bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Preoperative Medications on Length of Stay, Inpatient Pain, and Narcotics Consumption After Minimally Invasive Transforaminal Lumbar Interbody Fusion
Authors: Haws Brittany E. , Khechen Benjamin , Patel Dil V. , Bawa Mundeep S. , Guntin Jordan A. , Cardinal Kaitlyn L. , Wiggins Adam B. , Singh Kern
Published: September 2018

Study Design:

This is a retrospective cohort study.

Objective:

To determine the association between preoperative medications and length of stay, inpatient pain, and narcotics consumption after a minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).

Summary of Background Data:

Previous studies have identified risk factors for increased length of hospital stay, inpatient pain, and narcotics consumption. However, little is known regarding the effects of preoperative medications on outcomes after spine surgery.

Methods:

A prospectively maintained surgical database of patients undergoing primary, single-level MIS TLIF was retrospectively reviewed. Preoperative medications taken within 30 days before surgery were recorded for each patient and categorized by medication type. Poisson regression with robust error variance was used to determine the association between preoperative medications and length of stay, pain scores, and narcotics consumption. Multivariate analysis was performed using a backwards, stepwise regression to identify independent risk factors.

Results:

In total, 138 patients were included in this analysis. On bivariate analysis, benzodiazepines were associated with longer hospital stays [relative risk (RR)=2.03; P=0.031]. Benzodiazepines (RR=3.71; P<0.001) and preoperative narcotics (RR=2.60; P=0.012) were risk factors for pain ≥7 on postoperative day 0. On multivariate analysis, benzodiazepines were an independent risk factor for prolonged stay. Benzodiazepines, narcotics, and nonsteroidal anti-inflammatories were identified as independent risk factors for increased postoperative pain.

Conclusions:

These results suggest that benzodiazepines are a risk factor for increased length of stay and postoperative pain after MIS TLIF. Preoperative narcotics and nonsteroidal anti-inflammatories were also identified as risk factors for postoperative pain though this did not lead to increases in narcotics consumption. Patients taking these medications should undergo more vigilant perioperative monitoring for adequate pain management. More work must be done to further elucidate the association between preoperative medications and postoperative outcomes after MIS TLIF.
Risk Factors for a Long Hospital Stay Following Minimally Invasive Lumbar Discectomy
Authors: Khechen Benjamin , Haws Brittany E. , Patel Dil V. , Narain Ankur S. , Hijji Fady Y. , Bawa Mundeep S. , Cardinal Kaitlyn L. , Guntin Jordan A. , Singh Kern
Published: September 2018

Study Design:

Retrospective cohort study.

Objective:

The purpose of the study was to determine risk factors for discharge after postoperative day (POD) 0 in patients undergoing 1-level minimally invasive lumbar discectomy (MIS LD).

Summary of Background Data:

MIS LD has proven to be an effective treatment modality for low back pain and radiculopathy associated with intervertebral disc herniations. With increasing focus on cost reduction and value-based care, minimization of postoperative length of stay has become an important topic for physicians and hospital administrators.

Methods:

A prospectively maintained surgical database of patients who underwent 1-level MIS LD by a single surgeon from 2011 to 2016 was reviewed. Long length of stay was defined as discharge after POD 0. Bivariate and stepwise multivariate Poisson regression with robust error variance was used to determine risk factors for discharge after POD 0. Variables analyzed included patient demographics, comorbidities, operative characteristics, preoperative pain scores, postoperative inpatient pain scores, and postoperative narcotics consumption.

Results:

A total of 176 patients were included; 9.7% of included patients were discharged on POD 1 or later. On bivariate analysis, diabetic status (57.1% vs. 7.7%; relative risk [RR]=7.43; P<0.01) and narcotic consumption <6.00 oral morphine equivalents/h (13.1% vs. 1.2%; RR=11.11; P=0.019) were associated with a prolonged length of stay. On stepwise multivariate analysis, diabetic status (RR=10.5; 95% confidence interval, 3.60–30.98; P<0.001) was found to be independently associated with a prolonged length of stay after MIS LD.

Conclusions:

The results indicate that diabetic status is an independent risk factor for increased LOS following single-level MIS LD. Delayed hospital discharge can lead to increased costs, increased risk of complications, and decreased patient satisfaction. Thus, providers can use this information to better counsel diabetic patients and monitor them more closely following MIS LD. Additional work must be done to better understand risk factors for increased length of stay following MIS LD in procedure-specific populations.

Level of Evidence:

Level II.
Clonal heterogeneity of melanoma in a paradigmatic case study: future prospects for circulating melanoma cells
Authors: Scaini Maria Chiara , Pigozzo Jacopo , Pizzi Marco , Manicone Mariangela , Chiarion-Sileni Vanna , Zambenedetti Pamela , Rugge Massimo , Zanovello Paola , Rossi Elisabetta , Zamarchi Rita , Facchinetti Antonella
Published: September 2018

The management of metastatic melanoma is a difficult matter. Nevertheless, the advent of target therapy has significantly improved patient outcome, provided that tumor molecular characteristics become available: the detection of drug-resistant clones can contribute to understanding the reasons for resistance onset, influencing the choice of subsequent therapy. This work aimed to provide a possible explanation for the early resistance to vemurafenib developed by a patient with melanoma, and concurrently to assess the extent, and role, of the tumor clonal heterogeneity. We analyzed tissue samples from different sites and time points: first/second primary, three lymph node metastases, and circulating melanoma cells (CMCs). We first investigated these samples by the routine Sanger sequencing for BRAF, NRAS, and KIT, and then, we focused on specific hotspots by droplet digital PCR. We detected a BRAF V600E mutation by Sanger sequencing in the second primary and distant lymph node metastases, but not in the first primary or sentinel lymph node. Interestingly, by droplet digital PCR, the V600E mutation was also detected in the first primary, and the V600K in the second primary and metastases. Moreover, we identified a rare KIT V569G mutation, appearing to be CMC exclusive. This finding confirms the potential of CMCs as a source of tumor material for genetic analysis, reflecting real-time systemic disease evolution and, most likely, the most aggressive, treatment-resistant clones. In summary, this work underlines the importance of CMCs in the early identification of tumor clones putatively responsible for therapy resistance.
Expression and clinical significance of S100 family genes in patients with melanoma
Authors: Xiong Ting-feng , Pan Fu-qiang , Li Dong
Published: September 2018

Genes in the S100 family are abnormally expressed in a variety of tumor cells and are associated with clinical pathology, but their prognostic value in melanoma patients has not yet been fully elucidated. In this study, we extracted and profiled S100 family mRNA expression data and corresponding clinical data from the Gene Expression Omnibus database to analyze how expression of these genes correlates with clinical pathology. Compared with normal skin, S100A1, S100A13, and S100B were expressed at significantly higher levels in melanoma samples. S100A2, S100A7, S100A8, S100A9, S100A10, S100A11, and S100P were all highly expressed in primary melanoma samples but were expressed at low levels in metastatic melanoma, and all of these genes were strongly correlated with each other (P<0.001). We found the expression of these S100 family genes to be significantly correlated with both lymphatic and distant melanoma metastasis, as well as with American Joint Committee on Cancer grade but not with Clark’s grade, age, or sex. This suggests that expression of these genes may be related to the degree of tumor invasion. Although further validation through basic and clinical trials is needed, our results suggest that the S100 family genes have the potential to play an important role in the diagnosis of melanoma. S100 expression may be related to tumor invasion and may facilitate the early diagnosis of melanoma, allowing for a more accurate prognosis. Targeted S100 therapies are also potentially viable strategies in the context of melanoma.
Eosinophilic Dermatosis of Myeloproliferative Disease in a Young Adult With Diffuse Large B-Cell Lymphoma
Authors: Jencks Amy , Kiavash Katrin , Daveluy Steven , Thompson Andrew D.
Published: September 2018

Exaggerated insect bite reactions present as exuberant papular and vesiculobullous lesions in patients with hematologic malignant neoplasms. The most commonly reported hematological malignancy with exaggerated insect bite reactions is chronic lymphocytic leukemia. Other reported reactions have been seen in patients with mantle cell lymphoma. Clinical presentation may vary with many patients unaware of a previous insect bite. Therefore, the terms “exaggerated bite-like reaction” and “eosinophilic dermatosis of myeloproliferative disease” have been proposed. The lesions may wax and wane or persist for many years, and they seem to be unrelated to the underlying hematologic disorder course or therapy. In some circumstances, the lesions may actually precede the diagnosis of the hematological malignancy. In this study, we describe a case of “eosinophilic eruption of myeloproliferative disease” associated with diffuse large B-cell lymphoma in a young adult. To the best of our knowledge, this is the first case reported in association with diffuse large B-cell lymphoma.
Facial Phaeohyphomycosis in an Immunocompetent Individual: A Rare Presentation of a Rare Fungus
Authors: Kapatia Gargi , Pandey Tushar , Kakkar Nandita , Kaur Harsimran , Verma Roshan
Published: September 2018

Phaeohyphomycosis is a rare mycotic infection caused by heterogenous groups of dematiaceous fungi involving the skin and subcutaneous tissue. Here, we report a case of cutaneous phaeohyphomycosis presenting as cauliflower-like verrucous lesion over the face in an immunocompetent individual. Histopathology showed suppurative granulomatous inflammation replete with pigmented broad fungal hyphae which is stained with periodic acid–Schiff stain, Grocott's methanamine silver stain, Schmorl's stain, and Masson-Fontana stain. Culture showed black-colored colonies identified as Exophiala spinifera.
Mucinous Metaplasia of the Vulva in Zoon Vulvitis and Lichen Sclerosus et Atrophicus. Description of 3 Additional Cases of a Rarely Reported Histopathologic Finding
Authors: Santonja Carlos , Suárez-Peñaranda José Manuel , Carrasco Loreto , Fariña María del Carmen , Requena Luis
Published: September 2018

Mucinous metaplasia of the vulva (MMV) is a histopathologic finding that has been reported previously in only 3 patients and needs to be distinguished from vulvar extramammary Paget disease. We report 3 additional instances of MMV associated to Zoon vulvitis and vulvar lichen sclerosus et atrophicus. Histochemical and immunohistochemical studies were performed on biopsies from erythematous and erosive vulvar lesions of 3 women aged 64, 80 and 84 years, with features of Zoon vulvitis (2 cases) and lichen sclerosus et atrophicus (1 case). Mucin-containing epithelial cells were present on the uppermost layers of the squamous epithelium. On immunohistochemical study the metaplastic cells were positive for cytokeratin 7, epithelial membrane antigen and carcinoembryonic antigen, thus mimicking the phenotype of Paget disease. MMV is most likely related to chronic inflammation. Cytological and architectural features allow for distinction from Paget disease because the mucin-containing cells of mucinous metaplasia of the vulva lack atypia and are predominantly located on the most superficial layers of the surface epithelium.
Personal (Self) Perceptions of Submental Fat Among Adults in the United States
Authors: Baumann Leslie , Shridharani Sachin M. , Humphrey Shannon , Gallagher Conor J.
Published: September 2018

BACKGROUND

Satisfaction with discrete facial areas influences self-perceptions of attractiveness, self-esteem, and quality of life. Currently, there is a lack of understanding of how the submental area impacts feelings and behaviors.

OBJECTIVE

To characterize the effects of submental fat (SMF) on feelings/emotions and actions/behavior among adults in the United States.

METHODS

Online health-based surveys recruited approximately 400 adults (18–65 years) in each of 5 categories based on the respondent's assessment of their SMF. Respondents either agreed or disagreed with 17 statements regarding their feelings/emotions and actions/behaviors related to the area underneath their chin.

RESULTS

Overall, 1996 respondents were included (equal distribution of males/females; mean age, 41.9 years). Even a slight amount of chin fat was associated with negative feelings and behaviors. As SMF increased, so did the number of respondents reporting negative self-perceptions such as being embarrassed by the area under their chin. In general, a greater percentage of female compared with male respondents reported negative feelings and behavioral changes due to their submental area.

CONCLUSION

Excess SMF can have a substantial negative effect on a person's feelings of attractiveness and behaviors. Reduction of SMF may not only improve one's appearance, but also may enhance one's self-esteem.
Noninvasive Atrophic Acne Scar Treatment in Asians With a 755-nm Picosecond Laser Using A Diffractive Optic Lens—A Retrospective Photographic Review
Authors: Huang Ching-Hsin , Chern Erick , Peng Jui-Hui , Hsien-Li Peng Peter
Published: September 2018

BACKGROUND

The diffractive lens of the picosecond laser is relatively new, and there are few reports on its efficacy in treating atrophic acne scars, especially in Asian populations.

OBJECTIVE

Evaluating the efficacy of diffractive lens 755-nm picosecond laser for atrophic acne scar treatment in Asians.

PATIENTS AND METHODS

Forty-two patients who were treated for facial atrophic acne scars at a private dermatological clinic were enrolled in this retrospective analysis. Mean session count was 4.28. Before and after photographs were assessed by 2 blinded dermatologists, who rated the amount of overall skin quality improvement on a 5-point scale.

RESULTS

All patients experienced improvements in scar texture and overall skin quality after 2 to 6 sessions, with scores of +1.4, 1.45, 1.7, 1.33, 2.3, and 1.66 points after 2, 3, 4, 5, 6, and >6 treatments, respectively. There were no obvious adverse effects after treatment. The postinflammatory hyperpigmentation (PIH) risk was 4.7% (2 of 42, both spontaneously resolved).

CONCLUSION

The 755-nm diffractive lens picosecond laser showed good efficacy and low PIH rates when treating atrophic acne scars in darker skin–type patients. In addition to treatment results, additional improvements in overall skin quality and pigmentation make the picosecond laser an effective and desirable treatment option for Asians.
Efficacy, Safety, and Subject Satisfaction After AbobotulinumtoxinA Treatment of Upper Facial Lines
Authors: Hexsel Doris , Cartier Hugues , Hedén Per , Delmar Henry , Bergentz Per , Camozzato Fernanda , Siega Carolina , Skoglund Cecilia , Edwartz Carolina , Rees Diane , Kestemont Philippe
Published: September 2018

BACKGROUND

Botulinum toxins are the treatment of choice for wrinkles in the upper third of the face.

OBJECTIVE

The purpose of this study was to evaluate the efficacy, safety, and subject satisfaction of abobotulinumtoxinA (ABO) for treatment of upper facial lines.

MATERIALS AND METHODS

Subjects aged 35 to 50 years with moderate-to-severe upper facial lines were included in this study. Subjects received a maximum of 125 s.U. ABO in at least 2 indications with optional touch-up after 2 weeks. Assessments included wrinkle severity, global aesthetic improvement, subject satisfaction, and adverse events (AEs) 1, 3, and 6 months after treatment.

RESULTS

At Month 1, 100, 94, and 93% of subjects were responders in dynamic glabellar, lateral canthal, and forehead lines, respectively. All subjects were improved 1 month after treatment, and the majority of the subjects were still improved after 6 months. After treatment, most subjects were satisfied with the appearance of their face, felt better about themselves, and agreed that the treatment made them look the way they feel. Seven subjects (22%) had 8 ABO-related AEs (mild–moderate); headache was most commonly reported (9%).

CONCLUSION

AbobotulinumtoxinA effectively treated upper facial lines, with high patient satisfaction. Treatment was generally well-tolerated.
Gender-Affirming Hormone Therapy for Transgender Females
Authors: RANDOLPH JOHN F.
Published: September 2018

The provision of hormone therapy, both estrogens and antiandrogens, to adult transgender females is well within the scope of practice of the obstetrician gynecologist. The goal is to induce feminizing changes and suppress previously developed masculinization. Estrogens in sufficient doses will usually achieve both goals with augmentation by antiandrogens. The primary short-term risk of estrogens is thrombosis, but long-term risk in transgender females is unclear. Optimal care requires pretreatment education and assessment, individualized dosing, ongoing routine monitoring, and standard breast and prostate cancer screening.
Presidential Perspectives: Women’s Views From the Top
Authors: Roessler Genevieve , McBurney Ruth , Pryor Kathryn H. , Hamrick Barbara , Kirner Nancy P. , Martinez Nicole E.
Published: September 2018

This paper presents the perspectives of past presidents of the Health Physics Society who also happen to be women. Only 6 out of 63 Society presidents have been women, and of these six, five are still living and briefly reflect on their experiences here, alongside a brief discussion of the first female president of the Society. These perspectives provide historical insight into the evolution and happenings of the Society as well as adding personal touches to the office of the president that hopefully will encourage junior Society members to consider serving.
Setup and Characterization of a 137Cs Dosimetry Calibration Source in a Space-constrained Environment
Authors: Mapes Jasmine L. , Liu Kevin , Abraham Sara A. , Wilhelm Andrew S. , Latosz Logan V. , Kearfott Kimberlee J.
Published: September 2018

Proper characterization of 137Cs sources used for dosimeter calibration and performance testing is crucial for accurate and precise knowledge of air kerma rate and delivered dose. A 269 GBq 137Cs source was relocated to a new facility, which had a footprint of approximately 2.8 m × 3.6 m and a 3.4 m high ceiling. A small room size, such as in the new facility, may significantly increase backscatter from the walls or room return. Due to the limited source strength, a relatively close irradiation position of 1.00 m from the source was selected to decrease required exposure times. Proximity to the small but cylindrical source has the potential to alter the 1/r
2 relationship (inverse square law) of air kerma rate with distance associated with point sources. Practical tutorials concerning dosimetry irradiation facilities are largely absent from the archival literature. For those reasons, standard characterization experiments were repeated multiple times, great care was taken with positioning, several experiments were added to the standard ones, an ion chamber and dosimeters were used rather than film for greater accuracy and precision, and practical details of the process were recorded. The impacts of room size and finite source dimensions were quantified and mitigated by the efforts reported here. Recommendations for simple but thorough facility characterization, beam calibration, and quality control resulted.
Trust—what Connects Science to Daily Life
Authors: Ando Ryoko
Published: September 2018

Seven years have passed since the Tokyo Electric Power Company Fukushima Dai-ichi nuclear power plant disaster in March 2011. The actions taken by the Japanese government, such as issuing evacuation orders and setting decontamination and food safety standards, created huge confusion in society that led to a breakdown of trust. The residents of Suetsugi, a small village located about 30 km south of the plant, sought to understand and overcome the effects of radiation by measuring contamination and personal dose, etc. In my work through Ethos in Fukushima (a nonprofit organization in Iwaki, Fukushima), I learned that trust—not just measuring radiation or acquiring more scientific knowledge—has been the critical factor for them to regain a sense of order in their lives. The level of radiation has decreased since 2011; however, the community still struggles with rebuilding the community.
Consolidation of Health Physics Computer Codes: Sustainable Gains in Efficiency, Innovation, and Collaboration
Authors: Bush-Goddard Stephanie P. , Shaffer Vered A. , Norman Kerstun J.
Published: September 2018

A decade ago, the nuclear power industry in the United States was on the verge of a nuclear renaissance with the potential to create jobs, funding streams, and great demand for radiation protection personnel. However, based on the high capital investment cost of building and licensing nuclear reactors and declining fossil fuel prices, the renaissance did not reach its full potential. Radiation protection initiatives were developed to bring attention to the profession in order to increase funding for the health physics community during these times of declining resources. It is now essential that the community be innovative in how it uses existing funds and acquires resources. This paper describes a radiation protection computer code program that uses existing resources and international funding to sustain computer codes and tools used in the health physics profession. The program is called the U.S. Nuclear Regulatory Commission’s Radiation Protection Computer Code Analysis and Maintenance Program or RAMP. This collaborative, innovative, and transformative model can be followed by others seeking to alleviate the resource issues that exist within the health physics field.
Patterns of Altered Corneal Sensation in Patients With Chronic Migraine
Authors: Aykut Veysel , Elbay Ahmet , Esen Fehim , Kocaman Gulsen , Savran Elibol Emine , Oguz Halit
Published: September 2018

Objective:

Migraine is a central sensitization disease characterized by recurrent unilateral headache. The aim of this study was to evaluate corneal sensitivity and associated findings in patients with migraine.

Methods:

In this study, we included 58 patients with migraine (52 female and 6 male, mean age: 32.98±8.51 years) and 30 healthy control subjects (27 females and 3 males, mean age: 35.29±8.00 years). Only patients who did not have any eye disease were included in this study. Corneal sensation was evaluated with Cochet–Bonnet esthesiometer in five different regions of the cornea.

Results:

There was no significant difference between the groups for age, sex, and visual acuity. Increased mean sensitivity of the nasal cornea in the patients with migraine was found (55.0 vs. 53.75 mm, P=0.020). There was no significant difference in mean sensitivity for central (57.5 vs. 55 mm, P=0.163), temporal (57.5 vs. 55 mm, P=0.066), superior (52.5 vs. 52.5 mm, P=0.551), and inferior cornea (48.75 vs. 47.5 mm, P=0.818), or mean overall sensation (54.0 vs. 52.75, P=0.14), although there was a trend toward increased sensitivity in the patients with migraine. Among the subgroup of patients with unilateral migraine, mean overall sensation (54.0 vs. 53.0 mm, P=0.049) and temporal sensation (57.5 vs. 55.0 mm, P=0.043) were increased on the affected side.

Conclusion:

In this study, we have demonstrated that patients with migraine have increased corneal sensation, especially in the cornea of the affected side. This finding supports the idea that corneal sensation is altered in patients with migraine.
Compliance With Primary Open-angle Glaucoma and Primary Open-angle Glaucoma Suspect Preferred Practice Patterns in a Retail-based Eye Clinic
Authors: Stanley Jordan , Huisingh Carrie E. , Swain Thomas A. , McGwin Gerald , Owsley Cynthia , Girkin Christopher A. , Rhodes Lindsay A.
Published: September 2018

Purpose:

To determine the level of adherence to the American Academy of Ophthalmology preferred practice pattern (PPP) guidelines for quality primary open-angle glaucoma (POAG) and POAG suspect (POAGS) care among retail-based optometrists.

Methods:

Patients with a diagnosis of POAG or POAGS who participated in a telemedicine pilot project were included. Patients’ charts were evaluated for 15 elements of PPP guidelines for glaucoma care. Results were further stratified by number of follow-up visits and diagnosis.

Results:

Of 360 identified patients, 10 elements were documented in over 98%. Documentation of the remaining 5 components was as follows: dilated fundus examination 91.1%, central corneal thickness (CCT) 88.6%, visual field 78.9%, gonioscopy 47.5%, and target intraocular pressure (IOP) 15.6%. in total, 32.8% of patients were seen once, whereas the remaining 67.2% had multiple visits. In patients with multiple visits, providers were more likely to document systemic history (100.0% vs. 97.5%; P=0.0346), review of systems (100.0% vs. 97.5%; P=0.0346), gonioscopy (60.0% vs. 22.0%; P<0.001), CCT (94.2% vs. 77.1%; P<0.001), visual field (97.5% vs. 40.7%; P<0.001), and target IOP (22.4% vs. 1.7%; P<0.001) compared with single visit patients. In stratifying results by diagnosis, POAG patients more often received visual field testing (92.7% vs. 68.9%; P<0.001) and had an established target IOP (35.1% vs. 1.4%; P<0.001) compared with POAGS patients.

Conclusions:

Compliance with PPP guidelines for glaucoma care was very high for most elements but lower for performing dilated fundus examination, CCT, visual field, gonioscopy, and target IOP. This study highlights deficiencies in care likely to hamper the detection of glaucoma progression.
Antituberculosis Drug-induced Liver Injury in Children
Authors: Gafar Fajri , Arifin Helmi , Jurnalis Yusri D. , Yani Finny F. , Fitria Najmiatul , Alffenaar Jan-Willem C. , Wilffert Bob
Published: September 2018

Background:

As one of the most frequent and serious adverse reactions during tuberculosis (TB) treatment, antituberculosis drug-induced liver injury (ATLI) in children has been studied insufficiently compared with adults. We aimed to determine the incidence and risk factors of ATLI in children during the first 2 months of TB therapy.

Methods:

A total of 41 children with TB and treated with first-line anti-TB drugs were prospectively followed-up for the development of ATLI. Liver function tests were performed at baseline and after 2 weeks of therapy. Subsequent tests were conducted at 4, 6 and 8 weeks if the initial 2-week measurement was abnormal or if symptoms of hepatotoxicity were reported.

Results:

ATLI was detected in 11 (27%) patients within 14 to 42 days from the start of therapy, with most of them (54%) occurred after 2 weeks. TB treatment was stopped immediately in 6 of 11 patients who developed ATLI, and no recurrent hepatotoxicity after drug reintroductions in these patients. Univariate analysis showed that ATLI was significantly associated with TB meningitis (P < 0.01), hypoalbuminemia (P < 0.05) and hepatotoxic comedications (P < 0.01). Age, sex, nutritional status, HIV status and baseline liver function abnormalities were not associated with ATLI. Multivariate analysis identified hypoalbuminemia and hepatotoxic comedications (both P < 0.1) tend to be independently associated with ATLI.

Conclusions:

Children with hypoalbuminemia and use of hepatotoxic comedications are suggested to be monitored closely for the development of ATLI.
Nevirapine Concentrations During the First Month of Life and Maternal Efavirenz Washout in High-Risk HIV-Exposed Infants Receiving Triple Antiretroviral Prophylaxis
Authors: Anugulruengkitt Suvaporn , Cressey Tim R. , Suntarattiwong Piyarat , Ounchanum Pradthana , Srirompotong Ussanee , Jantarabenjakul Watsamon , Sophonphan Jiratchaya , Tawon Yardpiroon , Punnahitanon Sunti , Pancharoen Chitsanu , Chokephaibulkit Kulkanya , Puthanakit Thanyawee
Published: September 2018

Background:

Triple-drug infant antiretroviral prophylaxis containing nevirapine (NVP) is increasingly used to prevent HIV transmission among neonates at high risk of HIV infection. Our aim was to describe NVP concentration from birth through the first month of life.

Methods:

High-risk HIV-exposed neonates were enrolled in a prospective cohort in Thailand. High-risk neonates defined as maternal HIV RNA >50 copies/mL before delivery or mother received antiretroviral treatment for <12 weeks before delivery. Neonates received zidovudine (4 mg/kg) and lamivudine (2 mg/kg) twice daily, plus NVP (4 mg/kg) once daily (no lead-in) from birth to 6 weeks of life. Infant plasma samples were collected at 1, 2, 14 or 2, 7, 28 days of life. NVP trough concentrations (C24) were estimated using a population pharmacokinetic model and target C24 was ≥0.1 mg/L. “Washout” efavirenz (EFV) concentrations were assessed in infants whose mother received EFV-based antiretroviral treatment.

Results:

A total of 48 infants were included: 25 (52%) were male and 12 (25%) were preterm (gestational age 34–37 weeks). Median (interquartile range) predicted NVP C24 were 1.34 mg/L (1.13–1.84), 2.24 (2.00–2.59), 2.78 (2.61–3.12), 2.20 (1.86–2.44) and 0.81 (0.58–0.98) on days 1, 2, 7, 14 and 28 of life, respectively. NVP C24 was not significantly different between term and preterm infants. All infants maintained NVP C24 ≥0.1 mg/L. EFV via placental transfer remained detectable in infants up to 7 days of life.

Conclusions:

NVP 4 mg/kg daily from birth provided adequate prophylactic concentrations during the first month of life in high-risk HIV-exposed neonates.
Isolation and Characterization of New Probiotic Strains From Chinese Babies
Authors: Zhang Di , Zhang Shiqi , Guidesi Elena , Zonenschain Daniela , Sagheddu Valeria , Lee Soowon , Lim Chong-Yoon , Elli Marina
Published: September 2018

Goals:

The aims of this study were to isolate, to identify, and to characterize new potential probiotic strains from the feces of Chinese neonates.

Background:

Probiotic strains approved in China for use in infants were declared to originate from the human gut of Western subjects. Diet is listed among the main factors affecting the composition of the human gut along with other factors such as genetics, lifestyle, and health status. On the basis of this, the lifestyle of mothers, including dietary habits, could have an impact on the bacterial strains that colonize the gut of their babies.

Study:

Starting from fecal samples, plated onto selective media, of 26 babies, a total of 38 Lactobacillus and 45 Bifidobacterium colonies were isolated and subcultured, identified at the specie level with the partial sequencing of the 16S ribosomal RNA gene, and assessed for safety according to international guidelines for probiotics and European guidance. Only 6 Lactobacillus and 5 Bifidobacterium spp. were included for further analysis for the evaluation of survival rate within the gastrointestinal tract and for adhesive properties on the Caco-2 cell line. Some tests for prebiotic metabolism and growth on reconstituted skimmed milk were also performed.

Results:

Three Lactobacillus strains and 1 Bifidobacterium strain showing interesting adhesive abilities were included in the in vitro immune-stimulatory test with dendritic cells. Among these isolates, the Bifidobacterium breve 2TA showed the most interesting probiotic properties.

Conclusions:

The results obtained led to the identification of 4 new potential probiotic strains from Chinese babies to be submitted to further investigations about their metabolic and functional features.
Globus
Authors: Tawil José , Fass Ronnie
Published: September 2018

Globus is an area of interest for many medical specialists including otorhinolaryngologists, gastroenterologist, allergists, and psychiatrists. It may be caused by an organic disease, but it is not uncommon that an underlying etiology remains unidentified even after a full workup has been performed. Patients who suffer from globus usually visit several physicians from different specialties without finding a solution for their symptoms. Identifying the underlying cause of globus is not always a simple task; therefore, structural or functional abnormalities of the thyroid, larynx, pharynx, and esophagus should be investigated. Gastroesophageal reflux disease is commonly considered to be the underlying cause after being identified in an otorhinolarygeal (ear, nose, and throat) evaluation, which is usually the first diagnostic step. In the last few years, an inlet patch in the proximal esophagus has been shown to be associated with globus, and its elimination has resulted in symptom resolution in some patients. Finally, globus can be associated with psychiatric disorders as well as oropharyngeal hypersensitivity that could be either chemical or mechanical. Treatment is directed toward an identified organic cause; in those with a functional disorder, the mainstay of therapy includes neuromodulators and psychiatric/psychological interventions.
Bowel Preparation With Polyethylene Glycol 3350 or Fasting Only Before Peroral Single-balloon Enteroscopy
Authors: Lenze Frank , Nowacki Tobias , Schöppner Sabine , Ullerich Hansjörg , Bettenworth Dominik , Soriani Paola , Gabbani Tommaso , Mirante Vincenzo G. , Domagk Dirk , Manno Mauro , Lenz Philipp
Published: September 2018

Background:

Although bowel preparation before colonoscopy and capsule endoscopy is widely evaluated and usually follows established guidelines, a standard preparation regime for peroral small bowel enteroscopy is yet to be defined.

The aim of the present study was to compare small bowel preparation with polyethylene glycol (PEG) and “fasting only” (FO) before peroral single-balloon enteroscopy (SBE).

Study:

We compared small bowel preparation with PEG versus “FO” for peroral SBE in a randomized European multicenter trial. Patients’ and procedural characteristics were documented and carefully analyzed. Primary endpoint was the oral intubation depth of the small bowel. A modified Boston preparation scale was used to assess bowel cleansing as a secondary endpoint.

Results:

In total, 43 patients were enrolled in this study (FO group: n=25; PEG group: n=18). In both groups, patients’ characteristics were comparable. The indications for oral enteroscopy were equally distributed in both groups (P=0.894). The oral intubation depth was significantly higher in the PEG versus the FO group (261±87 vs. 203±66 cm; P=0.019; mean±SD), while the quality of bowel preparation was equally sufficient in both groups [complete visualization of the mucosa (Boston preparation scale) 83% versus 76% (P=1.000)].

Conclusions:

Small bowel preparation with PEG for SBE yields significantly deeper intubation as compared with “FO” preparation. As patient comfort and safety was similar in both groups, PEG preparation might be favored, especially if deep intubation of the small bowel is desired. For patients requiring visualization of the proximal jejunum, a FO preparation seems to be sufficient.
Intestinal Hyperpermeability in Gulf War Veterans With Chronic Gastrointestinal Symptoms
Authors: Zhang Buyi , Verne Meghan L. , Fields Jeremy Z. , Verne G. Nicholas , Zhou QiQi
Published: September 2018

Background:

Well over 700,000 United States military personnel participated in the Persian Gulf War in which they developed chronic health disorders of undetermined etiology. Up to 25% of Veterans had persistent and chronic gastrointestinal (GI) symptoms, which they suspected were related to their military service in the Gulf.

Aim:

The overall aim of the current study was to evaluate intestinal permeability in previously deployed Gulf War Veterans who developed chronic GI symptoms during their tour in the Persian Gulf.

Methods:

To accomplish this, we evaluated intestinal permeability (IP) using the urinary lactulose/mannitol test. Measurements of intestinal permeability were then correlated with mean ratings of daily abdominal pain, frequency of bowel movements, and consistency of bowel movements on the Bristol Stool Scale in all Veterans.

Results:

A total of 73 veterans had documented chronic GI symptoms (diarrhea, abdominal pain) and were included in the study. A total of 29/73 (39%) of veterans has increased IP and had a higher average daily stool frequency (P<0.05); increased liquid stools as indicated by a higher Bristol Stool Scale (P<0.01); and a higher mean M-VAS abdominal pain rating (P<0.01). Pearson correlation coefficients revealed that there was a positive correlation between increased IP and stool frequency, Bristol Stool Scale, and M-VAS abdominal pain rating.

Conclusions:

Our study demonstrates that deployed Gulf War Veterans with persistent GI symptoms commonly have increased intestinal permeability that potentiates the severity of abdominal pain, diarrhea, and stool consistency. These new findings in our study are important as they may lead to novel diagnostic biomarkers for returning Gulf War Veterans who suffer from chronic functional gastrointestinal disorders. These advances are also important for an increasing number of veterans who are now serving in the Persian Gulf and are at a high risk of developing these chronic pain disorders.
Impact of new direct-acting antiviral drugs on hepatitis C virus-related decompensated liver cirrhosis
Authors: Essa Mohamed , Sabry Aliaa , Abdelsameea Eman , Tharwa El-Sayed , Salama Mohsen
Published: September 2018

Background

The benefits of treatment of hepatitis C virus with direct-acting antiviral drugs in patients with decompensated liver cirrhosis (DLC) are still unclear.

Aim

To evaluate the degree of improvement in hepatic decompensation events and quality of life (QOL) in treated patients with DLC.

Patients and methods

One hundred and fifty patients with hepatitis C virus-related DLC were included; 75 of these patients received treatment (group I) [sofosbuvir (SOF) with either daclatasvir or ledipasvir for 24 weeks without ribavirin (RBV) or for 12 weeks with RBV] and 75 patients did not receive treatment as a comparable group (group II). Patients who achieved a sustained virological response at 12 weeks were assessed in terms of decompensation events, model for end-stage liver disease score, Child–Turcotte–Pugh score, biochemical changes, and QOL (applied on Mcguill QOL questionnaire) before starting treatment and 6 months after end of treatment, and were compared with untreated patients.

Results

Forty-two (56%) patients received SOF/daclatasvir for 24 weeks without RBV and 19 (25.3%) patients received SOF/ledipasvir for 24 weeks without RBV. The model for end-stage liver disease score improved in treated patients (mean change –1.73), but worsened in untreated patients (mean change +11.8) before and after 6 months. Also, the Child–Turcotte–Pugh score improved significantly (P<0.001). Serum albumin, prothrombin time, bilirubin, α-fetoprotein, and alanine aminotransferase improved in treated patients (P<0.001). Health-related QOL improved in treated patients (mean change +17.65) and worsened in untreated ones (mean change −18.68; P<0.001).

Conclusion

Treated patients with DLC showed an improvement in liver tests and health-related QOL. Longer durations of follow-up for decompensation events are needed.
Different kinetics of liver stiffness using shear wave elastography in patients with chronic hepatitis C infection treated with interferon-free regimens
Authors: Attia Dina , Deterding Katja , Cornberg Janet , Gebel Michael J. , Cornberg Markus , Manns Michael P. , Wedemeyer Heiner , Potthoff Andrej
Published: September 2018

Background

Direct-acting antivirals (DAAs) lead to a high rate of sustained virologic response (SVR) in chronic hepatitis C infection. The aim was to evaluate liver stiffness kinetics, using acoustic radiation force impulse (ARFI) imaging elastography, during and after DAAs in patients who had reached SVR.

Patients and methods

A total of 275 consecutive chronic hepatitis C virus-infected patients were included in this longitudinal prospective single-centre study. All patients received DAAs for 8 to 24 weeks, and liver stiffness measurements (LSMs) by ARFI at baseline, at week 4, week 12, week 24, and 24 weeks (SVR24) and 48 weeks (FU48) after the end of treatment were recorded. Transient elastography was performed at baseline and at SVR24.

Results

A decrease in LSM was detected at SVR24 by ARFI and transient elastography (P<0.001 and <0.001, respectively). A continuous gradual decrease in ARFI was observed in patients with cirrhosis versus a nonsignificant change in patients without cirrhosis until FU48 (P<0.001 vs. 0.877, respectively). At SVR24, higher baseline ARFI values (P=0.038) were associated with a decrease in LSM in patients with cirrhosis versus normal international normalization ratio (P=0.003), lower bilirubin (P=0.003), and higher albumin (P=0.007) in patients without cirrhosis. The incidence of liver stiffness decrease from baseline was higher in patients with cirrhosis than in those without cirrhosis (P<0.001), whereas the incidence of liver stiffness progression was more pronounced in advanced than in compensated cirrhosis (P<0.001).

Conclusion

After DAAs in patients with SVR, liver stiffness improves in patients with cirrhosis, whereas non-cirrhotic patients show no true change in liver stiffness. Liver stiffness worsens in patients with advanced liver disease.
Pancreatic adenocarcinoma with histologically proven portal vein infiltration: what is the outcome?
Authors: Martin David , Petermann David , Fontanella Sara , Pu Yan , Halkic Nermin , Demartines Nicolas , Schäfer Markus
Published: September 2018

Objectives

Technical feasibility and safety of portal vein (PV) and superior mesenteric vein (SMV) resection during pancreaticoduodenectomy (PD) for cancer has been confirmed, but oncological benefits remain unclear. The present study aimed to explore the long-term outcomes of PD with PV/SMV resection and proven histologically invasion.

Patients and methods

A total of 95 consecutive PD were performed between January 2008 and August 2013, and 29 patients underwent PV/SMV resection with histologically proven venous tumor infiltration. Patients were matched 1 : 1 to controls who did not undergo venous resection, based on demographic and tumor characteristics.

Results

Disease-free survival (DFS) of the PV/SMV invasion group and control group was 9.5 and 7.6 months, respectively (P=0.51). Median survival and survival at 1, 3, and 5 years were 12.9 months, 59, 17, and 10%, respectively, in case of PV/SMV invasion compared with 20.3 months, 72, 31, and 10%, respectively in control group (P=0.13). Patients with complete transmural infiltration presented nonsignificantly shorter DFS (9.0 months) compared with those with partial venous wall infiltration (18.4 months, P=0.78).

Conclusion

Histologically proven portal venous invasion in patients undergoing PD for adenocarcinoma seemed not to have an effect on both DFS and overall long-term survival.
Health Care Access and Physical and Behavioral Health Among Undocumented Latinos in California
Authors: Ortega Alexander N. , McKenna Ryan M. , Kemmick Pintor Jessie , Langellier Brent A. , Roby Dylan H. , Pourat Nadereh , Vargas Bustamante Arturo , Wallace Steven P.
Published: September 2018

Background:

This paper provides statewide estimates on health care access and utilization patterns and physical and behavioral health by citizenship and documentation status among Latinos in California.

Methods:

This study used data from the 2011–2015 California Health Interview Survey to examine health care access and utilization and physical and behavioral health among a representative sample of all nonelderly Latino and US-born non-Latino white adults (N=51,386). Multivariable regressions estimated the associations between the dependent measures and citizenship/documentation status among Latinos (US-born, naturalized citizen, green card holder, and undocumented).

Results:

Adjusted results from multivariable analyses observed worse access and utilization patterns among immigrant Latinos compared with US-born Latinos, with undocumented immigrants using significantly less health care. Undocumented Latinos had lower odds of self-reporting excellent/very good health status compared with US-born Latinos, despite them having lower odds of having several physical and behavioral health outcomes (overweight/obesity, physician-diagnosed hypertension, asthma, self-reported psychological distress, and need for behavioral health services). Among those reporting a need for behavioral health services, access was also worse for undocumented Latinos when compared with US-born Latinos.

Conclusions:

Patterns of poor health care access and utilization and better physical and behavioral health are observed across the continuum of documentation status, with undocumented immigrants having the worst access and utilization patterns and less disease. Despite fewer reported diagnoses and better mental health, undocumented Latinos reported poorer health status than their US-born counterparts.
Lack of Health Insurance Associated With Lower Probability of Head Computed Tomography Among United States Traumatic Brain Injury Patients
Authors: Renson Audrey , Schubert Finn D. , Bjurlin Marc A.
Published: September 2018

Background:

Uninsured traumatic brain injury (TBI) patients have higher mortality than their insured counterparts. One possible reason is disparities in receipt of appropriate diagnostic imaging.

Objective:

Examine the association between lack of insurance and use of diagnostic imaging.

Research Design:

This is a retrospective cohort study.

Subjects:

All adult patients admitted with severe (AIS>4 and GCS<15) TBI, in the National Trauma Data Bank 2010–2015.

Measures:

Primary outcome was receipt of head computed tomography (CT) and number of CT scans received. Secondary outcomes included head x-ray, angiography, or magnetic resonance imaging. Patients were classified as uninsured if their payment method was self-pay or not billed.

Results:

Of 59,540 patients meeting inclusion criteria, 18.9% were uninsured. After adjusting for demographic, clinical, and facility characteristics, compared with patients with any insurance, 4.47 per 100 (95% confidence interval, 1.60–7.34) fewer uninsured patients had a head CT, with uninsured patients receiving 13% (95% confidence interval, 3–21) fewer head CTs. There were no differences in x-ray, angiography, or magnetic resonance imaging receipt.

Conclusions:

Findings suggest lower receipt of guideline-indicated head CT among uninsured TBI patients. Mechanisms could include unconscious provider bias or institutional financial constraints. Further research is warranted to elucidate mechanisms and assess mediation by diagnostic imaging use of the insurance-mortality association.