bluuebunny/crossref_metadata_2025 huggingface dataset:
Non-traumatic perforation of the jejunum in a human immunodeficiency virus-infected patient receiving combination antiretroviral therapy
Authors: Lee Yi-Chien , Chiou Chien-Chun , Wang Jann-Tay , Yang Yi-Chun , Tung Shao-Hsien , Hsieh Szu-Min
Published: December 2019

Rationale:

Non-traumatic bowel perforation caused by cytomegalovirus (CMV) and Mycobacterium avium complex (MAC) infections has become rare among patients with acquired immunodeficiency syndrome (AIDS) in the era of combination antiretroviral therapy (cART); however, CMV-associated and MAC-related immune reconstitution inflammatory syndrome (IRIS) has subsequently emerged owing to the wide use of integrase inhibitor-based regimens. Here we report a case of spontaneous perforation of the jejunum in a patient with human immunodeficiency virus (HIV) infection with good compliance to cART.

Patient concerns:

A 32-year-old HIV-infected man developed CMV disease and DMAC infection, as unmasking IRIS, 3 days after the initiation of cART. After appropriate treatment for opportunistic infections, intermittent fever with enlarged lymph nodes in the abdomen occurred as paradoxical IRIS. The patient was administered prednisolone with subsequent tapering according to his clinical condition.

Diagnoses:

Unexpected perforation of hollow organ during the titration of steroid dose with clinical presentations of severe abdominal pain was diagnosed by chest radiography.

Interventions:

He underwent surgical repair with peritoneal toileting smoothly.

Outcomes:

He was discharged well with a clean surgical wound on post-operative day 10.

Lessons:

Bowel perforation may be a life-threatening manifestation of IRIS in the era of cART. Steroids should be avoided, if possible, to decrease the risk of bowel perforation, especially in IRIS occurred after opportunistic diseases involving the gastrointestinal tract.
A typical carcinoid of the lung – a case report with pathological correlation and propagation of the cancer stem cell line BKZ1 with synaptophysin expression
Authors: Windmöller Beatrice Ariane , Greiner Johannes F.W. , Förster Christine , Wilkens Ludwig , Mertzlufft Fritz , Schulte am Esch Jan , Kaltschmidt Barbara , Kaltschmidt Christian , Beshay Morris
Published: December 2019

Rationale:

Neuroendocrine tumors (NETs) of the lung account for 5% of all cases of lung cancer, which itself is the leading cause of cancer-related death worldwide. In accordance to its rarity, only few cell lines of NETs exist, which even often lack key characteristics of the primary tumor, making it difficult to study underlying molecular mechanisms.

Patient concerns:

The patient reported in this case is a 71-year old woman, which never smoked but suffered under dry cough.

diagnoses:

Chest CT-scan showed a paracardiac nodule of the lingula with 2 × 1.8 cm in diameter.

Interventions:

The detected paracardiac nodule of the lingula was anatomically resected using video assisted thoracic surgery.

Outcomes:

Histopathological diagnostic of the removed tissue identified the tumor as a well-differentiated typical carcinoid (TC), which represents one of the four subgroups of pulmonary NETs. Next to the successful treatment of the patient, we were able to propagate cancer stem cells (CSCs) out of the resected tumor tissue. To the best of our knowledge, we firstly isolated CSCs of a typical carcinoid, which were positive for the prominent CSC markers CD44, CD133 and nestin, confirming their stem cell properties. Additionally, CSCs, further referred as BKZ1, expressed the neuroendocrine marker synaptophysin, verifying their neuroendocrine origin. However, nuclear synaptophysin protein was also present in other stem cell populations, suggesting a role as general stem cell marker.

Lesson:

In line with the importance of CSCs in cancer treatment and the lack of CSC-models for neuroendocrine neoplasms, the here described BKZ1 cancer stem cell line of a typical carcinoid represents a promising new model to study pulmonary carcinoids and particular NETs.
Melanotic neuroectodermal tumor of infancy in ovary
Authors: Liu Zan , Li Ming , Tang Xianglian , Xiao Yaling , Xiao Zhenghui , Li Yong
Published: December 2019

Rationale:

Melanotic neuroectodermal tumor of infancy (MNTI) is an extremely rare benign pigmented neoplasm of neural crest origin with rapid expansile growth and a high recurrence rate. It is predominantly found in infants of <1 year of age, involvement of the head-and-neck region is the most common presentation though it is reported at other sites including mediastinum, shoulder, thigh, foot, epididymis, uterus and ovary. The patient reported here is the third case of MNTI presenting in an ovary, and the first reported in the infant ovary.

Patient concerns:

A 33-month-old girl was presented to our unit for a huge abdominal mass.

Diagnosis:

MNTI was eventually diagnosed by histological manifestations supplemented with immunohistochemical findings.

Interventions:

Exploratory laparotomy and complete resection were conducted successfully.

Outcomes:

Postoperative course was uneventful and no recurrence was displayed in the 6-month follow-up.

Lessons:

This case emphasizes that pediatric surgeons and pathologists must always consider the possibility of MNTI while dealing with ovarian neoplasms in infants. Although considered to be a benign tumor, proper treatment and close clinicoradiological follow-up of this tumor are of great importance
Clinical efficacy of extracranial-intracranial bypass for the treatment of adult patients with moyamoya disease
Authors: Yang Jun , Song Guang-fu , Li Hong-bin , Zhang Shi-hua , Yang Fu-yi
Published: December 2019

Background:

Moyamoya disease (MMD) is a major health concern associated with blocked arteries at the base of the brain. The aim of this study will synthesize the current evidence of the efficacy and safety of extracranial-intracranial bypass (EIB) for the treatment of adult patients with MMD.

Methods:

A systematically and comprehensively literature search will be performed in PubMed, EMBASE, Web of Science, CENTRAL, CINAHL, AMED, CBM, and CNKI to identify relevant randomized controlled trails (RCTs) investigating the efficacy and safety of EIB for treating MMD. We will search all above electronic databases from their inception to the July 30, 2019. Two review authors will independently perform study selection, data extraction, and conduct risk of bias evaluation using Cochrane risk of bias tool. We will also explore heterogeneity across studies. RevMan 5.3 software will be applied for statistical analysis performance.

Results:

This study will evaluate the efficacy and safety of EIB for the treatment of adult patients with MMD.

Conclusion:

The results of this study will provide latest evidence of the efficacy and safety of EIB for MMD.

Dissemination and ethics:

This study is based on published studies, thus, no ethical consideration is needed. The results of this study are expected to be published in peer-reviewed journals or will be presented on conference meeting.

Systematic review registration: PROSPERO CRD42019155839.
Management of lumbar spondylodiscitis developing after laparoscopic sacrohysteropexy with a mesh
Authors: Qu Da-Cheng , Chen Hong-Bin , Yang Mao-Mei , Zhou Hong-Gui
Published: December 2019

Introduction:

Lumbar spondylodiscitis is a rare and severe complication of laparoscopic sacrohysteropexy with a polypropylene mesh. However, a case of lumbar spondylodiscitis following laparoscopic sacrohysteropexy has not been reported so far. We present a case of lumbar spondylodiscitis following laparoscopic sacrohysteropexy with a mesh. We also discuss 33 cases of lumbar spondylodiscitis following sacral colpopexy and (or) rectopexy with a mesh.

Patient concerns:

A 46-year-old woman with 3 previous vaginal deliveries underwent laparoscopic mesh sacrohysteropexy for stage III uterine prolapse. One month after surgery, the patient developed persistent symptoms, such as stiffness of the lumbosacral portion, low back pain (LBP), persistent swelling, pain between the right iliac crest and the buttock, inability to bend down, and pain in the right lower limb. Symptoms were alleviated by a nonsteroidal anti-inflammatory drug. However, in the last 7 days, symptoms worsened and she was unable to stand or walk. The patient had very limited leg mobility.

Diagnosis:

Blood routine examination, erythrocyte sedimentation rate, C-reactive protein, and magnetic resonance imaging (MRI) of the lumbar spine indicated lumbar pyogenic spondylodiscitis.

Interventions:

Removal of mesh and hysterectomy via laparoscopy were performed immediately, and antibiotics were given simultaneously. However, on the basis of MRI findings and persistent symptoms, debridement, laminectomy, spinal canal decompression, bone grafting, and internal fixation via pedicle screw placement were performed 5 months after laparoscopic sacrohysteropexy.

Outcomes:

All symptoms were alleviated 5 days after the operation. The patient could stand in the erect position and raise her lower limbs within 2 weeks. She could resume her normal activities within 2 months after the operation, and her X-ray appeared normal.

Conclusion:

Persistent LBP and radiating pain may be the signals of lumbar spondylodiscitis. MRI is the gold standard diagnostic examination for lumbar spondylodiscitis. Awareness of symptoms, such as LBP and radiating pain symptoms, timely diagnosis, mesh removal, and referral to orthopedists are important to prevent more severe complications. Surgical practice needs to be improved further and any other infections should be treated immediately as the most likely causes of lumbar spondylodiscitis are related to the mesh and other infections.
Reversible cerebral vasoconstriction with thunderclap headache
Authors: Ji Jae Young , Jung Ho Soon , Yoo Sie Hyeon , Son Hee Dong , Kim A. Joo
Published: December 2019

Rationale:

Reversible cerebral vasoconstriction syndrome (RCVS) is often accompanied by thunderclap headaches. Although symptoms usually resolve spontaneously within 2 months, it can cause fatal complications, such as cerebral hemorrhage, and is difficult to differentiate from a migraine and other headaches on the basis of symptoms and Imaging study. In this case report, we explore clinical findings and appropriate treatment methods for RCVS through the case study of a female patient who experienced severe headache upon defecation

Patient concerns:

A 42-year-old female patient complained of a severe throbbing headache with a Numeric Rating Scale (NRS) score of 10 after defecation. The pain subsided temporarily after treatment with diclofenac 75 mg and Tridol 50 mg propacetamol 1 g, but the headache returned upon defecation; soon after, the patient complained again of regular headaches at 4 to 6-hour intervals irrespective of defecation.

Diagnosis:

Brain computed tomography (CT) and head and neck magnetic resonance angiography, performed during a headache episode, revealed no specific neurological findings. Blood analysis was also normal. Head and neck CT angiography, performed one month after the start of the headaches, revealed RCVS.

Interventions:

Treatment commenced with pregabalin (150 mg), oxycodone HCl/naloxone (10/5 mg), Alpram (0.5 mg), milnacipran (25 mg), and frovatriptan 25 mg, but there was no improvement in the headaches. The patient received bilateral trigger point injections (TPI) in the temporal muscles on four occasions at the pain clinic.

Outcomes:

Medication showed no effect, but after the patient received four sessions of bilateral TPI in the temporal muscles her NRS score eventually decreased from 10 to 2. The patient is currently continuing medication while still experiencing headaches at reduced intensities.

Lessons:

RCVS is difficult to diagnose; moreover, it is difficult differentiate RCVS from other headaches. However, as it can cause fatal complications, it should not be overlooked. It is essential to consider diagnostic treatment for all types of headaches because RCVS can be accompanied by headaches originating from other causes.
Prenatal diagnosis of a 5q35.3 microduplication involving part of the ADAMTS2 locus: a likely benign variant without apparent phenotypic abnormality
Authors: Yue Fagui , Yu Yang , Xi Qi , Zhang Hongguo , Jiang Yuting , Li Shibo , Liu Ruizhi , Wang Ruixue
Published: December 2019

Rationale:

Chromosomal duplications are associated with a series of genetic disorders. However, chromosome 5q duplications, especially pure 5q35.3 microduplications, have rarely been reported in the literature. Clinical phenotypes usually depend on the region of chromosome duplicated, its size, and loci.

Patient concerns:

From 2011 to 2017, prenatal amniotic fluid samples were obtained from 6 pregnant women diagnosed with pure 5q35.3 microduplications following different prenatal indications at our center. We followed up the children of these pregnancies and determined their postnatal health conditions.

Diagnoses:

Cytogenetic studies delineated that all patients had normal karyotypes, except for patient 6 who had 46,XX,inv(9)(p11q13). Single-nucleotide polymorphism array results showed 177–269 kb duplications of 5q35.3 (chr5:178728830–178997692) in these cases. All shared similar localization of ADAMTS2.

Interventions:

All pregnant women chose to continue the pregnancies. Follow-up analysis showed that the children presented normal physical and growth developments.

Outcomes:

We described six prenatal cases with similar 5q35.3 duplications involving part of the ADAMTS2 locus with no apparent postnatal phenotypic abnormalities.

Lessons:

Our research revealed that partial microduplication of ADAMTS2 (chr5:178728830–178997692) might be benign and not correlate with disorders. And there might exist phenotypic diversities of 5q35.3 duplications.
Prognostic and clinical significance of long non-coding RNA HNF1A-AS1 in solid cancers
Authors: Zhou Xi , Fan Yang-Hua , Wang Yan , Liu Yong
Published: December 2019

Background:

LncRNA HNF1A Antisense RNA 1 (HNF1A-AS1) is often dysregulated in cancer. We performed this meta-analysis to clarify the usefulness of HNF1A-AS1 as a prognostic marker in malignant tumors.

Methods:

The PubMed, OVID, and Web of Science databases were searched from inception to January 11, 2018. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated to explore the relationship between HNF1A-AS1 expression and survival. Odds ratios (OR) were calculated to assess the association between HNF1A-AS1 expression and pathological parameters.

Results:

Eight studies with a total of 802 patients were included in the study. The pooled hazard ratio (HR) suggested high HNF1A-AS1 expression correlated with poor overall survival (OS) (HR = 4.85, 95% confidence interval (CI): 2.43–9.68), and disease-free survival (DFS) (HR = 6.34, 95% CI: 1.03–39.12) in cancer patients. High HNF1A-AS1 expression also correlated with poor histological grade (OR = 1.88, 95% CI: 1.27–2.79), high tumor stage (OR = 4.04, 95% CI: 2.53–6.47), lymph node metastasis (LNM) (OR = 4.53, 95% CI: 2.30–8.92), and distant metastasis (OR = 5.99, 95% CI: 2.88–12.48). Begg funnel plot did not show any evidence of obvious asymmetry for high tumor stage (Pr > |z| = 0.368) and LNM (Pr > |z| = 1.000).

Conclusions:

Thus high HNF1A-AS1 expression is predictive of poor OS, DFS, lymph node metastasis, distant metastasis, histological grade, and larger tumor stage, which suggests high HNF1A-AS1 expression may serve as a novel biomarker of poor prognosis in cancer.
Septic shock caused by Rhizobium radiobacter in an elderly woman
Authors: Wang Dong-lian , Zhao Li-dong , Li Li-juan , Zhou Min-jie
Published: December 2019

Rationale:

Rhizobium radiobacter is a Gram-negative pathogen present in soil and plants. Cases of R radiobacter infection in immunocompromised hosts have been sporadically reported. However, septic shock caused by R radiobacter is rarely seen.

Patient concerns:

Here, we describe an elderly patient with a rapid progression of watery diarrhea, anorexia, fever, weakness, oliguria, and shock. Blood results showed increased total white blood cell count and C-reactive protein. Arterial blood gas results showed hypoxia and elevated lactate level. The Sequential Organ Failure Assessment score was 11. Blood culture at admission showed Gram-negative bacteria, which were later confirmed as R radiobacter.

Diagnosis:

Septic shock caused by R Radiobacter.

Interventions:

The patient was treated with intravenous cefoperazone/sulbactam and sequential oral levofloxacin.

Outcomes:

The patient recovered completely.

Conclusion:

R radiobacter may be considered as a potential opportunistic pathogen that may cause severe sepsis in elderly patients, especially those with multiple underlying diseases.
Pulmonary and mediastinum metastasis of uterine leiomyoma
Authors: Huang Liqiang , Shi Gaofeng , Wang Qi , Guo Yuwei , Cong Mengdi
Published: December 2019

Rationale:

Pulmonary benign metastasizing leiomyoma (PBML) is rare, usually occurs in women who underwent hysterectomy during the reproductive years, and has no obvious clinical symptoms. A full understanding of the characteristics of PBML is important for its sequential treatment and prognosis.

Patient concerns:

In this report, a 36-year-old female patient with previous uterine leiomyoma who underwent 3 surgical resections of the uterus, bilateral fallopian tubes, and partial omentum was investigated. The physical examination revealed a tumor in the right lower lobe and mediastinum and a solid nodule in the right middle lobe.

Diagnoses:

Chest computed tomography (CT) confirmed a tumor in the right lower lobe and mediastinum and a solid nodule in the right middle lobe. Further positron-emission tomography computed tomography (PET-CT) with 18F-fluorodeoxyglucose (FDG) of the whole body showed mildly intense accumulation of 18F-FDG in the tumor (maximum standardized uptake value [SUV max], 2.6). A pathological examination then confirmed the presence of fibrous and vascular tissue after CT-guided percutaneous biopsy of the tumor in the right lower lobe. Additionally, surgical resection of the tumor and nodule was performed for histological analysis and immunohistochemical assays for estrogen receptor (ER) and progesterone receptor (PR).

Interventions:

The patient underwent complete tumor surgical resection and nodule wedge resection.

Outcomes:

No postoperative complications occurred. No recurrence or other signs of metastasis were found during an 18-month follow-up observation period.

Conclusion:

In this case, lung and mediastinal metastasis of uterine fibroids was observed. However, depending on only a postoperative histological analysis is insufficient for the diagnosis of PBML. Histological analysis combined with an evaluation of the expression levels of ER and PR is crucial for the diagnosis and treatment of PBML.
Multidrug resistant lymph node fistula tracheobronchial tuberculosis
Authors: Liu Jiang , Xie Shouning , Yu Laishun , Su Xiaoling
Published: December 2019

Rationale:

The patient in this case report has been diagnosed with multidrug resistant lymph node fistula tracheobronchial tuberculosis (TBTB). The PubMed was searched using the keywords “Tuberculosis, Multidrug-Resistant”, “Tuberculosis”, and “Bronchial Fistula”, and the results yielded no similar case reports. Therefore, this report helps us to explore more on the causes of multidrug resistance and formation of lymph node fistula, as well as associated treatment strategies.

Patient concerns:

A 15-year old Tibetan girl who was previously treated in the local Hospital for Infectious Diseases for repeated TBTB demonstrated poor treatment outcomes, and so was further diagnosed in our hospital. After standard treatments, the cough and expectoration of the girl showed improvement, and mycobacterium culture showed negative results. Thoracic CT showed local compression of the right bronchus, and disappearance of stenosis. Bronchoscopy showed that the fistula was closed and healed.

Diagnoses:

Multidrug resistant lymph node fistula TBTB.

Interventions:

Antituberculosis drugs such as pyrazinamide (0.75 g/time, twice per day), moxifloxacin (0.4 g per day), protionamide enteric-coated tablets (0.2 g/time, 3 times per day), pasiniazide tablets (0.3 g/time, 3 times per day), and capreomycin (0.75 g per day) were orally administered. The treatment included an 8-month intensive treatment phase and a 12-month consolidation phase. Bronchoscopic local injection combined with cryotherapy was also conducted.

Outcomes:

Bronchoscopy showed that the fistula was closed and healed, mycobacterium culture showed negative results, and thoracic CT showed local compression of the right bronchus, disappearance of stenosis after treatment.

Lessons:

(1) This girl had a history of long-term oral intake of antituberculosis drugs, but the treatment effectiveness remained poor. Therefore, resistance to tuberculosis can be considered, and also mycobacterium culture and drug sensitivity tests should be considered. After these, the treatment strategies should be adjusted accordingly.

(2) TBTB should be further classified by analyzing under the bronchoscope to decide the best treatment strategy accordingly.
Uterine leiomyoma in a 13-year-old adolescent successfully treated with laparoscopic myomectomy
Authors: Morita Natsuko , Tanaka Tomohito , Hashida Sosuke , Tsunetoh Satoshi , Taniguchi Kohei , Komura Kazumasa , Ohmichi Masahide
Published: December 2019

Rationale:

Uterine leiomyoma, which is very common gynecological tumor in the reproductive years, is extremely rare in adolescence. We herein report a case of a uterine leiomyoma treated with laparoscopic surgery in an adolescent.

Patient concerns:

A 13-year-old girl with no gravida and her first menses at 11 years of age reported feeling bloated. She had a regular menstrual cycle but felt increased abdominal distension.

Diagnosis:

Transabdominal ultrasound and magnetic resonance imaging revealed uterine leiomyoma with a diameter of 10 cm.

Intervention:

Laparoscopic myomectomy was performed.

Outcomes:

The total weight of the leiomyoma removed was 660 g with pathological diagnosis of uterine leiomyoma. The postoperative course was uneventful. The patient was free of disease at the follow-up consultation 18 months after the treatment.

Lessons:

Laparoscopic approach is a very useful and minimally invasive surgery for symptomatic leiomyoma in adolescents.
Safety and feasibility of laparoscopic liver resection for patients with large or multiple intrahepatic cholangiocarcinomas
Authors: Zhu Yunfeng , Song Jiulin , Xu Xi , Tan Yifei , Yang Jiayin
Published: December 2019

Only a few high-volume centers have reported the efficacy of laparoscopic liver resection (LLR) for patients with intrahepatic cholangiocarcinoma (ICC). The minimally invasive approach is still controversial for ICC, especially when dealing with large (≥5 cm) or multiple (≥2) ICCs.

Patients with large and multiple ICCs who underwent LLR or open hepatectomy (OH) between January 2012 and June 2017 were included. Furthermore, 1:2 propensity score matching (PSM) was performed between the LLR group and the OH group. Short- and long-term outcomes were compared between the different techniques.

After PSM, LLR resulted in significantly longer operation time (median 225 minutes vs 190 minutes, P = .006) and pringle maneuver time (median 50 minutes vs 32.5 minutes, P = .001). There was no statistically significant difference in postoperative hospital stay between the different approaches (median 6 days vs 7 days, P = .092). The grade III/IV complication rates were comparable between the groups (5.6% vs 11.1%, P = .868). In the PSM subset, there was no significant difference in terms of overall survival (P = .645) or disease-free survival (P = .827) between patients in the LLR group and in the OH group.

The present study showed that patients who underwent LLR for large or multiple ICCs could obtain similar short- and long-term outcomes compared with those who underwent OH, and lymph node dissection (LND) was technically difficult but feasible during LLR.
Infection Concept Integration and Teaching Strategies in US Baccalaureate Nursing Programs in an Era of Concept-Based Curriculum
Authors: Manning Mary Lou , Pogorzelska-Maziarz Monika , Ward Julia
Published: December 2019

Background

Health care–associated infections remain a major patient safety problem. Antibiotic resistance and the resurgence of infectious diseases pose an escalating threat to public health. It is essential for nursing students to develop an understanding of the infection concept and the ability to apply their knowledge and skills in all settings.

Purpose

The purpose was to describe the integration of the infection concept and associated teaching strategies in US baccalaureate nursing programs.

Methods

A comprehensive literature review was conducted using multiple online databases.

Results

There is some evidence of infection concept integration within single courses but limited evidence of integration across courses. We were unable to ascertain the degree of infection concept integration throughout a curriculum. Faculty used a blend of creative, innovative strategies to foster active teaching and learning.

Conclusion

The concept of infection and the related teaching strategies used to help students organize infection-related knowledge, skills, and attitudes to form logical connections needs greater attention.
Neuroimaging Methods for Nursing Science
Authors: Atalla Sebastian W. , Kalvas Laura Beth , Campbell Jenna L. , Anderson Alison R. , Cowan Ronald L. , Wright Kathy , Humbel Angela C. , Monroe Todd B.
Published: December 2019

Background

Since the inception of magnetic resonance imaging, thousands of studies have appeared in the literature reporting on multiple imaging techniques. However, there is a paucity of neuroimaging research programs developed by nurse scientists.

Objectives

The purpose of this article is to introduce the nurse scientist to complex neuroimaging methods with the ultimate goal of creating impetus for future use of brain imaging in nursing research.

Methods

This article reviews common neuroimaging methods, presents vocabulary frequently used in neuroimaging work, provides information on access to resources in neuroimaging education, and discusses considerations for use of neuroimaging in research.

Results

Ten imaging modalities are reviewed, including structural and functional magnetic resonance imaging, computed tomography, positron emission tomography, and encephalography.

Discussion

Choosing an imaging modality for research depends on the nature of the research question, needs of the patient population of interest, and resources available to the novice and seasoned nurse scientist. Neuroimaging has the potential to innovate the study of symptom science and encourage interdisciplinary collaboration in research.
Two Methods for Calculating Symptom Cluster Scores
Authors: Salomon Rebecca E. , Crandell Jamie , Muscatell Keely A. , Santos Hudson P. , Anderson Ruth A. , Beeber Linda S.
Published: December 2019

Background

Symptom clusters are conventionally distilled into a single score using composite scoring, which is based on the mathematical assumption that all symptoms are equivalently related to outcomes of interest; this may lead to a loss of important variation in the data.

Objectives

This article compares two ways of calculating a single score for a symptom cluster: a conventional, hypothesis-driven composite score versus a data-driven, reduced rank regression score that weights the symptoms based on their individual relationships with key outcomes.

Methods

We conducted a secondary analysis of psychoneurological symptoms from a sample of 356 low-income mothers. Four of the psychoneurological symptoms (fatigue, cognitive dysfunction, sleep disturbance, and depressed mood) were measured with the Center for Epidemiological Studies Depression Scale; the fifth (pain) was measured using an item from the Medical Outcomes Study 12-item Short Form Health Survey (SF-12). Mothers’ function was measured using the 12-item Short Form Health Survey. The composite score was calculated by summing standardized scores for each individual psychoneurological symptom. In contrast, reduced rank regression weighted the individual symptoms using their respective associations with mothers’ function; the weighted individual symptom scores were summed into the reduced rank regression symptom score.

Results

The composite score and reduced rank regression score were highly correlated at .93. The cluster of psychoneurological symptoms accounted for 53.7% of the variation in the mothers’ function. Depressed mood and pain accounted for almost all the explained variation in mothers’ function at 37.2% and 15.0%, respectively.

Discussion

The composite score approach was simpler to calculate, and the high correlation with the reduced rank regression score indicates that the composite score reflected most of the variation explained by the reduced rank regression approach in this data set. However, the reduced rank regression analysis provided additional information by identifying pain and depressed mood as having the strongest association with a mother’s function, which has implications for understanding which symptoms to target in future interventions. Future studies should also explore composite versus reduced rank regression approaches given that reduced rank regression may yield different insights in other data sets.
Computed Tomography Perfusion Data for Acute Ischemic Stroke Evaluation Using Rapid Software: Pitfalls of Automated Postprocessing
Authors: Kauw Frans , Heit Jeremy J. , Martin Blake W. , van Ommen Fasco , Kappelle L. Jaap , Velthuis Birgitta K. , de Jong Hugo W.A.M. , Dankbaar Jan W. , Wintermark Max
Published: December 2019

Computed tomography perfusion (CTP) is increasingly used to determine treatment eligibility for acute ischemic stroke patients. Automated postprocessing of raw CTP data is routinely used, but it can fail. In reviewing 176 consecutive acute ischemic stroke patients, failures occurred in 20 patients (11%) during automated postprocessing by the RAPID software. Failures were caused by motion (n = 11, 73%), streak artifacts (n = 2, 13%), and poor contrast bolus arrival (n = 2, 13%). Stroke physicians should review CTP results with care before they are being integrated in their decision-making process.
Infections Are Leading Cause of In-Hospital Mortality in Indian Patients With Inflammatory Myopathy
Authors: Muhammed Hafis , Gupta Latika , Zanwar Abhishek Arvind , Misra Durga P. , Lawrence Able , Agarwal Vikas , Aggarwal Amita , Misra Ramnath
Published: December 2019

Objectives

We explored causes of in-hospital mortality in patients with inflammatory myositis at a tertiary care center in Northern India.

Methods

Records of adults and children diagnosed with dermatomyositis (DM), polymyositis, or anti-synthetase syndrome (ASSD) who died between 2000 and 2018 were reviewed, and causes of death were determined.

Results

Of the 38 patients, 20 had DM (including 2 clinically amyopathic DM), 4 juvenile DM, 12 polymyositis, whereas 2 had ASSD. Median age at death was 42.0 (interquartile range, 32.8–52.5) years. Median disease duration at death was 18.5 (interquartile range, 2.0–23.5) months. Twenty-four (63.2%) had infection as the primary cause of death. Other causes of death included pharyngeal muscle weakness and aspiration (n = 6), myocarditis (n = 2), respiratory failure (n = 2), cerebral bleed (n = 2), and pulmonary embolism (n = 1). One patient succumbed to rapidly progressive interstitial lung disease, whereas another patient with ASSD died following respiratory distress after rituximab infusion. In post hoc analysis, although thrombocytopenia appeared to be a risk factor for early mortality (odds ratio, 13.3; 95% confidence interval, 1.4–123.8; p = 0.01), this was not supported in the multivariate analysis.

Conclusions

Infections are the most common cause of in-hospital mortality in myositis patients.
Benefits of Screen-Based Postpartum Hemorrhage Simulation on Nontechnical Skills Training
Authors: Michelet Daphné , Barré Jessy , Job Anais , Truchot Jennifer , Cabon Philippe , Delgoulet Catherine , Tesnière Antoine
Published: December 2019

Background

Postpartum hemorrhage (PPH) is the leading cause of maternal death in the world. Nontechnical skills (NTS), such as communication and teamwork, are critical for efficient management of this obstetric emergency. Specific scenarios were designed on a screen-based simulator to train NTS. This study aimed to evaluate the impact of training midwives for NTS with a PPH screen-based simulation.

Methods

A total of 24 midwives participated in the study. They were randomized in 2 groups: the NTS group (n = 12) performed 3 screen-based scenarios designed to train NTS and the control group (n = 12) performed 3 basic scenarios of the screen-based simulation without the NTS training. A structured interview followed the simulation. On the same day, each trainee underwent individually an evaluation on a PPH high-fidelity simulation scenario. Three experts, blinded to the study arm, assessed the NTS with the Anesthetists Non-Technical Skills (ANTS) score.

Results

Midwives from the NTS group achieved higher median scores in each dimension of the ANTS score: task management (4 vs. 2/4, P < 0.0001), team working (4 vs. 2/4, P < 0.0001), situation awareness (4 vs. 2.7/4, P < 0.0001), and decision-making (4 vs. 2/4, P < 0.0001). The median value of the total ANTS score was higher in the NTS group than in the control group (15.5 vs. 8/16, P < 0.0001).

Conclusions

Our study highlights that training with a NTS screen-based simulation, with specific scenarios and debriefing, leads to higher midwives' nontechnical skills performance during simulated postpartum hemorrhage.
Guidelines and Essential Elements for Prebriefing
Authors: Rutherford-Hemming Tonya , Lioce Lori , Breymier Tonya
Published: December 2019

Summary Statement

Simulationists have reported essential elements that need to be included during prebriefing to establish best practices in simulation and support learner success in simulation. However, there is a gap in the literature; there is a need for synthesis of these reported elements.

This article reports the current established prebriefing standards and guidelines. It compiles all the elements that are recommended into one document to facilitate educator training. An infographic is included to serve as a cognitive aid and a checklist for facilitators to use in practice. Finally, this article discusses additional areas of inquiry and research that needs to be completed in relation to prebriefing.
The Prognostic Role of β-Catenin Mutations in Desmoid-type Fibromatosis Undergoing Resection Only
Authors: Timbergen Milea J. M. , Colombo Chiara , Renckens Michel , Kim Hee Sung , Rosmalen Joost van , Salas Sébastien , Mullen John T. , Colombo Piergiuseppe , Nishida Yoshihiro , Wiemer Erik A. C. , Verhoef Cornelis , Sleijfer Stefan , Gronchi Alessandro , Grünhagen Dirk J.
Published: December 2019

Objective:

This meta-analysis (PROSPERO CRD42018100653) uses individual patient data (IPD) to assess the association between recurrence andCTNNB1mutation status in surgically treated adult desmoid-type fibromatosis (DTF) patients.

Summary of Background Data:

The majority of sporadic DTF tumors harbor aCTNNB1(ß-catenin) mutation: T41A, S45F, and S45P or are wild-type (WT). Results are conflicting regarding the recurrence risk after surgery for these mutation types.

Methods:

A systematic literature search was performed on June 6th, 2018. IPD from eligible studies was used to analyze differences in recurrence according toCTNNB1mutation status using Cox proportional hazards analysis. Predictive factors included: sex, age, mutation type, tumor site, tumor size, resection margin status, and cohort. The PRISMA-IPD guideline was used.

Results:

Seven studies, describing retrospective cohorts were included and the IPD of 329 patients were used of whom 154 (46.8%) had a T41A mutation, 66 (20.1%) a S45F mutation, and 24 (7.3%) a S45P mutation, whereas 85 (25.8%) patients had a WTCTNNB1. Eighty-three patients (25.2%) experienced recurrence. Multivariable analysis, adjusting for sex, age, and tumor site yielded aP-value of 0.011 forCTNNB1mutation. Additional adjustment for tumor size yielded aP-value of 0.082 with hazard ratio's of 0.83 [95% confidence interval (CI) 0.48–1.42), 0.37 (95% CI 0.12–1.14), and 0.44 (95% CI 0.21–0.92) for T41A, S45P and WT DTF tumors compared to S45F DTF tumors. The effect modification between tumor size and mutation type suggests that tumor size is an important mediator for recurrence.

Conclusions:

Primary sporadic DTFs harboring aCTNNB1S45F mutation have a higher risk of recurrence after surgery compared to T41A, S45P, and WT DTF, but this association seems to be mediated by tumor size.
Medical Malpractice Litigation in Non–Mesh-Related Pelvic Organ Prolapse Surgery: An Analysis of 91 Cases
Authors: Yao Benjamin , Slopnick Emily , Sheyn David , Chapman Graham , El-Nashar Sherif , Hijaz Adonis , Mahajan Sangeeta
Published: December 2019

Introduction

Malpractice litigations have significant implications for patients and physicians. Studies have investigated mesh litigations in female pelvic reconstructive surgery, but none on nonmesh pelvic organ prolapse (POP) surgery. Our purpose is to determine the reasons for and outcomes of medical malpractice after nonmesh POP surgery.

Methods

Westlaw (Thompson Reuters, New York, New York) is a legal research database of US court records. We identified completed POP litigations from 1987 to 2018 using the following: “pelvic organ prolapse,” “enterocele,” “rectocele,” “cystocele,” “uterine prolapse,” and “vaginal wall prolapse.” Mesh-related cases were excluded. Outcomes included reasons for litigation, verdict, injury, and payments. Statistical analysis was performed with nonparametric tests and χ2 independence test.

Results

Ninety-one litigations were included. The median plaintiff age was 53 years (range, 36–85 years). The leading allegation was negligence of surgery (n = 59; 65%). The jury sided with the defendant physician in 67% of cases (n = 61). There was no association between case verdict and patient age (P = 0.781), geographic region (P = 0.824), or allegation (P = 0.904). The primary complications were urinary tract injury (n = 24; 26%), need for additional surgery (n = 22; 24%), and new postoperative urinary symptoms (n = 22; 24%). The median payout was $280,000 (interquartile range, $137,250–$1,300,000), with no difference between plaintiff awards or settlements (P = 0.659).

Conclusion

The leading allegation of malpractice litigations for nonmesh POP surgery is negligence of surgery, whereas the most common complication was urinary tract injury. A verdict in favor of the physician defendant was the most likely outcome. Plaintiff awards and settlements were not statistically different with no variation by region or time.
Cortical complexity analyses and their cognitive correlate in Alzheimer’s disease and frontotemporal dementia
Authors: Nicastro Nicolas , Malpetti Maura , Cope Thomas E. , Bevan-Jones William Richard , Mak Elijah , Passamonti Luca , Rowe James B. , O’brien John T.
Published: December 2019

The changes of cortical structure in Alzheimer’s disease (AD) and frontotemporal dementia (FTD) are usually described in terms of atrophy. However, neurodegenerative diseases may also affect the complexity of cortical shape, such as the fractal dimension of the brain surface. Thirty-two people with symptomatic AD-pathology (clinically probable AD, n=18, and amyloid-positive mild cognitive impairment, n=14), 24 with FTD and 28 healthy controls underwent high-resolution 3T structural brain MRI. Using surface-based morphometry, we created vertex-wise cortical thickness and fractal dimension maps for group comparisons and correlations with cognitive measures in AD and FTD. In addition to the well-established pattern of cortical thinning encompassing temporoparietal regions in AD and frontotemporal areas in FTD (FDR p< 0.05), we observed reductions of fractal dimension specifically involving precuneus and posterior cingulate for AD and orbitofrontal cortex and insula for FTD. Correlational analyses between fractal dimension and cognition showed that these regions were particularly vulnerable with regards to memory and language impairment in both AD and FTD. This study demonstrates a distinct pattern of fractal dimension impairment and correlation with cognition. Further studies are required to assess cortical complexity measures at earlier disease stages (e.g. in prodromal/ asymptomatic carriers of FTD-related gene mutations) to assess whether fractal dimension represents a sensitive imaging marker for prevention and diagnostic strategies.
Computation-guided optimization of split protein systems
Authors: Dolberg Taylor B. , Meger Anthony T. , Boucher Jonathan D. , Corcoran William K. , Schauer Elizabeth E. , Prybutok Alexis N. , Raman Srivatsan , Leonard Joshua N.
Published: December 2019

Splitting bioactive proteins, such as enzymes or fluorescent reporters, into conditionally reconstituting fragments is a powerful strategy for building tools to study and control biochemical systems. However, split proteins often exhibit a high propensity to reconstitute even in the absence of the conditional trigger, which limits their utility. Current approaches for tuning reconstitution propensity are laborious, context-specific, or often ineffective. Here, we report a computational design-driven strategy that is grounded in fundamental protein biophysics and which guides the experimental evaluation of a focused, sparse set of mutants—which vary in the degree of interfacial destabilization while preserving features such as stability and catalytic activity—to identify an optimal functional window. We validate our method by solving two distinct split protein design challenges, generating both broad insights and new technology platforms. This method will streamline the generation and use of split protein systems for diverse applications.
LIPID ANCHORING OF ARCHAEOSORTASE SUBSTRATES AND MID-CELL GROWTH IN HALOARCHAEA
Authors: Abdul-Halim Mohd Farid , Schulze Stefan , DiLucido Anthony , Pfeiffer Friedhelm , Filho Alexandre W. Bisson , Pohlschroder Mechthild
Published: December 2019

The archaeal cytoplasmic membrane provides an anchor for many surface proteins. Recently, a novel membrane anchoring mechanism involving a peptidase, archaeosortase A (ArtA) and C-terminal lipid attachment of surface proteins was identified in the model archaeonHaloferax volcanii. ArtA is required for optimal cell growth and morphogenesis, and the S-layer glycoprotein (SLG), the sole component of theH. volcaniicell wall, is one of the targets for this anchoring mechanism. However, how exactly ArtA function and regulation control cell growth and mor-phogenesis is still elusive. Here, we report that archaeal homologs to the bacterial phos-phatidylserine synthase (PssA) and phosphatidylserine decarboxylase (PssD) are involved in ArtA-dependent protein maturation.H. volcaniistrains lacking either HvPssA or HvPssD exhibited motility, growth and morphological phenotypes similar to those of ∆artA. Moreover, we showed the loss of covalent lipid attachment to SLG in the ∆hvpssAmutant and that proteolytic cleavage of the ArtA substrate HVO_0405 was blocked in the ∆hvpssAand ∆hvpssDstrains. Strikingly, ArtA, HvPssA, and HvPssD GFP-fusions co-localized to the mid position ofH. volcaniicells, strongly supporting that they are involved in the same pathway. Finally, we have shown that the SLG is also recruited to the mid cell prior to being secreted and lipid-anchored at the cell outer surface. Collectively, our data suggest haloarchaea use the mid cell as the main surface processing hotspot for cell elongation, division and shape determination.
Modulation of T helper 1 and T helper 2 immune balance in a stress mouse model duringChlamydia muridarumgenital infection
Authors: Belay Tesfaye , Martin Elisha , Brown Gezelle , Crenshaw Raenel , Street Julia , Freeman Ashleigh , Musick Shane , Kinder Tyler
Published: December 2019

A mouse model to study the effect of cold-induced stress onChlamydia muridarumgenital infection and immune response has been developed in our laboratory. Our previous results show that cold-induced stress increases the intensity of chlamydia genital infection, but little is known about the effect of cold-induced stress on differentiations and activities of T cell subpopulations and bone marrow derived dendritic cells (BMDCs). The factors that regulate the production of T helper 1 (Th1) or T helper 2 (Th2) cytokines is not clear. The objective of this study was to examine whether cold-induced stress modulates the expression of transcription factors and hallmark cytokines of Th1 and Th2 or differentiation of BMDCs duringC. muridarumgenital infection in mice. Our results show that mRNA level of beta2-adrenergic receptor (β2-AR) compared to β1-AR and β3-AR was high in mixed population of CD4+ T cells and BMDCs. Further, decreased expression of T-bet and low level of interferon-gamma (IFN-γ) production and increased expression of GATA-3 and interleukin-4 (IL-4) production in CD4+ T of stressed mice was observed. Exposure of BMDCs to feroterol (β2-AR agonist) or ICI,118551 (β2-AR antagonist), respectively, revealed significant stimulation or inhibition of β2-AR in stressed mice. Moreover, co-culturing of mature BMDC and naïve CD4+ T cells resulted in increased production of IL-4, IL-10, and IL-17 in culture supernatants, suggesting that stimulation of β2-AR leads to the increased production of Th2 cytokines. Overall, our results show for the first time that cold-induced stress is able to modulate the pattern of Th1 and Th2 cytokine environment, suggesting that it promotes the differentiation to Th2 rather than Th1 by the overexpression of GATA-3 correlated with elevated production of IL-4, IL-10, IL-23, and IL-17 in contrast to a low expression of T-bet correlated with less IFN-γ secretion in the mouse model.
PIM Kinases Alter Mitochondrial Dynamics and Chemosensitivity in Lung Cancer
Authors: Chauhan Shailender S. , Toth Rachel K. , Jensen Corbin C. , Casillas Andrea L. , Kashatus David F. , Warfel Noel A.
Published: December 2019

Resistance to chemotherapy represents a major obstacle to the successful treatment of non-small cell lung cancer (NSCLC). The goal of this study was to determine how PIM kinases impact mitochondrial dynamics, ROS production, and response to chemotherapy in lung cancer. Live cell imaging and microscopy were used to determine the effect of PIM loss or inhibition on mitochondrial phenotype and ROS. Inhibition of PIM kinases caused excessive mitochondrial fission and significant upregulation of mitochondrial superoxide, increasing intercellular ROS. Mechanistically, we define a signaling axis linking PIM1 to Drp1 and mitochondrial fission in lung cancer. PIM inhibition significantly increased the protein levels and mitochondrial localization of Drp1, causing marked fragmentation of mitochondria. An inverse correlation between PIM1 and Drp1 was confirmed in NSCLC patient samples. Inhibition of PIM sensitized NSCLC to chemotherapy and produced a synergistic anti-tumor response in vitro and in vivo. Immunohistochemistry and transmission electron microscopy verified that PIM inhibitors promote mitochondrial fission and apoptosis in vivo. These data improve our knowledge about how PIM1 regulates mitochondria and provide justification for combining PIM inhibition with chemotherapy in NSCLC.