bluuebunny/crossref_metadata_2025 huggingface dataset:
Concordance of Self- and Clinician-Collected Anal Swabs to Detect Human Papillomavirus in a Sample of HIV-Negative Men
Authors: Yared Nicholas F. , Horvath Keith J. , Baker Jason V. , Thyagarajan Bharat , Waterboer Tim , Kulasingam Shalini
Published: April 2019

Objective

The aim of this study was to determine the concordance of self- and clinician-collected anorectal swabs for the detection of human papillomavirus (HPV) DNA in a population of HIV-negative men who have sex with men (MSM).

Methods

This cross-sectional study involved recruitment of HIV-negative MSM in a Midwestern US metropolitan area to collect paired sequential self- and clinician-collected anorectal swabs using illustrated instructions. Swabs were tested for type-specific HPV DNA with a comparison of type-specific HPV categories detected by each method. The sensitivity and specificity of self-collection were calculated assuming clinician collection as the criterion standard. McNemar's test and κ statistics were used to determine percent agreement and concordance of self- and clinician-collected swab results.

Results

Seventy-eight participants had paired anorectal swab samples of adequate quality for analyses. The sensitivity and specificity of self-collected swabs for detection of all high-risk HPV DNA types were 69.8% and 91.4%, respectively. Similar degrees of sensitivity and specificity of self-collection were seen for other groups of high-risk HPV types. Percent agreement and κ statistic for self- and clinician-collected swabs for all high-risk HPV types were 80.8% and 0.53, respectively.

Conclusions

Self-collected anorectal swab samples showed lower sensitivity but moderate to high specificity for detection of high-risk and vaccine-preventable HPV types compared with clinician-collected swab samples. Self-collection instructional details and the thoroughness of clinician collection of samples may have impacted sensitivity and specificity, suggesting a need to optimize and standardize instructions.
Microdeletion of the entire IRF6 gene in a Subsaharian African’s family with Van der Woude syndrome
Authors: Mbuyi-Musanzayi Sébastien , Kasamba Eric I. , Revencu Nicole , Lukusa Prosper T. , Kalenga Prosper M. , Tshilombo François K. , Reychler Hervé , Devriendt Koenraad
Published: April 2019

Microdeletion of the entire interferon regulatory factory 6 (IRF 6) gene is a rare cause of Van der Woude syndrome (VDW) with only few cases reported in medical literature. Its occurrence in multiple affected members of a family is exceptional. The aim of this presentation was to describe a Central African family with typical VDW phenotype carrying anIRF6gene deletion. Here we reported phenotype features of members of a Central African family with VDW syndrome consisting of labioalveolar cleft, depressions of the lower lip with labial fistulae (lip pits), submucosal clefts and cleft palate. Mutation analysis by means of multiplex ligation-dependent probe amplification and chromosomal microarray revealed a 374.070 kb, deletion encompassing the entireIRF6gene in four affected family members. Microdeletion of the entireIRF6gene causes the classical VDW syndrome phenotype.
Zao Ren An Shen capsule for chronic insomnia
Authors: Birling Yoann , Bensoussan Alan , Sarris Jerome , Avard Nicole , Zhu Xiaoshu
Published: April 2019

Background:

Zao Ren An Shen (ZRAS), a Chinese Herbal Medicine product, has been proposed as an alternative to recommended treatments for chronic insomnia. There is a lack of strong evidence supporting this proposition.

Aims:

To assess the efficacy and safety of ZRAS capsule for chronic insomnia compared to placebo.

Methods:

A parallel-group, double-blind, randomized-controlled trial will be performed in Western Sydney University, Australia. After a 1-week placebo run-in, adults with chronic insomnia (n = 90) will be randomized in a 1:1 ratio to receive either ZRAS capsule or placebo for 4 weeks. Insomnia severity (Insomnia Severity Scale score), sleep parameters (measured with the Consensus Sleep Diary and actigraphy), fatigue levels (Fatigue Severity Scale score), psychological status (Depression Anxiety Stress Scale score), quality of life (Assessment of Quality of Life score), and adverse events will be assessed at baseline, mid-treatment, post-treatment and at a 1-month follow-up.

Expected outcomes:

We hypothesize that ZRAS capsule will improve insomnia severity, sleep parameters, fatigue levels, psychological status, and quality of life better than placebo at mid-treatment, post-treatment, and follow-up. We also hypothesize that the number of adverse events provoked by ZRAS capsule will be similar to placebo at these time-points.

Trial registration:

Australia New-Zealand Clinical Trial Registry (Registration number ACTRN12619000140156).
A technology-enabled electronic incident report to document and facilitate management of sport concussion
Authors: Linder Susan M. , Cruickshank Jason , Zimmerman Nicole M. , Figler Richard , Alberts Jay L.
Published: April 2019

Despite the widespread awareness of concussion across all levels of sport, the management of concussion from youth to college is inconsistent and fragmented. A fundamental gap contributing to inconsistent care is the lack of a scalable, systematic approach to document initial injury characteristics following concussion. The purpose of this study was to determine differences in injury profiles and management of youth, high school, and college athletes using a mobile application for incident report documentation.

A cohort study was conducted in which concussion electronic incident report data from 46 high schools and colleges, and Cleveland Clinic ambulatory concussion clinics were gathered and analyzed.

In sum, 1421 (N = 88 youth, N = 1171 high school and N = 162 college) athletes with sport-related concussions were included.

Despite the relative absence of red flags, youth athletes had a greater probability of being sent to the emergency department than high school and collegiate athletes. Over 60% of athletes were removed from play immediately post-injury. Injury recognition was delayed in 25% of athletes due to delayed symptom reporting (20% of males, 16% of females) or delayed symptom onset (5% of males, 9% of females). A significantly greater incidence of red flags was evident in males, and in high school and collegiate athletes compared to youth athletes.

The high frequency of youth athletes sent to the emergency department, despite the absence of red flags, may be a reflection of inadequate medical coverage at youth events, ultimately resulting in unnecessary utilization of emergency medicine services. The relatively high incidence of delayed injury reporting implies that additional educational efforts targeting student-athletes and the utilization of resources to improve injury detection are warranted. The systematic collection of injury-related demographics through the electronic mobile application facilitated interdisciplinary communication and improved the efficiency of managing athletes with concussion.
Risk of Parkinson disease in Sjögren syndrome administered ineffective immunosuppressant therapies
Authors: Ju Uei-Han , Liu Feng-Cheng , Lin Chin-Sheng , Huang Wen-Yen , Lin Te-Yu , Shen Chih-Hao , Chou Yu-Ching , Lin Cheng-Li , Lin Kuen-Tze , Kao Chia-Hung , Chen Chao-Hsien , Yang Tse-Yen
Published: April 2019

To determine the incidence and risk of Parkinson disease (PD) in patients with Sjögren syndrome (SS) according to a nationwide population-based database.

In total, 12,640 patients in the SS cohort and 50,560 in the non-SS cohort were enrolled from Taiwan's National Health Insurance Research Database from 2000 to 2010. We used the Cox multivariable proportional hazards model to determine the risk factors for PD in the SS cohort.

We observed an increased incidence of PD in patients with SS, with a crude hazard ratio (HR) of 1.40 and an adjusted HR (aHR) of 1.23. The cumulative incidence of PD was 1.95% higher in the SS cohort than in the non-SS cohort. The SS cohort had an elevated HR under medication use, namely cevimeline and pilocarpine (crude HR, 1.28), hydroxychloroquine (crude HR, 1.43; aHR, 1.46), and methylprednisolone (crude HR, 2.21; aHR, 1.49). Patients receiving other non-hydroxychloroquine immunosuppressant therapies had a lower risk (aHR, 0.86) of PD. Furthermore, patients with SS aged 20 to 49 years had a 1.93-fold higher risk of PD than did those without SS (aHR, 1.93). The risk of PD was higher (aHR, 2.20) in patients with SS without comorbidities than in those with comorbidities. The aHR of PD significantly increased when the follow-up period exceeded 9 years (aHR, 1.93).

We determined an increased risk of PD in patients with SS. Further investigation is warranted to determine the possible underlying mechanisms and the potential role of non-hydroxychloroquine immunosuppressants in ameliorating PD.
Weekly cisplatin for the treatment of patients with ovarian cancer
Authors: Zhang Dan-feng , Dou Peng-hui , Zhao Dong-xu , Li Jing , Hu Yu-hong
Published: April 2019

Background:

Ovarian cancer (OC) is one of the most leading causes of deaths in the Chinese women. The objective of this protocol is to perform a full-scale systematic review on the efficacy of weekly cisplatin (WC) for the treatment of patients with OC.

Methods:

Data sources will comprise of PubMed, PsycINFO, Scopus, Opengrey, Cochrane Central Register of Controlled Trials, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Allied and Complementary Medicine Database, and Chinese Biomedical Literature Database. All relevant randomized controlled trials from searched databases will be identified from their inception to the present. A defined search strategy will be implemented along with eligibility criteria. Relevant data will be extracted according to the predefined data collection form. Methodologic quality will be assessed by using Cochrane risk of bias tool; and data pooled and meta-analysis will be conducted by using fixed-effects, or random-effects model with RevMan 5.3 software.

Results:

This proposed systematic review will evaluate the efficacy of WC for patients with OC.

Conclusion:

The findings of this study may summarize the latest evidence for the WC on OC.

Ethics and dissemination:

Ethical approval is not required for this study, because it will be based on published studies, and existing sources of literature. The results of this study will be disseminated through peer-reviewed journal.

PROSPERO registration number:

PROSPERO CRD42018120938.
99mTc-SC lymphoscintigraphy and SPECT/CT findings in a case report of Gorham–Stout disease presenting with chylothorax and bone pain
Authors: Jiang Yuanyuan , Hou Guozhu , Cheng Wuying
Published: April 2019

Rationale:

Gorham–Stout disease (GSD) is a rare disorder characterized by multiple osteolytic lesions, sometimes complicated by chylothorax. The aim of this case report is to introduce a very rare case of Gorham–Stout syndrome, which involved several bones along with chylous pericardial and pleural effusions detected by 99mTc-sulfur colloid (SC) lymphoscintigraphy and single photon emission computed tomography/computed tomography (SPECT/CT).

Patient concerns:

A 15-year-old girl presented to our hospital complaining of shortness of breath and bone pain.

Diagnosis:

The CT showed multiple osteolytic lesions, left-sided pleural effusion, and pericardial effusion. 99mTc-SC lymphoscintigraphy showed discontinuation of thoracic duct and tracer accumulation on the left side chest. SPECT/CT revealed increased radioactivity uptake in pleural, pericardial effusions, and some thoracolumbar spines. Diagnostic thoracentesis to identify the nature of pleural effusion and histopathology of biopsy in the right femoral to that of the bone lesion were performed. Based on the clinical information, histopathologic, and radiographic findings, the diagnosis of GSD was made.

Interventions:

The patient received thoracic duct ligation and bisphosphonates treatment.

Outcomes:

After receiving thoracic duct ligation and bisphosphonates treatment, the patient's symptoms of bone pain and dyspnea were relieved, and the pericardial and pleural fluid was diminished dramatically. At the 3-month and 9-month follow-up visit, the patient had nearly complete remission without any complication.

Lessons:

The 99mTc-SC lymphoscintigraphy and SPECT/CT could provide significant value assessing the lymphatic abnormity and evaluating the extent of disease, therefore aiding to guide decision making in the clinic.
Prognostic significance of tumor length in patients with esophageal cancer undergoing radical resection
Authors: Yang Jianbao , Liu Yahong , Li Bin , Jiang Peng , Wang Cheng
Published: April 2019

Background:

The prognostic significance of tumor length in esophageal cancer (EC) remains controversial. Hence, we conducted a meta-analysis to quantitatively assess the prognostic significance of tumor length in EC patients.

Method:

A systematic literature search was conducted in the PubMed, EMBASE, and Web of Science. Hazard ratios (HRs) with their 95% confidence intervals (CIs) were used to assess the prognostic significance of tumor length for overall survival (OS), and disease-free survival (DFS) in EC patients.

Results:

A total of 21 articles with 22 eligible studies involving 9271 patients were included in this meta-analysis. The results of our pooling analyses demonstrated that tumor length was an independent prognostic parameter for OS (HR = 1.38, 95% CI: 1.24–1.54, P < .01) and DFS (HR = 1.29, 95% CI: 1.11–1.50, P < .01) in EC patients. Moreover, our subgroup analysis and sensitivity analysis showed that the pooled HRs assessing the prognostic significance of tumor length did not significantly fluctuated, suggesting our pooling analyses were stable and reliable.

Conclusion:

The results of this meta-analysis demonstrated that long tumor is an independent risk of poor OS and DFS in EC patients, suggesting that it may provide additional prognostic information and thus contribute to a better stratification of EC patients, especially for those with no lymph node metastasis. However, more well-designed prospective clinical studies with large sample size are needed to strength our conclusion due to several limitations in this meta-analysis.
Impact of antimalarial (AM) on serum lipids in systemic lupus erythematosus (SLE) patients
Authors: Tao Chen-Yang , Shang Jin , Chen Tao , Yu Dahai , Jiang Yu-Min , Liu Dong , Cheng Gen-Yang , Xiao Jing , Zhao Zhan-Zheng
Published: April 2019

Background:

Dyslipidemia is a common disorder in systemic lupus erythematosus (SLE) patients. It is still inconclusive whether antimalarial drugs could affect the serum lipids in SLE patients, therefore we conducted a systematic review and meta-analysis of available data to address this issue.

Methods:

We comprehensively searched the databases of PubMed, EMBASE and Cochrane Library from date of inception to Sep 2018 for both randomized controlled trials (RCTs) and observational studies. Review Manager 5.3 software was used for analysis. We performed meta-analysis using random-effects model and weighted the mean difference (WMD) and its 95% confidence interval (CI). The Q test was used to assess the presence of heterogeneity and the I

2
index was used to quantify the extent of heterogeneity.

Results:

In total, 8 studies met our selection criteria including 2 RCTs, 2 cohort studies, and 4 case-control studies. There were 717 patients (336 patients in CQ (chloroquine) or HCQ (hydroxychloroquine) group, and 381 patients in control group (SLE patients without the therapy of AM)). Compared with the control group, TC, TG, LDL-C, VLDL-C were associated with a significant decrease, respectively (WMD = −21.40 mg/dL, 95% CI −27.62 to −15.18, P < .00001), (WMD = −29.07 mg/dL, 95% CI −45.28 to −12.86, P = .0004), (WMD = −16.25 mg/dL, 95% CI −28.82 to −3.68, P = .01), (WMD = −6.41 mg/dL, 95% CI −12.39 to 0.44, P = .04), however the change of HDL-C did not reach statistically significance (WMD = 4.42 mg/dL, 95% CI −1.21 to 10.06, P = .12).

Conclusions:

CQ or HCQ can infect the serum lipids in SLE patients. However, these results should be interpreted with cautions since lacking sufficient RCTs.
Primary pulmonary hepatoid adenocarcinoma
Authors: Yang Kun , Jiang Huifeng , Li Qiuyao
Published: April 2019

Rationale:

Hepatoid adenocarcinoma of lung (HAL) is a rare malignant tumor, which can be defined as a primary alpha-fetoprotein (AFP)-producing lung carcinoma. The majority of hepatoid adenocarcinoma (HAC) expressed AFP in tumor cells, but AFP expression is not required for its diagnosis according to the modified diagnostic criteria. Despite that HAC exhibits a poor prognosis and ineffective treatment options, early diagnosis and aggressive treatment can result in long-term survival.

Patient concerns:

We report a 70-year-old Chinese male patient with alcoholic intake over 30 years and smoking history of 60 cigarettes per day for 40 years. He sought medical consultation for productive cough and hemoptysis sputum.

Diagnoses and interventions:

Chest CT scan revealed a mass (6.4 × 5.5 cm) in the left lower lobe of the lung. The patient underwent curative surgical resection, and subsequently diagnosed as HAL.

Outcomes:

Eighteen months after primary diagnosis, the patient died of multiple organ failure caused by distant metastases.

Lessons:

Familiarizing with the clinical features and modified diagnostic criteria of this rare tumor may increase awareness of the disease among clinicians and pathologists, thereby avoiding misdiagnosis and mistreatment.
Long-term compliance of vaginal pessaries
Authors: Hsieh Ming-Fang , Tsai Hsiao-Wen , Liou Wen-Shiung , Lo Ching-Chuan , Lin Zi-Han , An Ya-Fen , Lin Hsin-Yin
Published: April 2019

Vaginal pessary treatment for pelvic organ prolapse (POP) is relatively safe and cost-effective. Since long-term use is an important key to keep the benefit of pessary treatment, we would like to investigate the factors which might affect the compliance of vaginal pessaries. In this retrospective study, 65 women were included, and we found poor compliance in women with severe stress urinary incontinence (SUI) after reduction (1-hour pad test >10 gm vs ≦10 gm, 57.1% vs. 84.3%, P = .027). Besides, women younger than 60 years-old also had poor compliance (age ≦60-year-old vs >60-year-old, 58.3% vs 83.0%, P = .04). Other factors such as POP stage, history of hysterectomy, and types of pessaries, did not show significant influence on the long-term compliance in this study. Therefore, to evaluate the severity of SUI after reduction before providing pessary treatment is important to predict long-term compliance. Meanwhile, long-term pessary treatment seems to be more acceptable to elderly patients.
Reproducibility of normalized apparent diffusion coefficient measurements on 3.0-T diffusion-weighted imaging of normal pancreas in a healthy population
Authors: Ding Xun , Xu Haibo , Zhou Jun , Xu Jia , Mei Hao , Long Qingyun , Wang Yaxun
Published: April 2019

To prospectively compare the reproducibility of normal pancreas-normalized apparent diffusion coefficient (ADC) measurements for the normal pancreas and mean normalized ADCs at different pancreas anatomic locations.

In total, 22 healthy volunteers underwent pancreatic 3.0-T magnetic resonance (MR) imaging, including axial diffusion-weighted (DW) imaging with 3 b values used (0, 400, and 800 s/mm2) and with the respiratory-triggered (RT) technique. The mean ADCs from 3 regions of interest (ROIs) in 5 anatomic locations (head [H], body [B], and tail [T] of pancreas and spleen [S] and erector spinae muscles [M]) were calculated. The pancreas-normalized ADC was defined as the ratio of the ADC for the pancreas to the ADC for the spleen or erector spinae muscle. Reproducibility of ADCs and normalized ADCs was assessed by the Bland–Altman method. The ADC and normalized ADC data were analyzed by repeated-measures ANOVA.

Mean ADC and normalized ADC values did not differ (P >.05) with repeated measurements at the different pancreas anatomic locations. Reproducibility of pancreas-normalized ADC measurements in each of the 3 pancreatic anatomic locations was better with the erector spinae muscle rather than the spleen used as a reference. Mean ADC and normalized ADC values significantly differed between the 3 pancreatic segments (H: 1.36 × 10−3 mm2/s, B: 1.38 × 10−3 mm2/s, T: 1.25 × 10−3 mm2/s, P = .022; H/S: 1.75, B/S: 1.78, T/S: 1.59, P = .009; H/M: 0.91, B/M: 0.95, T/M: 0.85, P = .008). Mean ADC values and normalized ADC values showed a trend to decrease from the pancreatic head to tail.

Our preliminary results suggest that normalized ADC measurements for the pancreas show good intra- and interobserver reproducibility, the erector spinae muscle is a better choice than the spleen for calculating normalized ADC values for the pancreas, and the normalized ADC values are lower for the pancreatic tail than other pancreatic segments.
A novel method of Uniblocker placement: extraluminal technique supported by trachea length measurement
Authors: Liu Zhuo , Zhao Li , He Wensheng , Zhu Yan , Bao Lina , Jia Qianqian , Yang Xiaochun , Liang Shujuan
Published: April 2019

Background:

The use of bronchial blockers has been increased for one-lung ventilation; however, the placement of bronchial blockers is time consuming. The objective of this study was to compare the novel extraluminal technique of Uniblocker placement supported by trachea length measurement on computerized tomography images with conventional intraluminal Uniblocker placement method.

Methods:

Seventy adult patients undergoing left side thoracic surgery were included in the study. All the patients were randomly assigned to one of two groups: conventional intraluminal intubation group (CV-IN group, n = 35) or extraluminal CT guided group (CT-EX group, n = 35). The primary endpoints were the optimal positions of Uniblocker and the injuries of bronchi and carina. The secondary outcomes included the time of Uniblocker placement, the adequacy of lung collapse, the incidences of Uniblocker displacement, sore throat, and hoarseness postoperative.

Results:

In the CV-IN group, 19 of 35 Uniblockers went to the left main-stem bronchus on the initial blind insertion and 15 of 35 Uniblockers were considered as in optimal depth, whereas in the CT-EX group, 32 of 35 Uniblockers went to the left main-stem bronchus on the initial blind insertion and 31 of 35 Uniblockers were considered as in optimal depth (P < .01). The incidence of bronchi and carina injuries was obviously lower in the CT-EX group (occurred in 1 of 35 cases) than that in the CV-IN group (occurred in 8 of 35 cases) (P < .05). The time of Uniblocker placement took 145.4 s in the CV-IN group and 85.4 s in the CT-EX group (P < .01). The malpositions of Uniblocker, the degree of pulmonary collapse and the adverse events postoperative such as sore throat and hoarseness were not significantly different between the two groups (P > .05).

Conclusion:

The novel extraluminal technique of Uniblocker placement supported by trachea length measurement on computerized tomography images was proved to be more rapid, more accurate and less complications than conventional intraluminal Uniblocker placement method.
Effectiveness of extracorporeal shock wave monotherapy for avascular necrosis of femoral head
Authors: Tang Hua-Yu , Zhao Yu , Li Yu-Zhi , Wang Tian-Shu
Published: April 2019

Background:

Previous clinical studies have reported that extracorporeal shock wave (EPSW) monotherapy can effectively treat avascular necrosis of femoral head (ANFH). However, no systematic review has been conducted to assess its effectiveness and safety for patients with ANFH. Therefore, this study will systematically assess the effectiveness and safety of EPSW monotherapy for patients with ANFH.

Methods:

In this study, the following electronic databases will be searched from their inceptions to the present: Cochrane Library, EMBASE, PUBMED, Cumulative Index to Nursing and Allied Health Literature, China National Knowledge Infrastructure, and Chinese Biomedical Literature Database. This study will include randomized controlled trials for assessing the effectiveness and safety of EPSW monotherapy for patients with ANFH. Two independent authors will perform study selection, data extraction, and methodology assessment. RevMan 5.3 software will be used for statistical analysis.

Results:

This systematic review will provide latest summary evidence of EPSW monotherapy for patients with ANFH through assessing the outcome measurements. The primary outcome is pain intensity, which can be measured by visual analog scale or relevant measurement tools. The secondary outcomes are functional status of attacked femoral head, as assessed by Western Ontario and McMaster Universities Osteoarthritis Index, or other relevant scales; quality of life, as evaluated by The 36-Item Short Form Health Survey, or related instruments; and adverse events.

Conclusion:

The results of this study may provide the latest evidence for assessing the effectiveness and safety of EPSW for the treatment of ANFH.

Dissemination and ethics:

This study does not require ethical approval, because no individual data will be involved in this systematic review. The findings of this study will be published through a peer-reviewed journal.

Systematic review registration:

PROSPERO CRD42019124665.
Validity of routine reimaging of blunt renal trauma managed conservatively
Authors: Tomasz Ząbkowski , Piotr Piasecki , Ryszard Skiba , Marek Saracyn
Published: April 2019

The purpose of this study was to determine the need of repeat follow-up computed tomography imaging in patients with renal trauma.

All patients who were admitted in the trauma center of the Military Institute of Medicine with a diagnosis of kidney injury from January 2008 to December 2017 were identified. A retrospective review of all patients’ medical records and radiologic imaging was conducted.

Data on the following factors were collected – patients’ demographics, mechanism of trauma, American Association for the Surgery of Trauma renal injury scale, injury severity score, laboratory examinations, multiorgan injuries, transfusion of fresh frozen plasma and packed red blood cells, time of surgical procedure in multiorgan injuries, length of hospital stay, and acute kidney injury.

This group consisted of 37 patients with left renal injuries, 32 with right renal injuries, and 5 with bilateral renal injuries. Renal trauma due to blunt injury secondary to a motor vehicle accident was noted in 45 patients, falling from a height in 14 patients, injury from battery in 4 patients, sports-related activities in 1 patient, and other factors in 10 patients.

Of the 63 patients treated conservatively due to multiorgan trauma or isolated trauma, values of morphology, serum creatinine and blood urea nitrogen, and ultrasonography in all patients did not reveal any pathological changes within earlier kidney damage.

The conservative treatment of grade I-IV renal injury in the American Association for the Surgery of Trauma scale provided good outcome and only involved noninvasive ultrasonography.

This study confirms that routine follow-up computed tomography imaging can be safely omitted in renal injuries graded I-IV providing that the patient remains in good clinical state.
Sildenafil for Pulmonary Arterial Hypertension
Authors: Bhogal Sukhdeep , Khraisha Ola , Al Madani Mohammad , Treece Jennifer , Baumrucker Steven J. , Paul Timir K.
Published: April 2019

Pulmonary hypertension is a life-threatening illness with debilitating physical and emotional consequences. The progression of this devastating disease is characterized by a continuous increase in pulmonary vascular resistance, which results in elevated pulmonary artery pressure and leads to right heart failure. Treatment is focused on targeting the underlying complex etiology via the endothelin, prostacyclin, and nitric oxide (NO) pathways. Emergence of new treatments over the past 2 decades has led to improvement in the functional status and time to clinical worsening. Even with recent advances, outcomes remain suboptimal. Phosphodiesterase-5 (PDE-5) inhibitors, such as sildenafil, were approved for treatment of pulmonary arterial hypertension (PAH) by the Food and Drug Administration (FDA) in 2005, which holds promise in improving quality of life and therefore making this class of medications effective palliative therapy agents. In this review, we summarize the emergence of sildenafil as a treatment for PAH and its role as palliative therapy.
Crossing low-level donor-specific antibodies in heart transplantation
Authors: Olymbios Michael , Kobashigawa Jon A.
Published: April 2019

Purpose of review

Donor-specific antibodies (DSA) detected by solid-phase single-antigen bead (SAB) immunoassays have been associated with antibody-mediated rejection (AMR), cardiac allograft vasculopathy (CAV) and decreased survival after heart transplantation. The clinical relevance of low-level DSA is equivocal. This review examines the techniques used to define low-level DSA, the limitations of these techniques and recent clinical experience crossing low-level DSA.

Recent findings

Solid-phase multiplex bead immunoassays were introduced to solid-organ transplantation over 15 years ago. These technologies have a much greater sensitivity and specificity than older cell-based immunoassays. It was hoped that this increased resolution would lead to better outcomes by avoiding donors with antigens that transplant candidates produced antibodies against. Although some transplant patients with DSA show increased risk of AMR and decreased survival, a subset of patients with DSA at the time of transplant have outcomes comparable with patients with no DSA. Recent studies have demonstrated that DSA delineated according to titration studies and C1q assays better define low-level DSA that are well tolerated to cross. Early experience with crossing low-level DSA shows promise in kidney and heart transplantation.

Preliminary findings from heart and kidney transplant patients show acceptable outcomes after crossing low-level DSA. The policy of crossing low-level DSA increases the donor pool for sensitized heart transplant candidates.
Does the Canadian allocation system for highly sensitized patients work?
Authors: Aleksova Natasha , Ross Heather J.
Published: April 2019

Purpose of review

The number of sensitized heart transplant candidates is rising. Highly sensitized patients are disadvantaged because they encounter longer waiting times to heart transplant. Strategies to reduce their waiting times include waitlist prioritization and desensitization therapies. The purpose of this review is to describe the listing category for highly sensitized patients in the Canadian allocation system, examine the advantages and limitations of this strategy and provide an approach to the management of the highly sensitized patient awaiting heart transplant.

Recent findings

Analysis of data from the United Network of Organ Sharing shows that the incidence of death or removal from the waitlist in patients listed for heart transplant increases as the calculated panel reactive antibody (cPRA) increases and is independent of medical urgency. In the Canadian allocation system, patients with cPRA more than 80% have a similar incidence of death on the waitlist as less sensitized patients, suggesting they survive to be transplanted. Furthermore, prioritizing and transplanting highly sensitized patients has been associated with acceptable post-transplant outcomes.

The Canadian allocation system prioritizes highly sensitized patients to increase equity and access to transplantation while maintaining good post-transplant outcomes. Not all highly sensitized patients can wait for an organ, even if prioritized. A pragmatic individualized approach would consider the medical stability of the patient, the likelihood of transplant with a negative crossmatch and then determine whether waitlist prioritization or desensitization is the more appropriate strategy.
Intraoperative Peritoneal Washing Cytology on Survival in Pancreatic Ductal Adenocarcinoma With Resectable, Locally Advanced, and Metastatic Disease
Authors: Yin Zi , Ma Tingting , Chen Sheng
Published: April 2019

Objectives

The prognostic implications of intraoperative peritoneal washing cytology (IPWC) in patients with pancreatic ductal adenocarcinoma (PDAC) remains incompletely understood.

Methods

A meta-analysis was conducted to investigate the impact of IPWC status on the clinicopathologic features and survival outcomes in potentially resectable, locally advanced, and metastatic PDAC. Hazard ratio (HR) and 95% confidence interval (CI) were used as the pooled estimates.

Results

A total of 12 studies qualified for inclusion with 3751 PDAC patients. In resectable PDAC, the postoperative 5-year overall survival was significantly better in negative IPWC than in positive IPWC patients, with a pooled HR of 2.47 (95% CI, 1.90–3.21; P < 0.001; I
2 = 69%) in a random-effects model. Likely, combined outcome showed a significantly longer survival benefit in the negative IPWC group (HR, 2.80; 95% CI, 1.94–4.04; P < 0.001) in terms of recurrence-free survival. The presence of positive IPWC did not significantly alter survival outcomes in those PDAC patients with locally advanced or metastatic disease.

Conclusions

This systematic review and meta-analysis demonstrated that a positive IPWC status in patients with clinically resectable PDAC predicts a poor prognosis. Patients with positive IPWC should be regarded as a specific subgroup, with intensive adjuvant chemotherapy that seems to be warranted for further evaluation.
Impact of Antimicrobial Prophylaxis for Severe Acute Pancreatitis on the Development of Invasive Candidiasis
Authors: Horibe Masayasu , Sanui Masamitsu , Sasaki Mitsuhito , Honda Hitoshi , Ogura Yuki , Namiki Shin , Sawano Hirotaka , Goto Takashi , Ikeura Tsukasa , Takeda Tsuyoshi , Oda Takuya , Yasuda Hideto , Miyazaki Dai , Hirose Kaoru , Kitamura Katsuya , Chiba Nobutaka , Ozaki Tetsu , Yamashita Takahiro , Koinuma Toshitaka , Oshima Taku , Yamamoto Tomonori , Hirota Morihisa , Yamamoto Satoshi , Oe Kyoji , Ito Tetsuya , Masuda Yukiko , Saito Nobuyuki , Iwasaki Eisuke , Kanai Takanori , Mayumi Toshihiko
Published: April 2019

Objective

Antimicrobial prophylaxis is not generally recommended for patients with severe acute pancreatitis (SAP) owing to the limited clinical benefits. Nonetheless, it is frequently administered in actual practice given the patients' critical condition and the lack of solid evidence showing adverse effects of antimicrobial prophylaxis. We evaluated herein an association between antimicrobial prophylaxis and invasive pancreatic candidiasis as an adverse effect in patients with SAP.

Methods

This is a retrospective cohort study of all consecutive patients with SAP who were admitted to the study institutions (n = 44) between January 1, 2009, and December 31, 2013. We performed multivariable logistic regression analysis adjusting for the extent of pancreatic necrosis and surgical interventions for invasive pancreatic candidiasis.

Results

Of the 1097 patients with SAP, 850 (77.5%) received antimicrobial prophylaxis, and 21 (1.9%) had invasive pancreatic candidiasis. In multivariable logistic regression analysis, antimicrobial prophylaxis was significantly associated with the development of invasive pancreatic candidiasis (adjusted odds ratio, 4.23; 95% confidence interval, 1.14–27.6) (P = 0.029).

Conclusions

The results suggest that antimicrobial prophylaxis may contribute to the development of invasive pancreatic candidiasis, and therefore, the routine use of antimicrobial prophylaxis for SAP may be discouraged.
Trends and Outcomes of Hospitalizations Related to Acute Pancreatitis
Authors: Gapp Jonathan , Hall Alexander G. , Walters Ryan W. , Jahann Darius , Kassim Thamer , Reddymasu Savio
Published: April 2019

Objectives

The aim of this study was to determine the recent trends of the rates of hospitalization, mortality of hospitalized patients, and associated health care utilization in patients with acute pancreatitis (AP).

Methods

We identified adult patients with primary discharge diagnosis of AP from the National Inpatient Sample database. Patients with chronic pancreatitis and/or pancreatic cancer were excluded. Primary outcomes included age-adjusted incidence of AP and in-hospital mortality based on US standard population derived from the 2000 census data. Secondary outcomes were length of stay, inflation-adjusted hospital costs in 2014 US dollars, and procedural rates. Subgroup analysis included disease etiologies, age, race, sex, hospital region, hospital size, and institution type.

Results

From 2001 to 2014, the rate of primary discharge diagnosis for AP increased from 65.38 to 81.88 per 100,000 US adults per year. In-hospital case fatality decreased from 1.68% to 0.69%. Mortality rate is higher in patients with AP who are older than 65 years (3.4%). Length of stay decreased, with a median of 3.8 days; cost per hospitalization decreased since 2007 from $7602 to $6766 in 2014.

Conclusions

The rate of hospitalization related to AP in the United States continues to increase. Mortality, length of stay, and cost per hospitalization decrease. The increase in volume of hospitalization might contribute to an overall increase in health care resource utilization.
Ocoxin Oral Solution Exerts an Antitumoral Effect in Pancreatic Cancer and Reduces the Stromal-Mediated Chemoresistance
Authors: Hernandez-Unzueta Iera , Benedicto Aitor , Romayor Irene , Herrero Alba , Sanz Eduardo , Arteta Beatriz , Olaso Elvira , Márquez Joana
Published: April 2019

Objectives

Pancreatic carcinoma is one of the most aggressive cancers overcoming chemoresistance. Thus, novel compounds to complement the current antitumor agents are in need. Ocoxin oral solution (OOS) has proven antioxidant, anti-inflammatory, and antistromagenic properties. The aim of this study was to analyze the effect of OOS in an experimental pancreatic cancer model and its implication in stroma-related chemoresistance to paclitaxel and gemcitabine.

Methods

Murine pancreatic carcinoma 266-6 cells were treated with OOS to analyze cell cycle and to perform a mRNA comparative microarray study. Then the viability was assessed in combination with paclitaxel and/or gemcitabine. Chemoresistance induced by the medium taken from fibroblast cultures was also investigated on 6 human pancreatic carcinoma cell lines. Furthermore, an experimental model of pancreatic cancer was carried out to study the effect of OOS in vivo.

Results

Ocoxin oral solution enhances the cytotoxic effect of paclitaxel and gemcitabine, while it ameliorates the chemoresistance induced by fibroblast-derived soluble factors in human pancreatic cancer cells. The OOS also promotes the regulation of the expression of genes that are altered in pancreatic carcinoma and slows down 266-6 cell pancreatic tumor development in vivo.

Conclusions

Ocoxin oral solution could be a potential complement to the chemotherapeutic drugs for pancreatic adenocarcinoma.
Establishing the Clinical Nurse Specialist Identity by Transforming Structures, Processes, and Outcomes
Authors: Sanchez Kimberly , Winnie Kathrine , de Haas-Rowland Natalie
Published: April 2019

Purpose:

The purpose of this project was to delineate the clinical nurse specialist (CNS) from other nursing roles within this academic medical center with the goal of (1) aligning role responsibilities with core competencies, (2) categorizing role-specific activities using a productivity spreadsheet, and (3) disseminating role-sensitive outcomes.

Description of Project:

The Donabedian model was used to evaluate the recently added CNS position and ensure the position aligned with professionally established role responsibilities and practice expectations. Using CNS competencies and standards of practice, the job description was restructured. A process for tracking productivity was developed, and outcomes reporting method was selected.

Outcome:

Changes to the job description resulted in 88% of the job description being reflective of CNS competencies and standards of practice. With this new process, collective role-specific work increased from 36% to 95%. Outcomes were identified from 4 frequently performed role-specific activities.

Conclusion:

The CNS role was successfully established and differentiated from other nursing roles by redesigning the job description, documenting role-specific activities, and capturing role-sensitive outcomes. Success was captured and disseminated using a year-end report, resulting in a positive response from hospital leadership and a recognized need for current and additional CNSs.
Management of Endometriomas
Authors: Rehmer Jenna M. , Flyckt Rebecca L. , Goodman Linnea R. , Falcone Tommaso
Published: April 2019

Importance

Endometriomas are a unique and complex representation of the classic phenotypes of endometriosis. Associated symptoms, high recurrence rate, and multimodal approach represent ongoing challenges in the management of this chronic disease.

Objective

To review current literature regarding medical and surgical management of endometriomas.

Evidence Acquisition

An extensive literature search including PubMed and Cochrane Library was performed. Review was performed using the following key words: “endometrioma,” “cystectomy,” “chronic pain,” “infertility,” “IVF,” “menopause,” “recurrence.” All pertinent articles were assessed. The references of those articles were then reviewed, and additional publications were evaluated. Eligibility of the studies was first assessed on titles and abstracts. Full articles were then reviewed for all selected studies, and decision for final inclusion was made at that time.

Conclusions and Relevance

Cystectomy of ovarian endometriomas has been the first-line treatment for management for many years because it provides improved pain relief, reduces recurrence rates, and was thought to be favorable in in vitro fertilization. However, a growing body of evidence is demonstrating benefit, or at least no harm, in expectant management for asymptomatic patients with small, stable endometriomas. Medical management is often very effective and appropriate first line. When surgical intervention is appropriate, careful ovarian cyst excision with goal of ovarian tissue preservation and treatment of additional endometriosis by a trained surgeon can provide the patient the best long-term outcome and preservation of ovarian tissue and function.

Target Audience

Physicians from family medicine, obstetrics and gynecology, and reproductive endocrinology and infertility.

Learning Objectives

Following completion of this CME activity, physicians should be better able to accurately diagnose endometriomas; select appropriate medical management; determine when surgical intervention is warranted; and identify the importance of ovarian tissue–conserving surgical techniques.
Neurokinin 3 Receptor Antagonism Rapidly Improves Vasomotor Symptoms With Sustained Duration of Action
Authors: Prague Julia K. , Roberts Rachel E. , Comninos Alexander N. , Clarke Sophie , Jayasena Channa N. , Mohideen Pharis , Lin Vivian H. , Stern Theresa P. , Panay Nicholas , Hunter Myra S. , Webber Lorraine C. , Dhillo Waljit S.
Published: April 2019

(Abstracted from Menopause 2018;25(8):862–869)

Approximately 70% of postmenopausal women experience vasomotor symptoms, and 10% describe these symptoms as intolerable. Conventional treatment of hot flashes (HFs) includes hormone therapy and other alternative treatments; however, these treatments have mixed responses, variable availability, and can be contraindicated in some women such as those with a history of breast cancer.
Awareness of Fetal Movements and Care Package to Reduce Fetal Mortality (AFFIRM): A Stepped Wedge, Cluster-Randomised Trial
Authors: Norman Jane E. , Heazell Alexander E. P. , Rodriguez Aryelly , Weir Christopher J. , Stock Sarah J. E. , Calderwood Catherine J. , Burley Sarah Cunningham , Frøen J. Frederik , Geary Michael , Breathnach Fionnuala , Hunter Alyson , McAuliffe Fionnuala M. , Higgins Mary F. , Murdoch Edile , Ross-Davie Mary , Scott Janet , Whyte Sonia
Published: April 2019

(Abstracted from Lancet 2018;392:1629–1638)

Two to 6 million pregnancies were estimated to have ended in stillbirth in 2015. The aim of the AFFIRM study was to test the hypothesis that introduction of a reduced fetal movement care package for pregnant women and clinicians that increased women's awareness of the need for prompt reporting of RFM and that standardized management, including timely delivery, would alter the incidence of stillbirth.
Association of Race/Ethnicity With Very Preterm Neonatal Morbidities
Authors: Janevic Teresa , Zeitlin Jennifer , Auger Nathalie , Egorova Natalia N. , Hebert Paul , Balbierz Amy , Howell Elizabeth A.
Published: April 2019

(Abstracted from JAMA Pediatr 2018;172(11):1061–1069)

Racial/ethnic disparity in neonatal mortality associated with the increased risk of very preterm birth among black infants is well documented. However, racial/ethnic disparities in severe neonatal morbidities among very preterm infants are less studied, despite the association of these morbidities with long-term health disparities.
Motion in Magnetic Resonance
Authors: Runge Val M. , Richter Johannes K. , Heverhagen Johannes T.
Published: April 2019

Recent innovations in magnetic resonance, involving both hardware and software, that effectively deal with motion—whether inadvertent on the part of the patient or due to respiration and cardiac contraction—are reviewed, emphasizing major current advances. New technology involving motion sensing (kinetic, respiratory, and beat) is enabling simpler, faster, and more robust monitoring of the sources of motion. This information is being integrated, with new innovative imaging approaches, to effectively manage motion and its impact on image quality. Additional impact has been made by the use of compressed sensing and simultaneous multislice imaging, with these techniques maturing and being adopted to decrease scan time and thus the effect of motion. Guidance in terms of clinical use for techniques that effectively combat motion is provided, focusing on enabling faster and improved clinical scans. Magnetic resonance imaging is on the cusp of a major new leap forward in terms of image quality and clinical utility enabled by these technological advances.
Postoperative Complications of Plastic and Reconstructive Surgery in Solid Organ Transplant Recipients
Authors: Ka Soon Il , Kim Sung-Eun
Published: April 2019

Introduction:

As the number of organ transplants and the survival rate increase, solid organ transplant patients will need more plastic and reconstructive surgery. However, such patients take immunosuppressants, including prednisone, which makes wound healing slower and plastic surgeons more hesitate to operate. In this study, we examined postoperative complications of organ transplant patients who have undergone plastic and reconstructive surgery.

Materials & Methods:

Between 2002 and 2018, the total number of patients who visited our clinic after receiving organ transplants was 77. Retrospective reviews were performed on 35 patients, excluding those who received conservative treatment. Demographics, underlying diseases, causes of organ transplantation, immunosuppressive regimen, types of procedures, and postoperative complications were analyzed.

Results:

A total of 35 patients received 42 procedures. Eleven patients had undergone kidney transplantation, and 24 had undergone liver transplantation. The type of procedures were local flap (23.8%), primary closure (23.8%), skin graft (11.9%), and free flap (2.4%). There were 2 cases of aesthetic surgery. Among all the cases, complications occurred in 8 procedures (19%). Hematoma was the most common complication, followed by skin necrosis. All except 3 patients were completely healed within 6 weeks.

Discussion:

This study showed that hematoma was the most frequently occurring complication. In a few cases, wound healing was delayed. So, bleeding control was very important to prevent the development of hematoma. And organ transplants may not be a problem for plastic and reconstructive surgery.