bluuebunny/crossref_metadata_2025 huggingface dataset:
The blockade of corticotropin-releasing factor 1 receptor attenuates anxiety-related symptoms and hypothalamus–pituitary–adrenal axis reactivity in mice with mild traumatic brain injury
Authors: Kosari-Nasab Morteza , Sadeghi Tayebeh , Bashiri Hamideh , Shokouhi Ghaffar , Salari Ali-Akbar
Published: November 2018

Recent studies have shown that mild traumatic brain injury (mTBI) is associated with higher risk for anxiety-related disorders. Dysregulation in the hypothalamus–pituitary–adrenal (HPA) axis following mTBI has been proposed to be involved in the development of neurobehavioral abnormalities; however, the underlying mechanisms are largely unknown. The aim of this study was to determine whether the corticotropin-releasing-factor-1 (CRF-1) receptor is involved in the regulation of anxiety-related symptoms in a mouse model of mTBI. Animals with or without mTBI received intracerebroventricular injections of a CRF-1 receptor agonist (CRF; 0.01 nmol/mouse) or antagonist (antalarmin; 1 µg/mouse) for 5 days, and then the animals were subjected to anxiety tests (light-dark box and zero maze). The levels of adrenocorticotropic hormone and corticosterone, the most important markers of HPA axis, were also measured after behavioral tests. Our results indicated that mTBI-induced anxiety-related symptoms in mice through increased levels of adrenocorticotropic hormone and corticosterone, showing HPA axis hyperactivity. Interestingly, activation of CRF receptor by a subthreshold dose of CRF resulted in significant increases in anxiety-like behaviors and HPA axis response to stress, whereas blockade of CRF receptors by a subthreshold dose of antalarmin decreased anxiety-related symptoms and HPA axis response to stress in mTBI-induced mice. Collectively, these findings suggest that the CRF-1 receptor plays an important role in the regulation of anxiety-related behaviors following mTBI induction in mice and support the hypothesis that blockade of the CRF-1 receptor may be a promising therapeutic target for anxiety-related disorders in patients with TBI.
The Pyramidal Flap: an Innovative Technique for DIEP Flap Refinement
Authors: Leache M. Elena , Lozano Jose Ángel , Rubi Carlos G. , Pérez-Espadero Alberto , Escudero Francisco Jose
Published: November 2018

DIEP flap is considered the gold standard technique for breast reconstruction. One of the most frequent contour deformities after breast reconstruction with DIEP flap is a step-off deformity at the interface between the native chest wall and the reconstructed breast. Different techniques have been used to address this problem. We describe the pyramidal flap as a simple, single stage and low risk procedure, which specifically corrects the step-off or tapering deformity of the reconstructed breast with DIEP flap.
Ocular and Genetic Characteristics Observed in Two Cases of Fish-Eye Disease
Authors: Ustaoglu Melih , Solmaz Nilgun , Baser Burak , Kurtulgan Hande Kucuk , Onder Feyza
Published: November 2018

Purpose:

To present ocular findings and anterior segment–optical coherence tomography (AS-OCT) imaging findings of 2 cases of fish-eye disease (FED) involving 2 novel genetic variants of the lecithin–cholesterol acyltransferase (LCAT) gene.

Methods:

A case report.

Results:

A 46-year-old woman and 63-year-old man presented with blurred vision, burning sensation, and whitening of both eyes for 2 and 3 years, respectively. Ophthalmologic examination revealed slightly decreased visual acuity, yellowish-white diffuse corneal opacities causing corneal clouding, and dry eye disease bilaterally in both patients. AS-OCT imaging demonstrated diffuse hyperreflective corneal opacities predominantly located in the anterior stroma. On systemic examination, both patients had very low plasma high-density lipoprotein cholesterol levels. However, they did not have any systemic associations with familial LCAT deficiency or Tangier disease, which are differential diagnoses for corneal clouding and low plasma high-density lipoprotein cholesterol. Both patients were diagnosed with FED based on clinical findings. Furthermore, genetic analysis, in which novel variants of c.86A>G (p.Asn29Ser) in the first exon and c.1052A>G (p.Tyr351Cys) in the sixth exon on the LCAT gene were detected, confirmed the diagnosis.

Conclusions:

Although it is a rare genetic disorder, FED should be considered in the differential diagnosis of corneal clouding. Corneal lipid deposits, visible on AS-OCT are suggestive of FED, and genetic analysis can be used to confirm the clinical diagnosis. Finally, there may be a relationship between dry eye disease and LCAT enzyme deficiency disorders, which should be investigated in further studies.
Smaller-incision Revision of Trabeculectomy With Mitomycin: Long-term Outcomes and Complications
Authors: Chen Philip P. , Moeller Kristy L.
Published: November 2018

Purpose:

The purpose of this study was to assess long-term outcomes and complications of smaller-incision trabeculectomy revision with mitomycin (MMC) in glaucoma patients.

Methods:

Review of patients undergoing trabeculectomy revision with MMC for inadequate intraocular pressure (IOP) control. After dissection of subconjunctival fibrosis through a smaller (median, 5 mm) incision, MMC was topically applied and episcleral fibrosis was incised. Failure was defined as reoperation for glaucoma, or IOP reduction < 20% over 3 follow up visits.

Results:

Forty eyes (40 patients; mean age, 67±13 y) underwent revision; 9 revisions were combined with other surgery. Mean baseline IOP was 20.6±6.2 mm Hg on 2.6±1.4 glaucoma medications after 2.4±1.3 incisional ocular surgeries. At final follow-up (70±34 mo), 27 successful eyes (67.5%) had IOP of 9.2±2.4 mm Hg on 0.6±0.9 medications. Eleven eyes (27.5%) required reoperation for glaucoma, 7 (63%) within 7 months after revision. The Kaplan-Meier estimate of success at years 1, 2, 3, and 5 postoperatively was 77.5%, 72.2%, 69.5%, and 69.5%, respectively. Recovery of visual acuity to within 2 lines of baseline was 1.7±2.4 weeks (median 1). Complications included sustained hypotony (IOP, ≤5 mm Hg) in 2 eyes (1 also with corneal decompensation), 1 eye with wound leak, and 2 eyes with bleb leak (1 requiring surgical repair).

Conclusions:

Smaller-incision trabeculectomy revision with MMC resulted in substantial, sustained IOP reduction in most eyes with poorly functioning filtering blebs, with few serious complications and rapid recovery of baseline visual acuity in most eyes.
Melatonin Levels in Patients With Primary Open-angle Glaucoma With High or Low Intraocular Pressure
Authors: Kim Jung Yong , Jeong Ah Reum , Chin Hee Seung , Kim Na Rae
Published: November 2018

Purpose:

To evaluate circulatory melatonin levels by assessing nocturnal urinary excretion of 6-sulfatoxymelatonin (aMT6s) in patients with primary open-angle glaucoma (POAG) and to compare the high-tension group and the low-tension group.

Methods:

This study included 80 eyes of 41 POAG patients and 87 eyes of 44 control subjects. POAG group was further classified into high-tension group and low-tension group according to the pretreatment intraocular pressure (IOP). The first urine in the morning was collected and aMT6s were measured using a commercial ELISA kit. Urinary aMT6s levels were expressed as ng aMT6s/mg creatinine. Differences in melatonin levels among the control and POAG subgroups were evaluated by generalized estimating equation adjusting age, sex, sleep duration, and intereye correlation.

Results:

Urinary aMT6s/creatinine ratio did not differ between POAG and control group (P=0.097). The difference in the aMT6s/creatinine ratio between the 3 groups—high-tension group with baseline IOP≥21 mm Hg (19.74±3.12 ng/mg), low-tension glaucoma group with baseline IOP<21 mm Hg (26.71±3.47 ng/mg), and control group (30.35±3.05 ng/mg)—was statistically significant (P=0.046). Post hoc analysis revealed that the difference between the control and high-tension glaucoma groups was significant (P=0.014), whereas the difference between the control and low-tension glaucoma groups was not (P=0.436).

Conclusions:

This study found low melatonin levels in high-tension glaucoma compared with the control.
Evaluation of Conduction Disorders after Aortic Valve Replacement with Rapid Deployment Bioprostheses
Authors: D'Onofrio Augusto , Bagozzi Lorenzo , Tessari Chiara , Francescato Annalisa , Cibin Giorgia , Besola Laura , Pesce Rita , Toscano Giuseppe , Gerosa Gino
Published: November 2018

Objective

The aim of this retrospective, single-center study was to evaluate the occurrence of conduction disorders after rapid deployment aortic bioprosthesis implantation.

Methods

Electrocardiograms of patients undergoing INTUITY (Edwards Lifesciences, Irvine, CA USA) bioprosthesis implantation were collected at admission, during postoperative course, and at discharge. Primary end point was the occurrence of new-onset conduction disorders, defined as complete left bundle branch block, complete right bundle branch block, permanent pacemaker implantation, and worsening of pre-existing rhythm abnormalities. Secondary end points were the assessment of preoperative and postoperative QRS duration and the identification of transitory conduction disorders.

Results

Forty-four patients (July 2015–December 2016) were included in the analysis. Preoperatively, patients with normal conduction and with already existing disorders were 25 (56.8%) and 19 (43.2%), respectively. Primary end point occurred in 14 patients (31.8%). Two patients (4.5%) received pacemaker implantation. In patients with normal preoperative conduction, new abnormalities were found in eight cases (32%): all left bundle branch blocks with one pacemaker implantation. Worsening of pre-existing conduction disorders was found in six patients (31.6%) with one pacemaker implantation. QRS duration increased in 20 patients (45.4%), and average increase was 37 milliseconds. Overall, we observed a significant increase of QRS (96 ± 21 milliseconds vs. 111 ± 28 milliseconds, P < 0.001). Three patients experienced a new-onset temporary left bundle branch block.

Conclusions

New-onset conduction disorders or worsening of pre-existing rhythm abnormalities occur in one third of patients after rapid deployment aortic bioprosthesis implantation. Although the incidence of postoperative pacemaker implantation before discharge is low, strict follow-up is mandatory to identify a potential need for pacemaker implantation in a timely manner.
Titanium Fastener Utilization during HeartMate 3 Left Ventricular Assist Device Implantation
Authors: Johnson Carl A. , Melvin Amber L. , Robinson Davida A. , Amirjamshidi Hossein , Knight Peter A. , Gosev Igor
Published: November 2018

Objective

The objective of this study was to investigate the feasibility of using titanium fasteners for securement of the inflow sewing ring during HeartMate 3 implantation. The secondary objective was to compare cardiopulmonary bypass and total operative times between the titanium fastener and hand-tied knot groups.

Methods

Clearance between the sewing ring and the HeartMate 3 device was assessed in vitro. Thirty-one patients undergoing HeartMate 3 implantation via median sternotomy at a single center from April 2017 to February 2018 were reviewed. The sewing ring was secured with hand-tied knots (n = 18) or titanium fasteners (n = 13). Cannulation strategy and implantation technique were otherwise identical between groups. Central arterial and venous cannulation was performed for cardiopulmonary bypass. The left ventricular apex was cored, and the sewing ring was attached with hand-tied knots or titanium fasteners.

Results

There was adequate clearance for the titanium fastener to secure the inflow sewing ring and then connect to the HeartMate 3 in vitro. The inflow sewing ring was successfully secured during HeartMate 3 implantation in the titanium fastener group. Cardiopulmonary bypass time was 75 and 92 minutes for the titanium fastener and hand-tied groups, respectively ( P < 0.03). Total operative time was 177 and 193 minutes for the titanium fastener and hand-tied groups, respectively ( P = 0.513).

Conclusions

The inflow sewing ring of the HeartMate 3 was efficiently secured using titanium fasteners. Titanium fasteners resulted in shorter cardiopulmonary bypass times compared with the hand-tied group. There was no difference in total operative time.
Safety and Immunogenicity of a Full-dose, Split-virion, Inactivated, Quadrivalent Influenza Vaccine in Healthy Children 6-35 Months of Age
Authors: Robertson Corwin A. , Mercer Monica , Selmani Alexandre , Klein Nicola P. , Jeanfreau Robert , Greenberg David P.
Published: November 2018

Background:

For children <3 years of age, a half dose of inactivated influenza vaccine (7.5 μg hemagglutinin per strain) has been used for more than 30 years, but several studies indicate that a full dose (15 μg hemagglutinin per strain) can be used in this population without increasing the rate of fever or other reactions. Here, we compare the safety and immunogenicity of full and half doses of quadrivalent, split-virion, inactivated influenza vaccine (IIV4) in children 6–35 months of age.

Methods:

In this phase IV, randomized, observer-blinded, multi-center study, healthy children 6–35 months of age were randomized 1:1 to be vaccinated with a half or full dose of IIV4 (NCT02915302). The primary objective was to demonstrate that the rate of any fever (≥38.0°C) up to 7 days after a full dose of IIV4 was noninferior to the rate of fever after a half dose.

Results:

The study included 1950 children. Noninferiority in the rate of fever was demonstrated for the full dose versus the half dose of IIV4 (difference in rate = 0.84%; 95% confidence interval, −2.13% to 3.80%). Solicited reactions and unsolicited adverse events were similar between the dose groups. No vaccine-related serious adverse events were reported. Noninferiority of both hemagglutination inhibition geometric mean titers and seroconversion rates was demonstrated for all 4 vaccine strains for the full dose versus the half dose.

Conclusions:

In children 6–35 months of age, a full dose of IIV4 was immunogenic and had a safety profile comparable to that of a half dose, with no new safety concerns observed.
Smoking Status Among Patients With Newly Diagnosed Lung Cancer in Taiwan
Authors: YANG Chia-Chen , LIU Chien-Ying , WANG Kwua-Yun , WEN Fur-Hsing , LEE Yu-Chin , CHEN Mei-Ling
Published: November 2018

Background

Continued smoking after receiving a diagnosis of cancer seriously affects disease prognosis and survival. The prevalence and risk factors of continued smoking among patients with newly diagnosed lung cancer are unknown in Taiwan.

Purpose

The aims of this study were to assess the smoking status of patients with newly diagnosed lung cancer and to identify the characteristics that are associated with different smoking statuses.

Methods

Baseline data of a longitudinal study on smoking behaviors after lung cancer diagnosis were analyzed in this study. Patients were consecutively recruited from three medical centers in northern Taiwan. A structured questionnaire and medical chart reviews were used to collect data. Multinomial logistic regression analysis was used to examine the factors associated with continuing to smoke after being diagnosed with lung cancer.

Results

Among the 406 patients with newly diagnosed lung cancer who were recruited, 47.0% were never-smokers and 53.0% were ever-smokers. Among the second group, 38% were former smokers, 18% were recent quitters, and 44% were current smokers. Compared with former smokers, current smokers were more likely to be younger (OR = 1.05), to not exercise regularly (OR = 2.74), to currently live with smokers (OR = 2.48), and to have lower self-efficacy for refusing to smoke (OR = 0.95). Compared with recent quitters, current smokers were more likely to have lower self-efficacy for refusing to smoke.

Conclusions/Implications for Practice

A significant proportion of ever-smoker lung cancer patients in Taiwan will continue to smoke after receiving their diagnosis. Variables known to modify the risk factors associated with continued smoking such as regular exercise and better refusal self-efficacy should be considered and incorporated into future smoking cessation programs for patients with lung cancer.
Assessing Hyperbaric Oxygen for Carbon Monoxide Poisoning in Trauma Patients: A Call for Representation in Future Studies
Authors: Lund Jeremy , Samai Kathryn
Published: November 2018

Although carbon monoxide (CO) poisoning presents infrequently, it is a consequential and serious component of burn-related injuries, especially those injured via structure fire. A multitude of retrospective reviews and prospective trials have attempted to establish evidence demonstrating the ideal modality for oxygen administration in CO-poisoned patients; however, a consensus recommendation has not been reached. Given that half of fire-related patients succumb to CO poisoning, this is an imperative area of research.
Complications and Mortality Among Correctly Triaged and Undertriaged Severely Injured Older Adults With Traumatic Brain Injuries
Authors: Scheetz Linda J.
Published: November 2018

Determining differences in clinical outcomes of older adults treated at trauma centers (TCs) and nontrauma centers (NTCs) is imperative considering their persistent undertriage and the projected costs of fixing the problem. This study compared the incidence and predictors of complications and mortality among brain-injured older adults treated at TCs and NTCs. This secondary analysis of New York inpatient data included patients aged 55+ years, primary brain injury diagnosis, and acute care hospital admission. Interfacility transfers and nontraumatic brain injuries were excluded. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes identified complications and mortality. Injury severity was determined by mapping ICD-9-CM diagnoses to Abbreviated Injury Scale 2005 Revision 2008 dictionary scores. A subgroup analysis of 1,594 patients with New Injury Severity Scores greater than 15 was performed to examine complications and mortality. This study included 7,138 patients who met inclusion criteria. Predictors of subgroup complications included chronic renal failure, odds ratio (OR) = 2.251 (confidence interval [CI] = 1.470-3.447), p < .001; major operating room procedure, OR = 2.349 (CI = 1.679-3.285), p < .001; number of diagnoses, OR = 1.201 (CI = 1.158-1.245), p < .001; and number of procedures, OR = 1.119 (CI = 1.077-1.162), p £ .001. Mortality predictors included age, OR = 1.031 (CI = 1.017-1.045), p < .001; preexisting coagulopathy, OR = 1.753 (C = 1.130-2.719), p = .012; number of procedures, OR = 1.122 (CI = 1.081-1.166), p < .001; acute renal failure, OR = 3.114 (CI = 1.672-5.797), p < .001; systemic inflammatory response syndrome, OR = 4.058 (CI = 1.463-11.258), p = .007; adult respiratory distress syndrome, OR = 3.179 (CI = 1.673-6.041), p < .001; and subarachnoid bleed, OR = 2.667 (CI = 1.415-5.029), p = .002. Nearly 23% of the severely/critically injured patients experienced 1 or more complications. Incidence of complications was low and comparable for TCs and NTCs. The proportion of deaths was slightly higher at TCs but not significant. The most prevalent complications carry a high mortality risk.
Targeting Catheter-Associated Urinary Tract Infections in a Trauma Population: A 5-S Bundle Preventive Approach
Authors: Elkbuli Adel , Miller Ashley , Boneva Dessy , Puyana Salomon , Bernal Eileen , Hai Shaikh , McKenney Mark
Published: November 2018

Complications from catheter-associated urinary tract infections (CAUTIs) can cause morbidity and mortality. Our institution's Trauma Quality and Improvement Program analysis identified CAUTIs as an outlier complication in our trauma population. This study aimed to determine whether implemented measures would reduce CAUTI rates in trauma population. A 5-S CAUTI bundle was implemented. Its effects were measured on a prospectively collected dataset of adult trauma patients using our Trauma Registry during the 4-year study period. Implemented measures included (1) staff education, (2) bladder catheter stabilization, (3) patient and caregiver education, (4) keeping the collection bag below the bladder and above the floor, and (5) daily evaluations for discontinuation. Chi-squared and t-test analyses were used with significance defined as p < .05. Twelve thousand nine hundred and sixty-two trauma patients were admitted to trauma service during the 4-year study period. Of these, 94 developed CAUTIs, with an average age of 67 years and 56% were females. The average injury severity score was 16 in patients with CAUTIs compared with 9 in non-CAUTI patients (p < .0002). In the index year, CAUTIs occurred in 41 out of 3,054 (1.34%), the following year there were 34 out of 3,455 (0.98%), in 2016 there were 11 out of 3,246 (0.33%), and 8 out of 3,207 (0.25%) in 2017 (p < .001). Results demonstrated an 80% reduction in CAUTI rate. Execution of the 5-S CAUTI bundle resulted in a significant 80% reduction in CAUTI rate in our trauma population.
Collaborative Team Reflective Practice in Trauma Service to Improve Health Care
Authors: McDermott Hilary , Husbands Alaina , Brooks-Lewis Lisa
Published: November 2018

The importance of reflection and reflective practice is repeatedly reported in trauma literature, with the process of reflective practice being noted as invaluable for clinicians working within trauma settings. Although the literature on medical primary response trauma teams has reported clinicians' management of clinical roles and additional stressors, the practical applications and benefits of reflective practice insofar have not been identified in relation to complex trauma within multidisciplinary mental health services. This study aimed to identify the issues influencing the capacity for collaborative team reflective practice in a multidisciplinary child trauma mental health service within a UK National Health Service trust. Semistructured interviews were used to investigate the issues influencing the capacity for collaborative team reflective practice. The data were fully transcribed verbatim and analyzed using thematic analysis. The results suggest that clinicians working in a multidisciplinary child trauma service experience a positive benefit from collaborative team reflective practice, but that barriers exist, which influence the capacity to reflect. These include the management of reflective practice within the service, and department and service demands including the nature of the work/cases. Recommendations for the service and for future research are suggested to improve the capacity for collaborative team reflective practice.
Usefulness of Glycemic Control Using an Artificial Pancreas Apparatus for Cardiovascular Surgery
Authors: UEMURA HISASHI , Sekiya Naosumi , Mitsuno Masataka , Yamamura Mitsuhiro , Tanaka Hiroe , Ryomoto Masaaki , Sato Ayaka , Ueda Daisuke , Miyamoto Yuji
Published: November 2018

Blood glucose management is important for cardiovascular surgery using cardiopulmonary bypass. The usefulness of an artificial pancreas apparatus (STG-55) to control blood glucose in patients undergoing cardiopulmonary bypass was investigated. Subjects comprised 44 patients using the artificial pancreas during cardiopulmonary bypass between June 2016 and March 2017; 55 were initially enrolled, but 11 were excluded because of blood removal failure. Patients were divided into a monitoring group in which blood glucose levels were only monitored using the artificial pancreas (11 patients: six people with diabetes and 5 people without diabetes) and a management group with glycemic control by automatic insulin administration using the artificial pancreas (33 patients: people with diabetes and 21 people without diabetes). Mean maximum blood glucose levels and variation ranges significantly differed between the monitoring and management groups (p = 0.02). The variation range significantly differed between people with and without diabetes in the monitoring group (p = 0.008), but not in the management group. The artificial pancreas apparatus continuously and accurately reflected glycemic variations, facilitating strict and favorable control.
Surgical Techniques for Implanting the EVAHEART 2 Double Cuff Tipless Inflow Cannula
Authors: Motomura Tadashi , Kelly Brian
Published: November 2018

The EVAHEART 2 (Sun Medical Technology Research Corporation, Nagano, Japan) is an investigational centrifugal ventricular assist device in the United States, introduced a new type inflow, named “double cuff tipless” inflow cannula intended to mitigate the risks of cannula malposition and subsequent ischemic stroke events associated with thrombi around the inflow cannula. To achieve these performance benefits of the “tipless” design, however, it is crucial to adhere to the recommended surgical procedure. We introduced a polymer-based patient model that mimics a dilated cardiomyopathy apex for inflow cannula implantation training. Here, we used the model to simulate appropriate and inappropriate techniques for inflow suturing. With the appropriate technique, the inflow ostium is aligned on the endocardial plane, and the cut myocardial surface is not exposed to the bloodstream. By contrast, with the inappropriate technique, which is represented as a worst-case suturing scenario, the inflow ostium is misaligned, thus exposing the cut myocardial cross-section to the bloodstream. This misalignment can predispose to platelet deposition, thrombus formation, and pannus formation with long-term support. Repeated training with this human apex model is important to confirm the inflow position and intraventricular finish before moving on to human cases. Along with rigorous preclinical training, technical adherence will help to ensure better clinical outcomes.
Gastrointestinal recall questionnaires compare poorly with prospective patient diaries for gastrointestinal symptoms: data from population and primary health centre samples
Authors: Jones Michael P. , Walter Susanna , Faresjö Åshild , Grodzinsky Ewa , Kjellström Lars , Viktorsson Lisa , Talley Nicholas J. , Agreus Lars , Andreasson Anna
Published: November 2018

Background

Clinical understanding of gastrointestinal symptoms is commonly based on patient reports of symptom experience. For diagnosis and treatment choices to be appropriate, symptom reports need to be accurate. We examined the agreement between questionnaire recall and prospective diary enumeration of symptoms relevant to the irritable bowel syndrome.

Patients and methods

Data are reported from a randomly selected general population sample (n=238) and also a primary healthcare centre (PHC) sample (n=503, 10 PHCs). All the patients completed the questionnaires, which included Rome III-qualifying irritable bowel syndrome items and a stool and symptom diary over either 7 or 14 days. Agreement between retrospective questionnaire reports and prospective diaries was evaluated.

Results

Concordance between questionnaires and diaries was highest for the simple construct of the occurrence of abdominal pain, although after adjusting for possible chance, agreement was only moderate in the general population sample. More complex constructs, such as pain relieved by defecation, yielded poorer concordance. In general, concordance was stronger among PHC respondents than in the general population sample.

Conclusion

Concordance between questionnaires and diaries was generally poor and related to the complexity of the symptom construct and the type of respondent. The information used to classify individuals based on patient self-report may be unreliable, and therefore, more effort is needed to develop data collection instruments.
The efficacy and safety of endoscopic ultrasound-guided ablation of pancreatic cysts with alcohol and paclitaxel: a systematic review
Authors: Attila Tan , Adsay Volkan , Faigel Douglas O.
Published: November 2018

Endoscopic ultrasound (EUS)-guided pancreatic cyst ablation with alcohol lavage or paclitaxel-based regimens are investigative modalities. To evaluate the safety and efficacy of EUS-guided pancreatic cyst ablation with alcohol lavage or paclitaxel-based regimens. A systematic review of computerized bibliographic databases was carried out for studies of EUS-guided pancreatic cyst ablation with alcohol lavage or paclitaxel-based regimens from January 1980 to February 2018. EUS-guided cyst ablation-related outcomes (cyst resolution) and complications. Data were extracted from six studies (N=207 patients) for EUS-guided cyst ablation with alcohol lavage and eight studies (N=347 patients) for EUS-guided cyst ablation with paclitaxel-based regimens. The pooled proportion of patients with complete cyst resolution was 68/207 (32.8%) for EUS-guided cyst ablation with alcohol lavage and 221/347 (63.6%) for EUS-guided cyst ablation with paclitaxel. Postablation adverse events with EUS-guided ablation with alcohol lavage were 44/207 (21.7%), and those with EUS-guided ablation with paclitaxel-based regimens were 52/347 (15%). Limitations of this study are because of the variability in study design and regimens tested, paucity of randomized trials, and differences in pancreatic cyst types receiving treatment. EUS-guided cyst ablation appears to be effective and safe. The effect on pancreatic cancer incidence is unknown; EUS-guided pancreatic cyst ablation modalities require further improvement and validation to determine their role in the treatment of patients with pancreatic cystic lesions.
The diabetes pandemic and associated infections: suggestions for clinical microbiology
Authors: Toniolo Antonio , Cassani Gianluca , Puggioni Anna , Rossi Agostino , Colombo Alberto , Onodera Takashi , Ferrannini Ele
Published: November 2018

There are 425 million people with diabetes mellitus in the world. By 2045, this figure will grow to over 600 million. Diabetes mellitus is classified among noncommunicable diseases. Evidence points to a key role of microbes in diabetes mellitus, both as infectious agents associated with the diabetic status and as possible causative factors of diabetes mellitus. This review takes into account the different forms of diabetes mellitus, the genetic determinants that predispose to type 1 and type 2 diabetes mellitus (especially those with possible immunologic impact), the immune dysfunctions that have been documented in diabetes mellitus. Common infections occurring more frequently in diabetic vs. nondiabetic individuals are reviewed. Infectious agents that are suspected of playing an etiologic/triggering role in diabetes mellitus are presented, with emphasis on enteroviruses, the hygiene hypothesis, and the environment. Among biological agents possibly linked to diabetes mellitus, the gut microbiome, hepatitis C virus, and prion-like protein aggregates are discussed. Finally, preventive vaccines recommended in the management of diabetic patients are considered, including the bacillus calmette-Guerin vaccine that is being tested for type 1 diabetes mellitus. Evidence supports the notion that attenuation of immune defenses (both congenital and secondary to metabolic disturbances as well as to microangiopathy and neuropathy) makes diabetic people more prone to certain infections. Attentive microbiologic monitoring of diabetic patients is thus recommendable. As genetic predisposition cannot be changed, research needs to identify the biological agents that may have an etiologic role in diabetes mellitus, and to envisage curative and preventive ways to limit the diabetes pandemic.
Can Mobile Devices Be Used as an Active Learning Strategy? Student Perceptions of Mobile Device Use in a Nursing Course
Authors: Gallegos Cara , Gehrke Pamela , Nakashima Hannah
Published: November 2018

Background

It can be challenging to engage prelicensure nursing students in theoretical, nonclinical courses.

Purpose

The purpose of this study was to describe students' experiences with various teaching strategies and describe student perceptions of engagement and learning using a mobile device.

Methods

The study had a mixed-methods design, which included an online survey and oral interviews to elicit student perceptions of engagement and learning using a mobile device.

Results

Students, on average, reported high levels of perceived learning and moderate levels of perceived engagement. Analysis of the qualitative transcripts revealed 2 major themes clustered around learner practices and instructor/course practices.

Conclusions

Overall, students reported that using the mobile devices was a positive experience. Students benefited from thoughtful, intentional mobile device use that engaged them with course ideas, limited off-task distractions, and improved collaborative experiences with peers and the instructor.
Use of Script Concordance Activity With the Think-Aloud Approach to Foster Clinical Reasoning in Nursing Students
Authors: Tedesco-Schneck Mary
Published: November 2018

Background

Script concordance testing and the think-aloud (TA) approach uses clinical scenarios to evaluate clinical reasoning (CR).

Problem

Teaching strategies to both facilitate and evaluate CR are lacking. Adaptation of script concordance testing and the TA approach may be a useful teaching/learning strategy for CR.

Approach

Script concordance activity with the TA approach (SCA-TA method) was created and implemented in a nursing course to facilitate and evaluate CR.

Evaluation

Survey data provided valuable information of students' perception about the SCA-TA method as a teaching strategy.

Conclusions

The SCA-TA method holds promise to foster CR. Ongoing research to predict progression of CR is needed.
The Meaning of Grades
Authors: Poorman Susan G. , Mastorovich Melissa L.
Published: November 2018

Background

Although the literature is replete with information about grades, there is a lack of empirical evidence about the meaning of grades to nursing students.

Purpose

This study sought to understand the meaning of grades for nursing students at all educational levels.

Method

Using Heideggerian hermeneutic phenomenology, 46 nursing students from 14 schools were asked to tell about a time that stood out to them when they were graded. They then reflected on their story and described what this experience meant to them.

Results

Data analysis revealed several themes. The main theme was “needing an A.” It was discussed by students at every level of nursing education.

Conclusions

Students not only needed to get an A, but also they needed to get an A in every course they took, causing stress and disappointment when they were unable to achieve these grades. It seemed that what they were learning was not as important as the grade they received.
Point-of-Care Ultrasound Facilitates Bedside Diagnosis of Appendicitis With an Appendicolith in a Pediatric Patient
Authors: Pade Kathryn H.
Published: November 2018

A previously healthy 5-year-old boy presented to the emergency department with a history of tactile fevers, cough, congestion, decreased appetite, and abdominal pain. He had diffuse abdominal pain on examination and pain with ambulation. Emergency point-of-care ultrasound was used to diagnose appendicitis with an appendicolith. The diagnosis was confirmed by a radiology-performed ultrasound, and he was taken to the operating room for an appendectomy.
The Neuroscience of Pain: Biobehavioral, Developmental, and Psychosocial Mechanisms Relevant to Intervention Targets
Authors: Atlas Lauren Y. , al'Absi Mustafa
Published: November 2018

Chronic pain is a major problem in clinical medicine and public health, affecting approximately one in five adults, and is associated with significant societal and familial burden. Early-life adversities, psychological, and biobehavioral factors are associated with an elevated risk of the subsequent development of chronic pain. In this special issue of Psychosomatic Medicine, articles address the neuroscientific, psychological, and biobehavioral processes involved in acute and chronic pain. We focus on the following themes that emerged in this special issue: (a) risk factors and early adversity as related to chronic pain; (b) the role of expectations in shaping pain perception; and (c) mechanisms of interventions targeting pain modulation. This article concludes by outlining important new targets for research, including the neurobiology of pain, important methodological challenges, and targets for personalized pain interventions.
The Impact of Different Magnetic Resonance Imaging Equipment and Scanning Parameters on Signal Intensity Ratio Measurements in Phantoms and Healthy Volunteers
Authors: Young Laura K. , Gandy Stephen J. , Priba Lukasz , Matthew Shona Z. , Graeme Houston J.
Published: November 2018

Objectives

The aim of this study was to examine the variation in signal intensity ratio (SIR) values in Eurospin gel phantoms and healthy volunteer (HV) brain images in response to different magnetic resonance imaging hardware and software settings.

Materials and Methods

Gel phantoms with T1 relaxation times similar to the dentate nucleus (DN), pons (P), globus palladus (GP), and thalamus (Th) were scanned using a T1-weighted 2-dimensional spin-echo sequence on 2 magnetic resonance imaging scanners (3 T and 1.5 T). Imaging was performed by sequentially altering selected magnetic resonance (MR) parameters relative to a default pulse sequence, and the protocol was implemented repeatedly over 3 months. The experiment was also repeated on a cohort of 15 young HVs. Calculations of DN/P and GP/Th SIR values were derived for the images of the gels (GelDN/P and GelGP/Th) and the HVs (HVDN/P and HVGP/Th).

Results

For the default sequence, the mean SIR values of GelDN/P and GelGP/Th varied by ±2.20% and ±0.75%, respectively, when measured over multiple imaging sessions (3 T). Within a single imaging session, these variations were smaller (±0.17% for GelDN/P and ±0.15% for GelGP/Th). At 1.5 T, the equivalent SIR variations for GelDN/P were ±1.41% (multiple sessions) and ±0.41% (single session), and that for GelGP/Th were ±0.47% (multiple sessions) and ±0.33% (single session).

Sequential changes to the MR sequence parameters resulted in gel SIR variations as follows: 14.07% ± 2.43% (with/without normalization filters), −7.80% ± 0.28% (different echo times, TE), and −5.06% ± 0.59% (selective activation of RF coil elements). The largest variations were noted when the gels were positioned below the scanner isocenter, where SIR measurements were different by 22%.

For the HVs, the SIR values were found to be consistently within 0.64% (single session) for the default sequence. Sequential changes to the MR sequence parameters resulted in SIR variations of −24.47% ± 2.47% (with/without normalization filters), −15.32% ± 7.71% (different echo times, TE), and −2.90% ± 0.78% (selective activation of RF coil elements).

Conclusions

This study has demonstrated that SIR percentage changes from baseline of a similar magnitude to brain gadolinium contrast agent signal hyperintensities can be replicated in phantom models and HVs by altering common MR acquisition parameters and hardware.
Update 2018
Authors: Sanli Yasemin , Zukotynski Katherine , Mittra Erik , Chen Delphine L. , Nadel Helen , Niederkohr Ryan D. , Subramaniam Rathan M.
Published: November 2018

There are recent advances, namely, a standardized method for reporting therapy response (Hopkins criteria), a multicenter prospective cohort study with excellent negative predictive value of18F-FDG PET/CT for N0 clinical neck, a phase III multicenter randomized controlled study establishing the value of a negative posttherapy18F-FDG PET/CT for patient management, a phase II randomized controlled study demonstrating radiation dose reduction strategies for human papilloma virus–related disease, and Food and Drug Administration approval of nivolumab for treatment of recurrent head and neck squamous cell carcinoma.
ACR Practice Parameter for the Performance of Gallium-68 DOTATATE PET/CT for Neuroendocrine Tumors
Authors: Subramaniam Rathan M. , Bradshaw Marques L. , Lewis Kenneth , Pinho Daniella , Shah Chirayu , Walker Ronald C.
Published: November 2018

Radiopharmaceuticals targeting cell surface expression of somatostatin receptors (SSTRs) are particularly useful in the evaluation of neuroendocrine tumors. Gallium-68 DOTA-Tyr3-octreotatate (68Ga-DOTATATE) primarily binds to SSTR type 2 receptors. 68Ga DOTATATE PET/CT is proven to have high impact on the management of neuroendocrine patients compared to traditional anatomical imaging as well as provides additional information over that of conventional nuclear medicine studies (indium-III DTPA-octreotide). It can result in change in management of approximately 75% of patients with neuroendocrine tumors. 68Ga DOTATATE and 18F FDG PET/CT imaging are complementary, with the degree of uptake varying depending on the degree of differentiation of the tumor. Well-differentiated tumors maintain their SSTRs and are positive on 68Ga DOTATATE PET/CT scan, while dedifferentiated tumors are less likely to demonstrate uptake of 68Ga DOTATATE but will demonstrate uptake with 18F FDG PET/CT. In addition, 68Ga DOTATATE PET/CT identifies patients with SSTR expression in their tumors, who have progressed on somatostatin analog therapy, for treatment with 177Lu DOTATATE.
Practical Method for Calculation of Graft Index in Renal Transplant Scintigraphy
Authors: Yazici Bulent
Published: November 2018

Some quantitative indices have been described for renal transplant scintigraphy in evaluating graft dysfunction, some medical complications, and in predicting early and delayed graft function and long-term graft prognosis. Graft index is very useful and more accurate than many other indices in the prediction of delayed graft function and long-term prognosis. In this technical note, the method of calculation of graft index is shown in detail for the authors who want to use this index in further studies or in clinical practice.
Complete Remission After Single Radioiodine Therapy in Malignant Struma Ovarii With Bone and Lymph Node Metastases
Authors: Seifert Philipp , Gühne Falk , Theurer Sarah , Freesmeyer Martin
Published: November 2018

A 67-year-old woman presented with malignant struma ovarii after radical bilateral salpingo-oophorectomy. The surgery revealed a 4.4 cm papillary thyroid carcinoma (follicular variant) within a right-sided ovarian teratoma. 124I sodium iodide positron emission tomography / computed tomography and cervical ultrasound showed 2 slightly hyperfunctional thyroid nodules and several metastases, including bone metastases with intense iodine uptake. Thyroidectomy was necessary in preparation for radioiodine therapy and proofed the thyroid nodules to be benign. Complete remission was achieved by single radioiodine therapy (30 months of follow-up).
Predicting Response to Neoadjuvant Chemotherapy in Patients With Breast Cancer
Authors: Lee Hyunjong , Lee Dong-eun , Park Sohyun , Kim Tae Sung , Jung So-Youn , Lee Seeyoun , Kang Han Sung , Lee Eun Sook , Sim Sung Hoon , Park In Hae , Lee Keun Seok , Kwon Young Mi , Kong Sun Young , Joo Jungnam , Jeong Hae Jeong , Kim Seok-ki
Published: November 2018

Purpose

The aim of this study was to develop a combined statistical model using both clinicopathological factors and texture parameters from 18F-FDG PET/CT to predict responses to neoadjuvant chemotherapy in patients with breast cancer.

Materials and Methods

A total of 435 patients with breast cancer were retrospectively enrolled. Clinical and pathological data were obtained from electronic medical records. Texture parameters were extracted from pretreatment FDG PET/CT images. The end point was pathological complete response, defined as the absence of residual disease or the presence of residual ductal carcinoma in situ without residual lymph node metastasis. Multivariable logistic regression modeling was performed using clinicopathological factors and texture parameters as covariates.

Results

In the multivariable logistic regression model, various factors and parameters, including HER2, histological grade or Ki-67, gradient skewness, gradient kurtosis, contrast, difference variance, angular second moment, and inverse difference moment, were selected as significant prognostic variables. The predictive power of the multivariable logistic regression model incorporating both clinicopathological factors and texture parameters was significantly higher than that of a model with only clinicopathological factors (P = 0.0067). In subgroup analysis, texture parameters, including gradient skewness and gradient kurtosis, were selected as independent prognostic factors in the HER2-negative group.

Conclusions

A combined statistical model was successfully generated using both clinicopathological factors and texture parameters to predict the response to neoadjuvant chemotherapy. Results suggest that addition of texture parameters from FDG PET/CT can provide more information regarding treatment response prediction compared with clinicopathological factors alone.
Trapping of 18F-Fluciclovine (FACBC) in Superior Sagittal Sinus
Authors: Oldan Jorge Daniel , Miller Seth M. , Barnes Andrew , Khandani Amir Hossein
Published: November 2018

As 18F-fluciclovine (FACBC) becomes more popular, new incidental findings are discovered. We present here a case of a 71-year-old man with prostate cancer in whom an FACBC PET/CT showed uptake in the superior sagittal sinus, which was found to be simply due to a dilated superior sagittal sinus on subsequent MRI. Accumulation in the superior sagittal sinus is a variant that interpreters of FACBC PET/CT should be aware of.
Peritoneal Deciduoid Malignant Mesothelioma on 67Ga SPECT/CT
Authors: Lai Yung-Chi , Wu Yu-Chin , Kao Chia-Hung , Hsieh Te-Chun , Sun Shung-Shung
Published: November 2018

Malignant mesotheliomas may be classified into epithelioid (60%), sarcomatoid (20%), or mixed (20%) type microscopically. Malignant deciduoid mesothelioma, a rare phenotype of epithelioid mesothelioma, arises more commonly from the peritoneum of young women, but is also from the pleura of elderly people. In the current report, the authors describe an unusual case of peritoneal malignant epithelioid mesothelioma with rare deciduoid phenotype demonstrated with 67Ga SPECT/CT.
Intertumoral Heterogeneity of 18F-FDG and 68Ga-PSMA Uptake in Prostate Cancer Pulmonary Metastases
Authors: Perez Paola M. , Hope Thomas A. , Behr Spencer C. , van Zante Annemieke , Small Eric J. , Flavell Robert R.
Published: November 2018

We present a case of a 61-year-old man with history of prostate cancer and rising PSA levels referred for restaging. 68Ga-PSMA-11 PET/CT identified 2 lung nodules with low and moderate PSMA uptake. Subsequent 18F-FDG PET/CT showed high hypermetabolism in the nodule with low PSMA uptake, and low hypermetabolism in the nodule with moderate PSMA uptake. The isolated pulmonary findings and metabolic appearance is an atypical presentation of prostate cancer metastases and raised concern for a second primary malignancy. Fine-needle aspiration of the 18F-FDG active lung nodule confirmed metastatic prostatic adenocarcinoma that subsequently responded to androgen deprivation therapy and abiraterone acetate.
Sorafenib Reduced Significantly Heptopulmonary Shunt in a Large Hepatocelullar Carcinoma
Authors: d'Abadie Philippe , Borbath Ivan , Goffette Pierre , Amini Nadia , Lhommel Renaud
Published: November 2018

An 81-year-old man with a large hepatocellular carcinoma was referred in our institution for 90Y radioembolization (RE). The preliminary arteriography using 99mTc-macroaggregate albumin demonstrated an important hepatopulmonary shunt. It was an exclusion criterion for RE due to high risks of lung radiations. Then, the patient was treated with sorafenib during 4 months, stopped because of grade 3 toxicity. A second liver arteriography was performed, and 99mTc-macroaggregate albumin imaging showed an important reduction of the lung shunt. Transient therapy with sorafenib permitted to close the lung shunt and was a bridge for RE.