bluuebunny/crossref_metadata_2025 huggingface dataset:
Pulmonary Artery Catheters
Authors: Oldenburg Elizabeth , Muckler Virginia C. , Thompson Julie , Smallheer Benjamin
Published: May 2019

Pulmonary artery catheters (PACs) are invasive devices placed in critically ill patients to monitor hemodynamic data. They are a high-risk, and in some settings a low-volume, medical device due to the complex insertion procedure and potentially lethal complications. Smaller intensive care units (ICUs) have large variances in exposure to PACs, therefore strengthening ICU nurses' belief in their ability to manage these hemodynamic monitoring devices is of utmost importance. The design is a single-group, pre/posttest study conducted on a 15-bed ICU to survey nurses' self-efficacy, knowledge, and satisfaction of an e-learning educational module. Both PAC and noninvasive cardiac output monitor patient application data were collected prior to and following the intervention. Fifteen ICU nurses completed all components of the module. Confidence in ability to accurately interpret hemodynamic data increased from pre- to postintervention (P < .001), and knowledge also increased from pre- to postintervention, albeit not statistically significantly (P = .088). Overall, nurses reported satisfaction with the educational module. With increased self-efficacy, nurses can feel empowered and motivated to further improve patient care management. Thus, workplaces should continue to advocate for additional educational tools for high-risk, low-volume devices.
Focusing on Health and Not Simply Health Care
Authors: Auerbach John
Published: May 2019

As Americans consider the future of health coverage, there is one continually undervalued area worthy of attention, namely prevention. The article reviews the significant gains from the Affordable Care Act as well as the remaining needs to promote health and well-being and not solely focus on the treatment of illness and injury. It identifies changes in policies that would broaden future goals beyond the receipt of clinical care to the creation of a health system committed to also recognizing and addressing the social determinants of health and meaningfully incorporating consumers, particularly those with elevated risk of preventable illness, injury, and death, in policymaking.
Can We Find a Path Between Medicare for All and Building on the ACA?
Authors: Miller Michael
Published: May 2019

In this article, we explore the political and policy challenges involved in finding a path between incremental health reform and Medicare for All. We begin by clarifying our goals and move to examining the political barriers that any solution must contend with and overcome. Finally, we outline a path forward in which we must embrace the goals of Medicare for All, consider potential coalition dynamics before combining different goals into a single proposal, and acknowledge the important role states can play in advancing reform.
From the ACA to Even Better Reform
Authors: Davidson Stephen M.
Published: May 2019

Because health policy decision makers have different economic and political interests as well as different ideological persuasions, those committed to fairer and more comprehensive reform must be prepared to compromise in order to make progress toward their goals. The primary purpose of this essay is to describe a more nearly ideal health care system and identify factors that affect how patients and providers make utilization decisions. Having a clear vision of the ultimate goals to achieve will help participants in the political process to make compromises that advance the effort and to avoid those which undermine it.
Subgroup Differences and Determinants of Patient-Reported Mental and Physical Health in Patients With Ischemic Heart Disease
Authors: Rasmussen Trine Bernholdt , Palm Pernille , Herning Margrethe , Christensen Anne Vinggaard , Borregaard Britt , Nielsen Kathrine Sjøstedt Gandrup , Thrysoee Lars , Thorup Charlotte Brun , Mols Rikke , Juel Knud , Ekholm Ola , Berg Selina Kikkenborg
Published: May 2019

Background:

A growing population is living with ischemic heart disease (IHD). Patient-reported outcomes (PROs) are reliable prognostic tools. Studies exploring PROs are needed to identify vulnerable patients and guide targeted healthcare strategies.

Objectives:

The aims of this study were to (i) describe PROs at hospital discharge across 3 diagnostic subgroups: (1) chronic IHD/stable angina, (2) non-ST-elevation myocardial infarction (non-STEMI)/unstable angina, and (3) ST-elevation myocardial infarction (STEMI), and (ii) examine determinants for PROs at hospital discharge in patients with IHD.

Methods:

This study included a national cohort with register-data linkage including 14 115 adults with IHD discharged from Danish heart centers. Eligible patients (n = 13 476) were invited to complete a questionnaire, and 7 167 (53%) responded. Questionnaires included the Medical Outcome Study Short-Form 12, the Hospital Anxiety and Depression Scale, EuroQoL, HeartQoL, the Edmonton Symptom Assessment Scale, and ancillary questions. Sociodemographic and clinical characteristics were obtained from national registers. Student t test, χ
2 test, and adjusted linear and logistic regression analyses were conducted to investigate subgroup differences, and adjusted linear and logistic regression analyses were conducted to explore determinants for PROs.

Results:

Statistically significant subgroup differences were found, with groups reporting worst to best scores for most of PROs being as follows: chronic IHD/stable angina, non-STEMI/unstable angina, and STEMI. Symptoms of anxiety were highly prevalent in the non-STEMI/unstable angina group, with 33.8% exceeding a Hospital Anxiety and Depression Scale–Anxiety cutoff score indicating a possible anxiety disorder. Determinants for worse PROs included female sex, lower educational level, obesity, and poor physical fitness.

Conclusions:

Significant differences in PROs across IHD subgroups were observed and determinants for poor outcomes suggested. Results may guide differentiated care initiatives and resource allocation for preventative strategies.
Factors Associated With Nurses' Acceptance of the Electronic Intensive Care Unit
Authors: Beasley Brittany , Barone Claudia P. , Heo Seongkum , Wright Patricia B. , Selig James P. , Rhoads Sarah , Griebel Jack
Published: May 2019

Background:

Telemedicine intensivist-led intensive care (electronic intensive care unit [eICU®]) is recommended when on-site intensivist-led intensive care is not available. Although the effects of eICU on patient outcomes are comparable with bedside intensivist-led care, not all implementations of eICU are successful in improving patient outcomes. Therefore, the aims of this study were to (1) examine the associations of perceived usefulness, perceived ease of use, nurses' attitudes toward eICU, and intention to use and (2) determine which participant characteristics were associated with these four dependent variables.

Methods:

This cross-sectional, correlational study asked bedside registered nurses to complete an anonymous online survey to explore their acceptance of eICU.

Results:

Nurses' attitude toward eICU and intention-to-use eICU demonstrated the strongest association, r(120) = 0.83, p < .001. The most significant variable associated with perceived usefulness, perceived ease of use, nurses' attitudes toward eICU, and intention to use was support from nurses. In addition, support from physicians was significantly associated with perceived usefulness, perceived ease of use, and nurses' attitudes toward eICU.

Conclusions:

Support from both bedside physicians and registered nurses in the intensive care unit had the most association with acceptance of the eICU service. Gaining their support to use an eICU service is essential.
Common Risk Stratification of Hospital and Ambulatory Patients
Authors: Cowen Mark E. , Walsh Martha M. , Posa Patricia J. , Leeman Lauren R. , Van Hoek Elizabeth , Czerwinski Jennifer L.
Published: May 2019

The care of patients with multiple chronic conditions and those near the end-of-life is often compromised by miscommunications among the healthcare teams. These might be improved by using common risk strata for both hospital and ambulatory settings. We developed, validated, and implemented an all-payer ambulatory risk stratification based on the patients' predicted probability of dying within 30 days, for a large multispecialty practice. Strata had comparable 30-day mortality rates to hospital strata already in use. The high-risk ambulatory strata contained less than 20% of the ambulatory population yet captured 85% of those with 3 or more comorbidities, more than 80% of those who would die 30 or 180 days from the date of scoring, and two-thirds of those with a nonsurgical hospitalization within the next 30 days. We provide examples how the practice and partner hospital have begun to use this common framework for their clinical care model.
Mothers' Decisions About Donating Newborns' Blood Spots for Research
Authors: Eisenhauer Elizabeth R. , Tait Alan R. , Kane Low Lisa , Arslanian-Engoren Cynthia M.
Published: May 2019

Residual dried blood spots from millions of newborns are being stored and used for research. The state of Michigan proactively developed a broad consent process for research use of newborns' blood spots. However, the extent to which mothers make informed choices about this research is unclear. A descriptive, qualitative study was conducted examining this issue. Twenty-nine observations of the consent process and 20 semistructured interviews were conducted with mothers on the postpartum unit of a large, academic hospital in Michigan. Content analysis of the transcripts was conducted. While most mothers agreed to donate the blood spots (n = 14/20; 70%), findings indicated that most decisions were uninformed (n = 16/20; 80%), as mothers lacked knowledge of biobanking research. Misunderstandings about anonymity, the consenter's credentials, and entity conducting the research seemed to influence decision making. Suggestions for improving the consent process include (1) changing the venue of blood spot education and consent from the postpartum period to the perinatal period, (2) strengthening the depth of information and delivery of information provided about the topic, including ethical and values clarification, and (3) increasing consenter education and training. Implementation may help increase the proportion of informed decisions.
Relationship Between Middle Ear Volume and Long-term Audiological Outcomes in Congenital Aural Atresia Repair
Authors: Imbery Terence E. , Maldonado Michael , Mukherjee Sugoto , Kesser Bradley W.
Published: May 2019

Objective:

To assess the association of middle ear volume with long-term hearing outcomes in congenital aural atresia (CAA) repair.

Study Design:

Retrospective chart and radiological review.

Setting:

Single academic tertiary referral center.

Patients:

Children and adults who underwent CAA repair between 1995 and 2016. Patients were divided into “best” and “worst” audiometric groups, based on stability of postoperative air conduction pure-tone average (AC PTA) results. Ten patients were included for study in the “best” group, and 12 in the “worst” group.

Intervention(s):

CAA repair.

Main Outcome Measure(s):

Long-term (> 1 yr) postoperative three-tone (500, 1000, 2000 Hz) AC PTA, speech reception threshold (SRT), air bone gap, and semiautomated calculated middle ear volume from preoperative computed tomography (CT) scans.

Results:

Statistically significant differences were noted between “best” and “worst” groups in AC PTA, SRT, and air bone gap (p < 0.001). Mean middle ear volume in the “best” group was 434.6 mm3 (range 326.3–602.1 mm3) and 339.5 mm3 (range 199.4–502.1 mm3) in the “worst” group (p = 0.02). The majority in both groups were right ears (p = 0.38), and males outnumbered females in the “best” group (9 out of 10; p = 0.018). Preoperative Jahrsdoerfer grading scores were similar between groups (p = 0.31). Mean follow-up for the “best” and “worst” groups was approximately 3.5 and 4.5 yr, respectively.

Conclusions:

For patients undergoing CAA repair, larger middle ear volume is associated with stable and better long-term audiometric outcomes.
Extended Retro/Infralabyrinthine Approach to Cerebellopontine Angle and Internal Auditory Canal, a Radio-Anatomic Study
Authors: Kouhi Ali , Firouzifar Mohammadreza , Dabiri Sasan
Published: May 2019

Introduction:

There is a considerable controversy about approaches that preserve hearing in acoustic neuroma surgery. Transtemporal approaches have the advantage of extradural drilling and minimal cerebellar retraction. We aimed to measure the limits and exposure of extended infra/retrolabyrinthine approach using temporal bone dissection and temporal high resolution computed tomography (HRCT).

Materials and Methods:

Hundred temporal bone sides (unpaired) underwent HRCT. The images were used to estimate the limits and exposure of infra/retrolabyrinthine approach. Also, 10 temporal bone sides underwent the same imaging protocol then were dissected to measure actual exposure and limits of dissection. These measures were compared with those retrieved by HRCT to find if they are appropriate to be applied in general population.

Results:

Mean posterior fossa angle of vision (24.5 degrees), retrolabyrinthine (internal auditory canal) IAC (58.6%), and infralabyrinthine IAC exposures (73.2%) were documented based on data retrieved from CT scan. After temporal bone dissection, posterior fossa (p = 0.139) and infralabyrinthine exposures (p = 0.674) were not statistically different comparing with measures retrieved from CT scan; however, retrolabyrinthine exposure was overestimated (p = 0.012).

Conclusion:

We found that at least 20% more of IAC length can be exposed by extension of retrolabyrinthine to infralabyrinthine dissection. Infralabyrinthine exposure can be estimated preoperatively using temporal bone CT but the same is not true for retrolabyrinthine exposure.
Serum Bilirubin Level as a Potential Marker for the Hearing Outcome in Severe-Profound Bilateral Sudden Deafness
Authors: Bing Dan , Wang Da-Yong , Lan Lan , Zhao Li-Dong , Yin Zi-Fang , Yu Lan , Xie Lin-Yi , Guan Jing , Wang Qiu-Ju
Published: May 2019

Objective:

To investigate the association of serum bilirubin level with hearing outcomes in bilateral sudden sensorineural hearing loss (BSSHL) patients.

Participants:

One hundred thirteen in-patient BSSHL patients were consecutively enrolled between July 2008 and December 2015 in a tertiary center.

Main Outcome Measures:

Multivariable linear regression, generalized estimating equations (GEE), and stratified analyses were applied to examine the association between serum bilirubin level and hearing outcome measures such as final hearing threshold and absolute and relative hearing gains in BSSHL.

Results:

After full adjustment for potential confounders, total bilirubin levels (TBIL) were observed to be positively and independently associated with hearing outcomes as measured by final hearing (β [95% confidence interval {CI}]: −1.5 [−2.7, −0.2] dB HL per 1 μmol/L increase in TBIL) and absolute and relative hearing gains (β [95% CI]: 1.4 [0.2, 2.7] dB and 1.6 [0.2, 3.1] dB, respectively) in the severe to profound hearing loss subpopulation.

Conclusions:

Higher TBIL levels, within the normal or mildly elevated ranges, were independently and significantly associated with better hearing outcome in BSSHL patients with severe to profound hearing loss. Given bilirubin elevation treatments exist, our finding suggests a novel pharmacological strategy for this specific subpopulation.
Incus Necrosis and Blood Supply: A Micro-CT and Synchrotron Imaging Study
Authors: Enghag Sara , Strömbäck Karin , Li Hao , Rohani Seyed Alireza , Ladak Hanif M. , Rask-Andersen Helge , Agrawal Sumit
Published: May 2019

Background:

Incus necrosis is a common complication following stapes surgery and is associated with impaired microcirculation. The objective of this study was to investigate the vascular anatomy of the human incus by using light microscopy, micro-computed tomography (micro-CT), and synchrotron phase-contrast imaging (SR-PCI) for a novel three-dimensional (3D) analysis of the middle ear, mucosal folds, major vascular pathways, and intraosseous vascular bone channels.

Methods:

One-hundred-and-fifty temporal bones from the Uppsala collection were analyzed under light microscopy. Twenty temporal bones underwent high-resolution micro-CT scanning, and an additional seven specimens underwent SR-PCI at the Canadian Lightsource in Saskatoon, Canada. One of these specimens was from an individual who had undergone stapes surgery. Data were processed with volume-rendering software to create 3D reconstructions using scalar opacity mapping for bone transparency, cropping, and soft tissue analyses.

Results:

Micro-CT and SR-PCI with 3D rendering revealed the extensive vascular plexus within the un-decalcified incus bone communicating with the exterior surface. The relationship between the vessels, lenticular process, and incudostapedial joint were clearly observed. SR-PCI allowed for histologic-level detail while preserving the specimen and its 3D relationships.

Conclusion:

SR-PCI with 3D reconstructions confirmed the main vascular supply to the lenticular process along the intraosseous lenticular vessels. This is the first synchrotron analysis of a patient having undergone stapes surgery, and it suggests that incus necrosis associated with stapes surgery may be caused by a disruption of the lenticular blood flow induced by the prosthesis loop, and not by strangulation of mucosal vessels as has been previously described.
Interventions for medically unexplained symptoms in the emergency department: a critical literature review
Authors: Lennox George A.K. , Kendall Richard
Published: May 2019

Medically unexplained symptoms, defined as physical symptoms for which no organic pathology can be found, represent 4% of all emergency department attendances annually. The standard management of these patients involves extensive investigation to rule out organic pathology, followed by simple reassurance. We conducted a literature review to determine if there was any intervention that could improve these patient’s symptoms and reduce emergency department attendances. A search of MEDLINE, EMBASE and PsycINFO yielded 1612 unique citations, of which six studies met inclusion criteria. The studies were heterogeneous in terms of the participants involved, interventions tested and conclusions drawn. Three studies tested cognitive behavioural therapy, with two finding a reduction in emergency department attendance. Overall, evidence regarding interventions for patients with medically unexplained symptoms in the emergency department is limited and of a variable quality, despite comprising 4% of emergency department attendances. Further research is required to determine the best intervention for this challenging patient group.
Caring for the patient with a failing allograft: challenges and opportunities
Authors: Agrawal Nikhil , Pavlakis Martha
Published: May 2019

Purpose of review

The population of kidney transplant recipients with advanced chronic kidney disease is growing but their outcomes are poor and care is not standardized. There has been wide variety of research in recent years on different aspects of care in failing allografts, and these research findings may help the providers in optimizing care. The purpose of the review is to outline the challenges and opportunities in management of failing allograft, and provide tools for improvement.

Recent findings

This review summarizes the recent research in field of failing allograft including outcomes, immunosuppression, risk factor management, multidisciplinary CKD care, dialysis initiation, nephrectomy and re-transplantation.

Kidney allograft failure is a period of higher risk of mortality compared with other transition periods for patients with ESRD. Risk mitigation is a complex challenge for patients and their care teams. In addition to summarizing the recent literature, we propose a checklist approach to the various issues, medical, surgical, psychological and nutritional as patients approach kidney transplant failure while they consider initiation of dialysis and possible repeat transplantation. Once standard algorithms are instituted, studies can be conducted to identify those high-value interventions that actually reduce morbidity and mortality risk during this transition period.
Evaluation of Methods to Measure Production Pressure
Authors: Wilbanks Bryan A.
Published: May 2019

Background:

Production pressure is a major contributor to the occurrence of medical errors. Production pressure is the demand on health care professionals to increase the quantity of work at the expense of quality.

Purpose:

The purpose was to summarize the state of the science on measuring production pressure in health care settings so that evidence-based strategies could be identified that minimize medical errors.

Methods:

This was a literature review. The electronic databases PubMed, Embase, and Scopus were queried using the keywords “work pressure” or “production pressure.”

Results:

Production pressure is often measured with quantitative approaches that measure efficiency, staff workload, capacity utilization (number of hospital beds occupied), or psychometric instruments. Ethnography is a qualitative method that is also used to assess production pressure.

Conclusions:

There were several strategies identified to minimize the impact of production pressure on the occurrence of medical errors. These strategies can be categorized as administrator, educational, or workflow related.
Informatics Competencies for Nurse Leaders
Authors: Strudwick Gillian , Nagle Lynn , Kassam Iman , Pahwa Meera , Sequeira Lydia
Published: May 2019

OBJECTIVE

To consolidate informatics competencies for nurse leaders.

BACKGROUND

Nurses in leadership positions with financial and human resource responsibilities have the capacity to shape how technologies are selected, implemented, and used. Many nurse leaders are not equipped with the essential informatics competencies to do so effectively. There have been efforts to identify a set of standard informatics competencies that should be core to every nurse leader's suite of capabilities; nonetheless, these efforts have yet to be disseminated widely.

METHODS

A scoping review was conducted by: 1) identifying the research questions; 2) identifying relevant studies; 3) selecting studies; 4) extracting collected data; and 5) reporting the results.

RESULTS

Fifteen articles were found, and 11 competency themes related to informatics knowledge, informatics skills, and others were identified.

CONCLUSION

Findings of this review can be used to support nursing leaders in their identification of gaps in their informatics knowledge and skill.
Does Argininosuccinate Synthase 1 (ASS1) Immunohistochemistry Predict an Increased Risk of Hemorrhage for Hepatocellular Adenomas?
Authors: Lehrke Heidi D. , Van Treeck Benjamin J. , Allende Daniela , Denham Laura J. , Gonzalez Raul S. , Moreira Roger K. , Mounajjed Taofic , Naini Bita V. , Smoot Rory L. , Zreik Riyam T. , Jenkins Sarah , Graham Rondell P.
Published: May 2019

Hepatocellular adenomas (HCAs) often pursue an innocuous clinical course. Recent work has elucidated important subtypes of HCA and biomarkers to identify them, including HCA at an increased risk for malignant transformation. Another key complication of HCAs is the risk of spontaneous tumoral hemorrhage, which may be life-threatening. Identification of a predictive biomarker for this clinical complication would therefore be of clinical value. It has been suggested that Argininosuccinate Synthase 1 (ASS1) immunohistochemistry (IHC) identifies HCA with a high propensity for hemorrhage. The aim of our study was to validate ASS1 IHC as a predictive marker of hemorrhage. Eighty-nine HCAs were collected for ASS1 IHC and subtyped according to published criteria. Clinical records were examined for evidence of tumoral hemorrhage. Twenty-one (23.6%) HCAs were complicated by clinically detected hemorrhage and were more likely to be resected (P=0.0002). Hemorrhage complicated all WHO subtypes of HCA. There was no association between hemorrhage and HCA subtype (P=0.92). Neither the distribution of ASS1 expression nor the intensity of ASS1 expression compared to normal liver showed a significant association with hemorrhage (P=0.051 and 0.34). Interlaboratory comparison of 8 cases showed good agreement regarding the intensity (6/8 and 7/8) and distribution of staining (7/8 and 7/8) across 3 laboratories performing ASS1 IHC. In conclusion, all subtypes of HCA may be complicated by hemorrhage. ASS1 IHC expression did not correlate with hemorrhagic complications. Caution is prudent before routine implementation of ASS1 IHC in clinical practice.
Effect of Anodic tDCS Over Motor Cortex Versus Cerebellum in Cerebral Palsy: A Study Protocol
Authors: Villalta Santos Lucas , Benite Palma Lopes Jamile , Almeida Carvalho Duarte Natália , Galli Manuela , Collange Grecco Luanda André , Santos Oliveira Claudia
Published: May 2019

Purpose:

To compare the clinical and functional effects of treadmill training combined with anodic transcranial direct current stimulation (atDCS) on the primary motor cortex (Cz), specifically on the area of motor cortex representation of the lower limbs, and on the cerebellum (Cb) in children with spastic cerebral palsy (CP).

Methods:

Thirty children and adolescents with spastic CP will be randomly allocated in 3 groups: (1) treadmill training and atDCS on Cz; (2) treadmill training and atDCS on Cb; (3) treadmill training and sham tDCS on Cz. Evaluations of gait spatial-temporal parameters, functional mobility, functional balance, gross motor function, and functional performance will be performed 1 week before intervention and 1 week, 1 month, and 3 months after intervention. Every 3 months the participants will cross over groups.

Discussion:

This is a protocol for an intervention study comparing the clinical and functional effects of atDCS over Cz and Cb.
The Validity of the Montreal Cognitive Assessment for Moderate to Severe Traumatic Brain Injury Patients
Authors: Tay Matthew Rong Jie , Soh Yan Ming , Plunkett Tegan Kate , Ong Poo Lee , Huang Wanping , Kong Keng He
Published: May 2019

Objective

The aim of the study was to pilot the use of Montreal Cognitive Assessment as a quick clinical screen for cognitive assessment in traumatic brain injury patients.

Design

The study recruited 61 participants with moderate to severe traumatic brain injury presenting to a tertiary rehabilitation center under the Brain Injury Program. A Montreal Cognitive Assessment questionnaire and neuropsychological battery (Repeatable Battery for the Assessment of Neuropsychological Status and Color Trails Test) were administered to participants who had completed inpatient rehabilitation.

Results

Receiver operating characteristic analysis for the Montreal Cognitive Assessment revealed an optimal balance of sensitivity and specificity at 24/25 to discriminate participants who were classified as less than 5th centile on the Total Scale Index on the Repeatable Battery for the Assessment of Neuropsychological Status. This achieved a sensitivity, specificity, PPV, and NPV of 73.9%, 86.5%, 77.3%, and 84.2%, respectively. Receiver operating characteristic analysis for the trail making subtest of the Montreal Cognitive Assessment achieved a sensitivity, specificity, PPV, and NPV of 79.4%, 74.1%, 79.4%, and 74.1% in identifying patients classified as less than 5th centile on Color Trail Test part 2.

Conclusions

The use of Montreal Cognitive Assessment displayed good validity in identifying patients with clinically significant impairment on a standard neuropsychological assessment battery in the study population. However, it may lack sensitivity for estimating mild levels of impairment.
Chimeric Antigen Receptor T Cells for B-Cell Acute Lymphoblastic Leukemia
Authors: Ceppi Francesco , Gardner Rebecca A.
Published: May 2019

Chimeric antigen receptor (CAR) T-cell therapy is transforming the landscape for treatment of B-lineage acute lymphoblastic leukemia (B-ALL). Chimeric antigen receptor T-cell therapy makes use of T cells that have been modified to target a cancer-specific cell surface antigen. There is currently 1 Food and Drug Administration–approved CD19-directed CAR T-cell therapy for relapsed/refractory B-ALL with numerous other CAR T-cell products under clinical investigation. This review covers the development of CAR T cells for B-ALL, citing the remarkable efficacy of inducing remissions in a very high-risk population of patients. However, following the first round of CAR T-cell trials targeting CD19 in B-ALL, it has been found that approximately 50% of patients who initially respond will ultimately recur. Current efforts in the field are focusing on the identification of targets beyond CD19 as well as advancing strategies to promote more durable remissions as work is ongoing to move this therapy upfront.
Multiple Myeloma, Targeting B-Cell Maturation Antigen With Chimeric Antigen Receptor T-Cells
Authors: Shah Urvi A. , Smith Eric L.
Published: May 2019

Multiple myeloma is still an incurable malignancy despite the many new therapies approved over the last decade and therefore represents a significant unmet medical need. To address this need, adoptive cellular therapies using chimeric antigen receptor (CAR) T-cells are being explored in clinical investigations. The number of CAR T-cell trials for multiple myeloma has increased exponentially over the past few years. Although the data are preliminary at this time, the results have garnered much enthusiasm in the field. Immune therapies targeting B-cell maturation antigen have been the most widely developed, and much of these early data were presented at the recent American Society of Hematology 2018 meeting. Here we review the available data for anti–B-cell maturation antigen CAR T-cell therapies and discuss next steps as the field progresses forward.
Field Suitability and Diagnostic Accuracy of the Biocentric Open Real-Time PCR Platform for Dried Blood Spot–Based HIV Viral Load Quantification in Eswatini
Authors: Kerschberger Bernhard , Ntshalintshali Nombuso , Mpala Qhubekani , Díaz Uribe Paola Andrea , Maphalala Gugu , Kalombola Sydney , Telila Addissu Bekele , Chawinga Tiwonge , Maphalala Mukelo , Jani Aditi , Phugwayo Nomcebo , de la Tour Roberto , Nyoni Nomxolise , Goiri Javier , Dlamini Sindisiwe , Ciglenecki Iza , Fajardo Emmanuel
Published: May 2019

Background:

To assess the performance and suitability of dried blood spot (DBS) sampling using filter paper to collect blood for viral load (VL) quantification under routine conditions.

Methods:

We compared performance of DBS VL quantification using the Biocentric method with plasma VL quantification using Roche and Biocentric as reference methods. Adults (≥18 years) were enrolled at 2 health facilities in Eswatini from October 12, 2016 to March 1, 2017. DBS samples were prepared through finger-prick by a phlebotomist (DBS-1), and through the pipetting of whole venous blood by a phlebotomist (DBS-2) and by a laboratory technologist (DBS-3). We calculated the VL-testing completion rate, correlation, and agreement, as well as diagnostic accuracy estimates at the clinical threshold of 1000 copies/mL.

Results:

Of 362 patients enrolled, 1066 DBS cards (DBS-1: 347; DBS-2: 359; DBS-3: 360) were tested. Overall, test characteristics were comparable between DBS-sampling methods, irrespective of the reference method. The Pearson correlation coefficients ranged from 0.67 to 0.82 (P < 0.001) for different types of DBS sampling using both reference methods, and the Bland–Altman difference ranged from 0.15 to 0.30 log10 copies/mL. Sensitivity estimates were from 85.3% to 89.2% and specificity estimates were from 94.5% to 98.6%. The positive predictive values were between 87.0% and 96.5% at a prevalence of 30% VL elevations, and negative predictive values were between 93.7% and 95.4%.

Conclusions:

DBS VL quantification using the newly configured Biocentric method can be part of contextualized VL-testing strategies, particularly for remote settings and populations with higher viral failure rates.
Controversy around airborne versus droplet transmission of respiratory viruses: implication for infection prevention
Authors: Shiu Eunice Y.C. , Leung Nancy H.L. , Cowling Benjamin J.
Published: May 2019

Purpose of review

Health agencies recommend transmission-based precautions, including contact, droplet and airborne precautions, to mitigate transmission of respiratory viruses in healthcare settings. There is particular controversy over the importance of aerosol transmission and whether airborne precautions should be recommended for some respiratory viruses. Here, we review the current recommendations of transmission-based precautions and the latest evidence on the aerosol transmission of respiratory viruses.

Recent findings

Viral nucleic acids, and in some instances viable viruses, have been detected in aerosols in the air in healthcare settings for some respiratory viruses such as seasonal and avian influenza viruses, Middle East respiratory syndrome-coronavirus and respiratory syncytial virus. However, current evidences are yet to demonstrate that these viruses can effectively spread via airborne route between individuals, or whether preventive measures in airborne precautions would be effective.

Studies that use transmission events as outcome to demonstrate human-to-human transmission over the aerosol route or quantitative measurement of infectious respiratory viruses in the air are needed to evaluate the infectiousness of respiratory viruses over the aerosol route. When a respiratory virus in concern only leads to disease with low severity, airborne precautions are not likely to be justified.
Pittsburgh Compound-B Uptake in Meningioma With Histopathologic Correlation
Authors: Doi Shuhei , Kashiwagi Nobuo , Satou Takao , Kaida Hayato , Ishi Kazunari
Published: May 2019

Previous studies have reported increased Pittsburgh compound-B (PiB) uptake in meningiomas; however, histological correlation to elucidate the underlying mechanism has not yet been done. We report a case of an 82-year-old woman with an incidental intracranial tumor that showed focal increased PiB uptake. Because of tumor growth, surgical resection was performed, yielding a histological diagnosis of meningioma. Any special and immunochemical staining for amyloid did not reveal amyloid deposition in the tumor. Our findings suggest that increased PiB uptake was not associated with amyloid in this instance.
Two-Flap Otoplasty
Authors: Ersen Burak
Published: May 2019

Prominent ear deformity is a common congenital deformity of the external ear affecting 5% of the general population. Although this is a harmless deformity, several publications demonstrate the psychological distress, emotional trauma, and behavioral problems that this deformity can inflict on children. As a result of these concerns, corrective prominent ear surgery is now widely performed as a prophylactic surgery.

A laterally based perichondrioadipodermal flap and a medially based adipoperichondrial flap were elevated. A subdermal pocket was prepared over mastoid bone. Medially based adipoperichondrial flap was fixed to the posterior helical skin; laterally based perichondrioadipodermal flap was fixed to the mastoid bone periosteum. The helix-mastoid distances and concha-mastoid angles of the patients were measured preoperatively and at the sixth month of the surgery as the late postoperative assessment. Patients were also evaluated for suture extrusion, granuloma formation, deformity recurrence, and postauricular area sensitivity.

Twenty-two patients with bilateral prominent ear deformities were treated between January 2017 and January 2018. None of the patients suffered from skin necrosis, suture extrusion, hematoma, or wound infection at the early or late postoperative period. Unilateral recurrence was noted in 1 patient, and revision was performed.

Preparation of a medially based adipoperichondrial flap and a laterally based perichondrioadipodermal flap and the reposition of these flaps with opposite vectors not only decrease postoperative complication rates but also provide a primary otoplasty technique. The posterior fascia flap is already a well-documented and reliable protruding ear correction method.
Unusual Cause of Facial Asymmetry: Sturge-Weber Syndrome
Authors: Ogul Hayri , Kiziloglu Alper
Published: May 2019

Sturge-Weber syndrome is a rare neurocutaneous disease, also called encephalotrigeminal angiomatosis. In this study, we aimed to present a patient with Sturge-Weber syndrome who had atypical radiological findings and with dural arteriovenous fistula. The patient presented with hemifacial asymmetry. Sturge-Weber syndrome may present with atypical radiological findings and additional pathologies.
Advanced Application of TaTME Platform For a T4 Anterior Rectal Tumor
Authors: Baker Emily J. , Waters Peadar S. , Peacock Oliver , McCormick Jacob J. , Heriot Alexander G. , Warrier Satish K.
Published: May 2019

Transanal total mesorectal excision (TaTME) is a rapidly progressing technique in the management of both benign and malignant rectal disease. It is a technical advance to the current gold-standard approach to rectal cancer, the transabdominal total mesorectal excision. Until now, T4 stage cancers have been considered a relative contraindication to TaTME due to the perceived technical difficulty and increased complication rate. This case describes the TaTME operative technique for a T4b locally advanced, mid rectal anterior tumor in a young male postneoadjuvant chemoradiation. Employing a dual team hybrid TaTME (Cecil approach) with laparoscopic abdominal assistance, this case highlights the ability of TaTME to be successfully utilized in more advanced malignancy and technically difficult patients without an increase in complications, operative time, or hospital length of stay.
Cold Storage Increases Albumin and Advanced Glycation-End Product-Albumin Levels in Kidney Transplants: A Possible Cause for Exacerbated Renal Damage
Authors: Lo Sorena , Byrum Stephanie D. , Tackett Alan J. , Parajuli Nirmala
Published: May 2019

Background.

Prolonged cold storage (CS) of kidneys is associated with poor renal outcome after transplantation (Tx). We recently showed that in rats (Lewis), proteasome and renal function were severely compromised in kidney transplants subjected to CS (CS/Tx) as compared with those without CS exposure (autotransplanted [ATx]).

Methods.

Evaluation of whole-kidney extracts from our rat kidney transplant model showed a subset of proteins induced after CS/Tx when compared with ATx or sham groups; this study examined those proteins using mass spectrometry, western blotting, immunoprecipitation, and immunohistochemistry.

Results.

Mass spectrometry identified basal albumin levels in sham kidney extracts; western blots and immunohistochemistry confirmed this. Western blotting showed exceptionally higher albumin levels in both soluble and insoluble fractions of CS/Tx renal extracts when compared with ATx and sham groups. Surprisingly, levels of advanced glycation-end products (AGE) were higher in CS/Tx renal extracts. Furthermore, immunoprecipitation of albumin followed by western blotting for AGE revealed AGE-albumin in all 3 extracts; its levels were highest in CS/Tx extracts. Immunohistochemistry analysis of kidney sections revealed higher albumin or AGE levels in the CS/Tx group, and the protein was detected all over (within glomeruli, and intratubular and extratubular compartments) when compared with ATx and sham groups, which show confinement of these proteins to the extratubular compartment and within glomeruli. As expected, kidneys of the ATx group showed evidence of more macrophages, which was exacerbated in the CS/Tx group.

Conclusions.

These results suggested that CS/Tx increased AGE-albumin, which was correlated with increased inflammation and renal damage.
The Relationship Between Caregiver Burden and Emotion Recognition Deficits in Persons With MCI and Early AD
Authors: Spitzer Naama , Shafir Tal , Lerman Yaffa , Werner Perla
Published: May 2019

Objectives:

Emotion recognition (ER) abilities change in people with early Alzheimer disease (AD) and mild cognitive impairment (MCI) and can influence their caregivers’ lives and experiences. The aims of this study were: (1) to assess caregivers’ awareness of ER deficits in care-receivers with early AD or MCI; (2) to examine the mediating role of caregivers’ subjective evaluations on the relationship between caregiver burden and ER deficits in persons with MCI and early AD.

Methods:

Persons with MCI (N=29) and with early AD (N=26) performed an ER task (objective emotion recognition, OER) of watching short clips of dynamic bodily and dynamic facial expressions of 6 basic emotions. In addition, their family caregivers (N=55) were interviewed to measure their evaluation of their relatives’ ER ability (subjective emotion recognition, SER) as well as their own experience of burden.

Results:

Two thirds of the caregivers either underestimated or overestimated the care-receivers’ ER deficits. Regression results yielded a significant positive relationship between OER and SER, as well as a significant negative relationship between SER and caregiver burden. Moreover, SER was found to mediate the relationship between OER and caregiver burden.

Conclusion:

Caregivers’ better awareness of ER deficits in people with MCI and early AD might mitigate the deleterious consequences of caregiving for persons with cognitive deterioration and might therefore allow better chances for people with dementia to age in a homecare setting.
Dietary polyunsaturated fatty acid supply improves Daphnia performance during vertical migration
Authors: Navarro Jana Isanta , Fromherz Matthias , Dietz Michelle , Zeis Bettina , Schwarzenberger Anke , Martin-Creuzburg Dominik
Published: May 2019

Diel vertical migration (DVM) is a common predator avoidance strategy of zooplankton. Migration to deeper water layers during the day to escape visually hunting predators most likely requires physiological adaptations to periodically changing temperatures. Polyunsaturated fatty acids (PUFA) are essential nutrients that play crucial roles in membrane temperature acclimation. Exposure to cold temperatures typically results in an increase in the relative abundance of PUFA in cell membranes and PUFA requirements of Daphnia have been shown to increase with decreasing temperatures.

To assess the significance of dietary PUFA for coping with temperature fluctuations experienced during DVM, we reared Daphnia magna at either constantly warm or fluctuating temperatures simulating DVM both with and without dietary PUFA supplementation.

We show that the well-known positive effect of dietary eicosapentaenoic acid (EPA) supplementation on offspring production and population growth rates of Daphnia is more pronounced at alternating temperatures than at constantly warm temperatures. Exposure to alternating temperatures caused modification in body PUFA concentrations and, consequently, increased lipid peroxidation. However, detrimental effects of lipid peroxidation were not evident.

Our data demonstrate that the capacity to cope with the distinct temperature fluctuations experienced during DVM increases with dietary EPA supplementation, suggesting that an adequate dietary PUFA supply is crucial especially for migrating Daphnia populations. A dietary deficiency in long-chain PUFA may thus severely constrain predator evasion, potentially resulting in increased mortality and cascading effects on lower trophic levels.
Modelling tick bite risk by combining random forests and count data regression models
Authors: Garcia-Marti Irene , Zurita-Milla Raul , Swart Arno
Published: May 2019

The socio-economic and demographic changes occurred over the past 50 years have dramatically expanded urban areas around the globe, thus bringing urban settlers in closer contact with nature. Ticks have trespassed the limits of forests and grasslands to start inhabiting green spaces within metropolitan areas. Hence, the transmission of pathogens causing tick-borne diseases is an important threat to public health. Using volunteered tick bite reports collected by two Dutch initiatives, here we present a method to model tick bite risk using human exposure and tick hazard predictors. Our method represents a step forward in risk modelling, since we combine a well-known ensemble learning method, Random Forest, with four count data models of the (zero-inflated) Poisson family. This combination allows us to better model the disproportions inherent in the volunteered tick bite reports.

Unlike canonical machine learning models, our method can capture the overdispersion or zero-inflation inherent in data, thus yielding tick bite risk predictions that resemble the original signal captured by volunteers. Mapping model predictions enables a visual inspection of the spatial patterns of tick bite risk in the Netherlands. The Veluwe national park and the Utrechtse Heuvelrug forest, which are large forest-urban interfaces with several cities, are areas with high tick bite risk. This is expected, since these are popular places for recreation and tick activity is high in forests. However, our model can also predict high risk in less-intensively visited recreational areas, such as the patchy forests in the northeast of the country, the natural areas along the coastline, or some of the Frisian Islands. Our model could help public health specialists to design mitigation strategies for tick-borne diseases, and to target risky areas with awareness and prevention campaigns.
Circulating electrolytes and the prevalence of atrial fibrillation and supraventricular ectopy: the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Alonso Alvaro , Rooney Mary R. , Chen Lin Yee , Norby Faye L. , Saenger Amy K. , Soliman Elsayed Z. , O’Neal Wesley T. , Hootman Katie C. , Selvin Elizabeth , Lutsey Pamela L.
Published: May 2019

Background

Evaluating associations of circulating electrolytes with atrial fibrillation (AF) and burden of supraventricular arrhythmias can give insights into arrhythmia pathogenesis.

Methods

We conducted a cross-sectional analysis of 6,398 participants of the Atherosclerosis Risk in Communities (ARIC) study, ages 71-90, with data on serum electrolytes (magnesium, calcium, potassium, phosphorus, chloride, sodium). Prevalence of AF was determined from study 12-lead electrocardiograms and prior history of AF-related hospitalizations. A subset of 317 participants also underwent electrocardiographic recordings for up to 14 days using the Zio®patch. Burden of other supraventricular arrhythmias [premature atrial contractions (PACs), supraventricular tachycardia] was determined with the Zio®patch. We used multivariable logistic and linear regression adjusting for potential confounders to determine associations of electrolytes with arrhythmia prevalence and burden.

Results

Among 6,394 eligible participants, 614 (10%) had prevalent AF. Participants in the top quintiles of magnesium [odds ratio (OR) 0.82, 95% confidence interval (CI) 0.62, 1.08], potassium (OR 0.82, 95%CI 0.68, 1.00), and phosphorus (OR 0.73, 95%CI 0.59, 0.89) had lower prevalence of AF compared to those in the bottom quintiles. No clear association was found for circulating chloride, calcium or sodium. Higher concentrations of circulating calcium were associated with lower prevalence of PACs using a standard 12-lead electrocardiogram, while higher concentrations of potassium, chloride and sodium were associated with higher PAC prevalence. Circulating electrolytes were not significantly associated with the burden of PACs or supraventricular tachycardia among a subset of 317 participants with extended electrocardiographic monitoring.

Conclusion

Concentrations of circulating electrolytes present complex associations with selected supraventricular arrhythmias. Future studies should evaluate underlying mechanisms.