bluuebunny/crossref_metadata_2025 huggingface dataset:
Variation in Emergency Department Adherence to Treatment Guidelines for Inpatient Pneumonia and Sepsis: A Retrospective Cohort Study
Authors: Trent Stacy A. , Jarou Zachary J. , Havranek Edward P. , Ginde Adit A. , Haukoos Jason S.
Published: October 2018

Objectives

Evidence‐based clinical practice guidelines (CPGs) for the treatment of pneumonia and sepsis have existed for many years with multiple studies suggesting improved patient outcomes. Despite their importance, little is known about variation in emergency department (ED) adherence to these CPGs. Our objectives were to estimate variation in ED adherence across CPGs for pneumonia and sepsis and identify patient, provider, and environmental factors associated with adherence.

Methods

This was a multicenter retrospective study using standard medical record review methods. The population consisted of consecutive adults hospitalized for pneumonia or sepsis (identified by discharge ICD‐9 codes) at five Colorado hospitals (two academic, three community) who were admitted to the hospital from the ED and for whom the ED diagnosed or initiated treatment. The outcome measured was ED adherence to the CPG (primary) and in‐hospital mortality (secondary). Hierarchical generalized linear models were used for analysis.

Results

Among 827 patients, ED care was 57% adherence to CPGs with significant variation in adherence across CPGs (sepsis 50%, pneumonia 64%, p < 0.001). Patients were less likely to receive adherent care if they presented with chief complaints that were associated but not typical of the diagnosis (odds ratio [OR] = 0.6, 95% confidence interval [CI] = 0.4–0.8), received an ED diagnosis that was not specific to the CPG (associated diagnosis OR = 0.3 [95% CI = 0.2–0.5]; unrelated diagnosis OR = 0.4 [95% CI = 0.2–0.6]) or presented to a community hospital (OR = 0.6, 95% CI = 0.4–0.9). ED CPG nonadherence was associated with higher in‐hospital mortality (OR = 2.4, 95% CI = 1.2–4.8).

Conclusion

Adherence to ED infectious CPGs for pneumonia and sepsis varies significantly across diseases and types of institutions with significant room for improvement, especially in light of a significant association with in‐hospital mortality.
Cytochemical characterization of peripheral blood cell populations of two Cyprinidae,Carassius auratusandCtenopharyngodon idellus
Authors: Zhang Fumiao , Feng Ranran , Fang Wei , Shi Yanhui , An Liguo , Yang Guiwen
Published: October 2018

Fish are the most diverse species of all vertebrate groups, and their blood cells have shown variable characteristics in terms of morphology. Cytochemical staining for enzyme activity in blood leukocytes will help assess the immune function of fish. We characterize blood cells from crucian carp (Carassius auratus) and grass carp (Ctenopharyngodon idellus) by using a Diff‐Quick stain as well as different cytochemical methods. Blood specimens obtained from crucian carp and grass carp were evaluated after cytochemical staining for acid phosphatase (ACP), alkaline phosphatase (ALP), naphtholASchloroacetate esterase (AS‐DNCE), naphthyl acetate esterase (NAE), α‐naphthyl butyrate esterase (NBE), peroxidase (MPO) and periodic acid–Schiff's reaction (PAS) using commercial kits. Blood cell types were evaluated based on their morphological characteristics and the presence or absence of specific chromogen. The expression pattern of enzymes was similar between the two Cyprinidae and was also broadly consistent with other fish species. However, there were some interesting differences detected between crucian carp and grass carp, including naphtholASchloroacetate esterase activity in monocytes, peroxidase activity and location in thrombocytes. TheACP,ALPandMPOexpressions of different leukocytes of the two Cyprinidae were evaluated by Image Pro Plus and were analysed for statistical significant differences. This investigation provides basic haematology and enzyme activity analyses for crucian carp and grass carp and serves as an approach to evaluating the immune response of fish.
Volume outlier benchmark proposal for Australian Mohs surgery
Authors: Smith Harvey Ronald
Published: October 2018

Peer‐derived Australian Mohs data were used to define volume outliers and a benchmark for quality improvement. Higher volume practice was linked to less complex anatomical locations for surgery. Reflection on individual practice compared to peers may reduce the number of volume outliers in Mohs surgery.
A qualitative exploration of the role of leadership in service transformation in child and adolescent mental health services
Authors: Edbrooke‐Childs Julian , Calderon Ana , McDonnell Matthew , Hirvonen Hanna , Deighton Jessica , Wolpert Miranda
Published: October 2018

Background

Recent policy in England has called on services for children and young people's mental health and well‐being to develop and deliver local transformation plans to increase the provision of evidence‐based, outcomes‐informed and service user‐informed treatments. The role of local leadership in service transformation is poorly understood, despite evidence suggesting it is key to enacting change.

Purpose

To understand the role of local leaders and frontline practitioners in service transformation in child and adolescent mental health services.

Methodology

This study was a secondary analysis of semistructured interviews with n = 20 leaders and n = 29 frontline practitioners in child and adolescent mental health services taking part in a service transformation programme.

Results

Leaders’ role in service transformation in child and adolescent mental health services (CAMHS) was to: (a) foster impetus for transformation by demonstrating passion and commitment for change, (b) support practitioners in developing microsystem improvements and (c) bridging the organisation's goals with available resources.

Conclusions

When developing transformation plans for child and adolescent mental health services, local leaders should be transparent about reasoning and processes, enable practitioners to tailor implementation to need and provide ongoing support. Practitioner engagement needs careful planning given its crucial role in enabling collaboration that will facilitate change.
Fibroblast growth factor receptor 3‐mediated reactivation of ERK signaling promotes head and neck squamous cancer cell insensitivity to MEK inhibition
Authors: Ban Myung Jin , Byeon Hyung Kwon , Yang Yeon Ju , An Sojung , Kim Jae Wook , Kim Ji‐Hoon , Kim Da Hee , Yang Jaemoon , Kee Hyunjung , Koh Yoon Woo
Published: October 2018

Recurrent or metastatic head and neck squamous cell carcinoma (HNSCC) has been a longstanding challenge for head and neck oncologists, and current treatments still have limited efficacy. ERK is aberrantly overexpressed and activated in HNSCC. Herein, we aimed to investigate the cause of the limited therapeutic effect of selumetinib, a selective inhibitor of MEK in HNSCC, as MEK/ERK reactivation inevitably occurs. We assessed the effects of combining selumetinib with fibroblast growth factor receptor 3 (FGFR3) inhibitor (PD173074) on tumor growth. Selumetinib transiently inhibited MAPK signaling and reactivated ERK signaling in HNSCC cells. Rebound in the ERK and Akt pathways in HNSCC cells was accompanied by increased FGFR3 signaling after selumetinib treatment. Feedback activation of FGFR3 was a result of autocrine secretion of the FGF2 ligand. The FGFR3 inhibitor PD173074 prevented MAPK rebound and sensitized the response of HNSCC cells to selumetinib. These results provided rational therapeutic strategies for clinical studies of this subtype of patients that show a poor prognosis with selumetinib. Our data provide a rationale for combining a MEK inhibitor with inhibitors of feedback activation of FGFR3 signaling in HNSCC cells. ERK rebound as a result of the upregulation of FGFR3 and the ligand FGF2 diminished the antitumor effects of selumetinib, which was overcome by combination treatment with the FGFR3 inhibitor.
Instant Stippling on 3D Scenes
Authors: Ma Lei , Guo Jianwei , Yan Dong‐Ming , Sun Hanqiu , Chen Yanyun
Published: October 2018

In this paper, we present a novel real‐time approach to generate high‐quality stippling on 3D scenes. The proposed method is built on a precomputed 2D sample sequence called incremental Voronoi set with blue‐noise properties. A rejection sampling scheme is then applied to achieve tone reproduction, by thresholding the sample indices proportional to the inverse target tonal value to produce a suitable stipple density. Our approach is suitable for stippling large‐scale or even dynamic scenes because the thresholding of individual stipples is trivially parallelizable. In addition, the static nature of the underlying sequence benefits the frame‐to‐frame coherence of the stippling. Finally, we propose an extension that supports stipples of varying sizes and tonal values, leading to smoother spatial and temporal transitions. Experimental results reveal that the temporal coherence and real‐time performance of our approach are superior to those of previous approaches.
Eikenella corrodens lipopolysaccharide stimulates the pro‐atherosclerotic response in human coronary artery endothelial cells and monocyte adhesion
Authors: Viafara‐Garcia Sergio M. , Gualtero Diego F. , Avila‐Ceballos Daniel , Lafaurie Gloria I.
Published: October 2018

Eikenella corrodens is a gram‐negative bacterium, and although primarily associated with periodontal infections or infective endocarditis, it has been identified in coronary atheromatous plaques. The effect of its lipopolysaccharide (LPS) on human coronary artery endothelial cells (HCAECs) is unknown. Our aim was to examine the mechanism underlying the inflammatory response in HCAECs stimulated with E. corrodens‐LPS and to evaluate monocyte adhesion. Endothelial responses were determined by measuring the levels of chemokines and cytokines using flow cytometry. The surface expression of intercellular adhesion molecule 1 (ICAM‐1) was determined using a cell‐based ELISA, and the adhesion of THP‐1 monocytes to HCAECs was also monitored. The involvement of toll‐like receptors (TLRs) 2 and 4 was examined using TLR‐neutralizing antibodies, and activation of extracellular signal‐regulated kinase (ERK)1/2 and nuclear factor‐kappa B (NF‐κB) p65 were measured by western blotting and ELISA, respectively. Eikenella corrodens‐LPS increased secretion of interleukin‐8 (IL‐8), monocyte chemotactic protein 1 (MCP‐1), and granulocyte–macrophage colony‐stimulating factor (GM‐CSF), and expression of ICAM‐1 on the surface of HCAECs, consistent with the increased adhesion of THP‐1 cells. Moreover, E. corrodens‐LPS interacted with TLR4, a key receptor able to maintain the levels of IL‐8, MCP‐1, and GM‐CSF in HCAECs. Phosphorylation of ERK1/2 and activation of NF‐κB p65 were also increased. The results indicate that E. corrodens‐LPS activates HCAECs through TLR4, ERK, and NF‐κB p65, triggering a pro‐atherosclerotic endothelial response and enhancing monocyte adhesion.
Impact of crown fracture treatment on oral health‐related quality of life of children, adolescents, and their families: A prospective clinical study
Authors: Magno Marcela Baraúna , Jural Lucas Alves , Nogueira Ayla do Valle , Lenzi Michele Machado , Pithon Matheus Melo , Maia Lucianne Cople
Published: October 2018

Background

Enamel‐dentin fracture causes impact on the oral health‐related quality of life (OHRQoL) of children.

Aim

To evaluate the impact of treatment of crown fracture involving enamel and dentin (CFED) in the permanent dentition on the OHRQoL of children and adolescents (C/As) and their families.

Design

This prospective clinical study included C/As between 8 and 14 years who presented anterior CFED treated thought direct composite resin restoration. Their parents/caregivers (P/Cs) were also invited to take part of the study. The quality of life was evaluated thought the Child Perceptions Questionnaires (CPQ8‐10 and CPQ11‐14), Parental‐Caregiver Perceptions Questionnaire (P‐CPQ), and Familiar Impact Scale (FIS), applied before and 3 months after the restorative procedure. T test for dependent samples and Wilcoxon test were applied(P < 0.05).

Results

Of 32 C/As included, 30 completed the study. The treatment of CFED reduced the negative impact in OHRQoL of C/As (CPQ8‐10 P = 0.0065; CPQ11‐14 P = 0.0486; P‐CPQ, P = 0.0259), specially for “oral symptoms” (CPQ8‐10, P = 0.0003; P‐CPQ, P = 0.0455) and “emotional well‐being” (CPQ11‐14, P = 0.0431). Concerning the families’ perceptions, the treatment did not influence OHRQoL both in terms of the domains and total FIS score (P > 0.05).

Conclusion

Restorative treatment of CFED increases the OHRQoL of C/As but not influence the OHRQoL of their families.
Effects of a self‐management training for people with intellectual disabilities
Authors: Sandjojo Janice , Zedlitz Aglaia M. E. E. , Gebhardt Winifred A. , Hoekman Joop , den Haan Jeanet A. , Evers Andrea W. M.
Published: October 2018

Background

To help people with intellectual disabilities lead a more independent life, it is important to promote their self‐management. This study evaluated the effectiveness of a self‐management training for people with intellectual disabilities directed at independent functioning in daily life.

Method

In the training, 17 people with intellectual disabilities worked on personal self‐management goals covering a wide range of everyday affairs. Primary outcome measures focused on goal attainment, independence and support needs. Moreover, outcomes regarding psychopathological behaviour and quality of life were explored. Data were collected before and at the start of the training, and 3, 6, 9 and 12 months later.

Results

The training contributed to the attainment of self‐management goals and to the reduction in support needs (p < 0.01). There were no changes in independence, psychopathological behaviour and quality of life.

Conclusions

Results indicate that the training supports people with intellectual disabilities to self‐manage their daily affairs.
Transformative agency and tensions in knowledge management—A qualitative interview study for nurse leaders
Authors: Lunden Anne , Teräs Marianne , Kvist Tarja , Häggman‐Laitila Arja
Published: October 2018

Aim

To describe Finnish nurse leaders’ perceptions of and experiences with knowledge management.

Background

Health science research has traditionally focused on knowledge transfer and research evidence instead of knowledge management, culture and organisational learning. Systematic reviews indicate a lack of awareness about nurse leaders’ activities in knowledge management.

Design

Qualitative interview study according to the consolidated criteria for reporting qualitative research (see Supporting Information Table S1).

Methods

Data were collected at a Finnish public, social and healthcare organisation from 33 persons in 2015 and 2017 through 35 individual interviews and seven focus groups. Data were analysed by thematic analysis.

Results

Nurse leaders’ daily knowledge management activities included assurance of smooth work functions and decisions about sudden changes. When managing knowledge promotion, nurse leaders focused on the near future and served information providers, coaches and developers of operating culture. Anticipatory management of knowledge requirements emphasised nurse leaders’ roles as assessors and visionaries. Tensions while managing knowledge were related to the following: changes in clients’ service needs, insufficient structures and tools to support the assessment and joint development of competence, time and information management, the operating culture, and nurse leader support. Participants reported only few attempts to solve tensions and therefore little to no transformative agency.

Conclusion

Nurse leaders prioritised daily knowledge management over management of knowledge promotion and anticipatory management of knowledge requirements. Knowledge management in nursing is a complex task requiring a command of different kinds of agency and related leadership styles. The structures, processes and tools supporting knowledge management should be developed to ensure that activities are systematic.

Relevance to clinical practice

A description of nurse leaders’ perceptions of and experiences with knowledge management could improve recognition of nurse leaders’ agencies for knowledge management, identification of related tensions and application of lessons learned from tensions. This description could also promote nurses’ professional competence and supplement nurse leaders’ training.
Impact of breathing exercises in subjects with lung cancer undergoing surgical resection: A systematic review and meta‐analysis
Authors: Wang Ya‐Qing , Liu Xin , Jia Yong , Xie Jiao
Published: October 2018

Aims and objectives

To assess the effects of breathing exercises on postoperative pulmonary complications (PPCs), pulmonary function, 6‐min walk distance (6MWD) and the length of hospital stay (LOS) in lung cancer patients undergoing lung surgery.

Background

Lung cancer patients undergoing lung resection have poor pulmonary function and multiple PPCs. Breathing exercises may improve these symptoms.

Design

Systematic literature review and meta‐analysis were conducted.

Methods

All entries to the following databases were searched up until 20 December 2017: PubMed, EMBASE Ovid, the Cochrane Central Register of Randomized Controlled Trials, Web of Science, Wanfang, Weipu and Chinese National Knowledge Infrastructure databases. Only randomised controlled trials (RCTs) were included in the analysis.

Results

A total of sixteen articles including nine articles in Chinese language and seven articles in English met the inclusion criteria. Breathing exercises decreased PPCs, and in addition, the incidence of pneumonia and atelectasis in the postoperative subgroup was reduced. Predicted forced expiratory volume in 1 s (predicted FEV1%), predicted forced vital capacity (predicted FVC%), FVC and FEV1/FVC ratio had improved after breathing exercises, but the changes in FEV1 were not statistically significant. Furthermore, the LOS was significantly decreased, but no improvements were found in 6MWD.

Conclusions

The results showed that breathing exercises could improve lung function, decrease the incidence of PPCs and LOS in a sample of lung cancer patients undergoing pulmonary surgery.

Relevance to clinical practice

The analysis suggests that breathing exercises should be considered as a respiratory rehabilitation programme for lung cancer patients undergoing lung surgery in clinical practice.
Influence of phytogenics on recovery of the barrier function of intestinal porcine epithelial cells after a calcium switch
Authors: Bachinger Diana , Mayer Elisabeth , Kaschubek Theresa , Schieder Carina , König Jürgen , Teichmann Klaus
Published: October 2018

Background

The gut barrier is essential for animal health as it prevents the passage of potentially harmful foreign substances. The epithelial tight junctions support the intestinal barrier and can be disrupted by stress caused, for example, by pathogens or dietary or environmental factors, predisposing the host to disease. In animal husbandry, phytogenics (plant‐derived feed additives) are used to support and maintain growth, feed efficiency and health. Therefore, several phytogenics were tested in vitro for their influence on the barrier function recovery of intestinal porcine epithelial cells (IPEC‐J2) after disruption, particularly on the abundance of tight junction proteins.

Results

IPEC‐J2 treated with 1,000 µg/ml liquorice root extract, 80 µg/ml plant powder mix, or 80 µg/ml angelica root powder showed significantly higher trans‐epithelial electric resistance (TEER) 24 hr after tight junction disruption via a calcium switch assay than the control. In contrast, cells treated with 1,000 µg/ml oak bark extract showed a significantly lower TEER after 6 hr but not at later time points. The increased TEER caused by the liquorice root extract correlated with an increase in the abundance of the tight junction protein claudin‐4.

Conclusions

This study suggests potential beneficial effects of liquorice and angelica root extracts on the gut barrier function when used as feed additives for livestock. Further studies, especially in vivo, are necessary to confirm these findings.
“Chromosomes and genes, spawned these fateful scenes”: Rapid adaptation in an introduced fish
Authors: Seeb Lisa W. , McKinney Garrett J. , Seeb James E.
Published: October 2018

Humans by their very nature alter the distribution of species. Be it introduction of exotic species, habitat alterations or construction of barriers, anthropogenic changes provide novel experimental systems for the molecular ecologist to study evolutionary change. These events often provide a contradiction. Effective population sizes are generally low, and introduced populations are typically characterized by reduced diversity consistent with theoretical predictions of population bottlenecks and founder effects. However, despite reduced diversity, rapid change sometimes occurs. Identification of genomic regions associated with these rapid adaptive responses to novel selection pressures provides a window into genomic regions important in adaptive diversity, both in the novel and native ranges. These studies also provide an important means to estimate the pace of evolutionary change. In this issue, Willoughby et al. () compared the heterozygosity of steelhead (the anadromous form of rainbow trout Oncorhynchus mykiss) introduced into Lake Michigan in the late 1880s to the putative source population from the ancestral California range. After 25 generations of isolation in Lake Michigan, Willoughby et al. () found consistent genomewide reductions in genetic diversity as estimated by a measure of pooled heterozygosity. Despite this overall reduction in heterozygosity, three chromosomal regions showed signals of rapid adaptation and contained genes associated with osmoregulatory and wound‐healing functions.
Established and emerging strategies to crack the genetic code of obesity
Authors: Tam V. , Turcotte M. , Meyre D.
Published: October 2018

Tremendous progress has been made in the genetic elucidation of obesity over the past two decades, driven largely by technological, methodological and organizational innovations. Current strategies for identifying obesity‐predisposing loci/genes, including cytogenetics, linkage analysis, homozygosity mapping, admixture mapping, candidate gene studies, genome‐wide association studies, custom genotyping arrays, whole‐exome sequencing and targeted exome sequencing, have achieved differing levels of success, and the identified loci in aggregate explain only a modest fraction of the estimated heritability of obesity. This review outlines the successes and limitations of these approaches and proposes novel strategies, including the use of exceptionally large sample sizes, the study of diverse ethnic groups and deep phenotypes and the application of innovative methods and study designs, to identify the remaining obesity‐predisposing genes. The use of both established and emerging strategies has the potential to crack the genetic code of obesity in the not‐too‐distant future. The resulting knowledge is likely to yield improvements in obesity prediction, prevention and care.
Systematic Review and Meta‐Analysis on Neuropsychological Effects of Long‐Term Use of Opioids in Patients With Chronic Noncancer Pain
Authors: Allegri Nicola , Mennuni Simona , Rulli Eliana , Vanacore Nicola , Corli Oscar , Floriani Irene , De Simone Irene , Allegri Massimo , Govoni Stefano , Vecchi Tomaso , Sandrini Giorgio , Liccione Davide , Biagioli Elena
Published: October 2018

Background and Objective

Opioid treatments are often prolonged because of the pathology causing pain. We focused on the cognitive functions in patients with chronic pain treated with opioids. This topic is currently controversial, but in practice, the consequences are important in patients’ daily lives, social interactions, working ability, and driving.

Database and Data Treatment

Medline and Embase databases were searched for eligible articles. We included studies that enrolled patients with chronic noncancer pain, studies with patients receiving opioid treatment, studies with a control group not using opioids, and studies in which cognitive functions were evaluated with specific tests. The cognitive areas examined were as follows: attention, reaction time, executive functions, psychomotor speed, memory, and working memory. From 356 abstracts screened, 9 articles satisfied eligibility criteria and were included in our review: 7 observational and 7 experimental studies. We classified the pain treatments as follows: opioids, other drugs active on the central nervous system (CNS) (antidepressants/anticonvulsants), and treatments not specifically targeted to the CNS.

Results

Statistically significant differences were seen only with regard to attention between opioids alone and no centrally acting treatment (standardized mean difference [SMD]: −0.53, 95% confidence interval [CI] : −0.91, −0.15; P = 0.007; I2 = 23%) and between opioids combined with antidepressants and/or anticonvulsants and no centrally acting treatment (SMD: −0.62, 95% CI: −1.04, −0.20; P = 0.004; I2 = 0%). No other significant differences were observed.

Conclusions

Opioids reduce attention when compared with treatments not targeted on the CNS. If opioids are used together with antidepressants and/or anticonvulsants, this effect increases.

Significance

These findings on the neuropsychological effects of opioids could be used to generate strategies to refine pain treatments.
An alternative for extracorporeal photopheresis: 8‐methoxypsoralen and UVA‐treated leucocytes from allogeneic donors improve graft‐versus‐host disease in mice
Authors: Budde Holger , Papert Susanne , Reichardt Holger M. , Jarry Hubertus , Riggert Joachim , Legler Tobias J.
Published: October 2018

Background and Objective

Extracorporeal photopheresis (ECP) is an important immune tolerance inducing therapy for graft‐versus‐host disease (GvHD). However, a sufficient number of ECP cycles cannot be performed in patients with severe GvHD and contraindications for apheresis. Allogeneic sources of leucocytes for use as ECP treatment would be of great benefit. Therefore, this study aimed to test the therapeutic potential of novel sources of leucocytes for ECP.

Materials and Methods

Graft‐versus‐host disease mice were treated with ECP using therapeutic cells from different allogeneic sources. Splenocytes were incubated with 8‐methoxypsoralen (8‐MOP), irradiated with UVA light and injected into GvHD mice as a model for ECP.

Results

The therapy with 8‐MOP/UVA‐treated cells from healthy mice of the bone marrow transplantation (BMT) donor strain reduced the GvHD symptoms, at least in a model of chronic GvHD. In the acute GvHD model, 8‐MOP/UVA‐treated cells from the BMT donor or recipient strain did not show significant improvements in GvHD symptoms or survival time. Pre‐activation of cells by mixed lymphocyte reactions before 8‐MOP/UVA treatment also failed to result in significant differences in survival time or GvHD score. In contrast, ECP with third‐party 8‐MOP/UVA‐treated cells from a HLA‐mismatched donor resulted in a mean survival time of 37 days compared to 21 days in the control group.

Conclusion

In our analysis of novel allogeneic leucocyte sources for ECP, we could demonstrate that the source of the 8‐MOP/UVA‐treated cells is crucial. The underlying immunologic effect of allogeneic 8‐MOP/UVA‐treated cells needs to be investigated in future studies.
Beyond molecular profiling for “precision oncology”
Authors: Attenello Frank J.
Published: October 2018

Patient-derived tumor cultures genetically mirror patient tumors, expanding insights into therapeutic resistance.
Cerebrovascular autoregulation in preterm fetal growth restricted neonates
Authors: Cohen Emily , Baerts Willem , Caicedo Dorado Alexander , Naulaers Gunnar , van Bel Frank , Lemmers Petra M A
Published: October 2018

Objective

To investigate the effect of fetal growth restriction (FGR) on cerebrovascular autoregulation in preterm neonates during the first 3 days of life.

Design

Case–control study.

Setting

Neonatal intensive care unit of the Wilhelmina Children’s Hospital, The Netherlands.

Patients

57 FGR (birth weight <10th percentile) and 57 appropriate for gestational age (AGA) (birth weight 20th–80th percentiles) preterm neonates, matched for gender, gestational age, respiratory and blood pressure support.

Methods

The correlation between continuously measured mean arterial blood pressure and regional cerebral oxygen saturation was calculated to generate the cerebral oximetry index (COx). Mean COx was calculated for each patient for each postnatal day. The percentage of time with impaired autoregulation (COx>0.5) was also calculated.

Results

FGR neonates had higher mean COx values than their AGA peers on day 2 (0.15 (95% CI 0.11 to 0.18) vs 0.09 (95% CI 0.06 to 0.13), p=0.029) and day 3 (0.17 (95% CI 0.13 to 0.20) vs 0.09 (95% CI 0.06 to 0.12), p=0.003) of life. FGR neonates spent more time with impaired autoregulation (COx value >0.5) than controls on postnatal day 2 (19% (95% CI 16% to 22%) vs 14% (95% CI 12% to 17%), p=0.035) and day 3 (20% (95% CI 17% to 24%) vs 15% (95% CI 12% to 18%), p=0.016).

Conclusion

FGR preterm neonates more frequently display impaired cerebrovascular autoregulation compared with AGA peers on days 2 and 3 of life which may predispose them to brain injury. Further studies are required to investigate whether this impairment persists beyond the first few days of life and whether this impairment is linked to poor neurodevelopmental outcome.
Concurrent mechanical haemolytic anaemia and heparin-induced thrombocytopenia following transcatheter aortic valve replacement
Authors: Furukawa Nathan W , Jumalon Fernando M , Friedman Daniel B , Kelly Linda R
Published: October 2018

A 78-year-old man with a history of severe aortic stenosis presented with confusion, irregular behaviour and dyspnoea 8 days following transcatheter aortic valve replacement. His exam was consistent with a heart failure exacerbation and he had elevated aminotransferases, bilirubin and prothrombin time suggestive of shock liver. A CT head scan demonstrated a subacute large left temporoparietal infarction. His aminotransferase and prothrombin time levels normalised with diuresis, but his indirect bilirubin remained elevated and he developed anaemia and thrombocytopenia consistent with a haemolytic anaemia. A transthoracic echocardiogram demonstrated a paravalvular leak. His thrombocytopenia continued to worsen prompting testing for antibodies against heparin-PF4 complexes which was positive. A serotonin release assay later returned positive, confirming the diagnosis of heparin-induced thrombocytopenia. This case illustrates that the presence of haemolytic anaemia does not necessarily exclude other causes of thrombocytopenia that may occur concurrently.
Sleep-related eating disorder with mirtazapine
Authors: Shinith Dhanya , Mathilakath Anand , Kim Da-In , Patel Biren
Published: October 2018

Sleep-related eating disorder (SRED) is classified within parasomnia and is characterised by recurrent episodes of abnormal, dysfunctional eating during sleep. This report describes a case of SRED in a 19-year-old woman admitted to the psychiatric ward with worsening anxiety, low mood and suicidal ideation. She was started on low-dose mirtazapine for mood stabilisation and, following an incremental increase to 30 mg, she developed nocturnal binge eating of which she retained only partial memory on waking. She developed adverse health consequences as a result of these recurrent episodes. The subject’s symptoms were relieved rapidly following reduction of the dose of mirtazapine back to 15 mg.
Plasmablastic lymphoma masquerading solitary plasmacytoma in an immunocompetent patient
Authors: Diaz Rodrigo , Amalaseelan Julan , Imlay-Gillespie Louise
Published: October 2018

We report a case of a middle-aged woman who initially presented with a painful solitary destructive lesion at fifth lumbar vertebra. The initial diagnosis of plasma cell neoplasm was made based on limited histological information obtained from fragmented tissue sample. Clinicopathological findings were consistent with a solitary plasmacytoma, and she was treated with definitive radiotherapy. A month after completing radiotherapy, she was found to have multiple liver lesions. Subsequent liver biopsy confirmed plasmablastic lymphoma (PBL). She was treated with multiple lines of chemo/immunotherapy regimens with limited or no response. She died of progression of liver lesions causing hepatic failure 16 months post diagnosis. Because of its rarity and heterogeneous presentations, PBL could easily be overlooked clinically and pathologically in immunocompetent patients. Diagnosis of PBL should be considered when there is coexpression of myeloma and lymphoma immune markers.
Intraoperative Descemet’s membrane detachment in a case of phacomorphic glaucoma
Authors: Pujari Amar , Swamy Deepa R , Chaniyara Manthan Hasmukhbhai , Sharma Namrata
Published: October 2018

A 60-year-old female patient with phacomorphic glaucoma underwent initial medical management to control the intraocular pressure (IOP). After 48 hours, a stable IOP was achieved and subsequently the patient was planned for phacoemulsification followed by intraocular lens implantation. There was initial difficulty while reconstructing the corneal wounds; however, phacoemulsification and IOL implantation were uneventful but during viscoelastic removal, an inadvertent Descemet’s membrane detachment involving the central cornea was noted. Postoperatively corneal oedema persisted till 1 week, following which there was a gradual improvement with topical antibiotics, steroids and hyperosmotic agents. At the end of 6 months, the best corrected visual acuity was 20/25 with a central corneal thickness of 580 µm without any need for additional endothelial replacement surgery.
Treatment response in osmotic demyelination syndrome presenting as severe parkinsonism, ptosis and gaze palsy
Authors: Abdul Halim Sanihah , Mohd Amin Nur Aida
Published: October 2018

Osmotic demyelination syndrome commonly affects the pons and infrequently involves the extrapontine region. We report a patient with severe hyponatraemia who developed osmotic demyelination syndrome as a consequence of rapid sodium correction. The condition manifested as acute severe parkinsonism, bilateral ptosis and gaze impairment. MRI revealed typical features of central pontine and extrapontine myelinolysis. The patient improved gradually after treatment with a combination of levodopa, intravenous immunoglobulin and dexamethasone. However, it is important to emphasise that the improvement of neurological symptoms is not necessarily causal with these experimental therapies.
Dysphagia unveiling systemic immunoglobulin light-chain amyloidosis with multiple myeloma
Authors: Gonzalez Juan , Wahab Ahsan , Kesari Kavitha
Published: October 2018

Dysphagia is an uncommon presentation of systemic immunoglobulin light-chain (AL) amyloidosis with multiple myeloma (MM). Gastrointestinal (GI) involvement usually manifests with altered motility, malabsorption or bleeding. Furthermore, patients identified with GI amyloidosis, without previous diagnosis of a plasma cell disorder, are extremely rare. We report an elderly woman who presented with acute on chronic cardiac dysfunction, sick sinus syndrome and acute renal failure. While admitted, she developed intermittent dysphagia to both solids and liquids. Oesophagogastroduodenoscopy showed ulcerations of oesophagus and duodenum. Biopsies revealed focal amyloid deposition, stained with Congo red. Renal biopsy revealed amyloid deposition in renal arterioles. She underwent a bone marrow biopsy confirming MM, represented by more than 15% plasma cell population. She was started on treatment for heart failure, induction chemotherapy for MM and percutaneous gastrostomy tube for feeding. However, she continued to deteriorate, eventually opting for hospice, and ultimately died 2 days after discharge from hospital.
Persistent cervical lymphadenitis in a patient with prior thyroid cancer attributed to Kikuchi-Fujimoto disease
Authors: Zuckerman Roman , Damiani Louise , Ayyad Hashem A , Alpert Deborah R
Published: October 2018

We describe a 50-year-old woman with a history of thyroid cancer who presented with bilateral cervical and submandibular lymphadenopathy, low-grade fevers, and increasing fatigue. The patient underwent lymph node fine-needle aspiration, which showed no evidence of metastatic or lymphoproliferative disease. This procedure was complicated by a parapharyngeal abscess and cellulitis. She was treated unsuccessfully with various courses of antibiotics, but briefly responded to short courses of steroids. As her cervical lymphadenopathy returned, she underwent an excisional lymph node biopsy, which demonstrated caseating granulomatous lymphadenitis. Extensive review of systems, physical examination, laboratory and imaging studies demonstrated no evidence of malignancy, infection or systemic lupus erythematosus . Our patient was clinically diagnosed with Kikuchi-Fujimoto disease and successfully treated with prednisone tapered over 3 months. She remains in clinical remission.
Hidden diagnosis behind viral infection: the danger of anchoring bias
Authors: Iwai Kenji , Tetsuhara Kenichi , Ogawa Eiki , Kubota Mitsuru
Published: October 2018

Anchoring bias is one of the most common diagnostic biases that may lead to closed-minded thinking and could result in unnecessary tests, inappropriate patient management and even misdiagnosis. A 4-year-old boy was brought to the emergency department because of shaking chills. On the basis of bilateral swollen preauricular areas, high level of serum amylase and the prevalence of mumps, he initially received a diagnosis of mumps in spite of the shaking chills. However, blood culture turned out to be positive for two different kinds of bacteria. The patient finally received a diagnosis of polymicrobial bacteraemia resulting from suppurative appendicitis. We must consider and rule out bacteraemia in the differential diagnosis for patients who present with shaking chills, even in the presence of symptoms or information consistent with a more common viral infection such as mumps. In addition, intra-abdominal infection should be ruled out in the presence of polymicrobial enterobacteriaceae bacteraemia.
Acute mechanical duodenal obstruction due to giant hydronephrosis: an unusual cause of acute abdomen
Authors: Sharma Ashish , Agarwal Samarth , Sinha Rahul Janak , Garg Gaurav
Published: October 2018

Giant hydronephrosis (GH) is a rare clinical entity with about 600 cases and defined as the adult renal pelvis containing greater than 1 L of fluid, or at least 1.6% of the body weight or kidney occupying the hemiabdomen. The pelvic-ureteric junction (PUJ) obstruction is the most frequent cause of GH. We thus report a case of massive abdominal distension due to GH secondary to PUJ obstruction who presented with acute duodenal obstruction due to extrinsic compression and was managed with percutaneous nephrostomy followed by open nephrectomy.
Comparison of paclitaxel in combination with cisplatin (TP), carboplatin (TC) or fluorouracil (TF) concurrent with radiotherapy for patients with local advanced oesophageal squamous cell carcinoma: a three-arm phase III randomized trial (ESO-Shanghai 2)
Authors: Ai Dashan , Chen Yun , Liu Qi , Zhang Junhua , Deng Jiaying , Zhu Hanting , Ren Wenjia , Zheng Xiangpeng , Li Yunhai , Wei Shihong , Ye Jinjun , Zhou Jialiang , Lin Qin , Luo Hui , Cao Jianzhong , Li Jiancheng , Huang Guang , Wu Kailiang , Fan Min , Yang Huanjun , Zhu Zhengfei , Zhao Weixin , Li Ling , Fan Jianhong , Badakhshi Harun , Zhao Kuaile
Published: October 2018

Introduction

Concurrent chemoradiation is the standard therapy for patients with local advanced oesophageal carcinoma unsuitable for surgery. Paclitaxel is an active agent against oesophageal cancer and it has been proved as a potent radiation sensitiser. There have been multiple studies evaluating paclitaxel-based chemoradiation in oesophageal cancer, of which the results are inspiring. However, which regimen, among cisplatin (TP), carboplatin (TC) or fluorouracil (TF) in combination with paclitaxel concurrent with radiotherapy, provides best prognosis with minimum adverse events is still unknown and very few studies focus on this field. The purpose of this study is to confirm the priority of TF to TP or TF to TC concurrent with radiotherapy in terms of overall survival and propose a feasible and effective plan for patients with local advanced oesophageal cancer.

Methods and analysis

ESO-Shanghai 2 is a three-arm, multicenter, open-labelled, randomised phase III clinical trial. The study was initiated in July 2015 and the duration of inclusion is expected to be 4 years. The study compares two pairs of regimen: TF versus TP and TF versus TC concurrent with definitive radiotherapy for patients with oesophageal squamous cell carcinoma (OSCC). Patients with histologically confirmed OSCC (clinical stage II, III or IVa based on the sixth Union for International Cancer Control-tumour, node, metastasis classification) and without any prior treatment of chemotherapy, radiotherapy or surgery against oesophageal cancer will be eligible. A total of 321 patients will be randomised and allocated in a 1:1:1 ratio to the three treatment groups. Patients are stratified by lymph node status (N0, N1, M1a). The primary endpoint is overall survival and the secondary endpoint is progression-free survival and adverse events.

Ethics and dissemination

This trial has been approved by the Fudan University Shanghai Cancer Centre Institutional Review Board. Trial results will be disseminated via peer reviewed scientific journals and conference presentations.

Trial status

The trial was initiated in July 2015 and is currently recruiting patients in all of the participating institutions above.

Trial registration number

NCT02459457.
Influence of social determinants of health on patients with advanced lung cancer: a prospective cohort study
Authors: Takemura Tomoyasu , Kataoka Yuki , Okazaki Koya , Sakurai Azusa , Imakita Takuma , Ikegaki Shunkiti , Matsumoto Hirotaka , Saito Emiko , Takata Hirohito , Kaku Sawako , Wada Nobuko , Shinomiya Mariko , Otoshi Takehiro , Shimada Masatoshi , Nikaido Junichi , Iki Reika , Hirano Katsuya , Hirai Tomoyuki , Endo Kazuo , Naganuma Toru
Published: October 2018

Introduction

Socioeconomic factors with an influence on human health are known as social determinants of health (SDH). There are some SDH studies in patients with lung cancer, but important exposures such as social isolation and loneliness have not been adequately investigated. This study will assess the influence of SDH, particularly social isolation and loneliness, on patients with advanced lung cancer in Japan.

Methods and analysis

The inclusion criteria for this prospective cohort study will be as follows: a diagnosis of advanced lung cancer; unsuitability for curative surgery; and willingness to participate. The primary outcome will be the initial choice of treatment and the secondary outcomes will be overall survival, changes in disease staging or performance status, route to diagnosis and place of death. The exposures will be social isolation, loneliness, employment, insurance type, education and dementia. The study enrolment period will be 1 year and the follow-up duration will be 2 years. The log-rank test will be used to compare overall survival between patients when grouped according to the study exposures and multivariate analysis will be performed using Cox proportional hazards regression. The Χ2test will be used to compare the initial treatment, changes in disease stage and place of death, and logistic regression will be used for multivariate analysis of these factors. A p value <0.05 will be considered statistically significant.

Ethics and dissemination

This study has been approved by the Institutional Review Board at Hyogo Prefectural Amagasaki General Medical Center (No 29-164). A manuscript summarising the outcome of this study will be submitted to a peer-reviewed journal and the data will be presented at conferences.

Trial registration number

UMIN000031810.
Protocol for a multicentre, prospective cohort study of practice patterns and clinical outcomes associated with emergency department sedation for mechanically ventilated patients: the ED-SED Study
Authors: Fuller Brian M , Mohr Nicholas M , Roberts Brian W , Carpenter Christopher R , Kollef Marin H , Avidan Michael S
Published: October 2018

Introduction

In mechanically ventilated patients, sedation strategies are a major determinant of outcome. The emergency department (ED) is the earliest exposure to mechanical ventilation for hundreds of thousands of patients annually in the USA. The one retrospective study that exists regarding ED sedation for mechanically ventilated patients showed a strong association between deep sedation in the ED and worse clinical outcomes. This finding suggests that the ED may be an optimal location to study the impact of early sedation on outcome, yet a lack of prospective studies represents a knowledge gap in this arena. This protocol describes a prospective observational study aimed at further characterising ED sedation practices and assessing the relationship between ED sedation and clinical outcomes. An association between ED sedation and clinical outcomes across multiple sites would suggest the need for changes in the current sedation strategies used in the ED, and provide evidence for future interventional studies in this field.

Methods and analysis

This is a multicentre, prospective cohort study testing the hypothesis that deep sedation in the ED is associated with worse clinical outcomes. A cohort of over 300 mechanically ventilated ED patients will be included. The primary outcome is ventilator-free days, and secondary outcomes include hospital mortality, incidence of acute brain dysfunction and lengths of stay. Multivariable linear regression will test the hypothesis that deep sedation in the ED is associated with a decrease in ventilator-free days.

Ethics and dissemination

Approval of the study by the Institutional Review Board (IRB) at each participating site has been obtained prior to data collection on the first patient. This work will be disseminated by publication of peer-reviewed manuscripts, presentation in abstract form at scientific meetings and data sharing with other investigators through academically established means.
Diagnostic predictive value of Xpert Bladder Cancer Monitor in the follow-up of patients affected by non-muscle invasive bladder cancer
Authors: D´Elia Carolina , Pycha Alexander , Folchini Decio M , Mian Christine , Hanspeter Esther , Schwienbacher Christine , Vjaters Egils , Pycha Armin , Trenti Emanuela
Published: October 2018

Aims

Cystoscopy and urine cytology represent the gold standard for monitoring superficial bladder cancer (BC). Xpert BC Monitor is a new urinary marker based on the evaluation of five target mRNAs overexpressed in patients with bladder cancer. The aim of our study was to evaluate the diagnostic accuracy of Xpert BC Monitor in follow-up of patients with non-muscle invasive bladder cancer (NMIBC).

Methods

230 patients were included in this prospective study. Xpert BC Monitor cut-off was set to 0.5. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of cytology, Xpert BC Monitor and their combination were calculated and compared with cystoscopy/histology.

Results

52/230 patients showed a NMIBC recurrence, 45 low grade (LG) and 7 high grade (HG). Overall sensitivity was 11.5% for cytology, 46.2% for Xpert BC Monitor and 48.1% for the two tests combined. Sensitivity of cytology increased from 4.4% in LG to 57.1% in HG tumours whereas for the Xpert BC Monitor it was 40% in LG and 85.7% in HG tumours. Combined cytology and Xpert BC Monitor yielded an overall sensitivity of 42% for LG and 85.7% for HG. Overall specificity was 97.2% for cytology, 77% for Xpert BC Monitor and 75.8% for the two tests.

Conclusions

Sensitivity for the Xpert BC Monitor Test was significantly higher than for cytology. The test performed very well in terms of specificity but could not reach the value of cytology, while PPV and NPV performed approximately the same for both tests.