bluuebunny/crossref_metadata_2025 huggingface dataset:
The Feedback Tango: An Integrative Review and Analysis of the Content of the Teacher–Learner Feedback Exchange
Authors: Bing-You Robert , Varaklis Kalli , Hayes Victoria , Trowbridge Robert , Kemp Heather , McKelvy Dina
Published: October 2017

Purpose

To conduct an integrative review and analysis of the literature on the content of feedback to learners in medical education.

Method

Following completion of a scoping review in 2016, the authors analyzed a subset of articles published through 2015 describing the analysis of feedback exchange content in various contexts: audiotapes, clinical examination, feedback cards, multisource feedback, videotapes, and written feedback. Two reviewers extracted data from these articles and identified common themes.

Results

Of the 51 included articles, about half (49%) were published since 2011. Most involved medical students (43%) or residents (43%). A leniency bias was noted in many (37%), as there was frequently reluctance to provide constructive feedback. More than one-quarter (29%) indicated the feedback was low in quality (e.g., too general, limited amount, no action plans). Some (16%) indicated faculty dominated conversations, did not use feedback forms appropriately, or provided inadequate feedback, even after training. Multiple feedback tools were used, with some articles (14%) describing varying degrees of use, completion, or legibility. Some articles (14%) noted the impact of the gender of the feedback provider or learner.

Conclusions

The findings reveal that the exchange of feedback is troubled by low-quality feedback, leniency bias, faculty deficient in feedback competencies, challenges with multiple feedback tools, and gender impacts. Using the tango dance form as a metaphor for this dynamic partnership, the authors recommend ways to improve feedback for teachers and learners willing to partner with each other and engage in the complexities of the feedback exchange.
U.S. Physician–Scientist Workforce in the 21st Century: Recommendations to Attract and Sustain the Pipeline
Authors: Salata Robert A. , Geraci Mark W. , Rockey Don C. , Blanchard Melvin , Brown Nancy J. , Cardinal Lucien J. , Garcia Maria , Madaio Michael P. , Marsh James D. , Todd Robert F.
Published: October 2017

The U.S. physician–scientist (PS) workforce is invaluable to the nation’s biomedical research effort. It is through biomedical research that certain diseases have been eliminated, cures for others have been discovered, and medical procedures and therapies that save lives have been developed. Yet, the U.S. PS workforce has both declined and aged over the last several years. The resulting decreased inflow and outflow to the PS pipeline renders the system vulnerable to collapsing suddenly as the senior workforce retires. In November 2015, the Alliance for Academic Internal Medicine hosted a consensus conference on the PS workforce to address issues impacting academic medical schools, with input from early-career PSs based on their individual experiences and concerns. One of the goals of the conference was to identify current impediments in attracting and supporting PSs and to develop a new set of recommendations for sustaining the PS workforce in 2016 and beyond. This Perspective reports on the opportunities and factors identified at the conference and presents five recommendations designed to increase entry into the PS pipeline and nine recommendations designed to decrease attrition from the PS workflow.
Beyond “Dr. Feel-Good”: A Role for the Humanities in Medical Education
Authors: Kumagai Arno K.
Published: October 2017

Although educators embrace the values that are nominally included in the idea of “the art and science of medicine,” the arts and humanities have remained at the edges of medical education. One reason for this exile is the overwhelming emphasis in the curriculum on biomedical science over the social sciences and humanities. Other causes are self-inflicted—a frequent lack of theoretical rigor in the design of educational offerings and, more important, no clear answer to the question of how the humanities can make better physicians. A common justification for including the arts and humanities in medical education—that spending time with literature, music, and the visual arts contributes to student and faculty reflection and well-being—is compelling; however, it risks further marginalizing the field as a soft, feel-good supplement to training.

In this Invited Commentary, the author proposes several unique ways in which the arts and humanities contribute to the development of physicians who practice with excellence, compassion, and justice.

These ways include disrupting taken-for-granted beliefs and assumptions; introducing a pause in perceiving, thinking, and acting; encouraging engagement with complexity and ambiguity; seeing past the surface to historical and societal influences and causes; and encouraging an awareness of the multiple, unique voices and perspectives of patients. Ultimately, the humanities prompt awareness of the space in which physicians care for human beings in their moments of greatest need and bear witness to fundamental changes in their patients and in themselves.
Perioperative Management of the Adult Patient on Venovenous Extracorporeal Membrane Oxygenation Requiring Noncardiac Surgery
Authors: Fierro Michael A. , Daneshmand Mani A. , Bartz Raquel R.
Published: October 2017

The use of venovenous extracorporeal membrane oxygenation is increasing worldwide. These patients often require noncardiac surgery. In the perioperative period, preoperative assessment, patient transport, choice of anesthetic type, drug dosing, patient monitoring, and intraoperative and postoperative management of common patient problems will be impacted. Furthermore, common monitoring techniques will have unique limitations. Importantly, patients on venovenous extracorporeal membrane oxygenation remain subject to hypoxemia, hypercarbia, and acidemia in the perioperative setting despite extracorporeal support. Treatments of these conditions often require both manipulation of extracorporeal membrane oxygenation settings and physiologic interventions. Perioperative management of anticoagulation, as well as thresholds to transfuse blood products, remain highly controversial and must take into account the specific procedure, extracorporeal membrane oxygenation circuit function, and patient comorbidities. We will review the physiologic management of the patient requiring surgery while on venovenous extracorporeal membrane oxygenation.
Functional outcome of displaced radial head fractures in children treated by elastic stable intramedullary nailing
Authors: Guyonnet Clément , Martins Antoine , Marengo Lorenza , Mansour Mounira , Rousset Marie , Samba Antoine , Dimeglio Alain , Canavese Federico
Published: October 2017

The objectives of this study were to retrospectively investigate the clinical and radiological outcomes of displaced radial head fractures in children treated by elastic stable intramedullary nailing (ESIN) and evaluate the functional outcome of these injuries using the short version of the Disabilities of the Arm, Shoulder and Hand outcome questionnaire (Quick DASH). A total of 24 patients (nine males and 15 females) fulfilled the inclusion criteria. The mean age at the time of injury was 10.7±2.8 years (range: 9.5–16.33 years). Before surgery, the mean angulation was 53.8°±18.4° (range: 28°–82°) differentiating fractures on the basis of Judet’s classification. The mean Quick DASH score was a good 4 (range: 0–15.9). Functional outcomes were similar irrespective of the severity of fracture displacement (P>0.05), presence or absence of associated fracture (P>0.05), and time immobilized (P>0.05). The Quick DASH score was better in children younger than 9 years of age (1.62) than children older than 9 years of age (4.95), but without a statistically significant difference (P=0.058). Children with displaced radial head fractures treated with ESIN showed good functional outcomes. Associated fracture injuries were not a predictive factor of functional outcome. Open reduction must be avoided as it carries an increased risk of complications.
Using eHealth to Increase Autonomy Supportive Care
Authors: Johnsen Helle , Blom Karina Fischer , Lee Anne , Nørgaard Birgitte
Published: October 2017

eHealth solutions are increasingly implemented in antenatal care to enhance women’s involvement. The main aim of this study was to evaluate women’s assessment of autonomy supportive care during the antenatal care visits among low-risk pregnant women. An intervention study was conducted including a control group attending standard antenatal care and an intervention group having access to an eHealth knowledge base, in addition to standard care. A total of 87 women were included in the control group and a total of 121 women in the intervention group. Data were collected using an online questionnaire 2 weeks after participants had given birth. Data were analyzed using χ
2 tests and Wilcoxon rank sums. Use of an eHealth knowledge base was associated with statistically significant higher scores for women’s overall assessment of antenatal care visits, the organization of antenatal care visits, confidence after antenatal care visits, and involvement during antenatal care visits. We also found a statistically significant higher overall self-perceived autonomy supportive care in the intervention group compared with the control group.
Myoepithelial-Rich and Infiltrative Giant Vascular Eccrine Spiradenoma: A Unique Presentation of a Rare Adnexal Tumor
Authors: Georgesen Corey , Magro Cynthia
Published: October 2017

A rare variant of the eccrine spiradenoma, the giant vascular eccrine spiradenoma, has been characterized as a large circumscribed and sometimes hemorrhagic solitary tumor occurring in adults older than 50 years. Histopathologically, the lesion is comprised of distinct cell populations and cystic hemorrhagic glandular spaces. We present a 68-year-old Bengali man with a giant vascular eccrine spiradenoma and describe immunohistochemical features of this tumor. In addition, we highlight unique aspects of this case, including a rich myoepithelial component and focal pseudocapsular infiltration.
Cold-Induced Dermatoses: Case Report and Review of Literature
Authors: Saenz Ibarra Barbara , Meeker Jason , Jalali Omid , Lynch Michael C.
Published: October 2017

Cold panniculitis and perniosis are the most common cold-induced dermatologic disorders and are clinically characterized by indurated and erythematous nodules and plaques that develop at sites exposed to excessive cold and wet conditions. Cold panniculitis is most commonly seen in infants, but adult cases involving the thighs of equestrians are well known and have come to be known as equestrian cold panniculitis or equestrian perniosis. Recently, similar cases have been described in nonequestrian settings with the prolonged use of ice-packs or other cold-therapy devices. We describe the case of 51-year-old female patient who underwent recent arthroscopic shoulder surgery for repair of a rotator cuff tear and presented to the dermatology clinic for painful and erythematous nodules on her arm. A punch biopsy demonstrated a superficial and deep perivascular and periappendageal lymphocytic infiltrate with some spillover into the superficial subcutaneous adipose tissue. Focal vacuolar changes along the basal layer of the epidermis with a few dyskeratotic keratinocytes were present. A mild increase in interstitial mucin was seen, but no significant papillary dermal edema. On clinical questioning she admitted to sustained use of icepacks on the injured shoulder postoperatively for up to 18 hours a day. Based on clinical and histopathologic features the diagnosis of ice-pack dermatosis was made. A review of cold-induced dermatoses is considered with a focus on the main histologic differential diagnoses.
Heterotopic Cutaneous Meningioma: An Unusual Presentation Occurring in a Patient With a Remote History of Intracranial Meningioma
Authors: Enwereuzo Chibuike , Moral Luis , Henneberry Jean M.
Published: October 2017

Meningioma is a neoplasm of the meninges, which usually occurs in intracranial sites. Extracranial meningioma has been frequently reported in the sinonasal tract and skull bone, often as extension of intracranial meningiomas. Isolated heterotopic meningioma without contiguous intracranial lesion is extremely rare. A 56-year-old woman presented in December 2015 with 2 firm subcutaneous scalp masses; one in the left lateral (temporal) and the other in the left superior (parietal) region. The clinical impression was that of lipoma. Pathologic examination revealed an ill-defined proliferation of uniform meningothelial cells in a fibroblastic stroma interspersed within adipose tissue. The excised lesions had similar histologic features. Immunohistochemical stains were performed and the tumor cells were positive for epithelial membrane antigen and negative for S-100. A diagnosis of extracranial meningioma, WHO grade I was made. The patient's medical history was significant for intracranial meningioma of the frontal lobe in October 2007, which was diagnosed as atypical meningioma, WHO grade II. Comparison of the scalp masses to her previous meningioma revealed a distinctly different morphologic pattern. In light of the 8-year interval between the scalp and intracranial meningioma and the difference in histologic grades, it is unlikely that her most recent tumors represent a recurrence or metastasis of the intracranial tumor.
The Effectiveness of Transitions-of-Care Interventions in Reducing Hospital Readmissions and Mortality
Authors: Kamermayer Angela K. , Leasure A. Renee , Anderson Lisa
Published: October 2017

Background:

The Affordable Care Act of 2010 set forth payment models that provided $10 billion to incent the health care system in developing innovative programs that target reform, including transitional care to reduce preventable readmissions. While transitional care programs exist, US hospitals remain challenged, with 1 in 5 readmissions within 30 days.

Objective:

This systematic review examined the effectiveness of select evidence-based transitions-of-care interventions on reducing 30-day readmission rates, reducing emergency room visits, and reducing mortality rates.

Methods:

The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines formed the framework for this systematic review. Key study characteristics informed the eligibility criteria and search strategy. Two reviewers independently appraised selected studies using the Critical Appraisal Skills Programme tools. Included studies were summarized and synthesized in order to draw conclusions across studies.

Results:

Interventions are aimed at reducing the readmission rate of the adult general medical population. The population of focus in this review includes patients at risk of avoidable readmissions, which includes patients requiring higher levels of care secondary to complications that can contribute to higher mortality after discharge from an acute care setting.

Discussion:

The findings of this review support the use of transitions-of-care interventions such as tailored discharge planning and postdischarge phone calls.
Incongruence in Perceptions
Authors: Thomas Sarah , Quirk Lindsay , Blevins Cheri , Quatrara Beth , Letzkus Lisa
Published: October 2017

Background:

Patient satisfaction is at the forefront of quality care and patient outcomes. The literature identifies the discrepancy between nurse and patient perceptions in a variety of care settings; few studies have investigated the perceptions of care in a critical care unit. Understanding the perceptions in a critical care unit is necessary to optimize organizational performance related to quality, safety, patient-centered care, and efficiency.

Objective:

The purpose of the study was to determine whether a discrepancy exists between what patients and families perceive as satisfaction with their care as compared with the nurses’ perception of what constitutes positive patient satisfaction in a medical critical care unit.

Methods:

A cross-sectional, prospective study was conducted to assess patient-perceived satisfaction with nursing care versus nursing perceptions in the medical intensive care unit. A convenience sample of patients and/or family members and the nurses providing their care was conducted. The validated Patient Satisfaction with Nursing Care Quality Questionnaire and Nurse’s Assessment of the Patient’s Expectations Questionnaire were used to assess perceptions. Patients and/or their family members and nurses’ responses were evaluated as matched pairs. The data were analyzed using Spearman correlation.

Results:

Forty-eight matched pairs of questionnaires were completed. There was not a correlation (r = 0.135; 95% confidence interval, −0.16 to 0.41; P = .363) between the overall patient and nurse averages for common questions. The analysis of the individual patient and nurse items revealed statistically significant correlations between only 2 of the 19 items, information given (P = .027) and recognition of opinions (P = .043).

Correlations within patient questionnaires were noted in some areas such as patients’ perception of quality of care and expectations, overall quality of nursing care, and patient expectations and patients’ likelihood to recommend the hospital to family and friends. Patient satisfaction was influenced by a number of factors, most notably patient expectations.

Implications for Practice:

Nurses’ perceptions of positive patient satisfaction in critical care are incongruent with patients’ perceptions. Improving nurses’ awareness of the patient experience could improve patient satisfaction. Further studies examining patient expectations could be beneficial in improving patient satisfaction in the critical care setting.
INTRAVITREAL AFLIBERCEPT AND RANIBIZUMAB INJECTIONS FOR TYPE 3 NEOVASCULARIZATION
Authors: Cho Han Joo , Hwang Hyun Ji , Kim Hyoung Seok , Han Jung Il , Lee Dong Won , Kim Jong Woo
Published: October 2017

Purpose:

To compare the effectiveness of intravitreal injection of aflibercept with ranibizumab in patients with Type 3 neovascularization.

Methods:

Sixty-three treatment-naive eyes with Type 3 neovascularization (58 patients) were retrospectively analyzed. The eyes had received intravitreal aflibercept or ranibizumab injections. All patients were treated using an initial series of three monthly loading injections, followed by further injections as required. The visual and anatomical outcomes of treatment were evaluated after 12 months.

Results:

The mean best-corrected visual acuity in the aflibercept-treated group (21 eyes), expressed as the logarithm of the minimum angle of resolution, improved from 0.71 ± 0.42 (Snellen equivalent; 20/102) to 0.54 ± 0.39 (20/69) after 12 months of treatment (P = 0.022). Similarly, in the ranibizumab-treated group (42 eyes), the best-corrected visual acuity improved from 0.68 ± 0.38 (20/95) to 0.53 ± 0.36 (20/67) (P = 0.013) at 12 months. The central foveal thickness decreased in the aflibercept-treated group from 356 ± 139 μm to 212 ± 155 μm and in the ranibizumab-treated group from 348 ± 177 μm to 208 ± 161 μm (P = 0.014 and P = 0.017, respectively). There was no significant difference between the groups about improvement in best-corrected visual acuity or decrease in central foveal thickness. However, geographic atrophy was significantly more frequent in the aflibercept-treated group, occurring in 42.9% of eyes, than in the ranibizumab-treated group (19.0% of eyes; P = 0.045).

Conclusion:

There was no difference between the aflibercept and ranibizumab treatments in terms of visual acuity improvement after 12 months in patients with Type 3 neovascularization. However, geographic atrophy developed more frequently in the aflibercept-treated group.
Suprachoroidal Bleeding After XEN Gel Implantation
Authors: Prokosch-Willing Verena , Vossmerbaeumer Urs , Hoffmann Esther , Pfeiffer Norbert
Published: October 2017

Purpose:

To report for the first time a clinical case of suprachoroidal bleeding after XEN45 gel implantation.

Observations:

A 84-year old female patient with pseudoexfoliation glaucoma with intraocular pressure (IOP) (20 mm Hg) above target despite maximal IOP-lowering therapy was scheduled for XEN45 gel implantation. The XEN45 gel implantation went without complications and was properly placed in the anterior chamber and beneath the conjunctiva. On the first postoperative day, the patient presented with an IOP of 4 mm Hg, a functioning bleb and a deep anterior chamber. On the second day she developed suprachoroidal bleeding. A wait and see strategy was followed and the patient monitored steadily. The bleeding resolved spontaneously after 6 weeks.

Conclusions and Importance:

Minimally invasive glaucoma surgery is developed to provide a safer and less-invasive option to reduce IOP in glaucoma patients compared with trabeculectomy. Although the concept of the XEN45 gel stent seems to be a favorable to reach IOP-lowering results similar to those of trabeculectomy, complications may be similar, too. We have to keep this in mind when informing patients about surgical options.
Antisense oligonucleotides selectively suppress target RNA in nociceptive neurons of the pain system and can ameliorate mechanical pain
Authors: Mohan Apoorva , Fitzsimmons Bethany , Zhao Hien T. , Jiang Yuhong , Mazur Curt , Swayze Eric E. , Kordasiewicz Holly B.
Published: October 2017

There is an urgent need for better treatments for chronic pain, which affects more than 1 billion people worldwide. Antisense oligonucleotides (ASOs) have proven successful in treating children with spinal muscular atrophy, a severe infantile neurological disorder, and several ASOs are currently being tested in clinical trials for various neurological disorders. Here, we characterize the pharmacodynamic activity of ASOs in spinal cord and dorsal root ganglia (DRG), key tissues for pain signaling. We demonstrate that activity of ASOs lasts up to 2 months after a single intrathecal bolus dose. Interestingly, comparison of subcutaneous, intracerebroventricular, and intrathecal administration shows that DRGs are targetable by systemic and central delivery of ASOs, while target reduction in the spinal cord is achieved only after direct central delivery. Upon detailed characterization of ASO activity in individual cell populations in DRG, we observe robust target suppression in all neuronal populations, thereby establishing that ASOs are effective in the cell populations involved in pain propagation. Furthermore, we confirm that ASOs are selective and do not modulate basal pain sensation. We also demonstrate that ASOs targeting the sodium channel Nav1.7 induce sustained analgesia up to 4 weeks. Taken together, our findings support the idea that ASOs possess the required pharmacodynamic properties, along with a long duration of action beneficial for treating pain.
Practical management of concomitant acute heart failure and worsening renal function in the emergency department
Authors: Ferreira João Pedro , Chouihed Tahar , Nazeyrollas Pierre , Levy Bruno , Seronde Marie F. , Bilbault Pascal , Braun François , Roul Gérald , Kénizou David , Zannad Noura , Girerd Nicolas , Rossignol Patrick
Published: October 2017

Worsening renal function (i.e. any increase in creatinine or decrease in the estimated glomerular filtration rate) is common in patients admitted for acute heart failure in the emergency department. Although worsening renal function (WRF) has been associated with the occurrence of dismal outcomes, this only appears to be the case when associated with clinical deterioration. However, if the clinical status of the patient is improving, a certain increase in serum creatinine may be acceptable. This WRF, which is not associated with clinical deterioration or adverse outcomes (e.g. during treatment up-titration), has been referred to as ‘pseudo-WRF’ and should not detract clinicians from targeting ‘guideline-recommended’ therapies. This is an important message for emergency physicians to pursue diuretics as long as signs of pulmonary congestion persist to improve the clinical status of the patient. In the present review, we aim to provide clinicians in acute settings with an integrative and comprehensive approach to cardiorenal interactions in acute heart failure.
Effect of High-Dose Allopurinol Pretreatment on Cardiac Biomarkers of Patients Undergoing Elective Percutaneous Coronary Intervention: A Randomized Clinical Trial
Authors: Alemzadeh-Ansari Mohammad Javad , Hosseini Seyed Kianoosh , Talasaz Azita Hajhossein , Mohammadi Mohammad , Tokaldani Masumeh Lotfi , Jalali Arash , Pourhosseini Hamidreza
Published: October 2017

Background:

Increased accumulation of reactive oxygen species contributes to pathophysiologic states such as endothelial dysfunction, metabolic and functional impairment, inflammatory activation, and other features of cardiovascular pathophysiology. Allopurinol acts as a xanthine oxidase inhibitor that reduces the amount of free radicals after reactive oxygen species generation.

Methods and Results:

In this placebo-controlled randomized clinical trial, all patients admitted with coronary artery disease who are candidates for elective percutaneous coronary intervention (PCI) were included. The 254 patients were randomly divided into 2 groups. Blood samples for cardiac biomarkers (creatine kinase [CK]-MB and troponin T [cTnT]) were collected from all patients after admission (the day before PCI), and also 8 and 16 hours after intervention. In group 1 (133 patients), 600 mg allopurinol was orally administered on the day before PCI, and another same dose on the day of PCI, and the elective PCI was performed. In group 2 (121 patients), elective PCI was performed without pretreatment with allopurinol. In an unadjusted model, the serum levels of both CK-MB and cTnT, 16 hours after PCI were higher in the placebo group as compared with the allopurinol group, although it was statistically insignificant. We compared the maximum levels of CK-MB and cTnT (8 or 16 hours after PCI) and their maximum changes in both groups. After adjustment for confounders, use of allopurinol did not have any statistically significant association with the rise of cardiac-spec–fic enzymes.

Conclusions:

Allopurinol could not be effective significantly, in patients undergoing elective PCI, to decrease cardiac-specific enzymes, and seems not to be of use before PCI.
Clinically Significant Differences in Ki-67 Proliferation Index Between Primary and Metastases in Resected Pancreatic Neuroendocrine Tumors
Authors: Richards-Taylor Sebastian , Tilley Charles , Jaynes Eleanor , Hu Haixiao , Armstrong Thomas , Pearce Neil W. , Plant Rachel , Cave Judith
Published: October 2017

Objective

Pancreatic neuroendocrine tumors (NETs) (pNETs) have a varied prognosis according to their grade. The European Neuroendocrine Tumor Society grading system uses assessment of the proliferation index via Ki-67 immunohistochemistry to aid prognosis. There is evidence that the proliferation index can vary significantly within a single tumor, but it is not fully understood to what extent heterogeneity occurs between the primary and metastatic sites and how this may affect the grade. The aim of this study is to determine whether the grade assigned to a pNET varies depending on which site is selected for Ki-67 immunolabeling.

Methods

Patients were selected from our institution's NET database. Patients were included if they had a confirmed pNETs, had multiple resection specimens, and had consented to research being performed on their specimens. Ki-67 immunohistochemistry was performed on all resected specimens meeting the inclusion criteria.

Results

Pancreatic neuroendocrine tumors specimens resected from 16 patients were analyzed. There was no trend to higher Ki-67 in metastatic than primary disease. Ki-67 was on average 3% higher in liver metastases than lymph node metastases (P < 0.001).

Conclusions

The grade of pNETs varies according to the tumor selected for Ki-67 immunolabeling. Useful information can be gained by performing Ki-67 PI on liver metastases.
Different Clinical Characteristics Between Distal Cholangiocarcinoma and Pancreatic Head Carcinoma With Biliary Obstruction
Authors: Yokoyama Yukihiro , Ebata Tomoki , Igami Tsuyoshi , Sugawara Gen , Mizuno Takashi , Yamaguchi Junpei , Nagino Masato
Published: October 2017

Objectives

The aim of this study was to compare the perioperative clinical characteristics between patients with distal cholangiocarcinoma (DCC) and pancreatic head carcinoma (PHC) with biliary obstruction.

Methods

This study included patients who underwent pancreatoduodenectomy and were diagnosed with DCC (n = 85) or PHC (n = 90) by final pathological examination. Perioperative clinical characteristics were compared for patients with DCC versus PHC with biliary obstruction.

Results

Median coronal thickness of the pancreatic neck was significantly greater, whereas the main pancreatic duct diameter was significantly smaller in patients with DCC than patients with PHC. Most patients with DCC (95%) had a soft pancreas, whereas only 29% of patients with PHC had. The incidence rates of overall morbidity, infectious complications, and pancreatic fistula were significantly higher in patients with DCC than those in patients with PHC. Eleven DCC patients (12%) were preoperatively misdiagnosed with PHC. Among them, intraductal ultrasonography of the bile duct was performed in 7 patients, and the presence of PHC was suspected in 3 of these patients because intraductal ultrasonography detected a small intrapancreatic mass.

Conclusions

This study clearly showed different perioperative characteristics between patients with DCC and PHC. It is not uncommon to misdiagnose PHC as DCC. Intraductal ultrasonography may be helpful in differentiating DCC and PHC.
SPINK1 Gene is Significantly Associated With Pancreatitis
Authors: Liu Jie , Lu Shun-yuan , Wang Yan-gui , Wei Zhi-yun , Zhang Hong-xin
Published: October 2017

Objectives

This research was applied to case-control studies of the association between pancreatitis and SPINK1 gene to assess the joint evidence for the association, the influence of individual studies, and evidence for publication bias.

Methods

MEDLINE and Embase were searched to identify longitudinal studies evaluating pancreatitis and SPINK1. Odds ratios (ORs) and 95% confidence interval (CI) were pooled using random-effect models and calculated using Carlin method. Publication bias was assessed using Egger et al's approach (A famous statistic method by Egger et al). Sensitivity, heterogeneity, and trim and fill analyses were conducted.

Results

Based on the results, we found that (1) the results support for the association between pancreatitis and SPINK1, when analyzed totally and by subdivision (total [OR, 7.771; 95% CI, 5.232–11.543; P < 0.000]; European [OR,6.400; 95% CI, 4.346–9.426; P < 0.000]; Asian [OR, 11.823; 95% CI, 4.612–30.310; P < 0.000]; American [OR, 3.777; 95% CI, 1.596–8.939; P = 0.002]; mixed: [OR, 13.566; 95% CI, 2.322–79.252, P = 0.004]); (2) no evidence indicates that this association is accounted for by any one study, and no evidence indicates any publication bias exists.

Conclusions

The results indicated that SPINK1 gene, particularly the N34S mutation, has a genetic association with the development of pancreatitis.
Disrupted Executive Function and Aggression in Individuals With a History of Adverse Childhood Experiences
Authors: Xue Jiao-Mei , Lin Ping-Zhen , Sun Ji-Wei , Cao Feng-Lin
Published: October 2017

Here, we explored the functional and neural mechanisms underlying aggression related to adverse childhood experiences. We assessed behavioral performance and event-related potentials during a go/no-go and N-back paradigm. The participants were 15 individuals with adverse childhood experiences and high aggression (ACE + HA), 13 individuals with high aggression (HA), and 14 individuals with low aggression and no adverse childhood experiences (control group). The P2 latency (initial perceptual processing) was longer in the ACE + HA group for the go trials. The HA group had a larger N2 (response inhibition) than controls for the no-go trials. Error-related negativity (error processing) in the ACE + HA and HA groups was smaller than that of controls for false alarm go trials. Lastly, the ACE + HA group had shorter error-related negativity latencies than controls for false alarm trials. Overall, our results reveal the neural correlates of executive function in aggressive individuals with ACEs.
Cholangitis Lenta
Authors: Torous Vanda F. , De La Cruz A. Laura , Naini Bita V. , Wang Hanlin L.
Published: October 2017

Cholangitis lenta, also known as ductular cholestasis, cholangiolar cholestasis, or subacute nonsuppurative cholangitis, is an uncommon type of cholangitis characterized by ductular reaction with inspissated bile in dilated ductules. The literature on this unique entity has been limited to only a few studies based on a very limited number of cases, which importantly suggest an association with sepsis and/or intra-abdominal infection. The clinical, laboratory, and histologic features of 28 cases of cholangitis lenta are herein investigated. Twenty-five (89.3%) patients were liver transplant recipients. Most notably, the majority of patients showed clinical signs and symptoms of sepsis, and positive microbiology cultures were demonstrated in 24 (85.7%) patients. Significantly, 15 (53.6%) patients died during their hospitalization, ranging from 2 days to 5 months after the initial liver biopsy that showed histologic features of cholangitis lenta. Among the 13 discharged patients, including 2 who received retransplantation, 4 (14.3%) subsequently died of pneumonia, graft dysfunction, or fungal infection within 7 months to 9.3 years. Only 9 (32.1%) patients were alive at the last follow-up, with the follow-up time ranging from 3.8 to 10.4 years. Our data show that the finding of cholangitis lenta on liver biopsy is thus frequently associated with sepsis and with a high mortality rate. Therefore, accurate diagnosis of this condition on liver biopsy is imperative as it is an indication that the patient may have a potentially life threatening condition that requires immediate medical attention and management.
Toward Biological Subtyping of Papillary Renal Cell Carcinoma With Clinical Implications Through Histologic, Immunohistochemical, and Molecular Analysis
Authors: Saleeb Rola M. , Brimo Fadi , Farag Mina , Rompré-Brodeur Alexis , Rotondo Fabio , Beharry Vidya , Wala Samantha , Plant Pamela , Downes Michelle R. , Pace Kenneth , Evans Andrew , Bjarnason Georg , Bartlett John M.S. , Yousef George M.
Published: October 2017

Papillary renal cell carcinoma (PRCC) has 2 histologic subtypes. Almost half of the cases fail to meet all morphologic criteria for either type, hence are characterized as PRCC not otherwise specified (NOS). There are yet no markers to resolve the PRCC NOS category. Accurate classification can better guide the management of these patients. In our previous PRCC study we identified markers that can distinguish between the subtypes. A PRCC patient cohort of 108 cases was selected for the current study. A panel of potentially distinguishing markers was chosen from our previous genomic analysis, and assessed by immunohistochemistry. The panel exhibited distinct staining patterns between the 2 classic PRCC subtypes; and successfully reclassified the NOS (45%) cases. Moreover, these immunomarkers revealed a third subtype, PRCC3 (35% of the cohort). Molecular testing using miRNA expression and copy number variation analysis confirmed the presence of 3 distinct molecular signatures corresponding to the 3 subtypes. Disease-free survival was significantly enhanced in PRCC1 versus 2 and 3 (P=0.047) on univariate analysis. The subtypes stratification was also significant on multivariate analysis (P=0.025; hazard ratio, 6; 95% confidence interval, 1.25-32.2). We propose a new classification system of PRCC integrating morphologic, immunophenotypical, and molecular analysis. The newly described PRCC3 has overlapping morphology between PRCC1 and PRCC2, hence would be subtyped as NOS in the current classification. Molecularly PRCC3 has a distinct signature and clinically it behaves similar to PRCC2. The new classification stratifies PRCC patients into clinically relevant subgroups and has significant implications on the management of PRCC.
Revisiting the Appendiceal Diameter via Ultrasound for the Diagnosis of Acute Appendicitis
Authors: Chicaiza Henry P. , Malia Laurie , Mulvey Christine H. , Smith Sharon R.
Published: October 2017

Objectives

This study aims to investigate the optimal outer appendiceal diameter via ultrasound for the diagnosis of acute appendicitis.

Methods

A retrospective chart review was conducted on patients (ages, 2–18 years) presenting to an urban pediatric emergency department between January 1, 2009 and December 31, 2010 with suspected acute appendicitis. Children were considered as having “suspected acute appendicitis” if they (1) presented with acute abdominal pain and had either a surgical consult or an abdominal ultrasound, or (2) presented or transferred with the stated suspicion of acute appendicitis. Pathology reports were used to confirm the diagnosis of appendicitis. The appendiceal diameters were determined by board-certified pediatric radiologists.

Results

A total of 320 patient charts were reviewed (females, 57%; mean age, 10.9; SD, 3.9). Seventy-two percent (N = 230) of the patients screened positive for acute appendicitis via ultrasound, 69% (N = 222) had confirmed acute appendicitis, 75% (N = 239) of the ultrasound reports included an outer appendiceal diameter. Overall, ultrasound was found to be highly sensitive (91%) and moderately specific (74%). With an outer appendiceal diameter of 6 mm as a cutoff, ultrasound had an excellent sensitivity (100%) but poor specificity (43%). With an outer diameter of 7 mm as a cutoff, sensitivity decreased to 94% but specificity increased to 71%. With increasing cutoff size, the sensitivity decreased and specificity increased.

Conclusions

Our data suggest that the optimal outer appendiceal diameter for the diagnosis of acute appendicitis should be 7 mm instead of the currently used 6 mm.
The Gut and Its Microbiome as Related to Central Nervous System Functioning and Psychological Well-being: Introduction to the Special Issue of Psychosomatic Medicine
Authors: Mayer Emeran A. , Hsiao Elaine Y.
Published: October 2017

Accumulating evidence indicates bidirectional associations between the brain and the gut microbiome with both top-down and bottom-up processes. This article describes new developments in brain-gut interactions as an introduction to a special issue of Psychosomatic Medicine, based on a joint symposium of the American Psychosomatic Society and the American Gastroenterological Association. Literature review articles indicate that several psychiatric disorders are associated with altered gut microbiota, whereas evidence linking functional gastrointestinal disorders and dysbiosis has not been firmly established. The association between dysbiosis with obesity, metabolic syndrome, and Type 2 diabetes mellitus is still inconclusive, but evidence suggests that bariatric surgery may favorably alter the gut microbial community structure. Consistent with the literature linking psychiatric disorders with dysbiosis is that life adversity during childhood and certain temperaments that develop early in life are associated with altered gut microbiota, particularly the Prevotella species. Some studies reported in this issue support the hypothesis that brain-gut interactions are adversely influenced by reduced functional activation of the hippocampus and autonomic nervous system dysregulation. The evidence for the effects of probiotics in the treatment of Clostridium difficile colitis is relatively well established, but effects on mental health and psychophysiological stress reactivity are either inconclusive or still in progress. To conceptualize brain-gut interactions, a holistic, systems-based perspective on health and disease is needed, integrating gut microbial with environmental ecology. More translational research is needed to examine the mental and physical health effects of prebiotics and probiotics, in well-phenotyped human populations with sufficiently large sample sizes.
Antiviral treatment of severe non-influenza respiratory virus infection
Authors: Brendish Nathan J. , Clark Tristan W.
Published: October 2017

Purpose of review

Non-influenza respiratory virus infections are a frequent cause of severe acute respiratory infections, especially in infants, the elderly, and the immunocompromised. We review here the current treatment options for non-influenza respiratory viruses and promising candidate antiviral agents currently in development.

Recent findings

Small molecule antiviral agents active against respiratory syncytial virus (RSV), such as ALS-8176 and GS-5806, show considerable promise in challenge studies and are undergoing late-phase clinical trials in hospitalised adults and children. Monoclonal antibodies (mAbs) active against non-influenza respiratory viruses are broadly at a preclinical stage. Broad-spectrum antivirals, such as favipiravir and nitrazoxanide, have potential utility in treating illness caused by non-influenza respiratory viruses but further definitive clinical trials are needed.

Severe non-influenza respiratory virus infection is common and current treatment is largely supportive. Ribavirin is used in immunocompromised patients but its use is limited by toxicity and the evidence for its efficacy is weak. Effective antiviral treatment for RSV may shortly become available, pending the results of ongoing clinical trials. For other non-influenza viruses, effective treatments may become available in the medium term. Early detection of respiratory viruses with rapid molecular test platforms will be crucial in differentiating virus types and directing the prompt initiation of novel treatments when available.
Comparative Assessment of Anti-HLA Antibodies Using Two Commercially Available Luminex-Based Assays
Authors: Clerkin Kevin J. , See Sarah B. , Farr Maryjane A. , Restaino Susan W. , Serban Geo , Latif Farhana , Li Lingzhi , Colombo Paolo C. , Vlad George , Ray Bryan , Vasilescu Elena R. , Zorn Emmanuel
Published: October 2017

Background

Allospecific anti-HLA antibodies (Abs) are associated with rejection of solid organ grafts. The 2 main kits to detect anti-HLA Ab in patient serum are commercialized by Immucor and One Lambda/ThermoFisher. We sought to compare the performance of both platforms.

Methods

Background-adjusted mean fluorescence intensity (MFI) values were used from both platforms to compare sera collected from 125 pretransplant and posttransplant heart and lung transplant recipients.

Results

Most HLA class I (94.5%) and HLA class II (89%) Abs with moderate to high MFI titer (≥4000) were detected by both assays. A modest correlation was observed between MFI values obtained from the 2 assays for both class I (r = 0.3, r
2 = 0.09, P < 0.0001) and class II Ab (r = 0.707, r
2 = 0.5, P < 0.0001). Both assays detected anti–class I and II Ab that the other did not; however, no specific HLA allele was detected preferentially by either of the 2 assays. For a limited number of discrepant sera, dilution resulted in comparable reactivity profiles between the 2 platforms.

Conclusions

Immucor and One Lambda/ThermoFisher assays have a similar, albeit nonidentical, ability to detect anti-HLA Ab. Although the correlation between the assays was present, significant variances exist, some of which can be explained by a dilution-sensitive “prozone” effect.
Predictors of Driving Cessation in Dementia
Authors: Connors Michael H. , Ames David , Woodward Michael , Brodaty Henry
Published: October 2017

A diagnosis of dementia implies the eventual need to relinquish driving. This is associated with significant morbidity and anticipating when it will need to occur can be important for planning. Patients, however, vary in the course of their disease. We sought to identify predictors of driving cessation in patients with dementia, including both baseline characteristics and changes in cognition and function over time as indicators of disease trajectory. A total of 779 patients with dementia were recruited from 9 memory clinics around Australia. Patients and their carers reported their driving status and completed measures of dementia severity, cognition, function, neuropsychiatric symptoms, and medication use at regular intervals over a 3-year period. Of the 247 patients still driving at baseline, 147 (59.5%) stopped driving during the study. Variables that predicted driving cessation included older age; female sex; greater dementia severity and cognitive and functional impairments at baseline; and greater increases in dementia severity and cognitive and functional impairments over 3 and 6 month periods. The findings confirm that easily assessable characteristics, including changes over time, predict future driving status. The findings underscore the value of regularly assessing patients with standardized measures to determine disease trajectory and likely prognosis
Baseline White Matter Hyperintensities and Hippocampal Volume are Associated With Conversion From Normal Cognition to Mild Cognitive Impairment in the Framingham Offspring Study
Authors: Bangen Katherine J. , Preis Sarah R. , Delano-Wood Lisa , Wolf Philip A. , Libon David J. , Bondi Mark W. , Au Rhoda , DeCarli Charles , Brickman Adam M.
Published: October 2017

Introduction:

We examined associations between magnetic resonance imaging (MRI) markers of cerebrovascular disease and neurodegeneration with mild cognitive impairment (MCI) diagnosis at baseline and conversion from normal cognition to MCI at follow-up.

Methods:

Framingham Offspring participants underwent brain MRI and neuropsychological assessment at baseline (n=1049) and follow-up (n=561). Participants were classified at baseline and at follow-up as cognitively normal or MCI using sensitive neuropsychological criteria. White matter hyperintensity (WMH) volume, covert brain infarcts, hippocampal volume, and total cerebral brain volume were quantified.

Results:

Baseline measures of WMH and hippocampal volume were associated with MCI status cross-sectionally and also with conversion from normal cognition to MCI at 6.5-year follow-up. Annualized change rates in total cerebral brain volume and hippocampal volume were associated with conversion from normal cognition to MCI to follow-up.

Discussion:

Baseline WMH and hippocampal volume are markers that are both associated with conversion from normal cognition to MCI, highlighting the role of both vascular lesions and neurodegeneration in MCI.
Real-World Safety and Patient Profile of Fingolimod in Relapsing-Remitting Multiple Sclerosis: A Prospective Analysis in Buenos Aires, Argentina
Authors: Rojas Juan Ignacio , Patrucco Liliana , Miguez Jimena , Cristiano Edgardo
Published: October 2017

Objective

The aim was to evaluate fingolimod safety and patient profiles in a real-world setting in Buenos Aires, Argentina.

Methods

Relapsing-remitting patients with multiple sclerosis who had been prescribed fingolimod and at least 18 months or more of follow-up were included. Demographic, clinical, and safety issues were described during first dose and follow-up.

Results

A total of 145 patients were included, 68% female; mean age, 30 ± 10.5 years; mean disease duration, 6.5 ± 3.1 years; mean fingolimod use, 25 ± 13 months. Eleven patients (7.6%) discontinued fingolimod (7 owing to disease activity/4 owing to desire of pregnancy and personal decisions). Forty-two percent of patients experienced adverse events: headache, fatigue, liver enzyme elevation, and lymphopenia were the most commonly found. No serious cardiac event was reported during the first dose.

Conclusions

The safety and patient profile of fingolimod in a new real-world setting were consistent with information provided from phase III clinical trials.