bluuebunny/crossref_metadata_2025 huggingface dataset:
Physician characteristics correlate with hospital readmission rates
Authors: Skolka Michael , Lehman Erik , Khalid Muhammad , Hennrikus Eileen
Published: March 2020

Hospital readmission rates are used as a metric to measure quality patient care. While several tools predict readmissions based on patient-specific characteristics, this study assesses if physician characteristics correlate with hospital readmission rates.

In a 5-year retrospective electronic record review at a single institution, 31 internal medicine attending physicians’ discharges were tracked for a total of 70 physician years, and 15,933 hospital discharges. Each physician's yearly 7-day, 8 to 30-day, and 30-day readmission rates were compared. Each rate was also correlated with years of post-graduate clinical experience, discharge volume, physician sex, and fiscal year.

Individual physicians had significantly different 7-day, 8 to 30-day, and 30-day readmission rates from each other. The rates were not related to sex, years after post-graduate training, or fiscal year. However, physician patient volume correlated with 7-day readmission rates. Physicians who discharged ≤100 patients per year had a higher 7-day readmission rate than physicians who discharged >100 patients per year. This correlation with patient volume did not hold for the 8 to 30-day and 30-day readmission rates.

Individual physicians differ in their patient readmission rates in 7-day, 8 to 30-day, and 30-day categories. A critical level of a physician's hospital activity, as reflected by the number of patient discharges per year (>100), results in lower 7-day readmission rates. Sex, post-graduate years of clinical experience, and fiscal year did not play a role. The lack of correlation between each physicians’ 7-day and 8 to 30-day readmission rates suggests that different physician factors are involved in these 2 rates.
Metformin therapy and cognitive dysfunction in patients with type 2 diabetes
Authors: Zhang Qing-Qing , Li Wen-Shan , Liu Zhou , Zhang Hui-Li , Ba Ying-Gui , Zhang Rui-Xia
Published: March 2020

Background:

Type 2 diabetes (T2D) is a risk factor for cognitive dysfunction. The relationship between metformin therapy and cognitive function in patients with T2D is unknown. Therefore, we determined the relationship between metformin therapy and cognitive function in patients with T2D using a meta-analysis.

Methods:

We systematically searched the Cochrane library, PubMed, and Embase to identify studies showing correlations, and we calculated hazard ratios (HRs).

Results:

We identified 10 studies including 254,679 participants. Metformin significantly reduced the occurrence of cognitive dysfunction in patients with T2D (HR 0.90; 95% CI [0.88, 0.92]). Compared with other hypoglycemic drugs, sulfonylureas also improved cognitive dysfunction (HR 0.92; 95% CI [0.88, 0.95]). Thiazolidinediones gave no statistically significant improvement in cognitive dysfunction (HR 0.97; 95% CI [0.87, 1.07]). The use of insulin aggravated cognitive dysfunction (HR 1.34; 95% CI [1.24, 1.43]). In the subgroup analysis of various regions controlling for age, gender, education, diabetes course, complications, metformin administration and dosage, and follow-up time, metformin significantly improved cognitive dysfunction in patients in the Americas and Europe (HR 0.69; 95% CI [0.63, 0.74]), (HR 0.71; 95% CI [0.66, 0.76], respectively), while metformin did not significantly improve cognitive dysfunction in Asian patients (HR 0.99; 95% CI [0.96, 1.01]).

Conclusions:

Metformin significantly improved cognitive dysfunction in patients with T2D. Sulfonylureas also improved cognitive dysfunction. Thiazolidinediones had no significant effect on cognitive dysfunction. The use of insulin aggravated cognitive dysfunction. Metformin improved cognitive dysfunction more significantly in patients in the Americas and Europe than in Asia.
Dose-response association of resting heart rate and hypertension in adults
Authors: Shen Lijun , Wang Yuming , Jiang Xuesong , Ren Yongcheng , Han Chengyi , Yang Yongguang
Published: March 2020

Background:

The association of resting heart rate (RHR) and hypertension in adults is unclear. We aimed to perform a meta-analysis of cohort studies to clarify the association.

Methods:

We searched PubMed and Embase from their inception to November 3, 2017, for published articles. We used a random effects model to combine study-specific relative risks (RRs) and 95% confidence intervals (CIs). We used restricted cubic spline functions to assess the dose-response relationship.

Results:

Nine cohort articles (12 independent studies) with 79,399 individuals and more than 26,380 incident cases of hypertension were included. The summary RR for hypertension was 1.09 (95% CI: 1.06–1.13) with each 10 bpm increment in RHR. The cubic spline model suggested that when compared with 55.5 beats per minute, the risk of hypertension significantly increased with increasing levels of RHR (P

nonlinearity
 = 0.059).

Conclusion:

We found a linear dose-response association between RHR and incident hypertension in adults.
Intramural hematoma of colon
Authors: Wang Jing , Sun Xiaoyan , Shi Hongkun , Cao Dianbo
Published: March 2020

Introduction:

Colonic intramural hematomas are rarely encountered clinical entity. Colonic intramural hematomas are frequently associated with blunt trauma, and they could occur spontaneously in patients under anticoagulant therapy or with bleeding diathesis. There were few reports on synchronous colon cancer and intramural hematoma. Intramural hematomas of gastrointestinal tract in those patients undergoing anticoagulation treatment often occurred at the esophagus, duodenum, and small intestine, while colon was rarely affected site. Clinical symptoms of colonic intramural hematomas may include abdominal pain, lower gastrointestinal bleeding, and occasionally bowel obstruction.

Patient concerns:

We herein report 2 cases of colonic intramural hematomas. Case 1 presented with abdominal pain and decreased defecation. Colonoscopy and contrast-enhanced computed tomography (CT) revealed intramural hematoma proximal to the neoplasm at ascending colon. Case 2 was a patient under regular anticoagulation therapy after coronary arterial stent implantation. His chief complaints were intermittent abdominal pain and distension. Colonoscopy and contrast-enhanced CT demonstrated intramural hematoma at sigmoid colon.

Diagnosis:

Case 1 was diagnosed synchronous colonic intramural hematoma and colon cancer at ascending colon via surgery. Case 2 was diagnosed intramural hematoma of sigmoid colon through colonoscopy and follow-up CT.

Interventions:

Case 1 underwent right hemicolectomy. Case 2 received conservative treatment including anticoagulation discontinuation, total parenteral nutrition, and intravenous hydration.

Outcomes:

They both had a good recovery.

Conclusion:

Colonoscopy and CT are useful in diagnosing colonic intramural hematoma. The optimal treatment should be individualized according to different etiologies causing hematoma.
A case report of immune-mediated arthritis in a patient with cutaneous melanoma receiving checkpoint inhibition therapy
Authors: Papaxoinis George , Anastasopoulou Amalia , Laskari Katerina , Diamantopoulos Panagiotis , Benopoulou Olga , Gogas Helen
Published: March 2020

Introduction:

Immune checkpoint inhibitors (ICIs) represent an important advance in the treatment of melanoma. ICIs may induce autoimmune phenomena caused by concurrent activation of the immune system against normal cells. During the last years, cases of musculoskeletal side effects, especially immune-mediated arthritis (IA), have been increasingly reported.

Patient concerns:

We present a 59-year-old woman, who was treated with pembrolizumab for a relapsed BRAF V600E mutated cutaneous malignant melanoma. The patient presented with right knee arthritis on week 30.

Diagnosis:

The erythrocyte sedimentation rate and serum C-reactive protein levels were elevated, while rheumatoid factor and anti-cyclic citrullinated peptide antibodies were negative. Imaging confirmed the presence of fluid mainly in the suprapatellar bursa. Synovial fluid analysis revealed an inflammatory effusion, while other etiologies of inflammatory arthritis were excluded.

Interventions:

Arthritis improved with an intra-articular injection of 8 mg dexamethasone. Twelve days later the arthritis relapsed in both knees, and although it was resistant to nonsteroidal anti-inflammatory treatment, it improved with systemic steroids. Tapering of methylprednisolone dose was feasible with the coadministration of leflunomide and subsequently hydroxychloroquine.

Outcomes:

Arthritis resolved and the patient is free of complications and disease activity 20 months after the initiation of the second line systemic treatment.

Conclusions:

We present an unusual case of IA associated with pembrolizumab treatment. The originality of the current report is based on the late occurrence, the monoarticular initial distribution, and uncommon location of IA at the knee.
Mammotome-assisted removal with minimal incision of large juvenile fibroadenoma of breast
Authors: Wang Tongling , Zhu Lin
Published: March 2020

Introduction:

Giant juvenile breast fibroadenoma can cause deformity and should be excised. Cosmesis is an important consideration in young patients.

Patient concerns:

The patient was admitted to our hospital for a mass of 6 × 6 cm in her left breast.

Diagnose:

A giant juvenile fibroadenoma.

Interventions:

With the help of Mammotome, we translated the larger mass to smaller one and removed it via a small circumareolar incision with no residual tumor.

Outcomes:

There was no recurrence of disease after 2 years.

Conclusion:

Mammotome-combined resection is a new approach that can be used to excise giant fibroadenomas with a minimal incision, and provides a favorable contour to the breast.
Effects of Systemic Steroid Administration on Recurrence of Pericardial Effusion in Pediatric Patients After Hematopoietic Stem Cell Transplantation
Authors: Leong Kieran , Heal Martha E. , Bass John L. , Aggarwal Varun , Narasimhan Shanti , Gupta Ashish , Hiremath Gurumurthy
Published: March 2020

Although rare in the general pediatric population, the incidence of pericardial effusion is significantly higher in pediatric patients undergoing hematopoietic stem cell transplant (HCT) with a reported incidence of up to 16.9%. The development of pericardial effusion in this setting is associated with higher mortality. Although pericardiocentesis is a relatively safe procedure for treating pericardial effusion, it is invasive, painful, and exposes an immunosuppressed patient to the risks of infection, bleeding, and injury to surrounding structures. Given the procedural risks of pericardiocentesis, systemic steroids are often administered for the treatment of pericardial effusion given their use for pericarditis in the general population. However, the effectiveness of systemic steroids for the treatment of pericardial effusion in the pediatric HCT population has not been confirmed. We studied the role of systemic steroids, administered at the time of initial pericardiocentesis performed for pericardial effusion, in preventing repeat pericardiocentesis. A total of 37 pericardiocenteses after HCT were performed during the study period with 25 patients undergoing first-time pericardiocentesis and 15 of those patients receiving systemic steroids. Eight patients required repeat pericardiocentesis; 5 of 15 (33%) received steroids and 3 of 10 (30%) did not receive steroids. Our data in this small cohort of pediatric HCT patients did not show a significant difference in the need for repeat pericardiocentesis with the use of systemic steroids, initiated within 48 hours of pericardiocentesis.
Developing a Curriculum to Educate Postgraduate Practitioners on Scholarly Projects
Authors: Moore-Gibbs Ashley , Munn Lindsay Thompson
Published: March 2020

Many hospitals across the country have postgraduate fellowship programs for nurse practitioners and physician assistants. An important aspect of these programs is a scholarly project focused on patient outcomes. However, many fellows lack the experience and skills necessary to complete a scholarly project. This article presents a scholarly project curriculum with relevant information for nurses in professional development as they equip learners with the knowledge, structure, and support necessary to produce high-quality scholarly work.
Five Waves of an Online HIV Self-Test Giveaway in New York City, 2015 to 2018
Authors: Edelstein Zoe R. , Wahnich Amanda , Purpura Lawrence J. , Salcuni Paul M. , Tsoi Benjamin W. , Kobrak Paul H. , Santos Paul A. , Andaluz Adriana , MacGregor Jennifer H. , Matsuki Jennifer D.M. , Katz David A. , Daskalakis Demetre C. , Myers Julie E.
Published: March 2020

Background

HIV self-tests increase HIV status awareness by providing convenience and privacy, although cost and access may limit use. Since 2015, the New York City (NYC) Health Department has conducted 5 waves of an online Home Test Giveaway.

Methods

We recruited adult cisgender men who have sex with men (MSM) and transgender and gender-nonconforming (TGNC) individuals who had sex with men, who were living in NYC, not previously HIV diagnosed, and using paid digital advertisements (4–8 weeks per wave). Eligible respondents were e-mailed a code to redeem on the manufacturer's website for a free HIV self-test and an online follow-up survey ~2 months later. For key process and outcome measures, we present means across 5 waves.

Results

Across the 5 waves of Home Test Giveaway, there were 28,921 responses to the eligibility questionnaire: 17,383 were eligible, 12,182 redeemed a code for a free HIV self-test, and 7935 responded to the follow-up survey (46% of eligible responses). Among eligible responses, approximately half were Latino/a (mean, 32%) or non-Latino/a, black (mean, 17%). Mean report of never testing before was 16%. Among 5903 follow-up survey responses who reported test use, 32 reported reactive results with no known previous diagnosis (0.54%), of whom 78% reported receiving confirmatory testing. Report of likelihood of recommending the Home Test Giveaway to friends was high (mean, 96%).

Conclusions

We recruited diverse NYC MSM and TGNC and distributed a large number of HIV self-tests to them. Among respondents who reported newly reactive tests, the majority reported confirmatory testing. This seems to be one acceptable way to reach MSM and TGNC for HIV testing, including those who have never tested before.
Evaluation of the National Sexually Transmitted Disease Curriculum: Reach, Utilization, and Engagement
Authors: Snoeyenbos Newman Gretchen , Bauer Karin , Karpenko Andrew , Unruh Kenton T. , Johnston Christine , Marrazzo Jeanne M. , Workowski Kimberly A. , Spach David H.
Published: March 2020

Background

With increasing rates of sexually transmitted infections in the United States, there is a critical need to educate health professionals on the prevention, diagnosis, and treatment of sexually transmitted infections. The National Sexually Transmitted Disease Curriculum (NSTDC, https://www.std.uw.edu) is a free, online curriculum, funded by the Centers for Disease Control and Prevention. The purpose of this article is to evaluate the reach, utilization, and engagement of users with the curriculum.

Methods

Data on NSTDC utilization was collected for 24 months after the February 1, 2017 launch. For all users, Google Analytics was used to determine total number of users, geographic location, age and sex, and average session duration. For registered users, additional data analysis included work-role, demographics, and completion of self-study modules, check-on-learning questions, and question banks. User satisfaction was measured on a 5-point Likert scale.

Results

During the evaluation period, 136,270 individual users accessed the NSTDC, including 24,652 registered users. Among all registered users, 10,660 (43.2%) were registered nurses, 2810 (11.4%) physicians, 4942 (20.1%) Advanced Practice Nurses and Physician Assistants, and 6213 (25.2%) nonclinicians. Among registered users, 18,533 (75.2%) completed at least 1 module, 7898 (32.0%) completed all 7 modules, and 19,804 (80.4%) answered optional check-on-learning questions. Median satisfaction with the content was (5) very satisfied (interquartile range, 4–5).

Conclusions

The NSTDC is a free, guideline-based, online curriculum with novel dual functionality that has achieved extensive reach with a broad array of health professionals who engage deeply with the material. The wide usage of NSTDC demonstrates the need for high-quality, unbiased, free content in user-focused formats.
Presence and Concentrations of Select Bacterial Vaginosis-Associated Bacteria Are Associated With Increased Risk of Pelvic Inflammatory Disease
Authors: Haggerty Catherine L. , Ness Roberta B. , Totten Patricia A. , Farooq Fouzia , Tang Gong , Ko Daisy , Hou Xuezhou , Fiedler Tina L. , Srinivasan Sujatha , Astete Sabina G. , Fredricks David N.
Published: March 2020

In a vaginal 16S ribosomal RNA gene quantitative PCR study of 17 pelvic inflammatory disease (PID) cases and 17 controls who tested positive for Chlamydia trachomatis, women who additionally tested positive for Atopobium vaginae, Sneathia spp., Megasphaera spp., Eggerthella-like bacterium or Prevotella amnii were more likely to develop PID.
Severe E-Cigarette, or Vaping, Product Use Associated Lung Injury Requiring Venovenous Extracorporeal Membrane Oxygenation
Authors: Aldy Kim , Cao Dazhe James , McGetrick Molly , Willcutts David , Verbeck Guido , De Silva Imesha , Hsu Stephanie
Published: March 2020

Objectives:

To report a severe case of e-cigarette or vaping product use-associated lung injury with complex course requiring venovenous extracorporeal membrane oxygenation.

Design:

Case report.

Setting:

PICU in an academic medical center.

Patients:

A 16-year-old girl presenting with gastrointestinal and respiratory symptoms was admitted to our PICU after having progressive respiratory failure and bilateral pulmonary ground-glass opacities on chest CT.

Interventions:

Venovenous extracorporeal membrane oxygenation

Measurements and Main Results:

After extensive infectious workup was unrevealing, she reported a history of vaping e-cigarette containing either nicotine or delta-9-tetrahydrocannabinol oil prior to symptom onset. She was given a presumptive diagnosis of e-cigarette or vaping product use-associated lung injury. The PICU team in consultation with pulmonology and medical toxicology started high-dose IV methylprednisolone 1 mg/kg bid. Despite initial improvements, she continued to require positive pressure ventilation and developed pneumomediastinum with progression to tension pneumothoraces and a persistent air leak. Unable to maintain her oxygenation, she was placed on venovenous extracorporeal membrane oxygenation for a prolonged course and had a tracheostomy placement. The clinical course, severity, and range of interventions in affected patients around the country have varied widely. Respiratory symptoms have been the most severe, but the constellation of symptoms in e-cigarette or vaping product use-associated lung injury include constitutional symptoms (fevers, weight-loss) and gastrointestinal symptoms (nausea, vomiting, diarrhea). In many cases, steroid use led to rapid clinical improvements. However, other cases with severe illness, like our patient, necessitated high-dose IV steroids, intubation, and venovenous extracorporeal membrane oxygenation. The underlying etiology and pathophysiology of e-cigarette or vaping product use-associated lung injury remains unknown. The Centers for Disease Control and Prevention in conjunction with state/local health departments and the Food and Drug Administration is actively investigating the outbreak.

Conclusions:

Clinicians need to be aware of the current outbreak of e-cigarette or vaping product use-associated lung injury and ask about vaping in patients presenting with gastrointestinal and respiratory symptoms. Treatment options are anecdotal and necessitate a multidisciplinary approach.
Access to Outpatient Pediatric Mental Health Care After Emergency Department Discharge
Authors: Sheridan David C. , Marshall Rebecca , Nunez Morales Andrea , Johnson Kyle
Published: March 2020

Objectives

Pediatric mental health presentations to emergency departments (EDs) have shown dramatic increases nationally. This study aimed to identify the ability of patients discharged with mental health from the ED to establish outpatient care.

Methods

This was a cross-sectional study of all mental health patients aged 7 to 19 years who were seen by a child psychiatry consult team in a tertiary care pediatric ED from September 2016 to January 2017. Patients were contacted by phone at least 6 months after discharge. Data obtained included time to follow-up, reasons for delayed follow-up, type of provider seen, and frequency of outpatient visits.

Results

Two hundred twenty-eight charts were reviewed and 51 were successfully interviewed. The median age was 14 years and 61% were female. Most patients (61%) reported seeing a psychiatrist or therapist, whereas 19% reported a primary care provider and 19% reporting “other.” The majority were able to establish care within 1 month (73%), whereas 9% reported never obtaining outpatient follow-up. Most patients (58%) were able to be seen more than once per month. The most common reason for delayed follow-up was provider availability.

Conclusions

This study found that a large number of patients were able to be seen within 1 month of discharge for mental health care. However, almost 10% of patients never established outpatient care, which is concerning and is an area needing further research.
Challenges Faced by Therapists Providing Services for Infants With or at Risk for Cerebral Palsy
Authors: Gmmash Afnan S. , Effgen Susan K. , Goldey Katie
Published: March 2020

Objective:

The purpose of this study was to identify the challenges physical therapists (PTs) and occupational therapists (OTs) have in providing early intervention (EI) for infants with or at risk for cerebral palsy.

Methods:

Therapists' responses to an open-ended question were collected via survey that was distributed to EI providers and analyzed using content analysis.

Results:

The primary self-reported barriers to PT/OT EI services had 5 themes: (1) inadequate communication and collaboration, (2) challenges in coordination with family, (3) policy limitations, (4) meeting the child's individual medical needs, and (5) unequal access to resources.

Conclusion:

Respondents reported that barriers are complex and exist at the individual, family, team, and societal levels. Further research is needed to explore barriers and solutions at each of these levels, from meeting a child's individual medical needs to improving interprofessional communication to increasing equitable access to resources.
Oxygen Consumption While Walking With Multijoint Neuromuscular Electrical Stimulation After Stroke
Authors: Makowski Nathaniel S. , Kobetic Rudi , Foglyano Kevin M. , Lombardo Lisa M. , Selkirk Stephen M. , Pinault Gilles , Triolo Ronald J.
Published: March 2020

This case study evaluated the effect of implanted multijoint neuromuscular electrical stimulation gait assistance on oxygen consumption relative to walking without neuromuscular electrical stimulation after stroke. The participant walked slowly with an asymmetric gait pattern after stroke. He completed repeated 6-min walk tests at a self-selected walking speed with and without hip, knee, and ankle stimulation assistance. His walking speed with neuromuscular electrical stimulation more than doubled from 0.28 ± 0.01 m/sec to 0.58 ± 0.04 m/sec, whereas average step length and cadence increased by 0.12 m and 24 steps/min, respectively. As a result, energy cost of walking with neuromuscular electrical stimulation decreased by 0.19 ml O2/kg per meter as compared with walking without stimulation while oxygen consumption increased by 1.1 metabolic equivalent of tasks (3.9 ml O2/kg per minute). These metabolic demands are similar to those reported for stroke survivors capable of walking at equivalent speeds without stimulation, suggesting the increase in oxygen consumption and decreased energy cost result from improved efficiency of faster walking facilitated by neuromuscular electrical stimulation. Although the effect of neuromuscular electrical stimulation on gait economy has implications for community walking within the user’s metabolic reserves, this case study’s results should be interpreted with caution and the hypothesis that multijoint neuromuscular electrical stimulation improves metabolic efficiency should be tested in a wide population of stroke survivors with varied deficits.
A descriptive analysis of pediatric post-tonsillectomy pain and recovery outcomes over a 10-day recovery period from 2 randomized, controlled trials
Authors: Postier Andrea C. , Chambers Christine , Watson David , Schulz Craig , Friedrichsdorf Stefan J.
Published: March 2020

Pediatric tonsillectomy involves an often painful and lengthy recovery period, yet the extended recovery process is largely unknown. This article describes postoperative recovery outcomes for 121 children aged 4 to 15 (mean 6.6 years, SD = 2.3) years enrolled in 1 of 2 clinical trials of analgesia safety and efficacy after tonsillectomy. Postoperative analgesia included scheduled opioid analgesic plus acetaminophen/ibuprofen medication use (first 5 days) and “as-needed” use (last 5 days). Clinical recovery as measured daily by the Parents' Postoperative Pain Measure (PPPM; an observational/behavioral pain measure), children's self-reported pain scores, side-effect assessments, need for unanticipated medical care, and satisfaction with recovery over 10 days was assessed. Higher Parents' Postoperative Pain Measure scores were correlated with poorer sleep, receipt of breakthrough analgesics, distressing side effects, higher self-reported pain scores, and need for unanticipated medical care. Higher self-reported pain scores were associated with more distressing adverse events, including nausea, vomiting, insomnia, lower parent satisfaction, and unplanned medical visits and hospitalizations. Pain and symptoms improved over time, although 24% of the children were still experiencing clinically significant pain on day 10. Scheduled, multimodal analgesia and discharge education that sets realistic expectations is important. This study adds to the emerging body of literature that some children experience significant postoperative pain for an extended period after tonsillectomy.
Ambulatory Blood Pressure Response to Romantic Partner Interactions and Long-Term Cardiovascular Health Outcomes
Authors: Cornelius Talea , Birk Jeffrey L. , Edmondson Donald , Schwartz Joseph E.
Published: March 2020

Objective

Lower blood pressure (BP) during romantic partner interactions may underlie the association between romantic relationships and better long-term cardiovascular health. This secondary analysis examined the effect of momentary ambulatory BP (ABP) response to partner interactions on between-person changes in left ventricular mass index and mean systolic and diastolic BP over time.

Methods

Participants were 538 married, working adults (mean [SD] = 46.9 [8.8] years, 56.7% female) with a screening BP of ≤160/105 mm Hg. Participants completed questionnaires, 24-hour ABP monitoring, and an echocardiogram at waves 1 and 2 (mean [SD] = 6.2 [1.0] years later). Associations between ABP response to partner (versus nonpartner) interactions and cardiovascular outcomes were examined using multilevel structural equation models.

Results

Participants with lower diastolic BP during partner interactions at wave 1 had a lesser increase in systolic BP at wave 2 (B= 1.68, SE = 0.61,p= .006; 9.84 mm Hg differential change in systolic BP for participants at +1/−1 SD diastolic ABP response to partner interactions). Participants with lower diastolic ABP during partner-specific interactions at wave 1 also had a lesser increase in diastolic BP (B= 0.83, SE = 0.42,p= .045; 4.89 mm Hg differential change in diastolic BP at +1/−1 SD). Systolic ABP response to partner-specific interactions did not predict changes in cardiovascular outcomes; diastolic ABP response did not predict changes in left ventricular mass index.

Conclusions

Momentary diastolic ABP response to partner-specific interactions may function as a mechanism underlying the cardioprotective effect of romantic relationships on long-term BP outcomes.
Self-Rated Health and Age-Related Differences in Ambulatory Blood Pressure: The Mediating Role of Behavioral and Affective Factors
Authors: Uchino Bert N. , Birmingham Wendy , Landvatter Joshua , Cronan Sierra , Scott Emily , Smith Timothy W.
Published: March 2020

Objective

Despite the well-established association between self-rated health (SRH) and health, little is known about the potential psychobiological mechanisms responsible for such links and if these associations differ by age. The main goals of this study were to investigate the links between SRH and ambulatory blood pressure (ABP), if age moderated the risk, and the health behavior/affective mechanisms responsible for such links.

Methods

A total of 188 men and women (94 married couples; ages, 18–63 years) completed a standard measure of SRH and a 1-day ABP assessment. Multilevel models were run to examine whether SRH was associated with daily ABP and whether these links were moderated by age. The Monte Carlo method was used to construct confidence intervals for mediation analyses.

Results

Results indicated that poor SRH was associated with higher ambulatory systolic blood pressure (SBP; b = 3.14, SE = 0.68, p < .001) and diastolic blood pressure (DBP; b = 1.34, SE = 0.43, p = .002) levels. Age also moderated the links between SRH and ambulatory SBP (b = 0.19, SE = 0.08, p = .011) and DBP (b = 0.14, SE = 0.05, p = .004), with links being stronger in relatively older individuals. However, only daily life negative affect significantly mediated the age by SRH interaction for both ambulatory SBP and DBP.

Conclusions

These results highlight the potential psychobiological mechanisms linking SRH to longer-term health outcomes. Such work can inform basic theory in the area as well as intervention approaches that target such pathways.
68Ga–Prostate-Specific Membrane Antigen Uptake in Dissecting Abdominal Aortic Aneurysm
Authors: Wong Veronica Chi Ken , Yip Joshua Wei Liang , Stevanovic Amanda , Le Ken , Mansberg Robert
Published: March 2020

An 81-year-old man with prostate adenocarcinoma (Gleason 4 + 3 = 7) treated with brachytherapy and intermittent androgen deprivation therapy was referred for serial 68Ga–prostate-specific membrane antigen (PSMA-HBED-CC) PET/CT scans for rising prostate-specific antigen. Findings were suggestive of local prostatic recurrence and nodal metastases. An incidental PSMA-avid focus was noted in the anterior wall of an infrarenal aortic aneurysm, with a contrast-enhanced hyperdense region surrounded by a semilunar hypodense region anteriorly, consistent with enlarging dissecting thrombus. Increased PSMA avidity in atherosclerotic hypertensive lesions may relate to active plaque instability, indicating a need for further evaluation.
FASpecT/CT, A New SPECT/CT Acquisition With Higher Sensitivity and Efficiency in Radioiodine Thyroid Cancer Imaging
Authors: Phillips William T. , Kukkar Vishal , Francis Gary L. , Gorzell Brandon C. , Cooper Albert W. , Metter Darlene F. , Lancaster Jack L.
Published: March 2020

Purpose

This article demonstrates the use of a new SPECT/CT acquisition protocol in patients with differentiated thyroid cancer (DTC).

Methods

SPECT/CT scans (FASpecT/CT) with fewer angle acquisitions were retrospectively reviewed in 30 DTC patients treated with radioiodine at University Hospital, San Antonio, Tex, from July 2017 to March 2019. This FASpecT/CT of 12 versus 60 to 64 sampled views for convention SPECT was made possible by iterative reconstruction.

Results

The FASpecT/CT protocol was judged to increase lesion detection in patients with low count rates. Furthermore, in patients with higher count rates, this technique reduced the acquisition time. FASpecT/CT patient images are shown as case examples in 4 of the 30 patients reviewed.

Conclusions

This FASpecT/CT acquisition in radioiodine-treated DTC offers the potential of higher sensitivity for metastatic lymph node detection in low count rates and a significant decrease in imaging time in high count rates. These advantages make SPECT/CT imaging more acceptable for patients who have difficulty with longer imaging times, to include the pediatric population.
Elevated 68Ga-DOTATATE Activity in Fibrous Cortical Defect
Authors: Wen Zhe , Zhang Lin , Batra Vandana , Zhuang Hongming
Published: March 2020

FDG PET/CT was performed for staging in a 15-year-old adolescent girl with cholangiocarcinoma, which showed only mild activity in the tumor but more impressive FDG activity in right femoral fibrous cortical defect without any other hypermetabolic lesions elsewhere. Pathological examination of the resected cholangiocarcinoma revealed significant neuroendocrine differentiation, which lead to subsequent 68Ga-DOTATATE PET/CT study. Unexpectedly, the same femoral fibrous cortical defect also had increased 68Ga-DOTATATE activity.
Splenogonadal Fusion in Children
Authors: Guney Isa Burak , Temiz Abdulkerim , Oksuzler Mahmut , Alkan Murat
Published: March 2020

Splenogonadal fusion (SGF) is a rare congenital malformation, which can be of a continuous or discontinuous type. It is characterized by splenic tissue fused with gonadal tissue. Because it lacks characteristic features, very few cases of SGF have been diagnosed preoperatively. Herein, we present a case with left side SGF who was diagnosed by99mTc-nanocolloid spleen scintigraphy.
Early Detection of Secondary Central Nervous System Lymphoma on PET/CT
Authors: Appaduray Shaun Previn , Khoo James , Somasundaram Nagavalli , Chan Jason , Yan Sean Xuexian
Published: March 2020

We present a case of secondary central nervous system relapse of lymphoma detected initially on PET/CT without corresponding findings on MRI. A 60-year-old lymphoma patient demonstrated an FDG-avid focus in left cerebellar hemisphere on restaging PET/CT. MRI brain showed no corresponding abnormality, and expectant management ensued. Six months later, she represented with metabolic progression of previously seen FDG-avid focus in left cerebellar hemisphere, now also manifesting as an enhancing mass on MRI. Posttreatment scan for presumed lymphoma relapse showed metabolic response. This case demonstrates the advantage of PET/CT over anatomical imaging to detect metabolic changes before structural changes become apparent.
Primary Peripheral Primitive Neuroectodermal Tumor of the Prostate on 18F-DCFPyL PET/CT
Authors: Liu Yachao , Xu Baixuan
Published: March 2020

Peripheral primitive neuroectodermal tumor (PNET) is a group of malignant tumors composed of small round cells. Peripheral PNET usually originates in the skeletal system. However, the presence of PNET lesion in prostate is extremely rare. We report a case of a 40-year-old man who presented with dysuria for more than 2 months. Pelvic MRI indicated prostatic malignant tumor, and 18F-DCFPyL PET/CT showed an isolated prostatic mass with high uptake of 18F-DCFPyL. Although 18F-DCFPyL is very specific for prostatic adenocarcinoma, a final diagnosis of peripheral PNET was made by pathology examination.
Extensive Subcutaneous Foreign Body Granulomas Associated With “Skin Popping” Demonstrated on 18F-FDG PET/CT
Authors: Dejanovic Danijela , Amtoft Annemarie Gjelstrup
Published: March 2020

In illicit drug use, “skin popping” refers to the method of administering drugs by injecting it into the subcutaneous tissue. “Skin popping” can lead to acute and chronic skin manifestations caused by the drug itself and/or by the various adulterants and fillers commonly added to drug substances. Chronic skin manifestations include a foreign-body reaction with formation of granulomas at the site of injection. We present the 18F-FDG PET/CT findings of extensive subcutaneous granulomas in a 58-year-old woman with a heroin addiction undergoing treatment for infective endocarditis of the mitral valve.
Incidence of Gastroesophageal Reflux Disease in Children With Cleft Lip and Palate and an Evaluation of Its Impact on Weight Gain
Authors: Premaratne Ishani D. , Brownstone Nicholas , Lotfi Philip , Imahiyerobo Thomas A.
Published: March 2020

Patients with cleft lip and/or palate have higher rates of failure to thrive (FTT), decreased growth, and more often experience feeding difficulties as compared with the general pediatric population (J Child Health Care. 2014;18:72–83). Although insufficient nursing, excessive air intake, and incorrect feeding methods have been established in the literature, the role of gastroesophageal reflux disease (GERD) as a contributing factor in cleft patients has not been thoroughly examined. Presently, there is a paucity of literature analyzing the incidence and effect of GERD on this unique population. Furthermore, no studies have evaluated the effect of GERD therapy on improvement of weight gain and FTT in cleft patients. The purpose of this retrospective review was to identify the incidence of GERD in the orofacial cleft population and to see if appropriate treatment was effective in improving weight gain. Fifty patients with cleft lip, cleft lip and palate, and isolated cleft palate were identified from a single surgeon's experience at a large academic medical center from 2015 to 2019. The data show that a significantly higher percentage of patients with cleft lip/and or palate have clinical evidence of GERD, which required treatment as compared with published reports of less than 1% in the noncleft population. The data also suggest that the patients diagnosed with GERD who received pharmacologic treatment showed improved weight gain as compared with those who did not. Given our findings, the diagnosis of GERD should be considered in orofacial cleft patients exhibiting signs of feeding difficulty or those with FTT. The early diagnosis and treatment of GERD in patients with orofacial clefts may improve weight gain.
Cone-Beam Computed Tomography Evaluation of the Eustachian Tube in Patients With Cleft Lip and Palate Compared With Normal Controls
Authors: Duman Suayip Burak , Bayrakdar Ibrahim Sevki , Yasa Yasin
Published: March 2020

The authors compared the morphological features of the Eustachian tube (ET) between patients with cleft lip and palate (CL/P) and normal controls using cone-beam computed tomography (CBCT). CBCT images of 51 CL/P patients (28 males and 23 females, mean age: 18.5 ± 8.0 years) and a control group of 52 patients (22 males and 30 females, mean age: 25.23 ± 10.65 years) were retrospectively evaluated. The Eustachian tube angle (ETA), Eustachian tube length (EL), and auditory tube angle (ATA) were measured on CBCT images. The ETA, EL, and ATA in the CL/P and normal control groups were 30.4 ± 6.2 and 36.7 ± 7.5°; 24.7 ± 3.7 and 27.7 ± 4.3 mm; and 142.4 ± 7.8 and 136.3 ± 4.1°, respectively. All between-group differences were statistically significant (all P < 0.05). There were no significant between-gender differences in either group (all P > 0.05). Continuous variables were compared using the Mann-Whitney U-test. The morphological features of the ET, measured via multiplanar reconstruction CBCT, differed between CL/P patients and normal controls. CBCT can be used to evaluate ET morphological features.
Temporal Evolution of Imaging Findings in Ossified Cephalohematoma
Authors: Kandemirli Sedat Giray , Cingoz Mehmet , Bilgin Cem , Olmaz Burak
Published: March 2020

Background:

Cephalohematoma is collection of blood between skull and periosteum that is confined by cranial sutures. Cephalohematomas usually resorb spontaneously within the first month of life; however, if it fails to resolve, ossified cephalohematoma may form.

Methods:

Clinical archiving system and picture archiving and communication system were retrospectively reviewed for cases of birth-related cephalohematoma. Cases of ossified cephalohematomas identified on imaging were retrieved from this subset of patients. Cross-sectional imaging findings in patients with ossified cephalohematomas were evaluated for location, size of the hematoma, and contours of the inner lamella.

Results:

Out of 115 cases of cephalohematoma, 7 cases had imaging findings consistent with ossified cephalohematoma. All ossified cephalohematomas were located parietally, with size ranging between 18 and 55 mm and the thickness of the outer rim of calcification ranging between 1.5 and 4.8 mm. The contour of inner lamella in relation to the surrounding normal cranial vault was normal in 5 cases, and inner lamella was depressed in 2 cases.

Three patients had follow-up imaging available for demonstration of changes in ossified cephalohematoma. The first case was an 11 day-old boy with a cephalohematoma with no signs of calcification at the time of initial imaging. Follow-up at 2 months of age showed partial regression of hematoma cavity with marked calcification at the hematoma walls. The second case was a 3 month-old boy with ossified cephalohematoma at initial imaging. Follow-up imaging at 7 months of age showed almost total regression of hematoma cavity, and approximation of inner and outer lamella with increased thickness of the cranial vault. The third case was a 1 month-old boy with ossified cephalohematoma at initial imaging that totally resolved without residual increased bone thickness at 21-month follow-up.

Conclusion:

These 3 cases demonstrate the variability in temporal changes that may occur in ossified cephalohematomas.
Qualitative Analysis of Knowledge, Attitudes, and Beliefs About Pessary Use Among Spanish-Speaking Women on the US-Mexico Border
Authors: Maldonado Pedro Antonio , Jackson Elisha , Petty Kate M. , Rondeau Nancy , Montoya T. Ignacio , Mallett Veronica T.
Published: March 2020

Objectives

To explore the knowledge, attitudes, and beliefs related to pessary use in Spanish-speaking women along the US-Mexico border.

Methods

Spanish-speaking women with symptoms of vaginal bulge were recruited from the urogynecology/gynecology clinics at Texas Tech University Health Sciences Center El Paso to participate in moderated focus groups. Discussion topics included knowledge of prolapse/pessaries, pros/cons of pessaries, alternatives, and prolapse surgery. Audio-recorded group discussions were transcribed verbatim, and qualitative analysis completed by independent review using grounded theory methodology. Common themes were identified and then aggregated to form consensus concepts, agreed upon by the reviewers.

Results

Twenty-nine Spanish-speaking women participated in 6 focus group discussions. Approximately half of women reported little or no prior knowledge about pessaries. Three main themes were identified from analysis: knowledge/perceptions, misinformation/misconceptions, and surgery-related concerns. Concepts identified from common themes included limited knowledge of pessaries, confusing “pessary” with “mesh,” willingness to try pessaries in order to avoid surgery, desire to try pessary if it was recommended by physician, limited efficacy or complications of surgery, and mesh-related concerns. Interestingly, some women reported that pessaries appear to be a treatment more often offered in the United States rather than in Mexico.

Conclusions

Most participants showed a willingness to try a pessary for symptoms of pelvic organ prolapse in an effort to avoid surgery, despite expressing limited knowledge about this treatment. Physician recommendations and risks of pessary use influence their likelihood of trying a pessary. These concepts serve as focus points for effective pessary counseling to help improve education and informed decision making in this patient population.
Dallas UtErus Transplant Study: Early Outcomes and Complications of Robot-assisted Hysterectomy for Living Uterus Donors
Authors: Johannesson Liza , Koon E. Colin , Bayer Johanna , McKenna Gregory J. , Wall Anji , Fernandez Hoylan , Martinez Eric J. , Gupta Amar , Ruiz Richard , Onaca Nicholas , Testa Giuliano
Published: March 2020

Background.

Uterus transplantation is a treatment for absolute uterine infertility and can be performed with living and deceased donors. Given the safety and increased utilization of robotic assistance with other gynecologic and transplant donor operations, we adopted a robot-assisted approach to donor hysterectomy. This study compared early outcomes and morbidity of the robot-assisted approach to donor hysterectomy with the traditionally performed open approach and addressed whether the robot-assisted approach is safe and offers advantages for the donor.

Methods.

Our institution has performed 18 living donor hysterectomies for uterus transplantation. This retrospective review compared the last 5 cases utilizing a robot-assisted technique and vaginal extraction of the uterus graft with the first 13 cases performed with an open laparotomy technique. Demographic, intraoperative, and postoperative data were examined.

Results.

There were no differences between the robot-assisted and the open living donor group with respect to age, body mass index, or gynecological history. Although the median operative time was shorter for the open approach (6.27 versus 10.46 h), the donors’ median estimated blood loss, length of hospital stay, and length of sick leave were less with the robot-assisted approach. There was no conversion to open hysterectomy in the robot-assisted cases, and the incidence of complications was similar between the 2 groups. There was no difference in early graft function.

Conclusions.

These preliminary results show that robot-assisted living donor hysterectomy is feasible and safe for the donors; it allows a faster postoperative recovery and the same early graft function.
Dual MicroRNA Blockade Increases Expression of Antioxidant Protective Proteins: Implications for Ischemia-Reperfusion Injury
Authors: Tingle Samuel J. , Sewpaul Avinash , Bates Lucy , Thompson Emily R. , Shuttleworth Victoria , Figueiredo Rodrigo , Ibrahim Ibrahim K. , Ali Simi , Wilson Colin , Sheerin Neil S.
Published: March 2020

Background.

MicroRNAs (miRNAs) are short noncoding RNAs which each cause repression of many target genes. Previous work has demonstrated that therapeutic blockade of single miRNAs is possible. miR-24-3p and miR-145-5p are reported to have a detrimental role in ischemia-reperfusion injury. As the action of miRNAs is inhibitory, we hypothesized that dual blockade of both miRNAs could synergistically upregulate shared target genes.

Methods.

Quantification of miRNA expression in donated kidneys was performed using polymerase chain reaction (PCR) panels. Ischemia-reperfusion injury was modeled in vitro by placing human umbilical vein endothelial cells into a hypoxic incubator (1% O2) for 24 hours, with reoxygenation for 6 hours. RNA expression was quantified with reverse transcription quantitative polymerase chain reaction and protein expression assessed with Western blot. Antisense oligonucleotides were used to inhibit miRNAs.

Results.

miR-24-3p and miR-145-5p were highly expressed in human kidneys following extended cold ischemia. In vitro, hypoxia caused significant upregulation of miR-24-3p (P ≤ 0.001) and miR-145-5p (P ≤ 0.001) and significant downregulation in messenger RNA of shared targets superoxide dismutase 2 (P ≤ 0.001) and heme oxygenase 1 (P ≤ 0.001). These changes were mirrored at the protein level. Dual inhibition of both miR-24-3p and miR-145-5p caused significant upregulation of superoxide dismutase 2 and heme oxygenase 1 protein following hypoxia-reoxygenation; fold change of 3.17 (P ≤ 0.05) and 6.97 (P ≤ 0.05) respectively. Dual inhibition resulted in reduced cellular reactive oxygen species production compared with negative control (P ≤ 0.05) and single blockade of miR-24-3p (P ≤ 0.01) or miR-145-5p (P ≤ 0.05).

Conclusions.

Dual blockade of 2 miRNAs can act synergistically to increase the expression of shared gene targets. Dual blockade of miR-24-3p and miR-145-5p represents a novel therapeutic option worthy of further research.