bluuebunny/crossref_metadata_2025 huggingface dataset:
Triple Combination Therapy for Pincer Nail Deformity: Surgical Matricectomy, Thioglycolic Acid, and Anticonvex Sutures
Authors: Dikmen Adile , Ozer Kadri , Ulusoy Mustafa Gurhan , Gursoy Koray , Koçer Uğur
Published: August 2017

BACKGROUND

Pincer nail deformity (PND) is characterized by an excessive transverse curvature of the nail plate that increases along the longitudinal axis of the nail. Although many conservative and surgical techniques have been used in clinical practice, an established consensus for the correction of PND has not been present yet.

OBJECTIVE

Aim of the technique described in this article is to provide to restore the suitable nail-matrix system curvature by a simplified and quick approach, which could be seen as a synthesis of conservative and surgical treatments described in the literature.

MATERIALS AND METHODS

Nineteen cases of pincer nail of the great toe in 14 patients were analyzed. After softening nail plate with 5% thioglycolic acid solution for at least half an hour, surgical bilateral matricectomy and 2 anticonvex sutures with 1-0 polypropylene were performed to ensure proper nail plate shape. Besides demographic data, visual analog scale (VAS) score for pain, width index, height index, patient and surgeon satisfaction scores, operation time, and the day of painless return to the daily activities were investigated.

RESULTS

A statistical significance was observed in VAS score for pain, width, and height indices between preoperative and postoperative values.

CONCLUSION

This report gives acceptable outcomes with a combination of surgery and conservative treatments.
Pathologists' Use of Second Opinions in Interpretation of Melanocytic Cutaneous Lesions: Policies, Practices, and Perceptions
Authors: Geller Berta M. , Frederick Paul D. , Knezevich Stevan R. , Lott Jason P. , Nelson Heidi D. , Titus Linda J. , Carney Patricia A. , Tosteson Anna N.A. , Onega Tracy L. , Barnhill Raymond L. , Weinstock Martin A. , Elder David E. , Piepkorn Michael W. , Elmore Joann G.
Published: August 2017

BACKGROUND

Research examining the role of second opinions in pathology for diagnosis of melanocytic lesions is limited.

OBJECTIVE

To assess current laboratory policies, clinical use of second opinions, and pathologists' perceptions of second opinions for melanocytic lesions.

MATERIALS AND METHODS

Cross-sectional data collected from 207 pathologists in 10 US states who diagnose melanocytic lesions. The web-based survey ascertained pathologists' professional information, laboratory second opinion policy, use of second opinions, and perceptions of second opinion value for melanocytic lesions.

RESULTS

Laboratory policies required second opinions for 31% of pathologists and most commonly required for melanoma in situ (26%) and invasive melanoma (30%). In practice, most pathologists reported requesting second opinions for melanocytic tumors of uncertain malignant potential (85%) and atypical Spitzoid lesions (88%). Most pathologists perceived that second opinions increased interpretive accuracy (78%) and protected them from malpractice lawsuits (62%).

CONCLUSION

Use of second opinions in clinical practice is greater than that required by laboratory policies, especially for melanocytic tumors of uncertain malignant potential and atypical Spitzoid lesions. Quality of care in surgical interventions for atypical melanocytic proliferations critically depends on the accuracy of diagnosis in pathology reporting. Future research should examine the extent to which second opinions improve accuracy of melanocytic lesion diagnosis.
Orifice Preserving Double Opposing Z-Plasty for Partial Split Ear Lobe Repair: A Review of 25 Cases
Authors: Sharma Harish K. , Gupta Deepti , Punj Shalu
Published: August 2017

BACKGROUND

Surgeons often come across split earlobe (SEL) deformities in their clinical practice which usually result from wearing heavy earrings for a long duration. It is of utmost importance to achieve a satisfactory repair with increased strength in one go.

OBJECTIVE

To describe a strong repair for partial SEL with preservation of the orifice.

MATERIALS AND METHODS

This study is a retrospective review of 25 patients (36 earlobes), who underwent repair of partial SEL deformity with an orifice preserving double opposing Z-plasty in the hospital, from January 2014 to June 2015. The duration of follow-up was 12 months.

RESULTS

Adequate cosmetic results were obtained in all patients with no need for revision surgery due to recurrence or scar dehiscence. Patients did not report any difficulty in wearing earrings and were satisfied with the aesthetic outcome.

CONCLUSION

The orifice preserving double opposing Z-plasty technique seems to offer an efficacious method of repair of partial SEL deformity with an acceptable scar. The technique is simple and reproducible with good aesthetic outcomes and minimal complications.
Chronic Uveitis Following Neodymium-Doped Yttrium Aluminum Garnet Laser Peripheral Iridotomy
Authors: Ali Amro , Rosenfeld Cyril , Rosenberg Eric , Sharma Sansar , Wandel Thaddeus L.
Published: August 2017

Purpose:

Assessment of a chronic uveitis entity in nonuveitic patients following neodymium-doped yttrium aluminum garnet (Nd:YAG) laser peripheral iridotomy.

Methods:

A 7-year retrospective observational case series of 5 patients that developed chronic uveitis following a Nd:YAG laser peripheral iridotomy treatment.

Results:

Five eyes of 5 nonconsecutive patients had developed chronic anterior uveitis lasting >12 weeks. Four patients were female, with a mean age of 60.3 years (range, 48 to 83 y), and a mean follow-up duration of 8 months after initiation of treatment.

Conclusions:

Chronic anterior uveitis should be addressed as a possible risk in patients undergoing Nd:YAG laser iridotomies. A larger prospective study would be necessary in establishing and exploring the association between these 2 entities.
Age-Specific Antibiotic Prescribing and Adherence to Guidelines in Pediatric Patients in Primary Care
Authors: Ivanovska Verica , Hek Karin , Mantel-Teeuwisse Aukje K. , Leufkens Hubert G. M. , van Dijk Liset
Published: August 2017

Background:

Most antibiotics in children are used to treat viral and self-limiting conditions. This study aims to compare physicians’ adherence to guidelines on antibiotic prescribing in fever and in ear and respiratory infections to children in different age groups in the Netherlands.

Methods:

Data were used from the NIVEL Primary Care Database. For all pediatric episodes of fever, acute otitis media (AOM), streptococcal pharyngitis (strep throat), sinusitis, acute tonsillitis, acute bronchitis/bronchiolitis and pneumonia in 2012, we determined whether national guidelines were followed with regard to whether an antibiotic was prescribed, and the type of antibiotic.

Results:

For diagnoses that generally do not require antibiotics, more prescriptions were found in adolescents’ episodes compared with children 0–4 and 5–11 years of age, respectively, (bronchitis: 52.0% versus 42.4% and 42.7%, and fever: 16.8% versus 9.0% and 14.2%). The same was true for diagnoses that require antibiotics (strep throat: 76.5% versus 55.0% and 49.5%, pneumonia: 71.6% versus 60.2% and 69.8% and tonsillitis: 57.8% versus 54.8% and 49.7%), except for AOM (43.9% versus 52.4% and 39.6%). First-choice amoxicillin was prescribed more frequently in children 0–4 years of age than in age groups 5–11 and 11–17 years (AOM: 88.0% versus 83.2% and 81.8%, and pneumonia:74.7% versus 57.2% and 53.8%). First-choice narrow-spectrum penicillins were prescribed more often in adolescents than in age groups 0–4 and 5–11 years (strep throat: 72.0% versus 63.6%, and 60.9% and tonsillitis: 67.9% versus 33.1 and 45.9%).

Conclusions:

Concerning adherence patterns include high antibiotic rates for bronchitis, particularly in adolescents, and underuse of narrow-spectrum penicillins in the 0–4 years group.
Beyond solicitousness: a comprehensive review on informal pain-related social support
Authors: Bernardes Sónia F. , Forgeron Paula , Fournier Karine , Reszel Jessica
Published: August 2017

Adults with chronic pain cite social support (SS) as an important resource. Research has mostly focused on general SS or pain-specific solicitousness, resulting in a limited understanding of the role of SS in pain experiences. Drawing on SS theoretical models, this review aimed to understand how pain-related SS has been conceptualized and measured and how its relationship with pain experiences has been investigated. Arksey and O'Malley scoping review framework guided the study. A database search (2000-2015) was conducted in PsycINFO, CINAHL, MEDLINE, and EMBASE using a combination of subject headings/keywords on pain and SS; 3864 citations were screened; 101 full texts were assessed for eligibility; references of 52 papers were hand searched. Fifty-three studies were included. Most studies were either a-theoretical or drew upon the operant conditioning model. There are several self-report measures and observational systems to operationalize pain-related SS. However, the Multidimensional Pain Inventory remains the most often used, accounting for the centrality of the concept of solicitousness in the literature. Most studies focused on individuals with chronic pain self-report of spousal pain-related SS and investigated its main effects on pain outcomes. Only a minority investigated the role of pain SS within the stress and coping process (as a buffer or mediator). Little is known about mediating pathways, contextual modulation of the effectiveness of SS exchanges, and there are practically no SS-based intervention studies. Drawing on general SS models, the main gaps in pain-related SS research are discussed and research directions for moving this literature beyond solicitousness are proposed.
Psychometric Properties of the 9-item European Heart Failure Self-care Behavior Scale Using Confirmatory Factor Analysis and Rasch Analysis Among Iranian Patients
Authors: Lin Chung-Ying , Pakpour Amir H. , Broström Anders , Fridlund Bengt , Årestedt Kristofer , Strömberg Anna , Jaarsma Tiny , Mårtensson Jan
Published: August 2017

Background:

The 9-item European Heart Failure Self-Care Behavior scale (EHFScB-9) is a self-reported questionnaire commonly used to capture the self-care behavior of people with heart failure (HF).

Objective:

The aim of this study was to investigate the EHFScB-9’s factorial structure and categorical functioning of the response scale and differential item functioning (DIF) across subpopulations in Iran.

Methods:

Patients with HF (n = 380; 60.5% male; mean [SD] age, 61.7 [9.1] years) participated in this study. The median (interquartile range) of the duration of their HF was 6.0 (2.4–8.8) months. Most of the participants were in New York Heart Association classification II (NYHA II, 61.8%); few of them had left ventricular ejection fraction assessment (11.3%). All participants completed the EHFScB-9. Confirmatory factor analysis was used to test the factorial structure of the EHFScB-9; Rasch analysis was used to analyze categorical functioning and DIF items across 2 characteristics (gender and NYHA).

Results:

The 2-factor structure (“adherence to regimen” and “consulting behavior”) of the EHFScB-9 was confirmed, and the unidimensionality of each factor was found. Categorical functioning was supported for all items. No items displayed substantial DIF across gender (DIF contrast, −0.25–0.31). Except for item 3 (“Contact doctor or nurse if legs/feet are swollen”; DIF contrast, −0.69), no items displayed substantial DIF across NYHA classes (DIF contrast, −0.40 to 0.47).

Conclusions:

Despite the DIF displayed in 1 item across the NYHA classes, the EHFScB-9 demonstrated sound psychometric properties in patients with HF.
Venous Diverticula Causing Pulsatile Tinnitus Treated With Coil Embolization and Stent Placement With Resolution of Symptoms: Report of Two Cases and Review of the Literature
Authors: Shastri Ravi K. , Chaudhary Neeraj , Pandey Aditya S. , Telian Steven A. , Gemmete Joseph J.
Published: August 2017

Objective:

To report two cases of pulsatile tinnitus caused by complex venous diverticula with successful treatment via coil embolization and stent placement followed by complete resolution of symptoms. We also review the literature pertaining to venous diverticula causing pulsatile tinnitus treated using endovascular techniques.

Patients:

Two women patients, aged 27 and 29 years, presented to our institution with 3-month histories of pulsatile tinnitus. In each case, non-invasive imaging and conventional digital subtraction angiography (DSA) confirmed the presence of a complex right transverse-sigmoid sinus junction diverticulum.

Intervention:

Both patients underwent stent-assisted coil embolization of the venous diverticula.

Main Outcome and Results:

Clinical and DSA follow-up at 6 and 12 months confirmed resolution of symptoms with obliteration of the venous diverticulum. We also performed a PubMed database search for the period January 1995 through June 2016 using the terms pulsatile tinnitus, venous aneurysm/diverticulum, stent-assisted coil embolization, and endovascular treatment and identified reports of 14 additional patients treated using endovascular techniques.

Conclusions:

Venous sinus diverticula causing pulsatile tinnitus can be successfully treated with stent-assisted coil embolization with complete resolution of clinical symptoms. This is in concordance with 13 case reports in the literature involving 14 patients with venous sinus diverticula treated using endovascular techniques.
Impact of Insurance Status and Race on Outcomes in Nonvariceal Upper Gastrointestinal Hemorrhage
Authors: Abougergi Marwan S. , Avila Patrick , Saltzman John R.
Published: August 2017

Background and Goals:

We examined the interaction between race, insurance, and important outcomes in nonvariceal upper gastrointestinal hemorrhage (NVUGIH).

Study:

Adults with NVUGIH were selected from the National Inpatient Sample. Primary outcome: in-hospital mortality. Secondary outcomes: treatment modalities [esophagogastroduodenoscopy (EGD), early EGD, and endoscopic or radiologic therapy], and resource utilization (length of hospital stay and total hospitalization charges).

Results:

Mortality was similar for Medicare and private insurance [adjusted odds ratios (aOR): 1.15 95% confidence interval (CI) 0.90 to 1.47), P=0.24], but higher for under/uninsured patients [aOR: 1.84 (CI: 1.42 to 2.40), P<0.01]. Compared with Medicare, patients with private insurance had more EGDs [aOR: 1.35 (CI: 1.23 to 1.48), P<0.01], early EGDs [aOR: 1.29 (CI: 1.21 to 1.38), P<0.01], and endoscopic [aOR: 1.19 (CI: 1.11 to 1.27), P<0.01], or radiologic therapy [aOR:1.35 (CI: 1.06 to 1.71), P=0.01]. Patients who were under/uninsured had less EGDs [aOR: 0.84 (CI: 0.76 to 0.91), P<0.01] or endoscopic therapy [aOR: 0.74 (CI: 0.68 to 0.81), P<0.01], but similar odds of early EGD [aOR: 0.95 (CI: 0.88 to 1.02), P=0.13] or radiologic therapy [aOR: 1.01 (CI: 0.75 to 1.37), P=0.75]. Compared with whites, blacks had lower [aOR: 0.73 (CI: 0.58 to 0.93), P=0.01] and Native Americans higher mortality [aOR: 2.60 (CI: 1.57 to 4.13), P<0.01]. Blacks were less likely [aOR: 0.86 (CI: 0.79 to 0.94), P<0.01] and Asians more likely [aOR: 1.24 (CI: 1.05 to 1.47), P=0.01] to have EGDs. Both blacks and Hispanics had lower, whereas Asians had higher early EGD rates. Patients with private insurance had lower total charges [adjusted mean difference: −$2761 (CI: −$4617 to −$906), P<0.01].

Conclusions:

Insurance and race have independent effects on NVUGIH mortality, therapeutic modalities used, and resource utilization. Black and under/uninsured patients have the worst outcomes.
Fat-soluble Vitamin Deficiencies and Inflammatory Bowel Disease
Authors: Fabisiak Natalia , Fabisiak Adam , Watala Cezary , Fichna Jakub
Published: August 2017

Background:

Vitamin deficiency is frequently associated with inflammatory bowel disease (IBD). Supplementation of vitamins could thus serve as an adjunctive therapy. The present meta-analysis reviews the deficiencies and alterations in serum fat-soluble vitamins (A, D, E, and K) reported in IBD patients.

Materials and Methods:

PubMed database search was performed to identify all primary studies up to January 2015 that evaluated the serum concentrations of fat-soluble vitamin levels in IBD patients compared with healthy individuals. We estimated pooled mean differences between groups and estimated their relations with some compounding variables (age, disease duration, C-reactive protein, albumin), using a meta-regression analysis.

Results:

Nineteen case-control studies met selection criteria. In patients with Crohn’s disease (CD), vitamin A, D, E, K status was lower than in controls [D=212 μg/L.92; 95% confidence interval (CI), 95.36-330.48 μg/L, P=0.0002; D=6.97 nmol/L, 95% CI, 1.61-12.32 nmol/L, P=0.01; D=4.72 μmol/L, 95% CI, 1.60-7.84 μmol/L, P=0.003; D=1.46 ng/mL, 95% CI, 0.48-2.43 ng/mL, P=0.003, respectively]. Patients with ulcerative colitis had lower levels of vitamin A than controls (D=223.22 μg/L, 95% CI, 44.32-402.12 μg/L, P=0.01). Patients suffering from CD for a longer time had lower levels of vitamins A (95% CI=7.1-67.58 y, P=0.02) and K (95% CI, 0.09-0.71 y, P=0.02). Meta-regression analysis demonstrated statistically significant associations between the levels of inflammatory biomarkers: C-reactive protein (P=0.03, 95% CI, −9.74 to −0.6 mgl/L) and albumin (P=0.0003, 95% CI, 402.76-1361.98 g/dL), and vitamin A status in CD patients.

Conclusion:

Our meta-analysis shows that the levels of fat-soluble vitamins are generally lower in patients with inflammatory bowel diseases and their supplementation is undoubtedly indicated.
Etiologies and Impact of Readmission Rates in the First 180 Days After Hematopoietic Stem Cell Transplantation in Children, Adolescents, and Young Adults
Authors: Maher Ossama M. , Silva Jorge G. , Huh Winston W. , Cuglievan Branko , DePombo April , Kebriaei Partow , Park Minjeong , Liu Diane , Tillman Chloe , Tarek Nidale , Cooper Laurence J.N. , Tewari Priti
Published: August 2017

Introduction:

High rates of patients require readmission to the hospital within 6 months of hematopoietic stem cell transplantation (HSCT). We investigated the relationship between readmission rates and outcomes after HSCT in children, adolescents, and young adults (CAYA).

Materials and Methods:

A retrospective analysis of patients (26 years or younger) treated with HSCT was conducted.

Results:

A chart review of 435 CAYA who underwent HSCT from 2008 to 2015 revealed that 171 patients (39%) had at least 1 hospital readmission within 180 days of transplant; 87% received allogeneic and 13% received autologous HSCT. A total of 312 readmission events were reported. The median follow-up time was 31 months. Documented infection (n=99) and graft-versus-host disease complications (n=60) were the most common causes. Higher than 2 readmission rates were associated with lower overall survival (OS) (P=0.001) and disease-free survival (P<0.001) in patients who received allogeneic HSCT. These findings were not found in the autologous HSCT. In a multivariate analysis of those who received allogeneic HSCT, prior treatment with ≥2 chemotherapy regimens (P=0.03) was independent predictor of lower OS. There were also trends noted toward lower OS for patients with documented infections at index admission or subsequent readmissions (P=0.09).

Conclusions:

More than 2 hospital readmissions within 6 months of allogeneic HSCT in CAYA, who are either heavily pretreated or had documented infections at index admission or subsequent readmissions adversely affected the outcomes.
Refractory LCH With Secondary Intracranial PNET: A Case Report and Review of Literature
Authors: Chayapathi Varsha , Mahajan Amita , Kalra Manas
Published: August 2017

The occurrence of second malignant neoplasms in patients with Langerhans cell histiocytosis is infrequent but has been reported. Here we report the case of a child with refractory Langerhans cell histiocytosis who was treated with cladribine and later developed a secondary intracranial primitive neuroectodermal tumor. The possible association of cladribine with second neoplasm is further discussed.
Longitudinal Analysis of Echocardiographic Abnormalities in Children With Sickle Cell Disease
Authors: Harrington Jamie K. , Krishnan Usha , Jin Zhezhen , Mardy Christopher , Kobsa Serge , Lee Margaret T.
Published: August 2017

Background:

Cardiac abnormalities have been described in echocardiograms of children with sickle cell disease (SCD). However, longitudinal studies investigating progression of echocardiographic abnormalities across the pediatric age spectrum in SCD are lacking.

Methods:

A retrospective longitudinal analysis of 829 echocardiograms from pediatric patients with SCD at steady-state was performed. Left heart parameters included left ventricular end-systolic, end-diastolic diameters, fractional shortening, and mass. Right ventricular pressure was estimated by tricuspid regurgitation gradient. Tricuspid regurgitation gradient ≥25 mm Hg, az-score ≥2 for LV parameters and ≤−2 for left ventricular fractional shortening were considered abnormal.

Results:

Kaplan-Meier analysis revealed that echocardiographic abnormalities were detected by 5 years of age, and the cumulative incidence progressively increased throughout childhood. Age, male gender, HbSS and Sβθthalassemia genotype, white blood cell count, platelet count, total bilirubin, admissions for pain crises and acute chest syndrome were positively, whereas hemoglobin was negatively associated with cardiac abnormalities.

Conclusion:

Cardiac abnormalities began early in childhood and progressively increased with age. Our study highlights the high cumulative incidence of cardiac abnormalities in children with SCD, which could represent a marker of disease severity.
Very Long-term Sequelae After Nonradical Surgery Combined With Brachytherapy in an Infant With a Chemotherapy-resistant Rhabdomyosarcoma of the Tongue
Authors: van Rijswijk Petra M. , van den Heuvel-Eibrink Marry M. , van den Akker Erica L.T. , Slagter Cleo , Lequin Maarten H. , Aarsen Femke K. , van Atteveld Jenneke E. , Wagner Anja , van Grotel Martine
Published: August 2017

In 2003, van Grotel and colleagues reported an infant suffering a chemotherapy-resistant eRMS of the tongue, that was treated with subtotal tumor resection and brachytherapy after major medical ethical discussions. As no long-term sequelae of such a procedure have been described, perspectives were uncertain at that time. Now, after 15 years, we describe hypoplasia of the mandibula, compromised dentation, osteopenia, neuropsychological deficits, and moderate speech impairment as the most prominent late effects. Also, mandibular cysts and basal cell carcinomas in the irradiated area, eventually led to the diagnosis Gorlin syndrome.
Mesenteric Primitive Myxoid Mesenchymal Tumor in a 7-Month-Old Boy
Authors: Chacon Daniella , Correa Catalina , Luengas Juan P.
Published: August 2017

Mesenteric tumors are rare, especially in the pediatric population. We present a case of a 7-month-old boy with an incidental abdominal mass identified as a Primitive Myxoid Mesenchymal Tumor of Infancy derived from the small bowel mesentery. This neoplasm is part of a spectrum of myofibroblastic lesions, with distinct clinical, morphologic, IHQ reactivity, and an aggressive clinical course. There is a paucity of evidence for the management of these tumors, and surgical resection remains the mainstay of treatment.
Wiskott-Aldrich Syndrome Misdiagnosed as Immune Thrombocytopenic Purpura: A Case Report
Authors: Karalexi Maria A. , Tzanoudaki Marianna , Fryganas Andreas , Gkergki Alexia , Spyropoulou Dora , Papadopoulou Anna , Papaevangelou Vassiliki , Petrocheilos Ioannis
Published: August 2017

Wiskott-Aldrich syndrome (WAS) is a rare X-linked immunodeficiency characterized by various clinical phenotypes. We report the case of a 3-year-old immigrant boy presenting with persistent infant-onset thrombocytopenia treated for refractory immune thrombocytopenic purpura. Sequence analysis confirmed the diagnosis of WAS. The patient responded neither to IV infusions of immunoglobulin (Ig) nor a thrombopoietin receptor agonist and is currently planned for stem cell transplantation. Raised awareness is thus vital of this potentially misdiagnosed and lethal disorder. The diagnosis of WAS should be considered in all males with infant-onset immune thrombocytopenic purpura-like features, especially, if mean platelet volume is decreased (<7 fL) and good increment to platelet transfusions are evident.
Immature Ovarian Teratoma: When to Give Adjuvant Therapy?
Authors: Faure-Conter Cécile , Pashankar Farzana
Published: August 2017

The question of giving or not adjuvant chemotherapy in pure ovarian immature teratomas (ITs) remains unsolved to date and illustrates differences in management between pediatric and adults oncologists. Because of the rarity of these tumors, this question has never been addressed through randomized trials. Standard of care for adult women with ovarian ITs is postoperative platinum based chemotherapy for all patients except FIGO stage IA, grade 1 tumors, whereas pediatric series concluded that surgery alone is curative for completely resected ovarian ITs, regardless of grade. Moreover the role of chemotherapy in incompletely resected tumors and its impact on the rate of malignant relapses needs to be better assessed. This emphasizes the urgent need for cooperation between adult and pediatric teams.
Sinusoidal Obstruction Syndrome During Chemotherapy of Pediatric Cancers and its Successful Management With Defibrotide
Authors: Kizilocak Hande , Dikme Gürcan , Özdemir Nihal , Kuruğoğlu Sebuh , Adaletli İbrahim , Erkan Tülay , Celkan Tiraje
Published: August 2017

Sinusoidal obstruction syndrome (SOS) is a life-threatening complication generally occurring after hematopoietic stem cell transplantation. SOS after standard dose chemotherapy in malignancies is rare. Between the year 1995 and 2016, 414 patients were diagnosed with acute lymphoblastic leukemia and 113 patients were diagnosed with Wilms tumor in our institution. Among these patients, 4 patients with acute lymphoblastic leukemia (0.96%) and 2 patients with Wilms tumor (1.7%) developed SOS during treatment. SOS behaves like a local disseminated intravascular coagulation. Defibrotide has proved to be effective in SOS. In this article, we report our experience with defibrotide in SOS.
Giant Cell Tumor of the Ribs and Aneurysmal Bone Cyst Presenting With Hemothorax in a Child
Authors: Alias Hamidah , Doris Lau Sie Chong , Loh C-Khai , Ishak Mohd Izzuan , Mohammed Fazarina , Jamal Rahman , Abdul Latif Hasniah
Published: August 2017

Giant cell tumor (GCT) is one of the most common tumors of bone and is the most common precursor of aneurysmal bone cysts (ABC). The clinical behavior of concurrent GCT and ABC can be very aggressive in children. GCT of the ribs, with or without ABC, is rarely seen in children. We report a case of an 8-year-old girl with GCT and associated ABC of the ribs who presented with sudden onset of chest pain and breathlessness due to a hemothorax. The patient was successfully treated by surgical resections and arterial embolization. She has remained well for 4 years after the initial surgery.
Health-related Quality of Life and Associated Factors Among Thalassemia Major Patients, Southeast of Iran
Authors: Bazi Ali , Sargazi-aval Omolbanin , Safa Amin , Miri-moghaddam Ebrahim
Published: August 2017

Low quality of life (QOL) is a feature that has been overlooked in thalassemia major (TM) patients. Our aim was to assess QOL in school-aged TM patients in Zabol city and surrounding rural areas in southeast of Iran. The study was performed in 2014. QOL was evaluated using Pediatric Quality of Life Inventory 4 (PedsQL4) questionnaire addressing physical, emotional, social, and educational, along with psychological health in 80 TM patients. Also, 80 age-matched and sex-matched subjects without any chronic illness served as control group. Mean age of the patients was 11.7±4.1 years old. Total QOL scores was 51.4±13.3 in the patients. In comparison, mean value of total QOL score in controls was 91.1±3.3 (P<0.0001). Poor and moderate QOL were observed in 44.7% and 48.7% of the patients, respectively. Mean functioning scores for physical, emotional, social, educational, and psychological dimensions in the patients were 56.2±119, 69.6.4±23.3, 27.1±22.1, 52.3±18.1, and 48.9±11.8, respectively. The lowest level of QOL was related to the social field (81.3% with less than average score), while the highest QOL was related to the emotional aspect (58.8% with good QOL; >75 scores). Overall, female sex, poor compliance with chelation therapy, and residency in urban areas were significantly associated with poor QOL. In conclusion, providing a psychiatric health package seems to be essential for improving QOL in TM patients, especially in social field.
International Nursing: How Much Power Do Nurse Managers Have?
Authors: Trus Marija , Martinkenas Arvydas , Suominen Tarja
Published: August 2017

This study was conducted to explore issues of nurse managers' power and empowerment. Data were collected from nurse managers by way of a questionnaire consisting of background factors, work-related questions, and power-related questions at the unit and organization levels. The degree of empowerment was evaluated using 2 established instruments (CWEQ-II and Work Empowerment Questionnaire). The overall level of managers' personal power within their own units was relatively high. Nurse managers' perception of their power at an organizational level was found to be at a moderate level. Several factors related to an individual's professional background were correlated to power issues, both at the unit and organizational levels. Structural and psychological empowerment correlated with the overall level of power at a unit level and the overall level of power at an organizational level. Nurse managers self-reported their own general power at a unit level as high, which offers them possibilities to lead the development of nursing care in their units. Organizations may benefit more from nurse managers' leadership by more fully integrating them in the development processes of the entire organization.
A New Tool for Quality
Authors: Haycock Camille , Schandl Annette
Published: August 2017

As health care systems aspire to improve the quality and value for the consumers they serve, quality outcomes must be at the forefront of this value equation. As organizations implement evidence-based practices, electronic records to standardize processes, and quality improvement initiatives, many tactics are deployed to accelerate improvement and care outcomes. This article describes how one organization utilized a formal clinical audit process to identify gaps and/or barriers that may be contributing to underperforming measures and outcomes. This partnership between quality and audit can be a powerful tool and produce insights that can be scaled across a large health care system.
On-boarding the Middle Manager
Authors: O'Connor Mary
Published: August 2017

The trend of promoting clinical experts into management roles continues. New middle managers need a transitional plan that includes support, mentoring, and direction from senior leaders, including the chief nursing officer (CNO). This case study demonstrates how the CNO of one organization collaborated with a faculty member colleague to develop and implement a yearlong personalized on-boarding program for a group of new nurse middle managers.
Report From the Night Shift
Authors: Weaver Susan H. , Lindgren Teri G. , Cadmus Edna , Flynn Linda , Thomas-Hawkins Charlotte
Published: August 2017

The administrative supervisor role (the nurse leader on the evening or night shift) has been present in hospitals for more than 100 years, but research is just commencing regarding how this leader achieves nurse and patient safety. This focused ethnographic study was conducted in 2 parts. The first part consisted of focus groups with night-shift staff nurses, held at 7 hospitals in the mid-Atlantic region of the United States, with the objective of obtaining the staff nurses' perception of the supervisors' role. The second part consisted of interviews with 30 administrative supervisors, recruited nationally from 20 different states, to explore the supervisors' perspective on practices used to enhance safety. The focus group and interview transcripts were thematically analyzed, using an iterative, comparative method to identify codes and sort for patterns. The findings reveal that administrative supervisors “make it (whatever needs to be done) work” and achieve nurse and patient safety by building trust with the staff, doing rounds, educating, and providing support to the front line team. These shift leaders foster a culture of safety with their relationship-oriented leadership style. By gaining further understanding about the administrative supervisor role, new workflow processes can be explored; specific continuing education programs can be developed; and additional research can be conducted.
A Rural “Grow Your Own” Strategy
Authors: Johnson Ingrid M.
Published: August 2017

Rural health care leaders are increasingly tasked with the responsibility of providing health access to 21% of the national population with only 10% of the provider workforce. Provider recruitment strategies offering loan repayment have had some success in the short term but are less impactful at creating a long-term retention rate, unless the providers have an existing connection to either the community in which they are working or rural health care. Responding to these data, a demonstration project and study has been underway in Colorado to test a rural focused “grow your own” advanced practice registered nurse (APRN) model. Phase 1 is designed to measure recruitment of RNs from inside rural communities to return to school and become primary care providers within those communities. Phase 2 will measure completion of education and phase 3 will measure retention rates in those communities. This article reports on phase 1 of the project, which is recruitment. The project offers stipend support with assistance in the school application process, educational support, clinical and job placement assistance, and monthly coaching. In addition, communities were asked to provide matching funds to support the APRN students with a goal of creating a self-sustaining model that will build a continuous pipeline of APRN providers. This strategy avoids the costly need to recruit and relocate providers who have no ties to the community. Thirty-four of 36 nurses (94%) responded to the study survey. Survey results suggested that the combination of financial, community, and employer support utilized in this model could serve to create a new and sustainable strategy for building a rural APRN provider workforce pipeline. The ultimate outcome has the potential to ensure that all people in rural areas have access to a high-quality, well-educated primary care provider.
Curricular Interventions to Promote Self-care in Prelicensure Nursing Students
Authors: Ashcraft Pamela F. , Gatto Susan L.
Published: August 2017

Personal self-care should be an expectation of the professional nursing role. This study evaluated self-care behaviors and perceptions of prelicensure nursing students after the integration of curricular interventions designed to promote self-care behaviors. Although few statistically significant changes were found, findings indicate that changes were beginning to occur and self-care behaviors were not declining: the curricular interventions are having a positive impact on self-care behaviors in nursing students.
Reexpression of Prior Stroke Symptoms in Adults
Authors: Siegler James E. , George Alexander J. , Martin-Schild Sheryl
Published: August 2017

A “stroke mimic” refers to any clinical condition that causes neurological symptoms clinically indistinguishable from a cerebral lesion that affects a vascular distribution, but is not caused by ischemia. One subtype of stroke mimic, termed stroke reexpression, is a form of mimicry in which previously recovered or improved stroke symptoms recur in the setting of a neurological disturbance (seizure, hypoperfusion state) or a systemic disturbance (toxic, metabolic, infectious). Many reports of stroke reexpression exist in the literature and are well known to clinicians, but there has been no consensus regarding terminology that has been published to date. The purpose of this review is to summarize several examples of stroke reexpression and propose simple, useful criteria for this clinical condition.
Subarachnoid Hemorrhage Revealing Moyamoya Syndrome in a Patient With May-Hegglin Anomaly
Authors: Béjot Yannick , Barnay José-Luis , Chavent Adrien , Daubail Benoit , Jacquin Agnès , Kazemi Apolline , Ricolfi Frédéric , Giroud Maurice
Published: August 2017

Introduction:

Moyamoya syndrome is a rare progressive cerebrovascular occlusive disease for which several associated conditions have been described.

Case Report:

We report the case of a 76-year-old woman with a history of May-Hegglin anomaly who presented with an isolated unusual diffuse headache. Initial laboratory investigations showed only thrombocytopenia (platelet count 95000/μL). Unenhanced brain computed tomography scan revealed a small subarachnoid hemorrhage in the left frontal lobe. Computed tomography angiography showed occlusion of the terminal portion of the left internal carotid artery (ICA) and narrowing of the terminal portion of the right ICA with abnormal collateral vessels. Conventional angiography confirmed the tight stenosis of the extremity of the right ICA, and the occlusion of the left ICA, associated with an extensive collateral network consistent with moyamoya syndrome. No aneurysm was identified.

Conclusions:

The rarity of these 2 diseases makes a fortuitous association very unlikely. We thus concluded that this observation could be the first reported case of May-Hegglin anomaly as a cause of moyamoya syndrome.
In Vitro Synergy Testing of Gentamicin, an Old Drug Suggested as Future Treatment Option for Gonorrhoea, in Combination With Six Other Antimicrobials Against Multidrug-Resistant Neisseria gonorrhoeae Strains
Authors: Singh Vikram , Bala Manju , Bhargava Aradhana , Kakran Monika , Bhatnagar Ravi
Published: August 2017

Background

Emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) Neisseria gonorrhoeae is a serious concern and combination therapy has been recommended to delay the onset of treatment failures. Gentamicin, an old and inexpensive antibiotic, is recommended in combination with azithromycin for treatment failures cases with the first-line regimen as per the latest Centers for Disease Control and Prevention sexually transmitted disease treatment guidelines. However, not much literature is available on in vitro and in vivo efficacy of this combination. Therefore, this study was carried out to evaluate the in vitro synergy of gentamicin in combination with azithromycin and 5 other antimicrobials.

Methods

In vitro synergy of gentamicin in combination with cefixime, ceftriaxone, spectinomycin, azithromycin, moxifloxacin, and ertapenem was determined by Etest for 75 N. gonorrhoeae strains, of which 65 were MDR and one was XDR. Fractional inhibitory concentration index (FICI) of ≤0.5 and >4.0 denoted synergy and antagonism respectively.

Results

Maximum efficacy of gentamicin was observed in combination with ertapenem (geometric mean FICI, 0.56) followed by cefixime (FICI, 0.87). There was no antagonism for both these combinations. However, antagonism was demonstrated in 5.3%, 8%, 8%, and 10.7% strains when gentamicin was paired with spectinomycin (FICI, 1.34), ceftriaxone (FICI, 1.13), azithromycin (FICI, 1.49), and moxifloxacin (FICI, 1.30), respectively.

Conclusions

The findings suggest that gentamicin significantly enhances the in vitro therapeutic potency of ertapenem and cefixime which will be potentially effective to control the spread of MDR and XDR N. gonorrhoeae. The study warrants more in vitro studies and clinical trials for gentamicin + azithromycin and other 3 combinations because of considerable antagonism.
Multiple Sclerosis
Authors: Sommer Nora N. , Saam Tobias , Coppenrath Eva , Kooijman Hendrik , Kümpfel Tania , Patzig Maximilian , Beyer Sebastian E. , Sommer Wieland H. , Reiser Maximilian F. , Ertl-Wagner Birgit , Treitl Karla M.
Published: August 2017

Objectives

The aim of this study was to assess the diagnostic accuracy of a modified high-resolution whole-brain three-dimensional T1-weighted black-blood sequence (T1-weighted modified volumetric isotropic turbo spin echo acquisition [T1-mVISTA]) in comparison to a standard three-dimensional T1-weighted magnetization-prepared rapid gradient echo (MP-RAGE) sequence for detection of contrast-enhancing cerebral lesions in patients with relapsing-remitting multiple sclerosis (MS).

Materials and Methods

After institutional review board approval and informed consent, 22 patients (8 men; aged 31.0 ± 9.2 years) with relapsing-remitting MS were included in this monocentric prospective cohort study.

Contrast-enhanced T1-mVISTA and MP-RAGE, both with 0.8 mm3 resolution, were performed in all patients. In a substudy of 12 patients, T1-mVISTA was compared with a T1-mVISTA with 1.0 mm3 resolution (T1-mVISTA_1.0). Reference lesions were defined by an experienced neuroradiologist using all available sequences and served as the criterion standard. T1-mVISTA, T1-mVISTA_1.0, and MP-RAGE sequences were read in random order 4 weeks apart. Image quality, visual contrast enhancement, contrast-to-noise-ratio (CNR), diagnostic confidence, and lesion size were assessed and compared by Wilcoxon and Mann-Whitney U tests.

Results

Eleven of 22 patients displayed contrast-enhancing lesions. Visual contrast enhancement, CNR, and diagnostic confidence of contrast-enhancing MS lesions were significantly increased in T1-mVISTA compared with MP-RAGE (P < 0.001). Significantly more contrast-enhancing lesions were detected with T1-mVISTA than with MP-RAGE (71 vs 39, respectively; P < 0.001). With MP-RAGE, 25.6% of lesions were missed in the initial reading, whereas only 4.2% of lesions were missed with T1-mVISTA. Increase of the voxel volume from 0.8 mm to 1.0 mm isotropic in T1-mVISTA_1.0 did not affect the detectability of lesions, whereas scan time was decreased from 4:43 to 1:55 minutes.

Conclusions

Three-dimensional T1-mVISTA improves the detection rates of contrast-enhancing cerebral MS lesions compared with conventional 3D MP-RAGE sequences by increasing CNR of lesions and might, therefore, be useful in patient management.
Dental development in
Homo naledi
Authors: Cofran Zachary , Walker Christopher S.
Published: August 2017

Humans’ prolonged somatic development and life history are unique among primates, yet their evolutionary origins remain unclear. Dental development has been used as a proxy to reconstruct life history evolution in the hominin clade and indicates a recent emergence of the human developmental pattern. Here, we analyse tooth formation and eruption in two developing dentitions of
Homo naledi
, a late-surviving, morphologically mosaic hominin species. Deciduous dental development is more similar to humans than to chimpanzees, probably reflecting hominin symplesiomorphy rather than bearing life history significance. The later stages of permanent tooth development present a mix of human- and chimpanzee-like patterns. Surprisingly, the M
2
of
H. naledi
emerges late in the eruption sequence, a pattern previously unknown in fossil hominins and common in modern humans. This pattern has been argued to reflect a slow life history and is unexpected in a small-brained hominin. The geological age of
H. naledi
(approx. 300 kya), coupled with its small brain size and the dental development data presented here, raise questions about the relationship between dental development and other variables associated with life history.
Using stochastic epidemiological models to evaluate conservation strategies for endangered amphibians
Authors: Drawert Brian , Griesemer Marc , Petzold Linda R. , Briggs Cheryl J.
Published: August 2017

Recent outbreaks of chytridiomycosis, the disease of amphibians caused by the fungal pathogen
Batrachochytrium dendrobatidis
(Bd), have contributed to population declines of numerous amphibian species worldwide. The devastating impacts of this disease have led researchers to attempt drastic conservation measures to prevent further extinctions and loss of biodiversity. The conservation measures can be labour-intensive or expensive, and in many cases have been unsuccessful. We developed a mathematical model of Bd outbreaks that includes the effects of demographic stochasticity and within-host fungal load dynamics. We investigated the impacts of one-time treatment conservation strategies during the disease outbreak that occurs following the initial arrival of Bd into a previously uninfected frog population. We found that for all versions of the model, for a large fraction of parameter space, none of the one-time treatment strategies are effective at preventing disease-induced extinction of the amphibian population. Of the strategies considered, treating frogs with antifungal agents to reduce their fungal load had the greatest likelihood of a beneficial outcome and the lowest risk of decreasing the persistence of the frog population, suggesting that this disease mitigation strategy should be prioritized over disinfecting the environment or reducing host density.
Russian scientists and the Royal Society of London: 350 years of scientific collaboration
Authors: Kolchinsky Edouard , Hossfeld Uwe , Levit Georgy S.
Published: August 2017

This paper examines the dynamics of the honorary membership of Russian scientists at the Royal Society over a 350-year period. Using several outstanding Russian scientists as examples (Dmitrii Mendeleev, Il'ya Metschnikoff, Ivan Pavlov and Nikolai Vavilov), we will demonstrate how a combination of cultural and political factors influenced the dynamics of memberships. Furthermore, we explain how their memberships of the Royal Society influenced their scientific careers.
Stable, metastable and unstable cellulose solutions
Authors: Gubitosi Marta , Nosrati Pegah , Koder Hamid Mona , Kuczera Stefan , Behrens Manja A. , Johansson Eric G. , Olsson Ulf
Published: August 2017

We have characterized the dissolution state of microcrystalline cellulose (MCC) in aqueous tetrabutylammonium hydroxide, TBAH(aq), at different concentrations of TBAH, by means of turbidity and small-angle X-ray scattering. The solubility of cellulose increases with increasing TBAH concentration, which is consistent with solubilization driven by neutralization. When comparing the two polymorphs, the solubility of cellulose I is higher than that of cellulose II. This has the consequence that the dissolution of MCC (cellulose I) may create a supersaturated solution with respect to cellulose II. As for the dissolution state of cellulose, we identify three different regimes. (i) In the stable regime, corresponding to concentrations below the solubility of cellulose II, cellulose is molecularly dissolved and the solutions are thermodynamically stable. (ii) In the metastable regime, corresponding to lower supersaturations with respect to cellulose II, a minor aggregation of cellulose occurs and the solutions are kinetically stable. (iii) In the unstable regime, corresponding to larger supersaturations, there is macroscopic precipitation of cellulose II from solution. Finally, we also discuss strong alkali solvents in general and compare TBAH(aq) with the classical NaOH(aq) solvent.