bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical outcomes of prenatal diagnosis of the fetal micrognathia
Authors: Lu Jin-Wen , Lu Dan , Zhang Xiao-Li , Bai Jiao
Published: January 2020

Rationale:

Micrognathia is a subtle facial malformation characterized by a small mandible and receding chin. Fetal micrognathia is often associated with chromosomal abnormalities, skeletal dysplasia, and various syndromes. Once it is dignosised, detailed fetal malformation screening and chromosome examination should be carried out.

Patient concern:

One pregnant woman with suspicion of fetal micrognathia was referred from her local hospital to our hospital for detailed fetal malformation screening and fetal echocardiography. Examination of the fetus was performed using a two-dimensional and three-dimensional ultrasound probe in multiple planes. The fetus showed micrognathia without glossoptosis with features of the inferior facial angle (IFA) ≤50° and his tongue reached anterior mandibular border box during normal movement.

Diagnoses:

The fetus was diagnosed as isolated micrognathia prenatally without multisystem abnormalities.

Interventions:

Amniocentesis was performed and the fetus was found to carry 46XN with 6q14.1 duplication, the significance of which was unclear.

Outcomes:

The fetus was labored through vagina at 38 weeks gestation. A small soft cleft palate was diagnosed after delivery.

Lessons:

This case suggests that once prenatal diagnosis of the fetal micrognathia has been made, we should carefully examine the presence of fetus's multisystem developmental abnormalities and due consideration should be given for associated soft cleft palate.
Capillary hemangioma arising from the lesser omentum in an adult
Authors: Nagano Hideki , Goi Takanori , Taguchi Seiichi , Tsubaki Takayoshi , Tsuchiyama Toshikuni , Uematsu Hidemasa , Noriki Sakon
Published: January 2020

Rationale:

Although capillary hemangiomas, common lesions involving the proliferation of small capillary vessels and a single layer of endothelial cells, can arise in any organ, they are rarely reported in the greater or lesser omentum. Here in, we report a case of capillary hemangioma arising from the lesser omentum in an adult with interesting diagnostic imaging findings, including changes in tumor size over time on computed tomography (CT), that was resected using laparoscopic surgery. To our knowledge, this is the first English report to describe a capillary hemangioma arising from the lesser omentum.

Patient concerns:

A 63-year-old Japanese man received hemodialysis for chronic renal failure due to diabetic nephropathy, and a small, gradually enlarging tissue mass was found near the lesser curvature of the stomach on plain CT performed annually, without any associated complaints. Diagnostic imaging revealed an 18 × 15-mm tumor with a homogenous, highly enhanced effect in the early phase that was attenuated but prolonged in the delayed phase. Magnetic resonance imaging showed a mass with low signal intensity on T1-weighted imaging and relatively high signal intensity on T2-weighted imaging.

Diagnosis:

The patient was diagnosed with capillary hemangioma arising from the lesser omentum according to the pathological and immunohistological findings.

Interventions:

The patient underwent laparoscopy for excision of the tumor from the lesser omentum.

Outcomes:

At the 1 year follow-up, the patient had no recurrence of the tumor.

Lessons:

We describe the first case worldwide of capillary hemangioma that was a true vascular tumor arising from the lesser omentum. Although capillary hemangioma arising from the lesser omentum is extremely rare, it should be considered in the differential diagnosis of patients presenting with a highly enhanced lesser omental tumor, and laparoscopy can be safely applied for the excision of this tumor.
The efficacy and safety of mirabegron on overactive bladder induced by benign prostatic hyperplasia in men receiving tamsulosin therapy
Authors: Su Shunye , Lin Jinlei , Liang Liqin , Liu Ludong , Chen Zhipeng , Gao Yuan
Published: January 2020

Background:

We conducted a meta-analysis to assess the efficacy and safety of mirabegron on overactive bladder (OAB) induced by benign prostatic hyperplasia (BPH) in men receiving tamsulosin therapy.

Methods:

We performed the analysis by using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The databases including MEDLINE, EMBASE, and the Cochrane Controlled Trials Register were retrieved to get information regarding randomized controlled trials of mirabegron on OAB induced by BPH in men receiving tamsulosin therapy. We also searched the references of included literatures.

Results:

Three randomized controlled trials containing a total of 1317 BPH patients were included in the analysis. Co-primary efficacy end points: the mean number of micturitions per day [the mean difference (MD) = –0.27, 95% confidence interval (CI): –0.46 to –0.09, P = .004], the urgency episodes per day (the MD = –0.50, 95% CI: –0.77 to –0.22, P = .0004), the total OAB symptom score (the MD = –0.69, 95% CI: –1.00 to –0.38, P < .0001), and mean volume voided (the MD = 10.76, 95% CI: 4.87–16.64, P = .0003) indicated that mirabegron was effective in treating OAB induced by BPH in men receiving tamsulosin therapy. Safety assessments that included treatment-emergent adverse events (odds ratio = 0.88, 95% CI: 0.68–1.13, P = .31) indicated that mirabegron was well tolerated with the exception of post-void residual urine volume (MD = 12.02, 95% CI: 6.01–18.04, P < .0001).

Conclusions:

This analysis demonstrates that mirabegron is an effective and safe treatment for OAB symptoms induced by BPH in men receiving tamsulosin therapy with a low occurrence of side effects. Besides, we should be aware that the administration of mirabegron might have the risk of increasing post-void residual urine volume.
Association of human serotonin receptor 4 promoter methylation with autism spectrum disorder
Authors: Hu Zhenyu , Ying Xiuru , Huang Ling , Zhao Yuanzhi , Zhou Dongsheng , Liu Jing , Zhong Jie , Huang Tianyi , Zhang Wenwu , Cheng Fang , Duan Shiwei
Published: January 2020

Human serotonin receptor 4 (HTR4) encodes a 5-HT4 receptor involved in learning, memory, depression, anxiety, and feeding behavior. The aim of this study was to investigate the association between the deoxyribonucleic acid (DNA) methylation of HTR4 promoter and autism spectrum disorder (ASD), a disease characterized by communication disorder and repetitive or restrictive behavior.

Peripheral blood DNA was obtained from 61 ASD children and 66 healthy children, and the DNA methylation of HTR4 promoter was assessed by quantitative methylation-specific polymerase chain reaction. We used percentage of methylated reference (PMR) to represent DNA methylation level.

Due to significant age differences between ASD cases and controls (3 [2, 5] years and 6 [5, 6] years, P = 3.34E-10), we used binary logistic regression analysis for adjustment. Our results showed that the DNA methylation levels of HTR4 promoter were significantly lower in children with ASD than in healthy children (median PMR: 66.23% vs 94.31%,P = .028, age-adjusted P = .034). In addition, the DNA methylation of HTR4 promoter was inversely associated with age in male ASD cases (total cases: r = –0.283, P = .027; male cases: r = –0.431, P = .002; female cases: r = –0.108, P = .752). Dual-luciferase reporter gene assay showed that the reporter gene expression in the strain with recombinant pGL3-promoter-HTR4 plasmid was significantly higher than that in the strain with pGL3-promoter plasmid (fold change = 2.01, P = .0065), indicating that the HTR4 promoter fragment may contain transcription factors to upregulate promoter activity.

Our study suggested that hypomethylation of the HTR4 promoter is a potential biomarker for predicting the risk of male ASD.
Clinical study for external Chinese herbal medicine LC09 treating hand-foot skin reaction associated with the antitumor targeted drugs
Authors: Wang Gui , Jia Liqun , Pei Yuying , Yu Ran , Gao Yu , Deng Chao , Lou Yanni
Published: January 2020

Background:

Molecular targeted anticancer drugs such as multikinase inhibitors have shown obvious therapeutic advantages in a variety of tumors. The occurrence of hand-foot skin reaction (HFSR) is positively correlated with therapeutic effect, but it is also the most common cause of dose limiting toxicity for this treatment. This can lead to interruption or decrement of the treatment, a reduction in quality of life for patients, as well as potentially leading to secondary infections. As a result, the curative effect of targeted anticancer drugs will be negatively impacted. Currently, there is no certain and effective therapy. External use of Chinese herb medicine LC09 in the early treatment of HFSR has shown positive outcomes, but it is necessary to carry out further clinical research to confirm.

Objectives:

The purpose of this study was to investigate the efficacy and safety of topical soaks of Chinese herbal medicine LC09 for HFSR induced by molecular targeted anticancer drugs.

Methods:

The trial is a prospective, randomized, controlled, double-blind, monocentric, and interventional study. A total of 66 patients with HFSR will be recruited and randomly assigned to receive either LC09 Granules or placebo. The primary outcomes are the assessment of HFSR grade and pain score. The secondary outcomes are the evaluation of the quality of life, incidence of targeted drug dosage reduction, and incidence of targeted drug withdrawal.

Discussion:

This prospective, randomized clinical trial will provide valuable data regarding the efficacy and safety of topical soak treatments with LC09 granules for HFSR. Positive results would provide evidence-based complementary therapeutic approach future treatments of HFSR.

Trial registration:

Chinese Clinical Trial Registry, http://www.chictr.org.cn, ChiCTR1900023679. Registered on 7 June 2019.
Multi-stage surgery combined with radiotherapy for treatment of giant anterior chest wall keloid
Authors: Liu Qingwu , Li Ping , Yang Zhishan , Qu Baoquan , Qin Chunfang , Meng Shengnan , Fang Huijuan , Wu Ruiying , Cheng Tiantian , Yang Dingquan
Published: January 2020

Rationale:

Giant keloids often have indications for surgical resection, but postoperative reconstruction of the skin and high recurrence of keloids are a challenge for clinical treatment. This article reports a rare successful treatment of a giant keloid in the anterior chest wall by multistage surgery combined with radiotherapy, which is why this case is meaningful.

Patient concerns:

A 66-year-old woman presented a giant keloid with ulcerations and severe itching on the anterior chest wall. She had a history of keloid disease for more than 10 years, and had been treated by multiple operations, with no success.

Diagnoses:

The patient was diagnosed as keloid based on her history and symptoms. Histopathology findings supported our diagnosis.

Interventions:

We successfully excised the keloid after 5 operations and 2 rounds of electron-beam radiotherapy, which was applied at 24 hours after the 4th and 5th operation.

Outcomes:

There was no sign of recurrence over the follow-up period of 24 months.

Lessons:

The combination of multistage surgery and radiotherapy presents as a good choice for the treatment of giant keloids.
A novel de novo MYH9 mutation in MYH9-related disease
Authors: Ai Qi , Zhao Linsheng , Yin Jing , Jiang Lihua , Jin Qiuying , Hu Xiaoli , Chen Sen
Published: January 2020

Introduction:

MYH9-related disease (MYH9-RD) is a rare autosomal dominant disorder caused by mutations in MYH9, which is responsible for encoding nonmuscle myosin heavy chains IIA (NMMHCIIA). MYH9-RD is clinically characterized by congenital macrothrombocytopenia, granulocyte inclusions variably associated with the risk of developing progressive sensorineural deafness, cataracts and nephropathy.

Patient concerns:

A 5-year-old boy had a history of a mild bleeding tendency and chronic thrombocytopenia, first identified at four months of age. No other family members were noted to have similar clinical features or hematologic disorders.

Diagnoses:

The boy was diagnosed with MYH9-RD. Light microscopic examination of peripheral blood films (Wright-Giemsa stain) showed marked platelet macrocytosis with giant platelets and basophilic Döhle-like inclusions in 83% of the neutrophils. Immunofluorescence analysis disclosed a type II pattern, manifested by neutrophils which contained several circle-to-oval shaped cytoplasmic NMMMHCA-positive granules. Sequencing analysis of MYH9-RD genes was carried out and revealed a novel missense mutation of c.97T>G (p.W33G) in the patient but not in his parents.

Intervention:

No treatment is necessary. Recognition of MYH9-RD is important to Avoiding unnecessary and potentially harmful treatments.

Outcomes:

The patient's condition remained stable during the follow-up.

Conclusions:

As a result of identifying this missense mutation in this particular case, we have added c.97T>G (p.W33G) to the broad spectrum of potential MYH9 mutations.
Self-Rated Religiosity/Spirituality and Four Health Outcomes Among US South Asians
Authors: Stroope Samuel , Kent Blake Victor , Zhang Ying , Kandula Namratha R. , Kanaya Alka M. , Shields Alexandra E.
Published: January 2020

Almost no research exists on the relationship between religiosity/spirituality (R/S) and health in the US South Asian population. Using data from the joint Study on Stress, Spirituality, and Health and Mediators of Atherosclerosis Among South Asians Living in America Study (MASALA), this article examined associations between self-rated R/S and self-rated health, emotional functioning, trait anxiety, and trait anger in a community-based sample (n = 933) from the Chicago and San Francisco Bay areas. Ordinary least squares regression was used to analyze categorical differences in levels of R/S and ordinal trends for R/S, adjusting for potential confounders. Being slightly or moderately religious/spiritual was associated with lower levels of self-rated health compared with being very religious/spiritual, and being slightly or moderately religious/spiritual was associated with higher levels of anxiety. In both cases, there was no significant difference between very religious/spiritual individuals and non-religious/spiritual individuals, suggesting a curvilinear relationship. Self-rated R/S was not significantly associated with emotional functioning or anger. In sum, high-R/S and low-R/S individuals had salutary associations with self-rated health and anxiety compared with individuals with slight/moderate levels of R/S. It is important for clinicians and policy makers to recognize the role R/S can play in the health status of South Asians living in the United States.
Sleep Quality and Health-Related Quality of Life in Older People With Subjective Cognitive Decline, Mild Cognitive Impairment, and Alzheimer Disease
Authors: Leng Minmin , Yin Huiru , Zhang Ping , Jia Yong , Hu Mingyue , Li Guichen , Wang Chunyan , Chen Li
Published: January 2020

We aimed to investigate sleep quality and health-related quality of life (HRQOL) in older adults with subjective cognitive decline (SCD), mild cognitive impairment (MCI), and Alzheimer disease (AD). A total of 221 participants were divided into the following five groups: normal controls (NCs), SCD without memory concerns (SCD-0), SCD with memory concerns (SCD-1), MCI, and AD according to their cognitive status. Compared with NC, individuals with SCD-0, SCD-1, MCI, and AD had more sleep problems and reduced HRQOL. Participants with poor sleep quality had an increased risk of cognitive impairment compared with participants with good sleep quality. Within all five subgroups, individuals with poor sleep quality reported more difficulties in HRQOL than individuals with good sleep quality. Future studies employing a longitudinal design, larger samples, and objective evaluation tools are needed.
Innovative Nurse-Led Initiatives Improve Population Health
Authors: Lal M. Maureen
Published: January 2020

The evolving healthcare environment has put a new emphasis on population health. Healthcare organizations, and the nurses who work in them, are in a unique position to reach beyond hospital walls to address unmet needs and improve the health and lives of the community they serve. This month's Magnet® Perspectives column examines nurses' growing impact on population health through the lens of the 2019 Magnet Prize winner, OSF HealthCare Saint Francis Medical Center. Learn how OSF Saint Francis nurses developed an innovative program to address food insecurity among their community's most vulnerable residents and improve health outcomes. The column also explores how American Nurses Credentialing Center Magnet-recognized organizations promote strong external partnerships that extend nurses' influence from the traditional one-patient-at-a-time approach to broader, population-based outreach.
The Effectiveness of Charge Nurse Training on Leadership Style and Resiliency
Authors: Spiva LeeAnna , Davis Stephan , Case-Wirth Jill , Hedenstrom Lisa , Hogue Vicky , Box Melissa , Berrier Elizabeth , Jones Chenille , Thurman Susan , Knotts Kimberly , Ahlers Lauren
Published: January 2020

OBJECTIVE

The study objective was to investigate a charge nurse pilot training program as an effective, evidence-based training modality to improve leadership style and resiliency.

BACKGROUND

Leadership is inherent and necessary in the charge nurse role. Little published research about charge nurse leadership training programs exists.

METHODS

A pre-post design, with intervention and comparison groups, was conducted at an integrated healthcare system. A random sample of charge nurses was selected to pilot a standardized charge nurse leadership training program including in-person learning to foster leadership skills and nurture resiliency.

RESULTS

The sample included 19 control participants and 22 intervention participants. Significant improvement was noted in transformational, transactional, leadership outcomes, and resiliency from preintervention to postintervention for the all subjects. Of the 22 intervention participants, the training elicited higher satisfaction with leadership behavior, followed by effectiveness and their ability to motivate. Charge nurses who attended training had higher resiliency scores pre-post intervention.

CONCLUSION

The charge nurse pilot training was an effective program that led to improved leadership style and resiliency.
The Impact of Critical Reflective Inquiry Education on Experienced Nurses’ Insights Into Practice
Authors: Bolg Julee R. , Dwyer Patricia A. , Doherty Dennis P. , Pignataro Shelly J. , Renaud Ashley M.
Published: January 2020

Successful succession planning necessitates use of innovative strategies to encourage and support knowledge recovery and transfer. This quality improvement project evaluated the impact of a critical reflective inquiry workshop on experienced nurses’ insights into practice. Nurses assessed written clinical narratives using the Critical Reflective Inquiry Assessment Tool before and after the workshop. Guided reflection led by nursing professional development practitioners fostered insight into practice, which is an essential step in supporting knowledge transfer to novice nurses.
A Prospective Randomized Trial of an Oral Patient-Controlled Analgesia Device Versus Usual Care Following Total Hip Arthroplasty
Authors: Pizzi Lois J. , Bates Madalyn , Chelly Jacques E. , Goodrich Carlyn J.
Published: January 2020

BACKGROUND:

Multimodal pain management for surgery patients may include the use of a combination of scheduled oral pain medications with as-needed (PRN) oral opioids. Multiple concurrent time demands on nursing staff frequently cause delays in the delivery of oral PRN pain medication compromising pain management.

PURPOSE:

Postoperative pain control was compared using a wireless oral patient-controlled analgesia device for the delivery of oxycodone with a control group receiving PRN oxycodone from nursing staff.

METHODS:

Thirty patients were prospectively randomized into each of 2 groups after total hip arthroplasty. Patient demographics, pain scores, drug dose data, and physical therapy data were collected from chart reviews. Additional data were obtained from patient and nursing surveys.

RESULTS:

Device patients recorded statistically lower pain scores while taking lower doses of oxycodone on postoperative Day 1 as compared with the control group. Patient surveys indicated that those in the device group reported lower pain scores 24 hours prior to discharge, albeit not statistically different from the control group. Men in the device group reported statistically lower pain scores with physical therapy than men in the control group. Findings from the nursing survey indicate that nurses favored the device over nurse-administered PRN.

CONCLUSION:

Patients using the wireless patient-controlled analgesia (PCA) (oral) device had less pain at rest and with activity (men) while taking lower doses of oxycodone with each dose. Nursing surveys indicated that nursing staff in this orthopedic postoperative unit found the device easy to use, reliable, and efficient. They also recommended its adoption for those capable of using it.
Postmortem Chikungunya Diagnosis
Authors: Reilly Jo Marie , Xing Wenxue , Levicky Vladimir , Souccar Sami , Rogers Christopher , Sathyavagiswaran Lakshmanan
Published: January 2020

Chikungunya is a mosquito-transmitted viral illness with clinical hallmarks of rash, fever, arthralgia, and myalgia. It is rarely fatal, although vulnerable populations, to include elderly, children, and those with multiple comorbid illnesses, are more susceptible to severe infection and death. There have been multiple areas of the world with periodic chikungunya epidemics. With increased immigration, foreign travel, epidemics, and global spread of the virus, it is prudent to consider chikungunya as a diagnosis both clinically and postmortem when a patient presents with rash, fevers, and arthralgia. We present a case of a patient with recent foreign travel, a rash, fever, and arthralgia with mosquito bites who succumbed to chikungunya viral infection with pneumonia. His diagnosis was established postmortem. A review of the literature is included in this report. This case stresses the delayed time to diagnose chikungunya with serologic testing and the importance of using reverse transcriptase–polymerase chain reaction to aid in rapid and accurate diagnosis and management.
Superior Mesenteric Vein Thrombosis in a Pediatric Patient
Authors: Khetarpal Shailesh
Published: January 2020

Patients with inflammatory bowel disease are at increased risk of thromboembolism. There are various sites for thromboembolism including the cerebral, limbs, abdominal vessels, retina, and lungs. Here, we report a case of a 17-year-old patient with a history of Crohn disease presenting with abdominal pain. Upon further evaluation, the patient was found to have mesenteric vein thrombosis, which was discovered on computed tomographic scan. Potential causes, contributing factors, diagnosis, and treatment are discussed here.
Vulvar Ulcers in Children
Authors: Charamanta Maria , Soldatou Alexandra , Michala Lina
Published: January 2020

Objective

We aimed to describe our experience in diagnosing and managing Lipschutz ulcers in children.

Methods

This was a retrospective data review in a tertiary referral clinic for pediatric and adolescent gynecology. We identified patients referred with a vulval ulcer and recorded relating symptoms, presentation, and resolution.

Results

We identified 7 nonsexually active girls with vulvar ulcers presenting within the course of an upper respiratory infection, including fever and cough. Average age was 12.25 years (range, 11–14.5 years). All patients presented with at least one large painful ulcer within the inner surface of the labium minor, of up to 2 cm in diameter.

Initial presentation was of a bullous lesion that was then ulcerated, covered by a black gangrenous scab. Over the course of the week, the scab fell leaving a white-based ulcer that gradually healed. All children complained of dysuria stemming from contact irritation with urine. The ulcer gradually disappeared, leaving no mark within 10 days of initial presentation.

Two of 7 patients presented with 3 similar recurrences after flu-like symptoms.

None of the patients qualified for diagnosis of Behcet disease.

Conclusions

Lipschutz ulcers are painful genital lesions causing anxiety to the girl and her family. Pediatricians and gynecologists should be aware of the condition, diagnose it where appropriate, avoid unnecessary medication, and reassure the patient that it is self-limited.
Testicular Pain Pathway in Children
Authors: Bastianpillai Christopher , Ryan Kate , Hamid Sami , Li Chi-Ying , Green James S.A.
Published: January 2020

Objectives

Acute scrotal pain in children is a common presenting complaint in hospital, and it is imperative that cases of testicular torsion are identified and managed promptly. We aim to identify the most influential points in the pathway in determining whether patients are managed in the appropriate time frame, so these areas can be targeted to improve salvage rates.

Methods

Using quality improvement principles, the pediatric scrotal pain pathway was mapped out, commencing with initial symptom onset and ending with definitive surgical management. We retrospectively reviewed data on all patients between 0 and 18 years of age attending the emergency department at Whipps Cross University Hospital with acute scrotal pain between October 2010 and October 2013.

Results

Over the 3-year period, 238 patients 18 years or younger presented to casualty with scrotal pain. Of the patients assessed initially by an emergency department physician, 52.8% (n = 67) were discharged without referral. To our knowledge, none of these patients presented later with a missed torsion. Torsion was diagnosed in 23.2% of the patients operated on (n = 22), of which 5 required orchidectomy, comprising 2.1% of all patients presenting with scrotal pain. In this group, 4 were due to late presentation by the patient.

Conclusions

We demonstrate the value of different stages of the pathway, as more than half of patients seen in A&E were correctly discharged without referral. In the context of our study, late presentation to hospital appears to be the most significant factor leading to orchidectomy. To target this issue, awareness among both children and parents must be improved.
Internationally Acquired Severe Systemic Infections in Febrile Pediatric Travelers Presenting to the Emergency Department
Authors: Khan Masrur A. , Rosenberg Michael G. , Fein Daniel M. , Quezada Xavier H. , Reingold Rachel E. , Tadros Farid K. , Wolnerman Yonatan Y. , Yao Jennifer Y. , Schneider Carisa , Meltzer James A.
Published: January 2020

Objectives

Most children in the United States who visit the emergency department (ED) with fever have minor illnesses not requiring treatment or hospitalization. However, when a child has recently immigrated or traveled abroad, internationally acquired severe systemic infections (ISSIs) must be considered. We sought to describe children who have traveled internationally and present to the ED with a complaint of fever and to determine risk factors associated with ISSIs in these patients.

Methods

We conducted a retrospective study of children younger than 18 years who presented to 2 pediatric EDs in Bronx, NY (June 2007 to May 2017). Patients were included if they had both fever within 24 hours and international travel within 30 days. We compared groups using bivariate analyses and created a prediction model for ISSIs using multivariable logistic regression.

Results

Of the 353 children included, 44 (12%) had ISSI: 25 (57%), malaria; 6 (14%), dengue; and 13 (30%), bacteremia. Eight (18%) of those with ISSI presented with fever to another medical provider in the week prior but did not receive bloodwork. Four variables were independently associated with ISSIs: headache (odds ratio [OR], 21.7; 95% confidence interval [CI], 6.8–69.3), travel to Africa or Asia (OR, 18.8; 95% CI, 4.8–73.2), platelets of 150,000/μL or less (OR, 15.1; 95% CI, 4.7–48.6), and alanine aminotransferase level of 30 IU/L or greater (OR, 8.9; 95% CI, 3.1–25.3).

Conclusions

Children who travel internationally and present with fever upon return are at substantial risk for developing ISSIs. The diagnosis of ISSIs is often overlooked, but certain risk factors have the potential to aid clinicians.
Metastatic Hormone-Sensitive Prostate Cancer
Authors: Kinsey Emily N. , Zhang Tian , Armstrong Andrew J.
Published: January 2020

Purpose

In recent years, the treatment options for metastatic hormone-sensitive prostate cancer (mHSPC) have expanded significantly. In addition to androgen deprivation therapy, the systemic treatments now include docetaxel, abiraterone, enzalutamide, and apalutamide. Radiation to the primary is also an option for select low-volume patients.

Methods

We conducted a review of the pivotal trials that have changed the practice of mHSPC.

Results

We describe an overview of the trials that investigated docetaxel (CHAARTED and STAMPEDE-Docetaxel), abiraterone (LATTITUDE and STAMPEDE-Abiraterone), enzalutamide (ARCHES, ENZAMET), apalutamide (TITAN), and radiation to the primary (STAMPEDE-Radiation).

Discussion

The treatment of mHSPC is a complex topic, and treatment choice should be individualized. Patient preferences, cost, volume of disease, and side effect profiles are important in determining which option is the best for an individual patient.
Stereotactic Ablative Body Radiotherapy for Intermediate- or High-Risk Prostate Cancer
Authors: Loblaw Andrew
Published: January 2020

Stereotactic ablative radiotherapy (SABR) is a relatively novel form of high precision radiotherapy. For low- and intermediate risk patients, ultrahypofractionation (UHF - more than 5 Gy per day) has been compared to conventionally fractionated or moderately hypofractionated radiotherapy in two large randomized studies. A third smaller randomized study examined the question of the optimal frequency of treatments. The results of these studies will be reviewed. SABR for high risk prostate cancer has been shown to be feasible and is well tolerated with careful planning and setup techniques. However, there is currently insufficient data supporting its use for high-risk patients to offer SABR outside of a clinical trial. SABR costs less to the radiotherapydepartments and, the patient, as well as increasing system capacity. Therefore, it has the potential to be widely adopted in the next few years.
Induced oscillatory signaling in the beta frequency of top-down pain modulation
Authors: Diers Martin , de Vos Cecile C. , Gandhi Wiebke , Hoeppli Marie E. , Becker Susanne , Bock Elisabeth , Baillet Sylvain , Schweinhardt Petra
Published: January 2020

Background:

Induced synchronized brain activity, particularly in the beta-frequency range, has rarely been investigated in human electrophysiological studies of attentional modulation of the perception of nociceptive stimuli.

Methods:

We measured time-resolved brain responses to nociceptive stimuli in healthy subjects (final data set: n = 17) using magnetoencephalography (MEG). In addition to investigating evoked responses as previous studies, we tested whether synchronized beta activity induced by nociceptive stimuli differs between 2 attentional conditions. Subjects were presented simultaneously with 2 stimulus modalities (pain-producing intraepidermal electrical stimuli and visual stimuli) in 2 different experimental conditions, ie, “attention to pain” and “attention to color.” Pain ratings between conditions were compared using a 2-sided paired-samplettest; MEG data were analyzed with Brainstorm.

Results:

Pain ratings were significantly higher in the “attention to pain” compared with the “attention to color” condition. Peak amplitudes of the evoked responses were significantly larger in the “attention to pain” condition bilaterally in the insula and secondary somatosensory cortex, and in the primary somatosensory cortex (SI) contralateral to stimulation. Induced responses to painful stimuli were significantly stronger in contralateral SI in the beta-frequency range in the “attention to pain” condition.

Conclusions:

This study replicates previous reports w.r.t. the attentional modulation of evoked responses and suggests a functional role of induced oscillatory activity in the beta frequency in top-down modulation of nociceptive stimuli.
Repeatability and Agreement of Shear Wave Speed Measurements in Phantoms and Human Livers Across 6 Ultrasound 2-Dimensional Shear Wave Elastography Systems
Authors: Gilligan Leah A. , Trout Andrew T. , Bennett Paula , Dillman Jonathan R.
Published: January 2020

Objectives

Ultrasound shear wave elastography (SWE) is an imaging technique that quantifies liver stiffness. However, comparison data across newest ultrasound systems are sparse. The purpose of this study was to assess repeatability and agreement of shear wave speeds (SWSs) across 6 ultrasound 2-dimensional (2D) SWE systems.

Materials and Methods

This cross-sectional, Health Insurance Portability and Accountability Act–compliant study received institutional review board approval. Written informed consent was obtained. Serial 2D SWE examinations were performed with 6 ultrasound systems (Aplio i800, Canon Medical Systems; LOGIQ E10, GE Healthcare; Resona 7, Mindray North America; EPIQ Elite, Philips Healthcare; ACUSON Sequoia, Siemens Medical Solutions; and Aixplorer MACH 30, SuperSonic Imagine) on 4 elastic phantoms (SWS range, 0.82–3.51 m/s) and on livers of 24 adults (healthy volunteers and patients with known liver stiffening). Participants were imaged 2 times per ultrasound system, with 90 to 120 minutes between examinations. Median SWS was calculated from separately acquired SWS measurements per examination (40 phantom measurements and 10 liver measurements per examination).

Results

Overall intraclass correlation coefficient (ICC) for intersystem agreement of median SWS across systems was 0.99 (95% confidence interval, 0.96–1.0) in phantoms and 0.66 to 0.69 (95% confidence interval, 0.47–0.84) in humans across systems. Means of median SWS measurements in humans ranged from 1.24 to 1.56 m/s. Average individual subject-level variance (interquartile range/median SWS) across all examinations was 0.07, with an average coefficient of variation of 6.0%. Pairwise ICCs for intersystem agreement in subjects across systems ranged from 0.41 to 0.91; test-retest repeatability in subjects was excellent for all systems, with ICCs ranging from 0.87 to 0.97.

Conclusions

There is good to excellent intersystem agreement of measured SWS in elastic phantoms and in vivo livers across 6 ultrasound 2D SWE systems. Test-retest repeatability was excellent for all systems.
Deep Learning Approach for Generating MRA Images From 3D Quantitative Synthetic MRI Without Additional Scans
Authors: Fujita Shohei , Hagiwara Akifumi , Otsuka Yujiro , Hori Masaaki , Takei Naoyuki , Hwang Ken-Pin , Irie Ryusuke , Andica Christina , Kamagata Koji , Akashi Toshiaki , Kunishima Kumamaru Kanako , Suzuki Michimasa , Wada Akihiko , Abe Osamu , Aoki Shigeki
Published: January 2020

Objectives

Quantitative synthetic magnetic resonance imaging (MRI) enables synthesis of various contrast-weighted images as well as simultaneous quantification of T1 and T2 relaxation times and proton density. However, to date, it has been challenging to generate magnetic resonance angiography (MRA) images with synthetic MRI. The purpose of this study was to develop a deep learning algorithm to generate MRA images based on 3D synthetic MRI raw data.

Materials and Methods

Eleven healthy volunteers and 4 patients with intracranial aneurysms were included in this study. All participants underwent a time-of-flight (TOF) MRA sequence and a 3D-QALAS synthetic MRI sequence. The 3D-QALAS sequence acquires 5 raw images, which were used as the input for a deep learning network. The input was converted to its corresponding MRA images by a combination of a single-convolution and a U-net model with a 5-fold cross-validation, which were then compared with a simple linear combination model. Image quality was evaluated by calculating the peak signal-to-noise ratio (PSNR), structural similarity index measurements (SSIMs), and high frequency error norm (HFEN). These calculations were performed for deep learning MRA (DL-MRA) and linear combination MRA (linear-MR), relative to TOF-MRA, and compared with each other using a nonparametric Wilcoxon signed-rank test. Overall image quality and branch visualization, each scored on a 5-point Likert scale, were blindly and independently rated by 2 board-certified radiologists.

Results

Deep learning MRA was successfully obtained in all subjects. The mean PSNR, SSIM, and HFEN of the DL-MRA were significantly higher, higher, and lower, respectively, than those of the linear-MRA (PSNR, 35.3 ± 0.5 vs 34.0 ± 0.5, P < 0.001; SSIM, 0.93 ± 0.02 vs 0.82 ± 0.02, P < 0.001; HFEN, 0.61 ± 0.08 vs 0.86 ± 0.05, P < 0.001). The overall image quality of the DL-MRA was comparable to that of TOF-MRA (4.2 ± 0.7 vs 4.4 ± 0.7, P = 0.99), and both types of images were superior to that of linear-MRA (1.5 ± 0.6, for both P < 0.001). No significant differences were identified between DL-MRA and TOF-MRA in the branch visibility of intracranial arteries, except for ophthalmic artery (1.2 ± 0.5 vs 2.3 ± 1.2, P < 0.001).

Conclusions

Magnetic resonance angiography generated by deep learning from 3D synthetic MRI data visualized major intracranial arteries as effectively as TOF-MRA, with inherently aligned quantitative maps and multiple contrast-weighted images. Our proposed algorithm may be useful as a screening tool for intracranial aneurysms without requiring additional scanning time.
99mTc-HDP Bone Scintigraphy, SPECT/CT, and 18F-FDG PET/CT Diagnosis Imaging of Incidental Pleural Mesothelioma in a Patient With Biochemical Recurrences of Prostate Cancer
Authors: Fernández-Rodríguez Paula , Martín-Marcuartu Juan José , Acevedo Báñez Irene , Masero Carretero José Manuel , Jiménez-Hoyuela García José Manuel
Published: January 2020

We present the case of a 69-year-old man with history of prostate carcinoma treated with prostatectomy and subsequently with external beam radiotherapy and hormone therapy because of biochemical recurrences. More than 10 years after the diagnosis, follow-up 99mTc-HDP bone scans and SPECT/CT images demonstrated an incidental diagnosis of osteoblastic pleural plaques that quickly evolve to mesothelioma. PET/CT achieved the definitive diagnosis by guiding the biopsy to the highest and most accessible focus of glucidic hypermetabolism. Our case report raises the association between prostate cancer patients treated with external beam radiotherapy and the development of pleural mesothelioma despite having no history of exposure to asbestos.
Remember the Pitfall
Authors: Rosar Florian , Ries Martin , Khreish Fadi , Ezziddin Samer
Published: January 2020

We report of a 71-year-old woman with a 2-cm somatostatin receptor–positive intrapancreatic lesion almost misdiagnosed as neuroendocrine neoplasm. By additional red blood cell scintigraphy with heat-damaged erythrocytes, the lesion was identified as an intrapancreatic accessory spleen, and unnecessary operation (which was already planned) could be avoided. This case report reminds colleagues to consider accessory spleen as differential diagnosis for somatostatin receptor–positive lesions even when located inside the pancreas. In doubtful cases, a scintigraphy with heat-damaged erythrocytes is a very useful and complementary imaging method and should be performed before any planning of surgery.
Surgical Management of Primary Chronic Osteomyelitis of the Jaws: The Use of Computer-Aided-Design/Computer-Aided Manufacturing Technology for Segmental Mandibular Resection
Authors: Bolognesi Federico , Tarsitano Achille , Cicciù Marco , Marchetti Claudio , Bianchi Alberto , Crimi Salvatore
Published: January 2020

The term osteomyelitis of the jaws identifies different pathological patterns characterized by the involvement of the cortical bone and bone marrow in osteoarticular infections.

At the head and neck level, the segment most affected by osteomyelitis is the mandible and in most of the cases the cause of the infection is bacterial, as a result of pulp or periodontal infections, post-extraction alveolitis, foreign bodies and fractures. The mandibular PCO often presents with an insidious onset, without a striking acute phase, and it is characterized by recurrent episodes of pain, swelling, lockjaw, latero-cervical lymphadenopathy, without signs of suppuration.

Three patients have been collected and recorded for the study.

The authors believe that in the more advanced cases of PCO in adult patients, in which the mandibular bone appears almost entirely sclerotic and deformed, and that are not responsive to pharmacological therapy or to conservative surgical therapies such as decortication, it is necessary to perform a complete removal of the portion affected by osteomyelitis, with lower alveolar nerve preservation and contextual reconstruction with free microvascular bone flap.

Our review aims to describe the clinico-pathological features of a rare pathological entity, propose a surgical treatment algorithm using computer-aided-design/computer-aided manufacturing technology and review the existing literature.
Local Injection of Botulinum Toxin Type A to Prevent Postoperative Scar
Authors: Chen Sen , Yang Yan , Zhang Dong , Liu Yun , Li Yangqun
Published: January 2020

Background:

Physical scars, especially those in the head and neck area, can cause emotional and psychological distress. Recent studies, have suggested that botulinum toxin type A (BTX-A), also known as Botox, may improve surgical scars by speeding up the wound healing process. Injection of BTX-A is generally considered a less invasive approach.

Objectives:

The purpose of this meta-analysis was to assess the efficacy and safety of BTX-A in the prevention of postoperative scars compared to placebo or no treatment.

Materials and methods:

Following databases were searched from inception to March 2019: Cochrane Library, EMBASE, Web of Science, PubMed, and Open grey. Five trials registers were searched for potentially related trials. The authors also searched reference lists of relevant articles and contacted the investigators to identify additional published and unpublished studies.

Data collection and analysis:

Two authors independently evaluated all potential studies that met the selection criteria. Two authors independently extracted and analyzed the data.

Results:

Analysis was conducted on 267 patients who were enrolled in trials and randomly assigned to receive local injection of BTX-A (184 patients) and placebo (182 patients). Improved Vancouver scar scale scores were noted among patients treated with BTX-A injections compared with the control group (P = .000). The visual analogue scale scores revealed a significant improvement in appearance for the BTX-A-treated scars (P = .000). In addition, lower increase in width of the wound was observed in the experimental group compared to the control group (P = .000).

Recommendation:

This systematic review provided preliminary evidence that supports the efficacy and safety of BTX-A for the prevention of postoperative scar.
Comparison of the Clinical Efficacy of Boston Keratoprosthesis Type I and Repetitive Penetrating Keratoplasty for Refractory Keratopathy
Authors: Chen Yingxin , Wang Cuiyu , Liu Qiming , Wang Ziyue , Gao Minghong
Published: January 2020

Objective:

To compare the clinical efficacy of Boston Keratoprosthesis type I (B-KProI) and penetrating keratoplasty (PKP) for patients with refractory keratopathy after 1failed PKP in China.

Method:

The 42 consecutive cases with refractory keratopathy after 1 failed PKP, from July 2010 to December 2014, were divided into 2 groups according to the surgical method: KPro group (n = 21) and PKP group (n = 21). Visual acuity (LogMAR), corneal graft transparency, postoperative complications and corneal graft survival rate were observed. The follow-up time was 2 years. The Kaplan-Meier curve was used to analyze the survival rate of the two groups of corneal grafts.

Results:

The average best corrected visual acuity (BCVA) at 1, 6, 12, 18, and 24 months in KPro group were significantly lower than PKP group (P < 0.01). The best postoperative visual acuity and BCVA at postoperative 2 years in KPro group were lower than PKP group. The success rate of KPro group (86%) were significantly higher than PKP group (43%) (P < 0.01). There were no significant differences in indicate of complications in 2 groups including secondary glaucoma, secondary infectious corneal ulcer, corneal graft melting and endophthalmitis (P > 0.05).

Conclusion:

Compared with repetitive PKP, B-KProI had a higher success rate, improved postoperative visual acuity, reduced postoperative corneal transplant rejection rates and improved corneal graft survival rate.
Computational Evaluation of Potential Correction Methods for Unicoronal Craniosynostosis
Authors: Bozkurt Selim , Borghi Alessandro , Jeelani Owase , Dunaway David , Schievano Silvia
Published: January 2020

Unicoronal craniosynostosis is the second most common type of nonsyndromic craniosynostosis: it is characterized by ipsilateral forehead and fronto-parietal region flattening with contralateral compensatory bossing. It is a complex condition; therefore, which is difficult to treat because of the asymmetry in the orbits, cranium, and face. The aim of this study is to understand optimal osteotomy locations, dimensions, and force requirements for surgical operations of unicoronal craniosynostosis using a patient-specific finite element model and — at the same time — to evaluate the potential application of a new device made from Nitinol which was developed to expand the affected side of a unicoronal craniosynostosis skull without performing osteotomies. The model geometry was reconstructed using Simpleware ScanIP. The bone and sutures were modeled using elastic properties to perform the finite element analyses in MSc Marc software. The simulation results showed that expanding the cranium without osteotomy requires a significant amount of force. Therefore, expansion of the cranium achieved by Nitinol devices may not be sufficient to correct the deformity. Moreover, the size and locations of the osteotomies are crucial for an optimal outcome from surgical operations in unicoronal craniosynostosis.