bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationships Between Weight Change and Physical and Psychological Distress in Early-Stage Breast Cancer Survivors
Authors: Vance Vivienne , Mourtzakis Marina , Hanning Rhona
Published: May 2018

Background

Weight gain and unfavorable changes in body composition are common in a growing population of breast cancer survivors, but the etiology of these changes is poorly understood.

Objective

The aim of this study was to investigate relationships between weight change and symptoms of physical and psychological distress in the first 12 months of completing treatment in women who had completed treatment for breast cancer.

Methods

Physical distress and psychological distress were assessed using the Rotterdam Symptom Checklist, the Distress Thermometer, and the Fatigue Symptom Inventory.

Results

Weight change in 28 women since the completion of treatment (mean, 6.4 ± 4.4 months) ranged from −6.0 kg to +5.2 kg (mean, −0.4 ± 3.2), with 6 women gaining and 7 women losing an average of 3.5 ± 1.0 and 5.1 ± 0.8 kg, respectively. Rotterdam mean scores for physical (17.5 ± 9.0) and psychological distress (27.1 ± 16.9) were similar to previous findings for patients with early-stage breast cancer in active treatment and appear to be markedly higher than distress levels previously reported in cancer-free adults. Distress levels, based on the Distress Thermometer, were moderate to severe in 35% of women. Fatigue was common and associated with interference in daily living for some women. Fatigue duration was negatively correlated with weight change (P = −0.46, P < .05).

Conclusions

Symptoms of physical and psychological distress persist for some women in the first year after completing treatment and may associate with weight change.

Implications

These findings underscore a need for ongoing assessment and supportive care across the breast cancer trajectory and may guide dietary counseling aimed at promoting healthy body weight and overall health in early survivorship.
Patients at High Risk of Intervention for Pediatric Traumatic Liver Injury
Authors: Donnelly Katie A. , Breslin Kristen , O'Connell Karen J.
Published: May 2018

Objectives

Nonoperative management of hemodynamically stable liver lacerations in pediatric trauma patients is a safe and effective management strategy for pediatric patients; approximately 90% will be successfully managed nonoperatively. No study has specifically identified risk criteria for the need for intervention versus observation alone. Our objective for this study was to determine risk factors from the physical examination, computed tomography scan, and laboratory results associated with intervention for liver laceration.

Methods

We performed a retrospective cohort study using data from the Pediatric Emergency Care Applied Research Network Intra-abdominal Injuries Study public use data set. Data were collected prospectively at the time of enrollment; a limited data set was released for public use in 2014. Patients were included if they were diagnosed with a liver laceration by computed tomography scan. We used bivariable and multivariable analyses to determine associations of specific risk factors with intervention, defined as laparotomy, angiographic embolization, blood transfusion, death, or return to emergency department for any reason within 30 days.

Results

Of the 12,044 patients in the Intra-abdominal Injuries Study, 282 were diagnosed with a liver laceration. All patients were hospitalized, and 99 (35.1%) underwent an intervention. Variables were then eliminated if more than 10% of cases were missing data. Multivariable logistic regression identified the following independent risk factors for intervention: white blood cell count greater than 15 K/mcl (adjusted odds ratio [adjOR], 2.83; 95% confidence interval [CI], 1.43–5.63), pelvic fracture (adjOR, 2.50; 95% CI, 1.02–6.10), liver injury greater than grade 2 (adjOR, 2.16; 95% CI, 1.06–4.40), Glasgow Coma Scale score less than 15 (adjOR, 4.77; 95% CI, 2.27–7.63), and hematocrit less than 32% (adjOR, 4.79; 95% CI, 2.00–11.46).

Conclusions

We identified 5 high-risk criteria associated with intervention for traumatic liver laceration in pediatric patients. Prospective studies are necessary to validate these results before using them to determine disposition of pediatric patients with traumatic liver injuries.
Anticipatory Effects on Perceived Pain: Associations With Development and Anxiety
Authors: Michalska Kalina J. , Feldman Julia S. , Abend Rany , Gold Andrea L. , Dildine Troy C. , Palacios-Barrios Esther E. , Leibenluft Ellen , Towbin Kenneth E. , Pine Daniel S. , Atlas Lauren Y.
Published: May 2018

Objective

Naturalistic studies suggest that expectation of adverse experiences such as pain exerts particularly strong effects on anxious youth. In healthy adults, expectation influences the experience of pain. The current study uses experimental methods to compare the effects of expectation on pain among adults, healthy youth, and youth with an anxiety disorder.

Methods

Twenty-three healthy adults, 20 healthy youth, and 20 youth with an anxiety disorder underwent procedures in which auditory cues were paired with noxious thermal stimulation. Through instructed conditioning, one cue predicted low-pain stimulation and the other predicted high-pain stimulation. At test, each cue was additionally followed by a single temperature calibrated to elicit medium pain ratings. We compared cue-based expectancy effects on pain across the three groups, based on cue effects on pain elicited on medium heat trials.

Results

Across all groups, as expected, participants reported greater pain with increasing heat intensity (β = 2.29,t(41) = 29.94,p< .001). Across all groups, the critical medium temperature trials were rated as more painful in the high- relative to low-expectancy condition (β = 1.72,t(41) = 10.48,p< .001). However, no evidence of between-group differences or continuous associations with age or anxiety was observed.

Conclusions

All participants showed strong effects of expectancy on pain. No influences of development or anxiety arose. Complex factors may influence associations among anxiety, development, and pain reports in naturalistic studies. Such factors may be identified using experiments that employ more complex, yet controlled manipulations of expectancy or assess neural correlates of expectancy.
Nurses’ and Physicians’ Perceptions of Indwelling Urinary Catheter Practices and Culture in Their Institutions
Authors: Niederhauser Andrea , Züllig Stephanie , Marschall Jonas , Schwappach David LB
Published: May 2018

Objectives

Indwelling urinary catheters (IUCs) are commonly used devices in acute care that may lead to catheter-associated urinary tract infections or noninfectious complications. Responsibilities for IUC are usually shared between nurses and physicians, and a common mental model among the two professional groups is thus essential for a successful reduction in catheter use. The aim of this study was to determine variation in the perceptions of current practices and culture regarding IUC use between these two groups.

Methods

Nurses and physicians (N = 1579) from seven Swiss hospitals completed a written survey on safe IUC use in their institution. The survey assessed participant’s perceptions of current practices and culture in their institution, and their perceived responsibilities related to IUC care. t tests and logistic regression were used to examine differences in responses between physicians and nurses.

Results

Nurses and physicians each have their own tasks but also share responsibilities for catheter placement, care, and removal. Overall, nurses were more positive than physicians about current practices and culture regarding IUC use within their institution (mean scale scores = 5.4 for nurses versus 5.1 for physicians, P < 0.001). Perceptions of the two professional groups diverged most strongly on practices to avoid unnecessary placement of IUCs, the presence of shared values and attitudes in support of restrictive catheter use, and the other group’s leadership commitment.

Conclusions

Indwelling urinary catheter management is a strong interprofessional domain and a shared responsibility. It is crucial that measures to raise awareness and to communicate new standards target both nurses and physicians and are discussed in interprofessional formats.
Infections complicating cesarean delivery
Authors: Sood Geeta , Argani Cynthia , Ghanem Khalil G. , Perl Trish M. , Sheffield Jeanne S.
Published: May 2018

Purpose of review

Cesarean sections are common surgical procedures performed in a healthy population and are unique because of a relatively high rate of postoperative infection. There have been many important advances in understanding the pathogenesis of infection and evaluation of interventions to prevent post cesarean section infections in the last few years. Our purpose in this review is to analyze these new data, discuss unanswered questions, and propose changes in standard of care.

Recent findings

Wound closure techniques including subcuticular sutures and subcutaneous suturing have been shown to be effective at reducing surgical site infections. Wound dressings including negative pressure dressings likely do not decrease infection rates. The type, timing, and duration of preoperative prophylactic antibiotics, including adjunctive azithromycin for laboring women and multidose antibiotics in obese women, have also yielded mixed results. Our understanding of normal uterine microbiome and the impact of intrapartum antibiotics on the newborn is emerging.

The pathogenesis of surgical site infections after Cesarean section is complex and multifactorial. Many interventions to reduce infections have been studied with varying degrees of effectiveness. Despite advances in the area, important questions remain unanswered.
150-μm Spatial Resolution Using Photon-Counting Detector Computed Tomography Technology
Authors: Leng Shuai , Rajendran Kishore , Gong Hao , Zhou Wei , Halaweish Ahmed F. , Henning Andre , Kappler Steffen , Baer Matthias , Fletcher Joel G. , McCollough Cynthia H.
Published: May 2018

Objective

The aims of this study were to quantitatively assess two new scan modes on a photon-counting detector computed tomography system, each designed to maximize spatial resolution, and to qualitatively demonstrate potential clinical impact using patient data.

Materials and Methods

This Health Insurance Portability Act–compliant study was approved by our institutional review board. Two high–spatial-resolution scan modes (Sharp and UHR) were evaluated using phantoms to quantify spatial resolution and image noise, and results were compared with the standard mode (Macro). Patients were scanned using a conventional energy-integrating detector scanner and the photon-counting detector scanner using the same radiation dose. In first patient images, anatomic details were qualitatively evaluated to demonstrate potential clinical impact.

Results

Sharp and UHR modes had a 69% and 87% improvement in in-plane spatial resolution, respectively, compared with Macro mode (10% modulation-translation-function values of 16.05, 17.69, and 9.48 lp/cm, respectively). The cutoff spatial frequency of the UHR mode (32.4 lp/cm) corresponded to a limiting spatial resolution of 150 μm. The full-width-at-half-maximum values of the section sensitivity profiles were 0.41, 0.44, and 0.67 mm for the thinnest image thickness for each mode (0.25, 0.25, and 0.5 mm, respectively). At the same in-plane spatial resolution, Sharp and UHR images had up to 15% lower noise than Macro images. Patient images acquired in Sharp mode demonstrated better delineation of fine anatomic structures compared with Macro mode images.

Conclusions

Phantom studies demonstrated superior resolution and noise properties for the Sharp and UHR modes relative to the standard Macro mode and patient images demonstrated the potential benefit of these scan modes for clinical practice.
68Ga-DOTA-TOC Uptake in Pleomorphic Adenoma
Authors: Laurens S. Tom , Netea-Maier Romana T. , Aarntzen Erik J.H.G.
Published: May 2018

A 56-year-old man who was recently diagnosed with a carcinoid tumor of the os petrosum was referred for a 68Ga-DOTA-TOC PET/CT scan. Besides the moderately increased 68Ga-DOTA-TOC accumulation in the carcinoid tumor, the scan showed strongly increased and focal 68Ga-DOTA-TOC uptake in an additional lesion in the right parotid gland. The markedly different 68Ga-DOTA-TOC avidity suggested a different etiology, and histological examination demonstrated a pleomorphic adenoma.
18F-FDG PET/CT and MRI of a Mediastinal Malignant Granular Cell Tumor With Associated Recurrent Pericarditis
Authors: D’hulst Ludovic , Deroose Christophe , Strybol David , Coolen Johan , Gheysens Olivier
Published: May 2018

We report a rare case of a mediastinal malignant granular cell tumor in a 41-year-old man presenting with dyspnea, retrosternal chest pain, and recurrent pericardial effusion under treatment with corticosteroids. Because of recurrent episodes, further investigations with chest MRI and 18F-FDG PET/CT revealed a large infiltrating and strongly hypermetabolic mass in the mediastinum with pericarditis. Histopathology and immunohistochemical analysis showed large cells with greater pleomorphism and eosinophilic granular cytoplasm with positive staining for S100 protein and CD68 as well as high Ki67 proliferative index (15%) confirming the diagnosis of a malignant granular cell tumor.
Ectopic Salivary Gland in a Patient With Prostate Cancer at 18F-Choline PET/CT
Authors: Cuppari Lea , Evangelista Laura
Published: May 2018

A 65-year-old man with prostate cancer surgically treated in June 2016 underwent 18F-choline PET/CT in April 2017 for a biochemical recurrence of disease. PET/CT revealed a high tracer uptake in a solid nodulation near the left masseter muscle with a high SUVmax. The patient underwent both ultrasonography examination and fine needle aspiration cytology that confirmed the presence of an ectopic salivary gland. This case highlights that, in patients undergoing choline PET/CT, a careful analysis of the physiological biodistribution should be made by considering also the presence of accessory salivary glands.
Treatment of Head and Neck Arteriovenous Malformations Involving the Facial Nerve
Authors: Hua Chen , Yang Xi , Jin Yunbo , Zou Yun , Chen Hui , Ma Gang , Qiu Yajin , Hu Xiaojie , Tremp Mathias , Lin Xiaoxi
Published: May 2018

Background

Head and neck arteriovenous malformations (AVMs) involving branches of the facial nerve often cause tremendous cosmetic, functional, and psychological problems that are challenging to treat. We proposed an algorithm to obtain the optimal treatment and esthetic outcome.

Methods

Medical records of 24 patients were reviewed between 2002 and 2015. The lesions were classified into 4 types: type 1, involving no more than 2 facial nerve branches, with a maximal diameter of lesion of 5 cm or less (n = 7); type 2, involving no less than 2 facial nerve branches, with a maximal diameter of lesion of greater than 5 cm (type 2a, facial nerve preservation, n = 8; type 2b, facial reanimation, n = 5); and type 3, involving the mastoid segments or the trunk of the facial nerve (n = 4). Treatment efficacy was assessed and facial function was evaluated using the regional House-Brackmann Facial Nerve Grading System.

Results

Cure was achieved in 11 (45.8%) patients, and improvement was achieved in 12 (50.0%) patients, with a follow-up of 36.3 ± 32.9 months (range, 12–144 months). There was no significant difference of the regional House-Brackmann Facial Nerve Grading System score before and after treatment (type 1, unchanged; type 2a, P = 0.356; type 2b, P = 0.423; type 3, unchanged). Treatment outcomes were not significantly related to the type of nerve involvement (P = 1.000) and the facial reanimation procedure (P = 1.000).

Conclusions

Surgical excision or ethanol embolization alone is efficient for type 1 AVMs. The optimal approach for type 2a AVMs was surgery, followed by well-vascularized tissue transfer. In type 2b AVMs, the satisfied treatment results are achieved by lesion excision and immediate facial reanimation. A 2-stage strategy may result in contented treatment outcome in type 3 AVMs.
The Predictive Factors Associated With Comorbidities for Treatment Response in Outpatients With King Classification III Diabetes Foot Ulcers
Authors: Su Chun-Lin , Chang Chang-Cheng , Peng Yun-Shing , Chen Mei-Yen
Published: May 2018

Objective

The aim of this study is to investigate the preexisting predictive factors associated with comorbidities for diabetic foot ulcer (DFU) in King classification III at an outpatient clinic.

Method

This prospective study included 100 patients with DFU in King classification III treated at outpatient clinics in Chiayi Chang Gung Memorial Hospital from January 2011 to December 2011. The least follow-up time was 1 year. Medical documentations were in respect of patient's baseline characteristics, associated history, presence of comorbidities, follow-up time, and condition of wounds. Patients were divided into success group (healed or healing with wound reduction), stagnate group, and failure group (amputation or infection, need in-hospital medical service) in accordance with the treatment response of wounds. χ2 Test, Fisher exact test, and 1-way analysis of variance were used for variables in 3-group comparison, whereas Student t test was applied in 2-group comparison. The predictive factors with P value less than 0.1 were further investigated using the model of univariate logistic regression.

Results

With 3-group stratification according to treatment response—failure (n = 8), stagnate (n = 22), and success (n = 70)—the occurrence rate of retinopathy was higher in the treatment stagnate group (42.1%) than in the treatment failure (14.3%) and success groups (12.5%; P = 0.019); the rate of previous percutaneous transluminal angioplasty (PTA) history was higher in the treatment failure group (25%) than in the treatment stagnate (4.8%) and success groups (1.5%; P = 0.020). With 2-group stratification—failure (n = 8) versus nonfailure (n = 92), and success (n = 70) versus nonsuccess (n = 30)—PTA history was strongly associated with treatment failure (odds ratio [OR], 14.33; 95% confidence interval [CI], 1.71–120.32; P = 0.014), whereas retinopathy (OR, 0.21; 95% CI, 0.07–0.65; P = 0.006) was the major negative predictor for treatment success. Previous debridement met borderline significance to predict treatment nonsuccess (OR, 0.09; 95% CI, 0.01–1.01; P = 0.051). Sex, age, associated history, dyslipidemia, hypertension, coronary artery disease, cerebrovascular accident, chronic kidney disease, and end-stage renal disease and wound condition had no statistical significance.

Conclusions

Previous PTA and retinopathy, which indicated preexisting severe vasculopathy, are univariate predictive factors for treatment failure and nonsuccess, respectively, in patients with King classification III DFU. With the subdivision of King classification III DFU, medical history taking and fundus examination are acceptable methods for risk screening at an outpatient clinic.
Primary Intraosseous Hemangioma of the Foreman Rotundum Area
Authors: Qiu Xiaoyu , Zhang Chuanyu , Wang Weihong , Hao Dapeng
Published: May 2018

The primary intraosseous hemangioma is extremely rare in foreman rotundum area. However, it is very important for radiologists and otolaryngologists to be aware of it, in order to be able to provide accurately diagnosis as well choose the best treatment plan. The purpose of this article is to describe imaging features of this kind of tumor.
Cephalometric Findings in Nine Individuals With Richieri-Costa-Pereira Syndrome
Authors: Pinto Rayane de Oliveira , Peixoto Adriano Porto , Pinto Ary dos Santos , Richieri-Costa Antonio , Zechi-Ceide Roseli Maria , Ozawa Terumi Okada , Dalben Gisele da Silva
Published: May 2018

The Richieri-Costa-Pereira syndrome (RCPS) is an autosomal-recessive acrofacial dysostosis caused by mutations in EIF4A3, characterized by mandibular cleft comprising other craniofacial anomalies and limb defects such as cleft palate/Robin Sequence, microstomia, absence of mandibular central incisors, minor ear anomalies, clubfeet and first and 5 ray defects. The findings from this study are useful for better understanding the morphological consequences of disorders of EIF4A3, and having a better picture of the anatomic characteristics of the syndrome for a better therapeutic planning. Twenty-four angular and linear variables were measured to assess anteroposterior and vertical (superior-inferior) position of the cranial base, maxilla, mandible, and facial profile. The cephalometric radiographic analysis was performed on 9 individuals with RCPS, obtained at a mean age of 10.3 years, and compared with randomly selected age-matched 9 controls, without clefts and with well-balanced faces, with mean age of 10.6 years (both groups range 8.1 to 13.7 years). t test was used for analysis of means and Levene test for equality of variances. The syndrome group presented severe mandibular hypoplasia and retrognathism (P = 0.009, P = 0.001), greater facial convexity (N’PnPog and N'SnPog, P < 0.05) in syndrome group compared with the control group (P = 0.003, P = 0.004). In conclusion, in the RCPS group, most craniofacial defects affect the lower facial third, considering the severely affected mandible.
Glabellar Rejuvenation in Forehead Lift: Reversed Periosteum or Dermal Fat Graft to Cover Pedicled Glabellar Flap
Authors: Li Xiu-Qi , Wang Jia-Qi
Published: May 2018

Forehead aging is characterized by wrinkles, loss of skin elasticity, brow ptosis, and soft-tissue atrophy. For patients with prominent rhytids and marked brow ptosis, forehead lift is still the most effective treatment with a persisting result. In order to eliminate the glabellar wrinkles, forehead lift usually requires the removal of the corrugator supercilii muscle and procerus, which can lead to glabellar flattening or depression. Instead of muscle removal, the corrugator supercilii muscle, procerus, and the underlying galea were dissected as a pedicled glabellar flap. Then reversed periosteum or dermal fat graft was used to cover the glabellar flap to restore the glabellar volume. From January 2005 to November 2014, a total of 164 coronal and 42 trichophytic forehead lifts were performed. Reversed periosteum was used to cover the glabellar flap in 191 patients while dermal fat graft was applied in 15 patients with a follow-up period ranging from 6 months to 10 years. There was no irregularity or depression in the glabellar region in the group of reversed periosteal flap. The take of dermal fat graft placed over the glabellar flap was minimal. Complications from surgical procedures occurred in 2.91% of the patients. There was 1 asymmetry, 4 patients with higher than desired frontal hairline for implantation of autologous follicular units, and 1 patient with scar hyperplasia. There was no hematoma or nerve injury, no permanent numbness, and no alopecia. The techniques are simple and effective to eliminate the glabellar wrinkles and maintain or restore the glabellar volume.
Speech Therapy in Velocardiofacial Syndrome After Palatopharyngeal Pharyngoplasty
Authors: Jiang LiPing , Yang YuSheng , Liu Qiong
Published: May 2018

Velocardiofacial syndrome (VCFs) is a rare congenital disease with an incidence of 1:4000 to 1:6000. Previous studies have found that the abnormality is associated with 22qDS. As reported at the international VCFs conference held in 2006, >180 phenotypes have been identified with this syndrome. Accordingly, there is a wide range of clinical manifestations including congenital defects of the heart and palate, immune deficiencies, psychiatric illness, and speech, learning, and cognitive disabilities Among all the symptoms above, however, pharyngopalatine dysplasia has been observed in nearly every patient. Patients with VCFs often have velopharyngeal insufficiency, which may cause serious disorders in functional speech, with poor intelligibility, a glottal stop with hypernasality and a pharyngeal fricative, and dropping and weakening of consonants. Most also show defects in language learning. Therefore, specialized speech therapy is essential for patients with VCFs, mainly focused on correction of abnormal pronunciation. Long-term clinical experience has shown that speech therapy is based on 2 components: velopharyngeal function and behavior therapy. Our study focused mainly on establishing a corrective behavior guidance model of pronunciation for patients with VCFs.
Surgical Treatment of Maxillary Antrum Neoplasms
Authors: Abdulkareem Elham Hazeim , Aftan Kamal Turki
Published: May 2018

Paranasal sinus cancers comprise about 0.3% of all cancers and 80% of these lesions arise in the maxillary sinus. A masquerading primary sinus tumour represents a therapeutic challenge as most patients with maxillary antrum cancer are diagnosed with advanced disease. However, distant metastases rarely occur. We examined the clinical outcome of patients with antrum neoplasms. Medical records were obtained for all patients diagnosed with a sinus malignancy between July 2009 and January 2014. During this period, 41 patients with maxillary tumours were treated, among which 9 patients received a maxillectomy. There were 21 male and 20 female patients. All patients underwent computed tomography or magnetic resonance imaging. The most common complications were postoperative epistaxis and swallowing difficulty. The treatment of maxillary antrum tumours is complicated and needs advancements to improve early presentation, timely diagnosis, and better management outcomes.
Minimally Invasive Approach for Resection of Masseteric Vascular Malformations
Authors: Schultz Benjamin D. , Gray Rachel , Knobel Denis , Tanna Neil , Setabutr Dhave , Cheng Jeffrey A. , Ortiz Rafael , Bastidas Nicholas
Published: May 2018

Objective:

Vascular malformations (VMs) in the head and neck region often cause esthetic as well as functional problems for patients. Intramuscular VMs (IVM), such as those in the masseter, can cause severe facial asymmetry and typically are excised transcutaneously to facilitate wide exposure and safe dissection from the facial nerve. This requires extensive dissection, prolonged healing, and can lead to suboptimal facial scarring.

Methods:

We describe the technique of resecting large IVMs of the masseter muscle in 3 patients using an entirely intraoral approach with continuous nerve monitoring and without visible facial scarring or secondary deformity. Preoperative injection of sclerotherapy was performed to reduce intra-operative bleeding and optimize resection.

Results:

Successful excision was performed without complication in 3 patients to date. Total average operating room time was 120 minutes (range 95–145 minutes). Estimated blood loss was 213 mL (range 180–240 mL). The patients were discharged home either post-operative day (POD) 1 or 2, with 1 returning to work POD 4. Facial nerve function was normal postoperatively and no hematomas developed. Subjective masticatory function was equivalent to preoperative levels in all patients.

Conclusions:

Intraoral excision of VMs of the masseter muscle can be safely performed without added risk or complication. Continuous facial nerve monitoring allows minimally invasive approaches to be considered with less risk of iatrogenic facial nerve injury. We purport that this is a safe and effective method with substantially better esthetic outcomes compared with traditional transcutaneous approaches.
Radiologic Imaging of Ludwig Angina in a Pediatric Patient
Authors: Polat Gökhan , Sade Recep
Published: May 2018

Ludwig angina is an important disease with deadly consequences. Especially in the pediatric patient group, recognition of the disease may be difficult due to patient incompatibility. For this reason, radiologic imaging methods should be carefully selected. Diffusion-weighted magnetic resonance imaging and contrast-enhanced examinations are the most important methods for the diagnosis of the disease.
Giant Epidermoid Cyst of the Maxillary Sinus: A Postoperative Complication?
Authors: Erisir Ferhat , Kazikdas K. Cagdas , Tuna Yalcinozan Eda
Published: May 2018

Epidermoid cysts are benign lesions, which are usually detected on the floor of the mouth in the head and neck region. They can develop from abnormal epithelial components of an ectoderm tissue during the embryological life or alternatively they can arise from the implanted epithelium after trauma or surgery. The diagnosis of an epidermoid cyst in the maxillary sinus can be challenging and it could be easily mistaken for any benign or malign lesion of the nasal cavity and paranasal sinuses. In this case, we present a 44-year-old man with a giant epidermoid cyst in the right maxillary sinus with a previous history of paranasal sinus surgery. We present a very rare case of epidermoid cyst and also discuss the importance of radiological imaging modalities in differential diagnosis of a unilateral expansile mass in the maxillary sinus.
In vitro effects of a kaolin-coated hemostatic dressing on anticoagulated blood
Authors: Cripps Michael W. , Cornelius Canon C. , Nakonezny Paul A. , Vazquez Natalia , Wey Jocelyn C. , Gales Peter E.
Published: May 2018

BACKGROUND

The use of kaolin-coated dressings has become common and have efficacy in normal patients, but their increased use will inevitably include use on bleeding patients taking anticoagulants. We hypothesize that kaolin coating material (KCM) will improve clotting regardless of anticoagulation medication.

METHODS

A prospective study was performed on blood from patients who were on a vitamin K antagonist (VKA), unfractionated heparin (UH), an antiplatelet (AP) agent, a Xa inhibitor (Xa), or a direct thrombin inhibitor (DTI). None were on more than one type of anticoagulation medication. Viscoelastic testing was performed with and without KCM. All p values were adjusted for multiple comparisons.

RESULTS

The addition of KCM significantly decreased the time for initial clot formation (CT) in all groups. The mean CT for controls was decreased from 692 to 190.8 s (p < 0.0001). KCM decreased the initial clot formation time by about 1.5 times in those on DTI (p = 0.043) and 2.5 times in those taking AP medication (p < 0.001). The most profound effect was seen in those on UH (no KCM 1,602 s vs. KCM 440 s; p < 0.001), VKA (no KCM 1,152 s vs. 232 s; p < 0.01), and Xa (no KCM 1,342 s vs. 287 s; p < 0.001). Analysis of other clot formation parameters revealed that KCM significantly improved the clot formation kinetics (CFT) only in patients taking Xa (p = 0.03). KCM improved maximum clot strength in patients on Xa inhibitors (p = 0.05). Patients on UH had a larger effect size with an increase in clot strength from 24.35 mm to 43.35 mm whereas those on Xa had an increase of 38.7 mm to 49.85 mm.

CONCLUSION

In this in vitro analysis, the addition of KCM to the blood of patients taking any of these anticoagulation medications significantly improved the time to initial clot formation, indicating that kaolin-based hemostatic dressings will be effective in initiating clot formation in patients on anticoagulants.

LEVEL OF EVIDENCE

Therapeutic, level IV.
Diagnosis of Acute Cellular Rejection Using Probe-based Confocal Laser Endomicroscopy in Lung Transplant Recipients: A Prospective, Multicenter Trial
Authors: Keller Cesar A. , Khoor Andras , Arenberg Douglas A. , Smith Michael A. , Islam Shaheen U.
Published: May 2018

Background

Acute cellular rejection (ACR) in lung transplant recipients requires demonstration of perivascular lymphocytic infiltration in alveolar tissue samples from transbronchial biopsies (TBBs). Probe-based confocal laser endomicroscopy (pCLE) allows in vivo observation of alveolar, vascular, and cellular microstructures in the lung with potential to identify ACR. The objective of our prospective, blinded, multicenter observational study was to identify pCLE findings in patients with ACR diagnosed histopathologically by TBB.

Methods

Lung transplant recipients undergoing diagnostic bronchoscopies within 1 year posttransplant for suspected ACR had pCLE video imaging obtained immediately prior to tissue sampling via TBB. Findings of 2 pCLE criteria, abundant alveolar cellularity and perivascular cellularity (PVC), were assessed by 4 investigators familiar with pCLE and compared with histopathologic criteria of ACR to derive sensitivity, specificity, area under the receiver operating characteristic curve, and accuracy. Interobserver agreement was assessed by calculating intraclass coefficient and Fleiss κ. Findings were analyzed before and after a consensus meeting of investigators on interpreting images.

Results

Thirty pCLE procedures were performed on 24 patients, 8 showing ACR in TBB. Diagnostic performance and interobserver agreement using pCLE to identify PVC were significantly higher than those of abundant alveolar cellularity (P < 0.01). The number of blood vessels identified with PVC on pCLE was significantly correlated with histopathologic activity grading of ACR (P < 0.01). Perivascular cellularity agreement among investigators significantly improved after consensus meeting (P < 0.01).

Conclusions

When found on pCLE, PVC is a feasible and reproducible criterion for assessment of ACR in vivo, but there is a learning curve for image interpretation.
Kidney Dysfunction After Vascularized Composite Allotransplantation
Authors: Krezdorn Nicco , Tasigiorgos Sotirios , Wo Luccie , Lopdrup Rachel , Turk Marvee , Kiwanuka Harriet , Ahmed Salman , Petruzzo Palmina , Bueno Ericka , Pomahac Bohdan , Riella Leonardo V.
Published: May 2018

Background

Kidney dysfunction is a major complication after nonrenal solid organ transplants. Transplantation of vascularized composite allografts (VCA) has yielded successful midterm outcomes despite high rates of acute rejection and greater requirements of immunosuppression. Whether this translates in higher risks of kidney complications is unknown.

Methods

Ninety-nine recipients of facial or extremity transplants from the Brigham and Women’s Hospital (BWH) and the International Registry on Hand and Composite Tissue Transplantation (IR) were reviewed. We assessed immunosuppression, markers of renal function over time, as well as pretransplant and posttransplant renal risk factors.

Results

Data were obtained from 10 patients from BWH (age at transplant, 42.5 ± 13.8 years) and 89 patients (37.8 ± 11.5 years) from IR. A significant rise in creatinine levels (BWH, P = 0.0195; IR, P < 0.0001) and drop in estimated glomerular filtration rate (GFR) within the first year posttransplant was observed. The BWH and IR patients lost a mean of 22 mL/min GFR and 60 mL/min estimated GFR in the first year, respectively. This decrease occurred mostly in the first 6 months posttransplant (BWH). Pretransplant creatinine levels were not restored in either cohort. A mixed linear model identified multiple variables correlating with renal dysfunction, particularly tacrolimus trough levels.

Conclusions

Kidney dysfunction represents a major complication posttransplantation in VCA recipients early on. Strategies to mitigate this complication, such as reducing calcineurin inhibitor trough levels or using alternative immunosuppressive agents, may improve long-term patient outcomes. Standardizing laboratory and data collection of kidney parameters and risk factors in VCA patients will be critical for better understanding of this complication.
Electroencephalographic and Electrocardiographic Effect of Intravenous Lacosamide in Refractory Focal Epilepsy
Authors: Huang Chin-Wei W. , Brown Suzan , Pillay Neelan , Campo Martin Del , Tellez-Zenteno Jose , McLachlan Richard S.
Published: May 2018

Purpose:

Lacosamide selectively enhances slow inactivation of voltage-gated sodium channels to achieve seizure reduction. We studied the effect of intravenous lacosamide given as one of three single doses on EEG and electrocardiogram, as well as its tolerability in patients with drug-resistant epilepsy.

Methods:

This Canadian, investigator-initiated, multicenter, double-blind study recruited patients with refractory focal epilepsy admitted to a seizure monitoring unit. Participants received a loading dose of 100, 200, or 400 mg lacosamide over 30 minutes during continuous monitoring by video-EEG and 12-lead electrocardiogram. The number of interictal spikes, frequency and quantity of background EEG rhythms, corrected QT interval (QTc), PR interval, heart rate (HR), blood pressure, and respiration rate during 60 minutes before the administration were compared with 60 minutes after the infusion. We documented any adverse event during and after the infusion.

Results:

Seventy-one patients completed the study. There was a significant decrease in interictal spikes (P = 0.039) and decreased frequency of the alpha rhythm (P = 0.003). No significant difference in beta, theta, and delta frequency or amount was noted. There were significant increases in PR interval (153.4–155.8 ms, P = 0.031) and HR (73.4–75.5 bpm, P = 0.022), but QTc, blood pressure, and respiration rate were not affected. Twelve patients (16.9%) experienced transient and mild adverse events, mainly dizziness and leg tingling. More adverse events occurred with 400 mg lacosamide than with the lower doses (P = 0.048).

Conclusions:

Intravenous lacosamide is effective in decreasing interictal spikes. Despite a small effect on EEG and electrocardiogram rhythms, it is well tolerated with no serious adverse events.
Differences in Speed of Response of Depressive Symptom Dimensions in Older Persons During Electroconvulsive Therapy
Authors: Veltman Eveline M. , van Hulten Sophie , Twisk Jos , Dols Annemiek , van Exel Eric , Stek Max L. , Sienaert Pascal , Bouckaert Filip , van der Mast Roos C. , Rhebergen Didi
Published: May 2018

Introduction

Electroconvulsive therapy (ECT) is an important and effective treatment for depression. However, research on course trajectories of depressive symptoms during ECT is limited. Insight into putative differences in speed of response of depressive symptom dimensions may enable clinicians to optimally inform patients and their relatives. Therefore, we aim to examine course trajectories of depressive symptom dimensions in depressed older persons during ECT.

Methods

Data were derived from the Mood Disorders in Elderly treated with Electro Convulsive Therapy study, including 110 persons, aged 55 years or more, with a current diagnosis of major depressive disorder and referred for ECT. Exploratory factor analysis was used to identify symptom dimensions, using the 10 depression items of the Montgomery-Åsberg Depression Rating Scale (MADRS). Differences in course trajectories of symptom dimension during 2 weeks were examined by multilevel analyses.

Results

Three symptom dimensions were identified: a “mood,” “melancholic,” and “suicidal” dimension. Mood showed a significantly greater severity decline as compared with melancholic and suicidal at the 1-week follow-up. At the 2-week follow-up, both mood and melancholic demonstrated a significantly greater decline as compared with suicidal. However, because scores on the suicidality item of the Montgomery-Asberg Depression Rating Scale were already lower at baseline compared with the other items, a floor effect cannot be ruled out.

Discussion

All symptom dimensions of depression showed a rapid response to ECT. Our findings did not support the general assumption that suicidal symptoms may be the first to improve. However, a floor effect on the suicidality item cannot be ruled out.
Complex associations of environmental factors may explain Blanchard’s Cricket Frog,Acris blanchardideclines and drive population recovery
Authors: McCallum Malcolm L. , Trauth Stanley E.
Published: May 2018

Blanchard’s Cricket Frog,Acris blanchardi, is a small hylid frog that was once among the most common amphibians in any part of its range. Today, it remains abundant in much of the southern portion of its range, but is now disappearing elsewhere. Our analysis of habitat characters observed across several states revealed interesting relationships of these factors with the abundance or presence of Blanchard’s Cricket Frog. Further, we later established two ½ acre ponds based on these relationships that led to immediate colonization of the ponds by cricket frogs followed by explosive production of juveniles less than a year later. Our findings suggest that habitat management for this species should specifically manage the shoreline grade and especially the aquatic floating vegetation to maximize population growth and sustenance.
Towards an Ecological Trait-data Standard
Authors: Schneider Florian D. , Jochum Malte , Le Provost Gaëtane , Ostrowski Andreas , Penone Caterina , Fichtmüller David , Güntsch Anton , Gossner Martin M. , König-Ries Birgitta , Manning Pete , Simons Nadja K.
Published: May 2018

Trait-based approaches are widespread throughout ecological research, offering great potential for trait data to deliver general and mechanistic conclusions. Accordingly,a wealth of trait data is available for many organism groups, but, due to a lack of standardisation, these data come in heterogeneous formats.

We review current initiatives and infrastructures for standardising trait data and discuss the importance of standardisation for trait data hosted in distributed open-access repositories.

In order to facilitate the standardisation and harmonisation of distributed trait datasets, we propose a general and simple vocabulary as well as a simple data structure for storing and sharing ecological trait data.

Additionally, we provide an R-package that enables the transformation of any tabular dataset into the proposed format. This also allows trait datasets from heterogeneous sources to be harmonised and merged, thus facilitating data compilation for any particular research focus.

With these decentralised tools for trait-data harmonisation, we intend to facilitate the exchange and analysis of trait data within ecological research and enable global syntheses of traits across a wide range of taxa and ecosystems.
Identification of previously untypable RD cell line isolates and detection of EV-A71 genotype C1 in a child with AFP in Nigeria
Authors: Adewumi M.O. , Faleye T.O.C. , Okeowo C.O. , Oladapo A.M. , Oyathelemhi J. , Olaniyi O.A. , Isola O.C. , Adeniji J.A.
Published: May 2018

We previously attempted to identify 96 nonpolio enteroviruses (EVs) recovered on RD cell culture from children <15 years with acute flaccid paralysis (AFP) in Nigeria. We succeeded in identifying 69 of the isolates. Here, we describe an attempt to identify the remaining 27 isolates.

Twenty-six (the 27thisolate was exhausted) isolates that could not be typed previously were further analyzed. All were subjected to RNA extraction, cDNA synthesis, enterovirus 5‟-UTR– VP2 PCR assay and a modified VP1 snPCR assay. Both the 5’-UTR – VP2 and VP1 amplicons were sequenced, isolates identified and subjected to phylogenetic analysis.

Twenty of the 26 isolates analyzed were successfully identified. Altogether, 23 EV strains were recovered. Thesebelong to 11 EV (one EVA, nine EVB and one EVC) types which were EVA71 genotype C1 (1 strain), CVB3 (7 strains), CVB5 (1 strain), E5 (2 strain), E11 (3 strains), E13 (2 strain), E19 (1 strain), E20 (1 strain), E24 (2 strains), EVB75 (1 strain) and EVC99 (2 strains). Of the 11 EV types, the 5’-UTR-VP2 assay identified seven while the VP1 assay identified 10. Both assays simultaneously detected 7 of the 11 EV types identified in this study with 100% congruence.

In this study we identified 20 of 26 samples that were previously untypable. In addition, we provided evidence that suggests that a clade of EVA71 genotype C1 might have been circulating in sub-Saharan Africa since 2008. Finally, we showed that the 5’-UTR-VP2 assay might be as valuable as the VP1 assay in EV identification.
Statin use and breast cancer survival: A Swedish nationwide study
Authors: Borgquist Signe , Broberg Per , Tojjar Jasaman , Olsson Håkan
Published: May 2018

Background

A sizeable body of evidence suggests that statins can cease breast cancer progression and prevent breast cancer recurrence. The latest studies have, however, not been supportive of such clinically beneficial effects. These discrepancies may be explained by insufficient power. This considerably sized study investigates the association between both pre- and post-diagnostic statin use and breast cancer outcome.

Methods

A Swedish nation-wide retrospective cohort study of 20,559 Swedish women diagnosed with breast cancer (July 1st, 2005 through 2008). Dispensed statin medication was identified through the Swedish Prescription Registry. Breast cancer related death information was obtained from the national cause-of-death registry until December 31st, 2012. Cox regression models yielded hazard ratios (HR) and 95% confidence intervals (CI) regarding associations between statin use and breast cancer-specific and overall mortality.

Results

During follow-up, a total of 4,678 patients died, of which 2,669 were considered breast cancer related deaths. Compared to non- or irregular use, regular pre-diagnostic statin use was associated with lower risk of breast cancer related deaths (HR=0.77; 95% CI 0.63–0.95, P=0.014). Similarly, post-diagnostic statin use compared to non-use was associated with lower risk of breast cancer related deaths (HR=0.83; 95% CI 0.75–0.93, P=0.001).

Conclusion

This study evidently supports the notion that statin use is protective regarding breast cancer related mortality in agreement with previous Scandinavian studies, although less so with studies in other populations. These disparities should be further investigated to pave the way for future clinical trials investigating the role of statins in breast cancer.
Klebsiella huaxiensis sp. nov., recovered from human urine
Authors: Hu Yiyi , Wei Li , Feng Yu , Xie Yi , Zong Zhiyong
Published: May 2018

A Klebsiella strain, WCHKl090001, was recovered from a human urine sample in China in 2017. Phylogenetic analysis based on gyrA and rpoB housekeeping genes revealed that the strain was distinct from any previously described species of the genus Klebsiella though it was clustered with the Klebsiella oxytoca phylogroup including Klebsiella grimontii, Klebsiella michiganensis, and Klebsiella oxytoca. The whole genome sequence of strain WCHKl090001 has an up to 87.18% average nucleotide identity with those of type strains of all known Klebsiella species. In silico DNA-DNA hybridization (isDDH) values between strain WCHKl090001 and type strains of all known Klebsiella species range from 22.3 to 35.2%. Strain WCHKl090001 could be distinguished from species of the Klebsiella oxytoca phylogroup by its negative Voges-Proskauer reaction. Genotypic and phenotypic characteristics from this study indicate that strain WCHKl090001 should be considered to represent a novel species of the genus Klebsiella, for which the name Klebsiella huaxiensis sp. nov. is proposed. The type strain is WCHKl090001T (=GDMCC1.1379T = CCTCC AB 2018106 T).