bluuebunny/crossref_metadata_2025 huggingface dataset:
Early Axial Growth Outcomes of Pediatric Patients Receiving Proton Craniospinal Irradiation
Authors: De Brian , Cahlon Oren , Sine Kevin , Mah Dennis , Hug Eugen B. , Wolden Suzanne L.
Published: June 2018

Guidelines on proton craniospinal irradiation (p-CSI) target volume selection in children are lacking. We examined the impact of target volume selection on growth of children receiving p-CSI at a institution. Records of 58 patients who received p-CSI were reviewed. Median age at treatment initiation was 8 years (range, 2 to 18 y). Spinal target volumes included whole vertebral body (WVB) in 67% and partial vertebral body (PVB) in 33%. Height z-scores before and after p-CSI were assessed using Centers for Disease Control and Prevention stature-for-age charts. Maximal Cobb angle and height z-score change were compared for WVB versus PVB p-CSI using a t test. Among 93% of patients with detailed data, median follow-up was 19 months (range, 2 to 58 mo) after radiation therapy initiation. Quantitative growth evaluations were available for 64% of patients. Median change in height z-score was −0.5 (range, −2.1 to +0.7) after treatment, representing a decrease (P<0.001) in age-adjusted height. WVB patients had significantly greater reduction in height z-score versus PVB patients (P=0.004) but no difference in Cobb angle change (P>0.05). Despite reluctance surrounding its use in younger patients, PVB p-CSI was associated with similar spinal curvature and less growth suppression as compared with WVB p-CSI; a trial comparing WVB versus PVB in children may be warranted.
Immune Thrombocytopenia in a Child With Refractory Langerhans Cell Histiocytosis Following Cladribine Containing Therapy
Authors: Lai Chow Yee , Pettit Tristan
Published: June 2018

In this report, we present a young infant with multisystem Langerhans cell histiocytosis, who after cladribine and cytarabine salvage treatment developed immune thrombocytopenia (IT). On review of the literature, there were no previous reports of Langerhans cell histiocytosis–associated IT. Treatment of the IT with intravenous immunoglobulin and oral corticosteroids was unsuccessful. Eltrombopag, in combination with a 4-day course of dexamethasone was commenced as second-line therapy. Platelet recovery occurred 10 days after initiation of eltrombopag. The immune thrombocytopenia remains in long-term remission despite cessation of eltrombopag. Eltrombopag was safe and well tolerated.
Collaborative Rural Nurse Peer Review
Authors: Drobny Stephanie D. , Snell Amy , Morris Lisa , Harshbarger Cathy , Village Pat , Fischer Shelly A.
Published: June 2018

Background:

Peer review is an essential element of professional nursing practice.

Local Problem:

Implementing nursing practice peer review is a challenge in any organization; some characteristics of small and rural hospitals can make the task especially daunting.

Methods:

A team of nursing leaders and staff nurses from rural and critical access hospitals within 1 health care system was formed to make recommendations about implementing nursing practice peer review in the small rural facilities. Barriers included limited numbers of nurse reviewers by nursing specialty and inherent bias of reviewers due to personal knowledge of cases and nurses involved.

Interventions:

A collaborative rural nursing practice peer review council was created, with staff nurse and leader representation from 6 geographically distinct facilities.

Results:

The rural collaborative council has developed processes for case referral, reviewer assignment, investigation, and scoring founded on Just Culture principles. Satisfaction among staff nurses, reviewers, and Chief Nursing Officers has been high.

Conclusions:

Barriers to implementation of nursing practice peer review in rural hospitals can be mitigated through a collaborative approach, resulting in efficient and effective processes for small, rural, and geographically distinct hospitals.
Decreasing Wait Times and Increasing Patient Satisfaction
Authors: Godley Mary , Jenkins Jeanne B.
Published: June 2018

Background:

Patient satisfaction scores in the vascular interventional radiology department were low, especially related to wait times in registration and for tests/treatments, with low scores for intentions to recommend.

Purpose:

The purpose of our quality improvement project was to decrease wait times and improve patient satisfaction using Lean Six Sigma's define, measure, analyze, improve, and control (DMAIC) framework with a pre-/postintervention design.

Results:

There was a statistically significant decrease in wait times (P < .0019) and an increase in patient satisfaction scores in 3 areas: registration wait times (from 17 to 99 percentiles), test/treatment (from 19 to 60 percentiles), and likelihood to recommend (from 6 to 97 percentiles).

Conclusions:

Lean Six Sigma was an effective framework for use in decreasing wait times and improving patient satisfaction.
Perspectives on Patient and Family Engagement With Reduction in Harm
Authors: Schenk Elizabeth C. , Bryant Ruth A. , Van Son Catherine R. , Odom-Maryon Tamara
Published: June 2018

Background:

Despite continued efforts to improve safety in hospitals, hospital-acquired harm persists. Strategies have been identified to establish patient-centered care and improve patient engagement with care. However, the relationship of patient and family engagement to reduction of harm is not well understood, with limited findings available in current literature.

Purpose:

This qualitative study explored the perceptions and attitudes of patients and family members and several clinical disciplines toward patient engagement in reducing preventable harm in hospitalized patients.

Methods:

We conducted 8 focus groups at 2 nonprofit hospitals with several constituencies: patients/families, registered nurses, physician hospitalists, and pharmacists/physical therapists.

Results:

Thematic analysis of transcripts revealed multiple themes from different perspectives, including: family presence increases safety, the hospital environment is intimidating, and communication is essential, but I am not being heard.

Conclusions:

The rich data suggest a significant opportunity for reducing risk and harm by more actively engaging patients and families in the effort. Increasing patient acuity and complexity of care furthers the need for partnering with patients and families more intentionally for increased safety.
Association of Nurse Engagement and Nurse Staffing on Patient Safety
Authors: Brooks Carthon J. Margo , Hatfield Linda , Plover Colin , Dierkes Andrew , Davis Lawrence , Hedgeland Taylor , Sanders Anne Marie , Visco Frank , Holland Sara , Ballinghoff Jim , Del Guidice Mary , Aiken Linda H.
Published: June 2018

Background:

Nurse engagement is a modifiable element of the work environment and has shown promise as a potential safety intervention.

Purpose:

Our study examined the relationship between the level of engagement, staffing, and assessments of patient safety among nurses working in hospital settings.

Methods:

A secondary analysis of linked cross-sectional data was conducted using survey data of 26 960 nurses across 599 hospitals in 4 states. Logistic regression models were used to examine the association between nurse engagement, staffing, and nurse assessments of patient safety.

Results:

Thirty-two percent of nurses gave their hospital a poor or failing patient safety grade. In 25% of hospitals, nurses fell in the least or only somewhat engaged categories. A 1-unit increase in engagement lowered the odds of an unfavorable safety grade by 29% (P < .001). Hospitals where nurses reported higher levels of engagement were 19% (P < .001) less likely to report that mistakes were held against them. Nurses in poorly staffed hospitals were 6% more likely to report that important information about patients “fell through the cracks” when transferring patients across units (P < .001).

Conclusions:

Interventions to improve nurse engagement and adequate staffing serve as strategies to improve patient safety.
False Alarms and Overmonitoring
Authors: Simpson Kathleen Rice , Lyndon Audrey
Published: June 2018

Background:

Nurses can be exposed to hundreds of alarms during their shift, contributing to alarm fatigue.

Purpose:

The purposes were to explore similarities and differences in perceptions of clinical alarms by labor nurses caring for generally healthy women compared with perceptions of adult intensive care unit (ICU) and neonatal ICU nurses caring for critically ill patients and to seek nurses' suggestions for potential improvements.

Methods:

Nurses were asked via focus groups about the utility of clinical alarms from medical devices.

Results:

There was consensus that false alarms and too many devices generating alarms contributed to alarm fatigue, and most alarms lacked clinical relevance. Nurses identified certain types of alarms that they responded to immediately, but the vast majority of the alarms did not contribute to their clinical assessment or planned nursing care.

Conclusions:

Monitoring only those patients who need it and only those physiologic values that are warranted, based on patient condition, may decrease alarm burden.
Impacting the Patient's Experience in a Children's Hospital Using a Communication Bundle Strategy
Authors: Bumpers Bernadette , Dearmon Valorie , Dycus Paula
Published: June 2018

Background:

The aim of this quality improvement project was to determine whether a communication bundle would impact parents' ratings of nurse-child communication in relation to (a) how often the nurse listened carefully to the child and (b) how often the nurse explained things in a way easy for the child to understand.

Local Problem:

The Child Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores on the unit lagged behind the hospital's 75th percentile external benchmark established by the National Research Corporation.

Methods:

A convenience sample of the unit's staff participated in the project.

Interventions:

The outcome measure was a comparison of Child HCAHPS scores and percentile ranks for the questions pre- and postimplementation of the communication bundle.

Results:

Following implementation of the communication bundle, the unit's patient satisfaction scores for both questions exceeded the 75th-percentile benchmark.

Conclusions:

This project enhanced nurse communication at the bedside and the parent's perception of nurse-child communication.
Cerebellar Differentiation in Ovarian Teratoma: A Report of 6 Cases
Authors: Stewart Colin J.R. , Crook Maxine L.
Published: June 2018

Ovarian teratomas potentially demonstrate a wide range of tissue elements including central nervous system differentiation. The latter can include cerebellar tissue, which in our experience remains an under-recognized phenomenon. In the current study we present a review of 6 ovarian teratomas including 4 mature cystic teratomas and 2 immature teratomas showing cerebellar differentiation. Two cases were seen in consultation because the cerebellar elements were initially misinterpreted as immature teratomas. Two mature cystic teratomas focally demonstrated a distinct cerebellar architecture including folial type structures, but in all cases the cerebellar elements usually showed a less organized anatomic appearance, and sometimes these were concerning for immature teratomas upon initial examination. This concern was exacerbated in 5 cases by the presence of a cytologically immature and mitotically active neuronal component corresponding to the external granular layer of normal fetal and neonatal cerebellum. However, careful examination demonstrated the characteristic molecular, Purkinje and (internal) granular layers of cerebellum. Furthermore, while the external granular layer in teratomas strongly expressed Ki67, corresponding to the proliferative activity of this cellular compartment physiologically, immunostaining was often helpful in highlighting the preserved zonal pattern of cellular proliferation. The absence or minimal expression of SALL4, OCT3/4, and SOX2 was also helpful in this regard. Cytoplasmic OCT3/4 expression in osteoblasts was noted incidentally in 2 tumors, but further studies are required to determine whether this is a consistent and diagnostically useful finding.
Ectopic Fetal Hepatic Tissue in the Placenta
Authors: Stonko David P. , Liang Jiancong , Weeks Amy G. , Redline Raymond W. , Boyd Theonia K. , Watkins Jaclyn C. , Kovach Alexandra E.
Published: June 2018

When an unusual intraplacental lesion is identified during pathologic examination, it becomes of substantial import to determine whether it represents a normal structure, metastasis from the mother, or a primary benign tumor, including those secondary to abnormal embryologic development versus a primary malignant placental tumor. In this case report, we identified an incidental nest of intraplacental cells with nondiagnostic morphology and negative initial Glypican-3 stain in a healthy 35-wk gestation. This negative result prompted a broadening of the differential before ultimately determining this lesion was indeed ectopic liver with positive Arginase-1 and HepPar-1 staining. This may represent the mature hepatocyte phenotype within the lesional cells of this near-term birth, a dichotomy not previously discussed in the literature, which focuses on the fetal hepatocyte phenotype, also rarely seen. In this report, we summarize the previous literature regarding intraplacental ectopic liver, and we propose a sensitive approach to suspected ectopic liver of the placenta that may be sufficient to capture both the fetal and mature hepatocyte immunophenotypes. This approach may extend to other related pathologies including assessment of suspected intraumbilical hepatocytes.
Comparison of the Microstructures and Properties of Different Microcannulas for Hyaluronic Acid Injection
Authors: Wu Kelun , Xie Li , Wang Muyao , Jiang Yichen , Tang Yingfeng , Wang Hang
Published: June 2018

Background:

Microcannulas are used for hyaluronic acid and other filler injections and reduce the side effects and complications. There are several microcannulas and the differences between microcannulas have not been carefully investigated. The purpose of this study was to compare the microstructures and properties of different microcannulas by several trials and provide guidance for clinical application.

Methods:

Nine types of microcannulas from different manufacturers were chosen. Scanning electron microscopy was used to obtain high-definition images of microstructures, chemical composition analyzers were used to test the chemical composition of the tips, and a universal testing machine was used to measure mechanical properties. The injection speed test recorded the time spent for the weight to push hyaluronic acid out of microcannulas. The vessel piercing force test was conducted to simulate the process of puncturing the vessels in vitro.

Results:

The scanning electron microscopic images showed the tip shapes and inner surfaces that may relate to the characteristics. The chemical composition of most microcannulas met the American Society for Testing and Materials standards basically. The mechanical properties were obviously different. The results of the injection speed test were discrepant more than seven times. The vessel piercing test showed which microcannula was the most difficult and easiest to puncture the aorta.

Conclusions:

The results indicated that there are significant differences between different microcannulas. The differences are instructive to physicians for selecting suitable microcannulas to improve the injection effect and reduce discomfort and complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, V.
The Differential Use of Bilobed and Trilobed Transposition Flaps in Cutaneous Nasal Reconstructive Surgery
Authors: Knackstedt Thomas , Lee Kachiu , Jellinek Nathaniel J.
Published: June 2018

Background:

Bilobed and trilobed transposition flaps are versatile random pattern transposition flaps that reliably restore nasal symmetry, topography, light reflex, and contour and are frequently used in cutaneous nasal reconstructive surgery. The authors wish to compare the characteristics of bilobed and trilobed flaps in cutaneous reconstructive surgery and to identify scenarios for their differential use.

Methods:

A retrospective chart review over 7 years of consecutive patients who underwent reconstruction with a bilobed or trilobed flap after Mohs micrographic surgery was performed. Statistical analysis of patient and surgery characteristics, anatomical distribution, postprocedural events, and need for revisions after both flap types was conducted.

Results:

One hundred eleven patients with bilobed flaps and 74 patients with trilobed flaps were identified. Bilobed flaps are significantly more frequently used on the inferior nasal dorsum and on the sidewall, whereas trilobed flaps are significantly more frequently used on the nasal tip and infratip. No significant difference in postprocedural events (e.g., complications, erythema, trapdoor) was noted between the two flap types.

Conclusions:

Bilobed and trilobed transposition flaps are versatile means of repair for nasal reconstruction. Trilobed flaps may be used to repair defects in a more distal nasal location than bilobed flaps. Regardless of flap type, complications are rare.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Oncologic Resection and Reconstruction of the Chest Wall: A 19-Year Experience in a Single Center
Authors: Salo Juho T. K. , Tukiainen Erkki J.
Published: June 2018

Background:

The aim of this study was to analyze chest wall reconstruction following oncologic resection performed by a single surgeon over a 19-year period.

Methods:

A retrospective review was performed for 135 patients who underwent oncologic chest wall resection from 1997 to 2015.

Results:

Average patient age was 57.8 years. Indications for resection were advanced breast cancer (n = 44), soft-tissue sarcoma (n = 38), bone sarcoma or chondrosarcoma (n = 28), desmoid tumor (n = 11), metastasis from other cancers (n = 7), and other primary tumors (n = 7). There were 72 full-thickness and 63 partial-thickness resections (34 soft-tissue resections only and 29 skeletal bone resections only). Resection margins were wide (n = 29), marginal (n = 82), and intralesional (n = 24). Reconstruction was warranted in 118 cases: chest wall stabilization and flap coverage in 57, chest wall stabilization only in 36, and soft-tissue flap coverage only in 25 cases. In total, 82 flaps were performed (17 free flaps and 65 pedicled/local flaps). There were no perioperative mortalities or flap losses. Complications occurred in 29 operations (Clavien-Dindo classifications grade II, n = 12; grade IIIa, n = 4; grade IIIb, n = 10; and grade IVa, n = 3) and 19 reoperations were necessary. Median follow-up was 49 months. Survival was calculated by the Kaplan-Meier method. One-, 2-, and 5-year survival rates were 84, 82, and 70 percent, respectively.

Conclusion:

With careful patient selection, appropriate perioperative and postoperative care, and accurate surgical technique, even extensive chest wall resections and reconstructions are safe.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
A Simple Dynamic Strategy to Deliver Stem Cells to Decellularized Nerve Allografts
Authors: Rbia Nadia , Bulstra Liselotte F. , Bishop Allen T. , van Wijnen Andre J. , Shin Alexander Y.
Published: June 2018

Background:

The addition of adipose-derived mesenchymal stromal cells to decellularized nerve allografts may improve outcomes of nerve reconstruction. Prior techniques used for cell seeding are traumatic to both the mesenchymal stromal cells and nerve graft. An adequate, reliable, and validated cell seeding technique is an essential step for evaluating the translational utility of mesenchymal stromal cell–enhanced decellularized nerve grafts. The purpose of this study was to develop a simple seeding strategy with an optimal seeding duration.

Methods:

A dynamic bioreactor was used to seed rat and human mesenchymal stromal cells separately onto rat and human decellularized nerve allografts. Cell viability was evaluated by MTS assays and cellular topology after seeding was determined by scanning electron microscopy. Cell density and distribution were determined by Live/Dead assays and Hoechst staining at four different time points (6, 12, 24, and 72 hours). The validity and reliability of the seeding method were calculated.

Results:

Cells remained viable at all time points, and mesenchymal stromal cells exhibited exponential growth in the first 12 hours of seeding. Seeding efficiency increased significantly from 79.5 percent at 6 hours to 89.2 percent after 12 hours of seeding (p = 0.004). Both intrarater reliability (r = 0.97) and interrater reliability (r = 0.92) of the technique were high.

Conclusions:

This study describes and validates a new method of effectively seeding decellularized nerve allografts with mesenchymal stromal cells. This method is reproducible, distributes cells homogenously over the graft, and does not traumatize the intraneural architecture of the allograft. Use of this validated seeding technique will permit critical comparison of graft outcomes.
Anatomical Understanding of Target Subcutaneous Tissue Layer for Thinning Procedures in Thoracodorsal Artery Perforator, Superficial Circumflex Iliac Artery Perforator, and Anterolateral Thigh Perforator Flaps
Authors: Kim So Young , Lee Young Jae , Mun Goo-Hyun
Published: June 2018

Background:

Thinned perforator flaps, reported techniques, and degree of thinning differ by study. This study investigated the anatomy of subcutaneous tissue according to the varying fattiness and identified which component and how much of the subcutaneous tissue layer needed to be excluded to meet target flap thickness using computed tomography.

Methods:

Three stratified fattiness groups consisting of 30 donors were formed for thoracodorsal artery perforator, superficial circumflex iliac artery perforator, and anterolateral thigh flaps. Thickness of the superficial fat and the deep fat layers was measured at specific points in donor sites of the three flaps and the proportion of superficial and deep fat layers to exclude to reach the target flap thickness (4, 6, and 8 mm) was calculated.

Result:

The median proportion for the superficial fat layer varies depending on donor fattiness. The estimated percentage reduction of thickness after thin flap elevation along superficial fascia was approximately one-third of the whole layer. A variable proportion of each fat layer needs to be excluded to obtain required thinness and in very thick groups, part of the superficial fat layer must be removed to reach any of the target thicknesses for the three flaps.

Conclusions:

The present study demonstrated the frequent need for superficial fat layer manipulation when obtaining a thin perforator flap. To cope with various combinations of donor-site fattiness and different required thicknesses effectively, an appropriate thinning method should have increased adaptability, including the ability to control superficial fat layer thickness.
Acceleration of Magnetic Resonance Cholangiopancreatography Using Compressed Sensing at 1.5 and 3 T
Authors: Taron Jana , Weiss Jakob , Notohamiprodjo Mike , Kuestner Thomas , Bamberg Fabian , Weiland Elisabeth , Kuehn Bernd , Martirosian Petros
Published: June 2018

Objectives

Magnetic resonance cholangiopancreatography (MRCP) is an established technique in routine magnetic resonance examination. By applying the compressed sensing (CS) acceleration technique to conventional MRCP sequences, scan time can be markedly reduced. With promising results at 3 T, there is a necessity to evaluate the performance at 1.5 T due to wide scanner availabilities. Aim of this study is to test the feasibility of accelerated 3-dimensional (3D) MRCP with extended sampling perfection with application-optimized contrasts using different flip angle evolution (SPACE) using CS in navigator triggering and in a single breath-hold in a clinical setting at 1.5 T and 3 T and compare it with a conventional navigator-triggered 3D SPACE-MRCP.

Materials and Methods

Phantom measurements were performed to adapt sequence parameters. Conventional 3D SPACE-MRCP in navigator triggering (STD_MRCP) as well as CS-accelerated 3D SPACE-MRCP acquired in navigator triggering and in a single breath-hold (CS_MRCP and CS_BH_MRCP) was performed in 66 patients undergoing clinically induced MRI of the pancreatobiliary system at 1.5 T and 3 T. Image quality evaluation was performed by 2 independent radiologists. Dedicated statistics were performed (P< 0.05 considered significant).

Results

In patient imaging, CS_MRCP was superior to STD_MRCP and CS_BH_MRCP in aspects of overall image quality at 1.5 T (P= 0.01;P< 0.001) and 3 T (P= 0.002;P= 0.013). Overall image quality in CS_BH_MRCP was inferior compared with STD_MRCP and CS_MRCP at 1.5 T. At 3 T, overall image quality in CS_BH_MRCP was superior to STD_MRCP (P= 0.001). Scan time was reduced by 25% to 46% covering 5% of k-space (CS_MRCP at 1.5 and 3 T) and 97% covering 3.6% of k-space (CS_BH_MRCP at 1.5 and 3 T).

Conclusions

Compressed sensing-accelerated MRCP is feasible in clinical routine at 1.5 and 3 T offering major reduction of acquisition time. When applying a single breath-hold CS imaging, field strengths of 3 T are recommended.
Prostate-Specific Membrane Antigen Expression in Distal Radius Fracture
Authors: Hoberück Sebastian , Michler Enrico , Kaiser Daniel , Röhnert Anne , Zöphel Klaus , Kotzerke Jörg
Published: June 2018

A 79-year old man with prostate cancer under active surveillance for 5 years was referred for a PSMA-PET/MRI for re-evaluation because of a rising prostate-specific antigen value. PET/MRI revealed a ribbonlike tracer accumulation in a healing fracture of the distal radius. This case illustrates that PSMA expression may occur in healing bone fractures in the distal radius. It can be assumed that benign causes of tracer accumulations in the upper extremities are missed in PET/CT due to elevated position of the arms during image acquisition.
Prospective Validation of the Chinese Version of the Self-Efficacy for Exercise Scale Among Middle-Aged Patients With Coronary Heart Disease
Authors: Wong Eliza M.L. , Leung Doris Y.P. , Sit Janet W.H. , Chan Aileen W.K. , Chair Sek Ying
Published: June 2018

Purpose

The aim of this study was to further evaluate the psychometric properties of the Chinese version of the Self-Efficacy for Exercise Scale (SEE-C) among middle-aged outpatients with coronary heart disease (CHD).

Design

Psychometric evaluation design.

Methods

A convenience sample of 355 CHD patients was recruited and followed up at 3 and 6 months. Cronbach’s alpha, construct validity (exploratory factor analysis), and concurrent and predictive validity were examined.

Findings

The SEE-C had a single-factor structure that was stable over time and had high internal consistency. Baseline SEE-C scores were significantly and positively associated with quality of life and total exercise time per week and significantly and negatively associated with anxiety and depression. They also significantly predicted total exercise per week at the 3- and 6-month follow-ups.

Conclusions

The SEE-C is a robust, reliable, and valid measure of exercise self-efficacy for middle-aged Chinese CHD outpatients.

Clinical Relevance

The SEE-C can assess patients’ exercise self-efficacy, so that appropriate interventions to improve exercise self-efficacy can be provided.
“Theory Does Not Get You From Bed to Wheelchair”: A Qualitative Study on Patients’ Views of an Education Program in Spinal Cord Injury Rehabilitation
Authors: Bernet Madeleine , Sommerhalder Kathrin , Mischke Claudia , Hahn Sabine , Wyss Adrian
Published: June 2018

Purpose

The aim of this study was to evaluate a new nurse-guided patient education program in spinal cord injury rehabilitation with particular focus on the patients’ perspectives and experiences.

Design

Longitudinal qualitative study.

Methods

We conducted face-to-face interviews with 10 rehabilitation patients and used the content analysis method to analyze the data.

Findings

Patients emphasized the importance of the practical training of the education program. This impacted their well-being as well as their autonomy. They rated discussions with primary nurses and peers about physical or psychological concerns. However, after discharge, the learning process was ongoing, and patients experienced the transition to living at home as a major challenge.

Conclusions and Clinical Relevance

This research provides valuable information from the patients’ perspective for enhancing spinal cord injury patient education. Situational learning, based on the practical parts of patient education and working with peers, is highlighted.
Immediate Treatment of Complex Mandible Fracture in a Pediatric Patient
Authors: Colombo Luara Teixeira , Silva Raquel Barroso Parra da , Mulinari-Santos Gabriel , Silva Leonardo Freitas da , Fabris André Luis da Silva , Souza Francisley Ávila
Published: June 2018

The facial fractures in pediatric patients are rare, and they can need an immediate treatment to recover the function and aesthetic to the young patients. However, the open reduction internal fixation is controversial in pediatrics; it can be effectiveness to treat complex mandible fractures. Therefore, we present a case of a pediatric patient with a complex mandible fracture caused by an auto accident. The immediate treatment was successful with the use of open reduction internal fixation.
A Rise in Neutrophil Cell Size Precedes Organ Dysfunction After Trauma
Authors: Hesselink Lillian , Heeres Marjolein , Paraschiakos Fotis , ten Berg Maarten , Huisman Albert , Hoefer Imo E. , de Groot Mark C.H. , van Solinge Wouter W. , Dijkgraaf Marcel , Hellebrekers Pien , Van Wessem Karlijn J.P. , Koenderman Leo , Leenen Luke P.H. , Hietbrink Falco
Published: June 2018

Introduction:

Organ dysfunction remains a major cause of morbidity after trauma. The development of organ dysfunction is determined by the inflammatory response, in which neutrophils are important effector cells. A femoral fracture particularly predisposes for the development of organ dysfunction. This study investigated the chronologic relation between neutrophil characteristics and organ dysfunction in trauma patients with a femoral fracture.

Methods:

Patients with a femoral fracture presenting at the University Medical Center Utrecht between 2007 and 2013 were included. Data of neutrophil characteristics from standard hematological analyzers were recorded on a daily basis until the 28th day of hospital stay or until discharge. Generalized Estimating Equations were used to compare outcome groups.

Results:

In total 157 patients were analyzed, of whom 81 had polytrauma and 76 monotrauma. Overall mortality within 90 days was 6.4% (n = 10). Eleven patients (7.0%) developed organ dysfunction. In patients who developed organ dysfunction a significant increase in neutrophil count (P = 0.024), a significant increase in neutrophil cell size (P = 0.026), a significant increase in neutrophil complexity (P < 0.004), and a significant decrease in neutrophil lobularity (P < 0.001) were seen after trauma. The rise in neutrophil cell size preceded the clinical manifestation of organ dysfunction in every patient.

Conclusion:

Patients who develop organ dysfunction postinjury show changes in neutrophil characteristics before organ dysfunction becomes clinically evident. These findings regarding post-traumatic organ dysfunction may contribute to the development of new prognostic tools for immune-mediated complications in trauma patients.

Level of evidence:

Level II, etiologic study.
Use of qSOFA Score in Predicting the Outcomes of Patients With Glyphosate Surfactant Herbicide Poisoning Immediately Upon Arrival at the Emergency Department
Authors: Cho Yong Soo , Moon Jeong Mi , Chun Byeong Jo , Lee Byung Kook
Published: June 2018

Aim:

This study aimed to identify whether quick sequential organ failure assessment (qSOFA) performed immediately upon arrival can predict the outcome of patients with glyphosate surfactant herbicide (GlySH) poisoning.

Methods:

Adult patients with GlySH poisoning between January 2006 and April 2017 were included in this retrospective observational study. The qSOFA score (respiratory rate ≥22 breaths per minute, systolic blood pressure <100 mm Hg, and altered mental status) was assessed immediately upon arrival at the emergency department. The primary outcome was in-hospital mortality, and the secondary outcomes were life-threatening complications and organ injury.

Results:

Of the 150 patients who ingested GlySH, 14 (9.3%) died. The qSOFA score was significantly higher in the non-survival group (P < 0.001). qSOFA (odds ratio [OR], 2.73; 95% confidence interval [CI], 1.41–5.76) was independently associated with in-hospital mortality. The area under curve value of qSOFA was 0.841 (95% CI, 0.772–0.895). As qSOFA score increased from 0 to 3, the in-hospital mortality significantly increased (P < 0.001). The frequency of life-threatening complications, including organ injury, increased as the qSOFA score increased from 0 to 3 (P < 0.001).

Conclusions:

The qSOFA score measured upon arrival shows good prognostic performance in patients with GlySH poisoning. Moreover, the qSOFA may predict the development of life-threatening complications including organ injury. Thus, more attention should be paid to patients with GlySH poisoning with higher qSOFA scores.
The Effectiveness and Safety of Corticosteroids Therapy in Adult Critical Ill Patients With Septic Shock: A Meta-Analysis of Randomized Controlled Trials
Authors: Wen Yongyao , Zhu Yuhan , Jiang Qimin , Guo Nan , Cai Yangping , Shen Xiaoxu
Published: June 2018

Objective:

To investigate the effectiveness and safety of corticosteroids therapy in adult critical ill patients with septic shock.

Methods:

The PUBMED, EMBASE, Web of Science, Cochrane Library databases were systematically searched from the inception dates to March 24, 2018. To identify randomized controlled trials that evaluating the role of corticosteroids therapy in adult critical ill patients with septic shock. The primary outcome was 28-day mortality. The second outcomes included 90-day mortality, intensive care unit (ICU) mortality, in-hospital mortality, length of stay in ICU, length of stay in hospital, reversal of shock, and superinfection.

Results:

A total of 18 randomized controlled trials involving 8,128 adult critical ill patients with septic shock fulfilled the inclusion criteria. The outcomes of this meta-analysis showed that corticosteroids therapy did not significantly reduce the 28-day mortality [RR = 0.94; 95% CI, 0.84–1.05; Z = 1.07 (P = 0.285)]. However, corticosteroids therapy was associated with a significantly shorter length of stay in ICU [WMD = −1.55; 95% CI, −2.19 to −0.91; Z = 4.74 (P = 0.000)]. 90-day mortality, ICU mortality, in-hospital mortality, length of stay in hospital, reversal of shock, and superinfection had no significant difference between the corticosteroids therapy and placebo therapy (P > 0.05). Similar results were obtained in subgroups of trials stratified according to the dose of corticosteroids (high dose or low does).

Conclusions:

Based on the results of this meta-analysis, corticosteroids therapy was associated with a significantly shorter length of stay in ICU among adult critical ill patients with septic shock. The mortality was similar between the corticosteroids therapy and placebo.
Murine Pancreatic Cancer Alters T Cell Activation and Apoptosis and Worsens Survival After Cecal Ligation and Puncture
Authors: Lyons John D. , Chen Ching-Wen , Liang Zhe , Zhang Wenxiao , Chihade Deena B. , Burd Eileen M. , Farris Alton B. , Ford Mandy L. , Coopersmith Craig M.
Published: June 2018

Patients with cancer who develop sepsis have a markedly higher mortality than patients who were healthy prior to the onset of sepsis. Potential mechanisms underlying this difference have previously been examined in two preclinical models of cancer followed by sepsis. Both pancreatic cancer/pneumonia and lung cancer/cecal ligation and puncture (CLP) increase murine mortality, associated with alterations in lymphocyte apoptosis and intestinal integrity. However, pancreatic cancer/pneumonia decreases lymphocyte apoptosis and increases gut apoptosis while lung cancer/CLP increases lymphocyte apoptosis and decreases intestinal proliferation. These results cannot distinguish the individual roles of cancer versus sepsis since different models of each were used. We therefore created a new cancer/sepsis model to standardize each variable. Mice were injected with a pancreatic cancer cell line and 3 weeks later cancer mice and healthy mice were subjected to CLP. Cancer septic mice had a significantly higher 10-day mortality than previously healthy septic mice. Cancer septic mice had increased CD4+ T cells and CD8+ T cells, associated with decreased CD4+ T cell apoptosis 24 h after CLP. Further, splenic CD8+ T cell activation was decreased in cancer septic mice. In contrast, no differences were noted in intestinal apoptosis, proliferation, or permeability, nor were changes noted in local bacterial burden, renal, liver, or pulmonary injury. Cancer septic mice thus have consistently reduced survival compared with previously healthy septic mice, independent of the cancer or sepsis model utilized. Changes in lymphocyte apoptosis are common to cancer model and independent of sepsis model, whereas gut apoptosis is common to sepsis model and independent of cancer model. The host response to the combination of cancer and sepsis is dependent, at least in part, on both chronic comorbidity and acute illness.
Effects of Psychosocial Stress on Subsequent Hemorrhagic Shock and Resuscitation in Male Mice
Authors: Langgartner Dominik , Wachter Ulrich , Hartmann Clair , Gröger Michael , Vogt Josef , Merz Tamara , McCook Oscar , Fink Marina , Kress Sandra , Georgieff Michael , Kunze Julia F. , Radermacher Peter L. , Reber Stefan O. , Wepler Martin
Published: June 2018

Background:

Hypoxemia and tissue ischemia during hemorrhage as well as formation of oxygen and nitrogen radicals during resuscitation promote hyperinflammation and, consequently, trigger severe multi-organ failure (MOF). Individuals diagnosed with stress-related disorders or reporting a life history of psychosocial stress are characterized by chronic low-grade inflammation and a reduced glucocorticoid (GC) signaling. We hypothesized that exposure to chronic psychosocial stress during adulthood prior to hemorrhagic shock increases oxidative/nitrosative stress and therefore the risk of developing MOF in mice.

Methods and Findings:

To induce chronic psychosocial stress linked to mild immune activation and reduced GC signaling in male mice, the chronic subordinate colony housing (CSC) paradigm was employed. Single-housed (SHC) mice were used as controls. Subsequently, CSC and SHC mice were exposed to hemorrhagic shock following resuscitation to investigate the effects of prior psychosocial stress load on survival, organ function, metabolism, oxidative/nitrosative stress, and inflammatory readouts. An increased adrenal weight in CSC mice indicates that the stress paradigm reliably worked. However, no effect of prior psychosocial stress on outcome after subsequent hemorrhage and resuscitation could be detected.

Conclusions:

Chronic psychosocial stress during adulthood is not sufficient to promote hemodynamic complications, organ dysfunction, metabolic disturbances and did not increase the risk of MOF after subsequent hemorrhage and resuscitation. Intravenous norepinephrine to keep target hemodynamics might have led to a certain level of oxidative stress in both groups and, therefore, disguised potential effects of chronic psychosocial stress on organ function after hemorrhagic shock in the present murine trauma model.
Alpha-1 Adrenergic Receptor Agonist Phenylephrine Inhibits Sepsis-Induced Cardiomyocyte Apoptosis and Cardiac Dysfunction via Activating ERK1/2 Signal Pathway
Authors: Li Hongmei , Xing Yun , Yang Duomeng , Tang Xiangxu , Lu Daxiang , Wang Huadong
Published: June 2018

It was demonstrated that α1 adrenergic receptor (α1-AR) activation by phenylephrine (PE) attenuated cardiac dysfunction in lipopolysaccharide (LPS)-challenged mice. However, it is unclear whether PE suppresses sepsis-induced cardiomyocyte apoptosis. Here, we investigated the effects of PE on cardiomyocyte apoptosis in LPS-treated adult rat ventricular myocytes (ARVMs) and septic rats induced by cecal ligation and puncture. Cardiomyocyte apoptosis and caspase activity were detected by TUNEL and spectrophotometrical assay, respectively. Bax, Bcl-2 and cytochrome c (Cyt c) levels as well as IκBα, ERK1/2, p38 MAPK, JNK and cardiac troponin I (cTnI) phosphorylation were analyzed by Western blotting, and TNF-α concentration was analyzed by ELISA. PE inhibited LPS-induced caspase-3 activation in ARVMs, which was reversed by prazosin (a membrane permeable α1-AR antagonist), but not by CGP12177A (a membrane impermeable α1-AR antagonist). PE upregulated phosphorylated ERK1/2 and Bcl-2 contents, decreased TNF-α and Bax levels, Cyt c release, caspase-8/-9 activities as well as IκBα, p38MAPK and JNK phosphorylation in LPS-treated ARVMs, all of which were abolished by prazosin. Treatment with U0126 (a specific ERK1/2 inhibitor) reversed the effects of PE on IκBα, p38MAPK and JNK phosphorylation as well as caspase-3/-8/-9 activation in LPS-treated ARVMs. In septic rats, PE not only inhibited myocardial apoptosis as well as IκBα, p38MAPK, and JNK phosphorylation, but also upregulated myocardial phosphorylated ERK1/2. Furthermore, PE inhibited myocardial cTnISer23/24 phosphorylation and improved cardiac function in septic rats. Taken together, our data suggest that α1-AR activation by PE inhibits sepsis-induced cardiomyocyte apoptosis and cardiac dysfunction via activating ERK1/2 signal pathway.
Optimal Interval From Placement of a Self-expandable Metallic Stent to Surgery in Patients With Malignant Large Bowel Obstruction: A Preliminary Study
Authors: Matsuda Akihisa , Miyashita Masao , Matsumoto Satoshi , Sakurazawa Nobuyuki , Kawano Youichi , Yamada Takeshi , Matsutani Takeshi , Uchida Eiji
Published: June 2018

Objectives:

The aim of this study was to investigate the risk factors for postoperative complications (POCs) and optimal interval between a self-expandable metallic stent (SEMS) placement and elective surgery, “bridge to surgery (BTS)” in patients with malignant large bowel obstruction.

Materials and Methods:

BTS strategy was attempted in 49 patients with malignant large bowel obstruction from January 2013 to March 2017 in our institution. Two of these patients were excluded because they had undergone emergency surgery for SEMS migration.

Results:

Of these 47 patients, 8 had developed POC (Clavien-Dindo grading ≥II), whereas 39 patients had no such complications. Multivariate analysis identified only the interval between SEMS and surgery as an independent risk factor for POC. Furthermore, a cutoff value of 15 days for interval between SEMS and surgery was identified by receiver operating characteristic curve analysis.

Conclusions:

An interval of over 15 days is recommended for minimizing POC in patients undergoing elective surgery in a BTS setting.
A Prospective Randomized Clinical Trial of a Novel, Noninvasive Perfusion Enhancement System for the Prevention of Hospital-Acquired Sacral Pressure Injuries
Authors: Bharucha Jitendra B. , Seaman Linda , Powers Michele , Kelly Erica , Seaman Rodney , Forcier Lea , McGinnis Janice , Nodiff Isabel , Pawlak Brooke , Snyder Samantha , Nodiff Susan , Patel Rohan , Squitieri Rafael , Wang Lansheng
Published: June 2018

PURPOSE:

The purpose of this study was to determine the effectiveness of a novel, noninvasive perfusion enhancement system versus beds with integrated alternating pressure capabilities for the prevention of hospital-acquired sacral region (sacral, coccygeal, and ischium) pressure injuries in a high-risk, acute care patient population.

DESIGN:

A prospective randomized trial of high-risk inpatients without preexisting sacral region pressure injuries was conducted.

SUBJECTS AND SETTING:

The sample comprised 431 randomly enrolled adult patients in a 300-bed tertiary care community teaching hospital.

METHODS:

Subjects were randomly allocated to one of 2 groups: control and experimental. Both groups received “standard-of-care” pressure injury prevention measures per hospital policy, and both were placed on alternating pressure beds during their hospital stays. In addition, patients in the experimental group used a noninvasive perfusion enhancement system placed on top of their alternating pressure beds and recovery chairs throughout their hospital stay. Fischer's exact probability test was used to compare group differences, and odds ratio (OR) were calculated for comparing pressure injury rates in the experimental and control groups.

RESULTS:

Three hundred ninety-nine patients completed the trial; 186 patients were allocated to the experimental group and 213 patients to the control group. Eleven patients in the control group versus 2 in the experimental group developed hospital-acquired sacral region pressure injuries (51.6% vs 1.07%; P = .024). Control patients were 5.04 times more likely to develop hospital-acquired sacral region pressure injuries (OR = 0.1996; 95% CI, 0.0437-0.9125).

CONCLUSIONS:

Patients using a noninvasive perfusion enhancement system developed significantly fewer hospital-acquired sacral pressure injuries than those using an alternating pressure bed without the perfusion enhancement system. These findings suggest that a perfusion enhancement system enhances the success of use of pressure redistributing beds for prevention of hospital-acquired sacral pressure injuries.
Taste Receptor Cells in Mice Express Receptors for the Hormone Adiponectin
Authors: Crosson Sean M. , Marques Andrew , Dib Peter , Dotson Cedrick D. , Munger Steven D. , Zolotukhin Sergei
Published: June 2018

The metabolic hormone adiponectin is secreted into the circulation by adipocytes, and mediates key biological functions including insulin sensitivity, adipocyte development, and fatty acid oxidation. Adiponectin is also abundant in saliva, where its functions are poorly understood. Here we report that murine taste receptor cells express adiponectin receptors, and may be a target for salivary adiponectin. Analysis of a transcriptome dataset obtained by RNA-seq analysis of purified circumvallate taste buds, revealed high expression levels for three adiponectin receptor types. Immunohistochemical studies showed that two of these receptors, AdipoR1 and T-cadherin, are localized to subsets of taste receptor cells. Immunofluorescence for T-cadherin was primarily co-localized with the Type 2 taste receptor cell marker phospholipase β2, suggesting that adiponectin signaling could impact sweet, bitter, or umami taste signaling. However, adiponectin null mice showed no differences in taste responsiveness compared to wildtype controls in brief-access taste testing. AAV-mediated overexpression of adiponectin in the salivary glands of adiponectin null mice did result in a small but significant increase in behavioral taste responsiveness to the fat emulsion Intralipid. Together, these results suggest that salivary adiponectin can effect taste receptor cell function, though its impact on taste responsiveness and peripheral taste coding remains unclear.