bluuebunny/crossref_metadata_2025 huggingface dataset:
How Well Do Patients Clearly Understand Invasive Prenatal Genetic Diagnostic Testing? [38L]
Authors: Davis Jay , Pastore Lisa , Milone Gina F. , Persad Malini D. , Diana Garretto  , Herrera Kimberly
Published: May 2019

INTRODUCTION:

To determine patient clarity of the perceived benefits/drawbacks about invasive prenatal genetic diagnostic testing (PGDT).

METHODS:

Cross-sectional design. Voluntary, anonymous questionnaire (Q) assessing patient's decision making process in regards to invasive (CVS and/or amniocentesis) PGDT. Qs (paper and online options) were distributed between 2017 and 2018 to those recommended for PGDT in a university academic practice. Questions (5 items on clarity, 5-point Likert scale) were structured to evaluate patient decisional clarity, and were partly adapted from published validated Q's. Exclusion criteria: English or Spanish illiterate. Means, variances (SD), and ranges were tabulated.

RESULTS:

50 female patients returned the study; 38 (76%) completed it in entirety. 75% had equal PGDT decision making with their partner. Most were referred due to a positive carrier screen followed by positive cell free DNA result. Participants expressed high clarity of understanding advantages and disadvantages of PGDT (mean 3.28 on a 1=no clarity to 5=high clarity scale, SD 0.94).

CONCLUSION:

Patients have a clear understanding of PGDT; this may be attributable to in office counseling (MD and/or genetic counselors) done prior to decision making.
Improving Assessment and Documentation of Routine Prenatal Care Using a Standardized Template [40L]
Authors: Montgomery Holly , Duong Jennifer , Kauffman Kurt
Published: May 2019

INTRODUCTION:

Routine prenatal care is a vital aspect of improving both maternal and infant morbidity. Standardizing clinical documentation, using templates and automatic alerts, can improve patient care by ensuring providers cover all aspects of routine prenatal care. The objective of this study was to evaluate improvement in the assessment and documentation of routine prenatal care after implementing a standardized electronic template.

METHODS:

This was a retrospective review of postpartum visits at a single obstetrical clinic affiliated with an obstetrics and gynecology residency program. A sample of fifty charts was reviewed before and after implementation of a standardized electronic prenatal care template. Charts were evaluated for provider counseling and documentation on the basic prenatal care recommended for all pregnant patients. Gestational age at the last prenatal visit and number of prenatal visits attended was collected. IRB committee approval was waived for this quality improvement project.

RESULTS:

Average gestational age at the last prenatal appointment and average number of prenatal visits was similar for both time periods. After implementing the template, there was an improvement in addressing and documenting the following topics: group prenatal classes (56%), genetics (10%), complete pregnancy ultrasound (4%), prenatal 2s (4%), early diabetes mellitus (10%), diabetes mellitus (88%), influenza (18%), GBS status (4%), contraception (24%), Varicella (72%), HPV vaccination (74%), breastfeeding (46%), safe sleep (76%), and Rh immunization (16%).

CONCLUSION:

Implementing a standardized template improved provider counseling and documentation of several key aspects of routine prenatal care, including improving discussion of important maternal health factors, vaccination, contraception, and intended postpartum care.
Adherence in a Phase 3 Trial of a Multipurpose Vaginal pH-Regulator vs Nonoxynol-9 [2M]
Authors: Creinin Mitchell D. , Howard Brandi , Culwell Kelly R.
Published: May 2019

INTRODUCTION:

The multipurpose vaginal pH-regulator (MVP-R) is a water-based, petroleum-free vaginal gel which is acid-buffering and under investigation for prevention of pregnancy and sexually transmitted infections. We assessed treatment adherence in a phase 3 contraceptive trial comparing the MVP-R and nonoxynol-9 (N-9) spermicidal gel.

METHODS:

This randomized, open-label, non-inferiority study was conducted at 62 sites in the U.S. and Russia; all sites obtained IRB-approval and all subjects provided informed consent. The MVP-R (Amphora®, formerly known as Acidform) and N-9 were provided in pre-filled, single-use applicators. Women were instructed to use 1 applicator immediately before or up to 1 hour before vaginal intercourse, and to reapply product if more than 1 hour elapsed and for additional intercourse within 1 hour. Subjects recorded product use and coital activity on a daily diary.

RESULTS:

The 3,324 enrollees included 1,665 MVP-R and 1,659 N-9 subjects. Baseline characteristics were similar between treatment arms; characteristics of the overall Intent-to-Treat population included mean age 27.6±5.6 years, body mass index 27.8±8.0 kg/m2 (32.8% obese), 62.0% White, and 76.6% non-Hispanic. The study method was used as the only contraceptive method and used correctly in 85.6% of coital acts (85.9% MVP-R, 85.3% N-9). Overall, 61.5% of all subjects (63.0% MVP-R, 60.1% N-9) were adherent with the proper method use for ≥90% of coital acts. The most common reason for non-adherence was failure to reapply with additional acts of intercourse within 1 hour after application (390/2,935 [13.3%]).

CONCLUSION:

Most subjects used these on-demand, women-controlled products as directed. Adherence was similar between the two treatment groups.
Postmenopausal endometriosis, where are we now?
Authors: Ladanyi Camille , Boyd Sarah , Sticco Peter , Mohling Shanti
Published: May 2019

Purpose of review

Postmenopausal endometriosis is a gynecologic disease, affecting 2–5% of postmenopausal woman. Current literature assessing the prevalence, pathogenesis, and treatment of this uncommon condition is limited, stressing the necessity for future research. This review examines the current literature on postmenopausal endometriosis to help inform clinical decision-making and point to novel approaches for treatment and management.

Recent findings

Although one unifying theory to explain the pathogenesis of endometriotic lesions has not been elucidated, estrogen dependence is central to the pathophysiological process. The total quantity of estrogen production is mediated by multiple enzymes in complex pathways. Recent studies have confirmed the presence of these necessary enzymes in endometriotic lesions thereby suggesting a local source of estrogen and a likely pathogenic contributor. More research is needed to fully elucidate the mechanism of local estrogen biosynthesis; however, the current data provide possible explanations for the presence of postmenopausal endometriosis in an otherwise systemically hypoestrogenic environment.

All suspected endometriosis lesions should be surgically excised for optimization of treatment and prevention of malignant transformation. If hormone replacement therapy is initiated, combined estrogen and progestin is recommended, even in the setting of previous hysterectomy, given the risk of disease reactivation and malignant transformation of endometriotic lesions. Further research is needed to understand the true prevalence, cause, and progression in this patient demographic. Histologic studies evaluating tissue lesions and peritoneal fluid for estrogen receptors, estrogen metabolizing enzymes, immune cells, and nerve fibers will aide in clinical management and treatment planning.
Vocational Rehabilitation in the Veterans Health Administration Polytrauma System of Care: Current Practices, Unique Challenges, and Future Directions
Authors: Ottomanelli Lisa , Bakken Shana , Dillahunt-Aspillaga Christina , Pastorek Nicholas , Young Cynthia
Published: May 2019

Objective/Purpose:

Veterans and service members (V/SMs) with traumatic brain injury (TBI) and comorbid conditions are treated in the Veterans Health Administration (VHA) Polytrauma System of Care (PSC). These V/SMs comprise a unique population with distinct needs for restoring community reintegration, including participation in meaningful employment. Low employment rates after TBI vary and are influenced by many factors. Employment is a central aspect of the VHA priority of facilitating adjustment, and addressing vocational needs alongside healthcare is critical to community reintegration. The purpose of this article is to outline current practices of addressing vocational rehabilitation in the PSC, discuss the unique challenges in serving Veterans with polytrauma, and outline future directions to improve vocational services and outcomes.

Methods:

Briefly review literature on V/SM with TBI and employment, describe the PSC and VHA vocational programs for V/SM with polytrauma, and synthesize proceedings on vocational rehabilitation from the 2017 VHA “Community Reintegration in the Polytrauma System of Care” meeting.

Conclusions:

To advance and expand vocational services the following guidelines were recommended: (1) designing flexible services based on individualized needs, (2) increasing access to vocational services through communication and collaboration, (3) promoting cross-disciplinary education and engagement in vocational care, and (4) systematically tracking employment outcomes.
A Prospective Analysis of iStent Inject Microstent Positioning: Schlemm Canal Dilatation and Intraocular Pressure Correlations
Authors: Gillmann Kevin , Bravetti Giorgio E. , Mermoud André , Mansouri Kaweh
Published: May 2019

Précis:

A larger proportion of iStent inject microstents than suggested by gonioscopic examination could be entirely burrowed within the trabeculum (45.7%). The length of device protrusion within the anterior chamber is linked to postoperative intraocular pressure (IOP).

Introduction:

The iStent inject is a relatively new device designed to be implanted ab-interno through the trabecular meshwork. Although some preliminary studies have shown IOP-lowering potential, the full extent of the mechanisms through which IOP is reduced remains unconfirmed. The aim of this study was to use in vivo optical coherence tomography analysis of the anatomic and physiological effects of iStent inject device positioning on the structures of the iridocorneal angle and IOP.

Methods:

In total, 25 eyes of 19 subjects (mean age, 75.5±10.5 y) with mild to moderate open-angle glaucoma were enrolled in this prospective study. All patients underwent implantation of 2 iStent inject devices combined with cataract surgery. In the postoperative period, after IOP stabilized, anterior segment optical coherence tomography (AS-OCT) was performed and several measurements were made of the Schlemm canal (SC) and the devices’ positions. Thirteen unoperated fellow eyes served as control eyes.

Results:

Overall, 92% of devices were visible on AS-OCT versus 88% visible on gonioscopic examination. Of all visible devices, 54.3% had a protruding portion into the anterior chamber with a mean protruding length of 88.5 µm, and 72% of the devices’ heads were not positioned within the SC, with a mean shortest distance of 109.4 µm. In operated eyes, the average major diameter of SC was 308.7±197.4 µm (median, 303.8 µm) versus 126.9±60.3 µm in control eyes. Device protrusion and larger SC diameters were associated with lower postoperative IOP (r
s=−0.54; P=0.005 and r
s=−0.43; P=0.04, respectively), whereas the distance between the devices’ heads and SC was inversely associated with SC dilatation (r
s=−0.41; P=0.04).

Conclusions:

This study highlights the value of AS-OCT in exploring the positioning of trabecular bypass devices such as the iStent inject. Our study shows that more microstents than suggested by gonioscopy could be completely burrowed within the trabeculum. It also suggests that the surgical outcomes of cataract surgery combined with iStent inject implantation may be connected to the amplitude of device protrusion within the anterior chamber as well as the postoperative dimensions of the SC.
Changes in prevalence and severity of chronic kidney disease-associated pruritus over 6 years in a community hemodialysis clinic: a retrospective observational study
Authors: Ebata Toshiya , Takahashi Keiko
Published: May 2019

We compared the status of chronic kidney disease-associated pruritus among outpatients of a hemodialysis (HD) clinic in 2008 and 2014, using identical questionnaires. All outpatients receiving HD participated in the study. The prevalence of pruritus over the week before questionnaire administration was not significantly different between 2008 (58.6%) and 2014 (50.0%). However, the percentage of patients with moderate to extreme itch decreased from 48.5% to 29.0% (P<0.01). The rate of patient satisfaction with the antipruritic treatment increased from 22.6% to 68.0% (P<0.01). Our experience may encourage physicians to modify antipruritic treatments for better patient care.
Reliability and Validity of the Patient Health Questionnaire-9 as a Screening Tool for Poststroke Depression
Authors: Trotter Tanya L. , Denny Dawn L. , Evanson Tracy A.
Published: May 2019

Background: Screening for poststroke depression (PSD) using a valid and reliable tool is recommended for all stroke survivors. This literature review identifies the specificity, sensitivity, and appropriateness of the 9-item Patient Health Questionnaire (PHQ-9) to screen stroke patients for PSD. Methods: Relevant databases were searched using the following selection criteria: (1) peer-reviewed primary research, (2) published from 2012 to 2018 (to evaluate the most recent research using this tool), and (3) examined the specificity and sensitivity of the PHQ-9 for screening stroke survivors for PSD. Results: Six studies, with an overall level of evidence grade of “B,” representing an overall total sample size of 930 participants (851 given a diagnosis of stroke and 49 given a diagnosis of transient ischemic attacks) met criteria for inclusion in the review. Only 2 studies reported data on all of the components necessary to determine the robustness of this tool to screen for depression in stroke survivors. Conclusion: Evidence regarding the sensitivity and specificity of the PHQ-9 to screen stroke patients for PSD is inconclusive. Additional research is needed to address the appropriateness of the PHQ-9 as a depression screening tool in this population. Clinicians should validate the results of PHQ-9 screening of ischemic stroke patients for PSD with the Structured Clinical Interview for DSM-5, the standard for diagnosing depression, before initiating treatment of PSD.
Prelingual Deaf Children Treated With Cochlear Implant: Monitoring Performance With Percentiles
Authors: Manrique Manuel , Calavia Diego , Manrique-Huarte Raquel , Zulueta-Santos Cristina , Martin Mario , Huarte Alicia
Published: May 2019

Objectives:

To develop a percentile ranking system driven by speech recognition data obtained from different groups of patients treated with a cochlear implant to serve as a tool to monitor the progress of these patients.

Study Design:

Prospective study.

Setting:

Tertiary referral center.

Patients:

Diagnosed with a bilateral, profound sensorineural hearing loss treated with a unilateral cochlear implant.

Intervention:

Diagnostic.

Main Outcome Measure:

Six different percentiles (p) were classified taking into account the correlation between speech recognition outcome scores and age at implantation, with reference to the onset of hearing loss.

Results:

Four hundred sixteen prelingual patients were included. These subjects were divided into subgroups depending on age at implantation.

Prelingual group, from the fifth year after implantation, p50 centered on the following percentages of correct words in each subgroup: 100, 94.6, 91.4, 91.0, 79.2, and 63.1% in children implanted under 12 months, 1, 2, 3, 4 to 6, 7 to 10 years, respectively. After a 12-year follow-up, a significant negative correlation between age at implantation and speech recognition was observed in both prelinguals (Rhos=−0.578, p<0.001).

Conclusion:

A percentile system was developed to monitor the postimplant progress of prelingual deaf implanted patients, with potential applications in patient follow-up and handling circumstances that may deteriorate results.
Comparing Linear and Volumetric Vestibular Schwannoma Measurements Between T1 and T2 Magnetic Resonance Imaging Sequences
Authors: Tolisano Anthony M. , Wick Cameron C. , Hunter Jacob B.
Published: May 2019

Objective:

To compare linear and volumetric vestibular schwannoma (VS) measurements between different magnetic resonance imaging (MRI) sequences.

Study Design:

Retrospective case series.

Setting:

Tertiary care university hospital.

Patients:

Those with VS that had at least two separate MRI studies containing both T1-weighted contrast (T1C) and high-resolution T2-weighted (HRT2) images.

Intervention:

Two neurotologists measured the greatest linear axial dimension and segmentation volumes of VS.

Main Outcome Measure:

1) Correlation between T1C and HRT2 VS linear and volumetric measurements. 2) Comparing the interpretation of VS growth between T1C and HRT2 sequences and reviewers, defined as an increase in tumor diameter of more than or equal to 2 mm or a volume increase of more than or equal to 20%.

Results:

Twenty-three patients met inclusion criteria. Imaging studies encompassed a median of 25.2 months. At the initial imaging study, inter-observer measurements between reviewers, analyzed with intraclass correlation coefficients, for T1C diameters, T1C volumes, HRT2 diameters, and HRT2 volumes were 0.983 (95% confidence interval [CI] 0.972–0.989), 0.989 (95% CI 0.982–0.993), 0.992 (95% CI 0.988–0.995), and 0.998 (95% CI 0.995–0.999), respectively. The Cohen's kappa for growth rates between T1C diameters, T1C volumes, HRT2 diameters, and HRT2 volumes was 0.564 (95% CI 0.284–0.844), 0.704 (95% CI 0.514–0.894), 0.605 (95% CI 0.319–0.891), and 0.475 (95% CI 0.242–0.708), respectively.

Conclusions:

There are significant differences in VS volume measurements when utilizing T1C versus HRT2 images. However, there is “excellent” interobserver agreement between T1C and HRT2 diameters and volumes. T1C VS volumes may be more reliable than HRT2 volumes to determine growth.
Evaluation of Intracochlear Position of a Slim Modiolar Electrode Array, by Using Different Radiological Analyses
Authors: Ramos de Miguel Ángel , Durmo Irfan , Falcón González Juan Carlos , Borkoski Barreiro Silvia , Ramos Macías Angel
Published: May 2019

Introduction:

The radiological analysis following a cochlear implantation offers insight into the audiological outcomes of cochlear implant recipients. The wrapping factor (WF) is the most common radiological analysis measuring the modiolar position and depth of insertion of an electrode array. New measurements like the intracochlear position index (ICPI) or the homogeneity factor (HF) can offer more accurate information regarding the electrode's intracochlear position. We have also studied a new method to calculate the WF, by normalizing it with a new methodology (WFn).

Objectives:

To analyze and compare the results of the WF, ICPI, HF, and WFn obtained using a cone beam computer tomography (CBCT) with the histological analysis on temporal bone.

Material:

A perimodiolar electrode array (Nucleus Slim CI532) was inserted in three temporal bones. A perfect insertion was performed in the first temporal bone, according to the correct specifications. In the second specimen, a slightly over-inserted electrode was analyzed and in the third specimen a completely over-inserted electrode array was studied.

Method:

A CBCT was performed following the implantations and then, a histological analysis with slices perpendicular to the cochlea axis (modiolus). Each measurement was made 10 times by 10 experts (radiologist and otologist) with a total amount of 600 measurements (100 for each data, 3 CBCT and 3 histology). A t test statistical analysis was performed to compare the measurements between CBCT and histology.

Results:

It was observed that the ICPI and the HF correctly identify the three different insertions. Regarding the WF no significant difference in the two over-inserted specimens was found. The ICPI was the only measurement that shows no statistical difference between the CBCT and the histology, so it was considered the most accurate method. Finally, the WF shows a statistical difference between the CBCT and the histology in all cases, indicating the poor value of the radiological method. The WFn analysis includes the modiolar wall length in the measurement. This improves the final result as it reduces the error induced by the size of the cochlea.

Conclusion:

The ICPI and the HF provide better radiological information than the WF, regarding the intracochlear position of the electrode array. The most relevant difference is that the ICPI, HF, and WFn include modiolar and lateral wall dimensions, thereby using the diameter of the cochlear duct for the analysis.
First Experience With a New Thin Lateral Wall Electrode in Human Temporal Bones
Authors: Lenarz Thomas , Avci Ersin , Gazibegovic Dzemal , Salcher Rolf
Published: May 2019

Introduction:

A modern cochlear implant electrode array design must combine: improved surgical ease of use, structure preservation, particularly important for pediatric application, stable position within the cochlea over time, and a meaningful balance between hearing preservation against addressing sufficient cochlear tissue to support electrical-only hearing. The aim of this study was to investigate a new lateral wall electrode array design from Advanced Bionics on human temporal bones (TBs).

Methods:

Ten fresh-frozen TBs were implanted with the SlimJ electrode array via the round window. The electrode array is 23 mm long, with a cross-section varying from 0.25 × 0.55 mm at the most apical contact to 0.6 × 0.8 mm at the proximal marker contact. To assess location of the electrode array, the TBs were postoperatively scanned using cone beam computed tomography, and histology was performed to assess intracochlear trauma (Grades 0–4).

Results:

All electrode arrays were considered easy to insert. The average insertion depth was 432 degrees measured from the round window with a range from 411 to 450 degrees azimuth. Nine out of 10 electrode arrays were inserted fully (<0.5 mm out of the cochlea), one electrode array was left 1.5 mm out of the cochlea. No translocations were observed in all 10 cochleae, slight touching of the basilar membrane at the distal portion of the array was observed in 50% of the cases.

Conclusion:

The results from the new thin lateral wall electrode array from Advanced Bionics provided consistent scala tympani locations. No translocations were observed and almost all electrode arrays were fully inserted. These results are promising and the new electrode array will be further studied in clinical practice investigating hearing preservation capabilities and speech performance.
Prognostic Factors of Long-Term Hearing Preservation in Small and Medium-Sized Vestibular Schwannomas After Microsurgery
Authors: Huo Zirong , Chen Jianqing , Wang Zhaoyan , Zhang Zhihua , Wu Hao
Published: May 2019

Objective:

The authors evaluated the long-term hearing outcomes of patients with vestibular schwannoma (VS) to explore appropriate surgical treatment.

Study Design:

Retrospective study.

Setting:

Tertiary referral center.

Patients:

A total of 138 patients diagnosed with small and medium-sized VS with serviceable hearing from January 2006 to December 2015.

Interventions:

All patients underwent microsurgery via retrosigmoid (RSA) or middle cranial fossa approach (MFA) and were followed up for over 2 years.

Main Outcome Measures:

Pre- and postoperative hearing, including pure tone audiometry, speech discrimination score, and auditory brainstem response (ABR), were analyzed.

Results:

The mean tumor size and volume were 16.6 ± 3.4 mm and 1711.8 ± 918.5 mm3, respectively. Preoperative hearing levels were Class A in 42, Class B in 67, and Class C in 29 patients. Patients with a tumor from the superior vestibular nerve (SVN) had better hearing at diagnosis. Postoperative hearing levels were Class A, B, C, and D for 28, 17, 32, and 61 patients. Hearing outcomes were significantly better in patients with normal intraoperative I wave on ABR. Hearing loss within 6 months had a positive effect on postoperative hearing. Better preoperative hearing and tumors from SVN were correlated with better postoperative hearing outcomes. Tumor size, cystic variation, or extension to the fundus of internal auditory canal had no influence on hearing preservation.

Conclusions:

Better preoperative hearing, shorter hearing loss period, tumors from SVN, and normal intraoperative I wave are prognostic factors for serviceable hearing. RSA and MFA are effective and safe for tumor removal and hearing preservation.
Hematopoietic stem cells: self-renewal and expansion
Authors: Li Zhenrui , He Xi C. , Li Linheng
Published: May 2019

Hematopoietic stem cells (HSCs) are a unique population of cells with the remarkable ability to replenish themselves through self-renewal and to give rise to differentiated cell lineages. Though having been discovered more than 50 years ago, and having been widely used in bone marrow transplantation to treat blood disorders including leukemia, expansion of HSCs remains an unmet task, thus affecting its more effective usage in clinical practice.

Purpose of review

The purpose of this review article is to summarize past efforts in ex-vivo HSC expansion and to compare recent advances in expanding murine and human HSCs by targeting the N
6-methyladenosine (m6A) pathway.

Recent findings

Unlike past many efforts that mainly target single or limited pathways and often lead to lineage bias or expansion of progenitor cells or limited long-term HSCs (LT-HSCs), the blocking the degradation of m6A pathway has an advantage of stabilizing hundreds of key factors required for maintaining HSCs, thus resulting in expansion of functional LT-HSCs.

The new approach of targeting the m6A pathway has a promising application in clinical HSC-based transplantation.
The diagnosis and treatment of PCOS in adolescents: an update
Authors: Witchel Selma F. , Burghard Anne Claire , Tao Rachel H. , Oberfield Sharon E.
Published: May 2019

Purpose of review

Polycystic ovary syndrome (PCOS) is often difficult to diagnose in adolescents. Recent recommendations and concepts regarding the diagnosis and treatment of PCOS in the adolescent girl are considered.

Recent findings

The diagnosis of PCOS in adolescents should be primarily based on clinical and biochemical signs of hyperandrogenism and presentation with irregular menses. Because of the similarity of normal pubertal development and features of PCOS, the diagnosis should be deferred until at least 2 years following menarche. For girls who do not fulfill the diagnostic criteria, the focus should be on treatment of symptoms.

PCOS is a complex, multifaceted disorder, and should be diagnosed and treated in adolescents after taking into consideration the patient's full diagnostic picture, metabolic risks, and individual concerns, to both avoid overdiagnosis but yet be able to provide early and meaningful interventions.
Pancreatic Cysts and Intraductal Papillary Mucinous Neoplasm in Autosomal Dominant Polycystic Kidney Disease
Authors: McNicholas Bairbre A. , Kotaro Yoshida , Martin William , Sharma Ayush , Kamath Patrick S. , Edwards Marie E. , Kremers Walter K. , Chari Suresh T. , Torres Vicente E. , Harris Peter C. , Takahashi Naoki , Hogan Marie C.
Published: May 2019

Objectives

Pancreatic lesions in autosomal dominant polycystic kidney disease (ADPKD) are primarily cysts. They are increasingly recognized, with isolated reports of intraductal papillary mucinous neoplasia (IPMN).

Methods

Retrospective study to determine prevalence, number, size, and location of pancreatic abnormalities using abdominal magnetic resonance imaging (MRI) of genotyped ADPKD patients (seen February 1998 to October 2013) and compared with age- and sex-matched non-ADPKD controls. We evaluated presentation, investigation, and management of all IPMNs among individuals with ADPKD (January 1997 to December 2016).

Results

Abdominal MRIs were examined for 271 genotyped ADPKD patients. A pancreatic cyst lesion (PCL) was detected in 52 patients (19%; 95% confidence interval, 15%–23%). Thirty-seven (71%) had a solitary PCL; 15 (28%) had multiple. Pancreatic cyst lesion prevalence did not differ by genotype. Intraductal papillary mucinous neoplasia was detected in 1% of ADPKD cases. Among 12 IPMN patients (7 branch duct; 5 main duct or mixed type) monitored for about 140 months, 2 with main duct IPMNs required Whipple resection, and 1 patient died of complications from small-bowel obstruction after declining surgical intervention.

Conclusions

With MRI, PCLs were detected in 19% and IPMNs in 1% of 271 ADPKD patients with proven mutations, without difference across genotypes. Pancreatic cyst lesions were asymptomatic and remained stable in size.
Antibiotic Treatment in the First Week of Life Impacts the Growth Trajectory in the First Year of Life in Term Infants
Authors: Kamphorst Kim , Oosterloo Berthe C. , Vlieger Arine M. , Rutten Nicole B. , Bunkers Carin M. , Wit Ernst C. , van Elburg Ruurd M.
Published: May 2019

Objective:

Antibiotic treatment in early life appears to increase the risk for childhood overweight and obesity. So far, the association between antibiotics administrated specifically during the first week of life and growth has not been studied. Therefore, we studied the association between growth and antibiotics, given in the first week of life and antibiotic courses later in the first year of life.

Method:

A prospective observational birth cohort of 436 term infants with 151 receiving broad‐spectrum antibiotics for suspected neonatal infection (AB+), and 285 healthy controls (AB−) was followed during their first year. Weight, height, and additional antibiotic courses were collected monthly. A generalized‐additive‐mixed‐effects model was used to fit the growth data. Growth curve estimation was controlled for differences in sex, gestational age, delivery mode, exclusive breast‐feeding, tobacco exposure, presence of siblings, and additional antibiotic courses.

Results:

Weight‐for‐age and length‐for‐age increase was lower in AB+ compared with AB− (P < 0.0001), resulting in a lower weight and length increase 6.26 kg (standard error [SE] 0.07 kg) and 25.4 cm (SE 0.27 cm) versus 6.47 kg (SE 0.06 kg) and 26.4 cm (SE 0.21 cm) (P < 0.05 and P < 0.005, respectively) in the first year of life. Approximately 30% of the children in both groups received additional antibiotic course(s) in their first year, whereafter additional weight gain of 76 g per course was observed (P = 0.0285).

Conclusions:

Decreased growth was observed after antibiotics in the first week of life, whereas increased growth was observed after later antibiotic course(s) in term born infants in the first year of life. Therefore, timing of antibiotics may determine the association with growth.
Predictors of community reintegration and quality of life after hip fracture among community-dwelling older adults
Authors: Gilboa Yafit , Maeir Talia , Weber Ayelet , Maeir Adina , Rotenberg Shlomit
Published: May 2019

We aim to explore factors contributing to community reintegration and health-related quality of life (HRQoL) among community-dwelling older adults three months after discharge from inpatient rehabilitation following hip fracture. We performed a prospective cohort study with follow-up. Thirty-three consecutive patients (age 66–89) after surgery for hip fracture repair were recruited from an inpatient rehabilitation unit. Participants were 65+ years old, did not have dementia, and were independent in basic activities of daily living (BADL) at discharge. We examined the contribution of independent variables measuring BADL, cognition, emotional status, pain and social support to the explained variance of two main outcomes: the Reintegration to Normal Living Index (RNLI), measuring self-reported ability to participate in activities and return to life roles; and the Medical Outcomes Study Short-Form Health Survey (SF-12), assessing mental and physical aspects of HRQoL. Stepwise regression analyses revealed that: social support and pain while walking significantly explained 42.1% of variance in the RNLI; social support significantly explained 31.1% of the variance in the SF-12-physical subscale; the number of falls in the previous year, social support and executive functions assessed by the clock drawing test significantly explained 61.9% of the variance in the SF-12 mental subscale. Social support, pain while walking and the number of falls in the previous year can predict community reintegration and HRQoL among older adults three months after discharge from rehabilitation following a surgical hip fracture repair. These factors need to be addressed in rehabilitation programs.
Activities of Daily Living of Home Healthcare Patients
Authors: Osakwe Zainab Toteh , Larson Elaine , Andrews Howard , Shang Jingjing
Published: May 2019

Activities of daily living (ADLs) is an important measure of the quality of care provided in home healthcare (HHC), but few studies describe the ADLs of HHC patients. The objectives of this study were to (1) describe the types and levels of ADL dependency among patients receiving home care, (2) identify the risk factors for severe ADL dependency at admission, and (3) identify the predictors of ADL improvement during an HHC stay. This was a secondary data analysis of a 5% random sample (n = 105,654) of the national Outcome and Assessment Information Set (OASIS-C) for the year 2013. The dependent variables were severe ADL dependency level at admission and ADL improvement from admission to discharge. About two thirds (65%) of the patients (n = 99,991) had severe ADL dependency (dependence in seven or more ADLs) at admission. Older age, female gender, and impaired decision-making were associated with severe ADL dependency on admission. Of the 105,654 patients, 58.1% (n = 89,997) experienced ADL improvement. ADL improvement was associated with increasing HHC length of stay, being female, and prior inpatient stay. Clinicians, policy makers, and agencies could focus on modifiable characteristics to achieve the goal of ADL improvement.
The Value of Home Health Physical Therapy
Authors: Collins Tracey L. , Yong Karen W. , Marchetti Mary T. , Miller Kenneth L. , Booths Brian , Falvey Jason R.
Published: May 2019

The purpose of the Triple Aim is to improve population health, reduce healthcare costs, and improve the patient experience. These goals—to reduce cost while improving health outcomes and patient experiences have shifted utilization of services from other postacute care settings to the home. The purpose of this perspective article is to discuss how home healthcare services, and home physical therapy (PT) specifically, provide value to patients, caregivers, and payers to meet the goals of the Triple Aim. This article will substantiate the value of home PT and provide healthcare professionals with evidence-based information on the value of home PT.
Prevalence and Clinical Characteristics of Unintentional Ingestion of Marijuana in Children Younger Than 6 Years in States With and Without Legalized Marijuana Laws
Authors: Leubitz Andrew , Spiller Henry A. , Jolliff Heath , Casavant Marcel
Published: May 2019

Objective

The aim of this study was to examine the relationship between state marijuana legalization and the rates of unintentional ingestions of marijuana in children younger than 6 years.

Methods

This was a retrospective review of all marijuana ingestions in the National Poison Data System in children younger than 6 years between January 1, 2000, and July 31, 2017. Data analysis from NPDS included, age, sex, state and year of occurrence, clinical effects, therapies, health care facility utilization, and medical outcome. Population of children younger than 6 years was obtained from the US Census Bureau. Public records search provided state legal status of marijuana and year of state marijuana legalization.

Results

From 2000 through 2008, there was no significant change in the annual number or rate of ingestions of marijuana in children younger than 6 years across the United States. Following 2009, there was mean annual increase of 27% per year, rising to 742 ingestions per year or 2.98 ingestions per 100,000 population, respectively, in 2017. More than 70% of all cases occurred in states with legalized marijuana. Of all pediatric patients, 54.6% received some form of hospital-based care, of which 7.5% required critical care. Pediatric patients experienced a wide range of symptoms from drowsiness and confusion, to seizures and coma. Medical treatments ranged from hydration therapy to sedation and intubation. Poison centers safely managed 23.4% of these pediatric cases by phone, without the need for hospital evaluation.

Conclusion

There was a strong association between the legalization of marijuana and ingestions of marijuana by children younger than 6 years.
Caring for Children With Autism in an Emergency Department Setting
Authors: Mannenbach Mark S. , Passe Rebecca L. , Lovik Kimberly K. , Larson Erin M. , Laudon Sarah M. , Naeve Allyson , Bellolio M. Fernanda
Published: May 2019

Objective

Patients with autism spectrum disorder (ASD) and other developmental delays represent a unique patient population. We described a cohort of children with ASD cared for in an emergency department (ED) setting and the specific health care resources used for their care.

Methods

This is an observational study of consecutive children (<18 years) with ASD presenting for ED care. Comparisons of interest were evaluated using Wilcoxon rank sum and χ2 tests. Odds ratios (ORs) are reported with 95% confidence intervals (CIs).

Results

There were 238 ED visits over a 9-month period among 175 children. Median age was 9 years, and 62% were male. Reasons for ED visit were medical (51%), psychiatric (18%), injury/assault/trauma (16%), neurological (11%), and procedure related (4%.)

Children with psychiatric complaints had longer lengths of stay than those with other chief complaints (P < 0.0001; OR, 5.8; CI, 2.8–11.9) and were more likely to have urine (OR, 8.5; CI, 3.9–18.3) and blood work ordered (OR, 2.5; CI, 1.2–4.9) and less likely to have x-rays ordered (OR, 0.10; CI, 0.02–0.44).

Eighteen (8%) children received sedation. None required physical restraint. A total of 30% were admitted to the hospital. Those with psychiatric complaints were more likely to be admitted (54.8% vs 24.5%; OR, 3.7; CI, 1.9–7.4) than those with other chief complaints.

Conclusions

The care for children with ASD varied with age and health care issues. There was a high prevalence of psychiatric complaints, and many of these children were boarded in the ED waiting for an inpatient psychiatric bed. Those with psychiatric complaints were more likely to have multiple tests ordered and were more likely to be admitted.
Computer-Aided Diagnosis of Pulmonary Fibrosis Using Deep Learning and CT Images
Authors: Christe Andreas , Peters Alan A. , Drakopoulos Dionysios , Heverhagen Johannes T. , Geiser Thomas , Stathopoulou Thomai , Christodoulidis Stergios , Anthimopoulos Marios , Mougiakakou Stavroula G. , Ebner Lukas
Published: May 2019

Objectives

The objective of this study is to assess the performance of a computer-aided diagnosis (CAD) system (INTACT system) for the automatic classification of high-resolution computed tomography images into 4 radiological diagnostic categories and to compare this with the performance of radiologists on the same task.

Materials and Methods

For the comparison, a total of 105 cases of pulmonary fibrosis were studied (54 cases of nonspecific interstitial pneumonia and 51 cases of usual interstitial pneumonia). All diagnoses were interstitial lung disease board consensus diagnoses (radiologically or histologically proven cases) and were retrospectively selected from our database. Two subspecialized chest radiologists made a consensual ground truth radiological diagnosis, according to the Fleischner Society recommendations. A comparison analysis was performed between the INTACT system and 2 other radiologists with different years of experience (readers 1 and 2). The INTACT system consists of a sequential pipeline in which first the anatomical structures of the lung are segmented, then the various types of pathological lung tissue are identified and characterized, and this information is then fed to a random forest classifier able to recommend a radiological diagnosis.

Results

Reader 1, reader 2, and INTACT achieved similar accuracy for classifying pulmonary fibrosis into the original 4 categories: 0.6, 0.54, and 0.56, respectively, with P > 0.45. The INTACT system achieved an F-score (harmonic mean for precision and recall) of 0.56, whereas the 2 readers, on average, achieved 0.57 (P = 0.991). For the pooled classification (2 groups, with and without the need for biopsy), reader 1, reader 2, and CAD had similar accuracies of 0.81, 0.70, and 0.81, respectively. The F-score was again similar for the CAD system and the radiologists. The CAD system and the average reader reached F-scores of 0.80 and 0.79 (P = 0.898).

Conclusions

We found that a computer-aided detection algorithm based on machine learning was able to classify idiopathic pulmonary fibrosis with similar accuracy to a human reader.
Application of Three-Dimensional Printing Technology in the Orbital Blowout Fracture Reconstruction
Authors: Zhang Xiang , Chen Wei , Luo Ting-Yuan , Ma Juan , Dong Zhen , Cao Gang , Xu Jin-ke , Liu Bin-Yao , Zhang Qi-Rui , Zhang Sen-Lin
Published: May 2019

The aim of this study was to investigate the clinical outcomes of orbital blowout fracture repair by using the three-dimensional (3D) printing-assisted fabrication of individual titanium mesh. Clinical and radiologic data were analyzed for 12 patients with orbital floor and/or medial wall fractures. Lower eyelid incision was used to expose the fractures. Preoperative computed tomographic data were input into an imaging software to rebuild a 3D orbit and mirror the unaffected side into the affected side to replace the demolished orbit. A resin model of the reshaped orbit was generated and used to develop an individual titanium mesh for repairing the fractured orbital. The surgical results were assessed by value of enophthalmos and a comparison of preoperative and postoperative orbital volume difference. All patients had a successful treatment outcome without any complications. Clinical significant enophthalmos were not observed after treatment, and diplopia were solved within 2 weeks postoperative. No extraocular muscle limitation was observed. Postoperative computed tomography scans demonstrated appropriate positioning of titanium mesh and there was no implant displacement. The postoperative orbital volume and enophthalmos difference between the 2 eyes decreased significantly than preoperative (P < 0.001). Three-dimensional printing-assisted fabrication of individual titanium mesh is appropriate for use in orbital blowout fracture.
Use of Navigation System in Craniofacial Surgery
Authors: Gasparini Giulio , Saponaro Gianmarco , Todaro Mattia , Doneddu Piero , Tamburrini Gianpiero , D’Amato Giuseppe , Boniello Roberto , Pelo Sandro , Moro Alessandro
Published: May 2019

The use of navigated surgery in the treatment of craniofacial malformations can help obtain optimal results. In this article, the authors will discuss a case of anterior plagiocephaly, corrected with frontorbital bandeau remodeling. Navigation was used during the osteotomy and the reposition phase to ensure the correct positioning of the osteotomy instruments. It was also used to ensure that the bandeau was correctly repositioned in accordance with the surgical plan determined during the virtual simulation phase of the surgery.
Molding Helmet Therapy for Deformational Brachycephaly
Authors: Hallac Rami R. , Ajiwe Tochi , Effendi Maleeh , Seaward James R. , Kane Alex A.
Published: May 2019

Background:

Molding helmet therapy is used for the treatment of infants with deformational brachycephaly (DB). There is a lack of rigorous outcome measures of helmet therapy in patients with DB using 3-dimensional (3D) imaging, with most reports rely on either subjective or 2-dimensional analyses. Furthermore, the longitudinal assessment of head shape improvement over the course of helmet therapy has not been documented. Our goal was to assess the outcome of molding helmet therapy using 3D surface imaging, and to document the pace of improvement during treatment.

Methods:

The head shape of 18 infants with DB who underwent orthotic molding helmet therapy was assessed. The 3D scans were obtained before treatment, during treatment, and at the end of treatment. First, we applied shape analysis techniques based on template deformation to obtain average (composite) heads of the 18 patients at the 3 time points of treatment (pretreatment, during, and posttreatment). In addition, we used 3D curvature analysis to quantify the degree of flatness at the same time points.

Results:

Molding helmet therapy started at 6.7 ± 0.9 months of age and lasted for 4.3 ± 0.8 months. The overall difference in the occipital contour between pretreatment and end of treatment was 6.3 ± 1.7 mm. Curvature analysis revealed that 15% of the back of the head had prehelmet marked flatness (mean curvature <5/m), which decreased to 9% at 2.5 months into treatment and 7% at the end of treatment.

Conclusion:

Over 65% of the head shape improvement occurred during the 2.5 months of molding helmet therapy.
Prognostic Value of a Four-miRNA Signature in Patients With Lymph Node Positive Locoregional Esophageal Squamous Cell Carcinoma Undergoing Complete Surgical Resection
Authors: Wen Jing , Wang Geng , Xie Xuan , Lin Guangrong , Yang Hong , Luo Kongjia , Liu Qianwen , Ling Yihong , Xie Xiuying , Lin Peng , Chen Yuping , Zhang Huizhong , Rong Tiehua , Fu Jianhua
Published: May 2019

Objective:

This study was intended to identify prognostic biomarkers for lymph node (LN)-positive locoregional esophageal squamous cell carcinoma (ESCC) patients.

Summary of Background Data:

Surgery is a major treatment for LN-positive locoregional ESCC patients in China. However, patient outcomes are poor and heterogeneous.

Methods:

ESCC-associated miRNAs were identified by microarray and validated by quantitative real-time polymerase chain reaction analyses in ESCC and normal esophageal epithelial samples. A multi-miRNA based classifier was established using a least absolute shrinkage and selection operator model in a training set of 145 LN-positive locoregional ESCCs, and further assessed in internal testing and independent validation sets of 145 and 243 patients, respectively.

Results:

Twenty ESCC-associated miRNAs were identified and validated. A 4-miRNA based classifier (miR-135b-5p, miR-139-5p, miR-29c-5p, and miR-338-3p) was generated to classify LN-positive locoregional ESCC patients into high and low-risk groups. Patients with high-risk scores in the training set had a lower 5-year overall survival rate [8.7%, 95% confidence interval (CI): 0–20.3] than those with low-risk scores (50.3%, 95% CI: 40.0–60.7; P < 0.0001). The prognostic accuracy of the classifier was validated in the internal testing (P < 0.0001) and independent validation sets (P = 0.00073). Multivariate survival analyses showed that the 4-miRNA based classifier was an independent prognostic factor, and the combination of the 4-miRNA based classifier and clinicopathological prognostic factors significantly improved the prognostic accuracy of clinicopathological prognostic factors alone.

Conclusion:

Our 4-miRNA based classifier is a reliable prognostic prediction tool for overall survival in LN-positive locoregional ESCC patients and might offer a novel probability of ESCC treatment individualization.