bluuebunny/crossref_metadata_2025 huggingface dataset:
Dilemmas With Rotavirus Vaccine: The Neonate and Immunocompromised
Authors: Chiu Melissa , Bao Carol , Sadarangani Manish
Published: June 2019

Rotavirus (RV) is the leading cause of severe gastroenteritis in young children. However, because the incorporation of live-attenuated RV vaccines as part routine childhood immunization schedules, the rates of hospitalization from RV infections have decreased significantly across the globe. While RV vaccine safety and effectiveness have been well documented in the general population, there is controversy surrounding its use in preterm and immunocompromised infants. In this article, we review current research and consensus statements on the safety of the RV vaccine, the immunogenicity of the response and the potential for transmission and shedding of the virus postvaccination in both preterm infants and immunocompromised infants. RV vaccines are well tolerated in hospitalized preterm infants with no significant increase in nosocomial infections, gastrointestinal complications or feeding difficulties. In select immunocompromised infants (such as HIV-infected or HIV-exposed infants), RV vaccine administration did not increase the rate of adverse events. However, multiple case reports noted increased rates of adverse events in infants with severe combined immunodeficiency. The risk of viral shedding and transmission between vaccinated neonates and household contacts remain low and does not outweigh the benefit of vaccination.
Parasites in Human Stool: To Ignore or Not To Ignore?
Authors: Butters Coen , Yeoh Daniel K. , Curtis Nigel
Published: June 2019

Human stool contains a myriad of microorganisms, of which the vast majority are nonpathogenic and represent an important component of the healthy microbiome. The increasing use of molecular techniques has allowed the rapid identification of bacteria, viruses and parasites in human stool. This review focuses on the 3 main classes of parasite responsible for human disease, helminths, protozoa and ectoparasites, and highlights the importance of differentiating between pathogenic and nonpathogenic parasites.
Congenital Cytomegalovirus and Neonatal Herpes Simplex Virus Infections: To Treat or Not to Treat?
Authors: Whitley Richard J.
Published: June 2019

Congenital cytomegalovirus infections are among the most common of the newborn in the developed world. These infections are the most common cause of sensorineural hearing loss. Studies utilizing ganciclovir and valganciclovir demonstrate improved hearing and Bailey Developmental scores. Because of the ease of administration, valganciclovir is the recommended treatment of choice for 6 months. Therapy should be reserved for those babies with symptomatic disease; no data are available regarding the impact of treatment on those babies with asymptomatic disease.
Group B Streptococcus: Trials and Tribulations
Authors: Davies Hannah G. , Carreras-Abad Clara , Le Doare Kirsty , Heath Paul T
Published: June 2019

Group B Streptococcus (GBS) is estimated to have caused 319,000 cases of neonatal disease resulting in 90,000 infant deaths globally in 2015. It is also associated with maternal sepsis, preterm births, stillbirths and neonatal encephalopathy. There is a significant burden of neurologic impairment among survivors of infant GBS disease. Intrapartum antibiotic prophylaxis strategies have reduced the incidence of newborn early-onset GBS (occurring days 0–6) in some settings, but they are not feasible in many low and middle-income countries. A maternal vaccine given to pregnant women to stimulate passive transplacental transfer of protective antibodies has the potential to reduce maternal disease, adverse pregnancy outcomes and newborn disease. Phase I and II vaccine studies are occurring, but conducting phase III efficacy studies of a GBS vaccine candidate would require very large numbers due to the relatively low incidence of invasive GBS disease. It has therefore been proposed that alternative pathways to vaccine licensure should be explored, for example, through use of a regulatory approved correlate of protection and safety evaluation in mothers, fetuses and infants. These studies would then be followed-up with post-licensure phase IV studies in which vaccine effectiveness is evaluated.
RSV, Antibodies and the Developing World
Authors: Murray Alastair , Chu Helen Y.
Published: June 2019

Respiratory syncytial virus remains a major cause of infantile respiratory illness globally. Infants in the developing world experience the highest burden of mortality and morbidity. Risk factors associated with respiratory syncytial virus infection and progression to severe disease include household crowding, preterm birth and low birth weight. Maternally-derived antibody has a role in protection of infants through transplacental antibody transfer and breast milk antibody. Promising prevention strategies that are under development include vaccination during pregnancy and monoclonal antibody administration at birth.
Pain-related gaze biases and later functioning among adults with chronic pain: a longitudinal eye-tracking study
Authors: Jackson Todd , Yang Zhou , Su Lin
Published: June 2019

In previous studies that examined the impact of attention biases (ABs) on later pain outcomes, reaction times (RTs) in response to brief stimulus presentations had been used as measures of attention. Consequently, little is known about effects of ABs assessed during presentations of cues or biases in prolonged attention towards pain stimuli as influences on subsequent functioning. To address these gaps, 89 adults with chronic pain (68 women, 21 men) engaged in a baseline dot-probe task in which visual attention was tracked during injury-neutral (I-N) image pair presentations as well as a 6-month follow-up reassessing pain intensity and interference from pain. Neither RTs to probes after image pair offsets nor biases in initial orienting of gaze towards injury images predicted follow-up outcomes. However, participants who gazed at injury images for longer durations during I-N trials reported significantly more pain and interference at follow-up than did peers who gazed at injury images for less time, even after the impact of other significant baseline predictors had been controlled. In sum, results provided initial evidence for gaze biases reflecting prolonged vigilance towards pain-related information as a potential risk factor for relative elevations in pain and interference from chronic pain.
Repressor element 1–silencing transcription factor drives the development of chronic pain states
Authors: Zhang Fan , Gigout Sylvain , Liu Yu , Wang Yiying , Hao Han , Buckley Noel J. , Zhang Hailin , Wood Ian C. , Gamper Nikita
Published: June 2019

Chronic pain is an unmet clinical problem with vast individual, societal, and economic impact. Pathologic activity of the peripheral somatosensory afferents is one of the major drivers of chronic pain. This overexcitable state of somatosensory neurons is, in part, produced by the dysregulation of genes controlling neuronal excitability. Despite intense research, a unifying theory behind neuropathic remodelling is lacking. Here, we show that transcriptional suppressor, repressor element 1–silencing transcription factor (REST; neuron-restrictive silencing factor, NRSF), is necessary and sufficient for the development of hyperalgesic state after chronic nerve injury or inflammation. Viral overexpression of REST in mouse dorsal root ganglion (DRG) induced prominent mechanical and thermal hyperalgesia in vivo. Sensory neuron-specific, inducible Rest knockout prevented the development of such hyperalgesic state in 3 different chronic pain models. Genetic deletion of Rest reverted injury-induced hyperalgesia. Moreover, viral overexpression of REST in the same neurons in which its gene has been genetically deleted restored neuropathic hyperalgesia. Finally, sensory neuron specific Rest knockout prevented injury-induced downregulation of REST target genes in DRG neurons. This work identified REST as a major regulator of peripheral somatosensory neuron remodelling leading to chronic pain. The findings might help to develop a novel therapeutic approache to combat chronic pain.
Associations of mental health and family background with opioid analgesic therapy: a nationwide Swedish register-based study
Authors: Quinn Patrick D. , Rickert Martin E. , Franck Johan , Sariaslan Amir , Boersma Katja , Lichtenstein Paul , Larsson Henrik , D'Onofrio Brian M.
Published: June 2019

There is evidence of greater opioid prescription to individuals in the United States with mental health conditions. Whether these associations generalize beyond the US prescription environment and to familial mental health and socioeconomic status (SES) has not been examined comprehensively. This study estimated associations of diverse preexisting mental health diagnoses, parental mental health history, and SES in childhood with opioid analgesic prescription patterns nationwide in Sweden. Using register-based data, we identified 5,071,193 (48.4% female) adolescents and adults who were naive to prescription opioid analgesics and followed them from 2007 to 2014. The cumulative incidence of any dispensed opioid analgesic within 3 years was 11.4% (95% CI, 11.3%-11.4%). Individuals with preexisting self-injurious behavior, as well as opioid and other substance use, attention-deficit/hyperactivity, depressive, anxiety, and bipolar disorders had greater opioid therapy initiation rates than did individuals without the respective conditions (hazard ratios from 1.24 [1.20-1.27] for bipolar disorder to 2.12 [2.04-2.21] for opioid use disorder). Among 1,298,083 opioid recipients, the cumulative incidence of long-term opioid therapy (LTOT) was 7.6% (7.6%-7.7%) within 3 years of initiation. All mental health conditions were associated with greater LTOT rates (hazard ratios from 1.66 [1.56-1.77] for bipolar disorder to 3.82 [3.51-4.15] for opioid use disorder) and were similarly associated with concurrent benzodiazepine-opioid therapy. Among 1,482,462 adolescents and young adults, initiation and LTOT rates were greater for those with parental mental health history or lower childhood SES. Efforts to understand and ameliorate potential adverse effects of opioid analgesics must account for these patterns.
Attitudes Toward Long-Term Medication Use—A Comparison Between Concerned Populations and a Sample From the German General Population
Authors: Engelke Christina , Cordes Joachim , Kahl Kai G. , Schmidt-Kraepelin Christian
Published: June 2019

Purpose/Background

The present study was conducted to investigate the difference in attitudes toward psychiatric drugs, long-term medication, and depot formulations between psychiatric patients and patient-related groups and the German general public.

Methods/Procedures

Different groups (n = 50 patients, n = 34 relatives of patients, n = 42 psychiatrists, n = 70 medical students, and n = 58 psychiatric nursing professionals) were surveyed using a questionnaire to investigate their attitude toward depot medication and compared with matched participants from the German general public.

Findings/Results

Patients did not differ from their matched controls regarding their attitude toward potential reasons to reject a depot, whereas psychiatrists (P = 0.002) and nursing staff (P = 0.003) were more concerned about patients fearing an injection than their matched controls.

Implications/Conclusions

Psychiatrists and psychiatric nurses were significantly more concerned about giving an (intragluteal) injection because of concerns about patients' fears of this administration method than their matched controls. In contrast, patients' concerns about receiving an injection did not differ from their matched controls. Furthermore, we found that psychiatrists tended to believe that giving an injection might be time-consuming than giving oral medication. These results may emphasize the fact that the low rate of depot medication use is derived from subjective reservations of medical staff rather than actual negative attitudes or fears of patients.
Case Reports of Aripiprazole and Problematic Gambling in Schizophrenia
Authors: Lachance Alexandre , Corbeil Olivier , Corbeil Stéphanie , Chalifour Guillaume , Breault Ann-Sophie , Roy Marc-André , Demers Marie-France
Published: June 2019

Background

Pharmacovigilance studies have reported a higher risk of problematic gambling (PG) in people receiving aripiprazole (ARI), a partial dopamine agonist. This association needs to be specifically assessed in schizophrenia (SZ) given the high prevalence of risk factors for PG in this population (eg, comorbid substance use) and given the nature of the dopamine dysfunction in this disorder. At the present stage, case studies may shed light on such an association.

Methods

All published cases involving SZ patients with PG while on ARI were systematically identified. Two instruments were used to assess causality.

Results

We identified 16 published SZ cases exposed to ARI experiencing PG. Half of whom had a gambling history before ARI exposition. Naranjo scores led to the estimation of a possible link between ARI exposition and PG in 15 of 16 cases (average score of 3) and probable (score of 5) in 1 case. More than 50% of items were left unknown owing to the lack of information or scale limitations. Using the Liverpool algorithm, causality estimation was raised to probable in 13 of 16 cases, definite in 1 case, and nonassessable in 2 cases.

Conclusions

The present review confirms that ARI may be involved in the occurrence of PG in some SZ patients. However, important information to assess causality was frequently missing, and the 2 scales used did not yield the same degree of certainty. The current article calls for including more details in future case reports and for well-powered studies carefully assessing factors such as comorbid diagnoses.
Achieving Clinical Instructor Competence: A Phenomenological Study of Clinical Instructors' Perspectives
Authors: Coleman-Ferreira Kimberly , Tovin Melissa , Rone-Adams Shari , Rindflesch Aaron
Published: June 2019

Introduction.

Defining best practice in clinical education is currently a primary focus of the American Physical Therapy Association and the American Council of Academic Physical Therapy. Although professional standards exist for physical therapist clinical instructors (CIs), there is little published research regarding the pathway to achieving competence as a CI. Moreover, there is currently no published definition for competence as a CI within the profession of physical therapy (PT). This study attempts to describe the meaning of competence and the experience of achieving competence as perceived by both credentialed and noncredentialed CIs.

Subjects.

Twenty-nine physical therapist CIs who had independently supervised at least one full-time physical therapist student served as the subjects for this study.

Methods.

A phenomenological methodology was used to understand and interpret the meaning of CI competence and the experience of achieving competence from the CI participants' perspectives. Data were collected through focus group interviews and written statements and then were analyzed using thematic analysis.

Results.

The journey to competence, though unique to each CI, included commonalities. An overarching theme of “Empowerment” emerged from the data analysis and was supported by 6 subthemes: (1) the meaning of competence, (2) my first student, (3) finding the way, (4) barriers to achieving competence, (5) confidence, and (6) lifelong learning. Participants' descriptions of the meaning of competence included the roles of skilled clinician, teacher, mentor, reflective learning, collaborator, and effective communicator.

Discussion and Conclusion.

Findings can inform CIs striving for effectiveness in clinical teaching by defining the meaning of competence, as well as revealing a variety of pathways used to achieve competence. These examples could be helpful for Site Coordinators of Clinical Education, Directors of Clinical Education and others who teach CI development. The physical therapy education community and its professional bodies can use these findings to define CI competence and to direct future efforts and programs designed to prepare clinicians to effectively educate students in the clinical setting.
An Intervention Enhances Resilience in Entry-Level Physical Therapy Students: A Preliminary Randomized Controlled Trial
Authors: Mejia-Downs Anne
Published: June 2019

Introduction:

The purpose of this study was to assess the impact of a resilience curriculum on stress levels, resilience, and protective factors, among physical therapist (PT) students during academic stress. Physical therapist students experience high levels of psychological stress during their education. Individuals with greater resilience are better equipped to handle stress. There is a lack of research examining the effect of resilience interventions in PT students. All students enrolled in an entry-level Doctor of Physical Therapy (DPT) program in Indianapolis, IN were eligible. Forty-three students volunteered to participate and all contributed preintervention and postintervention data for the study.

Methods:

Participants were randomly assigned to receive a resilience curriculum (n = 22) or to a wait-list control group (n = 21), with the researcher blinded to the assignment. An 8-hour resilience curriculum was delivered in 4 consecutive, 2-hour weekly sessions to the intervention group. Both the intervention and the control groups completed baseline and follow-up assessments. The control group was offered a 2-hour condensed version of the curriculum after postintervention assessments. Outcomes measured included stress, resilience, coping flexibility, optimism, emotions, social support, and illness.

Results:

There were significantly greater increases in resilience (P = .03) and positive emotions (P = .02) in the intervention group compared to the control group. There were no significant differences in stress, coping flexibility, negative emotions, optimism, social support, or illness symptoms. Less perceived stress, greater coping flexibility, and higher positive mood scores predicted greater baseline resilience, accounting for 56% of the variance.

Discussion and Conclusion:

This preliminary study demonstrates that a resilience curriculum delivered to DPT students increases resilience and positive emotions. Providing DPT students with tools to improve psychological resilience may better prepare them to meet the demands inherent in entry-level DPT educational programs.
The relationship between protein convertase subtilisin kexin type-9 levels and extent of coronary artery disease in patients with non-ST-elevation myocardial infarction
Authors: Dalgic Yalcin , Abaci Okay , Kocas Cuneyt , Cetinkal Gokhan , Dalgic Sadiye N. , Buyuk Ahmet , Ser Ozgur S. , Batit Servet , Arat Alev , Gurmen Aziz T.
Published: June 2019

Background

Cardiovascular disease is one of the leading causes of death worldwide. According to the results of various studies, protein convertase subtilisin kexin type-9 (PCSK9) was determined as a novel risk factor for stable coronary artery disease. Few studies have investigated the relationship between PCSK9 levels and the severity of coronary artery disease in patients with acute coronary syndrome; thus, we herein aimed to investigate this relationship in patients with non-ST-elevation myocardial infarction (NSTEMI) who underwent coronary angiography.

Patients and methods

Herein, 168 patients with NSTEMI were prospectively enrolled, and severity of atherosclerotic lesions was determined using SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX), Gensini and Jeopardy scores. Plasma PCSK9 levels, lipid parameters and C-reactive protein levels were measured after a 12-h fasting period. The relationship of PCSK9 levels and clinical and laboratory parameters of patients with their SYNTAX, Gensini and Jeopardy scores was investigated.

Results

Pearson correlation analysis showed a strong positive correlation between PCSK9 and the three scores (P < 0.001,r > 0.5 for all). In ROC analysis, a mid-high SYNTAX score of at least 25 was predicted with a sensitivity of 81% and a specificity of 63% when the PCSK9 level was higher than 52.8 ng/ml (area under a curve 0.76,P < 0.001). Multivariate linear regression analysis revealed that PCSK9, low-density lipoprotein cholesterol and creatinine levels were independent predictors of a high SYNTAX score.

Conclusion

Taken together, high PCSK9 levels may be a risk factor for adverse events in patients with NSTEMI. Aggressive lipid-lowering therapies may benefit this group of patients.
Autologous stem cell transplantation for patients with viral hepatitis-induced liver cirrhosis: a systematic review and meta-analysis
Authors: Chen Bin , Pang Long , Cao Hongxin , Wu Dongbo , Wang Yonghong , Tao Yachao , Wang Menglan , Chen Enqiang
Published: June 2019

Background

Recently, stem cells have been used in the treatment of viral hepatitis-induced liver cirrhosis (LC), and stem cell therapy is showing potential therapeutic effects on liver function improvement. The consensus on effects and safety of stem cell therapy has not been reached, thus it is essential for us to conduct a systematic review and meat-analysis to investigate the efficacy and safety of stem cell therapy for viral hepatitis-induced LC.

Materials and methods

Medline, Embase, SinoMed and Cochrane Library databases were searched with appropriate keywords through 5 August 2018. We included eight trials involving 467 patients. The pooled weight mean difference (WMD) and 95% confidence interval (CI) were calculated using a fixed or random effects model. Quality assessment and publication bias were also performed. The selected studies were considered for meta-analysis using RevMan V5.3.

Results

Compared with traditional therapy group, autologous stem cell transplantation increased the level of albumin (WMD: 2.47, 95% CI: 1.05–3.90, P < 0.001), but decreased the level of total bilirubin (WMD: −2.26, 95% CI: −3.61 to −0.90, P = 0.001), alanine aminotransferase (WMD: −9.16, 95% CI: −16.47 to −1.85, P = 0.01) and prothrombin time (WMD: −3.02, 95% CI: −4.83 to −1.22, P = 0.001). Clinical symptoms such as edema, fatigue, anorexia and abdominal distention were alleviated. Model for End-Stage Liver Disease and Child–Pugh scores were decreased after stem cell therapy. Whereas, there was no statistically significant difference between two groups regarding aspartate aminotransferase, prothrombin time activity, ascites and pleural fluid. No procedure-related complications were found.

Conclusion

Autologous stem cell transplantation might have beneficial effects on patients with viral hepatitis-induced LC and is relatively safe for these patients. Further high-quality randomized controlled trials are needed.
Prevalence of dyspepsia in patients with cholecystolithiasis: a systematic review and meta-analysis
Authors: Latenstein Carmen S.S. , de Jong Judith J. , Eppink Jedda J. , Lantinga Marten A. , van Laarhoven Cornelis J.H.M. , de Reuver Philip R. , Drenth Joost P.H.
Published: June 2019

Cholecystolithiasis and functional gastrointestinal disorders are both highly prevalent in the industrialized world and may exist concomitantly. The presence of both conditions impedes identification of the source of symptoms, leading to a risk of ineffective cholecystectomies with lack of symptom resolution. We carried out a systematic review and meta-analysis to determine the prevalence of dyspepsia in patients with uncomplicated cholecystolithiasis. The electronic databases Medline, Embase, and Web of Science were searched for articles reporting the prevalence of dyspepsia in adults (≥18 years) with uncomplicated cholecystolithiasis. Pooled prevalence and 95% confidence interval were calculated. I
2 statistics were used to determine heterogeneity and the Methodological Evaluation of Observational Research criteria were applied for quality assessment. The study was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Of the 1696 studies evaluated, 13 reported the prevalence of dyspepsia in a total of 1227 cholecystolithiasis patients seeking medical care. The pooled prevalence of dyspepsia in patients with cholecystolithiasis was 65.7% (95% confidence interval: 51–79%). However, heterogeneity was large across studies. Overall, three studies used validated diagnostic criteria. Variation in diagnostic measures significantly influenced the prevalence of dyspepsia. In conclusion, symptoms similar to those of functional gastrointestinal disorders are common in patients with cholecystolithiasis, obscuring the source of abdominal complaints. Tools to select patients who will benefit from cholecystectomy are paramount to prevent ineffective surgery.
Correlations between the serum bilirubin level and ulcerative colitis: a case–control study
Authors: Shi Haitao , Feng Yuan , Jiang Jiong , Zhao Juhui , Li Xiao , Liu Xin
Published: June 2019

Objective

To analyze whether the bilirubin level is a protective factor in ulcerative colitis (UC) and the predictive value of the bilirubin level.

Patients and methods

We compared the bilirubin levels of 100 UC patients and 140 healthy controls as well as those of the subgroups of patients with different UC severities and then analyzed the correlation between the bilirubin level and UC and the correlations among the erythrocyte sedimentation rate (ESR), high sensitivity C-reactive protein (hs-CRP) level, UC severity, and bilirubin level. The predictive value of the bilirubin level for UC was determined by constructing a receiver operating characteristic (ROC) curve.

Results

The mean levels of the total bilirubin (TBIL) and indirect bilirubin (IBIL) in the UC were lower in comparison with the mean TBIL and IBIL levels in the control group, and the TBIL and IBIL levels were significantly higher in the mild activity subgroup than in the moderate and severe activity subgroups (P<0.05). TBIL (P<0.001, 95% confidence interval: 0.794–0.918) and especially IBIL (P<0.001, 95% confidence interval: 0.646–0.809) were independent protective factors for UC. There were also significant differences in the serum ESR and hs-CRP levels between the patients with different UC severities (ESR=χ
2: 23.975; hs-CRP=χ
2: 26.626, P<0.001), and there was a positive correlation between these two parameters (ESR=r: 0.472; hs-CRP=r: 0.495, P<0.001). However, the TBIL and IBIL levels were correlated negatively with the ESR (r
total=−0.429, r
indirect=−0.461, P<0.001) and hs-CRP (r
total=−0.289, r
indirect=−0.25, P<0.05) levels. The ROC curve showed that the threshold values of TBIL and IBIL were 8.87 and 6.735 µmol/l, the areas under the maximum ROC curve were 0.664 and 0.716, the sensitivities were 0.450 and 0.61, and the specificities were 0.800 and 0.786, respectively.

Conclusion

TBIL and especially IBIL may be independent protective factors for UC because of their antioxidant and anti-inflammatory effects. A low level of IBIL has a moderate predictive value for UC, and an IBIL level less than 6.735 µmol/l can be used as a defining index for predicting UC.
A review on co-existent Epstein–Barr virus-induced complications in inflammatory bowel disease
Authors: Wu Shuang , He Chuan , Tang Tong-Yu , Li Yu-Qin
Published: June 2019

There have been growing reports regarding the presence of Epstein–Barr virus (EBV) in the intestine portions of patients suffering from ulcerative colitis and Crohn’s disease, collectively termed as inflammatory bowel disease (IBD). Indeed, the prevalence of EBV infection increases in IBD patients due to prolonged employment of immunosuppressive drugs including azathioprine and infliximab. In turn, coinfection with EBV increases the propensity of development of lymphoproliferative disorders in the gastrointestinal tract including Hodgkin lymphoma, non-Hodgkin lymphomas, and lymphoepithelioma-like cholangiocarcinoma. Therefore, it is recommended that IBD patients on prolonged immunomodulator therapy should be monitored for the presence of primary intestinal lymphoproliferative diseases. Moreover, coinfection of EBV complicates the clinical course of IBD by increasing the severity, chronicity, inducing refractoriness and increasing relapse incidences. Therefore, it is recommended that antiviral drugs should be added in the conventional IBD therapy in the suspected cases of EBV infection. Research has also revealed that EBV-induced colitis is very similar to IBD and there are chances of misdiagnosis of IBD in the presence of EBV colitis. The proper diagnosis of EBV infection along with its timely treatment is necessary to avoid the severe complications in patients of IBD. The present review discusses the role of EBV coinfection in increasing the clinical complications of IBD patients.
Anticipatory care of children and adolescents with inflammatory bowel disease: a primer for primary care providers
Authors: Carman Nicholas , Mack David R. , Benchimol Eric I.
Published: June 2019

Purpose of review

About 10–20% of patients with newly diagnosed inflammatory bowel disease (IBD) are under 18 years of age, with incidence increasing in young children. Children with IBD have unique healthcare needs, which require coordination between primary care providers and pediatric gastroenterologists to provide appropriate care. This review highlights some key elements of anticipatory care in pediatric IBD, including vaccination, risk of serious infection and malignancy, psychosocial and educational needs, and cannabis use.

Recent findings

Therapies for IBD that include anti-tumor necrosis factor medications, especially when combined with corticosteroids are associated with higher risks of serious infections. Vaccination remains the best way to prevent infections. Live vaccinations should be avoided during immunosuppression, but the schedule should be otherwise completed, including vaccination for influenza, pneumococcus and meningococcus, and human papillomavirus. Malignancy risk is increased in IBD patients, both because of disease factors and resulting from immunomodulatory medications. Children with IBD are at risk for mental health disorders and negative educational outcomes, so identification of at-risk children and early intervention are important.

High-quality care in pediatric IBD requires coordination between pediatric gastroenterologists and primary care providers, with careful attention paid to the specific needs of children with IBD.
Eltrombopag Therapy in Children With Rare Disorders Associated With Thrombocytopenia
Authors: Frączkiewicz Jowita , Sęga-Pondel Dorota , Kazanowska Bernarda , Ussowicz Marek
Published: June 2019

Eltrombopag (ELT) is a thrombopoietin receptor activator that has shown efficacy in chronic immune thrombocytopenia. We report the outcome of ELT therapy in 4 children who were treated for rare hematologic disorders, including Pearson syndrome, DiGeorge syndrome, posttransplant allogeneic poor graft function (PGF), and Wiskott-Aldrich syndrome. The ELT tolerance in the analyzed group was good, with the exception of the child with Pearson syndrome, who experienced an exacerbation of cataracts and had to discontinue treatment. Thromboembolic events were observed in one child, who continued ELT therapy despite achieving normalized platelet counts. Independence from PLT transfusions was observed at the 4-week timepoint of therapy in patients with DiGeorge syndrome and PGF who responded to ELT. Discontinuation of therapy was successful in one child, who sustained the normal CBC values afterward. In 2 patients, an increase in neutrophil counts was observed during ELT therapy without additional intervention, and a positive correlation between neutrophil and platelet values during ELT therapy was observed in the child with PGF. ELT is effective in rare pediatric disorders, but response patterns are determined by the underlying disease. ELT shows promising results in patients, but constitutional hematopoiesis defects reduce the chances of a response.
Thiol Disulfide Homeostasis and Ischemia-modified Albumin Level in Children With Beta-Thalassemia
Authors: Odaman Al Işik , Ayçiçek Ali , Ersoy Gizem , Bayram Cengiz , Neşelioğlu Salim , Erel Özcan
Published: June 2019

Objective:

It is well known that increased oxidative stress leads to tissue damage in beta-thalassemia (β-thal) patients. Thiols are one of the most important antioxidant agents, and thiol/disulfide (SH/SS) homeostasis is a novel oxidative stress marker. This study aimed to investigate the relationship of thiol levels, SH/SS homeostasis, and ischemia-modified albumin (IMA) in patients with β-thal.

Materials and Methods:

A hundred transfusion-dependent β-thal patients and 41 healthy controls were included in the study.

Results:

Native thiol, total thiol, disulfide, catalase, and IMA levels were significantly higher in the β-thal group compared with the control group (P<0.02). There were no correlation between serum ferritin level and SH/SS homeostasis, and weak positive correlations were found between serum ferritin and IMA (r=0.242, P=0.022).

Conclusions:

Our study results suggest that antioxidant systems try to compensate for peroxidative damage in the patients’ group and serum IMA level was found increased because of increased oxidative status. To the best of our knowledge, there has been no report evaluating plasma dynamic SH/SS homeostasis in β-thal patients.
Peripheral Vestibular and Balance Function in Athletes With and Without Concussion
Authors: Christy Jennifer B. , Cochrane Graham D. , Almutairi Anwar , Busettini Claudio , Swanson Mark W. , Weise Katherine K.
Published: June 2019

Background and Purpose:

According to the most recent consensus statement on management of sport-related concussion (SRC), athletes with suspected SRC should receive a comprehensive neurological examination. However, which measures to include in such an examination are not defined. Our objectives were to (1) evaluate test-retest reliability and normative data on vestibular and balance tests in athletes without SRC; (2) compare athletes with and without SRC on the subtests; and (3) identify subtests for concussion testing protocols.

Methods:

Healthy athletes (n = 87, mean age 20.6 years; standard deviation = 1.8 years; 39 female and 48 male) and athletes with SRC (n = 28, mean age 20.7 years; standard deviation = 1.9 years; 11 female and 17 male) were tested using rotary chair, cervical vestibular-evoked myogenic potential (c-VEMP), and the Sensory Organization Test (SOT). A subset (n = 43) were tested twice. We analyzed reliability of the tests, and compared results between athletes with and without SRC.

Results:

Reliability ranged from poor to strong. There was no significant difference between athletes with and without SRC for tests of peripheral vestibular function (ie, rotary chair and c-VEMP). Athletes with SRC had significantly worse scores (P< 0.05) on vestibular-ocular reflex (VOR) cancellation gain, subjective visual vertical and horizontal variance, and all conditions of the SOT.

Discussion and Conclusion:

SRC did not affect medium frequency VOR or saccular function. SRC did affect the ability to use vestibular inputs for perception of vertical and postural control, as well as ability to cancel the VOR.

Video Abstract availablefor more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A274).
Stroke Survivors' Perspectives on Post–Acute Rehabilitation Options, Goals, Satisfaction, and Transition to Home
Authors: Krishnan Shilpa , Hay Catherine C. , Pappadis Monique R. , Deutsch Anne , Reistetter Timothy A.
Published: June 2019

Background and Purpose:

Patients and caregivers have not typically been involved in the selection of a post–acute care (PAC) provider. In 2015, the Centers for Medicare & Medicaid Services proposed the need to involve patients and their families during discharge planning. Engaging patients in rehabilitation decisions encourages shared decision making among patients and their clinicians. The purpose of this study was to examine stroke survivors' perspectives on their involvement in selecting a PAC provider and their goal setting and their satisfaction with the rehabilitation stay and their discharge advice for stroke survivors, prior to 2015.

Methods:

This qualitative study utilized semistructured interviews. Thematic content analysis was performed on interviews involving 18 stroke survivors (mean age = 68 years) related to their involvement in planning for their inpatient rehabilitation facility or skilled nursing facility stay, goal setting, and discharge needs.

Results:

More than half the participants were not involved in the selection of their PAC setting and believed that doctors made these decisions. Around two-fifths of stroke survivors reported that they were not involved in rehabilitation goal setting. Most patients were satisfied with their rehabilitation stay. When asked to recommend discharge topics for other stroke survivors, participants recommended additional information on health care services, interventions, and insurance coverage.

Discussion and Conclusion:

Despite recommendations to include stroke patients in PAC selection and goal setting, many former inpatient rehabilitation facility and skilled nursing facility patients report not being involved in either aspect of care.

Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A273).
Patterns in Forensic Decapitations
Authors: Pilloud Marin A. , Swenson Victoria M. , George Rebecca L. , Knight Laura D.
Published: June 2019

Separation of the head from the body can occur for a variety of reasons and in various locations across the neck. This study presents a review of the literature to identify the patterns of decapitations in forensic cases in relation to manner of death, age, and anatomical location (n = 88). The most common manner of death was suicide, followed by homicide and then accident. Ages ranged from 32 weeks prenatal to 85 years. Decapitation is reported at higher rates for individuals between 19 and 65. The majority of decapitations occurred at the midneck (second to fifth cervical vertebrae), followed by the upper neck and then the lower neck. This pattern holds true for all manners of death; however, in homicides, the percentage occurring at the midneck decreases. The findings of this study indicate some patterns in terms of manner of death, age, and location of decapitation, which could aid the medicolegal community in interpreting neck trauma. A case study is also briefly presented to illustrate findings.
Necessary Defense or Homicide?
Authors: Handlos Petr , Joukal Marek , Dokoupil Marek , Uvíra Matěj , Marecová Klára
Published: June 2019

Reconstruction of a criminal offense is a crucial approach in forensics and criminalistics allowing for the verification of the location, the particular method used, or the use of a specific instrument. This report describes the case of a young man who was killed by an arrow shot from a crossbow. The autopsy revealed a penetration of the head and significant damage to the brain stem. Although the cause of death was evident from the outset, it was necessary to clarify whether or not the arrow was shot as necessary self-defense. Ballistic investigation of the seized weapon and reconstruction of the crime was absolutely essential to bring forth conclusive evidence to convict the perpetrators of the murder.
Development of an Immunohistochemical Assay to Detect the Ataxia-Telangiectasia Mutated (ATM) Protein in Gastric Carcinoma
Authors: Miller Rachel M. , Nworu Chinedu , McKee Laurel , Balcerzak Denis , Pham Linh , Pugh Judith , Liu Yu-Zhen , Gustafson Heather , Marwah Ekta , Lamb Tiffany , Clements June
Published: June 2019

Ataxia-telangiectasia mutated (ATM), a key activator of DNA damage response mechanisms, represents a potential biomarker for targeted gastric carcinoma therapies. A phase II study (Study 39; NCT01063517) designed to investigate the combination olaparib plus paclitaxel in patients with recurrent or metastatic gastric cancer did not meet its primary endpoint of progression-free survival; however, an improvement in the secondary endpoint of overall survival was recorded with a greater overall survival benefit noted in patients with ATM-negative tumors. An ATM immunohistochemical (IHC) diagnostic assay was developed to identify patients who may respond favorably to targeted therapies and deployed in the confirmatory phase III GOLD trial (NCT01924533). The VENTANA ATM (Y170) assay was developed for investigational use in formalin-fixed, paraffin-embedded gastric carcinoma samples using an anti-ATM rabbit monoclonal antibody (clone Y170) and was optimized with OptiView DAB IHC Detection Kit on a BenchMark ULTRA instrument. The assay was deployed in studies assessing sensitivity, specificity, robustness, precision, and determining optimal ATM staining cutoff to define ATM-deficiency (ATM-low). The ATM (Y170) assay met all predefined product development acceptance criteria. Multiple parameters were characterized, including repeatability, reproducibility, analytical sensitivity, specificity, robustness, and product stability. The scoring algorithm was defined; gastric carcinoma samples were considered ATM-negative or ATM-positive when <25% or ≥25%, respectively, of tumor cell nuclei expressed ATM at any IHC stain intensity and nuclei of immune and/or endothelial cells expressed ATM at a moderate stain intensity (internal positive control). Results highlight reproducibility of the assay, supporting suitability for investigational use for evaluation of gastric carcinoma samples using tumor cell staining cutoff of <25% to define ATM-deficiency. Using this ATM assay, phase III GOLD trial (NCT01924533) clinical trial did not meet its primary endpoint, only suggesting, but not demonstrating, that assessment of ATM levels by IHC could possibly be useful in assessing the degree of benefit that may be achieved by adding olaparib to paxitaxel when treating gastric carcinoma. The utility of ATM (Y170) assay as a companion diagnostic requires further clinical validation.
Evaluation of Service Delivery Effectiveness Through Patient-Reported Outcome Measures
Authors: Faieta Julie , Schmeler Mark R. , Schiappa Vince J. , Hand Brittany N. , Schein Richard M. , Saptono Andi , Berner Theresa , DiGiovine Carmen P.
Published: June 2019

Objective

The aims of the study were to report the demographic characteristics and functional mobility for individuals accessing an academic medical center mobility device clinic and to compare functional mobility data across demographic characteristics and mobility device type.

Design

This study used a retrospective, cross-sectional design. Demographic, mobility type, and patient-reported outcome measure data for 833 clients were analyzed. The Functional Mobility Assessment was used as the patient-reported outcome measure to determine satisfaction.

Results

The mean (SD) baseline Functional Mobility Assessment score was 0.59 (0.25) on a 0–1 scale. Significant differences with the Functional Mobility Assessment scores were found across the mobility device types, with scooter and power wheelchair groups reporting higher satisfaction scores than those in the cane/crutch/walker or manual wheelchair groups. Device type, sex, and age were each found to be significant predictors of satisfaction scores (P < 0.01).

Conclusions

Mobility device type is associated with satisfaction level. Mobility devices that offer higher levels of assistance are associated with increased satisfaction. The Functional Mobility Assessment, mobility device type, and demographic data provide baseline information for evaluating the effectiveness of an academic medical center mobility device clinic.
Thyroid Cancer Bone Metastasis
Authors: Kondraciuk Jessica D. , Rice Samuel L. , Zhou Xiaosun , Gharzeddine Karem , Knezevic Andrea , Spratt Daniel E. , Sabra Mona , Larson Steven M. , Grewal Ravinder K. , Osborne Joseph R.
Published: June 2019

Purpose

Bone metastasis (BM) in differentiated thyroid cancer (DTC) is the second most common site of metastasis after lung. Bone metastases are associated with worse prognosis in DTC. In this study, we examined risk factors for overall survival in patients with BM and for the first time explore the pattern of genomic alterations in DTC BM.

Patients and Methods

A Health Insurance Portability and Accountability Act (HIPAA) compliant, institutional review board–approved retrospective evaluation of the medical record was performed for all patients treated at a single institution for thyroid cancer over a 16-year period. Seventy-four patients met inclusion criteria. Multiple prognostic factors including age, sex, genes, radioactive iodine, and radiation or kinase inhibitor therapies were analyzed. Univariate and multivariate analyses were performed.

Results

Treatment with external beam radiation was found to significantly increase survival (P = 0.03). The 5-year survival rate was 59% and median survival was 92 months. Patients who developed bone metastasis earlier tend to live longer (P = 0.06). The presence of TERT and BRAF mutations did not significantly worsen the prognosis (P = 0.10).

Conclusion

Patients with DTC can benefit from early treatment with external beam radiation therapy, especially those who develop bone metastasis within 3 years of primary TC diagnosis. Kinase inhibitor treatment tended to prolong survival but not in a statistically significant manner. Sex, age, and TERT or BRAF genetic mutations did not significantly affect the prognosis.
Midgut NET With Orbital, Myocardial, Testicular, Lymph Nodal and Pulmonary Metastases Presenting With Bilateral Proptosis—Role of 68Ga-DOTANOC PET/CT
Authors: Senthil Raja , Pratap Thara , Visakh R Arun , Philip Mathew
Published: June 2019

Neuroendocrine tumors (NET) are rare neoplasms and commonly metastasize to liver, lymph nodes and less frequently to bones and lungs. Metastases to other organs are extremely rare and we report a case of NET clinically presenting with bilateral proptosis secondary to metastases in orbits. 68Ga-DOTANOC PET/CT demonstrated somatostatin receptor overexpressing lesions in bilateral orbits, small intestine, lymph nodes, lungs, heart and testes in the absence of liver metastases.
Interlesional Heterogeneity of Metastatic Neuroendocrine Tumors Based on 18F-DOPA PET/CT
Authors: de Hosson Lotte D. , van der Loo–van der Schaaf Aline M. , Boellaard Ronald , van Snick Johannes H. , de Vries Elisabeth G. E. , Brouwers Adrienne H. , Walenkamp Annemiek M. E.
Published: June 2019

Purpose

Neuroendocrine tumors (NETs) can produce neuroendocrine amines resulting in symptoms. Selecting the most active amine-producing tumor lesions for local treatment might be beneficial for patients with metastatic small intestinal NET. Tumor burden correlates with catecholamine pathway activity. We analyzed interlesional heterogeneity with 18F-DOPA PET scans in patients with small intestinal NET and investigated if lesions with substantially higher 18F-DOPA uptake could be identified.

Methods

In this retrospective, observational study, the 18F-DOPA uptake was calculated by dividing SUVpeak of the lesion by the SUVmean of the background organ. The magnitude of heterogeneity between lesions within a patient was calculated by dividing the lesion with the highest by the one with the lowest 18F-DOPA uptake. Lesions with a higher 18F-DOPA uptake than the upper inner or outer fence (>1.5 or 3 times the interquartile range above the third quartile) were defined as lesions with mild or extreme high 18F-DOPA uptake, respectively, and presence of these was determined in patients with 10 lesions or more.

Results

18F-DOPA was detected over 680 lesions in 38 patients, of which 35 were serotonin producing. 18F-DOPA uptake varied with a median of 8-fold up to 44-fold between lesions within a patient. In 12 of 20 evaluable patients, lesions with mild high 18F-DOPA uptake were found, and in 5, lesions with extreme high 18F-DOPA uptake.

Conclusions

18F-DOPA-PET showed considerable heterogeneity in 18F-DOPA uptake between tumor lesions and identified lesions within patients with mild or extreme high 18F-DOPA uptake.