe the perspective of HCNs regarding older adult PHI, and 3) identify the potential role of technology in older adult health information transfer. We conducted and analyzed semistructured phone interviews with 17 HCNs from two home healthcare agencies. Five thematic areas emerged from interviews with HCNs: 1) common practices of obtaining health information; 2) barriers to obtaining health information; 3) ideal ways to obtain and provide health information; 4) use of patient portals; and 5) HCNs' use of technology for health information exchange. Most HCNs reported that it would be difficult for older adult patients to update their PHI without assistance, but HCNs lack the time and resources to assist older adults in PHI management activities.
Integration of an Advance Care Planning Model in Home Health
Authors: Mauleon Jessica , Staffileno Beth A.
Published: November 2019

Only 2.3% of patients at a Midwest home healthcare (HH) agency had documented advance directives (ADs), compared with 28% nationally. Of concern, this HH agency lacked standardized procedures for advance care planning (ACP) leading to inadequate staff knowledge regarding end-of-life, avoidable hospital readmissions, and delayed transitions into hospice care. Lack of ADs is directly correlated to higher hospital readmission rates and lower hospice length of stay. The purpose of this initiative was to develop evidence-based procedures using the Respecting Choices® ACP model to: 1) educate staff, 2) increase ACP conversations offered and completed among high-risk patients, 3) increase Practitioner Orders for Life-Sustaining Treatment (POLST) rates, 4) reduce 60-day hospital readmissions, and 5) support hospice care admissions. Staff received discipline-specific education on ACP/ADs. The Knowledge-Attitudinal-Experiential Survey on Advance Directives (KAESAD), assessed staff ACP/AD knowledge, confidence, and experiences. Standardized electronic medical record tools were created to track ACP conversations, POLST rates, 60-day hospital readmissions, and hospice admissions. Paired t-test and chi-square analyses compared changes pre- and post implementation. The KAESAD survey was analyzed for 75 staff (100%) and demonstrates improvement in knowledge, confidence, and experiences. Data also demonstrate increases in: ACP offered 6% to 80% (p < .001); ACP conversations completed 4% to 31% (p < .001); POLST rates 26% to 43.6% (p = .059); decreased 60-day hospital readmissions 40% to 20% (p = .025); whereas hospice care admissions was not impacted ranging from 10% to 5.5% (p = .381). Respecting Choices® serves as an effective ACP framework to improve ACP conversations, POLST rates, and hospital readmissions.
Opioid Crisis
Authors: Lee Vanessa Y. , Kowalski Sonya L.
Published: November 2019

As a result of the opioid epidemic, strategies have been implemented to reduce opioid consumption. These include regulatory policies, reduced opioid production, and nonopioid approaches for pain management. Although these policies may reduce opioid prescribing, there has been an unintended consequence for patients with severe cancer pain. Opioids are foundational for cancer pain management and are often required for patients during end-of-life care. Shortages of some opioid medications require knowledge of equianalgesic dosing. Equianalgesia is the conversion of comparable pain-relieving effects from one medication to another. There is a lack of consensus with regard to conversion standardization so researchers have created dosing principles that clinicians can follow. This article will describe some of these dosing principles and provide readers with sources for on-line dosage calculators.
Emerging Views of Kinships Created Through Oocyte Donation
Authors: Hershberger Patricia E. , Driessnack Martha , Kavanaugh Karen , Klock Susan C.
Published: November 2019

Background:

The United States has the highest number of oocyte donation cycles, which account for an estimated one-quarter of all worldwide oocyte donation cycles. Although there has been a steady rise in oocyte donation treatment, understanding the kinship views of those intimately involved is lacking. These include women oocyte donors and parents who received donor oocytes to establish a pregnancy.

Purpose:

To explore the views and perspectives about genetic relationships and lineages among women who were oocyte donors and parents who received donated oocytes 10 to 12 years after donors and parents underwent oocyte donation procedures to establish a pregnancy.

Study Design and Methods:

A longitudinal cohort of pregnant women who received donor oocytes participated in an expanded, follow-up study 12 years postpregnancy that included the women's heterosexual partners and biological fathers. Women who donated oocytes anonymously 10 to 12 years prior also participated. Qualitative content analysis was used to analyze participants' in-depth interviews.

Results:

Six women who received donor oocytes and their heterosexual partners and biological fathers (n = 6), representing 12 children conceived by oocyte donation, and 3 women who donated oocytes anonymously representing 3 children participated. Themes that emerged from the women oocyte donors included a reexamination of anonymity and contact with recipient families, managing disclosure to their own children about possible half-siblings, and potential for consanguinity. For recipient parents, there was an overwhelming sense of gratitude to the women oocyte donors, concerns about navigating genetic information gaps, and contemplating future contact with the donors and/or half-siblings.

Clinical Implications:

Nurses can play a vital role in supporting and educating women oocyte donors and recipient parents about navigating complex relationship issues in donor kinships.
Neurological Soft Signs and Clinical Features of Tic-Related Obsessive-Compulsive Disorder Indicate a Unique Subtype
Authors: Ekinci Okan , Erkan Ekinci Asli
Published: November 2019

Tic-related obsessive-compulsive disorder (OCD) may be a unique OCD subtype. This study examined whether neurological soft signs (NSSs) of patients with tic-related and tic-free OCD enable discrimination of these subgroups. We used the Neurological Evaluation Scale to assess 32 patients with tic-related and 94 with tic-free OCD, as well as 84 controls. Most patients with tic-related OCD were male, with earlier illness onset and poorer insight scores than those of patients with tic-free OCD. Patients with tic-related OCD had poorer motor coordination, sensory integration, and motor sequencing than did tic-free patients. Logistic regression using NSS subscale scores predicted tic-related OCD. Patients with tic-related OCD displayed greater neurodevelopmental abnormalities than did tic-free patients. NSSs of the former group suggest the need to separate this subgroup. Our results also support the newly introduced tic-related specifier in the fifth edition of the Diagnostic and statistical manual of mental disorders.
Self-Management Behaviors, Glycemic Control, and Metabolic Syndrome in Type 2 Diabetes
Authors: Ji Meihua , Ren Dianxu , Dunbar-Jacob Jacqueline , Gary-Webb Tiffany L. , Erlen Judith A.
Published: November 2019

Background

Diabetes self-management and glycemic control are suboptimal among Chinese patients with Type 2 diabetes with a large proportion of patients identified with metabolic syndrome.

Objectives

Based on social cognitive theory, this study examines the effect of selected personal, behavioral, and environmental factors on self-management behaviors, glycemic control, metabolic syndrome and Type 2 diabetes.

Methods

A cross-sectional study was conducted among 207 Chinese with Type 2 diabetes living in a suburban area of Beijing, China. Regression models were applied to examine the effect of selected personal, behavioral, and environmental factors on self-management behaviors, glycemic control, and metabolic syndrome. The relationship among individual self-management behaviors, glycemic control, and metabolic syndrome was also examined.

Results

Self-efficacy was significantly associated with all self-management behaviors. Social support was related to overall self-management, diabetes knowledge was related to diet, and depressive symptoms was related to self-monitoring. Problem-solving and self-management behaviors related to medication adherence and diet were significant correlates of glycemic control. Health literacy and self-management behaviors related to physical activity were correlates of metabolic syndrome.

Discussion

Findings suggest that a multifactorial approach may be beneficial when providing care for Chinese with Type 2 diabetes. In addition, these findings provide support for developing and testing tailored interventions that address problem-solving, health literacy, and self-efficacy, among other factors, to help patients achieve optimal glycemic control and thereby reduce their risk for metabolic syndrome and related complications.
Papilledema and Peripheral Neuropathies
Authors: Mathis Stéphane , Le Masson Gwendal , Soulages Antoine , Duval Fanny , Solé Guilhem , Boissonnot Michèle , Lathière Thomas , Bonduelle Thomas , Carla Louis , Nadal Louis , Baron Clément , Balaboi Irina , Ciron Jonathan , Vallat Jean-Michel
Published: November 2019

Introduction:

Papilledema is a common sign in ophthalmology and is typically associated with increased intracranial pressure (ICP) in neurological diseases. Since the beginning of the 20th century, some cases of papilledema have been reported in association with acute or chronic inflammatory neuropathies.

Case Report:

We describe a 42-year-old man with acute-onset inflammatory polyradiculoneuropathy and bilateral papilledema.

Conclusions:

Based on a personal case report and from an extensive review of the medical literature, we identify 2 distinct patterns. First, radiculoneuropathy may be a consequence of intracranial pressure (peripheral nerve involvement corresponding to a “false localizing sign”). Second, papilledema may occur after the onset of inflammatory neuropathy. For such cases, the pathophysiological mechanism remains unknown (eg, reactional inflammatory processes or actions of unknown autoantibodies) and requires further elucidation.
Successful Thrombolysis in the Setting of Marfan Syndrome and Chronic Aortic Dissection
Authors: Malek Elia G. , Nasreddine Wassim , Makki Achraf
Published: November 2019

Introduction:

Thrombolysis is the standard of care in acute ischemic stroke. It is usually contraindicated in patients with aortic dissection.

Case Report:

We report a case of Marfan syndrome and chronic aortic dissection presenting with acute ischemic stroke treated with thrombolysis.

Conclusion:

To our knowledge, this is the first case of Marfan syndrome with chronic aortic dissection undergoing thrombolysis for acute ischemic stroke with a near-complete recovery of neurological deficit and favorable long-term outcome.
Leukoencephalopathy With Predominant Infratentorial Involvement Caused by a Novel ABCD1 Mutation
Authors: Benzoni Chiara , Farina Laura , Pensato Viviana , Marotta Giorgio , Kuqo Altin , Mauro Elena , Pareyson Davide , Salsano Ettore
Published: November 2019

Introduction:

X-linked adrenoleukodystrophy (X-ALD) encompasses several clinical and neuroimaging phenotypes, including cerebral X-ALD, the most common phenotype in children, and adrenomyeloneuropathy, the most common phenotype in adults. A spinocerebellar variant of X-ALD has been described in individuals from the Far East, but the criteria for its diagnosis are unclear.

Case Report:

A 35-year-old man from Albania was assessed because of a familial, slowly progressive spastic-ataxic gait associated with neurogenic bladder, sexual dysfunctions, and manic-like behavior. There was no definite clinical feature that suggested cerebellar involvement (eg, cerebellar limb ataxia, nystagmus, and dysarthria). A few months earlier, he had received a diagnosis of Addison disease. Brain magnetic resonance imaging showed a leukoencephalopathy with predominant cerebellum and brainstem involvement, and 18FDG-PET revealed marked cerebellar hypometabolism. The diagnosis of X-ALD was made because we found an increase of very long chain fatty acids, and a new ABCD1 mutation (c.1627C>T, p.Pro543Ser).

Conclusions:

X-ALD should be included in the differential diagnosis of adult leukoencephalopathies with predominant involvement of infratentorial structures, that is, the cerebellum and brainstem. From a classification perspective, our patient (of white origin), like others (all of Asian origin), should be considered as suffering from a variant of adrenomyeloneuropathy rather than from spinocerebellar X-ALD. Actually, the term “spinocerebellar” or similar ones, such as “cerebello-brainstem dominant form,” should be limited to those exceptional cases, in which both the clinical and neuroimaging findings point exclusively (or at least predominantly) to the involvement of infratentorial structures.
Bronzino’s Claw Hand
Authors: Allen Nicholas Peter Legh
Published: November 2019

Background:

Lancet recently published an article concerning a work of art by Bronzino (1503-1572). Apart from incorrectly identifying Bronzino as a Renaissance artist, Vein and Mouret (2018) make an extraordinary medical claim based on their observation of the artistic image of the left hand of the sitter in Bronzino’s Mannerist Portrait of Bartolomeo Panciatichi (1540s). In short, seemingly without even a basic understanding of the tenets of Mannerist painting or the specifics of Bronzino’s enormous oeuvre, Vein and Mouret (2018) claim that Bronzino’s subject, Bartolomeo Panciatichi (1507-1582) was suffering from “a unilateral ulnar pathology.”

Methods:

The author analyses the image of Bartolomeo Panciatichi from an art historical perspective involving both formal analysis and stylistic analysis.

Results:

The specific portrayal of Panciatichi’s “claw hand” is more correctly a product of creative genius, designed to elicit an emotional response of “disquiet” from the informed spectator.

Conclusion:

There is in fact no portrayal of a unilateral ulnar pathology. If it were, then it means that many of Bronzino’s subjects suffered from exactly the same condition.
An Analysis of User Survey Data for an Internet Program for Testing for Sexually Transmitted Infections, I Want the Kit, in Maryland and Washington, DC
Authors: Hogenson Eiluned , Jett-Goheen Mary , Gaydos Charlotte A.
Published: November 2019

We evaluated the results of an acceptability survey administered online to users of I Want the Kit, which offers Internet-requested kits for sexually transmitted infection screening. User satisfaction was high for I Want the Kit, with many users in our survey being repeat patients of this program. Both male and female respondents preferred genital self-collected swabs over urine collected specimens. Strong interest was expressed in home testing options for other sexually transmitted infections.
Clinicians' Use of Intravaginal Boric Acid Maintenance Therapy for Recurrent Vulvovaginal Candidiasis and Bacterial Vaginosis
Authors: Powell Anna , Ghanem Khalil G. , Rogers Linda , Zinalabedini Ashley , Brotman Rebecca M. , Zenilman Jonathan , Tuddenham Susan
Published: November 2019

A retrospective chart review characterized clinicians' use of maintenance intravaginal boric acid for women with recurrent vulvovaginal candidiasis or bacterial vaginosis. Average length of use was 13 months with high patient satisfaction and few adverse events. Prospective studies are needed to evaluate the efficacy of maintenance boric acid for these conditions.
Pharyngeal Gonococcal Infections: A Cross-Sectional Study in a Network of Sexually Transmitted Disease Clinics; Sexually Transmitted Disease Surveillance Network—January 2016 to June 2018
Authors: Llata Eloisa , Braxton Jim , Asbel Lenore , Huspeni Dawn , Hsu Katherine , Kerani Roxanne P. , Nguyen Trang Quyen , Pathela Preeti , Schumacher Christina , Toevs Kim , Torrone Elizabeth
Published: November 2019

We conducted a cross-sectional analysis using sexually transmitted disease clinic data to determine test of cure rates among persons diagnosed with pharyngeal gonococcal infections who were treated with a nonceftriaxone, nonazithromycin therapy. Less than 10% returned for a test of cure, highlighting the need to understand factors that can lead to improved compliance.
Time Trends in First-Episode Genital Herpes Simplex Virus Infections in an Urban Sexually Transmitted Disease Clinic
Authors: Dabestani Nazila , Katz David A. , Dombrowski Julia , Magaret Amalia , Wald Anna , Johnston Christine
Published: November 2019

Background

Genital herpes simplex virus type 1 (HSV-1) has emerged as the leading cause of first-episode genital herpes among specific populations in the United States, such as adolescents, young adult women, and men who have sex with men (MSM). We examined trends in the etiology of first-episode genital herpes diagnoses over time in a sexually transmitted disease (STD) clinic population.

Methods

Using an electronic database, we identified persons diagnosed as having first-episode genital herpes at Public Health – Seattle & King County STD Clinic from 1993 to 2014 and compared risk factors for genital HSV-1 versus herpes simplex virus type 2 (HSV-2) infection.

Results

Of 52,030 patients with genital ulcers, 3065 (6.15%) had first-episode genital herpes infection: 1022 (33.3%) with HSV-1 and 2043 (67.7%) with HSV-2. Overall, 1154 (37.7%) were women, the median age was 28 years (interquartile range, 24–36 years), 1875 (61.2%) patients were white, and 353 (11.5%) were MSM. The number of patients diagnosed as having first-episode genital HSV-2 declined on average by 5.5 persons per year, from 208 in 1993 to 35 in 2014 (change of −5.6 per year; 95% confidence interval [CI], −6.9 to −4.1), whereas HSV-1 diagnoses remained stable at approximately 50 per year (change of 0.2; 95% CI, −0.4 to 0.9). In a multivariate model, persons diagnosed as having first-episode genital HSV-1 rather than genital HSV-2 infection were more likely to be younger (age <30 years [relative risk {RR}, 1.38; 95% CI, 1.22–1.55]), white (RR, 3.16; 95% CI, 2.57–3.88), and MSM (RR, 1.50; 95% CI, 1.31–1.71).

Conclusions

We observed a significant decrease in the frequency of first-episode genital HSV-2 and a stable number of first-episode genital HSV-1 infections in a STD clinic over the last 2 decades.