bluuebunny/crossref_metadata_2025 huggingface dataset:
Oxidative Stress and Genotoxicity in Pterygium: A Systemic Investigation
Authors: Kilic-Toprak Emine , Toprak Ibrahim , Caliskan Sadettin , Ozdemir Yasin , Demirtas Onder , Altintas Fatih , Kucukatay Vural
Published: May 2019

Objectives:

To perform a systemic investigation on oxidative stress and DNA damage in patients with primary pterygium.

Methods:

This prospective cross-sectional study included 32 patients with primary pterygium (60.1±2.0 years of age) and 33 age- and sex-matched (58.8±2.2 years of age) control subjects (P>0.05). A commercial kit was used for measuring serum total oxidant status (TOS) and total antioxidant status (TAS). The comet assay was performed after lymphocyte isolation from venous blood to quantitate DNA damage. Tail length (TL), tail intensity (TI), and tail moment (TM) were used for statistical analysis as parameters of DNA damage.

Results:

In the pterygium group, TOS and TAS were significantly higher when compared with those of the control group (P=0.019 and P=0.005, respectively). In terms of DNA damage, patients with pterygium had higher TL, TI, and TM than in the control subjects (P<0.0001 for all).

Conclusions:

Although current literature focuses on local factors in pterygium pathogenesis, patients with pterygium seem to have increased systemic oxidative status (and compensatory antioxidant response) and genotoxicity, which might create a predisposition for pterygium development.
Scheimpflug Imaging of the Danish Cohort of Patients With Wilson Disease
Authors: Telinius Niklas , Ott Peter , Sandahl Thomas , Hjortdal Jesper
Published: May 2019

Purpose:

The purpose of this study was to investigate the use of anterior segment imaging in diagnosing Kayser–Fleischer rings in patients with Wilson disease.

Methods:

In a tertiary center for Wilson disease, patients were examined with a Pentacam HR Scheimpflug-based tomography device in addition to conventional slit-lamp examination. The inferior part of the cornea was analyzed using both a built-in densitometry module and ImageJ.

Results:

Thirty-one patients with Wilson disease (78% of all Danish patients) were included, resulting in 83 examinations over a 5-year period. Ten had a manifest Kayser–Fleischer ring in the inferior part of the cornea on at least 1 examination, 5 had other causes of peripheral corneal scatter, and 16 had normal examinations. The built-in densitometry module performed poorly in discriminating between the presence and absence of a Kayser–Fleischer ring. However, analysis of the images in ImageJ and calculation of a normalized signal (peak posterior value/peak anterior value) with a cutoff value set to 1 detected 28 of 31 Kayser–Fleischer rings and resulted in 96% sensitivity and 95% specificity. In 12 patients who underwent 3 or more examinations during the period, changes in the normalized signal seemed to reflect the efficiency of the treatment, although more studies are needed for this conclusion.

Conclusions:

ImageJ-based analysis of Pentacam images has a high sensitivity in detecting Kayser–Fleischer rings and can be used as a diagnostic procedure for Wilson disease and may be a tool to monitor the disease in an objective manner.
Addition of Advanced Practice Registered Nurses to the Trauma Team: An Integrative Systematic Review of Literature
Authors: Crawford Callie C.
Published: May 2019

The total cost of inpatient care from a traumatic mechanism of injury in the United States between 2001 and 2011 was $240.7 billion. Medical resident work hour reductions mandated in 2011 left a shortage of available in-hospital providers to care for trauma patients. This created gaps in continuity of care, which can lead to costly increased lengths of stay (LOS) and increased medical errors. Adding advanced practice nurses (APNs) specializing in acute or trauma care to the trauma team may help fill this shortage in trauma care providers. The purpose of this integrative systematic review of the literature was to determine whether adding APNs to the admitting trauma team would decrease LOS. A systematic review of primary research in CINAHL and PubMed databases was performed using the following terms: nurse practitioner, advanced practice nurse, trauma team, and length of stay. Included studies examined the effects of adding APNs to trauma teams, were written in English, and were published in 2007–2017. Six studies were included in the final sample, and all were completed at Level I trauma centers in the United States except one from Canada. Combined sample size was 25,083 admitted trauma patients. All 6 studies reported a decrease in LOS ranging from 0.8 to 2.54 days when APNs were added to the trauma team. More research is needed to identify the best utilization of an APN on a trauma team. It is recommended that all trauma centers add APNs to the trauma team to not only decrease admitted trauma patients' LOS but also provide continuity of care, decreasing costs, and minimizing errors.
Treatment of Tinnitus Using Theta Burst Based Repetitive Transcranial Magnetic Stimulation—A Single Blinded Randomized Control Trial
Authors: Godbehere Joanna , Sandhu Jaswinder , Evans Alexander , Twigg Victoria , Scivill Ian , Ray Jaydip , Barker Anthony
Published: May 2019

Objective:

To determine whether theta burst repetitive transcranial magnetic stimulation is an effective treatment for chronic tinnitus compared with a control stimulus.

Study Design:

A two-arm, single-blind, randomized controlled trial comparing an active treatment group to a placebo control group.

Setting:

Neurotology department of a tertiary referral center.

Patients:

Forty new and existing patients with chronic unilateral or bilateral tinnitus were recruited from specialist hearing and balance clinics.

Interventions:

The subjects were randomized into two groups representing the treatment and sham subcategories. Two 40 second trains, 15 minutes apart of transcranial stimulation was provided using a super rapid stimulator (2.2. Tesla, Magstim Inc., Wales, UK) using a circular delivery coil. Treatment was provided over 5 consecutive days.

Main Outcome Measure:

Tinnitus functional index (TFI) scores were recorded before treatment, immediately after treatment, 2 weeks, and at 4 weeks following treatment and compared.

Results:

TFI scores were analyzed using the Shapiro–Wilk test and found to be normally distributed. A paired Student t test was then performed. Both the active treatment group and control group had a significant improvement in their TFI scores following treatment; however, there was no significant difference between active treatment and sham treatment groups.

Conclusion:

This study demonstrated a significant placebo effect following treatment with sham therapy and may suggest that repetitive transcranial magnetic stimulation does not have a therapeutic use in treating chronic tinnitus.
Hearing Results of Surgery for Acquired Atresia of the External Auditory Canal
Authors: Stultiens Joost J.A. , Huygen Patrick L.M. , Oonk Anne M.M. , Mylanus Emmanuel A.M. , Kunst Henricus P.M. , Hol Myrthe K.S. , Cremers Cor W.R.J. , Mulder Jef J.S. , Pennings Ronald J.E.
Published: May 2019

Objective:

To evaluate short- and long-term hearing results of surgery for acquired atresia of the external auditory canal (EAC) in a large patient cohort and to define preoperative audiometric conditions useful for patient counseling.

Study Design:

Retrospective cohort study.

Setting:

Academic tertiary referral center.

Patients:

Seventy-eight ears from 72 patients with postinflammatory acquired atresia of the EAC who underwent canal- and meatoplasty were included. Patients with involvement of the ossicular chain, (syndromic) external ear malformations, or congenital aural atresia were excluded.

Intervention:

Canal- and meatoplasty.

Main Outcome Measures:

Mean pure-tone averages of thresholds at 0.5, 1, 2, and 3 kHz (PTA0.5,1,2,3) for air conduction (AC), bone conduction, and air-bone gap (ABG) were calculated preoperatively and at short-term (≤0.55 yr) and long-term follow-up (>0.55 yr). Additionally, the numbers of ears with a closed ABG ≤10 dB and ≤20 dB, and with Social hearing (defined as: AC PTA0.5,1,2,3 ≤35 dB) were assessed.

Results:

At short-term follow-up AC PTA0.5,1,2,3 improved by 18 dB. Social hearing was obtained in 81% of the ears. Postoperatively, 35% of the ears had a closed ABG ≤10 dB, 83% was closed ≤20 dB. During follow-up, significant deterioration of 5 to 7 dB occurred for AC thresholds at 0.25, 0.5, and 1 kHz.

Conclusions:

Surgery for acquired atresia of the EAC is often beneficial. This study suggests overall advantageous surgery when the preoperative indication criteria ABG PTA0.5,1,2,3 >20 dB and AC PTA0.5,1,2,3 >35 dB are applied.
A New Lateral Wall Electrode: Evaluation of Surgical Handling, Radiographic Placement, and Histological Appraisal of Insertion Trauma
Authors: Rivas Alejandro , Yawn Robert J. , Kim Ana H. , Driscoll Colin , Cullen Robert , Rebscher Stephen J. , Isaacson Brandon
Published: May 2019

Objective:

To describe histologic and radiographic findings associated with insertion of a new lateral wall electrode in human temporal bones, as well as quantify the ease of insertion as characterized by multiple cochlear implant surgeons.

Setting:

Multi-institutional cadaveric study.

Methods:

The Slim J electrode was inserted in cadaveric temporal bones via a standard mastoidectomy and facial recess approach. Insertion was performed by five cochlear implant surgeons with no previous experience with the Slim J electrode array. Electrode array insertion was performed via a round window, an extended round window, or a cochleostomy approach. Intracochlear trauma, and angular insertion depth was assessed histologically and radiologically, respectively, after placement of the Slim J electrode array.

Results:

Scala tympani insertion was accomplished in all 40 specimens. Thirty-eight specimens (95%) showed minimal trauma (Esrhaghi grade 0 or 1). One patient had rupture of basilar membrane (grade 2 trauma) at 380 degrees. One patient had grade 4 trauma with scalar translocation beginning at 210 degrees. The mean angular insertion depth was 416.4 degrees (range: 338.7–509.2 degrees, SD 44 degrees). Surgical handling was described as easy in 38 cases (95%).

Conclusion:

In a human cadaveric model the lateral wall Slim J electrode produced minimal intracochlear trauma that was positioned completely within the scala tympani in 97.5% of cases.
Drafting a Surgical Procedure Using a Computational Anatomy Driven Approach for Precise, Robust, and Safe Vestibular Neuroprosthesis Placement—When One Size Does Not Fit All
Authors: Seppen Bart F. , van Hoof Marc , Stultiens Joost J. A. , van den Boogert Thomas , Guinand Nils , Guyot Jean-Philippe , Kingma Herman , Fornos Angelica Pérez , Handschuh Stephan , Glueckert Rudolf , Jacobi Linda , Schrott-Fischer Annelies , Chacko Lejo Johnson , van de Berg Raymond
Published: May 2019

Objective:

To design and evaluate a new vestibular implant and surgical procedure that should reach correct electrode placement in 95% of patients in silico.

Design:

Computational anatomy driven implant and surgery design study.

Setting:

Tertiary referral center.

Participants:

The population comprised 81 patients that had undergone a CT scan of the Mastoid region in the Maastricht University Medical Center. The population was subdivided in a vestibular implant eligible group (28) and a control group (53) without known vestibular loss.

Interventions:

Canal lengths and relationships between landmarks were calculated for every patient. The relationships in group-anatomy were used to model a fenestration site on all three semicircular canals. Each patient's simulated individual distance from the fenestration site to the ampulla was calculated and compared with the populations average to determine if placement would be successful.

Main Outcome Measures:

Lengths of the semicircular canals, distances from fenestration site to ampulla (intralabyrinthine electrode length), and rate of successful electrode placement (robustness).

Results:

The canal lengths for the lateral, posterior, and superior canal were respectively 12.1 mm ± 1.07, 18.8 mm ± 1.62, and 17.5 mm ± 1.23, the distances from electrode fenestration site to the ampulla were respectively 3.73 mm ± 0.53, 9.02 mm ± 0.90, and 5.31 mm ± 0.73 and electrode insertions were successful for each respective semicircular canal in 92.6%, 66.7%, and 86.4% of insertions in silico. The implant electrode was subsequently revised to include two more electrodes per lead, resulting in a robustness of 100%.

Conclusions:

The computational anatomy approach can be used to design and test surgical procedures. With small changes in electrode design, the proposed surgical procedure's target robustness was reached.
To Scan or Not to Scan—A Cross-Sectional Analysis of the Clinical Efficacy and Cost-Effectiveness of Audiometric Protocols for Magnetic Resonance Imaging Screening of Vestibular Schwannomas
Authors: Bhargava Eishaan Kamta , Coyle Paula , Wong Billy , Masood Ajmal , Qayyum Asad
Published: May 2019

Introduction:

Vestibular schwannomas (VS) are a rare cause of asymmetrical hearing loss, and routine screening with magnetic resonance imaging (MRI) can be costly. At present, no consensus exists on what qualifies as “asymmetrical sensorineural hearing loss” (ASNHL) and when a patient should be referred for screening.

Objectives:

1) Evaluation of published audiometric protocols on the basis of sensitivity and specificity when applied to local clinical cohort of patients with ASNHL; 2) determination of clinical risks of missing VS and potential wastes in screening “radiologically normal” cases; 3) assessment of the cost of MRI screening.

Methods:

Cross-sectional study with chart review in a 2-year (2015–2016) cohort of 1059 patients who underwent MRI screening and audiometry indicating sensorineural hearing loss. Fourteen previously published audiometric protocols were assessed for their sensitivity and specificity in guiding radiological diagnosis of VS, and cost analysis was performed.

Results:

6/14 audiometric protocols had a sensitivity greater than 85%. Diagnostic specificity ranged from 22.91 to 82.76%, clinical risks from 0 to 50%, and potential wastes from 17.24 to 77.09%. Average annual cost of screening was £64,069. Application of proposed local screening protocol had a projected cost saving of 32.19%. Cost of screening patients that benefit from treatment was compared with a utility function that quantified expected benefit.

Conclusions:

Development of an easy-to-apply algorithm incorporating high-sensitivity audiometric protocols may result in significant cost saving, with minimal clinical risk of missing cases. There was disparity between screening costs and monetary “benefit” of hearing.
Coronary artery calcium as a predictor of coronary heart disease, cardiovascular disease, and all-cause mortality in Asian-Americans: The Coronary Artery Calcium Consortium
Authors: Orimoloye Olusola A. , Banga Sandeep , Dardari Zeina A. , Uddin S. M. Iftekhar , Budoff Matthew J. , Berman Daniel S. , Rozanski Alan , Shaw Leslee J. , Rumberger John A. , Nasir Khurram , Miedema Michael D. , Blumenthal Roger S. , Blaha Michael J. , Mirbolouk Mohammadhassan
Published: May 2019

Background

Coronary artery calcium (CAC) has been shown in multiple populations to predict atherosclerotic cardiovascular disease. However, its predictive value in Asian-Americans is poorly described.

Patients and methods

We studied 1621 asymptomatic Asian-Americans in the CAC Consortium, a large multicenter retrospective cohort. CAC was modeled in categorical (CAC = 0; CAC = 1–99; CAC = 100–399; CAC ≥ 400) and continuous [ln (CAC + 1)] forms. Participants were followed over a mean follow-up of 12 ± 4 years for coronary heart disease (CHD) death, cardiovascular disease (CVD) death, and all-cause mortality. The predictive value of CAC for individual outcomes was assessed using multivariable-adjusted Cox regression models adjusted for traditional cardiovascular risk factors and reported as hazard ratios (95% confidence interval).

Results

The mean (SD) age of the population was 54 (11.2) years and 64% were men. The mean 10-year atherosclerotic cardiovascular disease risk score was 8%. Approximately half had a CAC score of 0, whereas 22.5% had a CAC score of greater than 100. A total of 56 deaths (16 CVD and 8 CHD) were recorded, with no CVD or CHD deaths in the CAC = 0 group. We noted a significantly increased risk of CHD [hazard ratio (HR): 2.6 (1.5–4.3)] and CVD [HR: 2.3 (1.8–2.9)] mortality per unit increase in In (CAC + 1). Compared to those with CAC scores of 0, individuals with CAC scores of at least 400 had over a three-fold increased risk of all-cause mortality [HR: 3.3 (1.3–8.6)].

Conclusion

Although Asian-Americans are a relatively low-risk group, CAC strongly predicts CHD, CVD, and all-cause mortality beyond traditional risk factors. These findings may help address existing knowledge gaps in CVD risk prediction in Asian-Americans.
Emerging single-cell tools are primed to reveal functional and molecular heterogeneity in malignant hematopoietic stem cells
Authors: Shepherd Mairi S. , Kent David G.
Published: May 2019

Purpose of review

The recent emergence of single-cell technologies has permitted unprecedented insight into the molecular drivers of fate choice in blood stem and progenitor cells. This review gives a broad overview of current efforts to understand the molecular regulators of malignant hematopoietic stem cells (HSCs) at the single-cell level.

Recent findings

The large-scale adoption of single-cell approaches has allowed extensive description of the transcriptional profiles and functional properties of single HSCs. These techniques are now beginning to be applied to malignant HSCs isolated directly from patients or from mouse models of malignancy. However, these studies have generally struggled to pinpoint the functional regulators of malignant characteristics, since malignant HSCs often differ in more than one property when compared with normal HSCs. Moreover, both normal and malignant populations are complicated by HSC heterogeneity.

Despite the existence of single-cell gene expression profiling tools, relatively few publications have emerged. Here, we review these studies from recent years with a specific focus on those undertaking single-cell measurements in malignant stem and progenitor cells. We anticipate this to be the tip of the iceberg, expecting the next 2–3 years to produce datasets that will facilitate a much broader understanding of malignant HSCs.
Hematopoietic-cell transplantation for lymphoma in the era of genetically engineered cellular therapy: it's not quite time to scrap the old vehicle for the new car
Authors: Scordo Michael , Lin Richard J. , Sauter Craig S.
Published: May 2019

Purpose of review

Second-line platinum-based salvage chemotherapy followed by high-dose chemotherapy and autologous hematopoietic-cell transplantation (AHCT) has remained the standard of care (SOC) for relapsed and primary refractory (r/r) diffuse large B-cell lymphoma (DLBCL) for greater than 2 decades. In the postrituximab era, this strategy has yielded disappointing outcomes for r/r patients with curability in less one-quarter of the patients by intention-to-treat.

Recent findings

Given the Food and Drug Administration (FDA) approval of chimeric antigen receptor (CAR) modified T cells directed against CD19 (CD19 CAR T) for DLBCL following two lines of therapy and/or failed AHCT, encouragement with this therapy in the second line for r/r patients has naturally prompted randomized phase III studies against the aforementioned SOC. The predominant hurdle to procession to AHCT is chemotherapy sensitivity after platinum-based salvage therapy.

In this review, we will discuss recent investigations to improve response rates in r/r DLBCL with the intent of proceeding to potentially curative AHCT, as well as investigations to decrease progression post-AHCT. In addition, data regarding currently FDA approved CD19 CAR T cells will be reviewed. Within 2–3 years, we will know if the multicenter/multinational studies of CD19 CAR T will replace SOC salvage therapy and AHCT in the second-line. The role of allogeneic HCT will also be briefly reviewed in the context of these therapies.
Decrement in Cellular Iron and Reactive Oxygen Species, and Improvement of Insulin Secretion in a Pancreatic Cell Line Using Green Tea Extract
Authors: Koonyosying Pimpisid , Uthaipibull Chairat , Fucharoen Suthat , Koumoutsea Evangelia Vlachodimitropoulou , Porter John B. , Srichairatanakool Somdet
Published: May 2019

Objectives

We have investigated the efficacy of mono- and combined therapy with green tea extract (GTE) in mobilizing redox iron, scavenging reactive oxygen species (ROS), and improving insulin production in iron-loaded pancreatic cells.

Methods

Rat insulinoma pancreatic β-cells were iron-loaded using culture medium supplemented with either fetal bovine serum or ferric ammonium citrate and treated with various doses of GTE for epigallocatechin-3-gallate (EGCG) equivalence and in combination with iron chelators. Cellular iron, ROS, and secretory insulin were measured.

Results

The rat insulinoma pancreatic cells took up iron from fetal bovine serum more rapidly than ferric ammonium citrate. After treatment with GTE (0.23–2.29 μg EGCG equivalent), cellular levels of iron and ROS were dose dependently decreased. Importantly, secretory insulin levels were increased nearly 2.5-fold with 2.29 μg of EGCG equivalent GTE, indicating a recovery in insulin production.

Conclusions

Green tea EGCG ameliorated oxidative damage of iron-loaded β-cells by removing redox iron and free radicals and attenuating insulin production. The impact can result in the restoration of pancreatic functions and an increase in insulin production. Green tea extract exerts iron-chelating, free-radical scavenging, and pancreato-protective effects in the restoration of β-cell functions, all of which we believe can increase insulin production in diabetic β-thalassemia patients.
Hepatic Encephalopathy in Children With Acute Liver Failure
Authors: Toney Nicole A. , Bell Michael J. , Belle Steven H. , Hardison Regina M. , Rodriguez‐Baez Norberto , Loomes Kathleen M. , Vodovotz Yoram , Zamora Ruben , Squires Robert H. ,   Pediatric Acute Liver Failure Study Group
Published: May 2019

Background:

Pediatric acute liver failure (PALF) is a public heath burden, often requiring prolonged hospitalization and liver transplantation. Hepatic encephalopathy (HE) is a complication of PALF with limited diagnostic tools to predict outcomes. Serum neurological markers (neuron‐specific enolase, S100β, and myelin basic protein) can be elevated in traumatic or ischemic brain injury. We hypothesized that these neuromarkers would be associated with the development of HE in PALF.

Methods:

PALF study participants enrolled between May 2012 and December 2014 by 12 participating centers were the subjects of this analysis. Daily HE assessments were determined by study investigators. Neurological and inflammatory markers were measured using enzyme‐linked immunosorbent assay and MILLIPLEX techniques, respectively. To model encephalopathy, these markers were log2 transformed and individually examined for association with HE using a generalized linear mixed model with a logit link and random intercept.

Results:

Eighty‐two children had neurological and inflammatory marker levels and HE assessments recorded, with the majority having assessments for 3 days during their illness. An indeterminate diagnosis (29%) was most common and the median age was 2.9 years. Significant associations were observed for HE with S100β (odds ratio 1.16, 95% confidence interval [1.03–1.29], P = 0.04) and IL‐6 (odds ratio 1.24 [1.11–1.38], P = 0.006).

Conclusions:

Serum S100β and IL‐6 are associated with HE in children with PALF. Measuring these markers may assist in assessing neurological injury in PALF, impacting clinical decisions.
Nutrition Interventions in Pediatric Pancreatitis
Authors: Theodoridis Xenophon , Grammatikopoulou Maria G. , Petalidou Arianna , Stamouli Eleni‐Maria , Fotiadou Iliana , Gkiouras Konstantinos , Bogdanos Dimitrios P. , Dardavessis Theodore
Published: May 2019

Objective:

Despite the fact that pediatric pancreatitis is an uncommon disease, its prevalence has increased in recent years. Nevertheless, until 4 years ago, the lack of nutritional guidelines for pediatric pancreatitis was evident, with all recommendations being based on clinical practice guidelines (CPGs) for adults. The aim of the present study was to review and critically appraise guidelines for the medical nutrition therapy (MNT) of pediatric pancreatitis.

Methods:

A comprehensive search was performed in electronic databases (PubMed, Scopus, National Institute for Health and Care Excellence), the International Guidelines Network, BMJ best practice, and the Scottish Intercollegiate Guidelines Network to identify CPGs on the MNT of pediatric pancreatitis. The validated AGREE II tool was used for guidelines appraisal by a team of 3 independent multidisciplinary reviewers.

Results:

A total of 4 CPGs were retrieved with pediatric pancreatitis MNT information. Out of the 4 advising bodies in total, the joint society paper published by the ESPGHAN/NASPGHAN received the highest score in almost all domains, whereas the Belgian consensus obtained the lowest score in all domains but stakeholder involvement, and was not recommended by 2 out of 3 reviewers.

Conclusions:

Pediatric pancreatitis guidelines appear heterogenous in quality, rigour, and transparency. Our study points out existing gaps and biases in the CPGs, and delineates the need for improving the domains identified as being of low‐quality.
Pediatric Intestinal Pseudo‐obstruction
Authors: Diamanti Antonella , Fusaro Fabio , Caldaro Tamara , Capriati Teresa , Candusso Manila , Nobili Valerio , Borrelli Osvaldo
Published: May 2019

Objective:

The aim of the study was to evaluate long‐term nutritional outcomes and clinical characteristics in a cohort of children with pediatric intestinal pseudo‐obstruction (PIPO) at neonatal‐onset (NO‐PIPO) and at later‐onset (LO‐PIPO).

Methods:

All children fulfilling new PIPO criteria over a 30‐year period were reviewed. Baseline demographic and clinical features as well as nutritional outcomes were collected. Nutritional outcomes included overall survival, prevalence of enteral autonomy and parenteral nutrition (PN) dependency, rate of major PN complications, and growth course.

Results:

Forty‐four patients were still alive at the end of the follow‐up. Twenty‐five patients (57%) achieved enteral autonomy, whilst 18 remained on PN. Among the patients requiring PN at the beginning of the study period, we found that 55% (CI 34–70) has the probability of remaining on PN at the latest follow‐up. Prevalence of gastrointestinal obstruction symptoms (P < 0.01), urinary involvement (P < 0.05), stoma placements [gastrostomy (P < 0.01), ileostomy P < 0.05)] and complex gastrointestinal surgery (P < 0.05) were significantly higher in NO‐PIPO than in LO‐PIPO. The number of patients requiring long‐term PN (P < 0.001) and the number of PN days (P < 0.05) were significantly higher in NO‐PIPO, whilst the number of patients achieving enteral autonomy was significantly higher in LO‐PIPO (P < 0.05).

Conclusions:

In our study, we have reported the nutritional outcome of a cohort of children with PIPO over a 30‐year period showing that about 20% of patients develop irreversible intestinal failure requiring life‐long PN. Nutritional and clinical outcomes seem to be influenced by the time of onset of the disease.
Home Healthcare Visits Following Hospital Discharge
Authors: Strano April , Briggs Andrea , Powell Nicole , Brockman Jody , Taylor Jennifer , Butler Amy , Soendker Marcheta , Upschulte Shirley , Long Ellen , Wills Rebecca , Ward-Smith Peggy
Published: May 2019

The purpose of this study was to determine if the timing of home care visits post hospitalization for heart failure influenced hospital readmission rates. Using a randomized control study design, hospital readmission data were collected from 67 recently discharged patients with heart failure. The control group (n = 32) received the usual care, whereas the intervention group (n = 35) received an altered scheduling of home care visits. Seven study participants were readmitted during the study time frame (control group n = 3; intervention group n = 4). Emergency room visits occurred three times (control group n = 1; intervention group n = 2). The timing of the home healthcare visit did not affect hospital readmission. Adherence to weight monitoring, fluid restriction, and medication administration improved with the home care visits. Greater attention to these activities should be the focus of home healthcare visits as they may decrease hospital readmissions.
Religiosity and Severity of Symptoms in Croatian Patients With Major Depressive Disorder or Schizophrenia
Authors: Kos Lana , Šagud Marina , Mihaljević-Peleš Alma , Kutleša Mislav , Kovač Tomislav , Trkulja Vladimir
Published: May 2019

We examined and compared the relationship between religiosity and symptom severity in patients with major depressive disorder (MDD) rated by the Hamilton Depression Rating Scale) and schizophrenia (rated by the Positive and Negative Syndrome Scale). The Duke University Religion Index, the Santa Clara Strength of Religious Faith (SCSORF) questionnaire, and the Brief Religious Coping scale scores were similar between patients with MDD (n = 50) and patients with schizophrenia (n = 50). In patients with MDD, higher organizational religious activity (ORA) (estimate = 2.28, 95% confidence interval [CI] = 0.37–4.19; p = 0.020) and higher negative religious coping (estimate = 0.43, 95% CI = 0.03–0.84; p = 0.037) were independently associated with more severe symptoms. In patients with schizophrenia, higher ORA was associated with lower negative symptoms (estimate = −1.99, 95% CI = −3.94 to −0.03; p = 0.046). Higher SCSORF was associated with lower ORA in both patient subsets, and thus indirectly with milder symptoms in patients with MDD and with more severe negative symptoms in patients with schizophrenia. The relationship between religiosity and symptom severity apparently differs in patients with MDD and those with schizophrenia.
Cluster Analysis According to Immunohistochemistry is a Robust Tool for Non–Small Cell Lung Cancer and Reveals a Distinct, Immune Signature-defined Subgroup
Authors: Sterlacci William , Fiegl Michael , Juskevicius Darius , Tzankov Alexandar
Published: May 2019

Clustering in medicine is the subgrouping of a cohort according to specific phenotypical or genotypical traits. For breast cancer and lymphomas, clustering by gene expression profiles has already resulted in important prognostic and predictive subgroups. For non–small cell lung cancer (NSCLC), however, little is known. We performed a cluster analysis on a cohort of 365 surgically resected, well-documented NSCLC patients, which was followed-up for a median of 62 months, incorporating 70 expressed proteins and several genes. Our data reveal that tumor grading by architecture is significant, that large cell carcinoma is likely not a separate entity, and that an immune signature cluster exists. For squamous cell carcinomas, a prognostically relevant cluster with poorer outcome was found, defined by a high CD4/CD8 ratio and lower presence of granzyme B+ tumor-infiltrating lymphocytes (TIL). This study shows that clustering analysis is a useful tool for verifying established characteristics and generating new insights for NSCLC. Importantly, for one “immune signature” cluster, the signature of the TIL (especially the amount of CD8+ TIL) was more crucial than the histologic or any other phenotypical aspect. This may be an important finding toward explaining why only a fraction of eligible patients respond to immunomodulating anticancer therapies.
Prediction of High-Grade Hip Joint Effusion With Simple Radiographs in Children
Authors: Cha Yunsik , Kang Michael Seungcheol , Park Soo-Sung
Published: May 2019

Objectives

The objective of this study was to investigate the predictive value of asymmetric joint space widening on simple radiographs for the presence of hip joint effusion in children with unilateral hip pain.

Methods

Sixty-eight patients aged 6 to 17 years with both simple radiograph and magnetic resonance imaging of both hips were retrospectively reviewed. We evaluated the predictive effects of radiographic surrogates for joint space widening on the presence of high-grade hip joint effusion. We also sought to investigate a predictive model for the presence of hip joint effusion with the patients' clinical and radiological data.

Results

Radiographic values showed high specificity but low sensitivity for the presence of high-grade joint effusion. On multivariate analysis, sex and the difference ratio of medial and superior gaps were independent predictive factors for unilateral high-grade hip joint effusion.

Conclusions

For children 6 years and older with asymmetric hip joint space widening on simple radiographs, further evaluations for the presence of hip joint effusion should be considered because of its high specificity. The predictability can improve if both medial and superior gaps, and sex are included in the evaluation. In girls, hip joint effusion seems to widen the joint space more easily than in boys, which may be owing to the more ligamentous laxity of and less musculature around the hip in girls. However, the risk of joint effusion should not be underestimated even if a child presents symmetry on the simple radiograph because of its low sensitivity and the possibility of bilateral involvements or early stage of diseases.
How Are Clinicians Treating Children With Sepsis in Emergency Departments in Latin America?
Authors: Kohn-Loncarica Guillermo A. , Fustiñana Ana L. , Jabornisky Roberto M. , Pavlicich Sonia V. , Prego-Pettit Javier , Yock-Corrales Adriana , Luna-Muñoz Consuelo R. , Casson Nils A. , Álvarez-Gálvez Eugenia A. , Zambrano Ibelice R. , Contreras-Núñez Cristina , Santos César M. , Paniagua-Lantelli Guadalupe , Gutiérrez Camilo E. , Amantea Sérgio L. , González-Dambrauskas Sebastián , Sánchez María José , Rino Pedro B. , Mintegi Santiago , Kissoon Niranjan ,   for the Red de Investigación y Desarrollo de la Emergencia Pediátrica Latinoamericana (RIDEPLA)
Published: May 2019

Objective

Guidelines adherence in emergency departments (EDs) relies partly on the availability of resources to improve sepsis care and outcomes. Our objective was to assess the management of pediatric septic shock (PSS) in Latin America's EDs and to determine the impact of treatment coordinated by a pediatric emergency specialist (PEMS) versus nonpediatric emergency specialists (NPEMS) on guidelines adherence.

Methods

Prospective, descriptive, and multicenter study using an electronic survey administered to PEMS and NPEMS who treat PSS in EDs in 14 Latin American countries.

Results

We distributed 2164 surveys with a response rate of 41.5%, of which 22.5% were PEMS. Overall American College of Critical Care Medicine reported guidelines adherence was as follows: vascular access obtained in 5 minutes, 76%; fluid infusion technique, 60%; administering 40 to 60 mL/kg within 30 minutes, 32%; inotropic infusion by peripheral route, 61%; dopamine or epinephrine in cold shock, 80%; norepinephrine in warm shock, 57%; and antibiotics within 60 minutes, 82%. Between PEMS and NPEMS, the following differences were found: vascular access in 5 minutes, 87.1% versus 72.7% (P < 0.01); fluid infusion technique, 72.3% versus 55.9% (P < 0.01); administering 40 to 60 mL/kg within 30 minutes, 42% versus 29% (P < 0.01); inotropic infusion by peripheral route, 75.7% versus 56.3% (P < 0.01); dopamine or epinephrine in cold shock, 87.1% versus 77.3% (P < 0.05); norepinephrine in warm shock, 67.8% versus 54% (P < 0.01); and antibiotic administration within first 60 minutes, 90.1% versus 79.3% (P < 0.01), respectively. Good adherence criteria were followed by 24%. The main referred barrier for sepsis care was a failure in its recognition, including the lack of triage tools.

Conclusions

In some Latin American countries, there is variability in self-reported adherence to the evidence-based recommendations for the treatment of PSS during the first hour. The coordination by PEMS support greater adherence to these recommendations.
Brief Report: Routine Use of Oral PrEP in a Phase 2 Rectal Microbicide Study of Tenofovir Reduced-Glycerin 1% Gel (MTN-017)
Authors: Liu Albert Y. , Norwood Aliza , Gundacker Holly , Carballo-Diéguez Alex , Johnson Sherri , Patterson Karen , Bekker Linda-Gail , Chariyalertsak Suwat , Chitwarakorn Anupong , Gonzales Pedro , Holtz Timothy H. , Mayer Kenneth H. , Zorrilla Carmen , Buchbinder Susan , Piper Jeanna M. , Lama Javier R. , Cranston Ross D. ,   on behalf of the Microbicide Trials Network-017 Team
Published: May 2019

Background:

As daily oral preexposure prophylaxis (PrEP) becomes standard for HIV prevention, routine use of PrEP is likely to increase within clinical trials of novel preventive agents. We describe the prevalence and characteristics of participants reporting nonstudy oral PrEP use within Microbicide Trials Network-017 (MTN-017), a phase 2 trial of a rectal microbicide.

Setting and Methods:

One hundred ninety-five HIV-uninfected men who have sex with men and transgender women were enrolled and followed in MTN-017 across 8 sites in the United States, Thailand, South Africa, and Peru from 2013 to 2015. Nonstudy oral PrEP use was recorded on case report forms and progress notes. Characteristics of PrEP users and non-PrEP users were compared using tests of statistical significance.

Results:

Overall, 11% of participants reported nonstudy oral PrEP use, all from the San Francisco (SF) site, accounting for 58% (22/38) of participants enrolled in SF. There was a higher median number of sex partners reported in the past 8 weeks before enrollment among oral PrEP users vs. nonusers (7 vs. 2, P = 0.02). Most PrEP users (18/22, 82%) began PrEP treatment during screening/after enrollment, and most (19/22, 86%) decided to continue oral PrEP after study completion.

Conclusion:

Nonstudy oral PrEP use in the first phase 2 study of tenofovir reduced-glycerin 1% gel was high at a single site in SF where community PrEP availability and use was expanding. Investigators should consider the evolving context of nonstudy oral PrEP use across trial sites when designing and interpreting trials of novel biomedical prevention modalities.
Paradoxical Early Increase in Prostate-Specific Membrane Antigen Uptake Following Cryoablation for Local Recurrence After Radical Prostatectomy
Authors: Mariotti Guilherme Cayres , Cunha Marcelo Livorsi , Carneiro Arie , Smaletz Oren , Baroni Ronaldo Hueb , Garcia Rodrigo Gobbo
Published: May 2019

We report a case of a 43-year-old man who underwent a radical prostatectomy 3 years before the procedure (June 2015) for a locally advanced Gleason 7(4 + 3) prostate adenocarcinoma (pT3aN0), with negative surgical margins, followed by salvage radiotherapy. He also underwent antiandrogen therapy for biochemical relapse (bicalutamide) from October 2016 through May 2017, but prostate-specific antigen continued to rise (2.5 ng/mL [December 2017] and 3.3 ng/mL [February 2018]). At this point, he underwent a 68Ga–prostate-specific membrane antigen PET/CT, and after multidisciplinary discussion, the therapeutic option chosen was image-guided salvage cryoablation.
Massive Bilateral Neck Abscess and Acute Mediastinitis Following Dental Implant Surgery
Authors: Cariati Paolo , Perez de Perceval Tara Miguel , Fernandez Solis Jose , Martinez Lara Ildefoso
Published: May 2019

Dental implantology is the most popular choice for the treatment of partial or total edentulism. However, in spite of its apparent simplicity, it represents a procedure that requires adequate surgical knowledge and remarkable technical skills. There are a number of potential complications related to dental implant surgery and some of these can be particularly dangerous. The most common and early complications of implant surgery are infection, implant migration, and implant rupture, and the patient could even swallow drills and other surgical instruments. Hence, it is important to implement special safety and sterility measures. The main aim of the present report is to present a case of massive bilateral cervical abscess and mediastinitis related to dental implant surgery. To our knowledge, there are only 2 cases in the literature that describe this type of complication in the field of oral implantol.
Efficacy and Safety of Patient-controlled Analgesia Compared With Epidural Analgesia After Open Hepatic Resection
Authors: Li Jennifer , Pourrahmat Mir-Masoud , Vasilyeva Elizaveta , Kim Peter TW , Osborn Jill , Wiseman Sam M.
Published: May 2019

Objective:

To compare the efficacy and safety of patient-controlled analgesia (PCA) to epidural analgesia in adults undergoing open hepatic resection.

Background:

Effective pain management in patients undergoing open hepatic resection is often achieved with epidural analgesia. However, associated risks have prompted investigation of alternative analgesic methods in this patient population.

Methods:

A comprehensive systematic literature review via Medline, Embase, and the Cochrane databases from inception until December 2, 2017 was conducted, followed by meta-analysis. Abstract and full-text screening, data extraction, and quality assessment were conducted by 2 investigators. Odds ratios (OR), mean differences (MD), and 95% confidence intervals were calculated using RevMan 5.3.

Results:

Four randomized controlled trials with 278 patients were identified. All studies compared the use of PCA to epidural, with differing regimens. Pooled MD and 95% confidence interval for pain score were higher for PCA at rest 24 hours postoperatively (0.59 [0.30, 0.88]), and with movement at 48 hours postoperatively (0.95 [0.31, 1.60]. Pooled MD for hospital length of stay was 1.23 days (−2.72, 5.19). Pooled OR was 0.68 (0.36, 1.3) and 0.24 (0.04, 1.36) for overall and analgesia-related complications, respectively. Need for blood transfusion had a pooled OR of 1.14 (0.31, 4.18).

Conclusions:

Epidural analgesia was observed to be superior to PCA for pain control in patients undergoing open hepatic resection, with no significant difference in hospital length of stay, complications, or transfusion requirements. Thus, epidural analgesia should be the preferred method for the management of postoperative pain in this patient population.
Perceptions of Risk Factors for Alzheimer Disease Among Community-Dwelling, Nondemented Older African Americans
Authors: Glover Crystal M. , CoCroft Shelytia , James Bryan D. , Barnes Lisa L.
Published: May 2019

Purpose:

Heightened Alzheimer disease (AD) risk among African Americans represents a racial disparity in aging. This study examines perceptions of AD risk factors among nondemented older African Americans.

Methods:

Participants indicated how important nine factors were in increasing one’s AD risk using a Likert-type scale with endpoints 1=not at all important to 4=extremely important. We examined perceptions of AD risk factors as a function of age, education, gender, and global cognition using separate logistic regression models.

Patients:

Participants were from The Minority Aging Research Study (N=610) with a mean age of 74.5 years, a mean education of 14.9 years, and 24% were men.

Results:

Of the AD risk factors, predictors were significantly related to genetics and God’s Will. Younger participants (est.=−0.06, P=0.02) and those with more education (est.=0.14, P=0.02) were more likely to report genetics as extremely important. Participants with more education were less likely to indicate God’s Will as extremely important (est.=−0.14, P<0.0005).

Conclusions:

Among older African Americans, age and education were important characteristics for the perception of AD risk factors. Findings can facilitate designing effective, culturally competent educational tools for meaningful engagement with older African Americans about AD.
SavvyCNV: genome-wide CNV calling from off-target reads
Authors: Laver Thomas W , De Franco Elisa , Johnson Matthew B , Patel Kashyap , Ellard Sian , Weedon Michael N , Flanagan Sarah E , Wakeling Matthew N
Published: May 2019

Identifying copy number variants (CNVS) can provide diagnoses to patients and provide important biological insights into human health and disease. Current exome and targeted sequencing approaches cannot detect clinically and biologically-relevant CNVs outside their target area. We present SavvyCNV, a tool which uses off-target read data to call CNVs genome-wide. Up to 70% of sequencing reads from exome and targeted sequencing fall outside the targeted regions - SavvyCNV exploits this ‘free data’.

We benchmarked SavvyCNV using truth sets generated from genome sequencing data and Multiplex Ligation-dependent Probe Amplification assays. SavvyCNV called CNVs with high precision and recall, outperforming five state-of-the-art CNV callers at calling CNVs genome-wide using off-target or on-target reads from targeted panel and exome sequencing. Furthermore SavvyCNV was able to call previously undetected clinically-relevant CNVs from targeted panel data highlighting the utility of this tool within the diagnostic setting. SavvyCNV is freely available.
Subcellular analyses of planarian meiosis implicates a novel, double-membraned vesiculation process in nuclear envelope breakdown
Authors: Guo Longhua , Guo Fengli , Zhang Shasha , Yi Kexi , McClain Melainia , Kuhn Claus-D. , Parmely Tari , Alvarado Alejandro Sánchez
Published: May 2019

Abstract

The cell nuclei of Ophisthokonts, the eukaryotic supergroup defined by fungi and metazoans, is remarkable in the constancy of both their double-membraned structure and protein composition. Such remarkable structural conservation underscores common and ancient evolutionary origins. Yet, the dynamics of disassembly and reassembly displayed by Ophisthokont nuclei vary extensively. Besides closed mitosis in fungi and open mitosis in some animals, little is known about the evolution of nuclear envelope break down (NEBD) during cell division. Here, we uncovered a novel form of NEBD in primary oocytes of the flatwormSchmidtea mediterranea. From zygotene to metaphase II, both nuclear envelope (NE) and peripheral endoplasmic reticulum (ER) expand notably in size, likely involvingde novomembrane synthesis. 3-D electron microscopy reconstructions demonstrated that the NE transforms itself into numerous double-membraned vesicles similar in membrane architecture to NE doublets in mammalian oocytes after germinal vesicle breakdown. The vesicles are devoid of nuclear pore complexes and DNA, yet are loaded with nuclear proteins, including a planarian homologue of PIWI, a protein essential for the maintenance of stem cells in this and other organisms. Our data contribute a new model to the canonical view of NE dynamics and support that NEBD is an evolutionarily adaptable trait in multicellular organisms.