bluuebunny/crossref_metadata_2025 huggingface dataset:
Whether productive authors using the national health insurance database also achieve higher individual research metrics
Authors: Hsieh Wan-Ting , Chien Tsair-Wei , Kuo Shu-Chun , Lin Hung-Jung
Published: January 2020

Background:

Many researchers use the National Health Insurance Research Database (HIRD) to publish medical papers and gain exceptional outputs in academics. Whether they also obtain excellent citation metrics remains unclear.

Methods:

We searched the PubMed database (www.ncbi.nlm.nih.gov/pubmed) using the terms Taiwan and HIRD. We then downloaded 1997 articles published from 2012 to 2016. An authorship-weighted scheme (AWS) was applied to compute coauthor partial contributions from the article bylines. Both modified x-index and author impact factor (AIF) proved complementary to Hirsch's h-index for calculating individual research achievements (IRA). The metrics from 4684 authors were collected for comparison. Three hundred eligible authors with higher x-indexes were located and displayed on Google Maps dashboards. Ten separate clusters were identified using social network analysis (SNA) to highlight the research teams. The bootstrapping method was used to examine the differences in metrics among author clusters. The Kano model was applied to classify author IRAs into 3 parts.

Results:

The most productive author was Investigator#1 (Taichung City, Taiwan), who published 149 articles in 2015 and included 803 other members in his research teams. The Kano diagram results did not support his citation metrics beyond other clusters and individuals in IRAs.

Conclusion:

The AWS-based bibliometric metrics make individual weighted research evaluations possible and available for comparison. The study results of productive authors using HIRD did not support the view that higher citation metrics exist in specific disciplines.
Head and neck verrucous carcinoma
Authors: Wang Na , Huang Ming , Lv Hong
Published: January 2020

Verrucous carcinoma is a rare variant of squamous cell carcinoma. The oral cavity, genitals, larynx, esophagus, and skin are usually affected, and the head and neck regions are the most affected areas. Few studies reported about head and neck verrucous carcinoma (VC) in the literature. Therefore, we conducted an extensive population-based study about the VCs to use population-based data to further investigate the incidence, treatment, and survival of head and neck verrucous carcinoma.

Patients from Surveillance, Epidemiology, and End Results database (SEER) between 1973 and 2015 were brought into our study. The data of VCs and other head and neck malignancies (OHNMs) patients were extracted for analysis. We compared characteristics of patients with VC with those of patients with OHNMs.

Results were obtained for 2039 cases of VC and 394,739 cases of OHNM. Compared to patients with OHNM, patients with VC were more often female (36.6% vs 31.1%; P < .001), younger (median age 62 vs 67 years; P < .001), and had a smaller tumor size (P < .001). VC cases were of lower histological grade and SEER stage (P < .001). The incidence of VC was 0.075 per 100,000 and decreased over time (annual change −1.855%, P < .001), whereas the incidence of OHNM showed no change. The primary treatment method for VC was surgery, with other treatments showing no significant therapeutic effect.

VC is rare, with a decreasing incident trend. The outcome is better compared with OHNM patients. Surgery could significantly improve VC patients’ prognosis.
Clinicopathologic features and prognostic analysis of Waldeyer ring B-cell lymphoma
Authors: Ma Zhiping , Shi Yi , Pang Xuelian , Li Xinxia , Cui Wenli , Zhang Wei
Published: January 2020

This retrospective study is to explore the clinicopathologic, immunophenotypic, and molecular genetic features of Waldeyer ring B-cell lymphoma (WR-BCL).

Tissue arrays from 65 WR-BCL cases were subjected to pathologic and immunophenotypic detections. Expression of Epstein–Barr virus-encoded small RNA (EBER) was detected by in situ hybridization. Interferon regulatory factor 4 (IRF4), BCL-2, BCL-6, and C-myelocytomatosis viral oncogeneav (MYC) gene abnormalities were investigated using interphase fluorescence in situ hybridization.

Among the 65 patients, there were 12 nasopharynx cases, 49 tonsil cases, and 4 tongue root cases. Moreover, there were 49 cases of diffuse large BCL (DLBCL) and 16 cases of follicular lymphoma (FL). More than 60% of the patients had Ann Arbor stage III/IV disease, with infiltrated neighboring organs, invaded spleens, and increased lactate dehydrogenase (LDH) levels. Tumor cells were positive for multiple myeloma antigen 1 (MUM1), BCL-2, BCL-6, and C-MYC. EBER expression was detected in lymphoma cells of 2 cases. Alteration frequencies of IRF4, BCL-2, BCL-6, and C-MYC were 24.6%, 32.3%, 27.7%, and 30.7%, respectively. Approximately 67.69% cases had stages 0 to II disease, while 32.31% cases had stage III disease. Five-year overall survival rate was 65.12%. Eastern Cooperative Oncology Group performance status (ECOG) score ≥2 was the only adverse factor for overall survival. IRF4/MUM1, C-MYC, and CD10 expressions were related to poor disease prognosis. WR-BCLs were largely dependent on ECOG, LDH, and bone marrow involvement. WR-DLBCL was associated with poor survival outcomes compared with WR-FL.

The WR-DLBCLs have distinct clinicopathologic features, with correlations between the IRF4/MUM1, C-MYC and CD10 expressions, ECOG, LDH, bone marrow involvement, and the disease prognosis.
Liver lobe based intravoxel incoherent motion diffusion weighted imaging in hepatitis B related cirrhosis: Association with child-pugh class and esophageal and gastric fundic varices
Authors: Chen Fan , Chen Yan-li , Chen Tian-wu , Li Rui , Pu Yu , Zhang Xiao-ming , Li Hong-jun , Tang Sun , Cao Jin-ming , Yang Jian-qiong
Published: January 2020

Liver cirrhosis is a common chronic progressive liver disease in clinical practice, and intravoxel incoherent motion (IVIM) is a promising magnetic resonance method to assess liver cirrhosis, so our purpose was to investigate association of liver-lobe-based IVIM-derived parameters with hepatitis-B-related cirrhosis and its severity, and esophageal and gastric fundic varices. Seventy-four patients with hepatitis-B-related cirrhotic and 25 healthy volunteers were enrolled and underwent upper abdominal IVIM diffusion-weighted imaging withb-values of 0, 20, 50, 80, 100, 200, 400, 600, and 800 s/mm2. IVIM-derived parameters (D, pure molecular diffusion;D∗, pseudo diffusion; andf, perfusion fraction) of left lateral lobe (LLL), left medial lobe (LML), right lobe (RL), and caudate lobe (CL) were assessed statistically to show their associations with cirrhosis and its severity, and esophageal and gastric fundic varices. In this research, we found thatD,D∗, andfvalues of LLL, LML, RL, and CL were lower in cirrhotic liver than in normal liver (allP-values <.05).D,D∗, andfvalues of LLL, LML, RL, and CL were inversely correlated with Child–Pugh class of cirrhosis (r = −0.236 to −0.606, allP-values <.05).Dof each liver lobe,D∗of LLL and CL, andfof LLL, LML, and CL in patients with esophageal and gastric fundic varices were lower than without the varices (allP-values <.05).Dvalues of RL and CL could best identify cirrhosis, and identify esophageal and gastric fundic varices with areas under receiver-operating characteristic curve of 0.857 and 0.746, respectively. We concluded that liver-lobe-based IVIM-derived parameters can be associated with cirrhosis, and esophageal and gastric fundic varices.
Pulmonary arteriovenous malformation exhibiting recanalization >10 years after coil embolization
Authors: Takao Shun , Masuda Takeshi , Yamada Takahiro , Yamaguchi Kakuhiro , Sakamoto Shinjiro , Matsushima Hayato , Horimasu Yasushi , Nakashima Taku , Miyamoto Shintaro , Iwamoto Hiroshi , Fujitaka Kazunori , Hamada Hironobu , Hattori Noboru
Published: January 2020

Rationale:

Some patients with pulmonary arteriovenous malformation (PAVM) present with hypoxemia and life-threatening complications, including stroke and cerebral abscess. Catheter embolization is currently the preferred treatment for PAVM. However, previous studies have revealed that the incidence of PAVM recanalization is approximately 10% 5 to 7 years after embolization. In contrast, there are no studies where recanalization has occurred over 10 years after embolization.

Patient concerns:

Herein, we report 2 cases diagnosed with cerebral embolism due to PAVM recanalization 13 years and 30 years after catheter treatment, in case I and II, respectively.

Diagnoses:

Both cases were diagnosed with PAVM recanalization on chest computed tomography (CT) examination performed after cerebral embolism development. Furthermore, pulmonary artery angiography revealed blood flow from the pulmonary artery to the vein in the PAVM, confirming PAVM recanalization.

Interventions:

Coil re-embolization was performed for the all recanalized PAVM.

Outcomes:

All the target lesions were successfully re-embolized in both cases. However, in case I, the second recanalization of embolized PAVM was confirmed 1 year after coil re-embolization. Consequently, the third embolization was performed in case I. In contrast to case I, the patient in case II was followed up without recanalization for 2 years after embolization.

Lessons:

We described the first 2 cases diagnosed with PAVM recanalization >10 years after the first catheter embolization. These cases suggest that patients with PAVMs should undergo life-long follow-up after catheter embolization.
Correlations between ISL1 rs1017 polymorphism and congenital heart disease risk
Authors: Ding Zhaohong , Yang Wenke , Yi Kang , Ding Yunhan , Zhou Dan , Xie Xiaodong , You Tao
Published: January 2020

Background:

ISL1 promotes cardiomyocyte differentiation and plays important roles in heart development. However, whether ISL1 rs1017 polymorphism is associated with the congenital heart disease (CHD) risk remains controversial.

Methods:

Five database including PubMed, Cochrane Library, ISI Web of Science, CNKI, and Wan Fang were searched by using key words “Insulin Gene Enhancer Protein ISL1” and “Single Nucleotide Polymorphism,” and “Congenital Heart Disease.” Five relative articles including 6 independent studies containing 2132 cases and 3812 controls were finally recruited to our study. Meta-analyses were performed by pooling odds ratios (ORs) and 95% confidence interval (CI) from included studies using STATA 12.0 software.

Results:

The associations between ISL1 rs1017 polymorphism and the risk of CHD were statistically significant under the allele model (T vs A; OR: 1.421; 95% CI: 1.072–1.882), heterozygous model (AT vs AA; OR: 1.342; 95% CI: 1.019–1.767), and dominant model (AT+ TT vs AA; OR: 1.466; 95% CI: 1.059–2.028). Sensitivity analysis indicated that the results were not stable. Subgroup analysis demonstrated that associations were found in Caucasians under the allele model and the heterozygous model (P < .05), but not the dominant model (P > .05).

Conclusion:

In summary, our meta-analysis results suggest that the T allele of ISL1 rs1017 is a risk factor for CHD. However, further studies based on large sample size and multi-ethnic population should be conducted to further prove this correlation.
Genetic variant of MAML2 in the NOTCH signaling pathway and the risk of bladder cancer
Authors: Shen Yang , Lu Qian , Ye Hesong , Deng Zhonglei , Ma Long , Zhang Qingling , Tang Jingyuan , Yuan Lin
Published: January 2020

The NOTCH signaling pathway plays a crucial role in cell phenotype and transformation. Single nucleotide polymorphisms (SNPs) may regulate gene expression to trigger bladder cancer susceptibility. Here, we aimed to explore the relationships between genetic variants in the NOTCH pathway and bladder cancer progression.

We screened SNPs located in NOTCH pathway genes using the 1000 Genomes Project dataset (CHB). A case-control cohort study including 580 bladder cancer cases and 1101 controls was conducted to genotype the candidate SNPs. The expression quantitative trait locus (eQTL) and bioinformatics analyses were performed to explore the biological function of the SNPs’ host gene and their relationship. Kaplan–Meier analysis was performed to assess the association between host gene expression and bladder cancer patient prognosis.

The rs7944701 in the intron of mastermind-like 2 (MAML2) had the strongest signal and was related to bladder cancer risk (OR = 1.329, 95% CI = 1.115–1.583, P = .001). eQTL analysis showed that rs7944701 with a C allele was negatively associated with mastermind-like 2 (MAML2) expression (TT versus TC/CC). Bioinformatics analysis indicated that MAML2expression was lower in bladder cancer tissues than in non-tumor tissues (P = 5.46 × 10−3). Additionally, bladder cancer patients with high MAML2 expression had a significantly poorer prognosis (HR = 1.53, 95% CI = 1.29–1.82, P = .010).

The rs7944701 in MAML2 was strongly associated with bladder cancer susceptibility in a Chinese population. This genetic variant and its host gene could be a potential novel biomarker for individuals suffering from bladder cancer.
Histogram analysis with computed tomography angiography for discriminating soft tissue sarcoma from benign soft tissue tumor
Authors: Wu Gang , Xie Ruyi , Li Yitong , Hou Bowen , Morelli John N. , Li Xiaoming
Published: January 2020

To investigate the feasibility of histogram analysis with computed tomography angiography (CTA) in distinguishing between soft tissue sarcomas and benign soft tissue tumors. Fourty nine patients (23 men, mean age = 44.3 years, age range = 25–64) with pathologically-confirmed soft tissue sarcoma (n = 24) or benign soft tissue tumors (n = 25) in the lower extremities undergoing CTA for tumor evaluation were retrospectively analyzed. Two radiologists separately performed histogram analyses of CT density with CTA images by drawing a region of interest (ROI). The 10th (P10), 25th (P25), 50th (P50), 75th (P75), 90th percentiles (P90), mean, and standard deviations (SD) of measured tumor density were obtained along with measurements of the absolute value of kurtosis (AVK), absolute value of skewness (AVS), and inhomogeneity for each tumor. Intra-class correlation coefficients (ICC) were calculated to determine inter- and intra-reader variability in parameter measurements. The Mann–Whitney U test was used to compare histogram parameters between soft tissue sarcomas and benign soft tissue tumors. Receiver operator characteristic (ROC) curves were constructed to evaluate the accuracy of tumor discrimination. ICC was greater than 0.7 for AVS, AVK, and inhomogeneity, and >0.9 for mean, SD, and all percentile measures. There was no significant difference in P10, P25, P50, P75, P90, mean, or SD between soft tissue sarcomas and benign tumors (P > .05). AVS, AVK, and inhomogeneity were significantly higher in soft tissue sarcomas (P < .05). Areas under the curve (AUC) were 0.81, 0.83, and 0.84 for AVS, AVK, and inhomogeneity respectively. AUC were below 0.6 for mean, SD, and all percentiles.

Skewness, kurtosis, and inhomogeneity measurements derived from histogram analysis from CTA distinguish between soft tissue sarcomas and benign soft tissue tumors.
Modified long-axis in-plane ultrasound technique versus conventional palpation technique for radial arterial cannulation
Authors: Wang Jiebo , Lai Zhongmeng , Weng Xianfeng , Lin Yong , Wu Guohua , Su Jiansheng , Huang Qijian , Zeng Jian , Liu Junle , Zhao Zisong , Yan Ting , Zhang Liangcheng , Zhou Linying
Published: January 2020

Background:

A low first-pass success rate of radial artery cannulation was obtained when using the conventional palpation technique (C-PT) or conventional ultrasound-guided techniques, we; therefore, evaluate the effect of a modified long-axis in-plane ultrasound technique (M-LAINUT) in guiding radial artery cannulation in adults.

Methods:

We conducted a prospective, randomized and controlled clinical trial of 288 patients undergoing radial artery cannulation. Patients were randomized 1:1 to M-LAINUT or C-PT group at Fujian Medical University Union Hospital between 2017 and 2018. Radial artery cannulation was performed by 3 anesthesiologists with different experience. The outcome was the first and total radial artery cannulation success rates, the number of attempts and the cannulation time, and incidence of complications.

Results:

Two hundred eighty-five patients were statistically analyzed. The success rate of first attempt was 91.6% in the M-LAINUT group (n = 143) and 57.7% in the C-PT group (n = 142; P < .001) (odds ratio, 7.9; 95% confidence interval, 4.0–15.7). The total success rate (≤5 minutes and ≤3 attempts) in the M-LAINUT group was 97.9%, compared to 84.5% in the palpation group (P < .001) (odds ratio, 8.5; 95% confidence interval, 2.5–29.2). The total cannulation time was shorter and the number of attempts was fewer in the M-LAINUT group than that in the C-PT group (P < .05). The incidence of hematoma in the C-PT group was 19.7%, which was significantly higher than the 2.8% in the M-LAINUT group (P < .001).

Conclusions:

Modified long-axis in-plane ultrasound-guided radial artery cannulation can increase the first and total radial artery cannulation success rates, reduce the number of attempts, and shorten the total cannulation time in adults.
Rosai–Dorfman disease manifesting as epibulbar and orbital tumor
Authors: Huang Qing , Cai Hong , He Weimin
Published: January 2020

Rationale:

Rosai-Dorfman disease (RDD) is a rare nonmalignant cell histiocytosis. Here, we report a rare, unusual clinical presentation of epibulbar and orbital tumor as a manifestation of RDD. We also review the literatures on clinical cases of orbital RDD.

Patient concerns:

A 44-year-old Chinese male was admitted with a 3-month history of eye redness, subconjunctival mass, and diplopia.

Diagnosis:

An initial diagnosis of epibulbar and orbital tumor was made according to the clinical symptoms, signs, and pre-operative contrast-enhanced computerized tomography results.

Interventions:

The mass was completely resected and pathology confirmed the RDD diagnosis. The patient received steroids after surgery.

Outcomes:

The patient recovered well on 18-month follow-up.

Conclusion:

This appears to be the first report of RDD manifesting as epibulbar and orbital tumor. Pre-operative diagnosis of RDD remains challenging. When the lesion causes diplopia, surgical resection is the most effective treatment.
Impact of Peer Specialist Services on Residential Stability and Behavioral Health Status Among Formerly Homeless Veterans With Cooccurring Mental Health and Substance Use Conditions
Authors: Ellison Marsha L. , Schutt Russell K. , Yuan Lo-Hua , Mitchell-Miland Chantele , Glickman Mark E. , McCarthy Sharon , Smelson David , Schultz Mark R. , Chinman Matthew
Published: January 2020

Objectives:

This study tested the impacts of peer specialists on housing stability, substance abuse, and mental health status for previously homeless Veterans with cooccurring mental health issues and substance abuse.

Methods:

Veterans living in the US Housing and Urban Development—Veterans Administration Supported Housing (HUD-VASH) program were randomized to peer specialist services that worked independently from HUD-VASH case managers (ie, not part of a case manager/peer specialist dyad) and to treatment as usual that included case management services. Peer specialist services were community-based, using a structured curriculum for recovery with up to 40 weekly sessions. Standardized self-report measures were collected at 3 timepoints. The intent-to-treat analysis tested treatment effects using a generalized additive mixed-effects model that allows for different nonlinear relationships between outcomes and time for treatment and control groups. A secondary analysis was conducted for Veterans who received services from peer specialists that were adherent to the intervention protocol.

Results:

Treated Veterans did not spend more days in housing compared with control Veterans during any part of the study at the 95% level of confidence. Veterans assigned to protocol adherent peer specialists showed greater housing stability between about 400 and 800 days postbaseline. Neither analysis detected significant effects for the behavioral health measures.

Conclusions:

Some impact of peer specialist services was found for housing stability but not for behavioral health problems. Future studies may need more sensitive measures for early steps in recovery and may need longer time frames to effectively impact this highly challenged population.
Optimal therapeutic strategies for mixed phenotype acute leukemia
Authors: Wolach Ofir , Stone Richard M.
Published: January 2020

Purpose of review

Mixed phenotype acute leukemia (MPAL) encompasses a rare group of clinically, immunophenotypically, and genetically diverse leukemias. Diagnosing and treating these patients remains challenging. In recent years, systematic efforts have been made to better define the genetic landscape of MPAL. These insights allow better understanding of the pathophysiology of MPAL, have the potential for a more biologically meaningful classification and may promote targeted, novel approaches to treat these leukemias.

Recent findings

Recent studies suggest that MPALs originate in a multipotent primitive cell, demonstrate large genetic diversity and include subgroups that may benefit from targeted therapy. Recent data support the use of ALL-type induction followed by allogeneic stem cell transplantation in first remission for most adults. Novel targeted approaches hold promise for treatment of MPAL; however, some may unpredictably select for clonal expansion of cells from a different lineage than observed at presentation.

A biologically and genetically driven classification of MPAL may yield more accurate prognosis and potentially direct therapy in patients with MPAL. Prospective efforts that incorporate targeted approaches based on genetics and immunophenotype are warranted.
Recent advances in allogeneic hematopoietic cell transplantation for acute myeloid leukemia
Authors: Gomez-Arteaga Alexandra , Gyurkocza Boglarka
Published: January 2020

Purpose of review

Allogeneic hematopoietic cell transplantation (HCT), with associated graft-versus-leukemia effects, remains the best postremission strategy for patients with intermediate or high-risk acute myeloid leukemia (AML), with a curative potential. Here, we highlight recent advances in allogeneic HCT that broadened access, refined prognostication, and improved outcomes of AML patients undergoing this procedure.

Recent findings

Eligibility for allogeneic HCT continued to expand to AML patients older than 60 years, as well as to patients lacking human leukocyte antigen (HLA)-matched donors with the advent of alternative donor sources, such as umbilical cord blood and HLA-haploidentical transplantation. Molecular profiling of AML has redefined prognostication for patients in specific AML genomic subgroups undergoing allogeneic HCT and has served as a new strategy for measuring minimal residual disease before and after allogeneic HCT. Using high intensity conditioning regimens has emerged as a potential strategy to reduce risk of relapse and improve overall survival, especially in patients with minimal residual disease prior to allogeneic HCT.

As access to allogeneic HCT continues to improve, also, with more refined prognostic strategies, the field continues to move to optimize transplantation approaches by decreasing the risk of relapse and minimizing transplant-related complications.
Coping and Its Relation to PTSD in Greek Firefighters
Authors: Theleritis Christos , Psarros Constantin , Mantonakis Leonidas , Roukas Dimitris , Papaioannou Angeliki , Paparrigopoulos Thomas , Bergiannaki Joanna Despoina
Published: January 2020

Firefighters are exposed continuously to intense stress situations and traumatic incidents, and are at high risk of developing posttraumatic stress disorder (PTSD). Coping mechanisms and behaviors have been examined as factors contributing to PTSD. The strategies that may be used to cope with stress and/or trauma differ between individuals and also between different professions and traumatic events (Nydegger et al., 2011). Although there is a vast literature on stress and coping processes that exists, very few studies investigated the way individual firefighters cope with trauma. Among several questionnaires that have been used to examine the effects of different types of coping mechanisms after traumatic incidents is the Albert Einstein College of Medicine–Coping Style Questionnaire (AECOM-CSQ; Plutchik and Conte, 1989). In August 2007, large areas in the Peloponnese, Greece, were devastated by wildfires. One month after the event, experienced researchers visited the affected area to provide psychological support and to investigate the psychosocial consequences among the local professional firefighters. One hundred two firefighters that were on duty for the entire period of firefighting (several days) were interviewed using several questionnaires, among them the AECOM-CSQ. Our hypothesis was that firefighters who presented with PTSD would be more inclined toward engaging in avoidance coping mechanisms. A total of 18.6% of the firefighters were found to have PTSD according to ICD-10 criteria. Logistic regression showed that firefighters using the coping mechanisms of minimization and blame were associated with the greater likelihood of PTSD. It seems that specific coping mechanisms used by firefighters immediately after the traumatic event might contribute to the development of PTSD.
Hemangioblastoma-like Clear Cell Stromal Tumor of the Lung
Authors: Lindholm Kaleigh E. , Moran Cesar A.
Published: January 2020

Five cases of an unusual primary benign stromal tumor designated as hemangioblastoma-like clear cell stromal tumor of the lung are presented. The patients are 4 women and 1 man between the ages of 39 and 52 years of age (average: 45.5 y). The patients presented with nonspecific symptoms of cough, chest pain, or dyspnea. None of the patients had any prior history of malignancy or tumor elsewhere. Diagnostic imaging showed the presence of an intrapulmonary tumor. Lobectomy was performed in all 5 patients. Grossly, the tumors were well-demarcated but not encapsulated with focal areas of hemorrhage without necrosis. Histologically, low power examination showed a cellular proliferation alternating with discrete dilated vessels reminiscent of a vascular neoplasm. Higher magnification showed medium-sized cells with clear cytoplasm arranged in sheets and cords. Mitotic activity and marked cellular atypia were not present. A wide panel of immunohistochemical studies was performed including epithelial, neural, muscle, vascular, and neuroendocrine markers, all of which showed negative staining. Tumor cells showed positive staining for vimentin. In 2 cases, fluorescence in situ hybridization for the solitary fibrous tumor was performed and was negative. Clinical follow-up in 3 patients showed no evidence of recurrence. The cases herein presented highlight an unusual benign stromal tumor of the lung, which needs to be considered in the differential diagnosis of tumors with a clear cell and vascular appearance.
Implementation of Targeted Point of Care HIV Testing in a Pediatric Emergency Department
Authors: Bhatt Seema R. , Eckerle Michelle D. , Reed Jennifer L. , Robinson Venita , Brown Angela , Lippe Joyce , Holland Carolyn , Iyer Srikant
Published: January 2020

Introduction:

HIV infection rates are increasing among adolescents. Despite guidelines recommending annual HIV screening among sexually active adolescents, 3.6% of adolescents tested for other sexually transmitted infections (STI) in a pediatric emergency department (PED) were screened for HIV. The aim was to increase HIV screening to 90%.

Methods:

Interventions were designed to address 4 key drivers thought to be critical in reliably offering HIV testing. The primary outcome measure was the proportion of adolescents offered HIV testing among those being tested for common STIs. Statistical process control charts were used to measure performance over time and differentiate common versus special cause variation.

Results:

We instituted point of care (POC) HIV testing in the PED in January 2012. The proportion of STI tested patients offered HIV testing was increased to >87% and sustained this performance. Implementation of a clinical decision support tool had the highest impact. The majority offered testing agreed, and the most common reason for refusal was a recent negative test. We identified eleven HIV positive patients over 5 years. Eight were newly diagnosed, and 3 had prior positive tests but were not connected to care. All 11 were successfully connected to providers with HIV care expertise.

Conclusions:

POC HIV testing is feasible, acceptable, and sustainable in a PED setting. The implementation of targeted HIV POC testing in the PED increased the number of HIV tests being offered, the number of high-risk patients being screened, and the number diagnosed and connected to care.
Effects of Eradication of HCV on Cardiovascular Risk and Preclinical Atherosclerosis in HIV/HCV-Coinfected Patients
Authors: Carrero Ana , Berenguer Juan , Hontañón Víctor , Navarro Jordi , Hernández-Quero José , Galindo María J. , Quereda Carmen , Santos Ignacio , Téllez María J. , Ortega Enrique , Sanz José , Medrano Luz M. , Pérez-Latorre Leire , Bellón José M. , Resino Salvador , Bermejo Javier , González-García Juan ,   GeSIDA 3603b Study Group
Published: January 2020

Background:

To assess the effects of eradication of hepatitis C virus (HCV) on cardiovascular risk (CVR) and preclinical atherosclerosis in HIV/HCV-coinfected patients.

Setting:

Prospective cohort study.

Methods:

We assessed serum lipids, 10-year Framingham CVR scores, pulse wave velocity, carotid intima–media thickness, and biomarkers of inflammation and endothelial dysfunction (BMKs) at baseline and 96 weeks (wk) after initiation of anti-HCV therapy (Rx) in HIV/HCV-coinfected patients.

Results:

A total of 237 patients were included. Anti-HCV therapy comprised pegylated interferon and ribavirin plus 1 direct-acting antiviral in 55.2%, pegylated interferon and ribavirin in 33.8%, and all-oral direct-acting antiviral in 11.0%. A total of 147 (62.0%) patients achieved sustained viral response (SVR). Median increases in low-density lipoprotein cholesterol in patients with and without SVR were 14 mg/dL and 0 mg/dL (P= 0.024), respectively. Increases in CVR categories were found in 26.9% of patients with SVR (P= 0.005 vs. baseline) and 8.1% of patients without SVR (P= 0.433). This resulted in a significant interaction between SVR and CVR over time (P< 0.001). No significant effect of SVR was observed for pulse wave velocity (P= 0.446), carotid intima–media thickness (P= 0.320), and BMKs of inflammation and endothelial dysfunction.

Conclusions:

In coinfected patients, eradication of HCV had no effect on markers of preclinical atherosclerosis and BMKs of inflammation and endothelial dysfunction but was associated with a clinically relevant rise in serum low-density lipoprotein cholesterol. Evaluation of CVR should be an integral part of care after the cure of chronic hepatitis C in patients with HIV.
Impaired Cognition Predicts Falls Among Women With and Without HIV Infection
Authors: Sharma Anjali , Vance David E. , Hoover Donald R. , Shi Qiuhu , Yin Michael T. , Holman Susan , Plankey Michael W. , Tien Phyllis C. , Weber Kathleen M. , Floris-Moore Michelle , Bolivar Hector H. , Golub Elizabeth T. , McDonnell Holstad Marcia , Rubin Leah H.
Published: January 2020

Objective:

To determine whether domain-specific neurocognitive (NC) impairments predict falls in HIV+ compared with HIV− women.

Design:

Cross-sectional data analysis from 825 HIV+ and 392 HIV− women in the Women's Interagency HIV Study with NC testing within 2 years before falls surveys.

Methods:

NC impairment (T score <40) was assessed in 7 domains: executive function, psychomotor speed, attention, learning, memory, fluency, and fine motor function. For domains associated with any fall within 6 months in simple logistic regression (P < 0.05), hierarchical regression models evaluated associations between NC impairment and odds of falling, adjusting for: (1) study site and HIV, (2) demographics, (3) comorbid conditions, (4) substance use/central nervous system active medications, and HIV-specific factors.

Results:

Median age was higher in HIV+ than HIV− women (51 vs. 48 yrs); prevalence of falls was similar (19% HIV+, 16% HIV−). Overall, executive function [OR (odds ratio) = 1.82, 95% CI (confidence interval): 1.21 to 2.74; P = 0.004], psychomotor speed (OR = 1.59, 95% CI: 1.05 to 2.42, P = 0.03), and fine motor (OR 1.70, 95% CI: 1.11 to 2.61, P = 0.02) impairments were associated with greater odds of falls in fully adjusted models. In fully adjusted models, associations of executive function, psychomotor speed, and fine motor were nonsignificant among HIV+ women; conversely, among HIV− women, associations with impaired executive and fine motor functions were strengthened and remained significant.

Conclusions:

Cognitive impairment was associated with falls among middle-aged HIV− but not HIV+ women. Additional studies should elucidate mechanisms by which domain-specific NC impairment impacts fall risk among older HIV+ and HIV− women and how different factors modify relationships between cognition and falls.
Time to Viral Suppression in Perinatally HIV-Infected Infants Depends on the Viral Load and CD4 T-Cell Percentage at the Start of Treatment
Authors: Schröter Juliane , Anelone Anet J.N. , Yates Andrew J. , de Boer Rob J. ,   on behalf of the EPIICAL Consortium
Published: January 2020

Background:

Interventions aiming for an HIV cure would benefit from rapid elimination of virus after the onset of antiretroviral therapy (ART), by keeping the latent HIV reservoir small.

Setting:

We investigated HIV suppression in 312 perinatally infected infants starting ART within 6 months after birth from the EPPICC (European Pregnancy and Paediatric HIV Cohort Collaboration).

Methods:

To better understand kinetic differences in HIV suppression among infants, we investigated their individual viral load (VL) decay dynamics. We identified VL decay patterns and determined times to viral suppression (TTS). For infants with strictly declining VLs (n = 188), we used parameter fitting methods to estimate baseline VLs, decay rates, and TTS. We subsequently identified the parameters determining TTS by linear modeling.

Results:

The majority of infants suppress HIV VL after the onset of ART. Some children experienced a long TTS due to an “erratic” VL decay pattern. We cannot exclude that this is partly due to treatment complications and subsequent treatment changes, but these children were characterized by significantly lower CD4 percentages (CD4%) at start of treatment compared with those with a “clean” VL decline. Focusing on this “clean” subset, the TTS could be predicted by mathematical modeling, and we identified baseline VL and CD4% as the major factors determining the TTS.

Conclusions:

As VL steeply increases and CD4% constantly decreases in untreated HIV-infected infants, the progression of an HIV infection is largely determined by these 2 factors. To prevent a further disease progression, treatment should be initiated early after contracting HIV, which consequently shortens TTS.
Brief Report: Interferon-γ–Inducible Protein 10—A Potential Marker for Targeted Viral Load Monitoring of Antiretroviral Treatment?
Authors: Reepalu Anton , Arimide Dawit A. , Balcha Taye Tolera , Björkman Per , Medstrand Patrik
Published: January 2020

Background:

The use of surrogate markers for targeting viral load (VL) testing could be an alternative to universal VL testing during antiretroviral treatment (ART) and would allow for more effective resource allocation. We investigated the correlation between levels of HIV RNA and interferon-γ–inducible protein 10 (IP-10) in Ethiopian adults at 12 months after ART initiation. In addition, we specifically investigated differences in IP-10 levels between patients with and without virological suppression.

Setting:

Cohort of HIV-positive adults receiving ART at Ethiopian health centers.

Methods:

Using a nested case–control design, individuals without virological suppression (HIV RNA ≥ 150 copies/mL) at 12 months after ART initiation were gender-matched with virologically suppressed controls (1:2 ratio). IP-10 levels were correlated with HIV RNA, and the distribution of IP-10 was compared for 3 VL strata: <150 copies/mL (VL < 150), 150–999 copies/mL (VL150-999), and ≥1000 copies/mL (VL ≥ 1000).

Results:

At 12 months after ART initiation, the following VL distribution was found among 192 individuals (50% women): VL < 150, 122/192 (63.5%); VL150-999, 23/192 (12.0%); and VL ≥ 1000 47/192 (24.5%). IP-10 and HIV RNA levels were positively correlated (r = 0.481; P < 0.0001). Median IP-10 levels for the VL strata were VL < 150: 159 pg/mL [interquartile range (IQR) 121–246], VL150-999: 174 pg/mL (IQR 131–276), and VL ≥ 1000: 343 pg/mL (IQR 190–529), respectively. These differences were statistically significant for VL ≥ 1000 versus VL < 150 (adjusted P < 0.001) and VL150-999 (adjusted P = 0.004), respectively.

Conclusions:

IP-10 and HIV RNA levels during ART showed significant correlations, with significantly higher IP-10 concentration in ART recipients with VL ≥ 1000 copies/mL compared to those with suppressed or undetectable VL.
Assessment of Lung Cancer Development in Idiopathic Pulmonary Fibrosis Patients Using Quantitative High-Resolution Computed Tomography
Authors: Palmucci Stefano , Torrisi Sebastiano E. , Falsaperla Daniele , Stefano Alessandro , Torcitto Alfredo G. , Russo Giorgio , Pavone Mauro , Vancheri Ada , Mauro Letizia A. , Grassedonio Emanuele , Sambataro Gianluca , Puglisi Silvia , Piciucchi Sara , Tomassetti Sara , Poletti Venerino , Basile Antonio , Vancheri Carlo
Published: January 2020

Purpose:

The purpose of this study was to investigate histogram-based quantitative high-resolution computed tomography (HRCT) indexes in the assessment of lung cancer (LC) development in idiopathic pulmonary fibrosis (IPF) patients.

Materials and Methods:

From IPF databases of 2 national respiratory centers, we retrospectively studied patients with and without LC development—respectively, divided into Group A (n=16) and Group B (n=33). The extent of fibrotic disease was quantified on baseline and follow-up HRCT examinations using kurtosis, skewness, percentage of high attenuation area (HAA%), and percentage of fibrotic area (FA%). These indexes were compared between the 2 groups using the Mann-Whitney U test. In the prediction of LC development, receiver operating characteristic analysis was performed to assess threshold values of HRCT indexes.

Results:

At baseline, no difference was reported among groups for kurtosis, skewness, HAA%, and FA%, with P-values of 0.0881, 0.0606, 0.0578, and 0.0606, respectively. On follow-up, significant differences were reported, with P-values of 0.0174 for kurtosis, 0.0313 for skewness, 0.0297 for HAA%, and 0.0407 for FA%.

On baseline HRCT, in the prediction of LC development, receiver operating characteristic analysis reported sensibility and specificity of 87.5% and 45.45% for kurtosis, 68.75% and 63.64% for skewness, 81.25% and 54.55% for FA%, and 75% and 60.61% for HAA%.

Conclusions:

LC development is associated with progression of fibrosis; at baseline, FA% and HAA% reported more convenient sensitivity/specificity ratios in the prediction of LC development.
Pericardial Fat Enhancement
Authors: Kallianos Kimberly G. , Lorca Maria C. , Moraes Gustavo L. , Devcic Zlatko , Lobach Iryna , Ordovas Karen G.
Published: January 2020

Purpose:

Studies have shown a modest association between pericardial fat volume (PFV) and coronary artery disease (CAD), potentially mediated by local inflammation. We aimed to investigate the association between a new biomarker of pericardial fat inflammation, named pericardial fat enhancement (PFE), and the severity of CAD on coronary computed tomography angiography (CCTA).

Materials and Methods:

We evaluated 114 patients referred for CCTA from 2007 to 2011. PFV, presence of obstructive CAD, and the burden of CAD were determined. PFE was measured in 10 mm2 regions of interest, adjusted to aortic enhancement (aPFE). The population was divided into those with greater than median (G-PFE) versus less than median pericardial fat enhancement (L-PFE). Stratified adjusted logistic regressions were performed. A P-value <0.05 was considered significant. The study was approved by our institutional review board.

Results:

Patients were 54.3±14.8 years of age, and 57/114 (50%) were male individuals, with body mass index of 27.3±6.3. There was an independent association between CAD severity and PFV. There was a significant independent association between PFV and obstructive CAD (odds ratio=1.26, P=0.005), and PFV and burden of CAD (odds ratio=1.25, P=0.05) in those with greater PFE. However, there was no significant association between obstructive CAD and CAD burden in either adjusted model for patients with less PFE.

Conclusions:

Our results suggest that PFE influences significantly the relationship between PFV and CAD, supporting the hypothesis of local pericardial fat inflammation as a mechanism for CAD development.
Program Director Survey of Aesthetic Plastic Surgery Fellowships in the United States
Authors: Brown Ciara A. , Nahai Foad , Miotto Gabriele C.
Published: January 2020

Background

Aesthetic surgery is a core component of plastic and reconstructive surgery. In 2014, the Accreditation Council for Graduate Medical Education established aesthetic surgery minimums for plastic surgery residents in training. Although many plastic surgery graduates successfully enter practice as an attending plastic surgeon after completion of plastic surgery training, others choose subspecialization. Aesthetic surgery fellowships offer further instruction in surgical and nonsurgical aesthetic procedures in addition to a unique opportunity for mentorship. The American Society for Aesthetic Plastic Surgery currently endorses 25 aesthetic fellowships. However, the literature regarding fellowship specifics is lacking.

Objectives

This study aimed to better define the current aesthetic surgery fellowships programs regarding operative experience, fellowship autonomy, program strengths, didactic learning, research experience/opportunities, compensation, and geographic region.

Methods

This study was performed by Emory University, Division of Plastic and Reconstructive Surgery, Atlanta, Georgia. In February 2019, an anonymous survey was sent via e-mail to all American Society for Aesthetic Plastic Surgery–endorsed aesthetic fellowship program directors. Three weeks later, a reminder e-mail was sent. No incentives were provided for survey completion.

Results

A 40% survey response rate was achieved (10/25). Aesthetic surgery fellowships are diverse in exposure, number of procedures, and training environment. In all programs, the fellow functioned as the first assistant in most cases. The percentages of face, breast, and total body procedures varied greatly among fellowships, as well as fellow involvement in critical portions of a case. Nearly all fellowships (9/10) offered a fellow's clinic. Didactic learning and research are components of all programs.

Conclusion

This study provides an overview of the current state of plastic surgery aesthetic fellowships in the United States, serving as the first of its kind.
A Systematic Review of Learning Curves in Plastic and Reconstructive Surgery Procedures
Authors: Tapking Christian , Kowalewski Karl-Friedrich , Hundeshagen Gabriel , Kneser Ulrich , Hirche Christoph
Published: January 2020

Background

Surgical learning curves reflect the trainee's rate of progress in gaining skills and competence for new procedures. Complex interventions such as free tissue transfers, with various linked skills and competences, transferred to one procedure are likely to have steep learning curves. This work aimed to report influence of learning curves on outcomes such as success rate, operative time, and complication rates in plastic surgery procedures.

Methods

The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic database literature search (PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trails) was performed. Articles were included when reporting effects of learning curves on outcomes in plastic surgery procedures.

Results

Twenty-nine articles focusing on learning curves in plastic surgery procedures were included. Studies reported on non–free flap breast reconstruction, mastectomy, and free flap reconstruction in general and for breast reconstruction and did not allow for pooling of the data because of heterogeneity. Most common outcomes for measuring improvements were success rate, operation time, and complication rate, which demonstrated improvements in almost all studies. Plateaus were reached in 45 to 100 cases for breast reconstructions and were not reported for other procedures. Only 2 studies did not find associations between surgical experience and clinical outcomes.

Conclusions

There are sparse data on learning curves in plastic surgery. Existing studies draw a heterogeneous picture, but especially free flap breast reconstructions seem to undergo learning curves with improvements in operative time, complication rates, and success rates. However, well-designed studies with clearly defined outcomes and comparison between surgeons of different levels over time should be performed.

Systematic review registration: PROSPERO: CRD42018108634
Complement Activation in Human Sepsis is Related to Sepsis-Induced Disseminated Intravascular Coagulation
Authors: Abe Tomohiro , Kubo Keisuke , Izumoto Shintaro , Shimazu Shihoko , Goan Atsushi , Tanaka Tatsuya , Koroki Takatoshi , Saito Katsutoshi , Kawana Ryo , Ochiai Hidenobu
Published: January 2020

Introduction:

In human sepsis, little is known about the relationships between complement activation and the clinical characteristics of sepsis, including disseminated intravascular coagulation (DIC), interventions, and prognosis.

Patients and Methods:

Adult patients with sepsis admitted from November 2016 to December 2018 were included. We used the plasma levels of soluble C5b-9 (SC5b-9) as a marker of complement activation. We compared the clinical characteristics and complement components between patients with and without DIC. We also compared the clinical characteristics and each DIC parameter across quartile groups for the SC5b-9 value.

Results:

Forty-nine sepsis patients were eligible. Thirty-four patients developed DIC, and eight patients died. The median (interquartile range) SC5b-9 value was 342 (261–501) ng/mL. Compared with patients without DIC, patients with DIC showed lower C3 levels (mean, 95.7 vs. 70.4 mg/dL, P < 0.01) and higher SC5b-9 levels (median, 287 vs. 400 ng/mL, P = 0.01). Patients were stratified by SC5b-9 quartile (ng/mL: low: < 260, moderate: 260–342, high: 343–501, highest: > 501). The mean Sequential Organ Failure Assessment score varied across these groups (P = 0.02). In the high and highest groups, many more patients received vasopressors and developed DIC. In the highest group, the coagulation parameters were severe, and thrombocytopenia was prolonged. In-hospital mortality tended to be high (33%) in the highest group.

Conclusions:

The degree of complement activation is related to DIC, severity, intensive interventions, and mortality. Further studies are needed to confirm the usefulness of SC5b-9 for stratifying sepsis patients.