bluuebunny/crossref_metadata_2025 huggingface dataset:
Breakage and migration of a high-speed dental hand-piece bur during mandibular third molar extraction
Authors: Matsuda Shinpei , Yoshimura Hitoshi , Yoshida Hisato , Sano Kazuo
Published: February 2020

Rationale:

Tooth extraction is a common dental surgical procedure. There is a possibility that various complications often occur during third molar tooth extractions.

Patient concerns:

The authors report herein 2 cases of migration of a high-speed dental hand-piece bur during mandibular third molar extraction—one case with the iatrogenic foreign body migrating into the mandibular body and another case with the iatrogenic foreign body migrating into the floor of mouth are reported.

Diagnosis:

The patient was diagnosed with the iatrogenic foreign body associated with mandibular third molar extraction by imaging examinations.

Interventions:

The authors performed elective surgery to remove the foreign body under general anesthesia in Case 1, and performed emergency surgery to remove the foreign body under local anesthesia in Case 2.

Outcomes:

The foreign bodies were removed, and complete removal of the foreign bodies was confirmed by postoperative x-ray examination. The patients’ postoperative courses were uneventful.

Lessons:

The selection of adequate surgical procedures and instruments will prevent the occurrence of iatrogenic foreign bodies. If migration accidents occur, their positions should first be confirmed by imaging examinations. Dentists and/or oral surgeons should perform removal operations considering the degree of emergency based on the results of imaging examinations.
Treatment of conjunctival papilloma with topical interferon alpha-2b - case report
Authors: Bolek Bartłomiej , Wylęgała Adam , Teper Sławomir , Kokot Joanna , Wylęgała Edward
Published: February 2020

Rationale:

Conjunctival papilloma is a benign neoplastic lesion of epithelial origin, with a minimal tendency toward malignancy and an exophytic growth type. Etiological factors that contribute to the appearance of papilloma are UV exposure, HPV infection, smoking, and immunodeficiency. A case report of limbal conjunctival papilloma treatment with topical interferon alpha-2b eye drops applied to the conjunctival sac.

Patient concerns:

A 49-year-old female patient treated in the Clinical Department of Ophthalmology for conjunctival lesion located in the temporal quadrant near the limbus of the right eye. Ocular examination of the patient's eye did not show any abnormalities: visual acuity—20/20, intraocular pressure—16 mmHg.

Diagnoses:

During physical examination, a broad-based pink lesion of size 4 mm × 6 mm was found in interpalpebral bulbar conjunctiva with prominent feeder vessels and soft consistency. Lesion in the biomicroscopic examination did not show any sign of malignancy. In Swept Source Optical Coherence Tomography (SS-OCT) there was no sign of infiltration into sclera or cornea. In vivo confocal microscopy (IVCM) examination, revealed loss of the normal conjunctival epithelium - hyper-reflective cells, variation of cell size. A clinical diagnosis of limbal conjunctival papilloma was made.

Interventions:

Interferon alpha-2b 1 million IU/ml eye drops were applied 4 times a day for 5 months. The treatment lasted 5 months without changing the dosing regimen. Three months after the start of the interferon treatment, a complete regression of the lesion was achieved. Treatment was continued for the following 2 months. Controlled IVCM after 6 months showed only few hyper-reflective cells and fibrotic tissue.

Outcomes:

Treatment of conjunctival papilloma with topical interferon alpha-2b led to the complete regression of the lesion. Although after the therapy the conjunctiva appears normal both in slit lamp and in the OCT examination, there is a noticeable fibrosis of the tissue in confocal microscopy. During the 14-month follow-up period, there were no recurrent lesions.

Lessons:

In this study, topical interferon alpha-2b has been shown to be an effective and safe therapy for small-to-medium-size conjunctival papilloma without any sign of malignancy.
Relationship between plasma levels of 25-hydroxyvitamin D and arterial stiffness in elderly Chinese with non-dipper hypertension
Authors: Gu Jian-Wei , Liu Ju-Hua , Xiao Hui-Neng , Yang Yun-Feng , Dong Wen-Ju , Zhang Quan-Bo , Liu Li , He Cheng-Shi , Wu Bi-Hua
Published: February 2020

Elderly individuals with non-dipper hypertension are at high risk of cardiovascular disease because of increased stiffness of peripheral arteries. Since, vitamin D deficiency is prevalent in elderly Chinese. We examined whether reduced plasma levels of 25-hydroxyvitamin D [25(OH)D] may help promote this stiffness.

Hypertensive patients at least 60 years old without history of peripheral arterial disease at our hospital were retrospectively divided into dipper and non-dipper groups according to the results of 24-hour ambulatory blood pressure monitoring. Plasma levels of 25(OH)D were measured by enzyme immunoassay. Peripheral arterial stiffness was measured based on the cardio-ankle vascular index (CAVI).

Of the 155 patients enrolled, 95 (61.3%) were diagnosed with non-dipper hypertension and these patients had significantly lower plasma levels of 25(OH)D than the 60 patients with dipper hypertension (19.58 ± 5.97 vs 24.36 ± 6.95 nmol/L, P < .01) as well as significantly higher CAVI (8.46 ± 1.65 vs 7.56 ± 1.08 m/s, P < .01). Vitamin D deficiency was significantly more common among non-dipper patients (57.9% vs 31.7%, P < .01). Multivariate regression showed that age and 25(OH)D were independently related to CAVI, with each 1-ng/ml decrease in 25(OH)D associated with a CAVI increase of +0.04 m/s.

Non-dipper hypertension is associated with vitamin D deficiency and reduced plasma levels of 25(OH)D. The latter may contribute to stiffening of peripheral arteries, increasing the risk of cardiovascular disease.
Intrauterine double-balloon tamponade vs gauze packing in the management of placenta previa
Authors: Wei Jing , Dai Yimin , Wang Zhiqun , Gu Ning , Ju Hongfang , Xu Youdi , Xu Biyun , Hu Yali
Published: February 2020

Background:

To evaluate the effectiveness and safety of a newly designed intrauterine double-balloon catheter to arrest postpartum hemorrhage (PPH) following cesarean delivery (CD) for placenta previa.

Methods:

We conducted an open-label, multicenter randomized controlled trial in two referral centers and one general hospital. Women with continuous bleeding after placental delivery following CD for placenta previa, who failed to respond to uterotonics, suturing and uterine devascularization, and in the absence of suspected deeply invasive accreta were eligible subjects. Eligible subjects were randomized to receive intrauterine double-balloon catheter (n = 102) or gauze packing (n = 102). The main outcome was the rate of successful hemostasis without the need for additional surgical interventions. The secondary outcomes included the volume of blood loss during and after CD, the rate of PPH, incidence and amount of blood transfusion, hysterectomy, surgical complications, intensive care unit admission, need for re-laparotomy, length of hospital stay, and readmission.

Results:

The 224 participants were recruited before delivery, with 20 excluded (14 cases bleeding stopped after uterotonics and/or local myometrium sutures and 6 patients with placental increta). Finally, 102 women were assigned in catheter group and 102 others in gauze group. There was no difference in the rate of successful hemostasis in the catheter and gauze groups (93.1% vs 91.2%, P = .80). Compared with those in the gauze group, women in the catheter group showed significantly less blood loss within 24 hours postpartum (895 [612.3–1297.8] vs 1156 [882.5–1453.3] ml, P < .01), lower rate of PPH ≥1000 ml (42.2% vs 63.7%, P < .01). Accordingly, women in the catheter group had significantly less maternal adverse events such as postpartum anemia, puerperal morbidity, and postpartum pain.

Conclusion:

Uterine tamponade using a double-balloon catheter was as effective as gauze packing in hemostasis, and appeared to be superior in reducing postpartum blood loss and pain following CD for placenta previa. Using double-balloon catheter in managing PPH in this situation may be a preferable alternative to minimize maternal morbidity.
Non-alcoholic fatty liver disease in inflammatory bowel disease patients
Authors: Karaivazoglou Katerina , Konstantakis Christos , Tourkochristou Evanthia , Assimakopoulos Stelios F. , Triantos Christos
Published: February 2020

Non-alcoholic fatty liver disease is a highly prevalent medical condition, characterized by intrahepatic fat accumulation which may eventually lead to hepatic inflammation, cell death and reactive fibrosis. Obesity and metabolic disturbances constitute significant contributors to liver steatosis pathogenesis, however, there is a growing awareness that fatty liver may emerge even in normal weight or metabolically healthy individuals. In recent years, advanced imaging techniques have revealed that liver steatosis is quite common in inflammatory bowel disease patients, suggesting that intestinal inflammation and disturbances of the liver-gut axis may also play a key role in non-alcoholic fatty liver disease pathophysiology. The current review focuses on the co-occurrence of the two disorders, integrating research findings on epidemiology, clinical characteristics and common pathophysiological processes. The study of liver steatosis in inflammatory bowel disease patients may provide useful insights on the complex links between dietary fat intake, metabolic dysregulation, gut physiology and intrahepatic cellular mechanisms underlying liver inflammation and damage.
Payment for Contraceptive Services in Safety Net Clinics
Authors: Darney Blair G. , Biel Frances M. , Rodriguez Maria I. , Jacob R. Lorie , Cottrell Erika K. , DeVoe Jennifer E.
Published: February 2020

Objectives:

We describe payor for contraceptive visits 2013–2014, before and after Medicaid expansion under the Affordable Care Act (ACA), in a large network of safety-net clinics. We estimate changes in the proportion of uninsured contraceptive visits and the independent associations of the ACA, Title X, and state family planning programs.

Methods:

Our sample included 237 safety net clinics in 11 states with a common electronic health record. We identified contraception-related visits among women aged 10–49 years using diagnosis and procedure codes. Our primary outcome was an indicator of an uninsured visit. We also assessed payor type (public/private). We included encounter, clinic, county, and state-level covariates. We used interrupted time series and logistic regression, and calculated multivariable absolute predicted probabilities.

Results:

We identified 162,666 contraceptive visits in 219 clinics. There was a significant decline in uninsured contraception-related visits in both Medicaid expansion and nonexpansion states, with a slightly greater decline in expansion states (difference-in-difference: −1.29 percentage points; confidence interval: −1.39 to −1.19). The gap in uninsured visits between expansion and nonexpansion states widened after ACA implementation (from 2.17 to 4.1 percentage points). The Title X program continues to fill gaps in insurance in Medicaid expansion states.

Conclusions:

Uninsured contraceptive visits at safety net clinics decreased following Medicaid expansion under the ACA in both expansion and nonexpansion states. Overall, levels of uninsured visits are lower in expansion states. Title X continues to play an important role in access to care and coverage. In addition to protecting insurance gains under the ACA, Title X and state programs should continue to be a focus of research and advocacy.
Risk Factors Influencing Tolerance and Clinical Features of Food Protein–induced Allergic Proctocolitis
Authors: Buyuktiryaki Betul , Kulhas Celik Ilknur , Erdem Semiha B. , Capanoglu Murat , Civelek Ersoy , Guc Belgin Usta , Guvenir Hakan , Cakir Murat , Dibek Misirlioglu Emine , Akcal Omer , Volkan Burcu , Toyran Muge , Sag Elif , Kertel Alev C. , Ginis Tayfur , Kocabas Can N. , Orhan Fazıl , Can Demet
Published: February 2020

Objective:

Continued progress in our understanding of the food protein–induced allergic proctocolitis (FPIAP) will provide the development of diagnostic tests and treatments. We aimed to identify precisely the clinical features and natural course of the disease in a large group of patients. Also, we investigated the predicting risk factors for persistent course since influencing parameters has not yet been established.

Methods:

Infants who were admitted with rectal bleeding and had a diagnosis of food protein–induced allergic proctocolitis in 5 different allergy or gastroenterology outpatient clinics were enrolled. Clinical features, laboratory tests, and prognosis were evaluated. Risk factors for persistent course were determined by logistic regression analyses.

Results:

Among the 257 infants, 50.2% (n = 129) were girls and cow's milk (99.2%) was the most common trigger. Twenty‐four percent of the patients had multiple food allergies and had more common antibiotic use (41.9% vs 11.8%), atopic dermatitis (21% vs 10.2%), wheezing (11.3% vs 1.5%), colic (33.8% vs 11.2%), and IgE sensitization (50% vs 13.5%) compared to the single‐food allergic group (P < 0.001, P = 0.025, P = 0.003, P < 0.001, respectively). In multivariate logistic regression analysis, presence of colic (odds ratio [OR]: 5.128, 95% confidence interval [CI]: 1.926–13.655, P = 0.001), IgE sensitization (OR: 3.964, 95% CI: 1.424–11.034, P = 0.008), and having allergy to multiple foods (OR: 3.679, 95% CI: 1.278–10.593, P = 0.001] were found to be risk factors for continuing disease after 1 year of age.

Conclusion:

Although most children achieve tolerance at 1 year of age, IgE sensitization, allergy to multiple foods, and presence of colic were risk factors for persistent course and late tolerance. In this context, these children may require more close and extended follow‐up.
Pharmacokinetics, Pharmacodynamics, and Immunogenicity of Infliximab in Pediatric Inflammatory Bowel Disease
Authors: Winter Dwight A. , Joosse Maria E. , de Wildt Saskia N. , Taminiau Jan , de Ridder Lissy , Escher Johanna C.
Published: February 2020

Objectives:

Infliximab (IFX), a monoclonal antibody directed against tumor necrosis factor alpha is a potent treatment option for inflammatory bowel disease (IBD). Dosing regimens in children are extrapolated from adult data using a fixed, weight‐based dose, which is often not adequate. While clinical trials have focused on safety and efficacy, there is limited data on pharmacokinetic characteristics and immunogenicity of IFX in children. The objective was to provide a systematic overview of current literature on pharmacokinetic and immunogenicity of IFX in children with IBD, to assess the validity of current adult to pediatric dosing extrapolation.

Methods:

A literature search identified publications up to October 2018. Eligibility criteria were study population consisting of children and/or adolescents with IBD, report of IFX trough levels and/or antibodies‐to IFX, full text article or abstract, article in English, and original data.

Results:

Initial electronic search yielded 2360 potentially relevant articles, with 1831 remaining after removal of duplicates. An additional search yielded another 202 potentially relevant articles. Of the 2033 retrieved articles, 2000 articles were excluded based on title, abstract, or eligibility criteria. Clearance of IFX was increased in young children and children with extensive disease, leading to lower trough levels after extrapolated dosing of 5 mg/kg, antibodies‐to IFX emergence, and subsequent reduced efficacy.

Conclusions:

Adult to pediatric weight–based dosing extrapolation is often inadequate. We provide several considerations for optimal dosing of IFX in children and adolescents with IBD.
Influence of the 2012 European Guidelines in Diagnosis and Follow‐up of Coeliac Children With Selective IgA Deficiency
Authors: López Raquel Vecino , Cid Carmen Miranda , García Gloria Rodrigo , Romero Ruth García , Cilleruelo Maria Luz , Riechmann Enriqueta Román ,   Spanish Working Group on Coeliac Disease (Spanish Society of Paediatric Gastroenterology, Hepatology, Nutrition, SEGHNP)
Published: February 2020

Objectives:

The aim of the study was to describe diagnostic criteria used in children with coeliac disease (CD) and selective IgA deficiency; to determine if the publication of the 2012 ESPGHAN criteria prompted any changes; to evaluate the evolution of serological markers.

Methods:

Multicenter, retrospective, descriptive study of a cohort of children under 15 years with selective IgA deficiency diagnosed with CD (January 2006 to December 2016). Demographic, clinical, genetic, histological and IgG‐based antibodies were collected at diagnosis and follow‐up.

Results:

Eighty‐six children were included, 60 diagnosed after the guide. Two groups were established: G1 (n = 63) and G2 (n = 23) with or without diagnostic biopsy respectively. In G1: 87.3% were symptomatic, 87.3% had human leukocyte antigan (HLA) DQ2/DQ8 typing (all positive), all had IgG serology positive (71.5% ATG, 35% EMA, 19% DPG, 9.5% AGA), and all had villous atrophy (Marsh‐Oberhuber 2–3). Follow‐up data were available in 58 children, 34 after 2 years on a gluten‐free diet. Fifty‐two percentage remained ATG IgG‐positive despite good dietary adherence and symptom remission. Regarding G2: all were diagnosed post‐2012, had typical symptoms, HLA DQ2/DQ8 positive and ATG IgG × 10 ULN. Additionally, EMA IgG was performed in 14 (60%), all positive.

Conclusions:

In our cohort of children with selective IgA deficiency and diagnosed with CD, children without a diagnostic biopsy suggests that IgG serology was considered the equivalent as IgA isotype, even when this is not addressed in the aforementioned guidelines. Great heterogeneity was observed in the IgG serology used at diagnosis. After 2 years of a gluten‐free diet, half of children remained with a positive serology.
Efficacy and Safety of Carbon Dioxide Versus Air Insufflation for Colonoscopy in Deeply Sedated Pediatric Patients
Authors: Dharmaraj Rajmohan , Dunn Rachel , Fritz Julia , Dasgupta Mahua , Simpson Pippa , Cabrera Jose , Miranda Adrian , Lerner Diana G.
Published: February 2020

Objectives:

Studies have shown the advantages of carbon dioxide (CO2) over air insufflation in the adult population during colonoscopies. This study was designed to investigate the efficacy and safety of CO2 insufflation in deeply sedated children undergoing colonoscopy.

Methods:

This was a prospective, randomized, double‐blind clinical trial. We recruited 100 consecutive pediatric patients who had colonoscopy under deep sedation for various indications. Patients were first randomized by history of abdominal pain and then randomly assigned to either CO2 or air insufflation. Postprocedural abdominal pain scores were registered on a 10‐point visual analog rating scale and significant pain was defined as a score of 3 or higher. Abdominal circumferences and end tidal CO2 (ETCO2) levels were measured. Complications during and after the procedure were recorded.

Results:

We did not find statistically significant difference between CO2 and air insufflation on univariate analysis because of low number of children experiencing significant pain after colonoscopy. After adjusting for baseline pain, we found that pain was significantly lower in patients after CO2 versus air insufflation on multivariable analysis (P = 0.03). The significant factors related to pain were duration of the procedure (P = 0.006), history of abdominal pain (P = 0.002) and previous abdominal surgery (P = 0.02). CO2 insufflation was associated with decreased abdominal circumference after colonoscopy (P = 0.002). Girls were more likely to have pain regardless of intervention (P = .04).

Conclusions:

Most children tolerate endoscopic procedures without significant pain. Our study was underpowered to show significant difference between air and CO2 on univariate analysis. CO2 insufflation during colonoscopy, however, may reduce postprocedural abdominal pain. Significant factors for increased pain on multivariate analysis included colonoscopy length over 30 minutes, history of abdominal pain, and previous abdominal surgery.
Neurological Adverse Effects Associated With Anti‐tumor Necrosis Factor Alpha Antibodies in Pediatric Inflammatory Bowel Diseases
Authors: Bertrand Valérie , Massy Nathalie , Pigneur Bénédicte , Coopman Stéphanie , Durrieu Geneviève , Gaboriau Louise , Langlois Vincent , Gower‐Rousseau Corinne , Hugot Jean‐Pierre , Ruemmele Frank M. ,   GETAID (Groupe d’Etude thérapeutique des Affections Inflammatoires du Tube Digestif) Pdiatrique
Published: February 2020

Objectives:

Neurological adverse effects (NAEs) induced by biotherapies have been reported in the literature mainly in adult patients with inflammatory bowel disease (IBD), rheumatic diseases, or psoriasis. There are scant data in children. Aims of this study are to report and describe noninfective NAE associated with anti‐TNFα antibodies in pediatric IBD, and to evaluate their incidence.

Methods:

We retrospectively collected all reports of NAE in pediatric IBD treated with anti‐TNFα antibodies recorded in the French Pharmacovigilance Database. To estimate the national incidence of NAEs, we extrapolated data from the French regional inception population‐based cohort EPIMAD.

Results:

Between 2000 and 2018, 231 adverse events in pediatric IBD exposed to anti‐TNFα antibodies were reported to this Database. Seventeen NAEs (7.36%) were collected: 8 severe NAE (1 demyelinating neuropathy, 1 optic neuritis, 1 acute transverse myelitis, 1 polyradiculoneuritis, 1 sensorineural hearing loss, 1 seizure, 1 stroke, and 1 glioma), 7 moderate NAE (headaches), and 2 neuropsychic events. The median delay between anti‐TNFα start and NAE occurrence was 6 months (range: 13 days to 26 months). In 10 of 17 patients, anti‐TNFα antibodies were stopped. Nine of 17 patients had a complete resolution (including 2 severe NAE) and 8 of 17 a partial resolution (including 6 severe NAE). We estimate the incidence of severe NAE in pediatric IBD treated with anti‐TNFα antibodies at 1 case for 10,000 patients‐year in France.

Conclusions:

NAE associated with anti‐TNFα antibodies in pediatric IBD are rare. In severe NAE, we recommend to discontinue anti‐TNFα therapy and to consider alternative treatment.
Probiotics and Preterm Infants
Authors: van den Akker Chris H.P. , van Goudoever Johannes B. , Shamir Raanan , Domellöf Magnus , Embleton Nicholas D. , Hojsak Iva , Lapillonne Alexandre , Mihatsch Walter A. , Berni Canani Roberto , Bronsky Jiri , Campoy Cristina , Fewtrell Mary S. , Fidler Mis Nataša , Guarino Alfredo , Hulst Jessie M. , Indrio Flavia , Kolaček Sanja , Orel Rok , Vandenplas Yvan , Weizman Zvi , Szajewska Hania
Published: February 2020

More than 10,000 preterm infants have participated in randomised controlled trials on probiotics worldwide, suggesting that probiotics in general could reduce rates of necrotising enterocolitis (NEC), sepsis, and mortality. Answers to relevant clinical questions as to which strain to use, at what dosage, and how long to supplement are, however, not available. On the other hand, an increasing number of commercial products containing probiotics are available from sometimes suboptimal quality. Also, a large number of units around the world are routinely offering probiotic supplementation as the standard of care despite lacking solid evidence. Our recent network meta‐analysis identified probiotic strains with greatest efficacy regarding relevant clinical outcomes for preterm neonates. Efficacy in reducing mortality and morbidity was found for only a minority of the studied strains or combinations. In the present position paper, we aim to provide advice, which specific strains might potentially be used and which strains should not be used. In addition, we aim to address safety issues of probiotic supplementation to preterm infants, who have reduced immunological capacities and occasional indwelling catheters. For example, quality reassurance of the probiotic product is essential, probiotic strains should be devoid of transferable antibiotic resistance genes, and local microbiologists should be able to routinely detect probiotic sepsis. Provided all safety issues are met, there is currently a conditional recommendation (with low certainty of evidence) to provide either Lactobacillus rhamnosus GG ATCC53103 or the combination of Bifidobacterium infantis Bb‐02, Bifidobacterium lactis Bb‐12, and Streptococcus thermophilus TH‐4 in order to reduce NEC rates.
Lymphoid Enhancer Binding Factor 1 (LEF1) and Paired Box Gene 8 (PAX8): A Limited Immunohistochemistry Panel to Distinguish Solid Pseudopapillary Neoplasms and Pancreatic Neuroendocrine Tumors
Authors: Lu Haiyan , Allende Daniela , Liu Xiuli , Zhang Yaxia
Published: February 2020

Solid pseudopapillary neoplasms (SPNs) and pancreatic neuroendocrine tumors (PanNETs) are distinctive entities. However, due to overlapping morphologies, distinguishing them remains a diagnostic challenge. Our study investigates the utility of immunohistochemistry for nuclear lymphoid enhancer binding factor 1 (LEF1) and paired box gene 8 (PAX8) in differentiating these 2 entities. LEF1 and PAX8 immunohistochemistry were performed on fine-needle aspiration cell blocks and surgical resection specimens diagnosed as SPN or PanNET at our institution from January 2007 to August 2016. Eight SPN and 25 PanNET cell blocks and 17 SPN and 34 PanNET surgical resection specimens were examined. On cell blocks, positive staining for LEF1 had high frequency, sensitivity, and specificity for SPN (88%, 88%, and 88%) as did positive staining for PAX8 for PanNET (76%, 76%, and 75%). The findings on surgical resection specimens were consistent with those from cell blocks (LEF1+ in SPN: 100%, 100%, and 97%; PAX8+ in PanNET: 59%, 59%, and 100%). A combined LEF1+/PAX8− phenotype showed high sensitivity and specificity for SPN (cell block: 63% and 100%; surgical specimen: 100% and 98%) as did a LEF1−/PAX8+ phenotype for PanNET (cell block: 64% and 100%; surgical specimen: 59% and 100%). SPN and PanNET exhibit opposite immunophenotypic profiles with LEF1+/PAX8− in SPN and LEF1−/PAX8+ in PanNET. The combination of these 2 stains provides an effective means of distinguishing these 2 entities.
Quality and Safety in Healthcare, Part LXV
Authors: Harolds Jay A.
Published: February 2020

Matriculating medical students have a low degree of psychological distress. Yet, over time burnout, suicidal ideation, and evidence of depression become quite prevalent among medical students. Often, approximately 50% of the students and sometimes more suffer from burnout. The prevalence of depression in different studies varied but was often approximately 20%. Suicidal ideation in medical students in various articles had a prevalence of approximately 6% to 11%.
Longitudinal 18F-FDG Images in Patients With Alzheimer Disease Over More Than 9 Years From a Preclinical Stage
Authors: Ishibashi Kenji , Onishi Airin , Wagatsuma Kei , Fujiwara Yoshinori , Ishii Kenji
Published: February 2020

Background

Brain 18F-FDG uptake reportedly starts to decline more than 10 years before the onset of cognitive decline in dominantly inherited Alzheimer disease (AD). We compared longitudinal 18F-FDG images in sporadic AD to aging data from a large sample size to expand the current knowledge of 18F-FDG reduction for AD progression.

Methods

Participants comprised 2 individuals (subjects A and B at ages 65 and 68 years, respectively) and 107 control subjects (67.9 [SD, 4.9] years). Subject A underwent 18F-FDG PET a total of 8 times over 9 years from the preclinical to early dementia stages. Subject B underwent 18F-FDG PET a total of 11 times over 12 years from the preclinical to mild cognitive impairment stages. Control subjects underwent 18F-FDG PET twice over a mean follow-up period of 7.8 years. After placing the volume of interest on the AD-related hypometabolic regions, the longitudinal 18F-FDG images were compared among the subjects and control subjects.

Results

For the control group, the rate of 18F-FDG reduction was 2.2% per decade (ie, aging effects). The rates of 18F-FDG reduction were 9.41% over 9 years and 9.07% over 12 years in subjects A and B, respectively. We estimated that 18F-FDG uptake started to decrease 4 and 2 years before indications of memory loss in subjects A and B, respectively.

Conclusions

The present study suggests that the time between the beginning of 18F-FDG reduction and the onset of cognitive decline may be shorter in elderly individuals with AD compared with the recently estimated period in dominantly inherited AD.
Solitary Lip Extranodal Natural Killer/T-Cell Lymphoma on FDG PET/CT
Authors: Zhang Jianhua , Li Shusheng , Fan Yan , Li Qian , Nong Lin
Published: February 2020

A 54-year-old man presented with a history of upper lip pain for 4 weeks. Biopsy of the lip lesion revealed extranodal natural killer/T-cell lymphoma. 18F-FDG PET/CT scan showed the solely high uptake in the right upper lip without any other nodal or extranodal involvements.
Cost Utility Analysis of Staged Versus Single-Stage Cleft Lip and Palate Repair
Authors: Holzmer Stephanie , Davila Armando , Martin Mark C.
Published: February 2020

Purpose

As one of the most common congenital craniofacial deformities, cleft lip and palate repair is a complex and much published topic. Proper treatment can require a multitude of appointments and operations and can place a significant burden on both the patients' families and the health care system itself. One proposed solution has been to combine multiple cleft procedures. However, these more complex operations have drawn concerns from institutions and providers regarding increased cost. This study provides a cost utility analysis between single-stage and staged unilateral cleft lip and palate repairs.

Methods

A retrospective review was conducted via current procedural terminology code identification of all cleft-related operations performed between 2013 and 2018. Patients were screened according to diagnosis, and only analysis on unilateral cleft lip and palate patients was performed. Patients were split into 2 cohorts: those that underwent a single-stage complete cleft repair, which includes palate, lip, alveolus, and nasal repair—termed “PLAN” at our institution, and those that underwent more traditional staged lip and palate repairs. Demographic and billing data were collected for any procedure performed between patient ages 0 and 24 months. χ2, t-tests, and parametric regression analyses were performed to compare the cohorts.

Results

Between 2013 and 2018, 968 (n = 968) cleft-related operations were conducted at Loma Linda University Children's Hospital. Seven hundred ninety-six (n = 796) noncleft lip/palate repairs and 38 (n = 38) bilateral cleft lip repairs were excluded. Of the remaining 135 (n = 135) patients with unilateral cleft lip and palate, detailed cost data were available for 86 single-stage and 28 staged repairs. The average combined total cost for single-stage repairs was US $80,405 compared with US $109,473 for staged repairs (P < 0.001). The average total intraoperative cost for single-stage repairs was US $60,683 versus US $79,739 for staged repairs (P < 0.001), and the average total postoperative cost for single-stage repairs versus staged repairs was US $19,776 and US $29,703, respectively (P < 0.001).

Conclusions

This analysis suggests that single-stage PLAN repair, provides an effective, cost-efficient solution to unilateral cleft lip and palate care, reducing burden on patients' families and the health care system at large.
Is Less Actually More? An Evaluation of Surgical Outcomes Between Endoscopic Suturectomy and Open Cranial Vault Remodeling for Craniosynostosis
Authors: Melin Alyson A. , Moffitt Joseph , Hopkins David C. , Shah Manish N. , Fletcher Stephen A. , Sandberg David I. , Teichgraeber John F. , Greives Matthew R.
Published: February 2020

Background:

Both open cranial vault remodeling (CVR) and endoscopic suturectomy are effective in treating the anatomical deformity of craniosynostosis. While parents are increasingly knowledgeable about these 2 treatment options, information regarding the perioperative outcomes remains qualitative. This makes preoperative counseling regarding surgical choices difficult. The purpose of this study was to evaluate the outcomes in patients with craniosynostosis who underwent traditional CVR versus endoscopic suturectomy.

Methods:

Open and endoscopic craniosynostosis surgeries performed at our institution from January 2014 through December 2018 were retrospectively reviewed and perioperative data, including operative time, estimated blood loss, transfusion rate and length of stay, was analyzed. A student t test was used with significance determined at P < 0.05.

Results:

CVR was performed for 51 children while 33 underwent endoscopic procedures. Endoscopic suturectomy was performed on younger patients (3.8 versus 14.0 months, P < 0.001), had shorter operative time (70 versus 232 minutes, P < 0.001), shorter total anesthesia time (175 versus 352 minutes, P < 0.001), lower estimated blood loss (10 versus 28 ml/kg, P < 0.001), lower percentage transfused (42% versus 98%, P < 0.001), lower transfusion volume (22 versus 48 ml/kg, P < 0.001), and shorter length of stay (1.8 versus 4.1 days, P < 0.001) when compared to open CVR.

Conclusion:

Both open CVR and endoscopic suturectomy are effective in treating deformities due to craniosynostosis. The endoscopic suturectomy had significantly shorter operative and anesthesia time as well as overall and PICU length of stay. CVR was associated with greater intraoperative blood loss and more frequently required higher rates of blood transfusions.
The Postoperative Changes of Nasal Septum and Maxilla After Alveolar Bone Grafts in Patients With Unilateral Alveolar Cleft
Authors: Kim Jeenam , Jun Dongkeun , Lee Myungchul , Shin Donghyeok , Kim Soonheum , Jo Dongin , Kim Cheolkeun , Choi Hyungon
Published: February 2020

Background:

Alveolar clefts give rise to many aesthetic and functional problems among affected patients. Therefore, surgical adjustments of the bony defective anomalies are important. The authors performed secondary bone grafts and analyzed the effects particularly on the nasal septum and maxillary area (midface).

Methods:

The patients who had alveolar bone grafts were retrospectively reviewed with pre/postoperative 3-dimensional computed tomography; the measurements included distances between the anterior nasal spine (ANS) and the vertical midline, angles between the nasal septum and the transverse line, and angles between the floor of the pyriform aperture and the transverse line.

Results:

A total number of 23 patients were finally included in the study. The mean age of the patients was 9.7 ± 1.95 years (range, 7–14 years). The mean distance between the ANS and the vertical midline was 5.3 ± 4.70 mm/4.9 ± 4.15 mm pre/postoperatively, showing the mean paired difference of 0.4 ± 0.89 mm (P < 0.05). The mean angles between the nasal septum and the transverse line and between the floor of the pyriform aperture and the transverse line were 64.5 ± 14.69°/65.9 ± 13.73° and 21.7 ± 8.94°/11.5 ± 7.03° pre/postoperatively, showing the mean paired differences of −1.4 ± 2.78° and 10.1 ± 8.20°, respectively (both P < 0.05).

Conclusion:

The results suggest that secondary alveolar bone grafting has expanded effects on the adjacent midfacial structures.
ALPPS Improves Survival Compared With TSH in Patients Affected of CRLM
Authors: Hasselgren Kristina , Røsok Bård I. , Larsen Peter N. , Sparrelid Ernesto , Lindell Gert , Schultz Nicolai A. , Bjørnbeth Bjorn A. , Isaksson Bengt , Larsson Anna Lindhoff , Rizell Magnus , Björnsson Bergthor , Sandström Per
Published: February 2020

Objective:

To evaluate the oncological outcome for patients with colorectal liver metastases (CRLM) randomized to associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) or 2-stage hepatectomy (TSH).

Background:

TSH with portal vein occlusion is an established method for patients with CRLM and a low volume of the future liver remnant (FLR). ALPPS is a less established method. The oncological outcome of these methods has not been previously compared in a randomized controlled trial.

Methods:

One hundred patients with CRLM and standardized FLR (sFLR) <30% were included and randomized to resection by ALPPS or TSH, with the option of rescue ALPPS in the TSH group, if the criteria for volume increase was not met. The first radiological follow-up was performed approximately 4 weeks postoperatively and then after 4, 8, 12, 18, and 24 months. At all the follow-ups, the remaining/recurrent tumor was noted. After the first follow-up, chemotherapy was administered, if indicated.

Results:

The resection rate, according to the intention-to-treat principle, was 92% (44 patients) for patients randomized to ALPPS compared with 80% (39 patients) for patients randomized to TSH (P = 0.091), including rescue ALPPS. At the first postoperative follow-up, 37 patients randomized to ALPPS were assessed as tumor free in the liver, and also 28 patients randomized to TSH (P = 0.028). The estimated median survival for patients randomized to ALPPS was 46 months compared with 26 months for patients randomized to TSH (P = 0.028).

Conclusions:

ALPPS seems to improve survival in patients with CRLM and sFLR <30% compared with TSH.
Does Sex, Race, and the Size of a Kidney Transplant Candidate’s Social Network Affect the Number of Living Donor Requests? A Multicenter Social Network Analysis of Patients on the Kidney Transplant Waitlist
Authors: Gillespie Avrum , Gardiner Heather M. , Fink Edward L. , Reese Peter P. , Gadegbeku Crystal A. , Obradovic Zoran
Published: February 2020

Background.

A kidney transplant candidate’s social network serves as a pool of potential living donors. Sex and racial differences in network size, network strength, and living donor requests may contribute to disparities in living donor kidney transplantation.

Methods.

In this multicenter cross-sectional study, we performed an egocentric network analysis via a telephone survey of 132 waitlisted candidates (53% female and 69% Black) to identify demographic and network factors associated with requesting living kidney donations.

Results.

Female participants made requests to more network members than male participants: incidence rate ratio (IRR) 1.95, 95% confidence interval (CI) [1.24-3.06], P < 0.01. Black participants tended to make more requests than whites (IRR 1.65, 95% CI [0.99-2.73], P = 0.05). The number of requests increased with the size of the network (IRR 1.09, 95% CI [1.02-1.16], P = 0.01); however, network size did not differ by sex or race. Network members who provided greater instrumental support to the candidates were most likely to receive a request: odds ratio 1.39, 95% CI [1.08-1.78], P = 0.01.

Conclusions.

Transplant candidates’ networks vary in size and in the number of requests made to the members. Previously observed racial and sex disparities in living donor kidney transplantation do not appear to be related to network size or to living donation requests, but rather to the network members themselves. Future living donor interventions should focus on the network members and be tailored to their relationship with the candidate.
Frontotemporal dementias: main syndromes and underlying brain changes
Authors: Piguet Olivier , Kumfor Fiona
Published: February 2020

Purpose of review

Frontotemporal dementia (FTD) is a rare dementia, that accounts for about 15% of all dementia cases. Despite consensus diagnostic criteria, FTD remains difficult to diagnose in life because of its complex and variable clinical phenomenology and heterogeneous disorders. This review provides an update on the current knowledge of the main FTD syndromes -- the behavioural variant, semantic variant, and nonfluent/agrammatic variant-- their brain abnormalities and genetic profiles.

Recent findings

The complexity of the clinical features in FTD has become increasingly apparent, particularly in the domain of behaviour. Such behaviour changes are now also being recognized in the language variants of FTD. Initial interest on emotion processing and social cognition is now complemented by studies on other behavioural disturbance, that spans gambling, antisocial behaviours, repetitive behaviours, and apathy. At a biological level, novel pathological subcategories continue to be identified. From a genetic viewpoint, abnormalities in three genes explain nearly three quarters of familial cases of FTD.

In the absence of effective drug treatments, novel approaches are needed to target some of the most disabling features of FTD, such as language loss or behaviour disturbance. Recent interventions appear promising but will require confirmation.
What are the epileptic encephalopathies?
Authors: Trivisano Marina , Specchio Nicola
Published: February 2020

Purpose of review

To review the evolution of the concept of epileptic encephalopathy during the course of past years and analyze how the current definition might impact on both clinical practice and research.

Recent findings

Developmental delay in children with epilepsy could be the expression of the cause, consequence of intense epileptiform activity (seizures and EEG abnormalities), or because of the combination of both factors. Therefore, the current International League Against Epilepsy classification identified three electroclinical entities that are those of developmental encephalopathy, epileptic encephalopathy, and developmental and epileptic encephalopathy (DEE). Many biological pathways could be involved in the pathogenesis of DEEs. DNA repair, transcriptional regulation, axon myelination, metabolite and ion transport, and peroxisomal function could all be involved in DEE. Also, epilepsy and epileptiform discharges might impact on cognition via several mechanisms, although they are not fully understood.

The correct and early identification of cause in DEE might increase the chances of a targeted treatment regimen. Interfering with neurobiological processes of the disease will be the most successful way in order to improve both the cognitive disturbances and epilepsy that are the key features of DEE.
Why do seizures impair consciousness and how can we reverse this?
Authors: Lambert Isabelle , Bartolomei Fabrice
Published: February 2020

Purpose of review

Consciousness disorders occurring during seizures are a major source of disability in people with epilepsy. The purpose of this review is to show recent developments in the assessment and understanding of consciousness disorders in epilepsy.

Recent findings

The most frequent alterations in consciousness are alterations in the level of awareness. They are linked to disruptions on a large-scale network of fronto-parietal associative systems in different forms of focal seizures or in absences. Different theories account for these alterations.

Although there is no specific treatment for ‘consciousness,’ high expectations are placed on brain stimulation techniques, which need to be better defined in the future in terms of targets and parameters.
Dopamine D2 up-regulation in psychosis patients after antipsychotic drug treatment
Authors: Thompson Ilse A. , de Vries Erik F.J. , Sommer Iris E.C.
Published: February 2020

Purpose of review

Recently, it has been questioned whether the re-emergence of psychotic symptoms following antipsychotic discontinuation or dose reduction is attributable to underlying psychotic vulnerability or to rebound effects of chronic use of antipsychotic medication. It was repeatedly shown that relapse rates are high after discontinuation of maintenance treatment. A potential contributing factor could be the increase in density of postsynaptic dopamine D2 receptors in the striatum and the higher affinity of D2 receptors for dopamine after chronic blockade.

Recent findings

To date, little clinical evidence is available for the mechanisms involved in postsynaptic striatal D2 receptor up-regulation after use of antipsychotic medication, and most knowledge comes from animal studies.

Further research is needed to investigate whether antipsychotic medication causes neuroadaptations leading to a dopamine supersensitive state in humans, how long such hypersensitive states may last and what differences exist between high and low D2 affinity antipsychotic drugs. Further, information is needed on discontinuation schedules that provide optimal protection for relapse during hypersensitive periods.
Trade-off between offspring mass and number: the lightest offspring bear the costs
Authors: Van de Walle Joanie , Zedrosser Andreas , Swenson Jon E. , Pelletier Fanie
Published: February 2020

Life-history theory predicts a trade-off between offspring size and number. However, the role of intra-litter phenotypic variation in shaping this trade-off is often disregarded. We compared the strength of the relationship between litter size and mass from the perspective of the lightest and the heaviest yearling offspring in 110 brown bear litters in Sweden. We showed that the mass of the lightest yearlings decreased with increasing litter size, but that the mass of the heaviest yearling remained stable, regardless of litter size. Consistent with a conservative reproductive strategy, our results suggest that mothers maintained a stable investment in a fraction of the litter, while transferring the costs of larger litter size to the remaining offspring. Ignoring intra-litter phenotypic variation may obscure our ability to detect a trade-off between offspring size and number.
Climate warming and trophic mismatches in terrestrial ecosystems: the green–brown imbalance hypothesis
Authors: Thakur Madhav P.
Published: February 2020

Anthropogenic climate change can give rise to trophic mismatches in food webs owing to differential responses of consumer and resource organisms. However, we know little about the community and ecosystem level consequences of trophic mismatches in food webs. Terrestrial food webs are broadly comprised of two types of food webs: green food webs aboveground and brown food webs belowground between which mass and energy flow mainly via plants. Here, I highlight that the extent of warming-induced trophic mismatches in green and brown food webs differ owing to a greater stasis in brown food webs, which could trigger an imbalance in mass and energy flow between the two food webs. I then discuss the consequences of green–brown imbalance on terrestrial ecosystems and propose research avenues that can help understand the relationships between food webs and ecosystem functions in a warmer world.
Long-term memory for a learned behaviour in a wild bird
Authors: Shaw Rachael C. , Harvey Annette
Published: February 2020

Long-term memory is a crucial adaptation for long-lived species. However, there have been few tests of the long-term retention of learned behaviours in free living, wild animals. Here, we demonstrate that the North Island robin (
Petroica longipes
; hereafter toutouwai) can recall a learned foraging behaviour for close to 2 years, with no intervening reinforcement. Birds that had been trained to peck open lids to retrieve a concealed food reward spontaneously solved a lid opening task between 10 and 22 months since they had last encountered the lid opening apparatus. By contrast, naive individuals could not solve the task. This long-term retention of a learned skill with no reinforcement, spanning over a quarter of the median age for wild toutouwai in our population, suggests that this threatened species may be an ideal candidate for conservation management strategies aimed at teaching individuals about novel threats and resources.