bluuebunny/crossref_metadata_2025 huggingface dataset:
Longitudinal virological outcomes and factors associated with virological failure in behaviorally HIV-infected young adults on combination antiretroviral treatment in the Netherlands, 2000 to 2015
Authors: Weijsenfeld Annouschka M. , Blokhuis Charlotte , Stuiver Martijn M. , Wit Ferdinand W.N.M. , Pajkrt Dasja
Published: August 2019

Achieving and maintaining viral suppression in young adults (18–24 years) living with HIV is challenging. Overall HIV viral suppression rates are lower in young as compared to older adults. Longitudinal data provide valuable insight on dynamics of viral suppression and variables of potential influence on HIV virological failure (VF), but is scarce in young adults living with HIV on combination antiretroviral therapy (cART). We evaluated longitudinal virological outcomes of behaviorally young adults (18–24 years) living with HIV in the Netherlands over a period of 15 years.

We analyzed data from the Dutch national HIV database of 816 young adults living with HIV on cART in the Netherlands from 2000 to 2015. VF was defined as 2 consecutive detectable plasma HIV-1 viral load (VL) measurements > 200 copies/ml. Generalized linear mixed model analyses were used to assess HIV VF over time and identify risk factors associated with VF.

VF during the study follow-up occurred at least once in 26% of cases. The probability of experiencing VF decreased over the study period per calendar year (OR 0.78, 95% confidence interval [CI];0.72; 0.85). Factors significantly associated with VF were being infected through heterosexual contact (OR 5.20, CI 1.39;19.38) and originating from Latin America or the Caribbean (OR 6.59, CI 2.08;20.92). Smaller, yet significant risk factors for VF were being infected through a blood transfusion or a needle accident (OR9.93, CI 1.34;73.84, and having started with cART with a nadir CD4 count >500 cells/μl (OR 11.36, CI 2.03;63.48).

In our large cohort of young adults, the risk of VF has diminished over 15 years. Specific subgroups were identified to be at risk for suboptimal treatment.
Acute myeloid leukemia with adult atopic dermatitis as first manifestation
Authors: Ma Wei-Wei , Kasyanju Carrero Lorna Martin , Yin Xu-Feng , Liu Hou-Fang , Zhou Bing-Rong
Published: August 2019

Rationale:

Atopic dermatitis (AD) is a chronic recurrent dermatitis with profound itching, which could be the first manifestation of acute myeloid leukemia (AML).

Patient concerns:

A 53-year-old Chinese man suffered a 6-month history of systemic symmetrical dermatitis, accompanied with profound itching. The patient was diagnosed as “eczema” in several hospitals, and the effects of antihistamine and topical steroid creams were poor. Nocturnal sleep was seriously affected by aggravating pruritus. Laboratorial examination was compatible with AML-M4.

Diagnoses:

AML-M4 with AD as first manifestation.

Interventions:

IA regimen (ayninen and cytarabine) were used in induction chemotherapy. However, the patient did not achieve complete remission, and although his rash had improved, he still experienced severely general body itching. On the seventh day of chemotherapy, the patient entered the period of granulocyte deficiency with infection.

Outcomes:

The patient died due to septic shock after chemotherapy.

Lessons:

The case strengthens the awareness of AML with AD as first manifestation and raises oncological vigilance in patients with AD refractory.
Effectiveness evaluation of computer-aided diagnosis system for the diagnosis of thyroid nodules on ultrasound
Authors: Zhao Wan-Jun , Fu Lin-Ru , Huang Zhi-Mian , Zhu Jing-Qiang , Ma Bu-Yun
Published: August 2019

Background:

More and more automated efficient ultrasound image analysis techniques, such as ultrasound-based computer-aided diagnosis system (CAD), were developed to obtain accurate, reproducible, and more objective diagnosis results for thyroid nodules. So far, whether the diagnostic performance of existing CAD systems can reach the diagnostic level of experienced radiologists is still controversial. The aim of the meta-analysis was to evaluate the accuracy of CAD for thyroid nodules’ diagnosis by reviewing current literatures and summarizing the research status.

Methods:

A detailed literature search on PubMed, Embase, and Cochrane Libraries for articles published until December 2018 was carried out. The diagnostic performances of CAD systems vs radiologist were evaluated by meta-analysis. We determined the sensitivity and the specificity across studies, calculated positive and negative likelihood ratios and constructed summary receiver-operating characteristic (SROC) curves. Meta-analysis of studies was performed using a mixed-effect, hierarchical logistic regression model.

Results:

Five studies with 536 patients and 723 thyroid nodules were included in this meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio (DOR) for CAD system were 0.87 (95% confidence interval [CI], 0.73–0.94), 0.79 (95% CI 0.63–0.89), 4.1 (95% CI 2.5–6.9), 0.17 (95% CI 0.09–0.32), and 25 (95% CI 15–42), respectively. The SROC curve indicated that the area under the curve was 0.90 (95% CI 0.87–0.92). The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and DOR for experienced radiologists were 0.82 (95% CI 0.69–0.91), 0.83 (95% CI 0.76–0.89), 4.9 (95% CI 3.4–7.0), 0.22 (95% CI 0.12–0.38), and 23 (95% CI 11–46), respectively. The SROC curve indicated that the area under the curve was 0.96 (95% CI 0.94–0.97).

Conclusion:

The sensitivity of the CAD system in the diagnosis of thyroid nodules was similar to that of experienced radiologists. However, the CAD system had lower specificity and DOR than experienced radiologists. The CAD system may play the potential role as a decision-making assistant alongside radiologists in the thyroid nodules’ diagnosis. Future technical improvements would be helpful to increase the accuracy as well as diagnostic efficiency.
Randomized controlled evaluation of the effect of music therapy with cognitive-behavioral therapy on social anxiety symptoms: Retracted
Authors: Egenti Nkechi T. , Ede Moses O. , Nwokenna Edith N. , Oforka Theresa , Nwokeoma Bonaventure N. , Mezieobi Daniel I. , Onah Sabastian O. , Ede Kelechi R. , Amoke Chijioke , Offordile Edmund E. , Ezeh Ngozi E. , Eze Celestine O. , Eluu Patrick E. , Amadi Kingley C. , Ugwuanyi Benedict E. , Uzoagba Ngozi C. , Ugwonna Grace O. , Nweke Maduka L. , Victor-Aigbodion Vera
Published: August 2019

Objective:

This study examined the effects of music therapy with cognitive behavioral therapy on social anxiety in a sample of schooling adolescents in south-east Nigeria.

Methods:

We adopted a randomized controlled trial design involving a treatment group and a waiting-list control group. A total of 155 schooling adolescents served as the study sample. The sample size was ascertained usingGPowersoftware. A 12-week MTCBP manual for social anxiety was employed to deliver the intervention. Data analyses were completed using repeated measures analysis of variance.

Results:

We found that social anxiety significantly decreased in the treatment group over time, whereas the waitlist control group showed no significant changes in social anxiety. Therefore, music therapy with cognitive-behavioral therapy was significantly beneficial in decreasing social anxiety symptoms of the treatment group. The follow-up assessment performed after 3 months revealed a significant reduction in social anxiety for the treatment group.

Conclusion:

The study, therefore, suggests that the use of music therapy with cognitive-behavioral therapy is significant in reducing social anxiety among schooling adolescents.
Safety and effectiveness of endoscopic mucosal resection or endoscopic submucosal dissection for gastric neoplasia within 2 days’ hospital stay
Authors: Choi Joon Young , Park Young Soo , Na Gyeongjae , Park Sung Jae , Yoon Hyuk , Shin Cheol Min , Kim Nayoung , Lee Dong Ho
Published: August 2019

Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have been well-established methods of treating upper gastrointestinal neoplasia. The aim of this study was to identify the safety and effectiveness of endoscopic treatment for gastric neoplasia within a 2-day hospital stay.

Between 2004 and 2015, a total of 914 patients with gastric neoplasia were treated with EMR or ESD within 2 days of hospitalization. The neoplasia sites, en bloc resection rates, pathology, local residual neoplasia rates, and major complications were evaluated retrospectively.

The mean age was 63.4 years old, and 636 (69.6%) patients were male. Adenoma was the most common final diagnosis (60.9%), followed by adenocarcinoma (28.9%). The first follow-up endoscopy was performed 4.9 ± 1.1 months after the procedure, and an average of 4.4 endoscopic examinations were performed for 7.16 years (range, 2.1 to 10.2 years). Additional surgery was performed in 11 (1.2%) cases based on post-procedure pathology results. On follow-up endoscopy, a mean of 5.9 months after the procedure, there were 18 residual neoplasia cases (EMR = 13, ESD = 5). Only 4 (0.4%) patients returned to the emergency unit with delayed bleeding, but all 4 cases were successfully controlled with endoscopic treatment. There were no other complications such as delayed perforation or aspiration pneumonia during the 2 days in hospital.

EMR and ESD within only 2 days in hospital showed safe and effective outcomes in terms of managing early gastric neoplasia with low complication and local residual rates.
Tachycardia-induced cardiomyopathy in a patient with left-sided accessory pathway and left bundle branch block
Authors: Minciuna Ioan Alexandru , Puiu Mihai , Cismaru Gabriel , Gusetu Gabriel , Comsa Horatiu , Caloian Bogdan , Zdrenghea Dumitru , Pop Dana , Radu Rosu
Published: August 2019

Rationale:

Tachycardia-induced cardiomyopathy (TIC) is defined as systolic and/or diastolic dysfunction of the left ventricle resulting from prolonged elevated heart rates, completely reversible upon control of the arrhythmia. Atrioventricular reentrant tachycardia (AVRT) is one of the most frequent causes of TIC. In its incessant form, it is unlikely to be controlled by pharmacological treatment, catheter ablation being the principal therapeutic option. The coexistence of left bundle branch block (LBBB) in patients with AVRT may cause difficulties in the early diagnosis and management of tachycardia because of the wide complex morphology, making it harder to localize the accessory pathway (AP).

Patient concerns:

A 60-year-old woman, presented incessant episodes of palpitations and shortness of breath due to a LBBB tachycardia leading to hemodynamic instability.

Diagnosis:

The patient had a wide QRS tachycardia, with LBBB morphology and a heart rate of 160/minute. Echocardiography showed global hypokinesia with 25% left ventricular ejection fraction (LVEF). Considering the patient's clinical picture, TIC was suspected.

Interventions:

The electrophysiological study revealed a left lateral accessory pathway. Catheter ablation was successfully performed at the level of the lateral mitral ring.

Outcomes:

One week after the ablation the patient had no signs of heart failure and the LVEF normalized to 55%. During 6-months follow-up the patient presented no more episodes of tachycardia or heart failure and the LVEF remained normal.

Lessons:

AVRT is rarely associated with intrinsic LBBB, being a potential cause of TIC. In these patients, it is unlikely to control the arrhythmia pharmacologically, catheter ablation being the best therapeutic option. The variation of QRS complex duration between LBBB pattern in SR and AVRT could be useful for early diagnosis of an ipsilateral AP on surface ECG.
Lack of expression of ALK and CD30 in breast carcinoma by immunohistochemistry irrespective of tumor characteristics
Authors: Nassif Samer , El-Zaatari Ziad M. , Attieh Michel , Hijazi Maya , Fakhreddin Najla , Aridi Tarek , Boulos Fouad
Published: August 2019

CD30 is a member of the tumor necrosis factor family of cell surface receptors normally expressed in lymphocytes, as well as some lymphomas, but has been described in other malignancies. Anaplastic lymphoma kinase (ALK) is a tyrosine kinase receptor that belongs to the insulin receptor superfamily, and is normally expressed in neural cells, but has been detected in several malignancies. There is conflicting data in the literature that describes the expression of these receptors in breast cancer, and the aim of this study is to test the expression of CD30 and ALK in a cohort of Middle Eastern patients with breast carcinoma.

Cases of invasive breast cancer from the archives of AUBMC were reviewed over a period of 9 years, and the blocks that were used for immunohistochemical staining for ER, PR, Her-2/neu were selected. Immunohistochemical staining for CD30 (JCM182) and ALK (5A4 and D5F3) was performed.

Two hundred eighty-four cases were identified (2 cases were male), with a mean age of 55 ± 12. CD30 and ALK expression was not seen in any of the cases.

Our cohort showed complete negativity to both CD30 and ALK, adding to the conflicting data available in the literature, and more studies are needed to reliably identify a trend of expression of CD30 and ALK in breast carcinoma, especially in the Middle East.
Atypical presentation of giant cell arteritis in a patient with vertebrobasilar stroke
Authors: Elhfnawy Ahmed Mohamed , Bieber Michael , Schliesser Mira , Kraft Peter
Published: August 2019

Rationale:

Giant cell arteritis (GCA) is known to present with typical manifestations like temporal headache and visual abnormalities. However, several cases with atypical manifestations were reported. Stroke occurs in 3% to 7% of patients with GCA.

Patient concerns:

A 67-year-old male patient with known hypertension presented with somnolence, disorientation and mild bilateral limb ataxia. The magnetic resonance imaging showed multiple acute infarctions in the territory of the vertebrobasilar system with occlusion of the left vertebral artery.

Diagnosis:

Ten months later, during a routine neurovascular follow-up, recanalization of the left vertebral artery was observed and a hypoechoic concentric “halo” sign around both vertebral arteries, mainly on the left side was evident. On further examination of the superficial temporal artery, a hypoechoic concentric “halo” sign was also found, which—along with increased inflammatory markers—raised suspicion about GCA. Classical GCA features like headache, temporal tenderness or amaurosis fugax were not present. Repeated in-depth diagnostic work-up including 48 hours Holter-ECG did not reveal another stroke etiology.

Interventions:

Intravenous Methylprednisolone 250 mg/d was immediately started and after 6 days the dose was tapered to 80 mg/d. The patient was discharged on a tapering scheme with the recommendation to start azathioprine. Additionally, we placed the patient on acetylsalicylic acid 100 mg/d and clopidogrel 75 mg/d. However, the patient was not compliant to treatment; he stopped prednisolone early and did not start azathioprine.

Outcomes:

The inflammatory markers were markedly reduced at the beginning of the treatment. After stopping the immunosuppressive medications, the inflammatory markers were once again increased. Three months later, the patient developed bilateral middle cerebral artery and right occipital lobe infarctions.

Lessons:

In patients with cryptogenic vertebrobasilar strokes, GCA may be considered in the differential diagnosis, especially if the inflammatory markers are increased.
Penile prosthesis implant for primary erectile dysfunction in patient with Klippel-Trenaunay syndrome complicated by consumptive coagulopathy
Authors: Bettocchi Carlo , Spilotros Marco , Lucarelli Giuseppe , Utano Emanuele , Sebastiani Francesco , Bittner Lukas , Ditonno Pasquale , Battaglia Michele
Published: August 2019

Rationale:

Klippel-Trenaunay syndrome (KTS) is a congenital disorder characterized by cutaneous port wine capillary malformations, varicose veins with hemihypertrophy of soft tissue and bone.

Pelvic and retroperitoneal vascular malformations have been described up to the 30% of patients with KTS while hemangiomas of the urinary tract have been reported in 6%

Patient concerns:

A 30-year-old man with KTS was referred to our center for primary erectile dysfunction (ED) associated with varicosities of unusual distribution and asymmetry of the lower limbs. Furthermore, he suffered from hypertension and autosomal dominant polycystic kidney disease.

During penile prosthesis implantation, a significant intraoperative bleeding (1 liter) due to large scrotal venous malformations and profuse bleeding from both corpora was recorded. One month later, the day after the first prosthesis training session, the patient returned with swelling in the penoscrotal region. A large inguino-scrotal hematoma was drained. There was a complete bilateral dehiscence of corpora cavernosa with a spread venous bleeding in the scrotum.

Diagnoses:

CT scan showed hypertrophy of the right hypogastric artery with severe vascular malformations: the right pudendal artery was massively dilated with early visualization of venous drainage without evidence of arteriovenous fistulae; regular bulbocavernous capillary blush; right upper gluteus artery hypertrophic and dilated. Multiple twisting and aneurysms of the right internal pudenda artery were bleeding from multiple points. Cystoscopy showed a fistula between the proximal urethra and the penoscrotal dartos. Coagulation tests revealed the presence of factor XIII deficiency

Interventions:

The patient underwent several procedures including percutaneous scleroembolization of the internal pudendal arteries, removal of the penile implant, recombinant factor XIII (FXIII) administration, and cord blood platelet gel application.

Outcomes:

The patient was discharged after almost 3 months in hospital, hemodynamically stable.

Lessons:

Experience regarding management of ED in KTS patient is limited and in case of concomitant factor XIII deficiency, the clinical scenario can be life-threatening. A multidisciplinary approach including a urologist, an interventional radiologist and a hematologist in our experience represented the key approach in case of severe bleeding following surgery for ED.
Adenoid cystic carcinoma of the breast in a male
Authors: Pang Wenyang , Wang Zhengyi , Jin Xiaoyan , Zhang Qiang
Published: August 2019

Rationale:

Adenoid cystic carcinoma (ACC) of the breast is an infrequent neoplasm, and the occurrence in males is rare. Therefore, diagnostic and therapeutic challenges are inevitable.

Patient concerns:

Herein, we present a case of a 44-year-old man with a tumor on his right breast that he had known about for 6 years.

Diagnoses:

The patient underwent a lumpectomy, and the histological examination confirmed a diagnosis of ACC.

Interventions:

Modified radical mastectomy was subsequently conducted in the patient. No positive lymph nodes were observed in the postoperative pathological examination. Following the surgery, the patient received adjuvant chemotherapy.

Outcomes:

The patient remained recurrence-free at 26 months.

Lessons:

Compared to female breast ACC, male breast ACC may behave differently biologically and have a different prognosis. Our case will provide more diagnostic and treatment experience to deal with this disease.
The relationship of plasma fibrinogen with clinicopathological stages and tumor markers in patients with non-small cell lung cancer
Authors: Bian Nan-Nan , Shi Xin-Yu , Qi Hong-Yu , Hu Xin , Ge Yang , An Guang-Yu , Feng Guo-Sheng
Published: August 2019

Numerous studies have shown that the blood of cancer patients are generally in hypercoagulable statement. The aim of the present research is to study the relationships of plasma fibrinogen (Fbg) levels with clinicopathological stages (CS) and tumor markers of non-small cell lung cancer (NSCLC).

Baseline information, plasma Fbg levels, CS, and expression level of tumor markers were collected from medical records retrospectively. Unitary linear regression was used to analyze the relationships between continuous variables and Fbg, and multiple linear regression was used to analyze the relationships between categorical variables and Fbg. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology (Version 4) for NSCLC were adopted to evaluate CS.

A total of 652 NSCLC patients were included. Compared with the females, male patients had higher mean plasma Fbg levels (P < .001). The later the N stages (P = .002), M stages (P = .002), and CS (P = .001) were, the higher the average plasma Fbg levels were. The levels of squamous cell carcinoma antigen (P = .001), carbohydrate antigen 125 (P = .041), and neuron-specific enolase (P < .001) were positively correlated with plasma Fbg concentration. The plasma level of Fbg in lung adenocarcinoma patients (P < .001) was the lowest, while that of lung squamous cell carcinoma patients (P < .001) was the highest in NSCLC patients.

The plasma Fbg concentration is related to gender, CS, and tumor markers in patients with NSCLC.
Procalcitonin-guided antibiotic therapy in acute exacerbation of chronic obstructive pulmonary disease
Authors: Li Zhuying , Yuan Xingxing , Yu Ling , Wang Bingyu , Gao Fengli , Ma Jian
Published: August 2019

Background:

The benefit of a procalcitonin (PCT)-guided antibiotic strategy in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) remains uncertain.

Objectives:

This updated meta-analysis was performed to reevaluate the therapeutic potential of PCT-guided antibiotic therapy in AECOPD.

Data sources:

We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov up to February 2019 to identify randomized controlled trials (RCTs) investigating the role of PCT-guided antibiotic strategies in treating adult patients with AECOPD. Relative risk (RR) or mean differences (MD) with accompanying 95% confidence intervals (CIs) were calculated with a random-effects model.

Results:

Eight RCTs with a total of 1376 participants were included. The results suggested that a PCT-guided antibiotic strategy reduced antibiotic prescriptions (RR: 0.55; 95% CI: 0.39–0.76; P = .0003). However, antibiotic exposure duration (MD: −1.34; 95% CI: −2.83–0.16; P = .08), antibiotic use after discharge (RR: 1.61; 95% CI: 0.61–4.23; P = .34), clinical success (RR: 1.02; 95% CI: 0.96–1.08; P = .47), all-cause mortality (RR: 1.05; 95% CI: 0.72–1.55; P = .79), exacerbation at follow-up (RR: 0.97; 95% CI: 0.80–1.18; P = .78), readmission at follow-up (RR: 1.12; 95% CI: 0.82–1.53; P = .49), length of hospital stay (MD: −0.36; 95% CI: −1.36–0.64; P = .48), and adverse events (RR: 1.33; 95% CI: 0.79–2.23; P = .28) were similar in both groups.

Implications of key findings:

A PCT-guided antibiotic strategy is associated with fewer antibiotic prescriptions, and has similar efficacy and safety compared with standard antibiotic therapy in AECOPD patients.
Serum magnesium levels during magnesium sulfate infusion at 1 gram/hour versus 2 grams/hour as a maintenance dose to prevent eclampsia in women with severe preeclampsia
Authors: Pascoal Ana C. F. , Katz Leila , Pinto Marcela H. , Santos Carina A. , Braga Luana C. O. , Maia Sabina B. , Amorim Melania M. R.
Published: August 2019

Background:

Magnesium sulfate is the ideal drug for the prevention and treatment of eclampsia. Nevertheless, the best regimen for protection against eclampsia with minimal side effects remains to be established. This study aimed to compare serum magnesium levels during intravenous infusion of magnesium sulfate at 1 gram/hour versus 2 grams/hour as a maintenance dose to prevent eclampsia in pregnant and postpartum women with severe preeclampsia.

Methods:

A randomized, triple-blind clinical trial was conducted, comparing serum magnesium levels during the intravenous infusion of magnesium sulfate at 1 gram/hour versus 2 grams/hour as a maintenance dose for the prevention of eclampsia in 62 pregnant and postpartum women with severe preeclampsia, 31 in each group. An intravenous loading dose of 6 grams of magnesium sulfate was administered over 30 minutes in both groups. The patients were then randomized to receive a maintenance dose of either 1 or 2 grams/hour for 24 hours. Primary outcomes consisted of serum magnesium levels at the following time points: baseline, 30 minutes, every 2 hours until the end of the first 6 hours, and every 6 hours thereafter until the termination of magnesium sulfate infusion. Side effects, maternal complications, and neonatal outcomes were the secondary outcomes.

Results:

Serum magnesium levels were higher in the 2-gram/hour group, with a statistically significant difference from 2 hours after the beginning of the magnesium sulfate infusion (P <.05). Oliguria was the most common complication recorded in both groups, with no significant difference between the 2 regimens (RR 0.88; 95% CI: 0.49–1.56; P = .65). No cases of eclampsia occurred. Side effects were more common in the 2-gram/hour group (RR 1.89; 95% CI: 1.04–3.41; P = .02); however, all were mild. There were no differences between the 2 groups regarding neonatal outcomes, except for admission to neonatal intensive care, which was more frequent in the 1-gram/hour group (25% vs 6.3%; P = .04).

Conclusion:

Magnesium sulfate therapy at the maintenance dose of 1 gram/hour was just as effective as the 2-gram maintenance dose, with fewer side effects.
Effectiveness of electrical stimulation for postoperative pain in patients with osteosarcoma
Authors: Yu Tao , Tang Hua-yu , Wang Tian-shu , Wei Wei
Published: August 2019

Background:

This study aims to investigate the effectiveness and safety of electrical stimulation (ES) for postoperative pain (PPP) in patients with osteosarcoma systematically.

Methods:

We will systematically search the following electronic databases from inception to the May 1, 2019: MEDILINE, Cochrane Library, EMBASE, Web of Science, Springer, and CNKI without language restrictions. All literatures of randomized controlled trials (RCTs) and case-controlled studies (CCSs) of ES for PPP in patients with osteosarcoma will be included. RevMan 5.3 software (Cochrane Community; London, UK) and STATA 15.0 software (StataCorp; College Station) will be used for statistical analysis. Cochrane risk of bias will be used for methodological quality assessment for RCTs and Newcastle-Ottawa Scale will be utilized for CCSs.

Results:

This study will assess the clinical effectiveness and safety of ES for PPP in patients with osteosarcoma through assessing primary outcome of pain intensity and secondary outcomes of frequency of rescue analgesic use, cumulative morphine consumption, quality of recovery, as well as adverse events.

Conclusion:

This study will provide latest evidence on effectiveness and safety of ES for PPP in patients with osteosarcoma, and may also provide guidance for both clinician and further studies.

Dissemination and ethics:

This study does not require ethical approval, because it will not analyze the individual patient data. Its results are expected to be published in peer-reviewed journals.

Systematic review registration:

PROSPERO CRD42019135790.
Emotional problems in mothers of autistic children and their correlation with socioeconomic status and the children's core symptoms
Authors: Zhou Wensu , Liu Dan , Xiong Xiyue , Xu Huilan
Published: August 2019

To investigate the emotional problems (depressive and anxiety symptoms) of mothers of children with autism spectrum disorder (ASD) and explore the role of the mother's socioeconomic status (SES) and the core symptoms of the child on the mother's emotional problems.

This cross-sectional survey was performed in 180 mothers of children with ASD in Chang Sha city of China. The 7-item Generalized Anxiety Disorder Scale (GAD-7) and the 9-item Patient Health Questionnaire (PHQ-9) were used to assess the anxiety and depressive symptoms of the mothers of the autistic children. The education level and annual family income, as well as occupation, were be selected as components of the mother's SES. Autism Behaviour Checklist (ABC) and Social Responsiveness Scale (SRS) were used for the evaluation of the core symptoms of the children. A general information questionnaire was also used. The ordinal regression was used to examine the effect of the SES and children's core symptoms on maternal emotional problems.

The valid response rate was 92.7% (167 of 180 questionnaires were returned). Of the mothers studied, 72.5% and 80.2% had depressive and anxiety symptoms, respectively, and 67.1% suffered from both symptoms. Mother's SES was observed to be unrelated to maternal anxiety symptoms (P >.05). Only 1 component of the SES (junior high school education level) was related to depressive symptoms (OR = 0.31, 95% CI 0.12–0.80). SRS score under 115 (OR = 0.38, 95% CI 0.16–0.93) of autistic children was a protective factor against maternal anxiety symptoms. The borderline and mild behavioral problems (OR = 0.43, 95% CI 0.19–0.99; OR = 0.45, 95% CI 0.22–0.94, respectively) of autistic children were protective factors against maternal depressive symptoms.

Mothers of autistic children generally exhibited high levels of anxiety and depressive symptoms. The core symptoms of the autistic children were observed to be strongly associated with both maternal anxiety and depressive symptoms. Improvements in the core symptoms of children with ASD may help reduce maternal anxiety and depressive symptoms to some extent.
Adipogenesis for soft tissue reconstruction
Authors: Karagoz Huseyin , Zor Fatih , Goktas Esra , Gorantla Vijay S.
Published: August 2019

Purpose of review

It has been increasingly common to use adipose tissue for regenerative and reconstructive purposes. Applications of autologous fat transfer and different stem cell therapies have significant limitations and adipose tissue engineering may have the potential to be an important strategy in the reconstruction of large tissue defects. A better understanding of adipogenesis will help to develop strategies to make adipose tissue more effective for repairing volumetric defects.

Recent findings

We provide an overview of the current applications of adipose tissue transfer and cellular therapy methods for soft tissue reconstruction, cellular physiology, and factors influencing adipogenesis, and adipose tissue engineering. Furthermore, we discuss mechanical properties and vascularization strategies of engineered adipose tissue, and its potential applications in the clinical settings.

Autologous fat tissue transfer is the standard of care technique for the majority of surgeons; however, high resorption rates, poor perfusion within a large volume fat graft and widely inconsistent graft survival are the main limitations. Adipose tissue engineering is a promising field to reach the first goal of producing adipose tissue which has more predictable survival and higher graft retention rates. Advancements of scaffold and vascularization strategies will contribute to metabolically and functionally more relevant adipose tissue engineering.
Congenital Heart Disease: Prenatal Diagnosis and Genetic Associations
Authors: Hopkins Maeve K. , Dugoff Lorraine , Kuller Jeffrey A.
Published: August 2019

Importance

Congenital heart disease (CHD) is a common cause of neonatal morbidity and mortality. Several genetic abnormalities have been linked to congenital cardiac disease. When diagnosed prenatally, appropriate evaluation can help optimize neonatal outcomes.

Objective

The objective of this review is to identify appropriate prenatal genetic testing when congenital cardiac defects are identified antenatally. This review also identifies specific congenital cardiac defects that are associated with fetal aneuploidy and genetic syndromes.

Evidence Acquisition

A MEDLINE search of “genetic testing” or “microarray” and “congenital heart disease” and specific conditions reported in the review was performed.

Results

The evidence cited in this review includes case reports or case series (4) textbooks (3), systematic reviews (1), expert committee opinions (10), and 37 additional peer-reviewed journal articles that were original research or expert summaries.

Conclusions and Relevance

When CHD is identified through prenatal screening, patients should be referred for genetic counseling and offered appropriate genetic testing. Prenatal diagnosis of genetic syndromes related to CHD and close communication between obstetric, genetic, and pediatric providers can help optimize outcomes for both mother and baby.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After participating in this activity, physicians should be better able to distinguish the appropriate genetic screening and testing when congenital cardiac defects are diagnosed; assess associated risks of genetic abnormality with a diagnosed congenital cardiac defect; refer patients to genetic counselors for appropriate indication(s); describe the risks, benefits, and limitations of antenatal genetic testing and educate patient regarding these risks, benefits, and limitations; and identify indications for screening fetal echocardiography.
A Cost Minimization Analysis of Treatment Options for Postmenopausal Women With Dysuria
Authors: Bradley Megan S. , Beigi Richard H. , Shepherd Jonathan P.
Published: August 2019

(Abstracted from Am J Obstet Gynecol 2019; doi: 10.1016/j.ajog.2019.04.031)

The most common type of bacterial infection seen in an outpatient setting is urinary tract infection (UTI). In the United States, the overall lifetime prevalence of UTIs in women is greater than 50%.
Neurodevelopmental Outcome of Children With Spina Bifida Aperta Repaired Prenatally vs Postnatally: Systematic Review and Meta-analysis
Authors: Inversetti A. , Van der Veeken L. , Thompson D. , Jansen K. , Van Calenbergh F. , Joyeux L. , Bosteels J. , Deprest J.
Published: August 2019

(Abstracted from Ultrasound Obstet Gynecol 2019;53:293–301)

Spina bifida aperta is characterized by a congenital defect in the vertebral arches, with protrusion of the meninges and, in the case of myelomeningocele, protrusion of the spinal cord as well. In the majority of cases, spina bifida is not lethal in the neonatal period, although it is associated with higher mortality than in the normal population (44,000 deaths in 150,000 affected newborns per year worldwide).
Maternal Telomere Length Is Shorter in Intrauterine Growth Restriction Versus Uncomplicated Pregnancies, But Not in the Offspring or in IVF-Conceived Newborns
Authors: Perales-Puchalt Alfredo , Soberón Nora , Monterde Mercedes , Hervas-Marin David , Foronda Miguel , Desantes Domingo , Soler Inmaculada , Perales-Marin Alfredo , Pellicer Antonio , Blasco Maria A.
Published: August 2019

(Abstracted from Reprod Biomed Online 2019;38(4):606–612)

Telomeres are protective nucleoprotein structures found at the end of chromosomes that progressively shorten with each round of DNA replication during cell division. Telomere shortening is associated with physiological aging, and short telomeres have been found to be an early indicator of cardiovascular disease.
Comparison of Molecular and Histologic Ultrastaging Methods in Sentinel Lymph Node Analysis from Clinical Stage II Colon Cancers
Authors: Deroo Olivier , Lakkis Zaher , Paquette Brice , Grand David , Monnien Franck , Felix Sophie , Borg Christophe , Heyd Bruno , Kim Stefano , Valmary-Degano Séverine
Published: August 2019

Various studies have demonstrated that occult metastases may be present in patients with clinical stage II colon cancer. The objective of this prospective investigation was to compare the performance of molecular analysis and histologic ultrastaging in detecting occult metastases in sentinel lymph nodes (SLNs). SLNs were collected ex vivo during surgery in 29 patients. Quantitative reverse-transcription polymerase chain reaction (qRT-PCR) assays were constructed. The results were compared with histologic ultrastaging analysis by hemalum and eosin stain and immunohistochemistry on step serial sections. At least 1 SLN was identified in 76% of the cases. The first hemalum and eosin section identified metastases in 23% of the 22 SLNs. Immunohistochemistry identified isolated tumor cells in 24% of the remaining 17 cases. An overall 73% of the SLNs analyzed by qRT-PCR were positive. Four of them were negative for ultrastaging analysis. qRT-PCR is a powerful tool for the detection of occult metastases in colorectal SLN and seems to be more sensitive than histologic ultrastaging analysis. A larger prospective cohort study is necessary to provide further evidence.
System Factors Influencing the Use of a Family-Centered Rounds Checklist
Authors: Kelly Michelle M. , Xie Anping , Li Yaqiong , Cartmill Randi , Cox Elizabeth D. , Brown Roger L. , Wetterneck Tosha , Carayon Pascale
Published: August 2019

Introduction:

Checklists are used to operationalize care processes and enhance patient safety; however, checklist implementation is difficult within complex health systems. A family-centered rounds (FCR) checklist increased physician performance of key rounding activities, which were associated with improved parent engagement, safety perceptions, and behaviors. To inform FCR checklist implementation and dissemination, we assessed physician compliance with this checklist and factors influencing its use.

Methods:

Guided by a recognized human factors and systems engineering approach, rounding observations and ad hoc resident and attending physician interviews were conducted at a tertiary children’s hospital. Rounding observers documented 8-item checklist completion (nurse presence, family preference, introductions, assessment/plan, discharge goals, care team questions, family questions, and read back orders) and then interviewed physicians to elicit their perceptions of challenges and facilitators to FCR checklist use. We performed a directed content analysis of interview notes, iteratively categorizing data into known hospital work system components.

Results:

Of 88 individual patient rounds observed after checklist implementation, 90% included the nurse, and 77% occurred at the bedside. In an average patient rounding session, staff performed 82% of checklist items. Factors influencing checklist use were related to all hospital work system components, eg, physician familiarity with checklist content (people), visibility of the checklist (environment), providing schedules for rounding participants (organization), and availability of a mobile computer during rounds (technology).

Conclusions:

Multiple factors within hospital systems may influence FCR checklist use. Strategies, such as providing rounding schedules and mobile computers, may promote optimal engagement of families during rounds and promote pediatric patient safety.
A Quality Improvement Approach to Increase Exercise Assessment in Survivors of Childhood Leukemia
Authors: Coven Scott L. , Bibart Mindy , Frost Randall , Gallagher Travis , Guinipero Terri , Valasek Amy E. , Olshefski Randal
Published: August 2019

Introduction:

Survivors of childhood cancer are at increased risk of treatment-related cardiovascular disease, the severity of which is impacted by the level of regular exercise. Exercise assessments (EAs) are not a routine component of follow-up care.

Methods:

We incorporated a quantitative EA tool into the clinic triage during follow-up visits for survivors of acute lymphoblastic leukemia. The nursing staff was surveyed on the use of the EA tool to gauge understanding and level of comfort with addressing patient questions.

Results:

Over 27 months, the percentage of off-therapy acute lymphoblastic leukemia patients with documented EA increased from 0% to 80%. We noted degradation in EA completions in the last 6 months of the project, which we attributed to project nursing staff transition and failure to maintain education. Interventions that improved the percentage of completed EA included the incorporation the assessment tool into the electronic medical record and weekly reminders of scheduled eligible patients. A nurse incentive plan did not impact project success. Survey results revealed that the nursing staff were comfortable with the EA and did not view the new process as hurting patient flow.

Conclusion:

Implementation of an EA tool into routine clinic follow-up was successful. We met the project goal of assessing greater than 50% of the follow-up patients. This work will serve as the foundation for the next phase of the project, which will be to provide education on the importance of exercise and earlier intervention when a sedentary lifestyle is identified.
From correlation towards causality: modulating brain rhythms of pain using transcranial alternating current stimulation
Authors: Hohn Vanessa D. , May Elisabeth S. , Ploner Markus
Published: August 2019

Introduction:

Accumulating evidence suggests that neural oscillations at different frequencies and their synchrony between brain regions play a crucial role in the processing of nociceptive input and the emergence of pain. Most findings are limited by their correlative nature, however, which impedes causal inferences.

Objective:

To move from correlative towards causal evidence, methods that allow to experimentally manipulate oscillatory brain activity are needed.

Results:

Transcranial alternating current stimulation (tACS) is a noninvasive brain stimulation technique designed to modulate neural oscillations in a frequency specific manner and as such a suitable method to investigate the contribution of oscillatory brain activity to pain. Despite its appeal, tACS has been barely applied in the field of pain research. In the present review, we address this issue and discuss how tACS can be used to gather mechanistic evidence for the relationship between pain and neural oscillations in humans.

Conclusions:

Transcranial alternating current stimulation holds great potential for the investigation of the neural mechanisms underlying pain and the development of new treatment approaches for chronic pain if necessary methodological precautions are taken.
Neuroimaging-based pain biomarkers: definitions, clinical and research applications, and evaluation frameworks to achieve personalized pain medicine
Authors: Mackey Sean , Greely Henry T. , Martucci Katherine T.
Published: August 2019

One of the key ambitions of neuroimaging-based pain biomarker research is to augment patient and clinician reporting of clinically relevant phenomena with neural measures for prediction, prognosis, and detection of pain. Despite years of productive research on the neuroimaging of pain, such applications have seen little advancement. However, recent developments in identifying brain-based biomarkers of pain through advances in technology and multivariate pattern analysis provide some optimism. Here, we (1) define and review the different types of potential neuroimaging-based biomarkers, their clinical and research applications, and their limitations and (2) describe frameworks for evaluation of pain biomarkers used in other fields (eg, genetics, cancer, cardiovascular disease, immune system disorders, and rare diseases) to achieve broad clinical and research utility and minimize the risks of misapplication of this emerging technology. To conclude, we discuss future directions for neuroimaging-based biomarker research to achieve the goal of personalized pain medicine.
Vitamin D and Cytokine Profiles in Patients With Systemic Sclerosis
Authors: Hax Vanessa , Gasparin Andrese Aline , Schneider Laiana , Monticielo Odirlei André , Soares Helena Margot Flores , Streit Marianna do Amaral , Pfaffenseller Bianca , Xavier Ricardo Machado , Chakr Rafael Mendonça da Silva
Published: August 2019

Introduction

Hypovitaminosis D has been frequently described in systemic sclerosis (SSc). Cytokines are important mediators of tissue damage and clinical dysfunction in SSc and may be influenced by vitamin D levels.

Objective

To evaluate the serum levels of vitamin D and its correlation with the clinical features and cytokine profiles in SSc patients.

Methods

Case-control study, including 50 SSc patients and 35 healthy non matched controls. Serum levels of 25(OH) vitamin D were measured by chemiluminescence assay, and serum concentrations of interleukin 2 (IL-2), IL-4, IL-6, IL-10, tumor necrosis factor, and interferon γ were determined by flow cytometry.

Results

Fourteen patients (28%) had diffuse cutaneous SSc, 94% were female, 80% European derived, with a mean age of 57.2 ± 12.8 years. The serum vitamin D levels in SSc patients were 23.9 ± 8.5 ng/mL and 30.2 ± 6.2 ng/mL in the control group (standardized mean difference −6.19; 95% confidence interval, −9.9 to −2.3; p = 0.002), despite the more frequent supplementation of vitamin D in SSc patients (p = 0.014). No significant associations were found among vitamin D concentrations and cytokine levels. Serum levels of IL-6 were significantly elevated in SSc patients (p = 0.024) and were positively correlated with the modified Rodnan skin score (r
s = 0.291, p =0.041).

Conclusions

Despite lower vitamin D levels in SSc patients, there was no clear association with any cytokine. Serum levels of IL-6 were significantly elevated and positively correlated with the extent of skin involvement in SSc patients.
Scalp Avulsion Injuries and Replantation
Authors: Kashyap Nitin , Singhal Maneesh , Tiwari Raja , Chauhan Shashank , Manas Raj
Published: August 2019

Scalp avulsion injuries are usually attributed to entrapment of long hair or clothing in agricultural or industrial machinery or traffic accidents. Though rare, these injuries may be dangerous, and resulting cosmetic defect and alopecia lead to social stigma and poor self-esteem. Early intervention in the form of microvascular repair and replantation prevent morbidity and improve outcome. In this case series, we have discussed 3 cases of scalp replantation, 2 complete and 1 partial. Immediate microvascular reconstruction was planned in each case. Single surgical team approach was followed, vessels were identified and operated under an operative microscope. No vein grafts were used. Operative outcome was good, and scalp healed well. Cosmetic outcome was excellent, and there was no need for secondary revisions or use of tissue expanders. Immediate referral of such cases to institutes with facility for microvascular repair is recommended to reduce ischemia time. Superficial temporal artery is the first choice for microvascular repair in scalp replants, and a single artery anastomosis is sufficient to perfuse the entire scalp. Deep temporal artery is a viable alternative in cases where repair with superficial temporal vessels will require use of vein graft, cutting short operative time and associated complications.