bluuebunny/crossref_metadata_2025 huggingface dataset:
Adenoid cystic carcinoma in ventricle of larynx
Authors: Wang Qinying , Yu Xiao shuang , Liu Yongcai , Chen Haihong
Published: December 2018

Rationale:

Adenoid cystic carcinomas (ACCs) are malignant tumors and occur in the major and the minor salivary glands. ACCs are rare in the larynx.

Patient concerns:

A 55-year-old female patient who presented with a 12 months history of paraesthesia pharynges and hoarseness for 4 months. Laryngoscopy showed an endophytic lesion in the right supglottic area with no laryngeal stenosis. And magnetic resonance imaging (MRI) confirmed the presence of a submucosal mass in the supglottic area. Supporting laryngoscope was performed under general anesthesia and a lesion biopsy obtained.

Diagnoses:

The lesion was sent for frozen-section biopsy, which shows the lesion was the epithelial-derived tumors of salivary gland, but it was impossible to identify the relationship between the tumor and the surrounding normal tissue, and to judge the nature of the tumor further. So, the lesion was sent for the second frozen-section biopsy, an ACC of the larynx was confirmed and margins were negative.

Interventions:

The patient underwent partial laryngectomy.

Outcomes:

The patient was doing well except hoarseness during the follow-up period with no evidence of disease recurrence or metastasis for 17 months post-operatively.

Lessons:

Laryngeal ACC is a rare entity. When the nature of lesion cannot be confirmed, multiple biopsies may be required for confirm the diagnosis of pathology. It not only reduces patient's waiting time for surgery, but also define the diagnosis and surgical removal of lesion through a single anesthesia
Increased self-care activities and glycemic control rate in relation to health education via Wechat among diabetes patients
Authors: Dong Yonghui , Wang Ping , Dai Zhipeng , Liu Ke , Jin Yi , Li Ang , Wang Shengji , Zheng Jia
Published: December 2018

Background:

Health education has been considered as the effectiveness method to increase the self-care skills of diabetes patients. However, limited studies to investigate the association of health education via Wechat platform on increased the basic self-care skills and glycemic control rate in patients with type 2 diabetes.

Methods:

A total number of 120 type 2 diabetes patients were randomized into intervention (health education by Wechat platform plus usual care) and the control group (usual care). Biochemical parameters including fasting plasma glucose (FPG), 2-hour plasma glucose (2hPG), glycosylated hemoglobin A1c (HbA1c) were measured among the 2 groups at baseline 6-month and 12-month. Diabetes Management Self-Efficacy (SE) Scale was completed at baseline 6-month and 12-month.

Results:

Significant difference of HbA1c concentration and SE were found between intervention and control groups at 6-month and 12-month (P <.05). The effect of groups and health education duration times was found on reduced HbA1c concentration and increased the total score of SE (P <.05). No significant difference of FPG and 2hPG concentrations were found between intervention and control groups at 6 months and 12 months (P >.05).

Conclusion:

Health education of diabetic individuals via Wechat platform in conjunction with conventional diabetes treatment could improve glycemic control and positively influence other aspects of diabetes self-care skills.
Clinical efficacy and safety of apatinib in patients with advanced colorectal cancer as the late-line treatment
Authors: Liao Xiaoli , Li Hualan , Liu Zhihui , Liao Sina , Li Qian , Liang Chaoyong , Huang Yu , Xie Mingzhi , Wei Junbao , Li Yongqiang
Published: December 2018

There is currently no standard therapeutic regimen available for patients with advanced colorectal cancer in whom the disease continues to progress after 2 or more lines of chemotherapy. The purpose of this study is to investigate the efficacy and safety of apatinib in patients with advanced colorectal cancer for whom at least two lines of prior chemotherapy had failed.

Twenty seven patients with advanced colorectal cancer who had failed at least 2 lines chemotherapy were treated with apatinib (500 mg/day). As a comparison control, 26 advanced colorectal cancer patients with comparable clinical baseline characteristics including age, sex, Eastern Cooperative Oncology Group (ECOG) score, pathological type, carcinoembryonic antigen (CEA) level, tumor location, number and location(s) of metastasis, and previous chemotherapies were subject to observation. Survival analyses were performed via the Kaplan–Meier method. The toxicity were evaluated in all patients this study according to the National Cancer Institute Common Toxicity Criteria 4 (NCI CTC version 4.0).

A total of 53 well-matched patients with advanced colorectal cancer were retrospectively analyzed. The median follow-up time was 6.0 months (2.0–16.0 months). The median PFS was significantly longer for apatinib group than for observation group (2.0 vs. 1.1 months; HR = 3.88; 95% confidence interval [CI], 1.91–7.88; P < .001). However, there was no significant difference between the 2 groups for median OS (5.0 vs. 4.0 months; HR = 1.03; 95% CI, 0.56–1.90; P = .914). The disease control rate of the apatinib group was significantly better than that of the observation group (70.4% vs 26.9%, P = .002). There was no significant difference in the overall remission rate between the 2 groups (3.7% vs 0%, P = .322). Advanced colorectal cancer patients with 2 or fewer metastatic sites experienced longer PFS than those with more than 2 sites. High ECOG scores, cancer localization to the right side of colon and lymph node metastasis were associated with increased risk of death and all remained independent factors affecting OS. The most common grade 3/4 treatment-related adverse events were hypertension and hand-foot skin syndrome.

Apatinib treatment for patients with advanced colorectal cancer who had failed chemotherapy achieved better disease control and prolonged PFS relative to untreated controls. The toxicity was manageable.
Surgical removal of adult recurrent neuroblastoma located in the posterior mediastinum and retroperitoneum
Authors: Ma Xiang , Yang Yunchuan , Wang Zhaoying , Sun Wanliang , Zhang Dengyong , Wu Binquan , Wu Hua , Lu Zheng , Cui Peiyuan
Published: December 2018

Rationale:

Adult recurrent neuroblastoma is extremely rare, especially in the posterior mediastinum and retroperitoneal cavity. The surgical treatment of this special part of the tumor is also a clinical difficulty.

Patient concerns:

This study reports a case of a 24-year-old man with a history of treated posterior mediastinal neuroblastoma. Enhanced computed tomography found a heterogeneously enhancing mass occupying the retroperitoneal and posterior mediastinum, and the initial impression was recurrent neuroblastoma.

Diagnoses:

The patient was diagnosed with recurrent neuroblastoma based on his medical history and histopathological results.

Interventions:

The young adult underwent radical resection of recurrent neuroblastoma in posterior mediastinum and retroperitoneum through thoracoabdominal incision.

Outcomes:

The young patient recovered to normal within 10 days after surgery and had no relapse for following-up 12 months.

Lessons:

Despite the difficulty of surgery, it is feasible to remove the tumor in the posterior mediastinum and retroperitoneal cavity safely.
The efficacy and safety of tranexamic acid in reducing perioperative blood loss in patients with multilevel thoracic spinal stenosis
Authors: Xue Peng , Yang Junsong , Xu Xiaozhou , Liu Tuanjiang , Huang Yansheng , Qiao Feng , Huang Xiaoqiang
Published: December 2018

Study Design:

A retrospective study.

Objective:

To investigate the effectiveness and safety of intravenous tranexamic acid for reducing perioperative blood loss in patients with multilevel thoracic spinal stenosis (TSS).

Methods:

This is a retrospective observational study of 42 patients with multilevel TSS admitted from December 2016 to October 2017 to the spine department of Honghui Hospital who underwent posterolateral bone graft fusion with posterior laminectomy and decompression fixation. The patients were divided into 2 groups. All the surgeries were completed by the same surgeon. Group A received an intravenous infusion of 15 mg/kg 15 min prior to surgery. Continuous infuse on of tranexamic acid (TXA) at a dose of 1 mg/kg/h was provided throughout the operation until the skin was closed. Group B received no TXA as a blank control group. Group A comprised 10 males and 10 females with an average age of 53.41 ± 7.93 years; group B comprised 11 males and 11 females with an average age of 55.10 ± 8.43 years. The need for blood transfusion, volume of blood transfusion, blood coagulation function, extubation time, postoperative hospital stay and incidence of postoperative deep venous thrombosis (DVT) were recorded during and after the operation for the 2 groups.

Results:

There was no significant difference between the 2 groups in general characteristics, such as age, sex and body mass index (BMI) (P > .05). There was no significant difference between the 2 groups in the levels are instrumented and the laminectomy levels in each group. The average postoperative blood loss, need for blood transfusion, time to postoperative extubation and length of postoperative hospital stay in group A were lower than those in group B, and there was a significant difference between the 2 groups (P < .05). The preoperative and postoperative coagulation, and postoperative DVT did not occur 48 h after operation.

Conclusion:

In the treatment of multilevel thoracic spinal canal stenosis using trabeculectomy with posterior laminectomy and posterolateral bone graft fusion, TXA can reduce the amount of blood transfused and the need for blood transfusion and can shorten the extubation time and the length of postoperative hospital stay without increasing the incidence of postoperative coagulation dysfunction or postoperative DVT.

Level of Evidence: 4
Craniofacial anomalies associated with spondyloenchondrodysplasia
Authors: Hong Seok Woo , Huh Kyung-Hoe , Lee Jeong Keun , Kang Jeong-Hyun
Published: December 2018

Rationale:

Spondyloenchondrodysplasia (SPENCD) is an autosomal recessive skeletal dysplasia by biallelic mutations in ACP5 gene encoding tartrate-resistant acid phosphatase (TRAP). The extra-osseous phenotype of SPENCD is pleiotropic and involves neurological impairment and immune dysfunction. Dentofacial abnormalities and orofacial symptoms in SPENCD patients have been little discussed in the literature.

Patients concerns:

Herein we present clinical and radiological data regarding 2 siblings with SPENCD. Both patients exhibited short stature, cervical platyspondyly, growth disturbance with multiple skeletal deformities of the wrist, and systemic lupus erythematosus related autoimmunity. They experienced prolonged pain in the temporomandibular joint (TMJ) area and exhibited delayed dental development. One patient presented with midface hypoplasia, retrognathic mandible, and anterior openbite. Computed tomographic images demonstrated delayed spheno-occipital synchondrosis, obtuse cranial base angle, overdeveloped and anteriorly displaced sphenoidal sinuses, and compressed ethmoidal sinuses.

Diagnosis:

The genetic analysis revealed heterozygous for a missense mutations at ACP5 in both probands.

Interventions:

Routine follow-up with conservative treatment were conducted for 12 months.

Outcomes:

The elder sister's orofacial pain was relieved but the boy showed sustained masticatory and cervical muscle pain and TMJ arthralgia which had changed in accordance with systemic condition. No further teeth eruption or skeletal growth was observed in 2 siblings during the follow-up period.

Lessons:

These findings extend the phenotypic spectrum of SPENCD and indicate that compromised endochondral ossification and the loss of TRAP activity may affect altered dentofacial development and orofacial symptoms.
Infective endocarditis caused by Lactococcus lactis subsp. lactis and Pediococcus pentosaceus
Authors: Chen Fei , Zhang Zhigang , Chen Jianzhong
Published: December 2018

Rationale:

Lactococcus lactis and Pediococcus pentosaceus are rare pathogens which rarely caused infections in humans. Several cases with L. lactis endocarditis have been reported in the literature, among them few were caused by L. lactis subsp. Lactis. Opportunistic P. pentosaceus infections were rarely reported.

Patient concerns:

A 66-year-old man presented to our hospital due to persistent fever for 15 days. A physical checking revealed a grade II holosystolic murmur at the heart apex. A chest computed tomography (CT) scan suggested bronchitis. L. lactis subsp. lactis was identified in blood cultures. Transthoracic and transesophageal echocardiography revealed the presence of a large hyperechogenic mass in the left atrium, and a large floating vegetation on the mitral valve with a severe mitral regurgitation.

Diagnosis:

Infectious endocarditis caused by L. lactis subsp. Lactis was diagnosed.

Interventions:

Levofloxacin (0.5 g/day) was used for 20 days; however, L. lactis subsp. lactis remained to be isolated from blood culture. Therefore, vancomycin (2 g/day) was used to replace levofloxacin. Six days after the treatment with vancomycin, the blood culture revealed no L. lactis subspecies lactis, but yielded a growth of gram-positive and non-spore forming cocci; and P. pentosaceus was identified. Antimicrobial susceptibility test revealed P. pentosaceus was sensitive to penicillin and levofloxacin. Vancomycin was discontinued, and levofloxacin (0.5 g/day) was restarted and treated for another 7 days. The patient recovered with negative blood culture results, and discharged from the hospital.

Outcomes:

The patient recovered with negative blood culture results, and discharged from the hospital.

Lessons:

Our patient had a long-period of antibiotic treatment with strategy alterations. Standard interpretation criteria of Clinical and Laboratory Standards Institute (CLSI) for L. lactis should be established, and molecular tests will increase the identification rate of L. lactis infections.
Male asymptomatic hyperuricemia patients display a lower number of NKG2D+ NK cells before and after a low-purine diet
Authors: Gao Lichao , Jiang Yanfang , Wang Yichen , Qu Xiaozhang , Li Lei , Lou Xiaoqian , Wang Ye , Guo Hui , Liu Ya
Published: December 2018

Background:

Aberrant activation of the immune system has been reported in asymptomatic hyperuricemia (HUA) patients. However, very few studies have elucidated the role of natural killer (NK) cells in this disease.

Methods:

In this study, we evaluated the relationship between NK cells and HUA in 16 control subjects and 20 patients, who were all on a low-purine diet. We analyzed the number of circulating NK cells, its subsets, interferon-γ+, and CD107+ NK cells, by flow cytometry, before and after 4 and 24 weeks of diet control. We also assessed the potential association of the NK cells with clinical measures.

Results:

The patients consistently had a lower number of NKG2D+ NK cells before and after low-purine diet, even the serum uric acid (SUA) levels <7 mg/dL after diet control. Moreover, a lower number of NK cells and a higher number of CD107a+ NK cells were observed on recruitment. Low-purine diet was benefit on the improvement of the SUA levels, body mass index (BMI), and the number and functions of NK cells. Furthermore, the number of CD3−CD56+ NK cells and NKG2D+ NK cells negatively correlated with the BMI before and after diet control.

Conclusion:

The consistent lower number of NKG2D+ NK cells and correlated with BMI before and after low-purine diet may be involved in the occurrence and development of HUA.
Modified Buzhong Yiqi decoction for myasthenia gravis
Authors: Jiang Xiaotao , Chen Guoming , Huang Jiahua , Xie Linling , Shen Danting , Jiang Kailin , Xu Hua
Published: December 2018

Background:

Myasthenia gravis (MG) is an autoimmune disease caused by the transmission of dysfunction in the neuromuscular junction, manifesting partial or systemic skeletal muscle weakness and fatigue, which are exacerbated by activities and relieved after rest. Currently, the conventional therapy is applying cholinesterase inhibitors, steroids, immunosuppressant, and thymectomy. However, these drugs have obvious side effects. According to traditional Chinese medicine (TCM) theory, Buzhong Yiqi decoction (BYD) is a Qi-supplementing formula which is suitable for MG management as MG is generally diagnosed as “flaccidity syndrome” and considered caused by Qi-deficiency. An increasing number of clinical controlled studies also have found that BYD could improve the efficacy and reduced adverse effects in treating MG, but there is no systematic review of it. Therefore, we will use meta-analysis to evaluate the efficacy and safety of BYD for MG.

Methods:

PubMed, MEDLINE, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang data, Chinese Scientific Journals Database (VIP), and China biomedical literature database (CBM) will be searched to obtain the eligible studies published up to June 1, 2018. The primary outcome will be clinical absolute score before and after treatment, clinical relative score as well as effective rate. The secondary outcome will be the concentration of acetylcholine receptor antibody (AchRAb) in serum and adverse events incidence. Data analysis will be conducted using RevMan5.3 and Stata V.9.0 software. Trial sequential analysis (TSA) will be performed to assess the risk of random error and the validity of conclusion using TSA program version 0.9 beta.

Results:

This systematic review will provide a high-quality synthesis of BYD and its modified forms for MG from various evaluation aspects including clinical absolute score before and after treatment, clinical relative score, effective rate, the concentration of AchRAb in serum and adverse events incidence.

Conclusion:

The systematic review will provide evidence to assess the efficacy and safety of BYD and its modified forms in the treatment of MG.

Prospero registration number:

PROSPERO CRD42018095241.
Short- and long-term outcomes of laparoscopic versus open surgery for rectal cancer
Authors: Lin Zhong , Jiang Zheng-Li , Chen Dan-Yang , Chen Min-Fang , Chen Li-Hua , Zhou Peng , Xia Ai-Xiao , Zhu Yan-Wu , Jin Hui , Ge Qiang-Qiang
Published: December 2018

Objectives:

The present meta-analysis aimed to evaluate the short- and long-term outcomes of laparoscopic surgery (LS) versus open surgery (OS) for rectal cancer.

Methods:

PubMed, Web of Science, and Cochrane Library, were searched for eligible randomized controlled trials (RCTs) published up to June 2017. Operation related index, postoperative complication, and long-term survival rate and disease-free survival rate were evaluated by meta-analytical techniques.

Result:

Nine RCTs enrolling 4126 patients were included in the present meta-analysis. Compared to OS, LS had similar positive circumferential resection margin (CRM) and number of lymph nodes extracted (LNE) as well as long term 5 years survival rate and disease-free survival rate, but of which the risk tendency was higher in LS group. The short-term outcomes of major and total postoperative complication were lower in LS group.

Conclusions:

LS for rectal cancer was as safe and effective as OS in terms of long-term outcomes, but with lower postoperative complication.
Axillary lymph node metastasis as the first manifestation of male occult breast cancer
Authors: Wang Xinyu , Fan Liwen , Yan Wenxing , Zhang Qi , Bao Shunchao , Wang Ying , Bao Xin , Liu Linlin
Published: December 2018

Rational:

Occult breast cancer (OBC) is an extremely rare breast cancer and is defined by the presence of axillary metastasis without a primary tumor in the breasts or any abnormality on radiologic examination.

Patient concerns:

This case report presents a 49-year-old man who was diagnosed with male OBC, which first manifested as an axillary lymph node metastasis followed by the emergence of infraclavicular lymph node metastasis. Neither the breast nor other organs had any abnormality.

Diagnosis:

The pathological examination revealed metastatic adenocarcinoma. Immunohistochemical (IHC) staining results were positive for estrogen receptor (ER), progesterone receptor (PR), and gross cystic disease fluid protein-15 (GCDFP-15); and negative for human epidermal receptor-2 (Her-2) 1+, cytokeratin (CK) 7, CK20, and thyroid transcription factor-1 (TTF-1).

Interventions:

The patient underwent left axillary lymph node dissection but not a mastectomy. After the operation, the patient subsequently underwent chemotherapy, radiotherapy, and endocrinotherapy.

Outcomes:

Currently, he has been followed-up for >4 years without any signs of recurrence.

Lessons:

Careful physical and imaging examinations combined with pathological analysis are essential in the diagnosis of male OBC. Early surgery remains the primary treatment.
Effects of apolipoprotein E on nutritional metabolism in dementia
Authors: Farmer Brandon C. , Johnson Lance A. , Hanson Angela J.
Published: December 2018

Purpose of review

Various groups have explored the effect of apolipoprotein E (APOE) on neurodegeneration through nutritional and metabolic alterations. In this review, we hope to summarize recent findings in humans as well as preclinical APOE models.

Recent findings

Metabolic pathways including lipid metabolism appear to play a large role in the pathophysiology of Alzheimer's disease. Carrier status of the E4 variant of the APOE gene is the strongest genetic risk factor for Alzheimer's disease, and increasing evidence suggests that E4 carriers may respond differently to a host of dietary and metabolic-related treatments. A new appreciation is forming for the role of APOE in cerebral metabolism, and how nutritional factors may impact this role.

Considering the role dietary factors play in APOE-associated cognitive decline will help us to understand how nutritional interventions may facilitate or mitigate disease progression.
Lipoprotein metabolism in liver diseases
Authors: Perez-Matos Maria Camila , Sandhu Bynvant , Bonder Alan , Jiang Zhenghui Gordon
Published: December 2018

Purpose of review

The liver is the central hub of lipoprotein metabolism. A complex relationship exists between dyslipidemia and chronic liver diseases (CLDs). Recent advances in the genetics of nonalcoholic fatty liver disease (NAFLD) and alcoholic liver disease (ALD) exemplify the pivotal role of lipoprotein metabolism in the pathogenesis of CLD. We review these relationships in four quintessential forms of CLD: NAFLD, ALD, cholestatic liver disease and cirrhosis, with a focus on recent discoveries.

Recent findings

An I148 M variant in patatin-like phospholipase domain-containing protein 3 (PNPLA3) and an E167K variant in transmembrane 6 superfamily 2 (TM6SF2) are major genetic risk factors for the development and progression of NAFLD. These genetic variants also increase the risk of ALD. Both PNPLA3 and TM6SF2 are involved in the hepatic assembly of very low-density lipoprotein. The discovery of these two genetic variants highlights the risk of CLD when environmental factors are combined with functional modifications in the lipoprotein metabolism pathway.

The relationship between CLD and lipoprotein metabolism is reciprocal. On the one hand, the progression of CLD impairs lipoprotein metabolism; on the other hand, modifications in lipoprotein metabolism can substantially increase the risk of CLD. These relationships are at play among the most common forms of CLD affecting a significant proportion of the population.
Impact of a Nutrition-Focused Quality Improvement Intervention on Hospital Length of Stay
Authors: Siegel Sharon , Fan Linlin , Goldman Amanda , Higgins Joseph , Goates Scott , Partridge Jamie
Published: December 2018

Background:

Despite its high prevalence, malnutrition in hospitalized patients often goes unrecognized and undertreated.

Local Problem:

A hospital system sought to improve nutrition care by implementing a quality improvement initiative. Nurses screened patients upon admission using the Malnutrition Screening Tool and initiated oral nutrition supplements for patients at risk.

Methods:

We retrospectively reviewed the medical records of 20 697 adult patients to determine whether early initiation of nutrition therapy had reduced hospital length of stay and 30-day readmission rates.

Results:

We found the average time from hospital admission to oral nutrition supplement initiation was reduced by 20 hours (20.8%) after the quality improvement initiative was introduced (P< .01). Length of stay decreased 0.88 days (P< .05) more for patients at nutritional risk than patients not at nutritional risk; the probability of 30-day hospital readmission did not differ between groups.

Conclusion:

These results highlight the importance of adequate nutrition screening, diagnosis, and treatment for hospitalized patients.
Uterine Preservation vs Hysterectomy in Pelvic Organ Prolapse Surgery: A Systematic Review With Meta-analysis and Clinical Practice Guidelines
Authors: Meriwether Kate V. , Antosh Danielle D. , Olivera Cedric K. , Kim-Fine Shunaha , Balk Ethan M. , Murphy Miles , Grimes Cara L. , Sleemi Ambereen , Singh Ruchira , Dieter Alexis A. , Crisp Catrina C. , Rahn David D.
Published: December 2018

(Abstracted from Am J Obstet Gynecol 2018;219:129–146.e2)

Hysterectomy performed at the time of pelvic organ prolapse (POP) repair allows the surgeon to gain access to tissues used for apical suspension. However, hysterectomy adds surgical time and costs and may increase morbidity.
Gunshot Suicide
Authors: Bogdanović Milenko , Atanasijević Tatjana , Popović Vesna , Durmić Tijana , Radnić Bojana
Published: December 2018

The article describes a case of gunshot suicide to the head in a 51-year-old man. The entrance wound was located in the left temple and exit wound in the right temple. The entrance wound had the characteristics of a hard-contact gunshot wound. The most interesting finding in this case was cherry-red discoloration of the right temporal muscle surrounding the exit wound. This finding could make the determination of the entrance versus exit gunshot wound challenging, especially if the wounds are of atypical appearance. In addition, the finding described in the presented case could be the proof that carbon monoxide may follow the missile through the body and may be prominent in the soft tissue at the exit.
Factors Associated With Long-term Outcomes After Injury
Authors: Haider Adil H. , Herrera-Escobar Juan P. , Al Rafai Syeda S. , Harlow Alyssa F. , Apoj Michel , Nehra Deepika , Kasotakis George , Brasel Karen , Kaafarani Haytham M. A. , Velmahos George , Salim Ali
Published: December 2018

Objective:

The aim of this study was to determine factors associated with patient-reported outcomes, 6 to 12 months after moderate to severe injury.

Summary of Background Data:

Due to limitations of trauma registries, we have an incomplete understanding of factors that impact long-term patient-reported outcomes after injury. As 96% of patients survive their injuries, several entities including the National Academies of Science, Engineering and Medicine have called for a mechanism to routinely follow trauma patients and determine factors associated with survival, patient-reported outcomes, and reintegration into society after trauma.

Methods:

Over 30 months, major trauma patients [Injury Severity Score (ISS) ≥9] admitted to 3 Level-I trauma centers in Boston were assessed via telephone between 6 and 12 months after injury. Outcome measures evaluated long-term functional, physical, and mental-health outcomes. Multiple regression models were utilized to identify patient and injury factors associated with outcomes.

Results:

We successfully followed 1736 patients (65% of patients contacted). More than half (62%) reported current physical limitations, 37% needed help for at least 1 activity of daily living, 20% screened positive for posttraumatic stress disorder (PTSD), all SF-12 physical health subdomain scores were significantly below US norms, and 41% of patients who were working previously were unable to return to work. Age, sex, and education were associated with long-term outcomes, while almost none of the traditional measures of injury severity were.

Conclusion:

The long-term sequelae of trauma are more significant than previously expected. Collection of postdischarge outcomes identified patient factors, such as female sex and low education, associated with worse recovery. This suggests that social support systems are potentially at the core of recovery rather than traditional measures of injury severity.
The relationship between school personnel's confidence with using the school‐wide positive behaviour intervention support model and its sustainability
Authors: Chitiyo Jonathan , May Michael E. , Mathende Allen M. , Dzenga Chaidamoyo G.
Published: December 2018

Evidence demonstrating the effectiveness of the School‐wide Positive Behaviour Intervention Support model (SWPBIS) in managing problem behaviour among school students has been widely disseminated. As a result, the SWPBIS model is now widely implemented in schools across the US. Despite its widespread implementation and evidence demonstrating its efficacy, little is known about its sustainability. The scarcity of research studies examining the factors that influence the sustainability of SWPBIS provides a strong rationale for this study. The purpose of this study was to explore the relationship between school personnel's confidence with using SWPBIS and its sustainability. Participants were 104 school personnel employed in schools that implement SWPBIS in a southern region of Illinois. Regression analyses revealed that there is a significant relationship between personnel's confidence with using the model and its sustainability. The results led to important implications for practitioners involved in the implementation of SWPBIS and directions for future research are provided.
Bone Mineral Density Adult Age Estimation in Forensic Anthropology: A Test of the DXAGE Application
Authors: Bethard Jonathan D. , Berger Jacqueline M. , Maiers Justin , Ross Ann H.
Published: December 2018

Estimating age‐at‐death of individuals represented only by skeletonized human remains is a fundamental aspect of forensic anthropological casework. Recently, several researchers have proposed that bone mineral density (BMD) is a useful predictor of age‐at‐death in forensic contexts. Navega et al. (JFS 63(2):497–503) developed an online application called DXAGE for calculating age‐at‐death from BMD parameters. This study tests the utility of DXAGE by utilizing data from the National Health and Nutrition Examination Survey (NHANES). BMD data from a female subsample (n = 470) of the NHANES 2007–2008 dataset were analyzed, and the relationship between predicted age and real age was examined. Inaccuracy was 14.25 years, and bias was −7.20 years. Results show that there is a weak correlation between predicted and actual age (r = 0.47) using the DXAGE application. While BMD data are potentially useful for predicting age age‐at‐death, the DXAGE application should be used cautiously in forensic anthropological contexts.
Polymorphisms in the myeloid differentiation primary response 88 pathway do not explain low expression levels in sudden infant death syndrome
Authors: Bjørnvall Christina Dybdrodt , Opdal Siri H. , Rognum Torleiv O. , Ferrante Linda
Published: December 2018

Aim

The aim of this study was to investigate if a range of known rare and common genetic variants in the Toll‐like receptor 4 (TLR4)/myeloid differentiation primary response 88 (MyD88) pathway were present or overrepresented in sudden infant death syndrome (SIDS) compared to controls.

Methods

Genetic variations in the genes encoding TLR4, MyD88 and Interleukin‐1 receptor‐associated kinase 4 were analysed. The subjects investigated included 158 SIDS cases with a median age of 15.25 weeks (2–47 weeks), 80 cases of infectious death with a median age of 24.9 weeks (0–285 weeks) and 199 adult controls with a median age of 50 years (11–86 years). The cases were collected in the years 1988–2017, and the autopsies were performed at the Department of Forensic Sciences at Oslo University Hospital, Oslo, Norway.

Results

The results showed that none of the genetic variants selected from the MyD88 pathway were associated with neither SIDS nor infectious death. Most of the rare genetic variants were homozygote for the common allele in all groups, while the rest revealed allelic variation.

Conclusion

The genetic variations investigated in this study did not appear to be involved in the pathogenesis of SIDS.
A population pharmacokinetic model to predict the individual starting dose of tacrolimus in adult renal transplant recipients
Authors: Andrews L. M. , Hesselink D. A. , van Schaik R. H. N. , van Gelder T. , de Fijter J. W. , Lloberas N. , Elens L. , Moes D. J. A. R. , de Winter B. C. M.
Published: December 2018

Aims

The aims of this study were to describe the pharmacokinetics of tacrolimus immediately after kidney transplantation, and to develop a clinical tool for selecting the best starting dose for each patient.

Methods

Data on tacrolimus exposure were collected for the first 3 months following renal transplantation. A population pharmacokinetic analysis was conducted using nonlinear mixed‐effects modelling. Demographic, clinical and genetic parameters were evaluated as covariates.

Results

A total of 4527 tacrolimus blood samples collected from 337 kidney transplant recipients were available. Data were best described using a two‐compartment model. The mean absorption rate was 3.6 h−1, clearance was 23.0 l h–1 (39% interindividual variability, IIV), central volume of distribution was 692 l (49% IIV) and the peripheral volume of distribution 5340 l (53% IIV). Interoccasion variability was added to clearance (14%). Higher body surface area (BSA), lower serum creatinine, younger age, higher albumin and lower haematocrit levels were identified as covariates enhancing tacrolimus clearance. Cytochrome P450 (CYP) 3A5 expressers had a significantly higher tacrolimus clearance (160%), whereas CYP3A4*22 carriers had a significantly lower clearance (80%). From these significant covariates, age, BSA, CYP3A4 and CYP3A5 genotype were incorporated in a second model to individualize the tacrolimus starting dose:

urn:x-wiley:03065251:media:bcp13838:bcp13838-math-0001
Both models were successfully internally and externally validated. A clinical trial was simulated to demonstrate the added value of the starting dose model.

Conclusions

For a good prediction of tacrolimus pharmacokinetics, age, BSA, CYP3A4 and CYP3A5 genotype are important covariates. These covariates explained 30% of the variability in CL/F. The model proved effective in calculating the optimal tacrolimus dose based on these parameters and can be used to individualize the tacrolimus dose in the early period after transplantation.
Factors influencing return for maintenance treatment with percutaneous tibial nerve stimulation for the management of the overactive bladder
Authors: Salatzki Janek , Liechti Martina D. , Spanudakis Eleonora , Gonzales Gwen , Baldwin Joanne , Haslam Collette , Pakzad Mahreen , Panicker Jalesh N.
Published: December 2018

Objectives

To identify factors influencing return for maintenance percutaneous tibial nerve stimulation (PTNS) treatment after successful completion of a 12‐week course of treatment for overactive bladder (OAB).

Patients and Methods

Patients with OAB symptoms referred for PTNS treatment underwent 12 sessions of weekly PTNS treatment and were evaluated at baseline and week 12 using the International Consultation on Incontinence Questionnaire on OAB, the International Consultation on Incontinence Questionnaire on lower urinary tract symptom‐related quality of life (ICIQ‐LUTSqol) and a bladder diary (BD). Responders to treatment, evaluated using two patient‐reported outcome measures, were invited to return for maintenance treatment when symptoms returned. A PTNS Service Evaluation Questionnaire was used to evaluate factors influencing return for maintenance treatment.

Results

Seventy‐three patients were evaluated (mean age 58.9 [±14.7] years, 72.6% women) and clustered into three groups: group 1 (n = 25) did not respond to 12 weekly sessions of PTNS treatment; group 2 (n = 17) responded to treatment but did not return for maintenance treatment and group 3 (n = 31) responded to treatment and returned for maintenance treatment. There were no significant differences in demographic characteristics, diagnosis, baseline symptom scores and BD variables among the three groups. Patients belonging to groups 2 and 3 experienced a significant improvement from baseline to week 12 in total OAB scores (group 2: −1.54 ± 1.85; group 3: −1.85 ± 2.28; P < 0.05); however, patients returning for maintenance treatment reported significant improvements specifically in nocturia (BD difference = −0.4 ± 0.7 [P < 0.05] and ICIQ‐LUTSqol difference −0.48 ± 0.94 [P < 0.05]), and perceived benefits of the treatment with regard to their OAB symptoms compared to those not returning for maintenance treatment (difference between the two groups 25.6%; P = 0.030). Improvements in nocturia and perceived benefits predicted return for maintenance treatment based on a logistic regression analysis. Factors related to the need for repeat clinic visits, such as transportation, distance and time commitment, were not found to differ between the two groups.

Conclusions

Twelve‐session weekly PTNS is a safe and effective treatment for OAB. Responders to treatment returning for maintenance PTNS more often reported significant improvements in nocturia and perceived benefits over time, compared to those not returning for maintenance treatment. The BD provides a more objective assessment of treatment outcome after PTNS treatment.
EMBRace: Developing a Racial Socialization Intervention to Reduce Racial Stress and Enhance Racial Coping among Black Parents and Adolescents
Authors: Anderson Riana E. , McKenny Monique C. , Stevenson Howard C.
Published: December 2018

Researchers have illustrated the deleterious psychological effects that racial discrimination has exerted on Black Americans. The resulting racial stress and trauma (RST) from experiences with discrimination has been linked to negative wellness outcomes and trajectories for Black youth and families. Racial socialization (RS)—defined as the verbal and nonverbal messages that families use to communicate race to their children—can be a cultural strength and has been associated with positive outcomes in Black youth. Furthermore, the Racial Encounter Coping Appraisal and Socialization Theory (RECAST) encourages the frequent and competent use of RS between family members to cope with the negative impact of RST. Guided by RECAST, the purpose of this article is to describe the development of the Engaging, Managing, and Bonding through Race (EMBRace) intervention targeting the RS practices between Black adolescents and families. The authors explore current research on RST, discuss why traditional coping models for stress are inadequate for racially specific stressors, highlight RECAST as a burgeoning racial coping and socialization model, and describe how RS can be used as a tool to intervene within Black families. This is followed by a detailed description of the development and use of the EMBRace intervention which seeks to reduce RST through RS psychoeducation and practice, stress management, and the promotion of bonding in Black families. This article aims to serve as an example of a culturally relevant RS intervention for Black families who may benefit from clinical treatment for psychological distress from racially discriminatory encounters.
The structure of mammalian β‐mannosidase provides insight into β‐mannosidosis and nystagmus
Authors: Gytz Heidi , Liang Jason , Liang Yingke , Gorelik Alexei , Illes Katalin , Nagar Bhushan
Published: December 2018

β‐Mannosidase is a lysosomal enzyme from the glycosyl hydrolase family 2 that cleaves the single β(1–4)‐linked mannose at the nonreducing end of N‐glycosylated proteins, and plays an important role in the polysaccharide degradation pathway. Mutations in the MANBA gene, which encodes the β‐mannosidase, can lead to the lysosomal storage disease β‐mannosidosis, as well as nystagmus, an eye condition characterized by involuntary eye movements. Here, we present the first structures of a mammalian β‐mannosidase in both the apo‐ and mannose‐bound forms. The structure is similar to previously determined β‐mannosidase structures with regard to domain organization and fold, however, there are important differences that underlie substrate specificity between species. Additionally, in contrast to most other ligand‐bound β‐mannosidases from bacterial and fungal sources where bound sugars were in a boat‐like conformation, we find the mannose in the chair conformation. Evaluation of known disease mutations in the MANBA gene provides insight into their impact on disease phenotypes. Together, these results will be important for the design of therapeutics for treating diseases caused by β‐mannosidase deficiency.

Database

Structural data are available in the Protein Data Bank under the accession numbers 6DDT and 6DDU.
Screening for non‐alcoholic fatty liver disease in patients with type 2 diabetes mellitus using transient elastography
Authors: Lai Lee‐Lee , Wan Yusoff Wan Nur Illyana , Vethakkan Shireene Ratna , Nik Mustapha Nik Raihan , Mahadeva Sanjiv , Chan Wah‐Kheong
Published: December 2018

Background and Aim

The recommendation in regard to screening for non‐alcoholic fatty liver disease (NAFLD) among type 2 diabetes mellitus (T2DM) patients differs in major guidelines. The aim of this paper was to study the prevalence of NALFD and advanced fibrosis among T2DM patients.

Methods

This is a cross‐sectional study of consecutive adult T2DM patients attending the Diabetes Clinic of a university hospital. Significant hepatic steatosis and advanced fibrosis was diagnosed based on transient elastography if the controlled attenuation parameter was ≥ 263 dB/m, and the liver stiffness measurement was ≥ 9.6 kPa using the M probe or ≥ 9.3 kPa using the XL probe, respectively. Patients with liver stiffness measurement ≥ 8 kPa were referred to the Gastroenterology and Hepatology Clinic for further assessment, including liver biopsy.

Results

The data of 557 patients were analyzed (mean age 61.4 ± 10.8 years, male 40.6%). The prevalence of NAFLD and advanced fibrosis based on transient elastography was 72.4% and 21.0%, respectively. On multivariate analysis, independent factors associated with NAFLD were central obesity (OR 4.856, 95% confidence interval [CI] 2.749–8.577, P = 0.006), serum triglyceride (OR 1.585, 95% CI 1.056–2.381, P = 0.026), and alanine aminotransferase levels (OR 1.047, 95% CI 1.025–1.070, P < 0.001) while advanced fibrosis was associated with serum high‐density lipoprotein cholesterol (OR 0.355, 95% CI 0.126–0.997, P = 0.049), alanine aminotransferase (OR 1.023, 95% CI 1.009–1.037, P = 0.001), γ‐glutamyltransferase (OR 1.005, 95% CI 1.001–1.008, P = 0.017), and platelet levels (OR 0.995, 95% CI 0.992–0.999, P = 0.010). Seventy‐one patients underwent liver biopsy. The majority had non‐alcoholic steatohepatitis (83.1%) and ≥ F1 fibrosis (87.3%) while advanced fibrosis was seen in 36.6%.

Conclusion

The prevalence of NAFLD and advanced fibrosis based on transient elastography is high among T2DM patients.
Bone marrow‐derived interstitial cells of cajal are increased by electroacupuncture in the colon of diabetic mice
Authors: An Jing , Zhao Jiao , Liu Shi
Published: December 2018

Background and Aim

Insufficiency of interstitial cells of cajal (ICC) in the muscular plexus of colon has been proved in diabetic mice. Electroacupuncture (EA) at ST36 can accelerate ICC supplement in the colon of diabetic mice, but the source of increased ICC has not been clearly explored. Bone marrow cells possess the potential of migration and differentiation into ICC of the intestine. Our aim is to explore the effects of EA on variations of bone marrow‐derived ICC in the colon of diabetic mice as well as its mechanism.

Methods

Wild C57BL/6 mice were divided into six groups with random assignment method: control group, diabetic mellitus (DM) group, bone marrow transplantation (BMT) + DM group, BMT + DM + sham EA group, BMT + DM + low‐frequency EA group, and BMT + DM + high‐frequency EA group. Flow cytometric method was adopted to identify the chimera model. The specific location and expression levels of c‐Kit+ green fluorescent protein (GFP+) cells in colon were detected by immunofluorescence. Western blot and quantitative polymerase chain reaction were used to assess the expression level of c‐Kit, GFP, membrane‐band stem cell factor (mSCF), p‐ERK, p‐c‐Jun, ETV1, stromal cell‐derived factor 1 (SDF‐1), CXCR4, transforming growth factor β1 (TGF‐β1), and smad3.

Results

c‐Kit+ GFP+ cells in the muscular plexus of colon were apparently increased in the EA groups; the protein and mRNA expression level of CXCR4, SDF‐1, TGF‐β1, smad3, c‐kit, mSCF, p‐ERK, p‐c‐Jun, and ETV1 were elevated in the EA groups.

Conclusions

Electroacupuncture can effectively increase bone marrow‐derived ICC in the colon by SDF‐1/CXCR4, TGF‐β1/Smad3, and mSCF/Kit‐p‐ERK/p‐c‐Jun‐ETV1 signal pathway.
The experience of person‐centred practice in a 100% single‐room environment in acute care settings—A narrative literature review
Authors: Kelly Rosemary , Brown Donna , McCance Tanya , Boomer Christine
Published: December 2018

Aims and objectives

To review published research into the staff and adult patient experience of person‐centred practice in a 100% single‐room environment in acute care.

Background

There has been a significant move towards the 100% single‐room environment within healthcare systems. Furthermore, there has been a global move for developing person‐centred practice in a range of healthcare settings. Some studies have linked the role of the physical environment to patient outcomes and improved patient satisfaction; however, these are limited. Overall, there is little evidence in the international literature of the experience of care in single rooms in adult, acute care settings.

Design

A narrative description was developed using the major constructs of the person‐centred practice framework (PcPF). The PRISMA checklist provided additional rigour.

Method

Problems, Exposure, Outcomes (PEO) refined the search terms to: person‐centred, adult acute care, single room, staff experience and patient experience. CINAHL, Medline Ovid, Psycinfo, Embase, Web of Science and Scopus were searched for full‐text English language papers of empirical studies published between 2012–2017. PRISMA illustrated final paper determination, and the CASP/EPHPP frameworks were used for a critical appraisal of the 12 selected papers.

Results

The literature recognises the increasing complexity of health care in the acute care environment globally. The international literature available identifies staffs’ desire to practise person‐centredness, but much of the evidence is focused on care delivery. The impact of the single‐room environment on person‐centred practice links mainly to the constructs of the care environment and person‐centred processes within the PcPF.

Conclusion

This review focuses on empirical studies relating to person‐centred practice in the single‐room environment published in the last 5 years. While there is a significant body of work relating to person‐centredness and the delivery of person‐centred practice, and the impact of the environment on care delivery, there appears to limited evidence linking person‐centred practice, staff and patient experience and the single‐room environment.

Relevance to clinical practice

By understanding the context in which care is delivered, multiprofessional teams can explore how the delivery of person‐centred practice may be influenced by the physical environment and what changes to culture, systems and processes may be required to enhance the experience of care for patients and the delivery of care for staff.