bluuebunny/crossref_metadata_2025 huggingface dataset:
Outbreaks of Kingella kingae Infections in Daycare Centers Suggest Tissue Tropism of the Causative Strains
Authors: Yagupsky Pablo , El Houmami Nawal , Fluss Ronen
Published: December 2019

Background

Although Kingella kingae is recognized as an important pediatric pathogen, our knowledge of the virulence factors involved in the invasion of specific host’s tissues is limited. Outbreaks of K kingae infections in daycare centers represent natural experiments in which a single virulent strain, introduced into a cohort of susceptible young children, causes multiple infections. If K kingae strains exhibit tissue tropism, the syndromes observed in a given cluster of cases would be relatively homogeneous.

Methods

Clinical data of all the K kingae outbreaks known to date were gathered and analyzed. The clinical syndromes diagnosed in the affected attendees were classified as septic arthritis, osteomyelitis, tenosynovitis, soft tissue infection, bacteremia with no focal disease, endocarditis, and meningitis, and computed separately. To assess the similarity of the clinical syndromes detected within outbreaks, we used the Cramer V statistic, which is a measure of the association between 2 nominal variables and, for the purposes of the study, between the detected clinical syndromes and the outbreaks.

Results

A total of 23 outbreaks involving 61 attendees were identified. The mean±SD attack rate in the affected classrooms was 15.8% ± 4.8%, and the K kingae colonization rate among the attendees was 54.8% ± 25.3%. Seventy-two separate foci of infection were diagnosed. Osteomyelitis and septic arthritis were the most common clinical syndromes and were diagnosed in 26 children each, followed by tenosynovitis in 4 children. The clinical syndromes diagnosed among attendees to the same classroom showed a statistically significant tendency to be similar (P = .015).

Conclusions

The distribution of clinical syndromes in clusters of K kingae infections differs from that of sporadic cases. The causative strains combine enhanced virulence and high transmissibility, and show tropism toward bones, joints, and tendon sheaths. This information can be used to identify virulence factors associated with invasion of these specific host tissues.
True aneurysm of the digital artery: a case report and systematic literature review
Authors: Sheikh Zara , Selvakumar Sadasivam , Goon Patrick
Published: December 2019

Aneurysmal disease can occur in any vessel in the body and occur most commonly the aorta, cerebral and popliteal arteries; however, aneurysms of the digital artery remain a rare presentation. They form an important differential diagnosis in any patient presenting with a mass in the hand. This report presents the case of a 64-year-old man with a true aneurysm of the common palmar digital artery who underwent successful repair, following excision and end to end anastomosis. Only 21 cases of true digital artery aneurysm have been reported; we review the literature pertaining to the diagnosis and management of digital artery aneurysms since they were first described by Baruch et al in 1977.
Azole resistance in Candida from animals calls for the One Health approach to tackle the emergence of antimicrobial resistance
Authors: Castelo-Branco Débora de Souza Collares Maia , Paiva Manoel de Araújo Neto , Teixeira Carlos Eduardo Cordeiro , Caetano Érica Pacheco , Guedes Gláucia Morgana de Melo , Cordeiro Rossana de Aguiar , Brilhante Raimunda Sâmia Nogueira , Rocha Marcos Fábio Gadelha , Sidrim José Júlio Costa
Published: December 2019

This study initially aimed at investigating the occurrence of azole resistance among Candida spp. from animals and analyzing the involvement of efflux pumps in the resistance phenomenon. Then, the dynamics of antifungal resistance was assessed, by comparing the antifungal epidemiological cutoff values (ECVs) against C. albicans and C. tropicalis from humans and animals. Fifty azole-resistant isolates (24 C. albicans, 24 C. tropicalis; 2 C. parapsilosis sensu lato) were submitted to the efflux pump inhibition assay with promethazine and significant MIC reductions were observed for fluconazole (2 to 250-fold) and itraconazole (16 to 4000-fold). Then, the antifungal ECVs against C. albicans and C. tropicalis from human and animal isolates were compared. Fluconazole, itraconazole and voriconazole ECVs against human isolates were lower than those against animal isolates. Based on the antifungal ECVs against human isolates, only 33.73%, 50.39% and 63.53% of C. albicans and 52.23%, 61.85% and 55.17% of C. tropicalis from animals were classified as wild-type for fluconazole, itraconazole and voriconazole, respectively. Therefore, efflux-mediated mechanisms are involved in azole resistance among Candida spp. from animals and this phenomenon seems to emerge in animal-associated niches, pointing to the existence of environmental drivers of resistance and highlighting the importance of the One Health approach to control it.
Efficient gravitational lens optical scalars calculation of black holes with angular momentum
Authors: Boero Ezequiel F , Moreschi Osvaldo M
Published: December 2019

We provide new very simple and compact expressions for the efficient calculation of gravitational lens optical scalars for Kerr space–time, which are exact along any null geodesic. These new results are obtained recurring to well-known results on geodesic motion that exploit obvious and hidden symmetries of Kerr space–time and contrast with the rather long and cumbersome expressions previously reported in the literature, providing a helpful improvement for the sake of an efficient integration of the geodesic deviation equation on Kerr geometry. We also introduce a prescription for the observer frame that captures a new notion of centre of the black hole, which can be used for any position of the observer, including those near the black hole. We compare the efficient calculation of weak lens optical scalars with the exact equations, finding an excellent agreement.
Inferring the parallax of Westerlund 1 from Gaia DR2
Authors: Aghakhanloo Mojgan , Murphy Jeremiah W , Smith Nathan , Parejko John , Díaz-Rodríguez Mariangelly , Drout Maria R , Groh Jose H , Guzman Joseph , Stassun Keivan G
Published: December 2019

Westerlund 1 (Wd1) is potentially the largest star cluster in the Galaxy. That designation critically depends upon the distance to the cluster, yet the cluster is highly obscured, making luminosity-based distance estimates difficult. Using Gaia Data Release 2 (DR2) parallaxes and Bayesian inference, we infer a parallax of $0.35^{+0.07}_{-0.06}$ mas corresponding to a distance of $2.6^{+0.6}_{-0.4}$ kpc. To leverage the combined statistics of all stars in the direction of Wd1, we derive the Bayesian model for a cluster of stars hidden among Galactic field stars; this model includes the parallax zero-point. Previous estimates for the distance to Wd1 ranged from 1.0 to 5.5 kpc, although values around 5 kpc have usually been adopted. The Gaia DR2 parallaxes reduce the uncertainty from a factor of 3 to 18 per cent and rules out the most often quoted value of 5 kpc with 99 per cent confidence. This new distance allows for more accurate mass and age determinations for the stars in Wd1. For example, the previously inferred initial mass at the main-sequence turn-off was around 40 M⊙; the new Gaia DR2 distance shifts this down to about 22 M⊙. This has important implications for our understanding of the late stages of stellar evolution, including the initial mass of the magnetar and the LBV in Wd1. Similarly, the new distance suggests that the total cluster mass is about four times lower than previously calculated.
The human ZC3H3 and RBM26/27 proteins are critical for PAXT-mediated nuclear RNA decay
Authors: Silla Toomas , Schmid Manfred , Dou Yuhui , Garland William , Milek Miha , Imami Koshi , Johnsen Dennis , Polak Patrik , Andersen Jens S , Selbach Matthias , Landthaler Markus , Jensen Torben Heick
Published: December 2019

Recruitment of the human ribonucleolytic RNA exosome to nuclear polyadenylated (pA+) RNA is facilitated by the Poly(A) Tail eXosome Targeting (PAXT) connection. Besides its core dimer, formed by the exosome co-factor MTR4 and the ZFC3H1 protein, the PAXT connection remains poorly defined. By characterizing nuclear pA+-RNA bound proteomes as well as MTR4-ZFC3H1 containing complexes in conditions favoring PAXT assembly, we here uncover three additional proteins required for PAXT function: ZC3H3, RBM26 and RBM27 along with the known PAXT-associated protein, PABPN1. The zinc-finger protein ZC3H3 interacts directly with MTR4-ZFC3H1 and loss of any of the newly identified PAXT components results in the accumulation of PAXT substrates. Collectively, our results establish new factors involved in the turnover of nuclear pA+ RNA and suggest that these are limiting for PAXT activity.
Lateral intraventricular primary central nervous system lymphoma (LIPCNSL): a review
Authors: Yang J , Liu Z , Yang Y , Chen H , Xu J
Published: December 2019

Background

Lateral intraventricular primary central nervous system lymphoma (LIPCNSL) is an extremely rare intraventricular tumor with high malignancy and has never been systematically described.

Aim

To analyze the clinical characteristics and therapeutic strategy of LIPCNSL.

Design

Single-center retrospective study.

Methods

The clinical manifestation, imaging, treatment and outcomes of 13 patients with LIPCNSL who underwent craniotomy in West China Hospital between December 2008 and April 2018 were retrospectively analyzed.

Results

Eleven male and two female patients were enrolled. The mean age was 49.7 years (14–65 years). The frequent manifestations include symptoms of raised intracranial pressure and limb weakness. The mean duration was 1.8 months (1 week to 1 year). The average maximal diameter of tumors was 4.1 cm (1.8–6.1 cm). Gross total resection was achieved in 84.6% of patients. Symptoms improved in 69.2% of patients but developed in 30.8% of patients after surgery. The median recurrence-free survival (RFS) and overall survival (OS) were 2.0 months (1–86 months) and 3.0 months (1–124 months). High-dose methotrexate or/and radiotherapy significantly prolonged the RFS and OS (P < 0.05). Eight patients (72.7%) experienced relapse and progression. Salvage treatment significantly prolonged survival after relapse (P < 0.05).

Conclusions

LIPCNSL should be considered as a differential diagnosis of intraventricular tumors. High-dose methotrexate-based chemotherapy with or without radiotherapy should be the first-line treatment, and surgery is only for biopsy and improving symptoms. Long-term intensive follow-up is necessary and active salvage treatment should be performed after relapse.
Climate Finance
Authors: Hong Harrison , Karolyi G Andrew , Scheinkman José A
Published: December 2019

Climate finance is the study of local and global financing of public and private investment that seeks to support mitigation of and adaptation to climate change. In 2017, the Review of Financial Studies launched a competition among scholars to develop research proposals on the topic with the goal of publishing this special volume. We describe the competition, how the nine projects featured in this volume came to be published, and frame their findings within what we view as a broader climate finance research program.
Single-cell sequencing in hematology
Authors: Brierley Charlotte K. , Mead Adam J.
Published: December 2019

Purpose of review

In this review, we highlight key recent insights into hematopoiesis and hematological malignancies through the application of novel single-cell approaches. We particularly focus on biological insights made through the study of stem/progenitors cells in myeloid malignancy at single-cell resolution.

Recent findings

Bulk molecular profiling of hematological malignancies by next generation sequencing techniques has provided major insights into the molecular pathogenesis of blood cancers. This technology is now routinely implemented in advanced clinical diagnostics, leading to the development of novel targeted therapies. However, bulk genetic analysis can obscure key aspects of intratumoral heterogeneity which underlies critical disease events, such as treatment resistance and clonal evolution. The past few years have seen an explosion of novel techniques to analyze RNA, DNA, and protein expression at the single-cell level, providing unprecedented insight into cellular heterogeneity.

Given the ease of accessibility of liquid tumor biopsies, hematology is well positioned to move novel single-cell techniques towards routine application in the clinic. The present review sets out to discuss current and potential future applications for this technology in the management of patients with hematological cancers.
The microenvironment in myeloma
Authors: Lomas Oliver C. , Tahri Sabrin , Ghobrial Irene M.
Published: December 2019

Purpose of review

The aim of the review is to describe recent advances in our understanding of how multiple myeloma interacts with its cellular and molecular neighbours in the bone marrow microenvironment, and how this may provide targets for prognostication and prevention.

Recent findings

The bone marrow microenvironment in myeloma is beginning to yield targets that are amenable to therapy. A number of trials demonstrate some clinical efficacy in heavily pretreated disease. The challenge remains for how and when these therapeutic interventions are of particular benefit early in disease progression.

Multiple myeloma is rarely curable and its interactions with the bone marrow microenvironment are evident. However, separating cause from effect remains a challenge. We propose that targeting specific niches within the bone marrow will yield therapies that have the potential for significant benefit in myeloma and may facilitate earlier intervention to disrupt an environment that is permissive for myeloma progression.
Radiation-induced Osteomyelitis/Osteonecrosis of the Rib: SPECT/CT Imaging for Successful Surgical Management
Authors: Hamada Mariko , Nakahara Tadaki , Yazawa Masaki , Mikami Shuji , Kishi Kazuo
Published: December 2019

Chronic radiation-induced osteomyelitis/necrosis of the rib was rarely encountered in breast cancer patients even before the era of breast-conserving therapy. Few studies have focused on how to evaluate the extent of rib osteomyelitis for surgical management. A 78-year-old woman who had received radiation therapy after a radical mastectomy due to breast cancer 30 years ago manifested a rib pain and chest skin ulcers. Because chest magnetic resonance imaging failed to visualize osteomyelitis of the rib, a wide-ranged rib resection was initially planned considering her radiation field. An additional imaging, 3-dimensional (3D) single-photon emission computed tomography (SPECT)/computed tomography (CT), was performed to obtain 3D virtual chest images highlighting the areas of inflammatory or necrotic bone tissues; her osteomyelitis was localized in the left anterior chest. A chest wall reconstruction was performed using a vascularized pedicled latissimus dorsi myocutaneous flap on the left side after the resection of the ribs, part of the sternum, and costal cartilage with radical debridement of all necrotic tissues. The 3D SPECT/CT contributed to a safe chest wall reconstruction with a 40% reduction in resected bone and soft tissues when compared to the magnetic resonance imaging-based surgical plan. Pathology results showed no evidence of inflammation or necrosis in the surgical margin. No complication related to the reconstruction or no recurrence was observed during a postoperative 12-month follow-up. The present case suggested that 3D SPECT/CT can be applied to preoperative surgical planning related to bone diseases including osteomyelitis, traumas, bone tumors, and diabetic foot. The appropriate application of 3D SPECT/CT requires full validation through significant clinical experience.
Surgical management of mitral annular calcification
Authors: El-Eshmawi Ahmed , Alexis Sophia L. , Sengupta Aditya , Pandis Dimosthenis , Rimsukcharoenchai Chartaroon , Adams David H. , Tang Gilbert H.L.
Published: December 2019

Purpose of review

The aim of the article is to discuss different therapeutic options for patients with severe mitral valve dysfunction because of mitral annular calcification (MAC), including mitral valve repair, conventional mitral valve replacement, percutaneous transcatheter mitral valve replacement (TMVR), and hybrid procedures.

Recent findings

Optimal management of severe mitral valve disease because of MAC remains challenging. Various ‘resect’ or ‘respect’ repair strategies have been standardized and are applicable in eligible patients. Mitral valve replacement with a standard surgical bioprosthesis is often possible in nonrepair candidates, especially with noncircumferential MAC. TMVR has evolved as a feasible option for anatomically and/or clinically prohibitive open-surgery cases, with the caveat of strict anatomic eligibility criteria. Hybrid TMVR provides the advantages of both open-surgery and TMVR and has emerged as a promising alternative in select patients.

Surgical management of MAC and severe mitral valve disease continues to evolve. The addition of transcatheter valve options may benefit many patients previously considered inoperable and are now candidates for intervention. This review will summarize state-of-the-art management options for patients with MAC.
Treatment Outcome of Modified Argon Laser Photoablation for Conjunctival Cysts
Authors: Han Jisang , Lee Shin-Hyo , Choi Chul Young , Shin Hyun Jin
Published: December 2019

Purpose:

To evaluate the effectiveness of conjunctival cyst removal using a modified method of argon laser photoablation.

Methods:

Seventeen cases of symptomatic conjunctival cysts were included. After staining the surface of a conjunctival cyst with a dark purple marker, the cyst was incised using a 26-gauge needle. Low-energy argon laser photoablation was then applied around the incision site for a mean of 100 times.

Results:

During a mean follow-up period of 13.3 months (range 6–28 months), all conjunctival cysts were successfully corrected by applying either one or 2 laser sessions. Complete resolution occurred after a single laser session in 14 eyes (82.4%). There were 3 cases of recurrence with medium to large cysts, and repeating the same procedure produced surgical success in all of these cases; the conjunctival cyst recurred again after the second laser session in one of the 3 eyes, but this spontaneously regressed without further treatment. No postoperative complications such as conjunctival scarring or persistent ocular irritation were observed.

Conclusions:

Our modified method of argon laser photoablation uses staining of the conjunctival cyst surface to increase the amount of thermal laser energy absorbed by the target. This novel technique is simple and effective for treating conjunctival cysts in an outpatient clinic.
“Double-Bubble” Descemet Membrane Endothelial Keratoplasty Unfolding in Eyes With Deep Anterior Chambers and Anterior Chamber Intraocular Lenses
Authors: Parker Jack S. , Parker John S. , Melles Gerrit R.J.
Published: December 2019

Purpose:

To describe a standardized technique for Descemet membrane endothelial keratoplasty unfolding in eyes with deep anterior chambers and anterior chamber intraocular lenses (ACIOLs).

Methods:

Two air bubbles are used simultaneously: the first placed on top of the graft and the second one underneath.

Results:

The 2 bubbles work in concert—the bubble on top props the tissue partially open, while the bubble underneath levitates the graft away from the ACIOL and provides support for subsequent unfolding maneuvers.

Conclusions:

By sandwiching the graft between 2 bubbles, unfolding may proceed away from physical contact with the ACIOL, even in eyes with hyper-deep chambers.
Arthroscopic Posterior Cruciate Ligament Primary Repair
Authors: Vermeijden Harmen D. , van der List Jelle P. , DiFelice Gregory S.
Published: December 2019

Injury to the posterior cruciate ligament (PCL) is most commonly seen in the setting of a multiligamentous injured knee, and isolated PCL tears are rare. PCL injuries are generally treated either conservatively or by PCL reconstruction using a graft. If a proximal or distal tear is present, the injured ligament can also be treated by primary repair, in which the ligament is reattached to the tibial or femoral insertion. This has the (theoretical) advantages of preserving the native tissue, maintaining proprioception, and can be performed in a less invasive way when compared with reconstruction surgery. In this review, the appropriate patient selection, surgical indications, surgical techniques, and outcomes of primary repair of proximal and distal PCL tears will be discussed. Primary repair may be an alternative treatment for PCL reconstruction if appropriate patient selection is applied.
Factors Affecting Posttraumatic Stress Disorder in South Korean Trauma Nurses
Authors: Kim Su Ji , Yeo Jung Hee
Published: December 2019

Trauma nurses are exposed to suffering, death and dying, and vicarious trauma, which may result in nurses experiencing posttraumatic stress disorder (PTSD). This study aims to investigate the extent of PTSD and the effect of the frequency of traumatic events, coping strategies, and social support on PTSD in South Korean trauma nurses. A cross-sectional study was conducted. Participants were 145 trauma nurses recruited from 6 regional trauma centers in Korea. The data were collected through convenience sampling using self-administered questionnaires, including the Korean version of Impact of Event Scale-Revised (IES-R-K), the frequency of traumatic events, coping strategies, and social support. The data were analyzed with descriptive statistics, t test, analysis of variance, Pearson's correlation coefficients, and multiple linear regression. The prevalence of IES-R-K score of 25 or more (indicating a high risk of PTSD) was detected in 57.2% of the trauma nurses. The frequency of traumatic events, work at traumatic emergency units, dysfunctional coping, emotion-focused coping, and social support were found to be significantly associated with PTSD. Therefore, it is necessary to develop PTSD management programs in order to provide effective coping strategies and social support for relieving PTSD symptoms. At the same time, efforts to improve the working environment are needed.
Veganism, aging and longevity: new insight into old concepts
Authors: Norman Kristina , Klaus Susanne
Published: December 2019

Purpose of review

Plant-based diets are associated with better health and longevity. Veganism is a strict form of vegetarianism, which has gained increasing attention in recent years. This review will focus on studies addressing mortality and health-span in vegans and vegetarians and discuss possible longevity-enhancing mechanisms.

Recent findings

Studies in vegans are still limited. Epidemiologic studies consistently show lower disease rates, such as lower incidence of cancer and cardiovascular disease, but mortality rates are comparable with rates in vegetarians and occasional meat eaters. Reasons for following strict vegan diets differ, which may affect diet quality, and thus health and life-span. New insights into some characteristics of veganism, such as protein restriction or restriction in certain amino acids (leucine or methionine) show potentially life-span-enhancing potential. Veganism improves insulin resistance and dyslipidemia and associated abnormalities. Gut microbiota as mediator of dietary impact on host metabolism is more diverse in vegans and has been suggested to be a health-promoting factor. Vegan diets do not fulfill the requirements of children, pregnant women or old individuals who should receive adequate supplements.

There is substantial evidence that plant-based diets are associated with better health but not necessarily lower mortality rates. The exact mechanisms of health promotion by vegan diets are still not entirely clear but most likely multifactorial. Reasons for and quality of the vegan diet should be assessed in longevity studies.
Is slower advancement of enteral feeding superior to aggressive full feeding regimens in the early phase of critical illness
Authors: Lheureux Olivier , Preiser Jean-Charles
Published: December 2019

Purpose of review

An excessive caloric intake during the acute phase of critical illness is associated with adverse effects, presumably related to overfeeding, inhibition of autophagy and refeeding syndrome. The purpose of this review is to summarize recently published clinical evidence in this area.

Recent findings

Several observational studies, a few interventional trials, and systematic reviews/metaanalyses were published in 2017–2019. Most observational studies reported an association between caloric intakes below 70% of energy expenditure and a better vital outcome. In interventional trials, or systematic reviews, neither a benefit nor a harm was related to increases or decreases in caloric intake. Gastrointestinal dysfunction can be worsened by forced enteral feeding, whereas the absorption of nutrients can be impaired.

Owing to the risks of the delivery of an excessive caloric intake, a strategy of permissive underfeeding implying a caloric intake matching a maximum of 70% of energy expenditure provides the best risk-to-benefit ratio during the acute phase of critical illness.
Association of serum vitamin D level and nonalcoholic fatty liver disease: a meta-analysis
Authors: Liu Tian , Xu Lei , Chen Fu-Hua , Zhou Yi-Bo
Published: December 2019

We aimed to explore the potential link of serum vitamin D level with nonalcoholic fatty liver disease (NAFLD). PubMed, Embase and the Cochrane Library database were searched until the end of February 2018. Clinical studies with sufficient data investigating the relationship between serum vitamin D and NAFLD were included. The outcome data were processed to make an overall estimate of combined standardized mean differences (SMD) and pooled odds ratio (OR)/hazard ratios with 95% confidence intervals (CIs). Of the 309 initially retrieved studies, 15 studies of high quality involving a total of 20 096 participants (including 7803 NAFLD patients) were included in this meta-analysis. Meta-analysis of continuous data indicated that NAFLD patients had averagely 0.90 ng/ml lower levels of 25-hydroxyvitamin D compared with the non-NAFLD subjects (SMD −0.90; 95% CI: −1.29 to −0.52). Parallelly, pooled dichotomous data revealed that serum vitamin D level is negatively associated with NAFLD (OR = 0.64, 95% CI = 0.54–0.77), albeit with substantial heterogeneity. Next, subgroup analysis showed that Western NAFLD patients were more likely to be vitamin D deficient (OR = 0.60, 95% CI = 0.46–0.78). Finally, meta-regression showed that sample size, ethnic background, and diagnosis of NAFLD were possible sources of heterogeneity in the meta-analysis. Our results revealed that serum vitamin D level was inversely associated with an increased risk of NAFLD. Patients with hypovitaminosis D might benefit from extra supplement of vitamin D against the risk of NAFLD.
The association of 18F-fluorodeoxyglucose PET/computed tomography parameters with tissue gastrin-releasing peptide receptor and integrin αvβ3 receptor levels in patients with breast cancer
Authors: Arslan Esra , Aksoy Tamer , Can Trabulus Fadime Didem , Kelten Talu Canan , Yeni Begüm , Çermik Tevfik Fikret
Published: December 2019

Objective

Gastrin-releasing peptide receptor (GRPR) and integrinαvβ3 receptors are significantly associated with primary breast cancer, neovascular endothelial, and metastatic tumor cells. We aimed to evaluate GRPR and integrinαvβ3 receptor staining,18F-FDG uptake patterns and possible prognostic factors in breast cancer.

Methods

Ninety lesions of 87 subjects diagnosed with breast cancer were included in this prospective study. The sections were stained with GRPR and integrinαvβ3. Subjects were divided into four molecular subgroups: luminal A, luminal B, triple negative and HER2. PET/CT imaging was performed on all subjects. The groups were compared in terms of GRPR and integrinαvβ3 staining properties, possible prognostic factors and mean SUVmax values.

Results

Increased18F-FDG uptake was significantly associated with estrogen receptor and progesterone receptor negativity. Molecular subtypes were significantly associated with mean integrin scores (P = 0.030), while histopathological subtypes were significantly associated with mean GRPR scores (P = 0.029). Increased integrinαvβ3 expression is significantly associated with ER and PR negativity. Additionally, GRPR score was significantly correlated with estrogen receptor and progesterone receptor expression scores and a negative statistically significant correlation was detected between integrin and progesterone receptor scores. Mean primary lesion SUVmax had a statistically significant positive correlation with integrinαvβ3 score.

Conclusion

GRPR and integrinαvβ3 expression results are complementary to18F-FDG PET/CT findings, and are also significantly correlated with hormone receptors associated with aggressive subtypes. These results may pave the way for GRPR and integrinαvβ3 targeted imaging with68Ga-labeled molecules and systemic radionuclide treatment with177Lu-labeled compounds.
Safety considerations with biologics and new inflammatory bowel disease therapies
Authors: Queiroz Natália S.F. , Regueiro Miguel
Published: December 2019

Purpose of review

The safety profile of therapies is an important issue that should always be shared with patients when choosing their treatment. The introduction of biologics over the past 2 decades represented a breakthrough in the management of inflammatory bowel diseases (IBDs). With better understanding of the pathophysiology of the disease, emerging therapies targeting different mechanisms of action have been developed including targeted monoclonal antibodies and small molecules. However, increasing concerns about the safety and side effects of these drugs have been challenging clinicians in clinical practice.

Recent findings

Comparative safety data between different therapies are lacking in the literature. Most safety recommendations are based on adverse events reported in clinical trials and register-based cohorts. An extensive literature review addressing the risk of infections, malignancies, immunogenicity, and metabolic disorders was performed for biologics and new IBD therapies based on reported adverse events in pivotal trials, long-term extension trials and real-world studies.

In this article, we summarize the most recent data on safety of biologics and new IBD therapies and propose hierarchical positioning of drugs regarding safety based on expert opinion recommendations.
Recent insights into trace element deficiencies: causes, recognition and correction
Authors: Zemrani Boutaina , Bines Julie E.
Published: December 2019

Purpose of review

Trace elements are vital components involved in major body functions. Cases of trace elements deficiencies are increasingly encountered in clinical practice, although often underrecognized. This review gives a thorough insight into the newest findings on clinical situations associated with trace elements deficiencies in children and adults, their recognition and management.

Recent findings

Trace elements deficiencies are frequently found in various conditions, most commonly in burns, bariatric surgery, intestinal failure, renal replacement therapy, oncology, critical illness and cardiac surgery. The main trace elements involved are selenium, zinc, copper and iron. Trace elements deficiencies are associated with increased risk of morbidity and mortality. Recognition of clinical signs of trace elements deficiencies can be challenging. Although trace elements supplementation is indisputable in many circumstances, it is still debatable in other situations such as sepsis and cardiac surgery.

Recent findings on trace elements deficiencies could have important implications on health outcomes. Trace elements delivery is a core component of nutritional care. Front-line clinicians should be aware of at-risk clinical situations to provide correct and timely intervention. Future research should be directed towards investigating the potential benefits of antioxidant trace elements supplementation in children in whom studies are scarce, especially in critical conditions such as burns, sepsis and cardiac surgery.
Future of kidney stone management: surgical intervention miniaturization of PCNL: where is the limit?
Authors: Atassi Nabil , Knoll Thomas
Published: December 2019

Purpose of review

Miniaturization was the major trend in percutaneous nephrolithotomy in the past 15 years, aiming to lower tract-size-related complication rates while maintaining good stone-free-rates (SFR). Although there is some evidence that 18 Fr Mini-percutaneous lithotomy (PCNL) has comparable efficacy to conventional PCNL and a lower risk of bleeding, it is less clear whether further miniaturization led to an even better safety profile while maintaining good SFR. The present review evaluates the latest results on efficacy, safety, and feasibility of miniaturized techniques 14 Fr or less in PCNL.

Recent findings

Recent literature of the last 2 years reported outcomes of different systems from 4.85 to 14 Fr. Most of these studies demonstrated good efficacy when comparing with RIRS or conventional PCNL. Limitations were a decrease in SFR for stone sizes more than 2 cm, a longer operative time and the likelihood of pathologic intrarenal pressure (IRP) with a higher risk of postoperative fever or sepsis.

Miniaturization of PCNL is an innovative approach in order to lower complication rates and hospitalization time for therapy of renal stones. Limitations like longer OR time or higher IRP may limit the benefit of super miniaturized systems. Currently, the 18 Fr Mini-PCNL seems to be the most reliable solution for stones up to 25 mm, whereas RIRS remains the first choice in renal stones less than 10 mm.
Clinicopathologic Characterization of Children With B-Cell Non-Hodgkin Lymphoma Over 10 Years at a Tertiary Center in Cape Town, South Africa
Authors: Kriel Magdalena , Davidson Alan , Pillay Komala , Hendricks Marc , Phillips Lee-Ann
Published: December 2019

Background:

We characterized B-cell non-Hodgkin lymphoma (NHL) cases over 10 years at a tertiary children’s hospital to contribute to the body of knowledge on pediatric lymphoma in developing countries with a high human immunodeficiency virus (HIV) burden.

Methods:

A retrospective cohort study was carried out using clinical and laboratory records of children newly diagnosed with B-cell NHL from January 2005 to December 2014.

Results:

Seventy-five children ≤15 years of age were included. The majority had Burkitt lymphoma (n=61). Overall, (n=19) were HIV positive and 16% (n=12) had concurrent active tuberculosis. Bulky disease was present in 65.7% (n=46) and 30.1% (n=22) were classified as Lymphomes Malins B risk group C. The 5-year survival estimates for HIV-negative and HIV-positive children were similar in our cohort: 81% versus 79% for event-free survival and 85% versus 83.9% for overall survival. Of 3 children with Burkitt lymphoma, HIV, and Lymphomes Malins B group C, 2 died within 1 year.

Conclusions:

Irrespective of HIV status, the survival of children in our B-cell NHL cohort compares favorably with cure rates in developed nations, although advanced disease remains associated with a poor prognosis. Characterization of childhood NHL cases contributes to accurate risk stratification and tailored treatment.
The BRIGHTLIGHT National Survey of the Impact of Specialist Teenage and Young Adult Cancer Care on Caregivers’ Information and Support Needs
Authors: Martins Ana , Alvarez-Galvez Javier , Fern Lorna A. , Vindrola-Padros Cecilia , Barber Julie A. , Gibson Faith , Whelan Jeremy S. , Taylor Rachel M.
Published: December 2019

Background

Teenage and young adult cancer services in England are centralized in 13 principal treatment centers (TYA-PTC). These “specialist services” are designed to support caregivers as well as young people.

Objectives

To evaluate whether caregivers of young people with cancer had fewer unmet information and support needs if they had all/some care in a TYA-PTC.

Methods

Participants in a cohort study of young people with cancer nominated their main carer to complete the BRIGHTLIGHT Carer Questionnaire, completed 6 months after diagnosis. Comparisons were made according to where young people’s care was delivered: all, some, or no care in a TYA-PTC. Principal components analysis reduced the questionnaire to 5 dimensions, which were used as dependent variables in subsequent regression analysis.

Results

Four hundred seventy-six responses of 514 returned questionnaires (92%) were included in the analysis. The majority of caregivers were white, middle-aged, married/cohabiting mothers. Adjusted analysis indicated caregivers who had all/some care in a TYA-PTC had more satisfaction with support and also with services specifically provided for carers. Those who had some TYA-PTC care had greater satisfaction with information but less opportunity to be involved in decisions.

Conclusions

Caregivers of young people who had no TYA-PTC care have the most unmet information and support needs.

Implications for Practice

Nurses outside of the TYA-PTC need to be supported by the TYA-PTC in providing information/support for caregivers. When a young person is receiving care in multiple hospitals, nurses need to optimize opportunities for caregivers to be involved in decision making.
Calling an Oncological Emergency Telephone to Seek Advice
Authors: Jørgensen Lone , Jacobsen Heidi Ramlow , Pedersen Birgith , Uhrenfeldt Lisbeth
Published: December 2019

Background

Cancer treatment is increasingly provided on an outpatient basis, which may challenge patients and caregivers coping with illness and adverse effects at home. A telephone consultation is an accepted type of healthcare provision to support patients and prevent adverse outcomes when their capacity to self-manage is inadequate. Whether this option for help sufficiently supports patients needs further investigation.

Objectives

The aim of this study was to explore patients’ and caregivers’ experience of calling an oncological emergency telephone.

Methods

The study applies a phenomenological hermeneutic approach with 12 semistructured interviews. Patients and caregivers who had called the oncological emergency telephone within the last 2 months were included. The interview texts were analyzed by content analysis.

Results

Patients and caregivers perceive the emergency telephone as a lifeline that they consider calling when the patient’s condition changes from what they understand as normal to what they perceive as abnormal. They would rather call “one time too many than one time too few” if their resources are inadequate to ensure their safety. The tone, attitude, and professional competency of healthcare providers affect patients’ experience of the call.

Conclusions

The value of calling the oncological emergency telephone depends on the healthcare providers’ professional competences and skills to establish a relationship that makes patients feeling accommodated and taken care of.

Implications for Practice

Patients’ and caregivers’ perceptions of what constitutes a good telephone consultation represent significant knowledge that contributes to a more comprehensive and practice-based understanding of what is required to advise patients and caregivers in an oncological emergency telephone.
“We're Afraid to Say Suicide”
Authors: Monteith Lindsey L. , Smith Noelle B. , Holliday Ryan , Dorsey Holliman Brooke A. , LoFaro Carl T. , Mohatt Nathaniel V.
Published: December 2019

Suicide is a significant public health concern for veterans residing in rural communities. Although various initiatives have been implemented to prevent suicide among veterans, efforts specific to rural veterans remain limited. To aid such efforts, we examined stigma as a potential barrier to community readiness in the implementation of a community-based suicide prevention program for rural veterans. In this qualitative study, community readiness interviews were conducted with 13 participants in a rural community. Themes included lack of awareness regarding veteran suicide, rare discussions of veteran suicide, and suicide-related stigma within the community. Results suggest that prioritizing destigmatization may be particularly important to implementing community-based suicide prevention programming in rural communities. In particular, addressing community misconceptions regarding veteran suicide, while increasing knowledge of the extent to which veteran suicide occurs locally may facilitate increased awareness and thus community readiness to prevent suicide among rural veterans.
Do Polymer Coatings Change the Aberrations of Conventional and Wavefront-guided Scleral Lenses?
Authors: Hastings Gareth D. , Zanayed Julianna Z. , Nguyen Lan Chi , Applegate Raymond A. , Marsack Jason D.
Published: December 2019

SIGNIFICANCE

The findings of this study indicate that patients could simultaneously be offered the individualized optical correction of wavefront-guided (WFG) lenses and the superior comfort afforded by polymer coatings. This could be helpful to patients with ectasia suffering ocular dryness or dependent on scleral lenses for lengthy periods of wear.

PURPOSE

Wavefront-guided scleral lenses target lower- and higher-order aberrations of individual eyes using submicrometer-level contours in the anterior lens surface. Hydrophilic polyethylene glycol (PEG) polymer coatings applied to lens surfaces improve comfort and wettability. This study aimed to quantify aberration changes (e.g., masking) when applying polymer coatings to WFG and conventional scleral lenses.

METHODS

Two control lenses (remained uncoated) and 14 experimental lenses (two repeated builds of seven aberration designs: one spherical, two coma, four full WFG [second- to fifth-order aberrations]) were manufactured, and aberrations were measured (mean of three) by two operators before and after coating. Root mean square (RMS) and visual image quality (logVSX) differences were calculated for 6-mm diameters.

RESULTS

Median RMS aberration change due to coating was 0.012 μm (range, 0.008 to 0.057 μm). Maximum logVSX change due to coating was 0.073, predicting an approximately one letter change in acuity. Instrument sensitivity was 0.002 μm. Acute instrument and operator variabilities (standard deviations of individual [second- to fifth-order Zernikes] were all <0.027 μm). Longitudinal variability (control lenses) was low: all less than 0.017 μm. Although RMS of differences between repeated builds of all lenses was less than 0.25 D and not statistically significant, relatively, manufacture constituted the major variability, and RMS difference between repeated builds was at least four times greater than the effect of coating (median, 0.167 μm; range, 0.088 to 0.312 μm).

CONCLUSIONS

Application of polymer coatings caused measurable changes in aberrations of WFG and conventional scleral lenses; however, these were clinically and statistically insignificant and within variability of repeated lens manufacture. In their current states, WFG lenses and polymer coatings could be used simultaneously.
A Review of the Use of Confidence Intervals for Bland-Altman Limits of Agreement in Optometry and Vision Science
Authors: Carkeet Andrew
Published: December 2019

SIGNIFICANCE

Confidence intervals are still seldom reported for Bland-Altman 95% limits of agreement. When they are reported, 50% of articles use approximate methods and 50% use exact methods.

PURPOSE

Bland-Altman limits of agreement can be unreliable estimates, especially for small sample sizes. However, authors seldom use confidence intervals for limits of agreement. This article reviews their use in Optometry and Vision Science.

METHODS

A keyword search for “Bland,” “Altman,” “Bland-Altman,” “LoA,” and “limits of agreement” was conducted on the Optometry and Vision Science website within a time range from January 2016 to December 2018.

RESULTS

Fifty articles were reported or were judged to use Bland-Altman analysis; sample sizes ranged from 3 to 2072. Eight of these article reported confidence limits for limits of agreement, four of which used exact methods and four used Bland and Altman's approximate method.

CONCLUSIONS

Use of confidence intervals for limits of agreement has increased in Optometry and Vision Science but is far from universal. To assist researchers in calculating exact confidence limits for Bland-Altman limits of agreement, spreadsheets are included for performing the calculations and generating Bland-Altman plots with the confidence intervals included.
Metastatic Cutaneous Basal Cell Carcinoma: Report of 2 Cases Preceding the Hedgehog Pathway Antagonists Era
Authors: Bisceglia Michele , Panniello Gaetano , Nirchio Vincenzo , Sanguedolce Francesca , Centola Michele , Ben-Dor David J.
Published: December 2019

Basal cell carcinoma (BCC) of the skin is the most common type of malignant human tumor. However, metastatic BCC is a very rare event with weakly effective therapeutic options and a poor prognosis, until a few years ago. In 2012, small-molecule therapies, capable of inactivating the hedgehog signaling pathway and thus reducing tumor growth and progression, were introduced into clinical practice for the treatment of patients with advanced BCC. We present retrospectively 2 personal cases of metastatic BCC of the skin, from the premolecular therapy era, from primary tumors that arose years before in the head and neck area. The former case occurred in a 45-year-old woman with a history of recurrent BCC of the retroauricular skin who eventually died due to diffuse metastatic spread. The latter case concerned a 70-year-old man also with a history of recurrent BCC of the nasal-perinasal skin who developed multiple subcutaneous and lymph node metastases in the neck. In both cases, the diagnoses were based on biopsies of the metastatic sites. The first patient died 5 months after the diagnosis of metastatic disease, while the second was alive and disease-free 2 years after neck lymph node dissection and external radiation therapy, and then lost to follow-up. We extensively discuss several tumor entities with basal or basaloid features that may enter the differential diagnosis with BCC in metastatic sites. In addition, we briefly summarize the advances in clinical therapeutics using small molecules, which are now an integral part of the treatment of such advanced BCC cases.
Gene Expression Profiling of Head and Neck Tumors Identifies FOXP1 and SOX10 Expression as Useful for Distinguishing Ameloblastoma From Basaloid Salivary Gland Tumors
Authors: Ko Yen Chen Kevin , Varma Sushama , Zhu Chun Fang , Zhu Shirley Xiaolei , Vennam Sujay , Poh Catherine F. , Jordan Richard C. , Kong Christina , Pollack Jonathan R. , West Robert B.
Published: December 2019

Odontogenic tumors show considerable morphologic heterogeneity and at times the diagnosis can be challenging. Ameloblastoma, the most common odontogenic tumor, can have morphologic similarity to some salivary gland tumors and therefore we sought to identify biomarkers that might aid in the diagnosis by performing transcriptome wide gene expression profiling of 80 odontogenic and salivary gland neoplasms. These data identified the FOXP1+/SOX10− expression profile as characteristic of many odontogenic tumors including ameloblastoma but largely absent in salivary gland tumors. We then assessed 173 salivary gland tumors and 108 odontogenic tumors by immunohistochemistry for FOXP1 and SOX10 expression and found that 34/35 (97%) cases of ameloblastomas were diffusely positive for FOXP1 but completely negative for SOX10. None of the basaloid salivary neoplasms (basal cell adenoma, adenoid cystic carcinoma, polymorphous adenocarcinoma, and myoepitheloma) demonstrated FOXP1+/SOX10− expression pattern. Taken together, the results of this study suggest that the FOXP1+/SOX10− immunophenotype is common in odontogenic tumors including ameloblastoma and might be useful distinguishing these from similar appearing basaloid salivary gland tumors.