bluuebunny/crossref_metadata_2025 huggingface dataset:
Conditional Survival Analysis for Spinal Chondrosarcoma Patients After Surgical Resection
Authors: Song Kehan , Lin Kaiyuan , Guan Hanfeng , Li Feng
Published: March 2020

Study Design.

Retrospective analysis.

Objective.

To evaluate conditional survival after surgical resection for spinal chondrosarcoma patients.

Summary of Background Data.

Survival estimates are usually reported as survival from the time of surgery, but survival probabilities can change over time. Conditional survival, which is a measure of prognosis for patients who have survived a defined period of time, may be more clinically precise and relevant. However, data on conditional survival for spinal chondrosarcoma patients after surgical resection are still lacking.

Methods.

We used the Surveillance, Epidemiology, and End Results (SEER) database to identify 436 spinal chondrosarcoma patients who underwent surgical resection from 1994 and 2013. Kaplan–Meier analyses and Cox regression modeling were performed to evaluate prognostic factors associated with overall survival. Five-year conditional survival (i.e., probability of surviving an additional 5 years, given that a patient has already survived x years) was calculated as 5–CS(x) = OS(x+5)/OS(x). The effect of prognostic factors on conditional survival was also explored.

Results.

Four hundred thirty six patients were included in the study cohort. Overall, 1-, 3-, and 5-year overall survival were 92.8%, 79.1%, and 70.3%, respectively. Five-year conditional survival at 1, 3, and 5 years after surgery were 72.9%, 79.0%, and 87.5%. The overall survival rates were lower in cases of age more than or equal to 60 years, male patient, dedifferentiated subtype, Grade III tumor, tumor size more than or equal to 10 cm, distant metastasis, and radiotherapy. Conditional survival improved over time in each subgroup divided by age, sex, race, year of diagnosis, grade, tumor size, extent of disease (EOD), and radiotherapy. In addition, patients with the least favorable prognosis at baseline experienced the greatest increase in 5-year conditional survival over time (e.g., Grade I/II: 78.0%–89.7%, Δ11.7% vs. Grade III: 36.5%–66.6%, Δ30.1%; Localized/Regional: 72.9%–88.1%, Δ15.2% vs. Distant: 43.5%–74.1%, Δ30.6%).

Conclusion.

Conditional survival for spinal chondrosarcoma patients after surgical resection improves over time, especially for patients with initial high-risk characteristics. Information derived from conditional survival analysis may provide individualized approaches to surveillance and treatment of spinal chondrosarcoma.

Level of Evidence: 4
Butylphthalide has an Anti-Inflammatory Role in Spinal Cord Injury by Promoting Macrophage/Microglia M2 Polarization via p38 Phosphorylation
Authors: Wang Lin , Wu Jian-ping , He Xi-jing
Published: March 2020

Study Design.

An experimental animal study of treatment of spinal cord injury (SCI).

Objective.

This report aims to evaluate the in vivo effects of butylphthalide NBP on SCI biology and to explore its potential mechanism.

Summary of Background Data.

SCI causes great damage to humans. The inflammatory and reconstructive processes after SCI is regulated by activation of astroglial and microglial cells. Activated microglia/macrophages can be divided into M2 (anti-inflammatory) and M1 (pro-inflammatory) phenotypes. Butylphthalide (3-n-butylphthalide or NBP) treatment can significantly alleviate ischemic brain damage, and further study has confirmed that central neuroprotective effects can be realized by converting M1 polarized microglia/macrophages to the M2 phenotype. Thus far, it remains unknown whether NBP can modulate the transition of macrophages/microglia between the M1 and M2 phenotypes.

Methods.

We randomly divided male mice into three groups (sham group, SCI group, SCI+ NBP group). Molecular and histological tests were performed to detect the macrophage/microglia polarization as well as the potential mechanism of NBP in vivo and in vitro.

Result.

It was found that NBP treatment significantly attenuated the motor dysfunction and neuronal apoptosis induced by SCI. Treatment with NBP could also reduce pro-inflammatory cytokine release after SCI and could facilitate macrophage/microglia M2 polarization and inhibit M1 polarization after SCI. To verify the findings in animal experiments, we examined the effect of NBP on BV2 cell polarization, the results showed that NBP treatment could enhance M2 polarization and inhibit M1 polarization, and that M2 polarization occurred in a p38-dependent manner.

Conclusion.

NBP plays an important role in the anti-inflammatory response in SCI via the facilitation of macrophage/microglia M2 polarization as well as the inhibition of macrophage/microglia M1 polarization. The M2 polarization of macrophages/microglia occurs via activation of p38 pathway.

Level of Evidence: 3
Constructing Inpatient Pressure Injury Prediction Models Using Machine Learning Techniques
Authors: Hu Ya-Han , Lee Yi-Lien , Kang Ming-Feng , Lee Pei-Ju
Published: March 2020

The incidence rate of pressure injury is a critical nursing quality indicator in clinic care; consequently, factors causing pressure injury are diverse and complex. The early prevention of pressure injury and monitoring of these complex high-risk factors are critical to reduce the patients' pain, prevent further surgical treatment, avoid prolonged hospital stay, decrease the risk of wound infection, and lower associated medical costs and expenses. Although a number of risk assessment scales of pressure injury have been adopted in various countries, their criteria are set for specific populations, which may not be suitable for the medical care systems of other countries. This study constructs three prediction models of inpatient pressure injury using machine learning techniques, including decision tree, logistic regression, and random forest. A total of 11 838 inpatient records were collected, and 30 sets of training samples were adopted for data analysis in the experiment. The experimental results and evaluations of the models suggest that the prediction model built using random forest had most favorable classification performance of 0.845. The critical risk factors for pressure injury identified in this study were skin integrity, systolic blood pressure, expression ability, capillary refill time, and level of consciousness.
Anesthesia for Nonobstetric Surgery in Pregnancy
Authors: VASCO RAMIREZ MAURICIO , VALENCIA G CATALINA M.
Published: March 2020

Nonobstetric surgery during pregnancy occurs in 1% to 2% of pregnant women. Physiologic changes during pregnancy may have an impact when anesthesia is needed. Anesthetic agents commonly used during pregnancy are not associated with teratogenic effects in clinical doses. Surgery-related risks of miscarriage and prematurity need to be elucidated with well-designed studies. Recommended practices include individualized use of intraoperative fetal monitoring and multidisciplinary planning to address the timing and type of surgery, anesthetic technique, pain management, and thromboprophylaxis. Emergency procedures should be performed immediately and elective surgery should be deferred during pregnancy.
Differences in hypertension phenotypes between Africans and Europeans: role of environment
Authors: Faconti Luca , McNally Ryan J. , Farukh Bushra , Adeyemi Olusoji , Cruickshank J. Kennedy , Wilkinson Ian B. , Chowienczyk Phil J. , Ojji Dike
Published: March 2020

Objectives:

Hypertension phenotypes differ between Africans and Europeans, with a greater prevalence of low renin salt-sensitive hypertension and greater predisposition to adverse cardiac remodelling in Africans. To elucidate the roles of inheritance and environment in determining hypertension phenotypes in sub-Saharan Africans and white-Europeans, we compared phenotypes in white individuals in the UK (n = 132) and in African individuals in the UK (n = 158) and Nigeria (n = 179).

Methods:

Biochemistry, blood pressure, left ventricular structure (echocardiography) and 24-h urinary collections of sodium and potassium were measured.

Results:

Twenty-four-hour urinary sodium/potassium ratio was lower in individuals living in Europe (both African and white: 2.32 ± 0.15 and 2.28 ± 0.17) than in individuals in Nigeria (4.09 ± 0.26, both P < 0.001) reflecting proportionately higher potassium intake in Europeans (African or white) than African residents. Plasma renin was lower in Africans irrespective of residency than white Europeans, but aldosterone was higher in Africans in Europe than those in Africa (466.15 ± 32.95 vs. 258.60 ± 17.42 pmol/l, P < 0.001). Left ventricular mass index adjusted for blood pressure and other confounders was greatest in Africans in Europe (103.27 ± 2.32 g/m2) compared with those in Africa (89.28 ± 1.98 g/m2) or white Europeans (86.77 ± 2.63 g/m2, both P < 0.001).

Conclusion:

Despite a similar low renin state in African origin individuals living in Europe and Africa, a higher aldosterone level, possibly related to higher potassium intake or other environmental factors, may contribute to greater cardiac remodelling in Africans in Europe.
“Living in Contaminated Areas”—Consideration of Different Perspectives
Authors: Abend Michael , Nisbet Anne , Gering Florian , Averin Viktor , Andersson Kasper , Schneider Thierry , Mothersill Carmel , Zeeb Hajo , Scholz-Kreisel Peter , Yamashita Shunichi , Pölz-Viol Christina , Port Matthias
Published: March 2020

Following large-scale nuclear power plant accidents such as those that occurred at Chernobyl (Ukraine) in 1986 and Fukushima Daiichi (Japan) in 2011, large populations are living in areas containing residual amounts of radioactivity. As a key session of the ConRad conference, experts were invited from different disciplines to provide state-of-the-art information on the topic of “living in contaminated areas.” These experts provided their different perspectives on a range of topics including radiation protection principles and dose criteria, environmental measurements and dose estimation, maintaining decent living and working conditions, evidence of health risks, and social impact and risk communication. A short summary of these different perspectives is provided in this paper.
A New Smartphone Application to Predict Hematologic Acute Radiation Syndrome Based on Blood Cell Count Changes—The H-module App
Authors: Majewski Matthäus , Rozgic Marco , Ostheim Patrick , Port Matthias , Abend Michael
Published: March 2020

Treatment regimens for acute radiation syndrome have been improved over the past years. The application of appropriate therapy relies on rapid and high-throughput tests ideally conducted in the first 3 d after a radiation exposure event. We have examined the utility of blood cell counts (BCCs) 3 d post irradiation to predict clinical outcome for hematologic acute radiation syndrome (HARS). The BCCs and HARS severity information originated from data available in the System-for-Evaluation-and-Archiving-of-Radiation Accidents-based-on-Case-Histories (SEARCH). We found an almost complete discrimination of unexposed (HARS score H0) vs. irradiated individuals during model development and validation (negative predictive value > 94%) when using BCC data for all 3 d. We also found that BCC data increased the correct prediction of exposed individuals from day 1 to day 3. We developed spreadsheets to calculate the likelihood of correct diagnoses of the worried-well, requirement of hospitalization (HARS 2-4), or development of severe hematopoietic syndrome (HARS 3-4). In two table-top exercises, we found the spreadsheets were confusing and cumbersome, so we converted the spreadsheets into a smartphone application, named the H-module App, designed for ease of use, wider dissemination, and accommodation of co-morbidities in the HARS severity prediction algorithm.
Effects of Early Postoperative Physical Therapy Evaluation After Total Hip and Knee Arthroplasty on Discharge Disposition
Authors: Tsirakidis Lana , DeLucia Lauren , Elsabrout Kerri
Published: March 2020

Purpose:

To evaluate whether early initiation of postoperative physical therapy for patients after total hip arthroplasty (THA) and total knee arthroplasty (TKA) is associated with discharge disposition.

Methods:

For this retrospective project, a total of 118 patients with THA and 129 patients with TKA were included. Cases included elective single THA and TKA performed between October 2016 and September 2017. Retrospective chart data were analyzed to identify the association between physical therapy initiation on postoperative day (POD) 0 and POD 1, and discharge disposition.

Results:

Initiating physical therapy POD 0 was associated with discharge to home. In the combined THA/TKA analysis, patients who received physical therapy on POD 0 were significantly more likely to be discharged home, when compared with those starting physical therapy on POD 1 (72% and 53%, respectively), χ2(1) = 8.3 [χ2(1) = 8.3, P = .004]. After controlling for age, gender, and length of stay (LOS), physical therapy initiation on POD 0 increased the odds of discharge to home 2.4 times. For men, initiating physical therapy on POD 0 was associated with a 54% improvement in the proportion of patients who were discharged home (POD 0 = 79.7%, POD 1 = 51.7%), χ2(1) = 7.8, P = .005, Cramer's V = 0.28, P = .005. Significantly more patients aged 60 to 70 were discharged home when physical therapy was initiated on POD 0, compared with POD 1 (84.4% and 58.8%, respectively), χ2(1) = 7.8, P = .005, Cramer's V = 0.28.

Conclusions:

We found that providing physical therapy beginning on POD 0 after THA/TKA was associated with an increased proportion of patients discharged home, particularly among men between the ages of 60 and 70 years.
Finite Element Simulation of Prosthetic Foot Adaptation to Mediolateral-Angled Cross-Slopes
Authors: Maitland Murray E. , Allyn Katheryn J. , Ficanha Evandro , Colvin James M. , Wernke Matthew M.
Published: March 2020

Introduction

Balance, functional mobility, satisfaction with participation, residual limb comfort, and falls are persistent problems for people with lower-limb amputations (LLAs). Limited mediolateral accommodation of foot prostheses to cross-slope and uneven ground has been suggested to contribute to these problems. The purpose of this study is to examine how variations of prosthetic foot stiffness, width, and split toes alter mediolateral and vertical displacement, forward velocity, and ground-foot orientation during the stance phase of gait on cross-slopes using finite element computer simulation.

Materials and Methods

Model construction (material data, geometry, and mesh) and simulations were performed using Ansys LS Dyna. Durawalk foot geometry was used as the base model. Variations included cross-slope angle (5° increments from 10° to −10°), foot stiffness, body mass, foot width, and number of splits. Lateral deviation (millimeter), vertical displacement (millimeter), and change in forward velocity (% of initial) were obtained from the proximal pylon. Foot contact was measured as a percent of the base model foot width.

Results

For a given foot stiffness, mediolateral displacement, inferior vertical displacement, and forward velocity increased with increased cross-slope. Reduced foot stiffness decreased mediolateral displacement and increased foot contact, inferior vertical displacement, and forward velocity on cross-slopes. Wider foot design increased foot contact but increased mediolateral displacement on cross-slopes. Single- and double-split toes creating two or three cantilever springs improved foot contact and reduced mediolateral displacement compared with full-toe variations.

Conclusions

For full-width foot variations of stiffness, body mass, and width, properties that enabled maintenance of forward velocity during flat-ground walking gait resulted in mixed effectiveness on cross-slopes. Reducing foot stiffness resulted in deformation of the foot on cross-slopes, which reduced mediolateral displacement but increased forward velocity and vertical displacement. Increasing foot stiffness maintained vertical position and forward velocity but reduced foot contact and increased mediolateral displacement. Full-length splits of the foot into two or three cantilever springs resulted in less mediolateral displacement and improved foot contact. Full-length splits reduced performance changes from flat ground to cross-slopes compared with full-width prosthetic feet. Future studies will be necessary to determine which variations are optimal and if these results are sufficient for comfort, skin integrity, and performance for people with LLA who use prosthetic feet.
Balanced Biventricular Assist Versus Extracorporeal Membrane Oxygenation in Cardiac Arrest
Authors: Packer Erik J. S. , Slettom Grete , Solholm Atle , Omdal Tom Roar , Stangeland Lodve , Zhang Liqun , Mongstad Arve , Løland Kjetil , Haaverstad Rune , Grong Ketil , Nordrehaug Jan Erik , Tuseth Vegard
Published: March 2020

Mechanical assist devices in refractory cardiac arrest are increasingly employed. We compared the hemodynamics and organ perfusion during cardiac arrest with either veno-arterial extracorporeal membrane oxygenation (ECMO) or biventricular assisted circulation combining left- and right-sided impeller devices (BiPella) in an acute experimental setting. Twenty pigs were randomized in two equal groups receiving circulatory support either by ECMO or by BiPella during 40 minutes of ventricular fibrillation (VF) followed by three attempts of cardioversion, and if successful, 60 minute observation with spontaneous, unsupported circulation. Hemodynamic variables were continuously recorded. Tissue perfusion was evaluated by fluorescent microsphere injections. Cardiac function was visualized by intracardiac echocardiography. During VF device output, carotid flow, kidney perfusion, mean aortic pressure (AOPmean), and mean left ventricular pressure (LVPmean) were all significantly higher in the ECMO group, and serum-lactate values were lower compared with the BiPella group. No difference in myocardial or cerebral perfusion was observed between groups. In 15 animals with sustained cardiac function for 60 minutes after return of spontaneous circulation, left ventricular subendocardial blood flow rate averaged 0.59 ± 0.05 ml/min/gm during VF compared with 0.31 ± 0.07 ml/min/gm in five animals with circulatory collapse (p = 0.005). Corresponding values for the midmyocardium was 0.91 ± 0.06 vs. 0.65 ± 0.15 ml/min/gm (p = 0.085). Both BiPella and ECMO could sustain vital organ function. ECMO provided a more optimal systemic circulatory support related to near physiologic output. Myocardial tissue perfusion and sustained cardiac function were related to coronary perfusion pressure during VF, irrespective of mode of circulatory support.
Insulin resistance in bariatric surgery
Authors: Stenberg Erik , Thorell Anders
Published: March 2020

Purpose of review

To give an updated review on the underlying mechanisms and clinical effects of improved glucose control after bariatric surgery.

Recent findings

The basic principles of the mechanism for the metabolic effects of bariatric surgery can be categorized into calorie restriction, deviation of nutrients, and reduced amounts of adipose tissue. Recent findings suggest the importance of early changes following deviation of nutrients to more distal parts of the small bowel resulting in altered release of gastrointestinal hormones, altered gut microbiota, and weight-reduction. In the long-term, loss of adipose tissue results in reduced inflammation and improved insulin sensitivity. From a clinical perspective these changes are associated with remission of diabetes in patients with morbid obesity and type 2 diabetes, prevention of diabetes in patients with insulin resistance without overt type 2 diabetes and prevention of both microvascular and macrovascular complications for all patients with morbid obesity.

At present, bariatric surgery remains the most effective treatment option to improve glucose control and long-term complications associated with hyperglycemia in patients with obesity.

Although the mechanisms behind these metabolic effects remain only partially understood, further knowledge on these complex mechanisms may help identifying durable treatment options for morbid obesity and important metabolic comorbidities.
GATA2 +9.5 enhancer: from principles of hematopoiesis to genetic diagnosis in precision medicine
Authors: Soukup Alexandra A. , Bresnick Emery H.
Published: March 2020

Purpose of review

By establishing mechanisms that deliver oxygen to sustain cells and tissues, fight life-threatening pathogens and harness the immune system to eradicate cancer cells, hematopoietic stem and progenitor cells (HSPCs) are vital in health and disease. The cell biological framework for HSPC generation has been rigorously developed, yet recent single-cell transcriptomic analyses have unveiled permutations of the hematopoietic hierarchy that differ considerably from the traditional roadmap. Deploying mutants that disrupt specific steps in hematopoiesis constitutes a powerful strategy for deconvoluting the complex cell biology. It is striking that a single transcription factor, GATA2, is so crucial for HSPC generation and function, and therefore it is instructive to consider mechanisms governing GATA2 expression and activity. The present review focuses on an essential GATA2 enhancer (+9.5) and how +9.5 mutants inform basic and clinical/translational science.

Recent findings

+9.5 is essential for HSPC generation and function during development and hematopoietic regeneration. Human +9.5 mutations cause immunodeficiency, myelodysplastic syndrome, and acute myeloid leukemia. Qualitatively and quantitatively distinct contributions of +9.5 cis-regulatory elements confer context-dependent enhancer activity. The discovery of +9.5 and its mutant alleles spawned fundamental insights into hematopoiesis, and given its role to suppress blood disease emergence, clinical centers test for mutations in this sequence to diagnose the cause of enigmatic cytopenias.

Multidisciplinary approaches to discover and understand cis-regulatory elements governing expression of key regulators of hematopoiesis unveil biological and mechanistic insights that provide the logic for innovating clinical applications.
Utility of lymphadenectomy in bladder cancer: where do we stand?
Authors: Sung Hyun Hwan , Lerner Seth P.
Published: March 2020

Purpose of review

The aim of this review is to provide insight into the current state of lymph node dissection (LND) during radical cystectomy in patients with bladder cancer (BCa).

Recent findings

The first prospective, multicenter, randomized, phase III trial to assess the therapeutic benefit of extended versus limited LND at the time of radical cystectomy failed to demonstrate relevant improvement with extended LND, but showed that this approach does not increase overall complications. Although contemporary rate of LND during radical cystectomy has increased, it remains suboptimal. Minimally invasive radical cystectomy with LND is feasible in most patients and has similar lymph node yields and complication rates compared with open procedures when performed by experienced surgeons. Overall major complication, readmission and mortality rates do not significantly differ according to extent of LND.

Meticulous LND provides both diagnostic and potentially therapeutic benefits in patients with bladder cancer. Results of ongoing trials will provide additional insights regarding the anatomic extent and therapeutic benefit of extended versus standard true pelvic-only LND.
Transurethral resection of bladder tumor and the need for re-transurethral resection of bladder tumor: time to change our practice?
Authors: Soria Francesco , Giordano Andrea , Gontero Paolo
Published: March 2020

Purpose of review

To summarize the current knowledge on the role of repeated transurethral resection of the bladder (re-TURBT) at the light of recently published trials that indicate the possibility to safely avoid it in well selected patients.

Recent findings

Recently published trials tried to predict the histology of re-TURBT with the aim of improving patients’ selection for this procedure. The en bloc resection technique seems to improve the quality of the resection, thereby diminishing and even eliminating the risk of upstaging and the residual disease rate after TURBT. Moreover, the introduction of multiparametric MRI (mpMRI) in bladder cancer showed initial promising results and aims, in the next future, to play a role in the selection of patients for re-TURBT.

International guidelines agree to recommend re-TURBT in case of incomplete first resection and in T1 tumors. Conversely, the performance of re-TURBT in case of high-grade/high-risk Ta or in case of absence of detrusor muscle in TURBT specimen remains a matter of debate. Re-TURBT aims to reduce the risk of understaging the disease and to remove residual disease in case of persistent nonmuscle invasive bladder cancer. Actually, upstaging at re-TURBT is not a negligible event in T1 tumors (8–15%), while is quite uncommon in case of Ta tumors (0.4%). Residual disease at re-TURBT is usually found in the majority of patients (55–60%) and seems to impact oncological outcomes, even if recent evidence mitigated its relevance as prognostic factor.
Ureteral and urethral recurrence after radical cystectomy: a systematic review
Authors: Carando Roberto , Shariat Shahrokh F. , Moschini Marco , D’Andrea David
Published: March 2020

Purpose of review

The clinical significance of ureteral and urethral recurrence in patients treated with radical cystectomy for bladder cancer is scarce and heterogeneous. The aim of the current review is to summarize the recent literature on incidence, diagnosis and oncologic outcomes of ureteral and urethral recurrences after radical cystectomy.

Recent findings

Frozen section analysis (FSA) of ureteral margin had a sensitivity and specificity of 69–77 and 83–96%, respectively. Considering the ureteral margin, the reported sensitivity and specificity were 33–93 and 99–100%, respectively. Transurethral biopsy of the prostatic urethra might help in counseling patients’ treatment, although its accuracy and prognostic role is highly questionable. In patients treated with radical cystectomy, recurrence of the urethra or ureteral are rare, occurring approximately in 5% of patients. During the follow-up, urinary cytology and cross-sectional imaging improve the early detection of recurrence in asymptomatic patients, although the majority are diagnosed for symptomatic presentation. Their use should be tailored to the patient's risk of ureteral and/or urethral recurrence. Urethrectomy is indicated in case of singular urethral recurrence, whereas no clear data exists regarding the best management of ureteral recurrence, except surgical removal.

Intraoperative FSA of ureters and urethra share good specificity but poor sensitivity. Recurrence at urethra and upper tract are rare and discordant data exists regarding survival outcomes. Oncologic surveillance after radical cystectomy with the aim to detect these recurrences should be tailored to the individualized patient's risk.
Testosterone therapy and risk of breast cancer development: a systematic review
Authors: Ray Al , Fernstrum Austin , Mahran Amr , Thirumavalavan Nannan
Published: March 2020

Purpose of review

We aim to conduct a systematic review of the literature, document all reported cases of breast cancer development in cis men and female-to-male (FtM) transgender men undergoing testosterone replacement therapy (TRT), and determine if testosterone poses a substantial risk of breast cancer development and recurrence.

Recent findings

A systematic search through December 2019 was performed. Out of 1890, 15 studies were eligible for inclusion in the final analyses. In total, 22 patients have developed breast cancer while on testosterone treatment. Four cases were cis men, whereas 18 cases were FtM. Age ranged from 18 to 61 years. Testosterone treatment duration ranged from 5 weeks up to 25 years.

There is a relatively higher incidence of BCa in FtM on CSH therapy compared with cis men on TRT. Because of the small sample size of reported cases, we cannot delineate the exact relationship between testosterone therapy and BCa development. Additionally, we have limited data to suggest that TRT should or should not be contraindicated in cis men and FtM with a prior history of breast cancer.
Hyperdiploid Precursor B-acute Lymphoblastic Leukemia Presenting as a Cavernous Sinus Mass in a 4-Year-old Male
Authors: Sabulski Anthony , Bartlett Allison L. , Koch Bernadette L. , Vatner Ralph , Mizukawa Benjamin , Phillips Christine L.
Published: March 2020

Risk stratification and appropriate treatment selection for children with precursor B-acute lymphoblastic leukemia (B-ALL) have improved outcomes. We report the case of a 4-year-old male with a lymphomatous cavernous sinus mass, a previously undescribed presentation of newly diagnosed hyperdiploid B-ALL. Few case reports in the literature describe lymphomatous involvement in this region, but none are associated with pediatric B-ALL. This case presented unique treatment and risk assignment challenges given the intracranial location of this tumor and proximity to the central nervous system.
Local Ablative Therapies for Oligometastatic and Oligoprogressive Non–Small Cell Lung Cancer
Authors: Jairam Vikram , Park Henry S. , Decker Roy H.
Published: March 2020

More than half of all patients with non–small cell lung cancer (NSCLC) have metastatic disease at the time of diagnosis. A subset of these patients has oligometastatic disease, which exists in an intermediary state between locoregional and disseminated metastatic disease. In addition, some metastatic patients on systemic therapy may have limited disease progression, or oligoprogression. Historically, treatment of metastatic NSCLC was palliative in nature, with little expectation of long-term survival. However, an accumulation of evidence over the past 3 decades now demonstrates that local ablative therapy to sites of limited metastases or progression can improve patient outcomes for this complex disease. This review examines the evidence behind local ablative therapy in oligometastatic and oligoprogressive NSCLC, with a focus on surgery, stereotactic radiotherapy, and radiofrequency ablation.
Handoff Communication between Remote Healthcare Facilities
Authors: Helmig Sara , Cox Jennifer , Mehta Brinda , Burlison Jonathan , Morgan Jennifer , Russo Carolyn
Published: March 2020

Introduction:

Handoffs and transitions of care are common weak points in healthcare provider communication as patients move between sites. With no consistent pattern of communication between St. Jude Children’s Research Hospital (St. Jude) and its affiliated clinics, the Affiliate Program Office at St. Jude developed and implemented a standardized communication tool to facilitate patient transitions between different healthcare sites.

Methods:

Each team of providers created flow diagrams to define the current state of communication when patients were transitioning between remote sites. Fishbone diagrams identified the common barriers to effective communication as a lack of consistent communication and ownership. We developed a communication tool to address these barriers, which was disseminated by secure email. We measured the percent usage of the completed hand-off tool before a patient transitioned, staff experience, and the number of errors.

Results:

The time to send or receive the communication bundle was <10 minutes. Within 3 months of implementing the SMART bundle at 3 pilot sites, the bundle was used completely in 6 of 8 patient transitions and was associated with somewhat improved staff satisfaction. We identified no adverse events related to the communication bundle.

Conclusions:

In this small pilot study, we accomplished closed-loop communication between geographically remote healthcare sites by using an electronically transmitted standardized communication bundle.
The Vitals Risk Index—Retrospective Performance Analysis of an Automated and Objective Pediatric Early Warning System
Authors: Gorham Tyler J. , Rust Steve , Rust Laura , Kuehn Stacy , Yang Jing , Lin James Shuhan , Hoffman Jeffrey , Huang Yungui , Lin Simon , McClead Richard , Brilli Richard , Bode Ryan , Maa Tensing
Published: March 2020

Introduction:

Pediatric in-hospital cardiac arrests and emergent transfers to the pediatric intensive care unit (ICU) represent a serious patient safety concern with associated increased morbidity and mortality. Some institutions have turned to the electronic health record and predictive analytics in search of earlier and more accurate detection of patients at risk for decompensation.

Methods:

Objective electronic health record data from 2011 to 2017 was utilized to develop an automated early warning system score aimed at identifying hospitalized children at risk of clinical deterioration. Five vital sign measurements and supplemental oxygen requirement data were used to build the Vitals Risk Index (VRI) model, using multivariate logistic regression. We compared the VRI to the hospital’s existing early warning system, an adaptation of Monaghan’s Pediatric Early Warning Score system (PEWS). The patient population included hospitalized children 18 years of age and younger while being cared for outside of the ICU. This dataset included 158 case hospitalizations (102 emergent transfers to the ICU and 56 “code blue” events) and 135,597 control hospitalizations.

Results:

When identifying deteriorating patients 2 hours before an event, there was no significant difference between Pediatric Early Warning Score and VRI’s areas under the receiver operating characteristic curve at false-positive rates ≤ 10% (pAUC10 of 0.065 and 0.064, respectively; P = 0.74), a threshold chosen to compare the 2 approaches under clinically tolerable false-positive rates.

Conclusions:

The VRI represents an objective, simple, and automated predictive analytics tool for identifying hospitalized pediatric patients at risk of deteriorating outside of the ICU setting.
Intracellular Tenofovir-Diphosphate and Emtricitabine-Triphosphate in Dried Blood Spots Following Tenofovir Alafenamide: The TAF-DBS Study
Authors: Yager Jenna , Castillo-Mancilla Jose , Ibrahim Mustafa E. , Brooks Kristina M. , McHugh Cricket , Morrow Mary , McCallister Scott , Bushman Lane R. , MaWhinney Samantha , Kiser Jennifer J. , Anderson Peter L.
Published: March 2020

Background:

Tenofovir alafenamide (TAF), in combination with FTC, was recently approved for PrEP in the United States. The objective of this study was to assess the relationship between tenofovir-diphosphate (TFV-DP) and emtricitabine-triphosphate (FTC-TP) in dried blood spots (DBS) with adherence to TAF/FTC.

Methods:

TAF-DBS was a randomized, crossover clinical study of TFV-DP in DBS, following directly observed dosing of 33%, 67%, or 100% of daily TAF (25 mg)/FTC (200 mg). Healthy volunteers were randomized to 2 different, 12-week dosing regimens, separated by a 12-week washout. DBS were collected weekly. TFV-DP and FTC-TP were extracted from two 7-mm punches and assayed with LC-MS/MS.

Results:

Thirty-seven participants (17 female, 7 African American, and 6 Hispanic) were included. TFV-DP exhibited a mean half-life of 20.8 days (95% confidence interval: 19.3 to 21.3). The slope for TFV-DP versus dosing arm was 1.14 (90% confidence interval: 1.07 to 1.21). The mean (SD) TFV-DP after 12 weeks was 657 (186), 1451 (501), and 2381 (601) fmol/2 7-mm punches for the 33%, 67%, and 100% arms. The following adherence interpretations are proposed: <450 fmol/punches, <2 doses/wk; 450–949 fmol/punches, 2–3 doses/wk; 950–1799 fmol/punches, 4–6 doses/wk; and ≥1800 fmol/punches, 7 doses/wk. FTC-TP was quantifiable for 1 week after drug cessation in 50%, 92%, and 100% of participants in the 33%, 67%, and 100% arms, respectively.

Conclusion:

TFV-DP in DBS after TAF/FTC exhibited a long half-life and was linearly associated with dosing, similar to its predecessor tenofovir disoproxil fumarate. FTC-TP was quantifiable for up to 1 week after drug cessation. Together, these moieties provide complementary measures of cumulative adherence and recent dosing for TAF/FTC.
Is the Vectra 3D Imaging System a Reliable Tool for Predicting Breast Mass?
Authors: Wood Kasey Leigh , Zoghbi Yasmina , Margulies Ilana G. , Ashikari Andrew Y. , Jacobs Jordan , Salzberg Charles Andrew
Published: March 2020

Background

In selecting breast implants for breast reconstruction, current preoperative planning largely relies on 2-dimensional measurements, which are often limited in suboptimal accuracy and objectivity. Although the introduction of 3-dimensional imaging modalities has further improved preoperative planning, they require in-depth analysis of accuracy if they are to be considered as a standardized part of preoperative planning. Thus, the present study analyzes the reliability of the Vectra 3D Imaging System in predicting breast mass and explores potential confounding variables that may limit its accuracy.

Methods

A retrospective review of 202 breasts that received direct-to-implant reconstruction by a single surgeon between February 2015 and February 2019 was conducted. Variables recorded included Vectra predicted mass (VPM; in grams), mastectomy mass (MM; in grams), ptosis grade, and body mass index (BMI). Body mass index was classified as follows: underweight (BMI < 20 kg/m2), normal (20 kg/m2 ≤ BMI < 25 kg/m2), overweight (25 kg/m2 ≤ BMI < 30 kg/m2), and obese (BMI ≥ 30 kg/m2). Cup size was approximated as follows: A and smaller (MM ≤250 g), B (250 g < MM ≤ 450 g), C (450 g < MM ≤ 600 g), and D and larger (MM ≥ 600 g). Correlation between MM and VPM was evaluated using 2-tailed Pearson correlation coefficients (r), and associated formula was derived from a linear model. Equality of variances was assessed with the Bartlett test. Correlation coefficients calculated for ptosis and BMI categories were then compared with the overall correlation coefficient. Significance was set at α = 0.05, and analyses were conducted in R 3.6.0, version 1.70.

Results

There was a strong correlation between MM and VPM (R = 0.90, P < 0.0001). The following equation was derived to predict MM: [MM] = 0.8 × [VPM] + 32 (adjusted r
2 = 0.81). The Bartlett test indicated that VPM varies significantly across cup sizes (P < 0.0001). Comparison of correlation coefficients for ptosis and BMI categories revealed a significantly reduced correlation coefficient for pseudoptosis (0.90 vs 0.75, P = 0.0425).

Conclusions

The present study suggests that the reliability of Vectra in predicting breast mass varies across cup sizes and that there exists a significantly decreased association between VPM and MM among pseudoptotic breasts. These are important considerations when using this technology in surgical planning.
Anatomic Study and Clinic Application of Transverse Circumflex Scapular Artery Perforator Flap Repair of Lower Limb Soft Tissue Defects in Children
Authors: Pang Xiaoyang , Cao Zheming , Wu Panfeng , Tang Maolin , Qin Liming , Yu Fang , Zhou Zhenbing , Tang Juyu
Published: March 2020

Purpose

The aim of this study was to demonstrate the viability of the transverse circumflex scapular artery perforator flap (TCSAPF) in children with soft tissue defects of the lower limb.

Methods

In an anatomic study, 25 fresh cadavers were injected with lead oxide–gelatin for spiral computed tomography and 3-dimensional image reconstruction. In a 3-year clinical application study, children with soft tissue defects and exposed tendons and/or bones in the lower limb underwent free-TCSAPF repair of the defect.

Results

Perforators from the transverse branch of the circumflex scapular artery were identified in both anatomical and clinical studies. The average external diameter was 0.9 ± 0.3 mm. Each perforator supplied an average area of 63.5 ± 16.8 cm2 in anatomical. Twenty-one children were included in this group (9 boys, 12 girls, mean age, 6.6 ± 2.7 years). The size of the flaps ranged from 6 to 17 cm × 4.5 to 7 cm (average, 65.3 ± 22.6 cm2). The average flap harvesting time was 30.1 ± 8.5 minutes, average operation time was 138.6 ± 31.5 minutes, and average blood loss was 89.5 ± 21.9 mL. The average length of the vessel pedicle was 8.2 ± 2.4 cm. Arterial congestion occurred in one child, 18 hours postoperatively; subsequent re-exploration and great saphenous vein transplantation were successful. Of the 3 children who had bulky flaps, 1 patient underwent defatting. Satisfactory outcomes included good appearance and function of the recipient and donor areas.

Conclusions

The TCSAPF provides high-quality skin and vessel flexibility, providing a reliable blood supply in children. The flap has potential benefits over existing perforator flaps.
Electroconvulsive Therapy Versus Fluoxetine in Suicidal Resolution for Patients With Major Depressive Disorder
Authors: Lin Ching-Hua , Chen Cheng-Chung , Huang Chun-Jen
Published: March 2020

Objective

Resolution of suicidal ideation for patients with major depressive disorder is an important public health challenge. We aimed to determine whether electroconvulsive therapy (ECT) or fluoxetine was more efficacious in resolving suicidal ideation and achieving long-term protective effect against suicidality.

Methods

The data used in this study were drawn from 2 open-label trials for major depressive disorder patients receiving ECT or fluoxetine for acute treatment, together with continuation medication in the 12-week follow-up. We compared the effects of ECT and fluoxetine on suicidal ideation as scored by the suicide item on the 17-item Hamilton Rating Scale for Depression.

Results

The differences between these 2 groups in time to resolution of suicidal ideation (suicide item = 0) in the acute treatment period, and time to relapse of suicidal ideation (suicide item score ≥1 or rehospitalization for suicidality) in the follow-up period were analyzed. Electroconvulsive therapy–treated patients (n = 111) had significantly shorter time to resolution of suicidal ideation than fluoxetine-treated patients (n = 114) during acute treatment. However, there was no statistically significant difference in time to relapse of suicidal ideation between 2 groups in the 12-week follow-up period.

Conclusions

Electroconvulsive therapy was superior to fluoxetine in resolving suicidal ideation during acute treatment. Therefore, ECT should be an early consideration for suicidal patients. Electroconvulsive therapy and fluoxetine were equally effective in preventing recurrence of suicidal ideation in the 12-week follow-up period. Routine suicide risk assessments from hospital care to outpatient care are required to identify any signs of suicidal relapse.
Quality characteristics of Sikhye prepared with Sasa borealis extracts
Authors: Seo Ji-Hyung
Published: March 2020

This study was performed to evaluate the quality characteristics of Sikhyes (SBE-5, SBE-10, SBE-30, and SBE-50) prepared using various concentrations (5%, 10%, 30%, and 50%) of Sasa borealis extracts (SBE). There were no significant changes of pH and total acid contents in Sikhyes prepared with various concentration of SBE. Sikhye SBE-30 and Sikhye SBE-50 showed significantly higher contents in sweetness, reducing sugar, total polyphenol and flavonoid than other Sikhyes. In color, the more SBE was added, each Sikhye appeared the decreasing of L value, the increasing of b value and turbidity. In DPPH radical scavenging activity, there were no difference between Sikhye control (SBE free) and Sikhye SBE-5. But DPPH radical scavenging activity of Sikhye SBE-10, SBE-30 and SBE-50 increased proportionally as the concentration of SBE in Sikhyes were increased. The evaluation for taste tended to get high score in Sikhye SBE-30 and Sikhye SBE-50. The color preference decreased by additon of SBE. Overall preference showed a trend of decreasing in Sikhye SBE-50. These results indicates that the SBE could be beneficiary for preparation of Sikhye due to anti-oxidative effect, and the proper amounts of SBE would be about 30%.
Quality characteristics of coffee beverage processed by ultrasound-assisted extraction
Authors: Chung Hun-Sik , Cho Jeong-Seok , Kim Han-Soo , Kim Dong-Seob , Lee Young-Guen , Seong Jong-Hwan , Moon Kwang-Deog
Published: March 2020

The effects of ultrasound-assisted extraction (UAE) on the physicochemical and sensory characteristics of coffee beverage were investigated. Coffee powder (4 g) was soaked into 80 mL distilled water and extracted for 15, 30, 60, 120, 180, 240, or 300 sec at 60℃ in an ultrasonic bath (40 kHz, 300 W). Hot-water extraction (HE) at 80℃ for 300 sec was used as a control. Content of soluble solids in coffee beverage prepared by UAE (60~300 sec) was same or higher than those of HE, however, no significant differences were observed among the four beverages extracted for more than 120 sec. Clarity and browning index of beverage prepared by UAE (15 sec) and by HE were significantly higher and lower, respectively, compared to those of the other. Content of phenolic compounds was lower and higher respectively, in beverage prepared by UAE (15 sec, 30 sec) and UAE (60~300 sec) than by HE. DPPH radical scavenging activity was highest in beverage prepared by UAE (15 sec) and HE. Sensory evaluation showed that color, aroma, taste, and overall acceptability were rated with the best score for beverage prepared by UAE (15 sec) and the worst score for beverage prepared UAE (120~300 sec). Therefore, ultrasound-assisted extraction can be used for improving quality of coffee beverage.
Changes in physicochemical components of Astragalus membranaceus fermented with Phellinus linteus
Authors: Jang Yeon-Jeong , Kim Eun-Ju , Kim So Young , Lee Yun Hye , Park Shin-Young
Published: March 2020

This study analyzed the changes in physicochemical components of Astragalus membranaceus (AM) fermented with Phellinus linteus. Moisture content, pH, total acidity, total reducing sugar content, extraction yield, free sugar content, free amino acid and isoflavonoid (calycosin, formononetin) were investigated. The moisture content was increased during fermentation with Phellinus linteus. The pH level increased while the total acidity significantly decreased during fermentation. The reducing sugar content were in the range of 0.32~0.61%. The extraction yield using water was higher than that using 80% ethanol. The major free sugars were identified as glucose, fructose, sucrose and the content of free sugars decreased through fermentation. However, the glucose and sucrose contents of the water extracts were increased. In addition, the free amino acid increased significantly during fermentation. Finally, calycosin and formononetins contents in water extracts of after 30 days of AM fermentaion with Phellinus linteus were (3.91 mg/100 g) and (1.38 mg/100 g), respectively. These results suggest that fermentation with Phellinus linteus could be used to increase the bioactivity of AM. The mycelium-fermented AM could be a valuable source of functional material and edible resource for industry.