bluuebunny/crossref_metadata_2025 huggingface dataset:
Optimal cutoff value for assessing changes in intrahepatic fat amount by using the controlled attenuation parameter in a longitudinal setting
Authors: Ahn Sang Bong , Jun Dae Won , Kang Bo-kyeong , Kim Mimi , Chang Misoo , Nam Eunwoo
Published: December 2018

The controlled attenuation parameter (CAP) has shown a good correlation with the intrahepatic fat amount in cross-sectional studies. However, there is no study on whether the change of CAP scores can also show good correlation in a longitudinal setting. Therefore, we investigated the correlation between CAP and magnetic resonance imaging-estimated proton density fat fraction (MR PDFF) through serial examination in a longitudinal setting.

Sixty-five patients with nonalcoholic fatty liver disease were evaluated with MR PDFF and transient elastography including CAP at baseline and 3 months later.

The CAP and MR PDFF at baseline showed a strong correlation in assessing hepatic steatosis (r = 0.66, P < .001). After treatment, the correlation between the change in CAP after treatment and the intrahepatic fat change (%) on MR PDFF was not satisfactory (r = 0.37, P = .005) in the longitudinal setting. The optimal cutoff value of the change in CAP for discriminating an improvement or an aggravation in intrahepatic fat percentage (>1% change in MR PDFF) was selected as 38 dB/m (area under the receiver operating characteristic curve = 0.559). For CAP changes > 38 dB/m, the predictive value was 14/16 (87.5%), whereas for changes < 38 dB/m, the predictive value was 12/41 (29.3%). Thereby, the accuracy of the method using the change in CAP was only 26/57 (46%). In addition, Cohen's kappa value was not significant (κ=0.11, P = .186).

Careful interpretation of the steatosis change based on the CAP score is needed when the absolute change value is < 38 dB/m in a longitudinal setting.
Intravoxel incoherent motion and diffusion kurtosis imaging for discriminating soft tissue sarcoma from vascular anomalies
Authors: Wu Gang , Liu Xuanlin , Xiong Yan , Ran Jun , Li Xiaoming
Published: December 2018

To investigate the feasibility of intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) and diffusion kurtosis imaging (DKI) in discriminating soft tissue sarcoma from vascular anomalies.

Twenty-two patients with lower extremity soft tissue sarcoma and 15 patients with lower extremity vascular anomalies underwent IVIM-DWI and DKI. IVIM model generated true diffusion (D), perfusion fraction (f), and pseudo-diffusion coefficient (D∗). DKI model generated mean kurtosis (MK) and mean diffusion (MD). These parameters were measured by 2 radiologists separately through drawing region of interest. Intraclass correlation coefficient (ICC) was calculated to evaluate the inter-reader viability in measurement. The Mann–Whitney test was used to compare the parameters between vascular anomalies and soft tissue sarcoma. Receiver operating characteristic curves were constructed for assessing diagnostic accuracies.

ICC was more than 0.8 for apparent diffusion coefficient (ADC), D, D∗, f, MK, and MD. Mean ADC, D, and MD were significantly lower in soft tissue sarcoma versus vascular anomalies (P < .05). Mean D∗ and f were not significantly different (P > .05). Soft tissue sarcoma had significantly higher MK than vascular anomalies (P < .05). Areas under curve for ADC, D, MK, and MD were 0.876, 0.885, 0.894, and 0.812, respectively.

IVIM and DKI are feasible in discriminating soft tissue sarcoma from vascular anomalies.
Acupuncture for gender differences and similarities in cerebral activity of health volunteers
Authors: Li Ang , Wang Yuan-hong , Zhang Fan , Wang Feng , Zeng Xiang-xin , Yue Jin-huan , Li Xiao-ling , Zhang Qin-hong
Published: December 2018

This study aimed to explore the feasible gender differences and similarities in cerebral activity response to the acupuncture at local acupoints around knee.

Fifteen male and 15 female healthy adults were recruited and included in this study. Functional magnetic resonance imaging (fMRI) was applied to measure cerebral activity response to acupuncture at Liangqiu (ST34), Xuehai (SP-10), Neixiyan (EX-LE4), and Dubi (ST-35).

Acupuncture activated the postcentral gyrus, precuneus, temporal, posterior lobe, and occipital lobe in both males and females. When compared with females, males showed brain activation in the right middle frontal gyrus, inferior frontal gyrus, right precuneus, right superior parietal lobule, left cerebellum anterior lobe; and brain deactivation in the right frontal. When compared with males, females were observed brain activation in the right frontal lobe, right parietal lobe, and right middle temporal gyrus; and brain deactivation in the left and right medial frontal gyrus.

The results of this study demonstrated that the neural effects of local acupoints around knee might be different between male and female subjects. Further clinical trials should take this gender effect into account in their design of studies.
Acquired renal glucosuria in an undifferentiated connective tissue disease patient with a SLC5A2 heterozygous mutation
Authors: Gu Xiangchen , Chen Min , Xu Yanqiu , Wang Yi
Published: December 2018

Introduction:

Renal glucosuria is a renal tubular disorder caused by genetic conditions, drugs, and poisons. Mutations in the SLC5A2 gene are recently found to be responsible for the inherited renal glucosuria, while undifferentiated connective tissue disease (UCTD) was not considered pathogenic for renal glucosuria. Here, we present a case of acquired renal glucosuria in a UCTD patient.

Patient concerns:

A 30-year-old woman was seen in the outpatient clinic for complaints of frequent urination and dysuria. Laboratory tests showed a urinary tract infection (UTI) and persistent renal glucosuria. After antibiotic treatment, the UTI symptoms were relieved, but the renal glucosuria remained.

Diagnosis:

Laboratory tests ruled out renal tubular acidosis and diabetes mellitus. Genetic analysis showed a heterozygous mutations in the SLC5A2 gene. Meanwhile, immunological tests showed a high antinuclear antibody titer (1:160) and an elevated anti-Rho/SSA antibody level. Schirmer test, tear breakup time, and lip biopsy results were all negative. The patient did not meet the criteria for any known connective diseases. Therefore, she was diagnosed with UCTD. Interventions: The patient was started with the treatment of Hydroxychloroquine.

Outcomes:

Hydroxychloroquine treatment resolved the renal glucosuria. The patient's follow- up urinalysis showed no glucosuria at all.

Lessons:

This is the first case report to demonstrate that UCTD may induce renal glucosuria in a patient with a heterozygous mutation in SLC5A2. This case suggests that during the process of diagnosing renal glucosuria, in addition to familial renal glucosuria (FRG), autoimmune diseases, though rare, should also be taken into consideration.
Spontaneous vaginal cuff dehiscence and evisceration of multiple organs
Authors: Zhou Yan , Zhang Yichao , Liu Weicheng , Zhang Wei , Wang Xiwen , Yu Xueqiao , Ding Zhao , Gong Zhilin , Jiang Congqing , Qian Qun
Published: December 2018

Rationale:

Vaginal cuff dehiscence and evisceration constitute a rare but potentially life-threatening event that usually occurs in postmenopausal patients who have undergone hysterectomy. This is a valuable case of spontaneous transvaginal evisceration without pelvic surgery history.

Patient concerns:

A 74-year-old postmenopausal woman with an obstetric history of 7 full term vaginal deliveries, experienced sudden evisceration when she attempted to defecate.

Diagnoses:

Spontaneous vaginal cuff dehiscence and multiorgan evisceration.

Interventions:

After physical examination and fluid resuscitation, the patient had underwent the Hartmann's procedure, total hysterosalpingo-oophorectomy, sacrocolpopexy, and posterior colporrhaphy.

Outcomes:

The patient recovered well and the constipation symptoms have significantly improved. One-year follow-ups examination revealed complete healing of the vaginal cuff, and there was no evidence of prolapse.

Lessons:

We report a case of spontaneous vaginal cuff evisceration without pelvic surgery history but with constipation and redundant sigmoid colon. After resecting the necrotic sigmoid colon, the patient's constipation symptoms significantly improved. It is reasonable to speculate that the etiology was related to severe sigmoidocoele.
Chinese herbal medicine for recurrent aphthous stomatitis: a protocol for systematic review and meta-analysis
Authors: Zhang Ying , Ng Kwan-him , Kuo Chih-yu , Wu Dong-jie
Published: December 2018

Background:

Recurrent aphthous stomatitis (RAS) is the most frequent form of oral ulceration, characterized by recurrent oral mucosal ulceration in an otherwise healthy individual. This study was designed to evaluate the efficacy and safety of Chinese herbal medicine for recurrent aphthous stomatitis.

Methods:

Five databases will be searched from inception to date, including PubMed, Cochrane Library, EMBASE,CNKI, and CBM. The researchers will comprehensively screen clinical randomized trials of Chinese herbal medicine for recurrent aphthous stomatitis. The review will be conducted by 2 independent authors without time and language limitation. The risk of bias will be assessed by the Cochrane risk of bias tool.

Results:

Ethical approval is not required because this study is based on published papers. After peer-review, the study will be disseminated in scientific journals and conferences.

Conclusion:

This systematic review will provide evidence for the efficacy and safety of Chinese medicine for recurrent aphthous stomatitis.

PROSPERO registration:

CRD42018111955.
Clinical research on the efficacy and safety of Bosinji for low back pain with radiculopathy caused by herniated intervertebral disc of the lumbar spine
Authors: Goo Bonhyuk , Kim Sung-Jin , Kim Eun-Jung , Nam Dongwoo , Lee Hyun-Jong , Kim Jae-Soo , Park Yeon-Cheol , Baek Yong-Hyeon , Nam Sang-Soo , Seo Byung-Kwan
Published: December 2018

Background:

A lumbar herniated intervertebral disc (LHIVD) is a common problem that usually causes low back pain and radiating pain. The effectiveness of Bosinji, one of the herbal medicines used for low back pain and radiating pain in patient with LHIVD, has been reported in several studies; however, little clinical evidence is available owing to the methodological limitations in previous studies. Hence, the present study aims to establish the clinical evidence regarding the efficacy and safety of Bosinji in improving pain, function, and quality of life in LHIVD patients.

Method/design:

This is a multicenter, open-label, randomized, controlled, and equivalence trial with 2 parallel arms. A total of 74 patients who have low back pain and radiating pain due to LHIVD will be recruited and randomly allocated to the experimental group and control group. The patients in the experimental group and control group will take 2.5 g of Bosinji granule (1.523 g of Bosinji extract) or Loxonin tablet (60 mg of loxoprofen) 3 times a day for 6 weeks. Additionally, both groups will receive the same acupuncture treatment once a week for 6 weeks as a concurrent treatment. Changes in the 100-mm visual analogue scale (VAS) for low back pain after 6 weeks from baseline will be assessed as the primary outcome. Furthermore, the 100-mm VAS for radiating pain, Oswestry disability index (ODI), Roland–Morris disability questionnaire (RMDQ), EuroQol 5 Dimensions 5 Levels (EQ-5D-5L), global perceived effect (GPE), and deficiency syndrome of kidney index (DSKI) will be used to evaluate secondary outcomes. Outcomes will be assessed at baseline and at 3, 6, and 10 weeks after screening. For the safety evaluation, laboratory examinations including complete blood count, liver function test, renal function test, blood coagulation test, inflammation test, and urine analysis will be conducted before and after taking the medications.

Discussion:

The results of this trial will be used to establish clinical evidence regarding the use of Bosinji with acupuncture treatment in the treatment of patients with LHIVD.

Trial registration number:

NCT03386149 (clinicaltrials.gov) and KCT0002848 (Clinical Research Information Service of the Republic of Korea).
Clinical effects of extracorporeal shock-wave therapy and ultrasound-guided local corticosteroid injections for plantar fasciitis in adults
Authors: Li Shuxiang , Wang Kun , Sun Han , Luo Xiaomin , Wang Peng , Fang Sheng , Chen Haifeng , Sun Xiaoliang
Published: December 2018

Background:

The argument on whether extracorporeal shock-wave therapy (ESWT) and corticosteroid injections (CSIs) exert an equivalent pain control or which is the better treatment for plantar fasciitis (PF) in adults remains to be resolved. It is important and necessary to conduct a meta-analysis to make a relatively more credible and overall assessment about which treatment method performs better pain control in treatment of PF in adults.

Methods:

From the inception to July 2018, the Embase, PubMed, Web of Science, and Cochrane Library electronic databases were searched for all relevant studies. Only randomized controlled trials (RCTs) focusing on comparing ESWT and CSI therapies in PF cases in adults were included. The primary outcome measure was visual analog scale (VAS) reduction, whereas the secondary outcomes included treatment success rate, recurrence rate, function scores, and adverse events.

Results:

Nine RCTs involving 658 cases were included in this meta-analysis. In the present study, meta-analysis showed that high-intensity ESWT had superior pain relief and success rates relative to the CSI group within 3 months, but the ESWT with low intensity was slightly inferior to CSI for efficacy within 3 months. In addition, patients with CSI may tend to increase the need for the analgesic and more adverse events may be associated with the ESWT. However, the ESWT and CSI present similar recurrent rate and functional outcomes.

Conclusion:

Our analysis showed that the pain relief and success rates were related to energy intensity levels, with the high-intensity ESWT had the highest probability of being the best treatment within 3 months, followed by CSI, and low-intensity ESWT. More high-quality RCTs with long-term follow-up time are needed to further compare the differences of CSI and ESWT for adults with PF.
Cystic metastasis of prostate cancer
Authors: Zhang Bei , Bian Bingyang , Bi Lirong , Wang Zhuo , Zhao Yang , Wang Jiping
Published: December 2018

Rationale:

Prostate cancer often metastasizes (most commonly to the pelvic lymph nodes and axial skeleton); however, metastases to the pelvic cavity as a solitary mass are unusual. While metastatic prostate cancer is unconventional in pelvic cavity, cystic pelvic lesions are even more scarce. Accurate identification of cystic metastasis can be helpful in management of prostate cancer.

Patient concerns:

A 64-year-old male was admitted to our hospital due to urethral irritation symptom and dysuria.

Diagnosis:

In addition to prostate cancer, abdominal computed tomography (CT) scanning and magnetic resonance imaging (MRI) of the prostate revealed that a cystic mass was located at right pelvic cavity. Histopathological examination diagnosed the pelvic cystic mass as metastasis from prostatic cancer. Immunohistochemistry results demonstrated Calretinin (+), D2-40 (−), Ki-67 (10%+), Vimentin (−), CK-pan (+), CK5/6 (−), WT-1 (−), PSA (+), SALL4 (−), Villin (−), CK20 (−), CK7 (−), PAX-8 (−), and TTF-1 (−).

Interventions:

The cystic mass was removed. Primary cancer of the prostate was reserved as well. After discharge, the patient underwent in a two-year androgen deprivation therapy (ADT) treatment.

Outcomes:

After 13 months of discharge, no disease progression was found in the patient.

Lessons:

Although cystic prostate cancer is rare, the occurrence possibility should be considered when cystic lesions are accompanied with prostate cancer.
Compatibility and stability of dezocine and tropisetron in 0.9% sodium chloride injection for patient-controlled analgesia administration
Authors: Chen Peng , Chen Fuchao , Zhou Ben-hong
Published: December 2018

Tropisetron is an adjuvant for dezocine used in intravenous patient-controlled analgesia (PCA) and has been reported to provide superior pain control. It is efficacious in reducing the institutional incidence of postoperative nausea and vomiting (PONV), which decreases resource utilization and cost. However, no scientific evidence has been reported in the literature demonstrating analytical confirmation of the compatibility and stability of the combination of dezocine and tropisetron. Thus, the present study aimed to investigate the stability of dezocine with tropisetron in 0.9% sodium chloride injection form for PCA administration.

Commercial solutions of dezocine and tropisetron were combined and examined for compatibility and stability when diluted with 0.9% sodium chloride injection in polyolefin bags and glass bottles stored at 4°C or 25°C for up to 14 days. The initial concentrations were 40 mg/100 mL dezocine and 5 mg/100 mL tropisetron. For all samples, the compatibility parameters (including precipitation, cloudiness, discoloration, and pH values) were evaluated. Chemical stability was also determined using high-performance liquid chromatographic (HPLC) analysis.

After a 14-day period of storage at 4°C or 25°C, the initial concentrations of dezocine and tropisetron were maintained at at least 98%. All of the mixtures remained clear and colorless throughout the observation period, and no color change or precipitation was observed.

These results indicated that admixtures of 40 mg/100 mL dezocine and 5 mg/100 mL tropisetron in 0.9% sodium chloride injection were stable for at least 14 days when stored in polyolefin bags or glass bottles at 4°C or 25°C and protected from light.
Efficacy and safety of laparoscopic splenectomy and esophagogastric devascularization for portal hypertension
Authors: Zheng Shunzhen , Sun Ping , Liu Xihan , Li Guangbing , Gong Wei , Liu Jun
Published: December 2018

Many patients in China have portal hypertension secondary to liver cirrhosis. Splenectomy and devascularization have become an efficacious surgical procedure for portal hypertension, and has been recommended in China as the first choice for the treatment of portal hypertension for a long time. As a result of advances in laparoscopic equipment and techniques, splenectomy and esophagogastric devascularization have been carried out with laparoscope.

From January 2012 to December 2017, 453 patients who were diagnosed with portal hypertension and serious gastroesophageal varices received surgical management in our institution. 250 patients chose laparoscopic splenectomy and esophagogastric devascularization and 203 underwent open splenectomy and esophagogastric devascularization.

We retrospectively analyzed the perioperative data and follow-up data of these patients. The operation time of laparoscopic group was longer than open group (P ≤ .001). Intraoperative blood loss was less (P ≤ .001), the passing of flatus was earlier (P = .042), and postoperative hospital stay was shorter (P = .001) in the laparoscopic group. During postoperative follow-up of 4 to 75 months, the incidence of esophagogastric variceal rebleeding, encephalopathy, and secondary liver cancer showed no significant differences.

Laparoscopic splenectomy and esophagogastric devascularization were safe and more effective than open surgery for portal hypertension and gastroesophageal varices.
Diagnostic value of 18F-fluorodeoxyglucose positron-emission tomography/computed tomography for preoperative lymph node metastasis of esophageal cancer
Authors: Hu Jingfeng , Zhu Dengyan , Yang Yang
Published: December 2018

Objective:

We determined the value of 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (18FDG PET/CT) for the assessment of preoperative lymph node metastases in patients with esophageal cancer.

Methods:

We searched electronic database indexes for articles on PET/CT assessment of lymph node status. Information including true positives, false positives, false negatives, and true negatives was obtained. Based on these data, the pooled sensitivity, specificity, diagnostic odds ratio, and likelihood ratio were calculated using bivariate models and receiver operating characteristic curves (ROCs) were drawn.

Results:

Patients without neoadjuvant treatment had a pooled sensitivity and specificity (95% confidence interval [CI]) of 0.57 (0.45–0.69) and 0.91 (0.85–0.95), respectively. Patients who received neoadjuvant treatment had a pooled sensitivity and specificity of 0.53 (0.35–0.70) and 0.96 (0.86–0.99), respectively.

Conclusions:

The PET/CT has a high diagnostic specificity but its diagnostic sensitivity is low; thus, its diagnosis findings cannot accurately reflect the lymph node status.
A chronic sinus tract infection developing after suture anchoring of the ankle
Authors: Kim Woo Jong , Young Ki Won , Kim Chang Hyun , Won Sung Hun , Bae Kyu Hwan , Lee Hong Seop
Published: December 2018

Rationale:

Suture anchors are increasingly used to fix soft tissue to bone. Favorable outcomes of the modified Brostrom operation (MBO) using suture anchors have been reported. However, to the best of our knowledge, few complications of suture anchors used in ankle surgery have been described. Here, we present a rare case of successful treatment of a chronic sinus tract infection developing after the MBO using a suture anchor.

Patient concerns:

A healthy 18-year-old high school student presented with a chronic ulcerative wound in his right ankle 1 year after anterior talofibular and calcaneofibular ligament repair using a suture anchor at a local clinic. Clinical examination revealed a 1.5 × 2-cm-sized ulcerative wound, accompanied by a red-black discharge, on the anterior border of the right lateral malleolus. The wound could be approximated to the joint capsule level using a forceps.

Diagnosis:

A simple standing anteroposterior radiograph of the right ankle revealed mild, lateral soft-tissue swelling. Magnetic resonance imaging showed that a sinus tract running from the wound to the talar body crossed the anterior joint capsule, and bone marrow edema surrounding the talus.

Interventions:

We removed the sinus tract and the infected suture anchor. We rendered the wound zigzag-shaped and then performed simple suturing and applied a short leg cast.

Outcomes:

The wound healed completely by 4 weeks after surgery. The patient reported no complication or recurrence of infection at the 1-year follow-up.

Lessons:

To obtain wound healing, the chronic sinus tract must be removed. If the suture anchor is the cause of infection, it should be removed.
A case report: Co-occurrence of Wilson disease and oculocutaneous albinism in a Chinese patient
Authors: Rao Rao , Shu Shan , Han Yong Zhu , Chiu Yu-Jen , Han Yong Sheng
Published: December 2018

Rationale:

Both Wilson disease (WD) and Oculocutaneous Albinism (OCA) are rare autosomal recessive disorders that are caused by mutations on chromosome 13 and chromosome 11, respectively. Here, we report on a patient with coexisting WD and OCA, initially presenting episodes of tremors.

Patient concerns:

WD is a disorder of copper metabolism. The main sites of copper accumulation are the liver and the brain, resulting in hepatic symptoms. OCA is a disorder of melanin biosynthesis, characterized by a generalized reduction in pigmentation of the eyes (oculo-), skin (-cutaneous), and hair.

Diagnosis: The diagnosis of WD was confirmed by neurological symptoms, metabolism tests, and MRI scans. Interestingly, the patient also had very light skin color, blond hair and eyebrows, and dark brown eyelashes and irises. Because the association of dermatologic signs in WD has rarely been reported, OCA was highly suspected based on these clinical findings. Genetic analysis was subsequently conducted, and the results revealed the p. (Arg778Leu) mutation in 1 allele and the p. (Asn1270Ser) mutation in the other allele of the ATP7B gene, confirming the diagnosis of WD; the p. (D456fs) mutation in 1 allele and the p. (R299H) mutation in the other allele of the TYR gene, confirming the diagnosis of OCA. The family history was positive for WD with a 14-year-old younger brother also being diagnosed with it. Her parents are negative for OCA and WD.

Interventions:

Sodium dimercaptopropanesulfonate (DMPS) was given during hospitalization. D-penicillamine and zinc sulfate treatment was initiated after discharge for long-term control.

Outcomes:

Postural and intention tremor disappeared, and other symptoms and signs markedly improved after treatment.

Lessons:

In this study, we reported on the first case of a child who simultaneously presented WD and OCA, bringing up the possibility of a presumable link between these 2 rare diseases.
Psychometric Evaluation of an Instrument to Measure Prospective Pregnancy Preferences
Authors: Rocca Corinne H. , Ralph Lauren J. , Wilson Mark , Gould Heather , Foster Diana G.
Published: December 2018

Background:

Existing approaches to measuring women’s pregnancy intentions suffer important limitations, including retrospective assessment, overly simple categories, and a presumption that all women plan pregnancies. No psychometrically valid scales exist to prospectively measure the ranges of women’s pregnancy preferences.

Materials and Methods:

Using a rigorous construct modeling approach, we developed a scale to measure desire to avoid pregnancy. We developed 60 draft items from existing research, assessed comprehension through 25 cognitive interviews, and administered items in surveys with 594 nonpregnant women in 7 primary and reproductive health care facilities in Arizona, New Jersey, New Mexico, South Carolina, and Texas in 2016–2017. We used item response theory to reduce the item set and assess the scale’s reliability, internal structure validity, and external validity. Items were included based on fit to a random effects multinomial logistic regression model (partial credit item response model), correspondence of item difficulty with participants’ pregnancy preference levels, and consistency of each item’s response options with overall scale scores.

Results:

The 14 final items covered 3 conceptual domains: cognitive preferences, affective feelings, and practical consequences. Items fit the unidimensional model, with a separation reliability of 0.90 (Cronbach α: 0.95). The scale met established criteria for internal validity, including correspondence between each item’s response categories and overall scale scores. We found no important differential item functioning by participant characteristics.

Conclusions:

A robust measure is available to prospectively measure desire to avoid pregnancy. The measure can aid in identifying women who could benefit from contraceptive care and research on less desired pregnancy.
Impact of Patient Safety Culture on Missed Nursing Care and Adverse Patient Events
Authors: Hessels Amanda J. , Paliwal Mani , Weaver Susan H. , Siddiqui Deeba , Wurmser Theresa A.
Published: December 2018

Background:

A strong patient safety culture (PSC) may be associated with improved patient outcomes in hospitals. The mechanism that explains this relationship is underexplored; missed nursing care may be an important link.

Purpose:

The purpose of this study was to describe relationships among PSC, missed nursing care, and 4 types of adverse patient events.

Methods:

This cross-sectional study employed primary survey data from 311 nurses from 29 units in 5 hospitals and secondary adverse event data from those same units. Analyses include analysis of variance and regression models.

Results:

Missed nursing care was reported to occur at an occasional level (M = 3.44, SD = 0.24) across all 29 units. The PSC dimensions explained up to 30% of the variance in missed nursing care, 26% of quality of care concerns, and 15% of vascular access device events. Missed care was associated with falls (P < .05).

Conclusions:

Prioritized actions to enhance PSC should be taken to reduce missed nursing care and adverse patient outcomes.
Association of Endometrial Cancer Risk With Postmenopausal Bleeding in Women: A Systematic Review and Meta-analysis
Authors: Clarke Megan A. , Long Beverly J. , Del Mar Morillo Arena , Arbyn Marc , Bakkum-Gamez Jamie N. , Wentzensen Nicolas
Published: December 2018

(Abstracted from JAMA Intern Med 2018;178:1210–1222)

The incidence of endometrial cancer and deaths from this cancer has increased in recent years and is projected to rise over the next decade.
Subchorionic Hematoma: Correlation of Grading Techniques With First-Trimester Pregnancy Outcome
Authors: Heller Howard T. , Asch Elizabeth A. , Durfee Sara M. , Goldenson Robin P. , Peters Hope E. , Ginsburg Elizabeth S. , Doubilet Peter M. , Benson Carol B.
Published: December 2018

(Abstracted from J Ultrasound Med 2018;37:1725–1732)

A common finding on early first-trimester ultrasound (US) examinations, subchorionic hematoma (SCH) occurs in both asymptomatic patients and those presenting with vaginal bleeding. Previous studies assessing the risk of first-trimester pregnancy failure when an SCH is seen on an early pregnancy sonogram have used a variety of grading systems for characterizing the size of the hematoma, including subjective grading of the SCH as small, moderate, or large; calculating the volume of the SCH from its US measurements; estimation of hematoma size as a fraction of gestational sac size; and estimated fraction of the gestational sac that is surrounded by hematoma.
Prenatal Counseling and Parental Decision-Making Following a Fetal Diagnosis of Trisomy 13 or 18
Authors: Winn Phoebe , Acharya Krishna , Peterson Erika , Leuthner Steven
Published: December 2018

(Abstracted from J Perinatol 2018;38:788–796)

Trisomy 13 (T13) and 18 (T18) are chromosomal anomalies that have historically been considered lethal, but this notion has been questioned within the last decade by physicians, ethicists, and families. The literature has focused on the commonly described negative parental experience of prenatal and neonatal counseling and the extent of medical and surgical interventions that children with these conditions receive, their survival, and neurodevelopmental outcomes.
Sexual Response in Women With Mayer-Rokitansky-Küster-Hauser Syndrome With a Nonsurgical Neovagina
Authors: Both Stephanie , Kluivers Kirsten , ten Kate-Booij Marianne , Weijenborg Philomeen
Published: December 2018

(Abstracted from Am J Obstet Gynecol 2018;219:283.e1–283.e8)

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is an uncommon congenital condition characterized by an agenesis or hypoplasia of vagina and uterus. The first-line treatment approach—nononsurgical vaginal elongation by dilation—has high success rates (90%–96%).
High-grade Endometrial Carcinomas: Morphologic and Immunohistochemical Features, Diagnostic Challenges and Recommendations
Authors: Murali Rajmohan , Davidson Ben , Fadare Oluwole , Carlson Joseph A. , Crum Christopher P. , Gilks C. Blake , Irving Julie A. , Malpica Anais , Matias-Guiu Xavier , McCluggage W. Glenn , Mittal Khush , Oliva Esther , Parkash Vinita , Rutgers Joanne K. L. , Staats Paul N. , Stewart Colin J. R. , Tornos Carmen , Soslow Robert A.
Published: December 2018

This review of challenging diagnostic issues concerning high-grade endometrial carcinomas is derived from the authors’ review of the literature followed by discussions at the Endometrial Cancer Workshop sponsored by the International Society of Gynecological Pathologists in 2016. Recommendations presented are evidence-based, insofar as this is possible, given that the levels of evidence are weak or moderate due to small sample sizes and nonuniform diagnostic criteria used in many studies. High-grade endometrioid carcinomas include FIGO grade 3 endometrioid carcinomas, serous carcinomas, clear cell carcinomas, undifferentiated carcinomas, and carcinosarcomas. FIGO grade 3 endometrioid carcinoma is diagnosed when an endometrioid carcinoma exhibits >50% solid architecture (excluding squamous areas), or when an architecturally FIGO grade 2 endometrioid carcinoma exhibits marked cytologic atypia, provided that a glandular variant of serous carcinoma has been excluded. The most useful immunohistochemical studies to make the distinction between these 2 histotypes are p53, p16, DNA mismatch repair proteins, PTEN, and ARID1A. Endometrial clear cell carcinomas must display prototypical architectural and cytologic features for diagnosis. Immunohistochemical stains, including, Napsin A and p504s can be used as ancillary diagnostic tools; p53 expression is aberrant in a minority of clear cell carcinomas. Of note, clear cells are found in all types of high-grade endometrial carcinomas, leading to a tendency to overdiagnose clear cell carcinoma. Undifferentiated carcinoma (which when associated with a component of low-grade endometrioid carcinoma is termed “dedifferentiated carcinoma”) is composed of sheets of monotonous, typically dyscohesive cells, which can have a rhabdoid appearance; they often exhibit limited expression of cytokeratins and epithelial membrane antigen, are usually negative for PAX8 and hormone receptors, lack membranous e-cadherin and commonly demonstrate loss of expression of DNA mismatch repair proteins and SWI-SNF chromatin remodeling proteins. Carcinosarcomas must show unequivocal morphologic evidence of malignant epithelial and mesenchymal differentiation.
Issues in the Differential Diagnosis of Uterine Low-grade Endometrioid Carcinoma, Including Mixed Endometrial Carcinomas: Recommendations from the International Society of Gynecological Pathologists
Authors: Rabban Joseph T. , Gilks C. Blake , Malpica Anais , Matias-Guiu Xavier , Mittal Khush , Mutter George L. , Oliva Esther , Parkash Vinita , Ronnett Brigitte M. , Staats Paul , Stewart Colin J.R. , McCluggage W. Glenn
Published: December 2018

This article provides practical recommendations developed from the International Society of Gynecological Pathologists Endometrial Carcinoma Project to address 4 issues that may arise in the diagnosis of uterine corpus low-grade endometrioid carcinoma: (1) The distinction between atypical hyperplasia and low-grade endometrioid carcinoma. (2) The distinction between low-grade endometrioid carcinoma and serous carcinoma. (3) The distinction between corded and hyalinized or spindle cell variants of low-grade endometrioid carcinoma and carcinosarcoma. (4) The diagnostic criteria for mixed endometrial carcinomas, a rare entity that should be diagnosed only after exclusion of a spectrum of tumors including morphologic variants of endometrioid carcinoma, dedifferentiated endometrial carcinoma, carcinosarcoma, and endometrial carcinomas with ambiguous morphology.
Screening for Early Lung Cancer, Chronic Obstructive Pulmonary Disease, and Cardiovascular Disease (the Big-3) Using Low-dose Chest Computed Tomography
Authors: Heuvelmans Marjolein A. , Vonder Marleen , Rook Mieneke , Groen Harry J.M. , De Bock Geertruida H. , Xie Xueqian , Ijzerman Maarten J. , Vliegenthart Rozemarijn , Oudkerk Matthijs
Published: December 2018

Lung cancer, chronic obstructive pulmonary disease, and cardiovascular disease are highly prevalent in the general population and expected to cause most deaths by 2050. For these “Big-3,” treatment might cure, delay, or stop the progression of disease at a very early stage. Lung nodule growth rate (a biomarker for lung cancer), emphysema/air trapping (a biomarker for chronic obstructive pulmonary disease), and coronary artery calcification (a biomarker for cardiovascular disease) are imaging biomarkers of early stages of the Big-3 that can be acquired with low-dose computed tomography (CT). We hypothesize that a (combined) low-dose CT examination for detection of all 3 diseases may significantly improve the cost-effectiveness of screening in the future. We review the current evidence of the imaging biomarkers for the detection of the Big-3 diseases and present the potential health economic potential of Big-3 screening. Furthermore, we review the low-dose CT protocols to acquire these biomarkers and describe the technical considerations when combining the CT protocols for the different biomarkers.
Organizing principles of whole-brain functional connectivity in zebrafish larvae
Authors: Betzel Richard
Published: December 2018

Network science has begun to reveal the fundamental principles by which large-scale brain networks are organized, including geometric constraints, a balance between segregative and integrative features, and flexible brain areas. However, it remains unknown whether whole-brain networks imaged at the cellular level are organized according to similar principles. Here, we analyze whole-brain functional networks reconstructed from calcium imaging data recorded in larval zebrafish. Our analyses reveal that functional connections are distance-dependent and that networks exhibit hierarchical modular structure and hubs that span module boundaries. We go on to show that spontaneous network structure places constraints on stimulus-evoked reconfigurations of connections and that networks are highly consistent across individuals. Our analyses reveal, for the first time, basic organizing principles of whole-brain functional brain networks at the microscale. Our overarching methodological framework provides a blueprint for studying the correlated activity at the cellular level using a low-dimensional network representation. Our work forms a conceptual bridge between macro- and microscale network neuroscience and opens myriad paths for future studies to investigate network structure of nervous systems at the cellular level.
Single cell RNA-Seq reveals distinct stem cell populations that drive sensory hair cell regeneration in response to loss of Fgf and Notch signaling
Authors: Lush Mark E. , Diaz Daniel C. , Koenecke Nina , Baek Sungmin , Boldt Helena , St. Peter Madeleine K. , Gaitan-Escudero Tatiana , Romero-Carvajal Andres , Busch-Nentwich Elisabeth M. , Perera Anoja , Hall Kate , Peak Allison , Haug Jeffrey S. , Piotrowski Tatjana
Published: December 2018

Loss of sensory hair cells leads to deafness and balance deficiencies. In contrast to mammalian hair cells, zebrafish ear and lateral line hair cells regenerate from poorly characterized, proliferating support cells. Equally ill-defined is the gene regulatory network underlying the progression of support cells to cycling hair cell progenitors and differentiated hair cells. We used single cell RNA-Sequencing (scRNA-Seq) of lateral line sensory organs and uncovered five different support cell types, including quiescent and activated stem cells.In silicoordering of support cells along a developmental trajectory identified cells that self-renew and new groups of genes required for hair cell differentiation. scRNA-Seq analyses offgf3mutants, in which hair cell regeneration is increased, demonstrates that Fgf and Notch signaling inhibit proliferation of support cells in parallel by inhibiting Wnt signaling. Our scRNA-Seq analyses set the foundation for mechanistic studies of sensory organ regeneration and is crucial for identifying factors to trigger hair cell production in mammals. As a resource, we implemented a shiny application that allows the community to interrogate cell type specific expression of genes of interest.
Do elderly breast cancer patients have poorer survival outcome?
Authors: Suen Dacita To‐Ki , You Ka‐Po , Luk Wing‐Pan , Fung Ling‐Hiu , Kwong Ava
Published: December 2018

Aim

The aim of the present study was to compare breast cancer in elderly patients to their younger counterparts, and look for factors affecting the survival of elderly patients.

Patients and Methods

A retrospective study of breast cancer patients who had surgery at a university hospital from 2000 to 2015 was performed. Stage on presentation, tumour characteristics and modalities of treatment for patients aged >70 years were compared with those aged <70 years. Factors affecting breast cancer specific survival were assessed by multivariate Cox regression.

Results

In total, 3825 patients with breast cancer underwent surgery during the study period; 510 patients (13.3 per cent) were aged >70 years . The 5‐year overall survival for elderly patients was 76.9 per cent, which was poorer than their younger counterparts (89.5 per cent, P = 0.000). Multivariate analysis demonstrated that the use of adjuvant hormonal therapy (P = 0.001, hazard ratio: 0.481), advanced T‐stage (P < 0.05) and advanced N‐stage (P < 0.001) were the independent factors affecting breast cancer‐specific survival in elderly patients.

Conclusions

Elderly breast cancer patients had worse overall and breast cancer‐specific survival. Stage on presentation and the use of adjuvant hormonal therapy were independent factors affecting survival among elderly patients. Early diagnosis and comprehensive geriatric assessment to guide the optimal treatment plan would be useful for better survival outcomes in elderly breast cancer patients.
Cumulative impact: Why prison sentences have increased*
Authors: King Ryan D.
Published: December 2018

Why has the probability of going to prison after a felony conviction increased since the early 1980s? Social scientists often try to answer this question through macro‐level research that is aimed at examining correlations between prison admissions and crime rates or sociopolitical characteristics of states. That type of macro‐level inquiry, however, does not allow for a close examination of how characteristics of offenders changed over time, and whether such changes are consequential for understanding trends in the use of imprisonment. In the current study, I take a different approach—one in which case‐level data are observed over a lengthy time span—to investigate why the likelihood of going to prison for a given crime persistently increased for several decades. The results of analyses of more than 350,000 felony cases sentenced in Minnesota during a 33‐year period show that the probability of a defendant receiving a prison sentence increased from 1981 to 2013, as would be expected. The primary reason for the rising probability of imprisonment was the significant increase in the average offender's criminal record, which more than doubled during the observation period.
Progression of retinitis pigmentosa on multimodal imaging: The PREP‐1 study
Authors: Iftikhar Mustafa , Usmani Bushra , Sanyal Abanti , Kherani Saleema , Sodhi Simrat , Bagheri Saghar , Schönbach Etienne M. , Junaid Nadia , Scholl Hendrik P. N. , Shah Syed M. A.
Published: December 2018

Importance

It is important to establish reliable outcome measures to detect progression in retinitis pigmentosa (RP).

Background

To evaluate progression of RP using multimodal imaging, including spectral‐domain optical coherence tomography (SD‐OCT), fundus autofluorescence (FAF) and microperimetry (MP).

Design

Retrospective longitudinal study at a tertiary teaching hospital.

Participants

205 eyes of 106 patients with RP with 1 to 5 y of follow‐up.

Methods

Demographics and visual acuity (VA) were recorded, and each modality was graded at baseline and every annual follow‐up. SD‐OCT was graded for the width of ellipsoid zone (EZ), FAF was graded for the diameter and area of the hyperautofluorescent ring (if present), and MP was graded for mean, central and paracentral sensitivity. Spearman's correlation was used to measure correlations at baseline. Mixed effects models were used to estimate the annual change of each parameter, adjusted for disease duration.

Main Outcome Measures

Rate of progression.

Results

The median VA at baseline was 75 letters and was positively correlated with mean and central sensitivity (r: 0.372 and 0.394; P = 0.01 for both). All parameters (except paracentral sensitivity) were strongly correlated with each other (r: 0.673‐0.991; P < 0.001 for all). The annual rates of change for each parameter were as follows: VA, −2.3 letters (P < 0.001); EZ, −151 μm (P < 0.001); ring diameter, −132 μm (P < 0.001); ring area, −0.4 mm2 (P < 0.001); mean sensitivity, −0.3 dB (P < 0.001); central sensitivity, −0.7 dB (P < 0.001); paracentral sensitivity, −0.4 dB (P < 0.001).

Conclusions and Relevance

Structural and functional measures are well correlated in RP and can reliably measure disease progression within the course of a year.
Follicular induction and CK20+ Merkel cells overlying cutaneous focal mucinosis
Authors: Chairatchaneeboon Manasmon , Elenitsas Rosalie , Nguyen Jennifer V.
Published: December 2018

Background

Cutaneous focal mucinosis (CFM) or focal dermal mucinosis is a benign reactive process categorized as a primary mucinosis. Skin biopsy is essential for diagnosis, as the clinical appearance is often non‐specific. Follicular induction is a phenomenon whereby the epidermis is induced by an underlying process to form primitive or mature hair follicles, and is commonly seen overlying dermatofibromas. Follicular induction has been rarely described in CFM.

Methods

We performed a retrospective histological review of lesions of CFM confirmed by skin biopsy from 2010 to 2015 in our department.

Results

We found that 11% (11/98) of CFM lesions showed follicular induction. Cytokeratin 20 (CK20) immunostaining was performed on all 11 of these biopsies that showed follicular induction and highlighted an increased density of CK20+ Merkel cells within the basaloid epidermal proliferations.

Conclusion

As superficial basal cell carcinomas (BCC) often show a mucinous stroma around the basaloid islands, CFM with follicular induction may closely mimic a BCC histologically, particularly in superficial shave biopsies. Therefore, it is important that dermatopathologists be aware of this phenomenon. Furthermore, CK20+ staining within the basaloid epithelial proliferations may be helpful in differentiating CFM with follicular induction from a BCC.
Variability in sleep disturbance, physical activity and quality of life by level of depressive symptoms in women with Type 2 diabetes
Authors: Danhauer S. C. , Brenes G. A. , Levine B. J. , Young L. , Tindle H. A. , Addington E. L. , Wallace R. B. , Naughton M. J. , Garcia L. , Safford M. , Kim M. M. , LeBlanc E. S. , Snively B. M. , Snetselaar L. G. , Shumaker S.
Published: December 2018

Aims

To examine (1) the prevalence of depressive symptoms in women with Type 2 diabetes, (2) the associations between depressive symptoms and the following dependent variables: sleep disturbance; physical activity; physical health‐related; and global quality of life, and (3) the potential moderating effects of antidepressants and optimism on the relationship between depressive symptoms and dependent variables.

Methods

Participants in the Women's Health Initiative who had Type 2 diabetes and data on depressive symptoms (N=8895) were included in the analyses. In multivariable linear regression models controlling for sociodemographic, medical and psychosocial covariates, we examined the main effect of depressive symptoms, as well as the interactions between depressive symptoms and antidepressant use, and between depressive symptoms and optimism, on sleep disturbance, physical activity, physical health‐related quality of life; and global quality of life.

Results

In all, 16% of women with Type 2 diabetes reported elevated depressive symptoms. In multivariable analyses, women with depressive symptoms had greater sleep disturbance (P<0.0001) and lower global quality of life (P<.0001). We found evidence of significant statistical interaction in the models for quality‐of‐life outcomes: the increased risk of poor physical health‐related quality of life associated with antidepressant use was stronger in women without vs with depressive symptoms, and the association between greater optimism and higher global quality of life was stronger in women with vs without depressive symptoms.

Conclusions

To improve health behaviours and quality of life in women with Type 2 diabetes, sociodemographic and medical characteristics may identify at‐risk populations, while psychosocial factors including depression and optimism may be important targets for non‐pharmacological intervention.