bluuebunny/crossref_metadata_2025 huggingface dataset:
Sensory Modulation
Authors: Sinclair Cate , Meredith Pamela , Strong Jenny , Chalkiadis George A.
Published: October 2018

Objectives:

Sensory modulation patterns contribute to altered pain perception and disengagement in activities; atypical sensory modulation patterns have been associated with higher pain sensitivity, catastrophizing, and reduced function. Objectives of this study were to ascertain whether: adolescents with persistent pain had atypical sensory modulation patterns, atypical sensory modulation was associated with reduced functioning and higher pain, and pain catastrophizing mediated the relationship between sensory modulation and functional disability.

Methods:

Adolescents (N=70, females=63, males=7) attending tertiary level interdisciplinary team assessment for persistent pain completed sensory modulation (Adolescent/Adult Sensory Profile), pain catastrophizing (Bath Adolescent Pain Questionnaire), pain intensity, functional disability (Functional Disability Index), and quality of life (QOL) (Pediatric QOL Scales) questionnaires.

Results:

Adolescents with persistent pain had atypical patterns of sensory modulation compared with normative data. Sensory modulation patterns were not associated with pain intensity; however, higher sensitivity was associated with greater disability (r=0.36, P<0.01), and lower registration of sensation was associated with poorer emotional (r=0.31, P<0.01), social (r=0.35, P<0.01), and school-related (r=0.49, P<0.001) QOL. Sensory modulation, pain intensity, and catastrophizing contributed independently to disability; catastrophizing mediated sensory sensitivity and both functional disability and emotional QOL.

Discussion:

This study is the first to show that atypical sensory modulation patterns are associated with poorer function for adolescents with persistent pain, suggesting that individualized sensory-informed interventions can potentially facilitate participation in daily activities and improve QOL.
Zika Virus
Authors: Towers Victoria S. , Goldsmith Melissa , Goldsmith Patricia
Published: October 2018

Background:

A growing threat to maternal–fetal health, the most recent and largest outbreak of the Zika virus disease has introduced the devastating fetal effects of microcephaly and other central nervous system deficits.

Purpose:

This brief outlines a history of Zika virus disease, its known effects, best practice recommendations for providers to educate patients, and information for individuals on how to protect themselves.

Methods/Search Strategy:

A search of the literature using the databases PubMed, UptoDate, and CINAHL was conducted for articles published between 2009 and 2016. Key informant interviews with clinical genetics and public health professionals were conducted.

Findings/Results:

The proposed best practice recommendations for education regarding the Zika virus disease and appropriate prevention and treatment methods are outlined.

Implications for Practice:

As the Zika virus continues to spread and further research is conducted regarding its teratogenic effects, the need for concise and effective education is critical to raise awareness, decrease the potential for maternal exposure, and reduce fetal risks.

Implications for Research:

Therefore, the need for appropriate recognition, treatment, management, and prevention of the Zika virus disease prompts the necessity for further education and high-quality level research to be conducted and utilized.
Correlation of Premature Infant Sleep/Wakefulness and Noise Levels in the Presence or Absence of “Quiet Time”
Authors: Pugliesi Raiani Roberta , Campillos Michelle Siqueira , Calado Orsi Kelly Cristina Sbampato , Avena Marta José , Pradella-Hallinan Marcia Lurdes de Cacia , Tsunemi Miriam Harumi , Avelar Ariane Ferreira Machado , Pinheiro Eliana Moreira
Published: October 2018

Background:

Peak sound levels during sleep can compromise the development of hospitalized infants. Quiet time is a strategy implemented in neonatal units to promote the sleeping of neonates by reducing noise levels, luminosity, and handling during particular periods of the day.

Purpose:

To determine the impact of quiet time on reducing sound levels and increasing total sleep time.

Methods:

This longitudinal study was conducted at a neonatal intermediate care unit with a convenience sample of 12 premature infants. Four times per day, 60-minute quiet times were provided in the neonatal unit. Sleep-awake states and sound levels were evaluated during quiet times as well as 60 minutes before and afterward. Polysomnography was used for sleep-awake state assessment, and a noise dosimeter was used to check sound levels every 24 hours.

Results:

The preterm infants had a corrected gestational age of 35.0 ± 1.5 weeks and weighed 1606.0 ± 317.8 g. Total sleep time was highest during quiet time (P = .005). Premature infants remained awake for longer following quiet times (P = .005). There was also a reduction in sound level during quiet times compared with the other time frames (P = .006). No statistically significant relationship was found between total sleep time and sound levels more than 24 hours.

Implications for Practice:

Quiet time is a nursing intervention that should be implemented in all neonatal units.

Implications for Research:

Future research should use a greater sample size and other factors that influence sleep should be further investigated.
The Effects of Dynamic-range Automatic Gain Control on Sentence Intelligibility With a Speech Masker in Simulated Cochlear Implant Listening
Authors: Spencer Nathaniel J. , Tillery Kate Helms , Brown Christopher A.
Published: October 2018

Objectives:

“Channel-linked” and “multi-band” front-end automatic gain control (AGC) were examined as alternatives to single-band, channel-unlinked AGC in simulated bilateral cochlear implant (CI) processing. In channel-linked AGC, the same gain control signal was applied to the input signals to both of the two CIs (“channels”). In multi-band AGC, gain control acted independently on each of a number of narrow frequency regions per channel.

Design:

Speech intelligibility performance was measured with a single target (to the left, at -15 or -30°) and a single, symmetrically-opposed masker (to the right) at a signal-to-noise ratio (SNR) of -2 decibels. Binaural sentence intelligibility was measured as a function of whether channel linking was present and of the number of AGC bands. Analysis of variance was performed to assess condition effects on percent correct across the two spatial arrangements, both at a high and a low AGC threshold. Acoustic analysis was conducted to compare postcompressed better-ear SNR, interaural differences, and monaural within-band envelope levels across processing conditions.

Results:

Analyses of variance indicated significant main effects of both channel linking and number of bands at low threshold, and of channel linking at high threshold. These improvements were accompanied by several acoustic changes. Linked AGC produced a more favorable better-ear SNR and better preserved broadband interaural level difference statistics, but did not reduce dynamic range as much as unlinked AGC. Multi-band AGC sometimes improved better-ear SNR statistics and always improved broadband interaural level difference statistics whenever the AGC channels were unlinked. Multi-band AGC produced output envelope levels that were higher than single-band AGC.

Conclusions:

These results favor strategies that incorporate channel-linked AGC and multi-band AGC for bilateral CIs. Linked AGC aids speech intelligibility in spatially separated speech, but reduces the degree to which dynamic range is compressed. Combining multi-band and channel-linked AGC offsets the potential impact of diminished dynamic range with linked AGC without sacrificing the intelligibility gains observed with linked AGC.
Comparison of impact energy absorbance by various combinations of hip protector and flooring material
Authors: Hughes David , Nabhani Farhad
Published: October 2018

Background:

Understanding the nature of blunt force trauma and the energies involved is key to their effective attenuation. This study compares and analyzes the energy absorbance of various combinations of hip protectors and flooring materials to identify fracture prevention design variables.

Methods:

Testing was performed using a dynamic impact rig instrumented with linear encoders and a piezoelectric impact load cell, which allows for high rate of force and displacement measurements to be achieved during impact. Results show the effects of deceleration rate on peak load and measurably define the impact patterns for a range of protective materials, with compliant flooring and hip protectors reducing impact forces below the suggested fracture threshold (3742N).

Results:

The force reduction provided by a hip protector depends on the type of flooring and is greatest for falls onto carpet with a foam underlay. A combination of soft-shell protector with carpet and underlay showed the highest force attenuation (68%).

Conclusions:

The study showed that the effective selection and implementation of hip protectors in homes and care facilities must include the consideration of flooring type. The identification of peak deceleration rates also will inform the future development of multi-material protective aids.
A method for exoskeletal assistance in squatting to standing movement: a feasibility study
Authors: Rosenberg Nahum , Edelstein Eliezer
Published: October 2018

Background:

Impairment or fatigue of muscle groups in the trunk or lower limbs causes difficulty in rising from a seated position to standing. We hypothesized that a moment force generated externally on the knee axis might eliminate the need for the intrinsic force generation across the hip joint and provide external mechanical assistance for this movement, bypassing the trunk-hip force, which is otherwise essential. Since the force moment for this purpose acts on the knee axis, we evaluated a mechanical exoskeletal method based on a spring mechanism that passively extends the knee joint from almost full flexion in squatting to full extension in standing.

Methods:

Thirteen healthy volunteers (15-83 yr) were recruited for this study. Body movements from full squatting to upright standing, with and without application of an assisting exoskeletal device, were video recorded with reference to the femoral greater trochanter and the head of the humerus and expressed by torque across the knee and hip joints according to the measured vertical acceleration of the reference points.

Results:

We found that assisted knee extension up to 105 degrees from squatting is sufficient to passively proceed to full upright standing, with a significantly lower requirement for additional intrinsic muscle force of thigh and trunk (P<0.001 and P<0.01, respectively).

Conclusions:

This study demonstrated that the presented mechanical concept of assisted knee extension may provide improvement in the ability to rise from sitting or squatting to standing in individuals with muscle impairment, with possible improvement in quality of life.
Myelodysplastic syndromes in children
Authors: Galaverna Federica , Ruggeri Annalisa , Locatelli Franco
Published: October 2018

Purpose of review

Myelodysplastic syndromes (MDSs) are rare disorders in children, showing peculiar clinical manifestations and biological features. This review will summarize biological, genetic and clinical features of childhood MDS and will provide an update of the algorithm of treatment of the different disease variants.

Recent findings

The most recent classification of MDS includes refractory cytopenia of childhood (RCC), advanced and therapy-related MDS. Importantly, in children, these clonal hematopoietic disorders may be often associated with inherited bone marrow failure syndromes, this representing a challenge for diagnostic work-up and treatment. Moreover, germline syndromes predisposing to develop MDS/acute myeloid leukemia have been recently identified, such as those caused by mutations in GATA2, ETV6, SRP72 and SAMD9/SAMD9-L.

Treatment of childhood MDS varies according to specific disease features; allogeneic hematopoietic stem cell transplantation (HSCT) using a Human Leukocyte antigen (HLA)-identical donor, whenever available, represents the treatment of choice for most of these children. HSCT is indicated in MDS with excess of blasts, or in therapy-related MDS. For RCC patients, HSCT is recommended for RCC associated with monosomy 7, or complex karyotype and for patients showing severe neutropenia or transfusion dependence. Novel approaches of HSCT from an HLA-haploidentical relative after selective graft manipulation allow reducing transplant-related complications.
“Extramammary-Type” Paget Disease of the Breast
Authors: Fernandez-Flores Angel , Eraña Itziar , Cuevas Jesus
Published: October 2018

Background:

Mammary Paget disease and extramammary Paget disease (EMPD) have different prognoses. Because they are indistinguishable on histopathological grounds, they must be distinguished on a topographical basis.

Objective:

To study cases of Paget disease of the breast, which show similarities to EMPD.

Methods:

Cases were selected by 2 different approaches: (1) those with an exceptionally good evolution and no evidence of subjacent tumor and (2) those expressing MUC5AC.

Results:

Five cases were collected. All cases showed an indolent behavior with a known long clinical history in 2 cases (9 and 25 years, respectively) and a long follow-up in all cases but one (4–8 years). In all cases but one, surgery was performed, and no parenchymal tumor was found (either intraductal or infiltrating). All cases expressed cytokeratin 7 and MUC5AC without expression of MUC2, S100, or p40.

Limitations:

The short number of cases is a limitation of this study. In addition, case 5 is recent, so we have a very short follow-up.

Conclusions:

Some cases of mammary Paget disease behave like EMPD with slow progression and with no underlying associated tumor. Immunoexpression of MUC5AC might be a clue to identify them.
Perineal Stapled Rectal Prolapse Resection in Elderly Patients: Long-term Follow-up
Authors: Ram Edward , Hoffman Aviad , Goldes Yuri , Rosin Danny , Horesh Nir , Gutman Mordechai , Edden Yair
Published: October 2018

BACKGROUND:

Full-thickness rectal prolapse has a significant negative impact on quality of life. The therapeutic options, specifically in elderly patients, are imperfect. Perineal stapled rectal prolapse resection is a novel operation for treating external rectal prolapse. Long-term follow-up following this procedure is lacking. In our study, we report a long-term follow-up of 30 patients, analyzing the long-term recurrence rate, morbidity, and functional outcome.

OBJECTIVE:

This study aimed to examine the long-term results of perineal stapled rectal resection in a population unfit for prolonged general anesthesia.

DESIGN:

This was a cohort study with a prospective follow-up.

SETTINGS:

This study was conducted at a single tertiary referral center.

PATIENTS:

Patients undergoing perineal stapled rectal resection from January 2010 to June 2013 were included.

INTERVENTIONS:

Perineal stapled rectal prolapse resection was performed.

MAIN OUTCOME MEASURES:

The primary outcome measured was prolapse recurrence.

RESULTS:

A total of 30 patients underwent the surgical intervention. The median follow-up period was 61 months (range, 37–65). No intraoperative or postoperative complications occurred. Six patients (20%) had recurrent rectal prolapse, and continence was not achieved in any of the patients. Two patients who had recurrence underwent a redo perineal stapled rectal resection.

LIMITATIONS:

This study was limited by the small cohort of selected patients.

CONCLUSIONS:

Frail patients that can only endure a short procedure under regional anesthesia should be considered for perineal stapled rectal prolapse resection. The lack of mortality and morbidity, specifically in this population, along with the low long-term recurrence rates, make this a favorable surgical alternative. See Video Abstract at http://links.lww.com/DCR/A745.
Total Nose and Upper Lip Replantation: A Case Report and Literature Review
Authors: Elzinga Kate , Medina Abelardo , Guilfoyle Regan
Published: October 2018

The nose plays a critical role in olfaction, air filtration and humidification, and facial aesthetics. Most nasal amputations result from animal bites, human bites, and lacerations from glass. Successful replantation yields the best aesthetic and functional outcomes and is preferred compared with multistage nasal reconstruction. However, nasal replantation is technically challenging; establishing venous outflow can be particularly difficult. A 17-year-old male sustained a complete nose and upper lip amputation in a motor vehicle accident. The midface segment was emergently replanted. Two arteries (left dorsal nasal artery, left superior labial artery) and 1 vein (branch of the left supratrochlear artery) were anastomosed using microsurgical technique. A vein graft, systemic anticoagulation, and postoperative leeching were important adjuncts. Total operative time was 10 hours. Cold ischemia time was 2 hours and warm ischemia time was 1 hour. Two arteries were anastomosed to minimize the risk of ischemia of the nose and/or upper lip. Complete survival of the replanted segment was achieved. Eighteen months postoperatively, the patient has bilateral nasal patency, intact septal support, and an excellent aesthetic result. All efforts should be made to establish a venous anastomosis during nasal replantation to maximize functional and aesthetic outcomes. Partial necrosis is common following artery-only replantation, leading to tissue loss and contracture.
Gender-Affirming Hormone Therapy for Transgender Men
Authors: MORAVEK MOLLY B.
Published: October 2018

There are an estimated 1.4 million transgender adults in the United States, and lack of providers knowledgeable in transgender care is a barrier to health care. Obstetricians and Gynecologists can help increase access in part by becoming competent in gender-affirming hormone therapy. For transgender men, testosterone protocols can be extrapolated from those used for hypogonadal cisgender men. Unfortunately, there are not any high-quality, long-term prospective studies on the effectiveness and safety of different testosterone regimens specifically in transgender men, but the available data suggest that gender-affirming testosterone therapy is safe and effective with proper screening and monitoring.
Blood Products in the Management of Abnormal Placentation
Authors: GATTA LUKE A. , LOCKHART EVELYN L. , JAMES ANDRA H.
Published: October 2018

A critical tool in the successful management of patients with abnormal placentation is an established massive transfusion protocol designed to rapidly deliver blood products in obstetrical and surgical hemorrhage. Spurred by trauma research and an understanding of consumptive coagulopathy, the past 2 decades have seen a shift in volume resuscitation from an empiric, crystalloid-based method to balanced, targeted transfusion therapy. The present article reviews patient blood management in abnormal placentation, beginning with optimizing the patient’s status in the antenatal period to the laboratory assessment and transfusion strategy for blood products at the time of hemorrhage.
Undifferentiated Pleomorphic Sarcoma Metastatic to the Orbit
Authors: Ramsey Jonathan K. , Chen James L. , Schoenfield Lynn , Cho Raymond I.
Published: October 2018

Undifferentiated pleomorphic sarcoma is a malignancy of mesenchymal origin, which was previously known as malignant fibrous histiocytoma. It is known to occur on rare occasion as a primary orbital tumor, but no known cases of metastatic orbital involvement have been reported since 2002, when the reclassification of these tumors took place. The authors report a patient who presented with a metastasis to the left orbit 2 years after undergoing treatment of a high-grade undifferentiated pleomorphic sarcoma of the right thigh. Histopathology of the orbital mass was similar to the primary tumor biopsy prior to neoadjuvant chemotherapy and radiation. The appearance was markedly altered in the subsequent excisional tissue, which showed treatment changes. Immunohistochemistry and genetic testing also supported the metastatic nature of the orbital lesion. The patient’s tumor progressed rapidly despite systemic targeted therapy and orbital exenteration was performed. At 2 years follow up, the patient remained without evidence of tumor recurrence in the socket.
CRRT for sepsis-induced acute kidney injury
Authors: Romagnoli Stefano , Ricci Zaccaria , Ronco Claudio
Published: October 2018

Purpose of review

Sepsis-induced acute kidney injury (SI-AKI) represents the first cause of AKI in ICUs, and renal replacement therapy (RRT) is frequently applied in advanced AKI stages. The debate between ‘rescue’ indications for RRT start in patients with severe AKI (acidosis, hyperkalemia, uremia, oliguria/anuria, volume overload) and a proactive RRT initiation is still ongoing. In addition, current SI-AKI pathophysiologic theory has identified the toxic effects of soluble middle-molecules released during sepsis and inflammation (pathogen and damaged associated molecular patterns).

The purpose of the present review is to summarize the recent literature on RRT for patients with SI-AKI. Supportive or replacement measures for severe stages of renal dysfunction and blood purification techniques for sepsis syndrome will be reviewed.

Recent findings

Anticipated RRT for SI-AKI does not seem to improve survival or renal recovery. There is no clinical advantage by delivering continuous RRT at high doses for blood purification purposes. Similarly, specific applications with dedicated devices and membranes have yielded no clinical benefit in these patients, so far.

In the present review, the recent insights and results from large randomized and nonrandomized trials in the area of RRT applied both as supportive measures for kidney failure and blood purification techniques are described.
Continuous renal replacement therapy: individualization of the prescription
Authors: Haines Ryan W. , Kirwan Christopher J. , Prowle John R.
Published: October 2018

Purpose of review

Continuous renal replacement therapy (CRRT) is now the mainstay of renal organ support in the critically ill. As our understanding of CRRT delivery and its impact on patient outcomes improves there is a focus on researching the potential benefits of tailored, patient-specific treatments to meet dynamic needs.

Recent findings

The most up-to-date studies investigating aspects of CRRT prescription that can be individualized: CRRT dose, timing, fluid management, membrane selection, anticoagulation and vascular access are reviewed. The use of different doses of CRRT lack conventional high-quality evidence and importantly studies reveal variation in assessment of dose delivery. Research reveals conflicting evidence for clinicians in distinguishing which patients will benefit from ‘watchful waiting’ vs. early initiation of CRRT. Both dynamic CRRT dosing and precision fluid management using CRRT are difficult to investigate and currently only observational data supports individualization of prescriptions. Similarly, individualization of membrane choice is largely experimental.

Clinicians have limited evidence to individualize the prescription of CRRT. To develop this, we need to understand the requirements for renal support for individual patients, such as electrolyte imbalance, fluid overload or clearance of systemic inflammatory mediators to allow us to target these abnormalities in appropriately designed randomized trials.
Regional citrate anticoagulation for continuous renal replacement therapy
Authors: Kindgen-Milles Detlef , Brandenburger Timo , Dimski Thomas
Published: October 2018

Purpose of review

The delivery of an effective dialysis dose in continuous renal replacement therapy (CRRT) depends on adequate anticoagulation of the extracorporeal circuit. In most patients, either systemic heparin anticoagulation (SHA) or regional citrate anticoagulation (RCA) is used. This review will outline the basics and rationale of RCA and summarize data on safety and efficacy of both techniques.

Recent findings

The basic principle of RCA is to reduce the level of ionized calcium in the extracorporeal circuit via infusion of citrate. This way, effective anticoagulation restricted to the extracorporeal circuit is achieved. SHA and RCA were compared in a variety of studies. RCA significantly prolonged filter lifetime, reduced bleeding complications and provided excellent control of uremia and acid-base status. RCA was also safe in the majority of patients with impaired liver function, whereas caution must be exerted in those with severe multiorgan failure and persistent hyperlactatemia.

RCA per se is safe and effective for anticoagulation of CRRT. Compared to SHA, efficacy of anticoagulation is improved and adverse effects are reduced. RCA can be recommended as the anticoagulation mode of choice for CRRT in most ICU patients.
IgG4-related disease in the head and neck
Authors: Johnston James , Allen Jacqui E.
Published: October 2018

Purpose of review

To summarize current evidence regarding the pathophysiology, diagnostic criteria, and management of IgG4 disease in the head and neck.

Recent findings

The anti-CD20 antibody, rituximab is being used increasingly as a primary treatment modality in cases with a definitive diagnosis. Despite the favorable prognosis, it is now recognized that the incidence of cancer development within 3 years of diagnosis is higher than that of the general population.

IgG4-related disease is a sclerosing, chronic inflammatory disease, that is benign, and usually occurs in middle-aged to elderly individuals. Definitive diagnosis of IgG4-related disease requires radiological confirmation of enlargement of the affected organ, elevated serum IgG4 levels, and characteristic histopathological findings. Treatment is primarily with systemic corticosteroids or the monoclonal anti-CD20 antibody rituximab, surgical excision, or a combination of treatment modalities. Prognosis is good with complete remission in up to 90% of patients.
Screening for Postpartum Depression by Hospital-Based Perinatal Nurses
Authors: Logsdon M. Cynthia , Vogt Krista , Davis Deborah Winders , Myers John , Hogan Felicia , Eckert Diane , Masterson Katlin
Published: October 2018

Purpose:

The primary purpose of this study was to evaluate acceptability by new mothers of postpartum depression (PPD) screening and education about community resources by hospital-based perinatal nurses. A secondary purpose was to determine further screening for PPD that women received by community providers in the first few weeks after birth.

Methods:

The study design was descriptive. As per standard practice on the unit, all new mothers were screened for depression the night before hospital discharge using the Edinburgh Postnatal Depression Scale (EPDS). New mothers identified as high risk for depression by EPDS scores greater than or equal to 10 (n = 75) and a comparison group of mothers at low risk for depression with EPDS scores less than 10 (n = 26) were recruited from an academic health sciences center. Participants were contacted by telephone 2 to 4 weeks later and asked about the acceptability of screening for depression and education about community resources by hospital-based perinatal nurses, as well as if they had received further screening for depression by community providers. Descriptive and correlational statistics were used to analyze data.

Results:

The majority of new mothers found it acceptable to be screened for depression and educated about community resources by hospital-based perinatal nurses. Many new mothers were not asked about depressive symptoms by community providers. There was no significant correlation between demographics and depression risk.

Clinical Implications:

New mothers viewed depression screening and receiving information on community resources as a positive part of their care. Communication between inpatient and community caregivers should be improved so that new mothers can benefit from seamless depression assessment, evaluation, and treatment.
Airway Clearance of the Term Newborn
Authors: Adams Ellise D. , O'Neal Pamela V. , Hanson Linda A. , Norris Casey , Ayers Angela , Harbin Brandi
Published: October 2018

Purpose:

This descriptive, observational study explored the practice of airway clearance of the term newborn at birth. The American Academy of Pediatrics, the American Heart Association, and the European Resuscitation Council have established guidelines for suctioning the well newborn.

Study Design and Methods:

Airway clearance practices of nurses, obstetricians, and respiratory therapists at 10 cesarean births and 10 vaginal births were observed. Data were analyzed using descriptive statistics and through content analysis of narratives.

Results:

All newborns observed experienced at least one airway clearance event and multiple airway clearance passes. Indications for suctioning were not consistent with professional guidelines. Airway clearance procedures and practices were inconsistent. Two suction devices used: the blue bulb syringe and orogastric catheter. If a newborn was suctioned three times, the orogastric catheter was the predominate device used.

Clinical Implications:

There was a lack of adherence to established clinical guidelines for newborn airway clearance. Further study is needed to identify education of airway clearance guidelines. Specific protocols such as safe suctioning methods, correct device use, and observation of complications associated with airway management need to be developed to support a newborn's healthy transition at birth.
Novel Biomarker Approaches in Classic Hodgkin Lymphoma
Authors: Aoki Tomohiro , Steidl Christian
Published: October 2018

Classic Hodgkin lymphoma (cHL) is one of the most common lymphomas in the Western world. Advances in the management of cHL have led to high cure rates exceeding 80%. Nevertheless, relapse or refractory disease in a subset of patients and treatment-related toxicity still represents unsolved clinical problems. The introduction of targeted treatments such as PD-1 blockade and the CD30 antibody drug conjugate, brentuximab vedotin, has broadened treatment options in cHL, emphasizing the critical need to identify biomarkers with the goal to provide rationales for treatment selection, increase effective drug utilization, and minimize toxicity. The unique biology of cHL featuring low abundant tumor cells and numerous nonmalignant immune cells in the tumor microenvironment can provide various types of promising biomarkers related to the tumor cells directly, tumor microenvironment cross-talk, and host immune response. Here, we comprehensively review novel biomarkers including circulating tumor DNA and gene expression–based prognostic models that might guide the ideal management of cHL in the future.
Current Use of Biological Scaffolds in Plastic Surgery
Authors: Panayi Adriana C. , Orgill Dennis P.
Published: October 2018

Background:

Properly designed biodegradable scaffolds facilitate repair or regeneration of stromal tissues. Over the past 50 years, a variety of synthetic, semisynthetic, and decellularized scaffolds have been developed that provide surgeons with tools to reconstruct a wide array of structural defects.

Methods:

The authors review the literature of biological degradable scaffolds in current clinical use in the United States and highlight their design principles and products in common use.

Results:

Host tissues populate scaffolds with inflammatory cells, fibroblasts, blood vessels, nerves, and lymphatics. Cells lay down extracellular matrix macromolecules, whereas enzymes degrade the scaffold. Over time, the scaffold can be totally replaced by host tissues.

Conclusions:

The greatest use of scaffolds in plastic surgery is in skin replacement, breast reconstruction, abdominal wall reconstruction, and peripheral nerve repair. Other areas of importance are cartilage and bone replacement and support for lining replacements such as bowel, bladder, mucosa, and dura. The wide range of research being performed in this field is likely to provide surgeons with more choices and improved materials to repair and regenerate stromal structures.
Tips for Making a Successful Online Microsurgery Educational Platform: The Experience of International Microsurgery Club
Authors: Kwon Soo-Ha , Goh Raymond , Wang Zeng-Tao , Ting-Hsuan Tang Evelyn , Chu Cheng-Feng , Chen Yen-Chou , Chuieng-Yi Lu Johnny , Wei Ching-Yueh , Ting-Wei Hsu Angela , Nai-Jen Chang Tommy
Published: October 2018

The presence of online learning resources has grown tremendously in recent years. They provide powerful and yet easily accessible means of learning and sharing knowledge. Online learning resources now encompass all aspects of medicine, and microsurgery is no exception. International Microsurgery Club is a closed, invitation-only group based on the Facebook social media platform. It was initiated on May 6, 2016, with the primary objectives of providing a convenient forum for discussing challenging cases, sharing valuable resources, and providing opportunities for research collaboration. The membership of International Microsurgery Club has grown to over 8700 at 2 years’ existence, and continues to expand. International Microsurgery Club has become one of the largest online platforms for global microsurgeons. Here, the authors share their experience on how to establish a successful online platform for medical education.
Is Reconstruction Preserving the First Ray or First Two Rays Better Than Full Transmetatarsal Amputation in Diabetic Foot?
Authors: Suh Young Chul , Kushida-Contreras Beatriz Hatsue , Suh HyunSuk Peter , Lee Ho Seung , Lee Woo Je , Lee Seung Hwan , Hong Joon Pio (Jp)
Published: October 2018

Background:

The benefits of total transmetatarsal amputation over higher level amputation are well known. However, there are no studies evaluating the effects of first ray– or first two ray–sparing transmetatarsal amputation with flap coverage. The authors evaluated this approach with regard to functional outcome and to identify long-term complications.

Methods:

Retrospective data of 59 patients were evaluated according to their surgical method. Complete transmetatarsal amputation with free flap reconstruction was designated as the transmetatarsal amputation group with 27 patients and first ray– or first two ray–preserving transmetatarsal amputation with free flap reconstruction was designated as the ray group, with 32 patients. Demographics, flap outcomes, additional procedures after initial healing, and functional outcomes were measured and evaluated.

Results:

There was no statistically significant difference in demographic distribution and flap outcomes in either group, except for poor blood glucose control in the ray group. Additional procedures after initial healing showed no statistical difference, but the tendency of minor procedures was higher in the ray group. The maximum achieved ambulatory function was significantly better in the ray group, with an ambulatory function score of 4.4 compared with 3.7 in the transmetatarsal amputation group (p = 0.012).

Conclusions:

The preservation of the first ray or first two rays with free flap reconstruction may functionally benefit the patients despite the higher tendency toward minor procedures after initial healing. Furthermore, the progressive deformity of the preserved first and second toes will inevitably occur, requiring patients to undergo further surgery. Further studies are warranted to evaluate this approach.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Lactate is a Prognostic Factor in Patients Admitted With Suspected ST-Elevation Myocardial Infarction
Authors: Frydland Martin , Møller Jacob Eifer , Wiberg Sebastian , Lindholm Matias Greve , Hansen Rikke , Henriques Jose P.S. , Møller-Helgestad Ole Kristian , Bang Lia Evi , Frikke-Schmidt Ruth , Goetze Jens Peter , Udesen Nanna Louise Junker , Thomsen Jakob Hartvig , Ouweneel Dagmar M. , Obling Laust , Ravn Hanne Berg , Holmvang Lene , Jensen Lisette Okkels , Kjaergaard Jesper , Hassager Christian
Published: October 2018

Aims:

The diagnosis of cardiogenic shock depends on clinical signs of poor perfusion and low blood pressure. Lactate concentration will increase with poor tissue perfusion, and it has prognostic value in cardiogenic shock patients. We sought to assess the prognostic value of lactate concentration in subjects admitted with suspected ST-elevation myocardial infarction (STEMI).

Methods and Results:

In 2,094 (93%) out of 2,247 consecutive suspected STEMI-subjects, lactate concentration was measured on admission. The prognostic value of lactate concentration on 30-day mortality was assessed in addition to clinical signs of peripheral hypoperfusion, systolic blood pressure (sBP), and left ventricular ejection fraction (LVEF) in multivariable models.

Lactate concentration added prognostic information beyond signs of peripheral hypoperfusion, sBP, and LVEF, and was independently associated with 30-day mortality (hazard ratio [95% confidence interval] 1.11 [1.07–1.14], P < 0.0001). Lactate also provided predictive information on 30-day mortality to the combination of signs of peripheral hypoperfusion, sBP, and LVEF (area under the receiver-operating characteristics curve = 0.88 vs. 0.83, P < 0.0001).

Conclusions:

In conclusion, admission lactate concentration in suspected STEMI-subjects contains prognostic information on 30-day mortality when added to variables used in cardiogenic shock-definition. We recommend lactate measurement in STEMI-subjects, especially when signs of compromised hemodynamics are present.
How should we assess patient-reported outcomes in the onco-hematology clinic?
Authors: Cannella Laura , Efficace Fabio , Giesinger Johannes
Published: October 2018

Purpose of review

The improvement of clinical outcomes in hematologic malignancies has paved the way for a more systematic patient-reported outcomes (PROs) assessment in routine clinical practice. PROs help to narrow the gap between patients’ and healthcare professionals’ view of patient health and treatment success. This review outlines key aspects of planning and performing PRO assessments in daily routine such as the selection of PRO instruments, electronic PRO data collection, and the presentation and interpretation of PRO results.

Recent findings

A substantial body of literature has demonstrated that careful planning, adequate logistics, and elaborate methodology allow to successfully integrate the patients’ experience in routine care. Several examples exist of the clinical benefits of systematically collecting PRO information in daily care of patients with solid tumors. These include improved patient–physician communication, better symptom management, and, in patients with advanced disease, also fewer hospitalizations and prolonged survival. However, sparse evidence based data are available for patients with onco-hematologic diseases.

Data collected through PRO instruments provide unique information that complements traditional clinical examinations and may help improving patients’ management in clinical practice. Major efforts are now needed to implement PRO instruments in daily practice of patients with hematologic malignancies.
What's next in using CT scans to better understand cachexia?
Authors: Antoun Sami , Rossoni Caroline , Lanoy Emilie
Published: October 2018

Purpose of review

Cachexia (CAX), a protein metabolism disorder commonly associated with cancer, can be evaluated by computed tomography (CT) scan assessment of skeletal muscle mass (SMM), a parameter associated with patient outcome. This review analyzes current barriers for using CT scans of SMM in routine management for defining prognostic risk groups, and proposes new areas of research to reach a better understanding of CAX mechanisms.

Recent findings

Current research is focused on establishing a robust and relevant CAX staging system to reach a consensual definition. Previous biomarkers of CAX are poorly associated with outcome and do not exhibit clinical benefit. Systemic inflammatory marker, decrease in intake assessments, and/or nonnutritional criteria have been integrated to develop a multidimensional, highly complex CAX signature and CAX staging.

A standardized definition of sarcopenia is essential, and its value in clinical practice should be evaluated in prospective interventional studies using skeletal muscle assessment. SMM loss may be a key element in defining early protein disorders occurring before weight loss and could be used as a trigger for initiating early nutritional support. Changes in SMM and body composition during follow-up are useful tools for exploring CAX mechanisms in terms of intrinsic factors or tumor evolution.
Rapidly Progressive Dementia in the Outpatient Clinic: More Than Prions
Authors: Day Gregory S. , Musiek Erik S. , Morris John C.
Published: October 2018

Background:

Published approaches to the evaluation and management of patients with rapidly progressive dementia (RPD) have been largely informed by experience at academic hospitals and national centers specializing in the diagnosis of Creutzfeldt-Jakob disease. Whether these approaches can be applied to patients assessed within lower-acuity outpatient settings is unknown.

Methods:

A total of 96 patients with suspected RPD were assessed within the Washington University School of Medicine (Saint Louis, MO) outpatient memory clinic from February 2006 to February 2016. Consensus etiologic diagnoses were established following independent review of clinical data by 2 dementia specialists.

Results:

In total, 67/90 (70%) patients manifested with faster-than-expected cognitive decline leading to dementia within 2 years of symptom onset. Female sex (42/67, 63%), median patient age (68.3 y; range, 45.4 to 89.6), and years of education (12 y; range, 6 to 14) were consistent with clinic demographics. Atypical presentations of common neurodegenerative dementing illnesses accounted for 90% (60/67) of RPD cases. Older age predicted a higher odds of amnestic Alzheimer disease dementia (OR, 2.1 per decade; 95% CI, 1.1-3.8; P=0.02). Parkinsonism (OR, 6.9; 95% CI, 1.6-30.5; P=0.01) or cortical visual dysfunction (OR, 10.8; 95% CI, 1.7-69.4; P=0.01) predicted higher odds of another neurodegenerative cause of RPD, including sporadic Creutzfeldt-Jakob disease.

Conclusions and Relevance:

The clinical environment influences the prevalence of RPD causes. The clinical evaluation should be adapted to promote detection of common causes of RPD, specific to the practice setting.
Stroke mimics and chameleons
Authors: Moulin Solène , Leys Didier
Published: October 2018

Purpose of review

A stroke mimic is a situation in which a diagnosis of stroke at admission is not confirmed, and a stroke chameleon is a situation in which a stroke is revealed by clinical symptoms that are not usual in stroke. The objective of this review is to identify the most frequent clinical situations in which stroke mimics and chameleons are encountered and consequences for the patient.

Recent findings

The safety profile of intravenous thrombolysis (IVT) in patients who have stroke mimics is excellent, and intracranial hemorrhages are rare. Modern neuroimaging techniques help identifying most mimics. For stroke chameleons the role of imaging may be less important, especially when the clinical presentation is not suggestive of a brain disorder that request immediate neuroimaging. Education of health providers to identify such situations is crucial.

Stroke mimics account for up to 25% of admissions for probable strokes. The proportion of patients with stroke mimics decreases with use of MRI at baseline. Mimics cannot always be ruled out in emergency. The problem with mimics is that stroke facilities are not properly used, and patients may receive IVT. However, thrombolysis is usually well tolerated in mimics and we should not spend much time in all patients to improve diagnostic accuracy, knowing that the time lost is harmful in all patients, and will only prevent treating one mimic out of 100 patients. The problem with chameleons is more serious, because patients are not identified, and are not properly treated.
Neuromodulation of Right Auditory Cortex Selectively Increases Activation in Speech-Related Brain Areas in Brainstem Auditory Agnosia
Authors: Bestelmeyer Patricia E.G. , Davis Nick J. , Poliva Oren , Rafal Robert D.
Published: October 2018

Auditory agnosia is an inability to make sense of sound that cannot be explained by deficits in low-level hearing. In view of recent promising results in the area of neurorehabilitation of language disorders after stroke, we examined the effect of transcranial direct current stimulation (tDCS) in a young woman with general auditory agnosia caused by traumatic injury to the left inferior colliculus. Specifically, we studied activations to sound embedded in a block design using functional magnetic resonance imaging before and after application of anodal tDCS to the right auditory cortex. Before tDCS, auditory discrimination deficits were associated with abnormally reduced activations of the auditory cortex and bilateral unresponsiveness of the anterior superior temporal sulci and gyri. This session replicated a previous functional scan with the same paradigm a year before the current experiment. We then applied anodal tDCS over right auditory cortex for 20 min-utes and immediately re-scanned the patient. We found increased activation of bilateral auditory cortices and, for speech sounds, selectively increased activation in Broca’s and Wernicke’s areas. Future research might consider the long-term behavioral effects after neurostimulation in auditory agnosia and its potential use in the neurorehabilitation of more general auditory disorders.
Differential Susceptibility of Rat Retinal Ganglion Cells Following Optic Nerve Crush
Authors: VanderWall Kirstin B. , Lu Bin , Wang Shaomei , Meyer Jason S.
Published: October 2018

Retinal ganglion cells (RGCs) are a heterogeneous group of cells, comprised of numerous subpopulations, that work together to send visual information to the brain. In numerous blinding disorders termed optic neuropathies, RGCs are the main cell type affected leading to degeneration of these cells and eventual loss of vision. Previous studies have identified and characterized RGC subtypes in numerous animal systems, with only a handful of studies demonstrating their differential loss in response to disease and injury. Thus, efforts of the current study utilized an optic nerve crush (ONC) model to characterize the loss of RGCs and disease phenotypes associated with this injury. Additionally, the loss of RGC subtypes including direction selective-, alpha-, and ip-RGCs following ONC was explored. Results of this study demonstrated the differential loss of RGC subtypes with a high susceptibility for loss of alpha- and direction selective-RGCs and the preferential survival of ip-RGCs following ONC and allows for the establishment of additional studies focused on mechanisms and loss of these cells in optic neuropathies. Additionally, these results put important emphasis on the development of therapeutics targeted at the loss of specific subtypes as well as cellular replacement following injury and disease.