bluuebunny/crossref_metadata_2025 huggingface dataset:
Epidemiology of Comorbid Conditions Among Adults 50 Years and Older With Traumatic Brain Injury
Authors: Kumar Raj G. , Juengst Shannon B. , Wang Zhensheng , Dams-O'Connor Kristen , Dikmen Sureyya S. , O'Neil-Pirozzi Therese M. , Dahdah Marie N. , Hammond Flora M. , Felix Elizabeth R. , Arenth Patricia M. , Wagner Amy K.
Published: January 2017

Objectives:

Aging individuals with traumatic brain injury (TBI) experience multiple comorbidities that can affect recovery from injury. The objective of this study was to describe the most commonly co-occurring comorbid conditions among adults 50 years and older with TBI.

Setting:

Level I Trauma centers.

Participants:

Adults 50 years and older with moderate/severe TBI enrolled in the TBI-Model Systems (TBI-MS) from 2007 to 2014 (n = 2134).

Design:

A TBI-MS prospective cohort study.

Main Measures:

International Classification of Disease–9th Revision codes collapsed into 45 comorbidity categories. Comorbidity prevalence estimates and trend analyses were conducted by age strata (50-54, 55-64, 65-74, 75-84, ≥85 years). A dimension reduction method, Treelet Transform, classified clusters of comorbidities that tended to co-occur.

Results:

The 3 most commonly occurring comorbid categories were hypertensive disease (52.6/100 persons), other diseases of the respiratory system (51.8/100 persons), and fluid component imbalances (43.7/100 persons). Treelet Transform classified 3 clusters of comorbid codes, broadly classified as (1) acute medical diseases/infections, (2) chronic conditions, and (3) substance abuse disorders.

Conclusion:

This study provides valuable insight into comorbid conditions that co-occur among adults 50 years and older with TBI and provides a foundation for future studies to explore how specific comorbidities affect TBI recovery.
The Relationship Between Traumatic Brain Injury and Criminality in Juvenile Offenders
Authors: Gordon Wayne A. , Spielman Lisa A. , Hahn-Ketter Amanda E. , Sy Karla Therese L.
Published: January 2017

Objective:

To examine the relationship between traumatic brain injury (TBI) and criminal behavior in youth who are incarcerated or on probation in Texas.

Setting:

Seven juvenile justice facilities.

Participants:

Juvenile offenders in state or county correctional facilities or on probation.

Design:

Screening for TBI was conducted among adolescents at 7 juvenile justice centers.

Main Measures:

Participants were administered the Brain Injury Screening Questionnaire, and results were linked to participants' offense history and psychiatric diagnoses.

Results:

One in 4 juvenile offenders met criteria for TBI, and the majority of injuries occurred prior to the adolescents' criminal offenses. A history of TBI was related to more violent crimes, as well as more mental health diagnoses and symptoms.

Conclusion:

The high rates of TBI and levels of distress found in juvenile offenders suggest a need for preventive actions, interventions to compensate for challenges related to TBI, and programs to assist individuals' transitions into the community.
Reductions in Alexithymia and Emotion Dysregulation After Training Emotional Self-Awareness Following Traumatic Brain Injury: A Phase I Trial
Authors: Neumann Dawn , Malec James F. , Hammond Flora M.
Published: January 2017

Objectives:

To examine the acceptability and initial efficacy of an emotional self-awareness treatment at reducing alexithymia and emotion dysregulation in participants with traumatic brain injury (TBI).

Setting:

An outpatient rehabilitation hospital.

Participants:

Seventeen adults with moderate to severe TBI and alexithymia. Time postinjury ranged 1 to 33 years.

Design:

Within subject design, with 3 assessment times: baseline, posttest, and 2-month follow-up.

Intervention:

Eight lessons incorporated psychoeducational information and skill-building exercises teaching emotional vocabulary, labeling, and differentiating self-emotions; interoceptive awareness; and distinguishing emotions from thoughts, actions, and sensations.

Measures:

Toronto Alexithymia Scale-20 (TAS-20); Levels of Emotional Awareness Scale (LEAS); Trait Anxiety Inventory (TAI); Patient Health Questionnaire-9 (PHQ-9); State-Trait Anger Expression Inventory (STAXI); Difficulty With Emotion Regulation Scale (DERS); and Positive and Negative Affect Scale (PANAS).

Results:

Thirteen participants completed the treatment. Repeated-measures analysis of variance revealed changes on the TAS-20 (P = .003), LEAS (P < .001), TAI (P = .014), STAXI (P = .015), DERS (P = .020), and positive affect (P < .005). Paired t tests indicated significant baseline to posttest improvements on these measures. Gains were maintained at follow-up for the TAS, LEAS, and positive affect. Treatment satisfaction was high.

Conclusion:

This is the first study published on treating alexithymia post-TBI. Positive changes were identified for emotional self-awareness and emotion regulation; some changes were maintained several months posttreatment. Findings justify advancing to the next investigational phase for this novel intervention.
Branched Chain Amino Acids (BCAAs) and Traumatic Brain Injury: A Systematic Review
Authors: Sharma Bhanu , Lawrence David W. , Hutchison Michael G.
Published: January 2017

Background:

Despite the prevalence of traumatic brain injury (TBI), pharmaceutical treatment options for brain injury remain limited. However, nutritional intervention (such as with branched chain amino acids [BCAAs]) has emerged as a promising treatment option for TBI.

Objectives:

(1) To determine whether TBI patients have lower levels of endogenous BCAAs postinjury; and (2) to evaluate whether post-TBI BCAA supplementation improves clinical outcome.

Design:

A systematic review of primary research articles examining the relationship between BCAAs and TBI recovery indexed in Ovid/MEDLINE, EMBASE, and PsycINFO.

Results:

Of the 11 studies identified, 3 examined the effects of TBI on endogenous BCAA levels and consistently reported that BCAA concentrations were depressed postinjury. The remaining 8 studies examined the effects of BCAA supplementation on TBI outcome in animals (n = 3) and humans (n = 5). The animal studies (in mild-to-moderate TBI) showed that BCAAs improved post-TBI outcome. Similar results were found in human trials (conducted primarily in patients with severe TBI), with 4 of the 5 studies reporting improved outcome with BCAA supplementation.

Conclusion:

Although our review demonstrates an overall positive association between BCAAs and TBI outcome, the evidence of the efficacy of supplementation has been limited to severe TBI. To date, there is insufficient evidence to determine the benefits of BCAAs in mild TBI. Given the high frequency of mild TBI and the promise of BCAAs as an intervention in severe TBI, future research should examine the effects of BCAAs in milder brain injury.
DEXAMETHASONE INTRAVITREAL IMPLANT FOR X-LINKED (JUVENILE) RETINOSCHISIS
Authors: Mukhtar Sabrina , Potter Stephen M. , Khurshid Syed G.
Published: January 2017

Purpose:

Dexamethasone intravitreal corticosteroid implants (OZURDEX) have been used to treat subretinal fluid associated with several retinal diseases. We describe the use of a dexamethasone intravitreal implant for symptomatic management in a case of X-linked (juvenile) retinoschisis (XLRS).

Methods:

A 19-year-old man diagnosed with XLRS was treated with a dexamethasone intravitreal implant for his newly symptomatic subretinal fluid.

Conclusion:

Dexamethasone intravitreal implant treatment in the setting of XLRS has not been previously described. To the authors' knowledge, this is the first description of the use of corticosteroid implants to treat symptomatic subretinal fluid in XLRS. Further studies are warranted to investigate the role of corticosteroid implant treatment in XLRS.
LINCOFF RULES ARE NOT FOLLOWED IN RETINAL DETACHMENT WITH POSTERIOR BREAKS AND ATTACHED CORTICAL VITREOUS
Authors: Azad Shorya V. , Takkar Brijesh , Bhatia Indrish , Azad Rajvardhan
Published: January 2017

Purpose:

1) To evaluate factors governing flow of subretinal fluid and validate Lincoff rules (LRs) in cases of rhegmatogenous retinal detachment. 2) To identify cases of rhegmatogenous retinal detachment where LRs are not followed.

Method:

This was a retrospective study where 253 patients of rhegmatogenous retinal detachment were identified through surgery records. Two hundred and twenty-nine case sheets with complete record of ocular examination and surgical findings were analyzed. Seventy-five of the 229 patients, having subtotal rhegmatogenous retinal detachment where LR could be applied were included for analysis. Validity of LR was analyzed about location of break, lattice degeneration, posterior vitreous detachment (PVD), proliferative vitreoretinopathy, lens status, myopia, and trauma.

Result:

The mean age of the patients was 40.12 years. Sixty-one were men. Lincoff rule was validated in 59 of the 75 patients. Anterior breaks (P < 0.008) and PVD (P < 0.001) were found to have a significant association with validity of LR. Other attributes did not have a statistically significant association with validity of LR.

Conclusion:

Presence of posterior retinal breaks and absent PVD is associated with unusual flow of subretinal fluid. Lincoff rules are valid in most of the clinical scenarios.
Combined Effect of Ocular and Multifocal Contact Lens Induced Aberrations on Visual Performance: Center-Distance Versus Center-Near Design
Authors: Lopes-Ferreira Daniela , Fernandes Paulo , Queirós António , González-Meijome José M.
Published: January 2017

Purpose:

To evaluate the combined effects of inherent ocular aberrations and induced aberrations with a multifocal soft contact lens (MFCL) after 15 days of lens wear in presbyopic participants and their influence on visual performance at distance and near under high and low contrast conditions.

Methods:

Forty presbyopic participants (mean age, 48.7±3.4) presenting a mean addition of 1.53±0.58 D were fitted with Biofinity Multifocal (CooperVision) and included in the study. Measurements comprised distance and near monocular high (100%) and low contrast (10%) logMAR visual acuity (VA). Ocular aberrations were obtained with Hartmann–Shack aberrometer (IRX3, Imagine Eyes) and analyzed for 2 mm and maximum round natural pupil.

Results:

Distance VA was significantly higher in dominant eye, whereas near VA was significantly better in the non-dominant eye (P<0.05 in all conditions). For a 2-mm pupil in the dominant eye fitted with MFCL, spherical-like aberration significantly increased (P=0.027) so as higher-order aberrations (HOA) (P=0.002). A significant increase was also observed in spherical-like aberrations (P=0.001), coma-like aberrations (P=0.006) and HOA (P=0.004) in non-dominant eye. For the maximum round natural pupil size, a significant decrease in vertical coma was observed (P=0.018) in dominant eye, whereas a significant increase in spherical-like (P<0.001) and coma-like aberrations (P=0.007) was observed in non-dominant eye. A negative significant correlation was found between vertical coma and high contrast VA (Rho=−0.405, P=0.011) in dominant eye; whereas in non-dominant eye, a significant correlation was found between induced secondary astigmatism and distance VA under high (Rho=0.556, P<0.001) and low contrast (Rho=0.448, P=0.005).

Conclusions:

On-eye visual performance of MFSCL is dependent on the high-order aberrations induced by dominant and non-dominant design coupled with the wearer's inherent aberrations.
Exponential Decay Metrics of Topical Tetracaine Hydrochloride Administration Describe Corneal Anesthesia Properties Mechanistically
Authors: Ethington Jason , Goldmeier David , Gaynes Bruce I.
Published: January 2017

Purpose:

To identify pharmacodynamic (PD) and pharmacokinetic (PK) metrics that aid in mechanistic understanding of dosage considerations for prolonged corneal anesthesia.

Methods:

A rabbit model using 0.5% tetracaine hydrochloride was used to induce corneal anesthesia in conjunction with Cochet–Bonnet anesthesiometry. Metrics were derived describing PD-PK parameters of the time-dependent domain of recovery in corneal sensitivity. Curve fitting used a 1-phase exponential dissociation paradigm assuming a 1-compartment PK model. Derivation of metrics including half-life and mean ligand residence time, tau (τ), was predicted by nonlinear regression. Bioavailability was determined by area under the curve of the dose–response relationship with varying drop volumes.

Results:

Maximal corneal anesthesia maintained a plateau with a recovery inflection at the approximate time of predicted corneal drug half-life. PDs of recovery of corneal anesthesia were consistent with a first-order drug elimination rate. The mean ligand residence time (tau, τ) was 41.7 minutes, and half-life was 28.89 minutes. The mean estimated corneal elimination rate constant (ke) was 0.02402 minute−1. Duration of corneal anesthesia ranged from 55 to 58 minutes. There was no difference in time domain PD area under the curve between drop volumes.

Conclusions:

Use of a small drop volume of a topical anesthetic (as low as 11 μL) is bioequivalent to conventional drop size and seems to optimize dosing regiments with a little effect on ke. Prolongation of corneal anesthesia may therefore be best achieved with administration of small drop volumes at time intervals corresponding to the half-life of drug decay from the corneal compartment.
A novel inhibitor of active protein kinase G attenuates chronic inflammatory and osteoarthritic pain
Authors: Sung Ying-Ju , Sofoluke Nelson , Nkamany Mary , Deng Shixian , Xie Yuli , Greenwood Jeremy , Farid Ramy , Landry Donald W. , Ambron Richard T.
Published: January 2017

Activating PKG-1α induces a long-term hyperexcitability (LTH) in nociceptive neurons. Since the LTH correlates directly with chronic pain in many animal models, we tested the hypothesis that inhibiting PKG-1α would attenuate LTH-mediated pain. We first synthesized and characterized compound N46 (N-((3R,4R)-4-(4-(2-fluoro-3-methoxy-6-propoxybenzoyl)benzamido)pyrrolidin-3-yl)-1H-indazole-5-carboxamide). N46 inhibits PKG-1α with an IC50 of 7.5 nmol, was highly selective when tested against a panel of 274 kinases, and tissue distribution studies indicate that it does not enter the CNS. To evaluate its antinociceptive potential, we used 2 animal models in which the pain involves both activated PKG-1α and LTH. Injecting complete Freund's adjuvant (CFA) into the rat hind paw causes a thermal hyperalgesia that was significantly attenuated 24 hours after a single intravenous injection of N46. Next, we used a rat model of osteoarthritic knee joint pain and found that a single intra-articular injection of N46 alleviated the pain 14 days after the pain was established and the relief lasted for 7 days. Thermal hyperalgesia and osteoarthritic pain are also associated with the activation of the capsaicin-activated transient receptor protein vanilloid-1 (TRPV1) channel. We show that capsaicin activates PKG-1α in nerves and that a subcutaneous delivery of N46 attenuated the mechanical and thermal hypersensitivity elicited by exposure to capsaicin. Thus, PKG-1α appears to be downstream of the transient receptor protein vanilloid-1. Our studies provide proof of concept in animal models that a PKG-1α antagonist has a powerful antinociceptive effect on persistent, already existing inflammatory pain. They further suggest that N46 is a valid chemotype for the further development of such antagonists.
Can We Identify Minority Patients at Risk of Nonadherence to Antiplatelet Medication at the Time of Coronary Stent Placement?
Authors: Palacio Ana M. , Vidot Denise C. , Tamariz Leonardo J. , Uribe Claudia , Hazel-Fernandez Leslie , Li Hua , Garay Sylvia D. , Carrasquillo Olveen
Published: January 2017

Background:

Lack of medication adherence is associated with significant morbidity and mortality, particularly among minorities. We aim to identify predictors of nonadherence to antiplatelet medications at the time of percutaneous coronary intervention (PCI) with stent among African American and Hispanic patients.

Methods:

We used data collected for a randomized clinical trial that recruited 452 minority patients from a large US health insurance organization in 2010 post-PCI to compare telephone-based motivational interviewing by trained nurses with an educational video. The primary outcome was 12-month adherence to antiplatelet medications measured by the claims-based medication possession ratio (MPR). Adequate adherence was defined as an MPR of 0.80 or higher.

Results:

More than half of the sample (age, 69.52 ± 8.8 years) was male (57%) and Hispanic (57%). Most (78%) had a median income below $30 000 and 22% completed high school or higher. Univariate analyses revealed that symptoms of depression (<.01) and not having a spouse (P = .03) were associated with inadequate adherence. In multivariate analysis, baseline self-reported adherence (1.4; 95% confidence interval [CI], 1.05–1.89), depressive symptoms (0.49; 95% CI, 0.7–0.90), comorbidity (0.89; 95% CI, 0.80–0.98), and telephone-based motivational interviewing by trained nurses (3.5; 95% CI, 1.9–2.70) were associated with adherence.

Conclusions:

Having multiple comorbidities, depression, suboptimal adherence to medications, and low English proficiency at the time of PCI increase the risk of poor 12-month adherence to antiplatelets among minorities. Identifying these risk factors can guide PCI therapy and the use of evidence-based strategies to improve long-term adherence.
Pilot Study Evaluating the Impact of Otology Surgery Videos on Otolaryngology Resident Education
Authors: Poon Charles , Stevens Shawn M. , Golub Justin S. , Pensak Myles L. , Samy Ravi N.
Published: January 2017

Objectives:

Use of videos as educational tools is not a novel concept; however, there is a paucity of high-quality video resources available to otolaryngology trainees. We hypothesized that residents would deem surgical-videos using a multimedia-style format more valuable as preparatory tools. Aims of this study: 1) develop portfolio of otology/neurotology videos overviewing key steps, anatomy, and pearls by a senior surgeon; 2) have residents rate the effectiveness of the videos as a preoperative tool.

Study Design:

Prospective study.

Methods:

A video-library of procedures at (https://www.youtube.com/user/cisurgeon) was formatted via time-stamping to coincide expert level narration with closed captioning, critical procedural steps, relevant instrumentation, radiographic pictures, orientation cues, and anatomical highlights. Otolaryngology trainees of postgraduate years 2 through 5 (n = 13) watched a minimum of three videos and completed an assessment addressing: current resource identification/usefulness comparison, self-efficacy, impact on preparation time, and prioritization of resources.

Results:

The videos rated as highly useful compared with current resources (p = 0.002) and capable of promoting self-efficacy. Residents reported moderate-high prioritization of our multi-media formatted resource (scores >6) among their current preoperative regimen.

Conclusion:

The varied videos were rated highly in terms of usefulness, promoting self-efficacy and as a high-priority for a resident's surgical preparation. Multimedia-formatted training videos should be further explored for this generation of electronic-learners. Future studies with a larger cohort, objective approaches, and multidisciplinary involvement are needed to determine the full impact of this education medium on surgical-training.
Early Postoperative Imaging of the Labyrinth by Cone Beam CT After Stapes Surgery for Otosclerosis With Correlation to Audiovestibular Outcome
Authors: Vandevoorde Aurélie , Williams Marc T. , Ukkola-Pons Elsa , Daval Mary , Ayache Denis
Published: January 2017

Background:

Sensorineural complications of stapes surgery are rare but potentially serious. Imaging is usually performed to identify an underlying cause, such as excessive intravestibular penetration of the prosthesis or pneumolabyrinth suggesting perilymphatic fistula. Unfortunately, there is very little data in an unselected series of uneventful patients.

The aim of this study was to analyze the depth of prosthesis penetration within the vestibule and the rate of pneumolabyrinth the day or the day after the procedure by performing a cone beam computed tomography of the temporal bone in a cohort of unselected patients, and to correlate imaging findings to clinical outcome.

Methods:

A prospective monocentric study was conducted in a tertiary referral medical center. A cone beam computed tomography was performed in 80 consecutive patients having undergone stapes surgery for otosclerosis, the day or the day after the procedure. Penetration length and location of the prosthesis within the vestibule, as well as presence or absence of a pneumolabyrinth, were recorded, and compared with clinical data (vertigo, nystagmus, hearing measurement).

Results:

Pneumolabyrinth was found in 15% of the patients. The mean penetration length of the prosthesis within the vestibule was 1 mm (0–1.9 mm). No serious complication occurred during the study period. No correlations were found when comparing imaging findings to clinical outcome.

Conclusion:

Our results do not support empirically insights into detrimental effects of postoperative pneumolabyrinth or too long prosthesis after stapes surgery. Further studies are needed to better understand the causes of postoperative complications of stapes surgery.
Lucae's Springy Pressure Probe to Mobilize the Ossicular Chain: Rise and Fall of an Ingenious Instrument
Authors: Tange Rinze Anthony , Mudry Albert
Published: January 2017

Objectives/Hypotheses:

In 1884, Johann Constantin August Lucae (1835–1911), a German otologist from Berlin, introduced a new “method to mechanically treat chronic troubles of the mobility of the hearing organ transmission apparatus.” It consisted in the use of a springy pressure probe to directly mobilize the handle of the malleus. The aim of this study is to trace the invention, clinical use, technological modifications, and ultimate extinction of this instrument.

Method:

Review of Lucae's publications, comments by his colleagues, and trade catalogues published between 1880 and 1940.

Results:

Lucae presented at least six different models of his springy pressure probe during his career. Some of his colleagues modified it. The success rate was much disputed, and the instrument died with Lucae.

Conclusion:

Lucae's spring pressure probe is another example of the ingenuity of man to try to find a solution when confronted with an unclear and unresolved otological problem.
In Vivo Testing of Extracorporeal Membrane Ventilators: iLA-Activve Versus Prototype I-Lung
Authors: Kischkel Sabine , Bergt Stefan , Brock Beate , von Grönheim Johan , Herbst Anne , Epping Marc-Jonas , Matheis Georg , Novosel Esther , Schneider Joerg , Warnke Philipp , Podbielski Andreas , Roesner Jan P. , Lelkes Peter I. , Vollmar Brigitte
Published: January 2017

A side-by-side comparison of the decarboxylation efficacy of two pump-driven venovenous extracorporeal lung assist devices, i.e., a first prototype of the new miniaturized ambulatory extracorporeal membrane ventilator, I-lung versus the commercial system iLA-activve for more than a period of 72 hours in a large animal model. Fifteen German Landrace pigs were anesthetized and underwent mechanical hypoventilation to induce severe hypercapnia. Decarboxylation was accomplished by either the I-lung or the iLA-activve via a double lumen catheter in the jugular vein. Sham-operated pigs were not connected to extracorporeal devices. Cardiovascular, respiratory, and metabolic parameters were continuously monitored, combined with periodic arterial blood sampling for subsequent clinical blood diagnostics, such as gas exchange, hemolysis, coagulation parameters, and cytokine profiles. At the termination of the studies, lung tissue was harvested and examined histologically for pulmonary morphology and leukocyte tissue infiltration. Both extracorporeal devices showed high and comparable efficacy with respect to carbon dioxide elimination for more than 72 hours and were not associated with either bleeding events or clotting disorders. Pigs of both groups showed cardiovascular and hemodynamic stability without marked differences to sham-operated animals. Groups also did not differ in terms of inflammatory and metabolic parameters. We established a preclinical in vivo porcine model for comparative long-term testing of I-lung and iLA-activve. The I-lung prototype proved to be safe and feasible, providing adequate decarboxylation without any adverse events. Once translated into the clinical treatment, the new miniaturized and transportable I-lung device might represent a promising tool for treating awake and mobilized patients with decompensated pulmonary disorders.
Functional Tricuspid Regurgitation Model in a Beating Heart Platform
Authors: Jaworek Michal , Piola Marco , Lucherini Federico , Gelpi Guido , Castagna Marco , Lentini Giuliana , Antona Carlo , Fiore Gianfranco B. , Vismara Riccardo
Published: January 2017

Currently, clinicians are seeking new, minimally invasive treatment options for functional tricuspid regurgitation (FTR). Challenging tricuspid complexity requires the evaluation of the treatment techniques in adequate and realistic preclinical scenario. The purpose of this article is to describe the design and functional assessment of a novel passive beating heart model of the pulmonary circulation with the possibility to tightly control FTR. The model housed porcine hearts actuated by a volumetric pump that cyclically pressurized the right ventricle. The in-vitro FTR model exploited the tendency of the ventricle to dilate under pressure. The dilation entailed papillary muscles displacement and valve annulus enlargement, thus inducing tricuspid valve insufficiency. Employment of constraint bands allowed to restore valve competency. The system provided consistent replication of the main determinants of the pulmonary hemodynamics in a wide range of working conditions. The experimental model of FTR was reliable, easily controllable, and showed good stability-over-time. Echocardiography and fiberscope imaging provided a unique opportunity to investigate valve dynamics. These features make the platform suitable for realistic training purposes and testing of the upcoming FTR therapies.
The Effects of Probiotics and Symbiotics on Risk Factors for Hepatic Encephalopathy
Authors: Viramontes Hörner Daniela , Avery Amanda , Stow Ruth
Published: January 2017

Alterations in the levels of intestinal microbiota, endotoxemia, and inflammation are novel areas of interest in the pathogenesis of hepatic encephalopathy (HE). Probiotics and symbiotics are a promising treatment option for HE due to possible beneficial effects in modulating gut microflora and might be better tolerated and more cost-effective than the traditional treatment with lactulose, rifaximin or l-ornithine-l-aspartate. A systematic search of the electronic databases PubMed, ISI Web of Science, EMBASE, and Cochrane Library was conducted for randomized controlled clinical trials in adult patients with cirrhosis, evaluating the effect of probiotics and symbiotics in changes on intestinal microflora, reduction of endotoxemia, inflammation, and ammonia, reversal of minimal hepatic encephalopathy (MHE), prevention of overt hepatic encephalopathy (OHE), and improvement of quality of life. Nineteen trials met the inclusion criteria. Probiotics and symbiotics increased beneficial microflora and decreased pathogenic bacteria and endotoxemia compared with placebo/no treatment, but no effect was observed on inflammation. Probiotics significantly reversed MHE [risk ratio, 1.53; 95% confidence interval (CI): 1.14, 2.05; P=0.005] and reduced OHE development (risk ratio, 0.62; 95% CI: 0.48, 0.80; P=0.0002) compared with placebo/no treatment. Symbiotics significantly decreased ammonia levels compared with placebo (15.24; 95% CI: −26.01, −4.47; P=0.006). Probiotics did not show any additional benefit on reversal of MHE and prevention of OHE development when compared with lactulose, rifaximin, and l-ornithine-l-aspartate. Only 5 trials considered tolerance with minimal side effects reported. Although further research is warranted, probiotics and symbiotics should be considered as an alternative therapy for the treatment and management of HE given the results reported in this systematic review.
Effect of threatening life experiences and adverse family relations in ulcerative colitis: analysis using structural equation modeling and comparison with Crohn’s disease
Authors: Slonim-Nevo Vered , Sarid Orly , Friger Michael , Schwartz Doron , Sergienko Ruslan , Pereg Avihu , Vardi Hillel , Singer Terri , Chernin Elena , Greenberg Dan , Odes Shmuel
Published: January 2017

Background and aims

We published that threatening life experiences and adverse family relations impact Crohn’s disease (CD) adversely. In this study, we examine the influence of these stressors in ulcerative colitis (UC).

Patients and methods

Patients completed demography, economic status (ES), the Patient-Simple Clinical Colitis Activity Index (P-SCCAI), the Short Inflammatory Bowel Disease Questionnaire (SIBDQ), the Short-Form Health Survey (SF-36), the Brief Symptom Inventory (BSI), the Family Assessment Device (FAD), and the List of Threatening Life Experiences (LTE). Analysis included multiple linear and quantile regressions and structural equation modeling, comparing CD.

Results

UC patients (N=148, age 47.55±16.04 years, 50.6% women) had scores [median (interquartile range)] as follows: SCAAI, 2 (0.3–4.8); FAD, 1.8 (1.3–2.2); LTE, 1.0 (0–2.0); SF-36 Physical Health, 49.4 (36.8–55.1); SF-36 Mental Health, 45 (33.6–54.5); Brief Symptom Inventory-Global Severity Index (GSI), 0.5 (0.2–1.0). SIBDQ was 49.76±14.91. There were significant positive associations for LTE and SCAAI (25, 50, 75% quantiles), FAD and SF-36 Mental Health, FAD and LTE with GSI (50, 75, 90% quantiles), and ES with SF-36 and SIBDQ. The negative associations were as follows: LTE with SF-36 Physical/Mental Health, SIBDQ with FAD and LTE, ES with GSI (all quantiles), and P-SCCAI (75, 90% quantiles). In structural equation modeling analysis, LTE impacted ES negatively and ES impacted GSI negatively; LTE impacted GSI positively and GSI impacted P-SCCAI positively. In a split model, ES had a greater effect on GSI in UC than CD, whereas other path magnitudes were similar.

Conclusion

Threatening life experiences, adverse family relations, and poor ES make UC patients less healthy both physically and mentally. The impact of ES is worse in UC than CD.
Diagnosis and treatment of upper airway oedema caused by acute angio-oedema in the emergency department: a French consensus statement
Authors: Floccard Bernard , Javaud Nicolas , Deroux Alban , Boccon-Gibod Isabelle , Fain Olivier , Amarger Stéphanie , Blanchard-Delaunay Claire , Jeandel Pierre Y. , Marmion Nicolas , Ollivier Yann , Pralong Pauline , Gayet Stéphane , Du-Thanh Aurélie , Pelletier Fabien , Sailler Laurent , Robinson Philip , Launay David , Bouillet Laurence
Published: January 2017

Angio-oedema is a transitory, localized, noninflammatory oedema of subcutaneous tissue or mucous. When the oedema affects the mouth, lips, tongue or larynx, it can result in fatal asphyxiation in the absence of specific treatment. Oedema secondary to plasma extravasation is usually mediated by either histamine or bradykinin. As laboratory tests are not available in an emergency setting, the implicated mediator cannot be readily determined. The challenge for the emergency physician is to determine the aetiological type, evaluate severity and initiate adapted treatment by means of a structured approach. A team of experts from the French Reference Centre for Angio-oedema reached a consensus for recommendations for the diagnostic and therapeutic strategy to be adopted by emergency departments faced with angio-oedema of the upper airways in adults. The experts defined 11 important questions. Responses were rated using a two-round Delphi methodology. The 11 recommendations were related to triage on admission, a step-by-step diagnostic protocol, definition of attack severity, discouragement of instrumental examination, prioritization of treatment for severe attacks according to clinical signs and anticipation of access to specific treatments by the hospital. Angio-oedema of the upper airways can be fatal and requires anticipation by the emergency department. A search for the aetiology, an evaluation of clinical symptoms and the availability of the treatments are challenges justifying these recommendations.
Lipoprotein(a): new insights from modern genomics
Authors: Afshar Mehdi , Thanassoulis George
Published: January 2017

Purpose of review

Lipoprotein(a) [Lp(a)] is the strongest independent genetic risk factor for both myocardial infarction and aortic stenosis. It has also been associated with other forms of atherosclerotic cardiovascular disease (CVD) including ischemic stroke. Its levels are genetically determined and remain fairly stable throughout life. Elevated Lp(a), above 50 mg/dl, affects one in five individuals worldwide.

Recent findings

Herein, we review the recent epidemiologic and genetic evidence supporting the causal role of Lp(a) in CVD, highlight recommendations made by European and Canadian guidelines regarding Lp(a) and summarize the rapidly evolving field of Lp(a)-lowering therapies including antisense therapies and Proprotein Convertase Subtilisin/Kexin Type 9 inhibitors.

With novel therapies on the horizon, Lp(a) is poised to gain significant clinical relevance and its lowering could have a significant impact on the burden of CVD.

Video abstract

http://links.lww.com/COL/A14
Nonfunctioning Adrenocortical Carcinoma in Pediatric Acute Lymphoblastic Leukemia: A Case Report of a Rare Multiple Primaries Combination
Authors: Rashed Wafaa M. , Zekri Wael , Awad Madiha , Taha Hala , Abdalla Badr , Alfaar Ahmad S.
Published: January 2017

Childhood adrenocortical carcinoma (ACC) is a rare tumor and its association with acute lymphoblastic leukemia (ALL) is even rarer. One such case is discussed in this case report. A 3-year-old patient was concomitantly diagnosed with ALL and an initially nonmetastatic ACC. Management started by following the Total XV protocol without a window phase. Left adrenalectomy was conducted after the consolidation phase. Recurrence of a mass at the tumor bed was discovered at week 33 of the continuation phase. Reexcision was conducted, followed by the administration of an ACC protocol including cisplatin, etoposide, and doxirubicin. Mitotane was added when a pulmonary metastasis was discovered and then stopped after the patient suffered from an arachnoid cyst and speech difficulties. The ALL protocol was resumed from week 34 of the continuation phase. Progression of pulmonary nodules was noted after week 45. A pulmonary metastectomy was performed. The ALL protocol was resumed up to week 51 with a good response as proven by assessment of minimal residual disease. A further recurrence was diagnosed at the abdominal tumor bed with a paravertebral mass and a pulmonary nodule. The patient was assigned to palliative treatment and died after a 32-month survival. Such rare associations need more extensive discussions of the best possible management in scientific literature.
Antithrombin III as the Indicator of l-Asparaginase Activity in Children Treated for Acute Lymphoblastic Leukemia
Authors: Czogała Małgorzata , Balwierz Walentyna , Sztefko Krystyna , Rogatko Iwona
Published: January 2017

l-asparaginase (ASP) is widely used in the treatment of acute lymphoblastic leukemia (ALL) in children. Monitoring its activity is necessary because of the risk of drug inactivation as the result of an immune reaction. Besides allergic reactions, another frequent side effect of ASP treatment is coagulopathy, especially deficiency of antithrombin III (ATIII). The aim of this study was to analyze the relationship between ASP and ATIII activities and the possibility of ATIII activity use in an indirect ASP activity assessment. ASP and ATIII activity was measured in 76 children with ALL treated according to the ALL IC BFM 2002 protocol. A correlation between ASP and ATIII activities was found (R=−0.43, P=0.0001). ROC curve analysis revealed some utility regarding the determination of ATIII in identifying patients with low or undetectable ASP activity (area under the curve=0.87 [95% confidence interval, 0.77-0.96], P<0.0001 and 0.93 [95% confidence interval, 0.85-1.0], P<0.0001, respectively). Higher ATIII activity is associated with a higher probability of a decline in ASP activity. Examination of ATIII activity cannot replace a direct determination of ASP activity, but in the case of unavailability of the direct test, it can be a helpful surrogate parameter of drug activity.
Variation in Transfusion Requirements Among Children With Thalassemia on Regular Transfusion Programs: Which Formula Closely Predicts the Actual Requirements?
Authors: Cornell Nikki , Eisenhut Michael , Ramprakash Stalin
Published: January 2017

Background:

Various different formulae are used to calculate blood transfusion volumes in thalassemia. Using the right formula will avoid iron overload and complications of undertransfusion.

Observations:

Five years of transfusion data in 11 children with thalassemia showed that no single formula-calculated transfusion volumes accurately. The formula used in the United Kingdom with a hematocrit of the transfused blood of 0.6: (0.4×body weight×desired raise in hemoglobin [g/L]) yielded a volume closest to empirically determined requirements on average. Transfusion factors ranging from 0.3 to 0.48 were calculated as necessary to achieve the required volume for the individual patient.

Conclusions:

To meet transfusion requirements, individualization of formulas by establishment of the transfusion factor for each patient is helpful.
Iron Overload in the Liver of 2 Children: Nonalcoholic Steatohepatitis and Juvenile Hemochromatosis
Authors: Ünlüsoy Aksu Aysel , Caleffi Angela , Pietrangelo Antonello , Sari Sinan , Eğritaş Gürkan Ödül , Demirtaş Zeliha , Yilmaz Güldal , Dalgiç Buket
Published: January 2017

Background:

Iron overload disorders are hereditary hemochromatosis and secondary etiologies other than hereditary hemochromatosis. We describe 2 boys presenting with iron overload. Juvenile hemochromatosis and nonalcoholic steatohepatitis (NASH) related iron overload are the genetic and secondary causes, respectively.

Observations:

Both patients benefited from phlebotomy even if they had different etiologies.

Conclusions:

In childhood, the diagnosis of iron overload syndromes is crucial because they do not confront us with obvious symptoms and findings. Early initiation of a phlebotomy program can prevent mortality. NASH might lead to iron overload and iron overload might aggravate the clinical course of NASH.
Intracardiac Low-grade Sarcoma Following Treatment for Ewing Sarcoma
Authors: Ortiz Michael V. , Magnan Heather , Slotkin Emily K. , Ambati Srikanth R. , Chou Alexander J. , Wexler Leonard H. , Meyers Paul A. , Walsh Michael F. , Heaton Todd , Girardi Leonard N. , Wolden Suzanne L. , Price Anita P. , Kennedy Jennifer A. , Zehir Ahmet , Hameed Meera , Berger Michael F. , Kentsis Alex , Shukla Neerav
Published: January 2017

A 16-year-old male was diagnosed with Ewing sarcoma of the ribcage with pulmonary metastases. Six months after completion of scheduled therapy, he was found to have a new intracardiac mass, presumed recurrent Ewing sarcoma. EWSR1 fusion was not detected by droplet digital polymerase chain reaction from blood plasma. After no improvement with salvage chemotherapy, he underwent surgical resection that identified a low-grade spindle cell sarcoma. Despite the near-synchronous presentation of 2 unrelated sarcomas, extensive genomic analyses did not reveal any unifying somatic or germline mutations nor any apparent cancer predisposition. This case also highlights the potential role of utilizing plasma cell-free DNA for diagnosing tumors in locations where biopsy confers high morbidity.
The Symptom Experience of Patients With Advanced Pancreatic Cancer
Authors: Tang Chia-Chun , Von Ah Diane , Fulton Janet S.
Published: January 2017

Background:

Pancreatic cancer is a devastating disease with limited treatment options. More than 80% of pancreatic cancers are diagnosed in advanced stages and often have debilitating symptoms, making symptom management paramount, yet the symptom experience of patients with advanced pancreatic cancer (APC) is not well understood.

Objective:

The purpose of this integrative review is to synthesize the current evidence regarding the symptom experience of patients with APC.

Method:

An integrative literature review was conducted to identify the patient symptom experience in studies published from 2005 to 2015.

Results:

Sixteen studies met the inclusion criteria. All studies used a quantitative approach; 44% were quasi-experimental, 31% were descriptive, and 25% were correlational. Physical symptoms, especially pain, were the primary focus in most studies. Fatigue, loss of appetite, and impaired sense of well-being were prevalent and reported by patients to be of high intensity. Few studies examined psychological symptoms in patients with APC, although anxiety and depression were noted.

Conclusion:

Findings suggest that physical and psychological symptoms are prevalent, some with high intensity. Preselection of symptom inventories limits our ability to fully understand the symptom experience of patients with APC. Future qualitative work is needed to provide a more in-depth understanding of symptoms, especially symptom quality and distress level, from patients’ perspectives. More studies are needed to explore psychological symptoms and the interaction of physical and psychological symptoms.

Implications for Practice:

Findings help healthcare givers to better understand the symptom experience of their APC patients.
Effect of Peer-to-Peer Nurse–Physician Collaboration on Attitudes Toward the Nurse–Physician Relationship
Authors: Edwards Pamela B. , Rea Jean B. , Oermann Marilyn H. , Hegarty Ellen J. , Prewitt Judy R. , Rudd Mariah , Silva Susan , Nagler Alisa , Turner David A. , DeMeo Stephen D.
Published: January 2017

The goal of this study was to pilot a novel peer-to-peer nurse–physician collaboration program and assess for changes in attitudes toward collaboration among a group of newly licensed nurses and resident physicians (n = 39). The program included large group meetings, with discussion of key concepts related to interprofessional collaboration. In unit-based teams, the registered nurses and physicians developed a quality improvement project to meet a need on their unit. Creating learning activities like this program enable nursing professional development specialists to promote interprofessional collaboration and learning.
Career Mapping for Professional Development and Succession Planning
Authors: Webb Tammy , Diamond-Wells Tammy , Jeffs Debra
Published: January 2017

Career mapping facilitates professional development of nurses by education specialists and nurse managers. On the basis of national Nursing Professional Development Scope and Standards, our education and professional development framework supports the organization's professional practice model and provides a foundation for the professional career map. This article describes development, implementation, and evaluation of the professional career map for nurses at a large children's hospital to support achievement of the nursing strategic goals for succession planning and professional development.
Transforming Roles of Nursing Professional Development Practitioners
Authors: Warren Joan Insalaco , Harper Mary G.
Published: January 2017

This research was undertaken to delineate the future role of nursing professional development (NPD) specialists. Using a modified e-Delphi technique, seven key roles for NPD (partner for practice transitions, learning facilitator, change agent, mentor, leader, champion of scientific inquiry, and advocate for NPD specialty) and their concomitant competencies evolved. Results of this study informed the update of the NPD Scope and Standards of Practice and may be used to identify competencies for the specialty.
Donor Liver Small Droplet Macrovesicular Steatosis Is Associated With Increased Risk for Recipient Allograft Rejection
Authors: Choi Won-Tak , Jen Kuang-Yu , Wang Dongliang , Tavakol Mehdi , Roberts John P. , Gill Ryan M.
Published: January 2017

Although donor livers with <30% large droplet macrovesicular steatosis (MaS) and/or small droplet MaS (irrespective of percentage) are considered safe to use, this consensus is based on variable definitions of MaS subtypes and/or without a reproducible scoring system. We analyzed 134 donor liver biopsies from allografts transplanted at University of California at San Francisco between 2000 and 2015 to determine whether large and/or small droplet MaS is a risk factor for poor outcomes. Large droplet MaS was defined as a fat droplet occupying greater than one half of an individual hepatocyte, with nuclear displacement, and scored as the percentage of total parenchymal area replaced by large fat droplets on ×40 magnification. Small droplet MaS was defined as 1 to several discrete fat droplets, each occupying less than one half of an individual hepatocyte, and scored as the percentage of remaining hepatocytes (ie, hepatocytes not occupied by large fat droplets) containing small fat droplets on ×200 magnification (ie, small droplet MaS is the percentage of “remaining hepatocytes” with small fat droplets, and “remaining hepatocytes” is defined as 100% minus percent large droplet MaS). Thus, total MaS equals the sum of large and small droplet MaS, which cannot exceed 100%. Electronic medical records were reviewed to determine outcomes. There was an increased risk for acute cellular rejection (hazard ratio=2.5,P=0.0108) and bile duct loss suggestive of chronic ductopenic rejection (hazard ratio=2.4,P=0.0130) in donor livers with ≥30% small droplet MaS. Large droplet MaS (up to 60%) was not associated with adverse outcomes. Patient survival was not adversely affected by steatosis. Excellent agreement on the estimation of large (weighted κ=0.682) and small droplet MaS (weighted κ=0.780) was achieved. Our approach to donor steatosis scoring can identify liver allograft recipients at increased risk for rejection and highlights the importance of distinguishing between small and large droplet MaS in this evaluation.