bluuebunny/crossref_metadata_2025 huggingface dataset:
Taxonomy, phylogeny and evolution of the bumblebee bot flies (Oestridae: Hypodermatinae: Portschinskia)
Authors: Li Xin-Yu , Pape Thomas , Zhang Dong
Published: December 2019

The first phylogenetic study of Portschinskia is presented based on 42 adult morphological characters scored for all 11 species, including four new species Portschinskia burmensis sp. nov., Portschinskia sichuanensis sp. nov., Portschinskia xizangensis sp. nov. and Portschinskia yunnanensis sp. nov.Portschinskia luliangensis is established as a junior synonym of Portschinskia magnifica. Monophyly of Portschinskia is strongly supported by nine non-homoplasious synapomorphies. All cladograms resolve P. yunnanensis as a basal taxon and a well-resolved Portschinskia gigas clade {P. gigas + ((Portschinskia bombiformis + (P. burmensis + (P. magnifica + P. xizangensis))) + (Portschinskia himalayana + (Portschinskia przewalskyi + P. sichuanensis)))}. The only topological difference is Portschinskia loewii and Portschinskia neugebaueri either being sister taxa or branching off successively at the base of the P. gigas clade. Three colour-pattern types are recognized, with the yellow-tailed pattern optimized as the ancestral state. Our data show that the modal colour pattern of Portschinskia species is the same as in bumblebees, and a regional correlation in species diversity and colour patterns can be detected between sympatric Portschinskia and Bombus species. As a result, we suggest that colour patterns of Portschinskia can be explained as Batesian mimicry tracking locally dominant bumblebees.
Smoking Is a Risk Factor for Wound Complications after Direct Anterior Hip Arthroplasty with Mesh Tape Closure
Authors: Pachter Cole S. , Garfinkel Jonathan H. , Cochrane Niall H. , Romness David W. , Gladnick Brian P.
Published: December 2019

OBJECTIVE

To determine what factors increase the risk of early wound complications in patients undergoing direct anterior total hip arthroplasty whose wounds were closed with 2-octyl cyanoacrylate with mesh.

METHODS

This study was a retrospective review of 75 consecutive patients who underwent direct anterior total hip arthroplasty closed with 2-octyl cyanoacrylate with mesh.

MAIN RESULTS

Of 29 patients who were smokers, five patients (17.2%) developed a wound complication, whereas out of 46 nonsmokers, only one patient (2.2%) developed a wound complication (P = .029).

CONCLUSIONS

The authors recommend a closure technique that sufficiently protects the wound during healing, as well as preoperative patient optimization and smoking cessation.
Preventing and identifying hospital-acquired delirium
Authors: Volland Jennifer , Fisher Anna , Drexler Diane
Published: December 2019

Hospital-acquired delirium often goes unnoticed because the signs and symptoms resemble those of dementia and depression, making diagnosis difficult. This article explores the differences between delirium, dementia, and depression and discusses the role of nursing in patient assessment and education.
Risk factors associated with neonatal brachial plexus palsy in the United States
Authors: Vakhshori Venus , Bouz Gabriel J. , Alluri Ram K. , Stevanovic Milan , Ghiassi Alidad , Lightdale Nina
Published: December 2019

Neonatal brachial plexus palsy (NBPP) is a birth injury that can cause severe functional loss in the affected limb. The purpose of this study was to determine the temporal changes in the national incidence of this condition and whether associated risk factors have changed over time. Children born via vaginal delivery were identified in the Kids’ Inpatient Database (KID) from 1997 to 2012, and those with NBPP were identified. The trend in incidence and risk factors were assessed through the study period. The nationwide incidence of NBPP decreased during the study period. Infants with shoulder dystocia, fetal macrosomia, and gestational diabetes had the highest risk of developing NBPP, while multiple birth mates during delivery had a protective effect. Multiple risk factors, including shoulder dystocia, macrosomia, and heavy for dates became less predictive of the development of NBPP over time. Several risk factors predispose children to the development of NBPP, and the effect of these risk factors has been changing. This information can guide obstetric treatment to help prevent NBPP. Level of evidence is diagnostic, level 3.
Impact of a Progressive Mobility Program on the Functional Status, Respiratory, and Muscular Systems of ICU Patients: A Randomized and Controlled Trial*
Authors: Schujmann Debora Stripari , Teixeira Gomes Tamires , Lunardi Adriana Claudia , Zoccoler Lamano Murilo , Fragoso Aretha , Pimentel Mayara , Peso Claudia Neri , Araujo Priscila , Fu Carolina
Published: December 2019

Objectives:

The aim was to investigate whether patients who participated in a mobility program in the ICU performed better on functional status, muscle, mobility, and respiratory assessments upon discharge than patients who received conventional physiotherapy.

Design:

Randomized controlled trial.

Setting:

Blind evaluation.

Patients:

Adults with previous functional independence and without contraindications for mobilization were eligible.

Interventions:

The intervention group participated in an early and progressive mobility program with five levels of activity. The control group underwent the conventional treatment without a preestablished routine. We evaluated functional status, level of activity, respiratory status, muscle strength, and mobility at ICU discharge.

Measurements and Main Results:

We analyzed 49 patients in the control group and 50 patients in the intervention group. Our data showed patients with better functional status and more functionally independent patients in the intervention group compared with those in the control group (96% vs 44%; p < 0.001). The results of the sit-to-stand and 2-minute walk tests, as well as the results of the maximum voluntary ventilation tests, also varied between the groups. The intervention group had shorter ICU stays than the control group. Higher Barthel index scores were associated with the amount of activity and participation in the protocol. The benefits to functional status remained during follow-up.

Conclusions:

Patients who participated in an ICU mobility program had better functional status at discharge from the ICU. The other benefits of the program included better performance in the mobility tests and improved maximum voluntary ventilation performance.
3-Bromopyruvate alleviates the development of monocrotaline-induced rat pulmonary arterial hypertension by decreasing aerobic glycolysis, inducing apoptosis, and suppressing inflammation
Authors: Liu Jie , Wang Wang , Wang Lei , Qi Xian-Mei , Sha Yu-Hui , Yang Ting
Published: December 2019

Background:

Pulmonary arterial hypertension (PH) is a progressive disease with limited therapeutic options, ultimately leading to right heart failure and death. Recent findings indicate the role of the Warburg effect (aerobic glycolysis) in the development of PH. However, the effect of the glycolysis inhibitor 3-bromopyruvate (3-BrPA) on the pathogenesis of PH has not been well investigated. This study aimed to determine whether 3-BrPA inhibits PH and its possible mechanism.

Methods:

PH was induced in adult Sprague-Dawley rats by a single intraperitoneal injection of monocrotaline (MCT). 3-BrPA, or phosphate-buffered saline (PBS) was administered via intraperitoneal injection every other day from the first day of MCT-injection to 4 weeks of follow-up, and indices such as right ventricular systolic pressure (RVSP), right ventricular hypertrophy index (RVHI), pulmonary arteriolar remodeling indicated by percent media thickness (% MT), lactate levels and glucose consumption, were evaluated. Pulmonary arteriolar remodeling and right ventricular hypertrophy were observed in hematoxylin-eosin-stained lung sections. Western blotting, immunohistochemistry, and/or immunofluorescence analyses were used to measure the expression of relevant proteins. A cytochrome C release apoptosis assay and terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end-labeling staining were used to measure cell apoptosis.

Results:

MCT-induced PH showed a significant increase in glucose consumption (0 vs. 4 weeks: 0.87 ± 0.23 vs. 2.94 ± 0.47, P = 0.0042) and lactate production (0 vs. 4 weeks: 4.19 ± 0.34 vs. 8.06 ± 0.67, P = 0.0004). Treatment with 3-BrPA resulted in a concomitant reduction in glucose consumption (1.10 ± 0.35 vs. 3.25 ± 0.47, P = 0.0063), lactate production (5.09 ± 0.55 vs. 8.06 ± 0.67, P = 0.0065), MCT-induced increase in RVSP (39.70 ± 2.94 vs. 58.85 ± 2.32, P = 0.0004), pulmonary vascular remodeling (% MT, 43.45% ± 1.41% vs. 63.66% ± 1.78%, P < 0.0001), and right ventricular hypertrophy (RVHI, 38.57% ± 2.69% vs. 62.61% ± 1.57%, P < 0.0001) when compared with those of the PBS-treated group. 3-BrPA, a hexokinase 2 inhibitor, exerted its beneficial effect on PH by decreasing aerobic glycolysis and was also associated with inhibiting the expression of glucose transporter protein-1, inducing apoptosis, and suppressing inflammation.

Conclusions:

3-BrPA might have a potential beneficial effect on the PH treatment.
An Algorithmic Approach to Perineal Reconstruction
Authors: Westbom Catherine M. , Talbot Simon G.
Published: December 2019

Perineal wounds are one of the more challenging plastic surgical defects to reconstruct. Resections in the perineum vary in size and are frequently complicated by radiation, chemotherapy, and contamination. Furthermore, the awkward location and potential need to maintain function of the anus, urethra, and vagina and to allow comfortable sitting all contribute to the complexity of these reconstructions. In light of this complex nature, many options are available for flap coverage. In this paper, we discuss the properties of perineal defects that make each option appropriate.
Maintenance Therapy in the Treatment of Recurrent Epithelial Ovarian Cancer
Authors: GNADE COLETTE , MCDONALD MEGAN E.
Published: December 2019

A diagnosis of recurrent epithelial ovarian cancer carries with it a very poor prognosis despite aggressive chemotherapy with or without secondary surgical cytoreduction. Recently, maintenance treatment after second-line chemotherapy has gained momentum given promising results of antiangiogenics and PARP inhibitors used in this setting. When used appropriately, these agents may provide a meaningful survival benefit with minimal effects on quality of life. This paper reveals the current literature evaluating the use of maintenance therapy in the recurrent setting for the epithelial ovarian, fallopian tube, or primary peritoneal cancers.
Frequency and Influence of Exercise-Induced Artifact in Electrocardiograms During Exercise Treadmill Testing for Detection of Myocardial Ischemia
Authors: Srivatsa Adith , Bui Jon , Mahdi Ali A. , Amsterdam Ezra A.
Published: December 2019

Background:

Exercise treadmill testing (ETT) is frequently utilized for noninvasive detection of myocardial ischemia and coronary artery disease. The frequency of electrocardiogram (ECG) artifacts (ECGA) during ETT and their influence on the identification of exercise-induced ischemia are not known.

Methods:

We reviewed all ETTs with ST segment depression in the University of California, Davis, Medical Center treadmill database during each of the years 2012 and 2016 to identify tests with exercise-induced ST segment depression in the inferior and inferolateral leads. We identified cases with ECGA during progressive phases of the test, and we assessed the influence of comorbidities and the impact of ECGA on the diagnosis of coronary artery disease. Tests were considered false or true positive based on the result of confirmatory tests.

Results:

Of 2,100 tests, we identified 123 patients with exercise-induced ST segment depression in inferior or inferolateral leads (men, 43%; mean age, 59 ± 10 years; white, 59%). Tests were symptom-limited: maximum heart rate, 153 ± 18; peak METs (metabolic equivalents of resting total oxygen consumption), 9.4 ± 2.7; ECGA occurred in 91% of tests at peak exercise with earlier occurrence among females. Tests were less likely to be true positive with peak ECGA than those without ECGA (13% vs. 50%, p = 0.05).

Conclusions:

ECGA at peak exercise are frequent and related to peak heart rate and peak metabolic equivalents of resting total oxygen consumption, suggesting a motion effect. ECGA affected the diagnostic accuracy of ETT examinations, indicating that algorithms to reduce artifact for improved diagnosis of ETT require further investigation.
A qualitative study of the experience and impact of neuropathic pain in people living with HIV
Authors: Scott Whitney , Garcia Calderon Mendoza del Solar Maite , Kemp Harriet , McCracken Lance M. , C de C Williams Amanda , Rice Andrew S.C.
Published: December 2019

Painful distal symmetrical polyneuropathy is common in HIV and is associated with reduced quality of life. Research has not explored the experience of neuropathic pain in people with HIV from a person-centred perspective. Therefore, a qualitative interview study was conducted to more deeply understand the experience and impact of neuropathic pain in this population. Semistructured interviews were conducted with 26 people with HIV and peripheral neuropathic pain symptoms. Interviews explored the impact of pain and participants' pain management strategies. Interviews were transcribed verbatim and analysed using thematic analysis. Four themes and 11 subthemes were identified. Theme 1 reflects the complex characterisation of neuropathic pain, including the perceived unusual nature of this pain and diagnostic uncertainty. Theme 2 centred on the interconnected impacts of pain on mood and functioning and includes how pain disrupts relationships and threatens social inclusion. Theme 3 reflects the struggle for pain relief, including participants' attempts to “exhaust all options” and limited success in finding lasting relief. The final theme describes how pain management is complicated by living with HIV; this theme includes the influence of HIV stigma on pain communication and pain as an unwanted reminder of HIV. These data support the relevance of investigating and targeting psychosocial factors to manage neuropathic pain in HIV.
Atrial Fibrillation Induced From Commotio Cordis
Authors: Alkhamisi Ashkan , Carek Stephen M. , Dillon Michael C. , Clugston James R.
Published: December 2019

Case:

A 20-year-old male collegiate basketball player was evaluated for sudden chest pain, shortness of breath, dizziness, and blurry vision, following an elbow to the anterior chest by another player. His symptoms improved over 10 minutes of observation, but rhythm strip performed onsite showed atrial fibrillation, and the athlete was transmitted to the emergency department for further evaluation. Electrocardiogram in the ER confirmed atrial fibrillation with a rate of 85 bpm. Electrocardioversion was being arranged when he spontaneously converted to normal sinus rhythm, 2.5 hours from the traumatic event.

Conclusions:

Our case illustrates an unusual example of atrial fibrillation induced by commotio cordis (AFCC). Although less acutely life threatening and much less frequently described than ventricular fibrillation induced by commotio cordis, AFCC should be considered in the differential after blunt chest wall trauma. Currently, there are little data regarding management of patients with AFCC.
Quantitative assessment of Parkinsonian tremor by using biosensor device
Authors: Marino Silvia , Cartella Emanuele , Donato Nicola , Muscarà Nunzio , Sorbera Chiara , Cimino Vincenzo , De Salvo Simona , Micchìa Katia , Silvestri Giuseppe , Bramanti Alessia , Di Lorenzo Giuseppe
Published: December 2019

Parkinson disease (PD) is the second most common neurodegenerative disease which affects population older than 65 years. Tremor represents one of the main symptomatic triads in PD, particularly in rest state.

We enrolled 41 idiopathic PD patients, to validate the assessment of tremor symptoms.

To be enrolled in the study, patients had to fulfill the movement disorder society clinical diagnostic criteria for PD.

We used an innovative home-made, low-cost device, able to quantify the frequency and amplitude of rest tremor and stress condition

Our results confirmed the presence of tremor during muscular effort in a significant number of patients and the influence of emotional stress.

We suppose that this new device should be validated in clinical practice as a support of differential diagnosis and therapeutic management of PD patients.
Breast metastasis from colorectal cancer treated by multimodal therapy
Authors: Hsieh Tien-Chan , Hsu Chao-Wen
Published: December 2019

Introduction:

Breast metastases from primary colorectal carcinoma are extremely rare, with only 45 cases being reported previously. Since the most common malignancy in the breast and axilla is primary breast cancer regardless of cancer history, non-hematologic metastases may be misdiagnosed initially. Nevertheless, differentiating breast metastases from primary breast cancer is crucial because of their differences in prognosis and management.

Patient concerns:

We present a case of a 44-year-old Asian woman who noticed a new right breast lump after undergoing surgery and chemotherapy for her primary sigmoid colon cancer.

Diagnosis:

Image and immunohistochemistry findings were consistent with breast metastasis from primary colorectal adenocarcinoma.

Interventions:

The patient underwent breast tumor excision and reinitiated chemotherapy.

Outcomes:

The patient's disease progressed despite the interventions. She passed away 7 months after the detection of breast metastasis.

Conclusion:

When a new breast lesion is detected in patients with colorectal cancer history, the physician should consider the possibility of breast metastasis due to the poor prognosis. If a biopsy is necessary, cancer history should be provided to the clinicians to prevent incorrect pathological interpretation. In establishing the diagnosis, certain immunohistochemical markers have been shown to be sensitive and specific in previously reported cases. The combination of tumor excision and chemotherapy was the most common strategy in managing this condition with inconsistent clinical outcomes.
The role of drains in adolescent idiopathic scoliosis surgery
Authors: Kochai Alauddin , Erkorkmaz Ünal
Published: December 2019

Close suction drainage systems are widely used in orthopedics and spine surgeries. There are less studies investigating the outcomes of using subfascial closed suction drains in adolescent patients who had undergone idiopathic scoliosis surgery. We evaluated the outcomes of patients with and without closed suction drainage and to investigate whether close suction drainage is needed after adolescent idiopathic scoliosis (AIS) surgery.

We retrospectively investigated 63 patients, who underwent posterior spinal surgery for AIS from January 2015 to January 2018. The patients were divided into the following groups: Groups A (drainage group) and B (nondrainage group). We evaluated the wound drainage (wound oozing), need for transfusion, preoperative and postoperative hemoglobin levels, length of hospital stay, and postoperative blood loss from closed suction drains. Patients’ scoliosis was categorized according to the Lenke Classification System for Scoliosis. The level of instrumentations was also evaluated.

The median postoperative hemoglobin level was lower in group A than in group B. Postoperatively, group A underwent more blood transfusions than group B. Postoperative hospital stay was also significantly longer in group A than in group B. There was no statistical difference in the infection rate between the two groups.

Using drains after AIS surgery increases hospital stay duration, blood transfusion rate and patients’ anxiety of drain tube removal. Thus, closed suction drainage may not be suitable after AIS surgery.
Prescription of Chinese herbal products is associated with a decreased risk of uterine fibroids
Authors: Hsu Wei-Chen , Tsai Yueh-Ting , Hou Yu-Chang , Lai Jung-Nien
Published: December 2019

The finding of a decrease in subsequent fibroid-related operation following the use of Chinese herbal products (CHPs) has led to speculation that CHPs might play a role in uterine fibroids prevention.

This study provides an overview of uterine fibroids incidence, comparing CHP users with those who do not use CHPs, referred to as non-CHP users. The results can provide information to clinicians for counseling women about the preventive use of CHPs.

A total of 52,151 women (20–45 years of age) were recruited from a nationwide 1-million-person representative sample of those covered by National Health Insurance in Taiwan and were followed from 2000 to 2013. Exact matching was performed for comparative analysis. The age-specific hazard ratios (HRs) of uterine fibroids in relation to either CHP or the phytoestrogen use were calculated with multivariate Cox proportional hazard regression.

More than 71% of patients had used a CHP at some point previously. The overall incidence density rate of uterine fibroids for non-CHP users was estimated at 27.5 per 1000 patient-years. The corresponding values for CHP and the phytoestrogen users were lower than those of the non-CHP group (CHP group = 15.5; the phytoestrogen group = 12.5 per 1000 patient-years). The covariate adjusted HRs for uterine fibroid were 0.73 (95% confidence interval [CI] 0.63–0.85) and 0.65 (95% CI 0.52–0.82) in women using CHPs and the phytoestrogen, respectively.

CHPs seem to contribute to a decreased risk in developing uterine fibroids. Although the mechanism of action of these products is unclear, their use as a preventive agent for uterine fibroids might be taken into consideration.
Histopathological features of oral lichen planus and its response to corticosteroid therapy
Authors: Anitua Eduardo , Piñas Laura , Alkhraisat Mohammad H.
Published: December 2019

Oral lichen planus (OLP) exhibits variations in severity and response to corticosteroid therapy. This study aims to assess the histopathological features of OLP at the time of diagnosis and their relationship in response to corticosteroid therapy.

In this retrospective study, OLP patients were selected if a histopathological report was available. Data were collected regarding patients’ demographics and medical history. Clinical and histological data were also obtained. The outcomes were histopathological findings, clinical form of OLP, number of exacerbations per year, and the response to corticosteroid therapy.

In this study, 100 OLP patients were enrolled. Basal layer hydropic degeneration and band-like subepithelial lymphocytes infiltrate were observed in all patients. Plasma cells, identified in 62% of OLP patients, were significantly associated with fewer disease exacerbations and better response to corticosteroid treatment.

Identifying histopathological features that may affect the clinical course would be clinically helpful in tailoring patient management.
Characteristics of diabetic macular edema patients with serous retinal detachment
Authors: Hwang Hyung Bin , Jee Donghyun , Kwon Jin-woo
Published: December 2019

To determine characteristics of diabetic macular edema patients with serous retinal detachment (SRD).

We classified naïve diabetic macular edema (DME) patients with or without SRD, and compared their baseline characteristics; intravitreal bevacizumab (IVB) responsiveness; aqueous concentrations of IL (interleukin)-1β, -2, -8, -10, -17, placental growth factor (PlGF), and vascular endothelial growth factor (VEGF). In addition, factors associated with the existence of SRD were identified.

Of the 64 DME patients, 14 had SRD. The average levels of aqueous VEGF and PlGF were significantly higher in the SRD group than in the control group (P = .022 and P = .041, respectively). The best-corrected visual acuity (BCVA) and central subfield thickness (CST) did not differ significantly between the 2 groups at baseline or after 3 consecutive monthly IVBs. In multivariate logistic regression analysis, the level of aqueous VEGF was the only factor associated with the existence of SRD (odds ratio: 1.03; P = .038).

Rather than aqueous inflammatory cytokines, levels of aqueous VEGFs were associated with the occurrence of SRD in DME patients. In terms of prognosis, the existence of SRD was not related with BCVA or CST changes.
Acupuncture for hiccups
Authors: Li Xiao-Bing , Wu Dong-Jie , Yang Min-Chun
Published: December 2019

Background:

A Hiccup is a common disease that often occurs along with other chronic or acute conditions. At present, there is a lack of feasible therapies for hiccups, and acupuncture is a treatment method with enormous clinical practice worldwide.

Methods:

Based on a pre-defined search strategy, we searched seven databases and screened them by two independent investigators, without language and publication status restriction from inception to date. We use the pre-set form to incorporate data and utilize Revman software to synthesize data. We will evaluate the risk of bias in the inclusion of the study based on the Cochrane ‘Risk of bias’ assessment tool. The quality of the evidence will be evaluated according to the GRADEpro software.

Results:

This systematic review will evaluate the efficacy and safety of acupuncture treatment for hiccups. The entire process will be referred to the Cochrane handbook recommended by the Cochrane Collaboration.

Conclusion:

This review will provide systematic evidence to summarize whether acupuncture is an effective intervention in the treatment of hiccup.
Pulmonary embolism as the initial manifestation of right atrial myxoma
Authors: Ma Guofeng , Wang Dan , He Yongtao , Zhang Ruifeng , Zhou Yong , Ying Kejing
Published: December 2019

Rationale:

Pulmonary embolisms (PEs) are caused by emboli, which mostly originate from deep venous thrombi that travel to and suddenly block the pulmonary arteries. The emboli are usually thrombi, and right atrial myxoma emboli are rare.

Patient concerns:

A 55-year-old man presented with shortness of breath and syncope. We proceeded with computed tomography pulmonary angiography (CTPA) and transthoracic echocardiogram (TTE), the results of which suggested that the diagnosis was a right atrial mass.

Diagnosis:

A definitive diagnosis compatible with a right atrial myxoma (RAM) with tumoral pulmonary emboli after surgical excision was made.

Intervention:

Right atrial and pulmonary artery embolectomy.

Outcomes:

The patient followed an uneventful course during the 6 years of follow-up after surgery. According to a review of the literature, RAMs are often not diagnosed in a timely manner or even go completely undiagnosed. TTE, transesophageal echocardiography (TEE), CT, magnetic resonance imaging (MRI), and positron emission tomography/computed tomography may be helpful in the preoperative diagnosis. Surgical removal of the masses from the atrium and pulmonary arteries was relatively uneventful.

Lessons:

RAMs should be considered unlikely reasons for fatal pulmonary embolisms.
Oral health of 12-year-old children in Jilin province, China
Authors: Du Aobo , Zhang Hong , Chen Chong , Zhang Fenglan , Liu Xiaoxuan , Zhang Zhimin , Wang Rui
Published: December 2019

There is a lack of population-based surveys on oral health in Jilin province. Accordingly, this study aimed to understand the oral health status of 12-year-old children in Jilin province, China, to demonstrate the prevalence of oral health–related diseases, as well as to identify the associated risk factors.

From February to April 2017, a cross-sectional investigation was conducted among 2324 children aged 12 years from 63 public schools of 9 regions in Jilin province, China. A questionnaire of World Health Organization (WHO) was conducted to ascertain the potential risk factors associated with oral diseases. The 3 examiners, who received theoretical and clinical training before the investigation, underwent clinical examinations to assess dental caries, dental fluorosis, presence of calculus, and gingival bleeding. Furthermore, the mean decayed-missing-filled tooth (DMFT), the rate of pit and fissure closure, education level of patients, brushing habits, and sugar consumption were also evaluated. All data analyses were conducted using SPSS version 19.0.

A total of 2324 twelve-year-old children from 9 regions in Jilin-China were examined from February to April 2017. The prevalence of dental caries, dental fluorosis, calculus, and gingival bleeding reached 40.8%%, 21.8%, 47.93%, and 48.88%, respectively; the mean DMFT was 0.8787. The proportion of DMFT was 83.7% for decayed teeth, 0.2% for missing teeth, and 16.1% for filling teeth. The prevalence of pit and fissure closure was 10%.

Educational level of parents was negatively correlated with the prevalence of oral diseases, whereas sugar consumption was positively associated with dental caries prevalent in children. We also found that there was no association between brushing habits and dental caries in children aged 12 years in Jilin Province.
Propofol-based total intravenous anesthesia is associated with better survival than desflurane anesthesia in intrahepatic cholangiocarcinoma surgery
Authors: Lai Hou-Chuan , Lee Meei-Shyuan , Lin Kuen-Tze , Chan Shun-Ming , Chen Jen-Yin , Lin Yao-Tsung , Wu Zhi-Fu
Published: December 2019

Previous researches have shown that anesthesia can affect the outcomes of many kinds of cancer after surgery. Here, we investigated the association between anesthesia and patient outcomes after elective open intrahepatic cholangiocarcinoma surgery.

This was a retrospective cohort study of patients who received elective open intrahepatic cholangiocarcinoma surgery between January 2005 and December 2014. Patients were grouped according to the anesthesia received, that is, propofol or desflurane anesthesia. Kaplan–Meier analysis was performed and survival curves were constructed from the date of surgery to death. After propensity matching, univariable and multivariable Cox regression models were used to compare hazard ratios for death. Subgroup analyses were performed for tumor node metastasis staging and postoperative metastasis and recurrence.

A total of 34 patients (21 deaths, 62.0%) with propofol anesthesia and 36 (31 deaths, 86.0%) with desflurane anesthesia were eligible for analysis. After propensity matching, 58 patients remained in each group. In the matched analysis, the propofol anesthesia had a better survival with hazard ratio of 0.51 (95% confidence interval, 0.28–0.94, P = .032) compared with desflurane anesthesia. In addition, subgroup analyses showed that patients under propofol anesthesia had less postoperative metastases (hazard ratio, 0.36; 95% confidence interval, 0.15–0.88; P = .025), but not fewer postoperative recurrence formation (hazard ratio, 1.17; 95% confidence interval 0.46–2.93; P = .746), than those under desflurane anesthesia in the matched groups.

In a limited sample size, propofol anesthesia was associated with better survival in open intrahepatic cholangiocarcinoma surgery. Prospective and large sample size researches are necessary to evaluate the effects of propofol anesthesia on the surgical outcomes of intrahepatic cholangiocarcinoma surgery.
Silymarin Attenuates the Severity of Cerulein-Induced Acute Pancreatitis
Authors: Kim Myoung-Jin , Kim Dong-Uk , Choi Ji-Won , Kim Dong-Gu , Song Ho-Joon , Bae Gi-Sang , Park Sung-Joo
Published: December 2019

Objectives

In this study, we investigated the anti-inflammatory effects of silymarin on cerulein-induced acute pancreatitis (AP) in mice.

Methods

Cerulein (50 μg/kg) was injected intraperitoneally once hourly for 6 hours to induce AP. To investigate the prophylactic effects of silymarin, dimethyl sulfoxide or silymarin (25, 50, and 100 mg/kg) was injected intraperitoneally 1 hour before cerulein injection. To investigate the therapeutic effects of silymarin, dimethyl sulfoxide or silymarin (100 mg/kg) was injected intraperitoneally 1, 3, or 5 hours after the first cerulein injection. Blood, pancreas, and lungs were harvested 6 hours after the last cerulein injection.

Results

Pre- and posttreatment with silymarin decreased the pancreas weight/body weight ratio and serum amylase activity. Furthermore, silymarin treatment inhibited pancreas and lung injury and neutrophil infiltration during cerulein-induced AP. In addition, silymarin inhibited increased secretion of proinflammatory cytokines such as interleukin 1β, interleukin 6, and tumor necrosis factor α. Finally, mitogen-activated protein kinases (MAPKs) and nuclear factor-κB were activated by cerulein, and only p38 in MAPK was inhibited by silymarin.

Conclusions

These findings suggest that silymarin attenuates the severity of AP through inhibition of p38 MAPKs and that silymarin could be a potential prophylactic and therapeutic agent for the treatment of AP.
Characteristics of Long Noncoding RNAs in the Pancreas of Rats With Acute Pancreatitis
Authors: Xia Shijin , Lin Jing , Wang Ling , Shuang Xiaoping , Li Rui , Zhang Wei , Zheng Songbai
Published: December 2019

Objective

Long noncoding RNAs (lncRNAs) have received increasing attention as potential regulators of several biological processes. However, the precise effects of lncRNAs in acute pancreatitis (AP) have seldom been studied. This study aimed to describe the microarray-based differential expression profile of messenger RNA (mRNAs) and lncRNAs in AP and identify candidate biomarkers for the diagnosis, prognosis, and treatment of AP.

Methods

A rat model of AP was generated with retrograde pancreatic ductal injection of sodium taurocholate, and the pancreas was harvested for microarray detection. The biological functions of differentially expressed mRNAs noted from microarray data were assessed by bioinformatics analysis. A coding-noncoding gene coexpression network was built for the most promising mRNAs, from which 10 lncRNAs were selected for subsequent validation by real-time quantitative reverse transcription polymerase chain reaction.

Results

There were 1156 lncRNAs and 3022 mRNAs distinctively dysregulated in rats with AP relative to the controls. The significantly enriched Gene Ontology term associated with upregulated mRNAs was immune system process. Kyoto Encyclopedia of Genes and Genomes functional analysis demonstrated that the upregulated transcripts were highly enriched in natural killer cell-mediated cytotoxicity.

Conclusions

Further research is needed to establish lncRNAs uc.308-, BC158811, BC166549, BC166474, and BC161988 as diagnostic and therapeutic targets.
Pancreatic Stellate Cells Promote Tumor Progression by Promoting an Immunosuppressive Microenvironment in Murine Models of Pancreatic Cancer
Authors: Li Caixia , Cui Lihua , Yang Lei , Wang Botao , Zhuo Yuzhen , Zhang Lanqiu , Wang Ximo , Zhang Qi , Zhang Shukun
Published: December 2019

Objectives

Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal forms of cancer with poor prognosis. Pancreatic stellate cells (PSCs) play a vital role in PDAC development. The aim of this study was to explore tumor microenvironment response to PSCs in an orthotopic pancreatic cancer mouse model and to assess if PSCs secreted factors that can facilitate an immunosuppressive microenvironment.

Methods

Pancreatic ductal adenocarcinoma orthotopic tumor model, derived from coinjection of Panc02 cells plus PSCs, was used to investigate tumor proliferation, metastasis, and the population of immune cells in vivo, including regulatory T cells, M2-type macrophages, myeloid-derived suppressor cells, CD8+ T cells, CD4+ T cells, M1-type macrophages, natural killer (NK), and NK T cells.

Results

Pancreatic stellate cells promoted PDAC growth not only induced cell proliferation and metastasis, but also significantly increased the suppressive immune cell population of regulatory T cells, M2-type macrophages, and myeloid-derived suppressor cells. In addition, PSCs decreased the immune cell population of CD8+ T, CD4+ T cells, and M1-type macrophages in the spleen and tumor tissues of the tumor-bearing mice. Moreover, PSCs decreased the population of NK and NK T cells in the tumor tissues.

Conclusions

Our findings support PSCs playing multiple roles in PDAC development via promoting immunosuppressive microenvironment.
Prediction of Unresectability and Prognosis in Patients Undergoing Surgery on Suspicion of Pancreatic Cancer Using Carbohydrate Antigen 19-9, Interleukin 6, and YKL-40
Authors: Palmquist Camilla , Dehlendorff Christian , Calatayud Dan , Hansen Carsten Palnæs , Hasselby Jane Preuss , Johansen Julia Sidenius
Published: December 2019

Objectives

The aim was to determine whether serum levels of carbohydrate antigen (CA) 19-9, interleukin 6 (IL-6), and YKL-40 could identify advanced disease and poor prognosis in pancreatic cancer (PC) patients intraoperatively diagnosed with locally advanced or metastatic disease.

Methods

Two hundred ninety patients were included with preoperative blood samples. Plasma IL-6 and YKL-40 were determined by enzyme-linked immunosorbent assays.

Results

Interleukin 6 was elevated in patients with unresectable PC compared with resectable PC (P = 0.03). Carbohydrate antigen 19-9 and YKL-40 were similar. Patients with resectable tumors and greater than median preoperative CA 19-9, IL-6, and YKL-40 had shorter overall survival than patients with low levels (CA 19-9: hazard ratio [HR], 1.79; 95% confidence interval [CI], 1.13–2.83; P = 0.01; IL-6: HR, 1.83; 95% CI, 1.20–2.78; P = 0.01; YKL-40: HR, 1.60; 95% CI, 1.02–2.49; P = 0.04). Patients with resectable tumors and 2 or 3 high biomarker levels had significantly reduced overall survival compared with patients with low levels (2 high: HR, 2.97; 95% CI, 1.44–6.10; P = 0.00; 3 high: HR, 3.10; 95% CI, 1.45–6.65; P = 0.00).

Conclusions

Preoperative levels of CA 19-9, IL-6, and YKL-40 may be useful to identify a subgroup of PC patients with poor prognosis.
Variable Expression of MSH6 in Endometrial Carcinomas With Intact Mismatch Repair and With MLH1 Loss Due to MLH1 Methylation
Authors: Tandon Nidhi , Hudgens Courtney , Fellman Bryan , Tetzlaff Michael T. , Broaddus Russell R.
Published: December 2019

Immunohistochemistry for mismatch repair proteins MLH1, MSH2, MSH6, and PMS2 is an effective screen to detect individuals at risk for Lynch syndrome. College of American Pathologists guidelines stipulate that protein expression should be reported as present versus absent, as most patients with germline mutations in a mismatch repair gene have complete loss of protein expression in tumor cells. A similar approach is employed to screen for cancer patients eligible for immune checkpoint blockade. This “all or none” interpretive approach ignores substantial evidence that mismatch repair may be more finely regulated by other mechanisms. We have observed clinically that MSH6 expression is variable, even in carcinomas that are overall considered positive for MSH6 expression. A proof-of-principle study was therefore designed to more rigorously quantify the protein expression of MSH6 and its binding partner, MSH2, using image analysis applied to age-matched endometrioid grade 2 subsets that were either mismatch repair intact or MLH1-deficient due to MLH1 gene methylation. In both endometrioid groups, MSH6 expression was significantly lower than MSH2 expression. MSH6 expression increased in higher grade, mismatch repair intact serous carcinomas, but it was still significantly lower than that for MSH2. MSH2 expression was consistently high across the 3 different tumor groups. These results suggest that MSH6 expression is subject to wide fluctuations in expression, even when overall its expression is considered intact. While such fluctuations are likely not relevant for Lynch syndrome screening, they may be more impactful when considering patients eligible for immune checkpoint blockade.
Immunohistochemical Markers With Potential Diagnostic, Prognostic, and Therapeutic Significance in Uterine Carcinosarcoma: A Clinicopathologic Study of 43 Cases
Authors: Jones Terrell E. , Pradhan Dinesh , Dabbs David J. , Bhargava Rohit , Onisko Agnieszka , Jones Mirka W.
Published: December 2019

Uterine carcinosarcomas (UCS) are rare and highly aggressive tumors. Although it is currently accepted that the majority of UCS are metaplastic carcinomas, their aggressive behavior is unparalleled to that of any other high-grade endometrial neoplasms. Therefore, the search for the distinct immunohistochemical and molecular features that could help in the development of new treatment strategies continues. We evaluated the expression of PDL-1, growth hormone releasing hormone receptor, p53, WT1, PAX-8, estrogen receptor, HNF-1, and mismatch repair proteins in 43 UCS. Tumors were selected from the archives of the Magee-Womens Hospital University of Pittsburgh Medical Center Department of Pathology. Seventeen were stage I, 4 were stage II, 15 were stage III, and 7 were stage IV. The median age was 67 yr and median overall survival was 3.2 yr. Immunostaining for PAX8, HNF-1, and estrogen receptor showed statistically significant difference between epithelial and stromal components. Expression of p53 was significantly associated with clinical high stage, but other markers did not correlate with stage or survival. Immunostaining for programmed death ligand-1 was strongly positive in 30 UCS (70%), including 24 cases with tumor cell positivity, 12 cases with tumor cell and tumor-infiltrating immune cell positivity, and 6 cases with tumor-infiltrating immune cell positivity only. Of 27 tumors tested for mismatch repair expression, 12 (44%) showed loss of expression, 7 of which were PDL-1 positive. Growth hormone releasing hormone receptor was positive in 38 tumors (88%) and predominantly expressed in the epithelial component. The range of positivity for programmed death ligand-1 and growth hormone releasing hormone receptor suggests a possible potential adjuvant treatment that may be considered for UCS.
Pediatric pain treatment and prevention for hospitalized children
Authors: Friedrichsdorf Stefan J. , Goubert Liesbet
Published: December 2019

Introduction:

Prevention and treatment of pain in pediatric patients compared with adults is often not only inadequate but also less often implemented the younger the children are. Children 0 to 17 years are a vulnerable population.

Objectives:

To address the prevention and treatment of acute and chronic pain in children, including pain caused by needles, with recommended analgesic starting doses.

Methods:

This Clinical Update elaborates on the 2019 IASP Global Year Against Pain in the Vulnerable “Factsheet Pain in Children: Management” and reviews best evidence and practice.

Results:

Multimodal analgesia may include pharmacology (eg, basic analgesics, opioids, and adjuvant analgesia), regional anesthesia, rehabilitation, psychological approaches, spirituality, and integrative modalities, which act synergistically for more effective acute pediatric pain control with fewer side effects than any single analgesic or modality. For chronic pain, an interdisciplinary rehabilitative approach, including physical therapy, psychological treatment, integrative mind–body techniques, and normalizing life, has been shown most effective. For elective needle procedures, such as blood draws, intravenous access, injections, or vaccination, overwhelming evidence now mandates that a bundle of 4 modalities to eliminate or decrease pain should be offered to every child every time: (1) topical anesthesia, eg, lidocaine 4% cream, (2) comfort positioning, eg, skin-to-skin contact for infants, not restraining children, (3) sucrose or breastfeeding for infants, and (4) age-appropriate distraction. A deferral process (Plan B) may include nitrous gas analgesia and sedation.

Conclusion:

Failure to implement evidence-based pain prevention and treatment for children in medical facilities is now considered inadmissible and poor standard of care.
Surgical Assessment Units: The Key to More Efficient Emergency Surgical Provision and Admissions?
Authors: Reeds Matthew G. , Andreani Stefano M. , Rohatgi Ashish , Taylor Fiona G. M.
Published: December 2019

Background:

Hospitals establish surgical assessment units to promote efficiency and improve patient experience. Surgical assessment units are believed to reduce unnecessary admissions. We evaluated a hospital's on-call surgery service without this facility to determine benefits of implementation.

Methods:

All emergency surgery referrals made over a 3-month period were recorded, including whether the patient was immediately discharged directly from emergency surgery. Data collection was undertaken by each surgical firm on-call. Immediate discharges were classed as patients not admitted to the hospital overnight (regardless of whether the patient had outpatient follow-up planned).

Results:

Nine hundred eighty-four referrals were identified. Seven hundred ninety-three referrals had complete data and therefore were included for analysis. Of these, 349 patients (44.0% of referrals) were immediately discharged from emergency surgery, thereby preventing unnecessary admissions (a high proportion of surgical referrals not requiring hospital admission). This improves hospital efficiency, cost savings, and patient experience. Immediate discharge was less frequent and more difficult to accomplish if patients were initially assessed on wards (instead of in the emergency department). This is likely due to patients' perceptions that admission was required when transferred from emergency department to a ward.

Conclusions:

Establishment of surgical assessment units has multiple potential benefits to patients, hospitals and clinicians. Appropriateness of surgical assessment unit implementation by every hospital ought to be evaluated.
Using Design Thinking to Improve Patient-Provider Communication in the Emergency Department
Authors: Aaronson Emily L. , White Benjamin A. , Black Lauren , Sonis Jonathan D. , Mort Elizabeth A.
Published: December 2019

Quality Issue:

Emergency department overcrowding has been identified as a quality and patient safety concern.

Initial Assessment:

The need for a project focused on mitigating risk in the setting of overcrowding was identified.

Choice of Solution:

Design thinking is an improvement methodology that uses a process that prioritizes empathy for end users and is optimal for abstract problems.

Implementation:

The team leveraged design thinking to walk through a 5-step process. In the empathize phase, inputs were collected and safety themes identified. In the define phase, optimal communication was identified as the focus area of the project. During the ideate phase, the team looked both internally and externally to identify tactics that existed to improve communication. Next, the team prototyped different solutions. In the testing phase, 33 trainings with 289 clinicians were conducted.

Evaluation:

The evaluation of this program demonstrated that it was positively received by clinicians. Although only 72% of clinicians believed the course would be a valuable use of their time before taking it, 97% reported it was a valuable use of their time following completion (P < .001). Precourse self-evaluation of knowledge, skill, and ability was high. Despite this, postcourse self-efficacy improved significantly in all 4 domains studied.

Lessons Learned:

Design thinking offers an agile method for process improvement that was ideal for our relatively abstract problem. Although likely not an optimal method for a problem that is well understood, design thinking holds promise for many of the increasingly patient-centered initiatives that are underway in health care.