bluuebunny/crossref_metadata_2025 huggingface dataset:
Complete metabolic response to therapy of hepatic epithelioid hemangioendothelioma evaluated with 18F-fluorodeoxyglucose positron emission tomography/contrast-enhanced computed tomography
Authors: Giancipoli Romina Grazia , Monti Serena , Basturk Olca , Klimstra David , Keohan Mary Louise , Schillaci Orazio , Corrias Giuseppe , Sawan Peter , Mannelli Lorenzo
Published: October 2018

Rationale:

Hepatic epithelioid hemangioendothelioma (EHE) is a rare malignant vascular tumor of endothelial origin with a highly variable clinical presentation and natural history. Given its vascular origin, new therapies with inhibitors of vascular endothelial growth factor (VEGF) have been introduced in the treatment of these patients and have shown promising results. Few reports have described the role of 18F-Fluorodeoxyglucose positron emission tomography/contrast-enhanced computed tomography (18F-FDG PET/CT) in the evaluation of this tumor after treatment with anti-angiogenic agents. Our case reports how 18F-FDG PET-CT scan was critical in the assessment of this tumor after treatment with an anti-angiogenic agent, Pazopanib, demonstrating complete metabolic response.

Patient concerns:

A 30-year-old man with no previous significant medical history presented with pain in the right upper quadrant for over a year.

Diagnoses:

Multiple hepatic masses were found on abdominal ultrasound. Liver biopsy confirmed the diagnosis of epithelioid hemangioendothelioma. 18F-FDG PET/CT was performed for staging. Multiple FDG-avid hepatic, splenic, and lymph nodes lesions were detected on 18F-FDG PET/CT. A subsequent spleen biopsy confirmed splenic involvement. Immunohistochemistry was positive for CD31, CD34, and ERG, supporting the diagnosis of epithelioid hemangioendothelioma.

Interventions:

A 1-year cyclophosphamide treatment was provided followed by Pazopanib for 17 months.

Outcomes:

Six years after the first 18F-FDG PET/CT, 18F-FDG PET/CT performed for restaging demonstrated complete metabolic response to therapy. Follow-up CT demonstrated no interval changes in size of some of the treated lesions.

Lesson:

18F-FDG PET/CT is useful for baseline assessment and posttreatment follow-up of this rare cancer.
Diagnostic performance of PCA3 and hK2 in combination with serum PSA for prostate cancer
Authors: Mao Zujie , Ji Alin , Yang Kebing , He Wei , Hu Yingfang , Zhang Qi , Zhang Dahong , Xie Liping
Published: October 2018

Objectives:

The prostate cancer gene 3 (PCA3), human kallikrein 2, and miRNA-141 are promising prostate cancer (Pca) specific biomarkers. Our aim was to evaluate the detection of PCA3, human glandular kallikrein 2 (hk2), and miRNA-141 mRNA in peripheral blood of patients received prostate biopsy. What's more, we want to detect the value of combination of PSA (prostate specific antigen) in the early diagnosis of PCa.

Materials and methods:

Hundred patients were divided into 2 groups according to the results of pathologic diagnosis. Quantitative real-time PCR (qRT-PCR) was used to evaluate the mRNA of PCA3, hk2, and miRNA-141 in peripheral blood. At the same time, analyze those clinical outcomes used in the patients. We compared these different outcomes to evaluate the value of new molecular markers.

Results:

The level of mRNA of PCA3, hK2, and miR-141 in Pca group were significantly higher than that in BPH. PSA had the highest sensitivity in predicting Pca diagnosis (76.7%); PCA3 had the highest specificity (82.5%). And the combination of PCA3, PSA, and hK2 improved area under the curve (AUC)-receiver operating characteristic (ROC) curve largely, especially those with PSA 4-10ng/mL.

Conclusions:

PCA3, hK2, and miRNA-141 were biomarkers of Pca with potential clinical application value, especially in patients with PSA gray area. Combining PCA3, PSA, and hK2 performed better than individual biomarkers alone in predicting Pca.
Change in standardized uptake values in delayed 18F-FDG positron emission tomography images in hepatocellular carcinoma
Authors: Oksuzoglu Kevser , Ones Tunc , Ozguven Salih , Inanir Sabahat , Turoglu Halil Turgut , Bozkurtlar Emine , Celikel Cigdem Ataizi , Erdil Tanju Yusuf
Published: October 2018

Delayed 18F-2-fluoro-2-deoxy-d-glucose (18F-FDG) positron emission tomography (PET) imaging has been associated with improved diagnostic yield in several malignancies; however, data on the use of delayed imaging in patients with hepatocellular carcinoma (HCC) is scarce. This study aimed to examine tumoral and background standardized uptake value (SUV) alterations in dual-phase 18F-FDG PET/computed tomography (CT) imaging.

Fifty-two HCC cases underwent dual-time-point 18F-FDG PET/CT examination where early and delayed images were obtained. The maximum and mean SUVs (SUVmax and SUVmean) of the tumor were determined for both time points. Similarly, the average SUVmean were also determined for background (liver, soft tissue, and spleen). Changes in tumoral and background SUV between early and delayed images were examined.

The mean age was 62.0 ± 12.9 years (range, 20–88 years) and the majority of the patients were men (86.5%). Tumor SUVs, both tumor SUVmean and tumor SUVmax, significantly increased at delayed images when compared to early images. In contrast, the average SUVmean for the liver, soft tissue, and spleen significantly decreased at delayed images.

A significant increase in tumor SUV in delayed images in contrast to a significant decrease in background SUVs suggests that delayed images in HCC may contribute to diagnostic performance through a potential increase in the contrast between the tumor and background. However, further studies with larger sample sizes including patients with benign lesions and different grades of the disease are warranted to better elucidate the diagnostic contribution as well as the association of delayed imaging values with prognosis.
Independent factors associated with pneumonia among hospitalized patients with acute exacerbations of chronic obstructive pulmonary disease
Authors: Yu Songsong , Fang Qiuhong , Li Yinjuan
Published: October 2018

Acute exacerbations (AE) affect the prognosis of hospitalized patients with chronic obstructive pulmonary disease (COPD). Pneumonia further affects their prognosis and early diagnosis of pneumonia in AECOPD is important to initiate treatments. This study aimed to examine the differences between hospitalized AECOPD patients with and without pneumonia in order to identify risk factors of pneumonia among hospitalized patients with AECOPD.

This was a retrospective case–control study of patients with COPD hospitalized at the respiratory ward of Beijing Shijitan Hospital, Capital Medical University, from October 2010 to October 2013. Patients were divided into the pneumonia and nonpneumonia groups based on exudations or opacities on chest computed tomography (CT) at admission. Data were analyzed using the chi-square test and independent 2-sample ANOVA in SPSS 20.0. Logistic regression analysis was used to identify the factors independently associated with pneumonia. P < .05 was considered statistically significant.

A total of 164 patients were included. Smoking history (OR = 2.646, 95%CI 1.153–6.074, P = .022), use of drugs during the stable stage (OR = 0.435, 95%CI 0.216–0.877, P = .020), D-dimer levels (OR = 1.001, 95%CI 1.000–1.002, P = .049), percentage of neutrophils (OR = 0.271, 95%CI 0.078–0.940, P = .040), and magnitude of neutrophils increase (OR = 0.946, 95%CI 0.896–0.999, P = .046) were independently associated with pneumonia in patients with AECOPD. For severe and very severe COPD patients, smoking history (OR = 4.426, 95%CI 1.458–13.435, P = .009), use of drugs during the stable stage (OR = 0.384, 95%CI 0.168–0.877, P = .042), and fever (OR = 0.426, 95%CI 0.187–0.969, P = .023) were independently associated with pneumonia.

Smoking history, use of drugs during the stable stage, and percentage of neutrophils are independently associated with CT-diagnosed pneumonia among hospitalized AECOPD patients.
The predictability of dynamic preload indices depends on the volume of fluid challenge
Authors: Guinot Pierre-Grégoire , Marc Julien , de Broca Bruno , Archange Thomas , Bar Stéphane , Abou-Arab Osama , Dupont Hervé , Fischer Marc-Olivier , Lorne Emmanuel
Published: October 2018

This study was designed to assess the association between volume of fluid challenge (FC) and predictability of respiratory variation of stroke volume (ΔrespSV) in the operating theater.

Patients undergoing intermediate/high-risk surgery and monitored by esophageal Doppler monitoring (EDM) were prospectively included. All patients were under general anesthesia and mechanically ventilated. Exclusion criteria were frequent ectopic beats or preoperative arrhythmia, right ventricular failure, and spontaneous breathing. Hemodynamic parameters and esophageal Doppler indices (SV, cardiac output, ΔrespSV) were collected before, after infusion of 250 mL, and after infusion of 500 mL of crystalloid solution. Responders were defined by a >15% increase of stroke volume after FC at each step.

After infusion of a 250 mL FC, 41 patients (32%) were classified as fluid responders (R250). After infusion of a 500 mL FC, 80 patients (63%) were classified as fluid responders (R500). The predictability of ΔrespSV was fair with an area under the curve (AUC) of 0.79 (95% CI 0.71–0.86, P < .001) to predict fluid responsiveness with a 250 mL FC. With an AUC of 0.94 (95% CI 0.88–0.97, P < .0001), ΔrespSV presented an excellent ability to predict fluid responsiveness with a 500-mL FC.

Predictability of ΔrespSV changed with the volume of fluid infused to assess fluid responsiveness. The accuracy of ΔrespSV was higher with 500 mL than with 250 mL. Bedside studies evaluating the predictability of dynamic preload indices should define fluid responsiveness as a >15% increase of SV in response to a 500-mL FC.
Liquid biopsy prediction of axillary lymph node metastasis, cancer recurrence, and patient survival in breast cancer
Authors: Lee Ju-Han , Jeong Hoiseon , Choi Jung-Woo , Oh Hwa Eun , Kim Young-Sik
Published: October 2018

Background:

Liquid biopsies using circulating tumor DNA (ctDNA) and cell-free DNA (cfDNA) have been developed for early cancer detection and patient monitoring. To investigate the clinical usefulness of ctDNA aberrations and cfDNA levels in patients with breast cancer (BC), we conducted a meta-analysis of 69 published studies on 5736 patients with BC.

Methods:

The relevant publications were identified by searching PubMed and Embase databases. The effect sizes of outcome parameters were pooled using a random-effects model.

Results:

The ctDNA mutation rates of TP53, PIK3CA, and ESR1 were approximately 38%, 27%, and 32%, respectively. High levels of cfDNA were associated with BCs rather than with healthy controls. However, these detection rates were not satisfactory for BC screening. Although the precise mechanisms have been unknown, high cfDNA levels were significantly associated with axillary lymph node metastasis (odds ratio [OR] = 2.148, P = .030). The ctDNA mutations were significantly associated with cancer recurrence (OR = 3.793, P < .001), short disease-free survival (univariate hazard ratio [HR] = 5.180, P = .026; multivariate HR = 3.605, P = .001), and progression-free survival (HR = 1.311, P = .013) rates, and poor overall survival outcomes (HR = 2.425, P = .007).

Conclusion:

This meta-analysis demonstrates that ctDNA mutation status predicts disease recurrence and unfavorable survival outcomes, while cfDNA levels can be predictive of axillary lymph node metastasis in patients with BC.
Complete response of hepatocellular carcinoma with right atrium and pulmonary metastases treated by combined treatments (a possible treatment effect of natural killer cell)
Authors: Kim Dong Hyun , Cho Eunae , Cho Sung Bum , Choi Sung Kyu , Kim Sunmin , Yu Jieun , Koh Young-Il , Sim Da Woon , Jun Chung Hwan
Published: October 2018

Rationale:

Hepatocellular carcinomas (HCCs) with metastases to the right atrium (RA) and lungs are rare, with a poor prognosis. Furthermore, the treatment outcomes in patients with advanced HCCs remain unsatisfactory.

Patient concerns:

A 46-year-old man presented to our hospital for dyspnea on exertion and abdominal pain.

Diagnoses:

HCC and extra-hepatic metastases to the lung and RA.

Interventions:

Multidisciplinary treatment including radiotherapy (RT), transarterial chemoembolization (TACE), and sorafenib. During a follow-up evaluation computed tomography, he experienced a radio-contrast-induced anaphylaxis. After the event, treatment such as RT, TACE, and sorafenib were continued.

Outcomes:

His tumor burden decreased, finally leading to a complete response as per the modified Response Evaluation Criteria in Solid Tumors. The patient is still alive, 30 months after the episode. Subsequent blood tests showed increased natural killer (NK) cell activity, which was significantly higher than that seen in other age-matched HCC patients with an identical stage of the tumor, receiving sorafenib. This suggests that the increase in NK cells induced by anaphylaxis influenced the tumor burden.

Lessons:

We report here a rare case of long-term survival of an HCC patient with multiple metastases treated with multidisciplinary modalities, in which high NK cell activity was observed after a radio-contrast-induced anaphylactic reaction during follow-up investigations.
Effects of lifestyle on hepatobiliary enzyme abnormalities following the Fukushima Daiichi nuclear power plant accident
Authors: Takahashi Atsushi , Ohira Tetsuya , Okazaki Kanako , Yasumura Seiji , Sakai Akira , Maeda Masaharu , Yabe Hirooki , Hosoya Mitsuaki , Ohtsuru Akira , Kawasaki Yukihiko , Suzuki Hitoshi , Shimabukuro Michio , Sugiura Yoshihiro , Shishido Hiroaki , Hayashi Yoshimitsu , Nakano Hironori , Kobashi Gen , Kamiya Kenji , Ohira Hiromasa
Published: October 2018

Dramatic lifestyle changes due to the Fukushima Daiichi Nuclear Power Plant accident increased the prevalence of hepatobiliary enzyme abnormalities (HEA). We aimed to evaluate associations of HEA with specific lifestyle- and disaster-related factors in residents who lived near the Fukushima Daiichi Nuclear Power Plant.

This cross-sectional study included 22,246 residents who underwent a Comprehensive Health Check and the Mental Health and Lifestyle Survey from June 2011 to March 2012. Residents were divided into 2 groups based on residential area and housing status after the accident. Associations between HEA and lifestyle- and disaster-related factors, including psychological distress, were estimated using logistic regression analysis adjusted for demographic and lifestyle factors.

HEA was present in 27.3% of subjects. The prevalence of HEA was significantly higher in evacuees than controls (29.5% vs 25.7%, P < .001). There were significant differences in various lifestyle characteristics and the prevalence of post-traumatic stress disorder between evacuees and controls. Multivariable logistic regression analysis showed that age, sex, moderate to heavy drinking, and low/no physical activity were significantly associated with HEA regardless of evacuation status. Changes in jobs and unemployment were significantly associated with HEA in controls and evacuees, respectively.

Lifestyle and disaster-related factors, but not psychological distress, were associated with HEA among subjects who lived near the Fukushima Daiichi Nuclear Power Plant accident.
Effect of acupuncture at 3-points for intelligence on vascular dementia
Authors: Sun Weipeng , Li Minying , Lin Tong , Sun Zhizhong , Xie Yizi , Ji Shuliang , Lin Jietao , Wang Lin , Jia Chao , Zheng Liang , Wu Wei , Xu Danghan
Published: October 2018

Background:

Vascular dementia (VD) is a commonly-seen disease in the elderly. What is more, “Acupuncture at 3-points for intelligence” is one of the most important components of “Jin's three-needle therapy” created by Rui Jin, a professor of Guangzhou University of Chinese Medicine, which can be used in the VD patients. In this article, researchers will assess the clinical efficacy and safety of acupuncture at 3-points for intelligence in the treatment of VD.

Methods:

A systematic literature search for articles up to September 2018 will be conducted using 9 databases: PubMed, Cochrane Library, Embase, CNKI, CBM, VIP, Wanfang database, OASIS, and CiNii. Inclusion criteria are randomized controlled trials (RCTs) of acupuncture at 3-points for intelligence on treating VD. The primary outcome measures will be scores reflecting the neurological function of participants based on common medical scales. Hemorheology indexes, homocysteine (Hcy), acetylcholine (Ach), nitric oxide (NO), and adverse events will also be assessed. Stata V.13.0 software will be used for data synthesis, sensitivity analysis, meta-regression, subgroup analysis, and risk of bias assessment. A funnel plot will be developed to evaluate reporting bias. Egger and Begg tests will be further performed to conduct quantitative evaluation of publication bias and to evaluate the symmetry of funnel plot. We will use the Grading of Recommendations Assessment, Development, and Evaluation system to assess the quality of evidence.

Results:

The results of this systematic review and meta-analysis will be published in a peer-reviewed journal.

Conclusion:

Our study will provide the evidence for the clinical efficacy and safety of acupuncture at 3-points for intelligence in the treatment of VD.
A whole exome sequencing study of a Korean proband with idiopathic basal ganglia calcification and its daughter
Authors: Lee Byung Dae , Kong Ja Young , Kwon Chae Hwa , Park Je Min , Lee Young Min , Moon Eunsoo , Jeong Hee Jeong , Kim Soo Yeon , Lee Kang Yoon , Suh Hwagyu
Published: October 2018

Idiopathic basal ganglia calcification (IBGC) is characterized by brain calcification and a wide variety of neurological and psychiatric symptoms. In families displaying an autosomal dominant inheritance pattern, three causative genes have been identified: SLC20A2, PDGFRB, and very recently, PDGFB. While in clinical practice sporadic presentation of IBGC is frequent, well-documented reports of true sporadic occurrences are rare. We report a case of a 61-year-old woman who presented with depressive and dystonic symptoms revealing IBGC. Her 41-year-old daughter was healthy. In the proband, we identified 4 mutations in PDGFB, and 1 exonic mutation in SLC20A2, all of which were absent in the daughter. These mutations may result in a loss-of-function of PDGF-B or SLC20A2, which has been shown to cause IBGC in humans and disrupts the blood-brain barrier in mice resulting in brain calcification. Herein, we present the occurrence of a sporadic patient of IBGC and its causative mutations.
Resting Energy Expenditure in Patients With Familial Dysautonomia
Authors: Bar Aluma Bat‐El , Norcliffe‐Kaufmann Lucy , Sarouk Ifat , Dagan Adi , Ashkenazi Moshe , Bezalel Yael , Vilozni Daphna , Lahad Avishay , Efrati Ori
Published: October 2018

Objectives:

Familial dysautonomia (FD) is a rare hereditary sensory and autonomic neuropathy characterized by chronic lung disease and cyclic vomiting due to hyper‐adrenergic crises. Most FD patients are in a depleted nutritional state; however, the phenotype of the disease is quite different between patients, as for the severity of lung disease and the intensity and frequency of these pathognomonic crises. In this study we wanted to investigate whether resting energy expenditure (REE) levels are increased in this population, and if correlations exist between REE levels and phenotype severity.

Methods:

Data was collected from 12 FD patients (6/6 m/f). REE measurements were conducted by indirect calorimeter. Measured REE % predicted were correlated with pulmonary function, severity of the scoliosis, serum C‐reactive protein, yearly frequency of hyperadrenergic crisis, hospital admissions and the use of nocturnal noninvasive positive pressure ventilation.

Results:

Mean REE was 112 ±13% predicted with 50% being in a hypermetabolic state (REE/HB > 110%). Body mass index (BMI) was below normal range in 75% of patients, and reduced energy intake was also decreased in 75%. No significant correlations to disease severity factors were found. When dividing the subjects to REE levels above or below 125% predicted, Patients with REE above 125% predicted presented with significantly lower inspiratory capacity (42.7% predicted vs 62.8% predicted; P = 0.04).

Conclusions:

Hypermetabolic state was described in 50% of FD patients. The Low BMI is explained by combination of relative anorexia and increased REE. The REE levels are related to the underling respiratory disease.
Vandetanib Tumor Shrinkage in Metastatic Medullary Thyroid Cancer Allowing Surgical Resection of the Primary Site: A Case Report
Authors: Milner Thomas D. , Ronghe Milind , Shaikh Mohamad G. , MacGregor Fiona B. , Reed Nicholas
Published: October 2018

Vandetanib has been shown to improve progression-free survival in adults with advanced medullary thyroid cancer. This article describes a pediatric patient with metastatic medullary thyroid cancer secondary to sporadic multiple endocrine neoplasia 2B, treated with vandetanib. At presentation, he had an inoperable primary tumor, with carotid encasement, and pulmonary metastases. Vandetanib induced a significant response: calcitonin and carcinoembryonic antigen levels both fell considerably, primary tumor maximal diameter decreased by 68%, and pulmonary metastases became no longer detectable. This allowed surgical resection of the primary tumor. The patient remains well after over 6 years of vandetanib therapy, with no treatment toxicity.
Young Adult With Osteosarcoma of the Mandible and the Challenge in Management: Review of the Pediatric and Adult Literatures
Authors: Kuo Christopher , Kent Paul M.
Published: October 2018

Neoadjuvant chemotherapy for osteosarcoma of the jaw (OSJ) remains controversial despite being a standardized treatment in osteosarcoma of the long bones. We present a case of a 22-year-old male with OSJ and performed a retrospective systemic review of previously published literatures of OSJ. We identified 27 articles: 7% recommended neoadjuvant chemotherapy, 22% recommended adjuvant chemotherapy, 19% recommended both neoadjuvant and adjuvant chemotherapy, 33% recommended against chemotherapy and 19% stated the role of chemotherapy is unknown. The lack of consensus regarding the use of chemotherapy in OSJ, despite its benefits, demonstrates the need to establish a standardized algorithm for OSJ.
Idiopathic Purpura With Gray Platelets: an Acquired Form of Gray Platelet Syndrome
Authors: Lee Anselm Chi-wai
Published: October 2018

An acquired, transient bleeding disorder that predominantly affects children in Southeast Asia has been reported for the last 4 decades. The condition has been named idiopathic purpura with gray platelets (IPGP) or acquired platelet dysfunction with eosinophilia. In a retrospective review from a private pediatric clinic over an 8-year period, 10 consecutive children were diagnosed as IPGP with a mean age of 8.4 (3.7 to 16.2) years. Eosinophilia (>0.5×109/L) was absent in 1, while gray platelets were consistently found in all cases with a mean proportion of 64.5% (40% to 80%). Platelet aggregation tests were performed in 9 patients with abnormal responses consistent with platelet storage pool defect. All children recovered completely and spontaneously from 1 to 4 months after diagnosis without specific therapy. In an otherwise well child who presents abruptly with easy bruising and a platelet count >100×109/L, IPGP can be readily recognized as an acquired form of gray platelet syndrome. Eosinophilia is common but not mandatory for diagnosis.
Epstein-Barr Virus–Associated Pulmonary Carcinoma
Authors: Yeh Yi-Chen , Kao Hua-Lin , Lee Kang-Lung , Wu Mei-Han , Ho Hsiang-Ling , Chou Teh-Ying
Published: October 2018

Lymphoepithelioma-like carcinoma (LELC) of the lung is a rare Epstein-Barr virus (EBV)-associated carcinoma. It is histologically characterized by a syncytial growth pattern with marked lymphocytic infiltration that is indistinguishable from the histology observed in undifferentiated nasopharyngeal carcinomas. However, it has been noted that LELC can display nonclassic morphology and lack significant lymphocytic infiltration. In this study, we conducted a comprehensive clinicopathologic analysis of 61 patients with pulmonary LELC and performed automatic quantification of the lymphocytic infiltrate using the IHC Profiler software. We demonstrated that pulmonary LELCs have a morphologically continuous spectrum, ranging from classic poorly differentiated tumors with intense lymphocytic infiltration to nonclassic morphology with little lymphocytic infiltration. These EBV-associated tumors represent a distinct entity and usually occur in female and nonsmoking patients. Tumors with low lymphocytic infiltration can closely resemble nonkeratinizing squamous cell carcinoma and tend to be larger in size, have higher maximum standardized uptake values on radiography, and exhibit shorter times to recurrence than those with high lymphocytic infiltration. Through detailed pathologic examination, we observed several distinct morphologic features in pulmonary LELCs, including granulomatous inflammation, focal keratinization, spread through alveolar spaces, and lepidic spreading pattern. We also found that patients with tumors exhibiting granulomatous inflammation have favorable outcomes; however, spread through alveolar spaces did not significantly correlate with prognosis. As many of these “LELCs” do not resemble undifferentiated nasopharyngeal carcinoma or lymphoepithelioma, we propose using an alternative term, EBV-associated pulmonary carcinoma, to encompass the entire morphologic spectrum of this distinct disease entity.
Association between Practice Participation in a Pediatric-focused Medical Home Learning Collaborative and Reduction of Preventable Emergency Department Visits by Publicly-insured Children in Massachusetts
Authors: Kirby Paul B. , Christensen Anna L. , Bannister Louise , Konar Valerie
Published: October 2018

Introduction:

This study evaluates the impact of practice participation in a pediatric patient-centered medical home learning collaborative on preventable emergency department (ED) visits among children in MassHealth (Massachusetts Medicaid/Children’s Health Insurance Program).

Methods:

Claims and enrollment data were extracted for child MassHealth members (aged 3–18) comprising 2 groups: members enrolled in a group of 13 child-serving practices that participated in an intensive, 29-month long patient-centered medical home learning collaborative (intervention group), and members enrolled in a group of 12 comparison practices with roughly similar panel size, type, and geographic location (comparison group). Preventable ED visits were identified using a modified version of the New York University ED algorithm. Two analyses were then conducted: (1) a repeat cross-sectional analysis among children enrolled in intervention or comparison group practices during baseline (first half of 2011) and follow-up (second half of 2013) periods; and (2) a longitudinal analysis among a subset of children enrolled for the full study period (2011–2013). Both analyses tested whether the effect of the intervention differed for children with versus without chronic conditions (effect modification).

Results:

Preventable ED visits declined from baseline to follow-up among children in both intervention and comparison practices. In the cross-sectional analysis, the decrease was the same in both practice groups, and for children with versus without chronic conditions. The longitudinal analysis shows a statistically significantly greater decrease among children with chronic conditions enrolled in the intervention practices (P = 0.02).

Conclusion:

Children with chronic conditions might receive the greatest benefit from receiving care in a medical home setting.
Reduction of Analgesia Duration after Tracheostomy during Neonatal Intensive Care: A Quality Initiative
Authors: Puthoff Teresa D. , Shah Hevil , Slaughter Jonathan L. , Bapat Roopali
Published: October 2018

Introduction:

As survival has improved in the Neonatal Intensive Care Unit (NICU), there has been a 10-fold increase in the proportion of infants requiring a tracheostomy. At our institution, we observed a wide variation in the duration of opioid use posttracheostomy from 6 to 148 days. We aimed to decrease the duration of opioid exposure in postoperative tracheostomy patients in the NICU from a baseline average of 24 days to 7 days by December 31, 2017.

Methods:

We established a multidisciplinary team to develop change ideas to implement in 3 Plan-Do-Study-Act cycles that focused on enhanced care plan standardization and communication in patient care rounds with subsequent documentation in the medical record and the timely addition of dexmedetomidine to the postoperative care plan.

Results:

Baseline population was from October 2014 to December 2016. The mean posttracheostomy opioid duration was 24.6 days (range, 6–148 days); neuromuscular blockade was 2.89 days (range, 0–9 days), and benzodiazepine exposure was 20.9 days (range, 1–114 days). Following our interventions, the mean duration of posttracheostomy opioid duration was 5.4 days (range, 4–21 days); neuromuscular blockade was 3.14 days (range, 1–5 days), benzodiazepine duration was 8.88 days (range, 4–25 days), and dexmedetomidine was 4.6 days (range, 0–32 days).

Conclusions:

We utilized quality improvement methodology to standardize posttracheostomy management and demonstrate that we could significantly reduce the duration of opioid and benzodiazepine use after tracheostomy with the timely addition of dexmedetomidine, a structured written daily care plan, and clarification of roles and responsibilities.
Decreasing Unplanned Office Visits Due to Cast Problems in the Pediatric Population
Authors: Newman Sharon Lee , Gaffney John T.
Published: October 2018

Introduction:

Unplanned office visits due to cast-related problems in the pediatric orthopedic office are common. Decreasing problems associated with the use of a cast would improve patient safety, increase office productivity, and decrease inconvenience to the child and family.

Methods:

Pediatric patients treated with a cast in our office were included in the study if they returned for an unplanned office visit due to a cast-related problem. Group 1 received verbal cast care instruction. Group 2 had the same verbal instruction in addition to a written handout identical to the verbal instructions. Group 3 was provided the same verbal instructions and a revised handout limiting the number of instructions and focused on keeping the cast away from water.

Results:

The study included 550 patients with 146 in group 1, 124 in group 2, and 280 in group 3. Comparing group 1 (10.3%) and group 2 (10.5%), there was almost no difference in the rate of unplanned office visits due to cast-related problems. Combining the revised handout with verbal instructions in group 3, the percentage of patients returning for an unplanned visit was 6%. There was a relative decrease in office visits by 55% and an absolute decrease of 4.5% when comparing group 2 and group 3.

Conclusions:

There was a decrease in the number of unplanned office visits due to cast problems utilizing a handout focused on keeping the cast dry in collaboration with verbal cast care instructions. However, the decrease was not statistically significant.
Monitoring of Sugammadex Dosing at a Large Tertiary Care Pediatric Hospital
Authors: Syed Faizaan , Trifa Mehdi , Uffman Joshua C. , Tumin Dmitry , Tobias Joseph D.
Published: October 2018

Introduction:

Anesthesiologists use sugammadex to reverse neuromuscular blockade (NMB) produced by rocuronium and vecuronium. Its mechanism involves encapsulation of the neuromuscular blocking agent. Sugammadex dosing is based on the depth of NMB, assessed by measuring the train-of-four (TOF).

Methods:

We retrospectively reviewed procedures under general anesthesia in patients older than 1 year of age if they included sugammadex reversal of rocuronium-induced NMB. Documentation of TOF monitoring before and after reversal was noted, along with the dose of sugammadex administered. TOF was considered correctly documented if the anesthesia provider recorded the number of twitches before and after NMB reversal, or if they recorded 4 twitches before NMB reversal. We defined appropriate sugammadex dosing if it was within 10% of the recommended dose for the depth of NMB. We repeated this review after staff education and creating a reminder in the electronic health record system.

Results:

We included 100 patients in the preintervention analysis, of whom 30% had correct TOF documentation. Among patients with TOF assessment before sugammadex administration, the dose was appropriate in 34 of 40 cases. In the postintervention analysis, we reviewed 75 cases and found that correct documentation improved to 45% (P = 0.024). Among postintervention cases with TOF documented before sugammadex administration, sugammadex dosing was appropriate in 62 patients.

Conclusion:

Documentation of TOF was low (30%) before intervention and improved to only 45% after the interventions, suggesting that additional interventions are needed. Even before the intervention, with or without TOF documentation, the dose of sugammadex was generally consistent with recommendations.
Aesthetic Assessment of Infants With Different Cleft Types Before, During, and After Orthopedic Treatment
Authors: Nur Yilmaz Rahime Burcu , Germeç Çakan Derya , Nalbantgil Didem
Published: October 2018

Objective:

The aim of the present study is to compare the aesthetic assessments of infants with different types of cleft before (T1), during (T2), and after (T3) orthopedic therapy (OT) by orthodontists, dentists, and laypersons.

Methods:

Photographs of 3 patients (incomplete lip [C1], complete unilateral [C2], and complete bilateral cleft [C3]) at T1 (C1, C2, C3 chronologic age: 5, 2, 2 days), T2 (C1, C2, C3 chronologic age: 32, 28, 35 days; using forehead anchoraged nasal stent or conventional nasoalveolar therapy plates), and T3 (C1, C2, C3 chronologic age: 80, 91, 105 days) were collected from the archive. The nasolabial region at stage T3 were masked and also added to the evaluation form (T4). Fifty-one evaluators (17 orthodontists, 17 dentists, and 17 laypersons; mean age = 30.1 ± 3.63) assessed 21 frontal photographs using Asher-McDade et al's 5-point scale.

Results:

The scores of the orthodontists for T1 photographs were statistically lower than the dentists and laypersons (P < 0.05). The scores of T3 and T4 were similar in all groups (P > 0.05). The assessment scores progressively decreased from T1 to T3 (P > 0.05). The scores of both treatment methods were similar in the orthodontist group (P > 0.05), whereas the scores were lower for forehead anchored nasal stent in the other groups (P < 0.05).

Conclusion:

Orthodontists are familiar with cleft patients. Therefore, the aesthetic of infants at any therapy stage with different treatment methods was not categorized as poor. The enhanced scores at post-OT stage and the similar scores of masked and nonmasked post-OT photographs may underline the recognition of the rehabilitation period by not only specialists but also laypersons.
Asymmetric Protrusion of the Midface in Young Adults
Authors: Lee Shin-Hyo , Koh Ki-Seok , Song Wu-Chul
Published: October 2018

Purpose:

This study evaluated midfacial asymmetry using an alternative method that involved comparing bilateral patterns of the zygomaticomaxillary prominence in a young adult population.

Materials and Methods:

Three-dimensional reconstructed images based on computed tomography scans of 100 Koreans (mean age, 24.7 years) were evaluated with reference to lines spaced at 30° intervals and radiating from the center of an interporion line in a superior view. The surface inclination of the zygomaticomaxillary region was quantified on the same reference lines using a 3-dimensional ruler.

Results:

The 30°-interval line (at the level of the zygomaticotemporal suture) was longer on the left side than the right side in both males and females, whereas the left 60°-interval line (at the level of the zygomaticofrontal suture) was longer in females. Comparing the surface protrusion revealed that the zygomaticomaxillary region was more prognathic and inflated on the left side.

Conclusion:

Functional deviations are considered to be causes of asymmetric craniofacial growth. Postnatal growth allometry across the circummaxillary sutures as elucidated by this study could be useful information in craniofacial surgery.
The Effect of Spreader Graft and Mattress Suture Technique on Rhinoplasty in Patients With Nasal Hump Smaller Than 3 mm
Authors: Atighechi Saeid , Sarafraz Zahra , Baradaranfar Mohammadhossein , Dadgarnia Mohammadhossein , Zand Vahid , Meybodian Mojtaba , Mandegari Mohammad , Shirkhoda Shima , Vaziribozorg Sedighe
Published: October 2018

Introduction:

Rhinoplasty is a common plastic surgery that potentially has some complications such as postoperative deformities and breathing problems. A humpy nose is among the main reasons for rhinoplasty. Nasal valve (the narrowest part of the nasal airway) collapse may be occurred after nasal hump removal. Spreader graft is essential after more than 3 mm nasal hump removal. But the value of this graft is unknown for patients with nasal hump smaller than 3 mm. Mattress suture is another technique for widening the nasal valve angle. This study compares the effects of spreader graft and mattress suture technique on postoperative deformity and nasal valve patency in patients with nasal hump smaller than 3 mm as compared with control group (no graft and suture).

Methods:

In this clinical trial study 210 patients who underwent rhinoplasty with 2 different techniques involved. Their postoperative deformity and nasal valve patency were evaluated by subjective (questionnaire and digital photography) method before and after rhinoplasty during 6 months follow-up.

Results:

Statistically, nasal obstruction had no significant difference before and after rhinoplasty and no significant difference was observed between spreader graft and mattress sutures (P > 0.05), but significantly better results than control group (P < 0.05).

Conclusion:

In this study the results of nasal valve patency of 2 techniques were similar. Because of several considerations in spreader graft technique such as needing to septoplasty in this technique even in patients without septal deviation that causes longer surgical duration, excessive blood loss, it is recommended to use Mattress suture in patients with nasal hump smaller than 3 mm.
Application of Navigated Transcranial Magnetic Stimulation to Map the Supplementary Motor Area in Healthy Subjects
Authors: Schramm Severin , Sollmann Nico , Ille Sebastian , Meyer Bernhard , Krieg Sandro M.
Published: October 2018

Purpose:

The supplementary motor area is involved in the planning and coordination of movement sequences. This study investigates the potential of repetitive navigated transcranial magnetic stimulation for systematic mapping of the supplementary motor area by interfering with normal movement coordination processing.

Methods:

Ten healthy females (median age: 23.5 years) performed the Jebsen–Taylor Hand Function Test, first without stimulation (baseline) and afterward during application of repetitive navigated transcranial magnetic stimulation with 10 Hz to 6 cortical sites located within the supplementary motor area of both hemispheres. The test completion times (TCTs) were then compared between baseline performances and performances during stimulation.

Results:

We found significant slowing of TCTs in simulated page turning (baseline TCT 3.68 ± 0.67 seconds vs. stimulation TCT 4.04 ± 0.63 seconds, P = 0.0136), lifting small objects (baseline TCT 5.11 ± 0.72 seconds vs. stimulation TCT 5.47 ± 0.66 seconds, P = 0.0010), and simulated feeding (baseline TCT 6.10 ± 0.73 seconds vs. stimulation TCT 6.59 ± 0.81 seconds, P = 0.0027). Three other subtests were not affected, whereas one subtest was performed significantly faster (baseline TCT 17.09 ± 7.31 seconds vs. stimulation TCT 15.44 ± 5.72 seconds, P = 0.0073) under stimulation.

Conclusions:

Repetitive navigated transcranial magnetic stimulation is capable of influencing the performance of healthy participants in a task relying on hand coordination. Our approach can serve as a mapping tool for the supplementary motor area, potentially relevant for preoperative diagnostics in patients with brain tumors, epilepsy, or other brain lesions to improve outcome and potentially predict clinical course and postoperative recovery.
Genetic trade-offs between male reproductive traits inDrosophila melanogaster
Authors: Filice David C. S. , Long Tristan A. F.
Published: October 2018

InDrosophila melanogaster, males engage in both extensive pre- and post-copulatory competition for the opportunity to mate with females and subsequently sire offspring. The selection pressure for increased male reproductive success has resulted in the evolution of a wide diversity of sexual traits. However, despite strong selection, individuals often exhibit considerable phenotypic variation in the expression of these traits, and it is unclear if any of this variation is owing to underlying genetic trade-offs. Here, using hemiclonal flies, we examine how male reproductive success covaries with their ability to induce long-term stimulation of oogenesis and oviposition in their mates, and how this relationship may change over time. We found that males from hemiclone lines with phenotypes that were more successful in a short-term reproductive ‘scramble’ environment were less effective at stimulating long-term fecundity in females. Furthermore, we observed that males from hemiclone lines which showed the most improvement over a longer reproductive interaction period also tended to stimulate higher long-term fecundity in females. Together, these results indicate the presence of genetic trade-offs between different male reproductive traits and offer insights into the maintenance of their variation.
Building the space elevator: lessons from biological design
Authors: Popescu Dan M. , Sun Sean X.
Published: October 2018

One of the biggest perceived challenges in building megastructures, such as the space elevator, is the unavailability of materials with sufficient tensile strength. The presumed necessity of very strong materials stems from a design paradigm which requires structures to operate at a small fraction of their maximum tensile strength (usually, 50% or less). This criterion limits the probability of failure by giving structures sufficient leeway in handling stochastic components, such as variability in material strength and/or external forces. While reasonable for typical engineering structures, low working stress ratios—defined as operating stress as a fraction of ultimate tensile strength—in the case of megastructures are both too stringent and unable to adequately control the failure probability. We draw inspiration from natural biological structures, such as bones, tendons and ligaments, which are made up of smaller substructures and exhibit self-repair, and suggest a design that requires structures to operate at significantly higher stress ratios, while maintaining reliability through a continuous repair mechanism. We outline a mathematical framework for analysing the reliability of structures with components exhibiting probabilistic rupture and repair that depend on their time-in-use (age). Further, we predict time-to-failure distributions for the overall structure. We then apply this framework to the space elevator and find that a high degree of reliability is achievable using currently existing materials, provided it operates at sufficiently high working stress ratios, sustained through an autonomous repair mechanism, implemented via, e.g. robots.
Physical arguments and moral inducements: John Wallis on questions of antiquarianism and natural philosophy
Authors: Beeley Philip
Published: October 2018

In his posthumously published work
Chartham News
(1669), the antiquary William Somner tentatively sought to link the discovery of fossilized remains near Canterbury to the prehistoric existence of an isthmus connecting Britain and France, before calling on natural philosophers to pursue his explanation further. This call was eventually heeded by the Oxford mathematician John Wallis, but only after more than thirty years had elapsed. The arrival in England of a catalogue of questions concerning the geology of the Channel led to the republication of
Chartham News
in the
Philosophical Transactions
, prompting Wallis to develop a physical explanation based on his intimate knowledge of the Kent coastline. Unbeknown to Wallis at the time, that catalogue had been sent by G. W. Leibniz, who had in turn received it from G. D. Schmidt, the former Resident of Brunswick-Lüneburg in Sweden. Wallis's explanation, based on the principle of establishing physical causes both for the rupturing of the isthmus and for the origin of fossils, placed him in a camp opposed by Newtonian authors such as John Harris at a time when the priority dispute over the discovery of the calculus led to the severing of his ties with the German mathematician and philosopher Leibniz.
The hydrostatical works of George Sinclair (
c
. 1630–1696): an addendum
Authors: Craik Alex D. D. , Spittle Danielle
Published: October 2018

Further to a recent paper about the work of George Sinclair (
c
. 1630–1696), new biographical information has come to light. Following one year of study at St Andrews, Sinclair obtained a Master of Arts degree at Edinburgh University in 1649. Later, after his enforced resignation as a Regent at Glasgow University in 1666, he taught mathematics at Edinburgh University, without swearing the prescribed oath of allegiance. This employment terminated in 1674 with the appointment of James Gregory to Edinburgh's first established chair of mathematics. The interest of Robert Hooke in Sinclair's hydrostatical work is also noted.
Uniformity of stresses inside a non-elliptical inhomogeneity interacting with a mode III crack
Authors: Wang Xu , Chen Liang , Schiavone Peter
Published: October 2018

Using conformal mapping techniques and the theory of Cauchy singular integral equations, we prove that it is possible to maintain a uniform internal stress field inside a non-elliptical elastic inhomogeneity embedded in an infinite matrix subjected to uniform remote stress despite the fact that the inhomogeneity interacts with a finite mode III crack. The crack can be modelled either as a Griffith crack or as a Zener–Stroh crack. Our analysis further indicates that the existence of the crack plays a key role in influencing the shape of the corresponding inhomogeneity but not the internal uniform stress field inside the inhomogeneity. Numerical examples are presented to demonstrate the solution.
Quantitative measurement of gluten content in gluten-free foods
Authors: Kim Min-Soo , Kim JoongSu , Ryu Min jung , Kim Ki hong , Hwang Kwontack
Published: October 2018

Gluten proteins play a key role in the unique baking quality of wheat by determining the water absorption capacity, cohesivity, viscosity, and elasticity of the dough. However, gluten from wheat, barley, rye, and oat can induce gluten sensitivity as well as celiac disease in susceptible populations. Hence, the gluten levels in foods labeled “gluten free” should be monitored. In this study, gluten-containing samples (sample: 600 g, water: 390 g) were treated with the commercial enzyme Protamex® (0.1-0.3% of sample weight) for 1-4 h and then measured with three ELISA kits. In the more viscous sample after treatment with 0.1% Protamex® for 1 h, the measured gluten contents were 1,802.6, 1,718.6, and 1,698.7 mg/kg using the G12, GLUTEN-CHECK, and Wheat/gluten (Gliadin) ELISA kits, respectively. The sample treated with 0.3% enzyme for 4 h had a lower viscosity (32.2 cps), and all three kits gave its gluten content as around 8.4 mg/g. When gluten breaks down, it does not act as gluten and its degradation is due to the enzyme. However, even when Protamex® was used at the same concentration for the same time, the measured values seem to be different for samples with and without the final heating treatment.