bluuebunny/crossref_metadata_2025 huggingface dataset:
Serum levels of insulin-like growth factor 1 are negatively associated with log transformation of thyroid-stimulating hormone in Graves’ disease patients with hyperthyroidism or subjects with euthyroidism
Authors: Tseng Fen-Yu , Chen Yen-Ting , Chi Yu-Chiao , Chen Pei-Lung , Yang Wei-Shiung
Published: March 2019

Insulin-like growth factor 1 (IGF-1) has a molecular structure similar to that of insulin. As an essential mediator of growth hormone, IGF-1 plays a vital role in growth of children and anabolic effects of adults. We evaluated the serum levels of IGF-1 in patients with hyperthyroidism or euthyroidism.

In this study, 30 patients each of Graves’ disease with hyperthyroidism (HY group) and euthyroid individuals (EU group) were recruited. The HY patients were treated with antithyroid regimens as clinically indicated. No medications were given to EU patients. The demographic characteristics and anthropometric and laboratory data of both groups at baseline and 6 months were compared. Associations between levels of IGF-1 and free thyroxine (fT4), thyroid-stimulating hormone (TSH), or log transformation of TSH (logTSH) were analyzed.

At baseline, the HY patients had significantly higher serum IGF-1 levels than EU patients (median [Q1, Q3]: 305.4 [257.4, 368.1] vs. 236.7 [184.6, 318.8] ng/mL, P = .007). At 6 months, the HY patients still had higher serum levels of IGF-1 than EU patients (299.5 [249.9, 397.9] vs 222.1 [190.2, 305.4] ng/mL, P = .003). At baseline, the serum levels of IGF-1 in the HY and EU patients were positively associated with fT4 (β = 29.02, P = .002) and negatively associated with TSH (β = −31.46, P = .042) and logTSH (β = −29.04, P = .007). The associations between serum levels of IGF-1 with fT4 or TSH became insignificant at 6 months. However, the serum IGF-1 levels had persistent negative associations with logTSH at 6 months (β = −26.65, P = .021). The negative associations between IGF-1 and logTSH at baseline and 6 months remained significant even after adjustment with sex and age (β = −20.22, P = .023 and β = −20.51, P = .024, respectively).

The HY patients had higher serum IGF-1 levels than EU patients. The serum IGF-1 concentrations were negatively associated with logTSH in patients with hyperthyroidism or euthyroidism.
Effect of adiponectin level and genetic variation of its receptors on diabetic retinopathy
Authors: Liao Wen-Ling , Chen Yung-Hsiang , Chen Ching-Chu , Huang Yu-Chuen , Lin Hui-Ju , Chen Yng-Tay , Ban Bo , Wu Chia-Ming , Chang Ya-Wen , Hsieh Ai-Ru , Tsai Fuu-Jen
Published: March 2019

Adiponectin (APN) and its receptors have been reported to be associated with metabolic phenotypes. To better understand the effects of APN levels and its receptors on diabetic retinopathy (DR), we investigated the association of the plasma APN level and variations in APN-related genes with DR, individually and in combination.

Patients with type 2 diabetes (T2D; N = 1604), above 20 years of age from the Taiwanese population participated in the study. Demographic information, blood pressure, and serological markers were recorded at enrollment. Genomic DNA was isolated and genotyped. The plasma APN levels were measured by enzyme-linked immunosorbent assay.

T2D patients with DR (N = 632) had diabetes for a longer duration, and had higher HbA1c, and systolic and diastolic blood pressure compared to those without DR (N = 972) (P < .001, for all the parameters). Overall, 10 single nucleotide polymorphisms (SNPs) inADIPOQandCDH13susceptibility loci were associated with DR. Gene risk score (GRS) was calculated based on 10 SNPs for each subject and the cumulative effect of genes was observed. Among the subjects with plasma APN level (N = 518), natural logarithm (LN) of APN (LN [APN]; odds ratio [OR] = 1.63, 95% confidence interval [CI] = 1.19–2.25) and GRS (OR = 1.90, 95% CI = 1.11–3.26 for middle range of GRS, and OR = 2.61, 95% CI = 1.48–4.59 for high range of GRS) were independent risk factors for DR after adjustment for other parameters.

In conclusion, the plasma APN level and the genetic variations in adiponectin receptors were associated with DR.
Immunocompetent patient with a brain abscess caused by Nocardia beijingensis in Latin America
Authors: Solano-Varela David M. , Barrios-Vidales Edgar M. , Plaza David F. , Riveros William M. , Guzmán Julián , Chica Claudia E. , Patarroyo Manuel A.
Published: March 2019

Rationale:

Nocardia species are not commonly referred as primary infectious entities but rather as opportunistic pathogens. Infectious cases of Nocardia spp. in immunocompetent individuals are rare.

Patient concerns:

An immunocompetent 58-year-old patient presented with recurrent headaches.

Diagnosis:

A brain abscess was found and surgically drained. Matrix-assisted laser desorption ionization–time-of-flight mass spectrometry and heat shock protein 65/16S-23S rRNA gene intergenic spacer genotyping from the sample revealed the etiological agent as Nocardia beijingensis.

Interventions:

Meropenem/amikacin/Trimethoprim-sulfamethoxazole were administered.

Outcomes:

The infection persisted leading to the patient's death.

Lessons:

Here we present the first case of N. beijingensis infection of the central nervous system in an immunocompetent patient from Latin America. Further inquiry is needed to establish whether this species is more virulent than other Nocardia isolates.
A cross-sectional study on the correlation between physical activity levels and health-related quality of life in community-dwelling middle-aged and older adults
Authors: Abdelbasset Walid Kamal , Alsubaie Saud F. , Tantawy Sayed A. , Elyazed Tamer I. Abo , Elshehawy Ahmed A.
Published: March 2019

This study aimed to evaluate the association between physical activity level and health-related quality of life in community-dwelling middle aged and older adults in Egypt. Between May and August 2017, a cross-sectional study of 184 middle-aged and older adults between the ages of 55 and 64 years old (129 males and 55 females) with a mean age of 58 ± 4.3 years old participated in this study. Study participants were classified into 3 groups based on their level of physical activity (walking duration); low level of physical activity (<150 minutes/week), moderate level of physical activity (150–300 minutes/week), and high level of physical activity (>300 minutes/week). The health-related quality of life (HRQoL) was calculated using the Euro-Quality of life-5dimensions-3 levels scale questionnaire (EuroQol-5D-3L). Spearman's correlation coefficient was performed to determine the correlation between the physical activity level and HRQoL scores in community-dwelling middle-aged and older adults. The results showed a significant correlation between the physical activity levels and HRQoL dimensions. Significant differences were observed in the HRQoL scores between high, moderate and low-physical activity groups (P < .05). The moderate and high-physical activity groups had significantly higher HRQoL scores in all dimensions than low-physical activity group. The low-physical activity group showed a high predominance of the chronic disease compared to the high and moderate physical activity groups. It was concluded that high and moderate levels of physical activity have a great positive relationship with the HRQoL in community-dwelling middle-aged and older adults in Egypt. Recommendations should be dedicated to supporting the active lifestyle among the different population, particularly middle-aged and older adults.
Emerging molecular mechanisms of vascular dementia
Authors: Romay Milagros C. , Toro Camilo , Iruela-Arispe M. Luisa
Published: March 2019

Purpose of review

Microvascular ischemic disease of the brain is a common cause of cognitive impairment and dementia, particularly in the context of preexisting cardiovascular risk factors and aging. This review summarizes our current understanding of the emerging molecular themes that underlie progressive and irreparable vascular disease leading to neuronal tissue injury and dementia.

Recent findings

Cardiometabolic risk factors including diabetes and hypertension are known to contribute to vascular disease. Currently, the impact of these risk factors on the integrity and function of the brain vasculature has been target of intense investigation. Molecularly, the consequences associated with these risk factors indicate that reactive oxygen species are strong contributors to cerebrovascular dysfunction and injury. In addition, genetic linkage analyses have identified penetrant monogenic causes of vascular dementia. Finally, recent reports begun to uncover a large number of polymorphisms associated with a higher risk for cerebrovascular disease.

A comprehensive picture of key risk factors and genetic predispositions that contribute to brain microvascular disease and result in vascular dementia is starting to emerge. Understanding their relationships and cross-interactions will significantly aid in the development of preventive and intervention strategies for this devastating condition.
Assessing Palliative Care Knowledge Among Nurses in 2 Hospitals in Saudi Arabia
Authors: Aboshaiqah Ahmad E.
Published: March 2019

The aims of this study were to assess the palliative care knowledge among nurses in Saudi Arabia and to identify the demographic factors influencing such knowledge. A convenience sample of 365 nurses working in 2 hospitals in Saudi Arabia was surveyed using the Palliative Care Quiz for Nursing in this cross-sectional study. The mean score of the respondents in the Palliative Care Quiz for Nursing was 8.88 (SD, 1.75), which is interpreted as low knowledge. In terms of the theoretical categories of the scale, 9 of the 13 items in the category pain and symptom management were answered correctly by the majority of the respondents, whereas all the items in the psychosocial and spiritual care category were answered incorrectly by the majority of the respondents. Type of hospital, age, and attendance to palliative care education in the last 6 months were revealed as significant factors that influence the nurses’ palliative care knowledge. Continuing education on palliative care should be implemented by hospital administrations, and palliative care education should target the weakness of the nurses, especially those revealed in the study, such as on the psychosocial and spiritual care, some aspects of pain and symptom management, and philosophy and principles of palliative care.
Effect of Cognitive Behavioral Therapy on Improving the Cognitive Function in Major and Minor Depression
Authors: He Hui-Li , Zhang Ming , Gu Chuan-Zheng , Xue Ran-Ran , Liu Hong-Xia , Gao Cai-Feng , Duan Hui-Feng
Published: March 2019

The aim of this study was to investigate the effectiveness of cognitive behavioral therapy (CBT) on improving the cognitive function in minor depression (MiD) and major depression (MaD). The study will constitute a placebo-controlled single-blind parallel-group randomized controlled trial. The selected participants will be randomly allocated into one of two parallel groups with a 1:1 ratio: the CBT-based group and the general health education group. CBT significantly alleviated depressive symptoms of MiD and MaD at 12 weeks (p < 0.001), and the treatment effect was maintained for at least 12 months (p < 0.001). Interestingly, CBT significantly promotes more cognitive function of MiD and partial cognitive function of MaD at 12 weeks in the intervention group than in the control group (p < 0.01). CBT can alleviate depressive symptoms of both minor and MaDs. The effectiveness of CBT is different on improving the cognitive function in MiD and MaD.
Military Veteran Status and Posttraumatic Stress Disorder Symptomatology Among Urban Firefighters
Authors: Bartlett Brooke A. , Gallagher Matthew W. , Tran Jana K. , Vujanovic Anka A.
Published: March 2019

A significant portion of firefighters are military veterans, and both populations experience high rates of trauma and posttraumatic stress disorder (PTSD) symptomatology. We investigated main and interactive effects of military veteran status (MVS) and emotion regulation difficulties (ERD) with regard to PTSD symptom severity in firefighters. Covariates included trauma load, number of years in the fire department, and depressive symptom severity. The sample was composed of 839 (93.9% men; mean age = 38.4, SD = 8.5) trauma-exposed firefighters who completed a web-based questionnaire battery. Structural equation modeling was used. ERD were significantly, positively associated with PTSD symptom severity (β = 0.30, confidence interval [CI] = 0.20–0.41, p < 0.001). A significant interactive effect was noted (β = 0.07, CI = 0.01–0.14, p = 0.020); firefighters who endorsed MVS and greater ERD had the highest levels of PTSD symptom severity. It is vital that future work examine associations between MVS and relevant cognitive mechanisms for the purposes of informing effective screening, intervention, and prevention programs.
Turning Health Systems Data Into Actionable Information
Authors: Nelson-Brantley Heather V. , Jenkins Peggy , Chipps Esther
Published: March 2019

Health systems produce vast amounts of complex, multidimensional data. Health systems nurse leaders, informaticians, and nurse researchers must partner to turn these data into actionable information to drive quality clinical outcomes. The authors review health systems in the era of big data, identify opportunities for health systems-nursing research partnerships, and introduce emerging approaches to data science education in nursing.
Building Evidence-Based Nursing Practice Capacity in a Large Statewide Health System
Authors: Storey Susan , Wagnes Lisa , LaMothe Julie , Pittman Joyce , Cohee Andrea , Newhouse Robin
Published: March 2019

Integration of evidence-based practice (EBP) into the culture of a healthcare organization is essential to provide safe patient care and promote a thriving culture for the nurses within the healthcare organization. Collaboration and utilization of both clinical and academic experts facilitate the removal of barriers to EBP. This article describes the successful partnership between a healthcare system and school of nursing in executing a 3-phased multimodal approach to an EBP training program.
The Continuing Saga of Nurse Staffing
Authors: Blouin Ann Scott , Podjasek Kara
Published: March 2019

Registered nurses are the backbone of America's health systems, providing care and support to patients across the lifespan. Appropriate nurse staffing is critical to ensure safe and effective care for patients. Nurse staffing is a complex topic; nurse administrators find themselves facing escalating challenges to meet staffing needs. These challenges can be attributed to a variety of factors, both historical and new. This article examines the current factors contributing to nursing shortages, nurse staffing challenges, and the implications of inappropriate staffing on both financial and patient outcomes.
Variables Impacting Program Completion of Readmitted Associate Degree Nursing Students
Authors: Dries Kelly J.
Published: March 2019

Background

The projected shortfall in the number of RNs supports the need to identify variables impacting nursing student program completion. Studies are lacking as to variables that affect attrition and program completion of readmitted nursing students.

Purpose

This study examined academic and nonacademic variables that impact attrition and program completion of readmitted associate degree nursing students.

Methods

Survey and record review yielded student characteristics, support for learners, student effort, and student outcome measures that predicted attrition and program completion.

Results

Findings suggest that students earning a final grade of B+ or higher in the nursing fundamentals course complete the program. In addition, readmitted nursing students who were 33 years or older had decreased odds of completing the program by 1.44% for each year of age. The study also pointed to nonacademic variables that impacted attrition.

Conclusions

Measures to improve program completion of readmitted nursing students are included.
Managing Opioid Use in Orthopaedic Patients Through Harm Reduction Strategies
Authors: Worley Julie
Published: March 2019

Opioids are commonly prescribed in orthopaedics for acute or chronic pain for a variety of conditions, including injury, trauma, degenerative processes, and postsurgical. Patients who are taking opioids because of a substance use disorder (SUD) are also seen in orthopaedics. Patients who are prescribed opioids are at risk of developing an opioid use disorder (OUD). Ten percent of Americans will develop an SUD, which is considered a chronic medical condition that develops due to an imbalance in brain chemistry. In studies, orthopaedic surgeons have a high rate of prescribing opioids, but this rate is decreasing along with national average due to public and provider awareness of the opioid epidemic and professional recommendations. Despite the evidence of a neurobiological cause for SUDs, stigma toward patients with SUDs and a knowledge deficit are common among healthcare professionals, including orthopaedic nurses. A harm reduction approach when working with orthopaedic patients taking opioids either prescribed or used because of an OUD can be applied to reduce the problematic effects of opioids. Harm reduction strategies are supportive to the patient and include education and prevention, adopting evidence-based treatment and communication strategies, and the use of naloxone to prevent opioid overdose.
Performance of behavioral assays: the Rat Grimace Scale, burrowing activity and a composite behavior score to identify visceral pain in an acute and chronic colitis model
Authors: Leung Vivian S.Y. , Benoit-Biancamano Marie-Odile , Pang Daniel S.J.
Published: March 2019

Introduction:

The Rat Grimace Scale (RGS), a facial expression scale, quantifies the affective component of pain in rats. The RGS was developed to identify acute and inflammatory pain, and applicability in acute and chronic visceral pain is unknown. The dextran sulfate sodium (DSS) colitis model is commonly used in rats, but pain is rarely assessed, instead, disease progression is monitored with the Disease Activity Index (DAI; assessing fecal blood, stool consistency, and weight loss).

Objectives:

The aim of this study was to assess whether the RGS and 2 additional behavioral tools (composite behavior score [CBS] and burrowing) could identify pain in an acute and chronic DSS colitis model.

Methods:

Male and female Sprague-Dawley rats were block randomized to (1) acute colitis (4 days DSS in drinking water); (2) chronic colitis (4 days DSS, 7 days water, and 3 days DSS); or (3) control (14 days water). Disease Activity Index, RGS, CBS, and burrowing assessments were performed daily.

Results:

Rat Grimace Scale scores increased as DAI scores increased during both acute and chronic phases. Burrowing only decreased during the acute phase. By contrast, CBS scores did not increase significantly during either colitis phase.

Conclusions:

These data show that the RGS and burrowing did not decrease in a sustained manner during chronic phase visceral pain, and that variables assessed in the DAI are indicative of pain. This suggests that the RGS can be applied to a wider range of pain types and chronicity than originally suggested. These findings increase the application of the RGS as a pain scale and welfare improvement tool.
Brief Report: Response to Hepatitis A Virus Vaccine in HIV-Infected Patients Within a Retrospective, Multicentric Cohort: Facing Hepatitis A Outbreaks in the Clinical Practice
Authors: Neukam Karin , Delgado Fernández Marcial , Hernández Quero José , Rivero-Juárez Antonio , Llaves-Flores Silvia , Jiménez Oñate Francisco , Gutiérrez-Valencia Alicia , Espinosa Nuria , Viciana Pompeyo , López-Cortés Luis F.
Published: March 2019

Background:

Various recent outbreaks of hepatitis A virus (HAV) have been described in men who have sex with men despite the availability of an effective vaccine. This study aimed to determine the current rates of seroconversion after receiving HAV vaccine (HAV-V) in HIV-infected patients under real-life conditions.

Setting:

Patients were selected from a Southern Spanish multicentric cohort of HIV-infected subjects.

Methods:

Retrospective analysis of all patients who received 2 doses (standard scheme) from April 2008 to May 2016 or from June 2016 to February 2018 facing an HAV outbreak with shortage of HAV-V, 1 single dose of HAV-V. Response to HAV-V was defined as positive anti-HAV IgG between 1 and 12 months after the last vaccination dose.

Results:

A total of 522 patients were included, mainly men who have sex with men (86.2%). In the standard-dose group, 303/343 [88.3%; 95% confidence interval (CI): 84.5 to 91.5] patients showed seroconversion as compared with 149/179 (83.2%; 95% CI: 76.9 to 88.4) of the single-dose group (P = 0.107). Undetectable baseline HIV-RNA (adjusted odds ratio: 4.86; 95% CI: 1.86 to 12.75; P = 0.001) and a CD4+ T-cell count ≥350/μL (adjusted odds ratio, 3.96; 95% CI: 1.26 to 12.49; P = 0.019) were independently associated with response to both regimens. A higher CD4/CD8+ ratio was also associated with response after a single dose.

Conclusions:

HIV-infected patients should be encouraged to undergo HAV-V with 2 standard doses 6 months apart; a single dose achieves a high rate of seroconversion in those patients with favorable response factors and may be enough to limit future outbreaks in case of HAV-V shortage until supply is reestablished.
Detecting Disengagement From HIV Care Before It Is Too Late: Development and Preliminary Validation of a Novel Index of Engagement in HIV Care
Authors: Johnson Mallory O. , Neilands Torsten B. , Koester Kimberly A. , Wood Troy , Sauceda John A. , Dilworth Samantha E. , Mugavero Michael J. , Crane Heidi M. , Fredericksen Rob J. , Mayer Kenneth H. , Mathews William C. , Moore Richard D. , Napravnik Sonia , Christopoulos Katerina A.
Published: March 2019

Background:

Engagement in care is critical to achieving and sustaining optimal benefits of efficacious antiretroviral therapies for HIV infection. Current metrics of engagement in care, including problematic patterns of retention in care, adherence to treatment, and viral suppression, are often detected late in the disengagement process. We sought to develop and validate a patient-centered screener of engagement in care that can be used to identify deficits in patient perceptions of engagement before the development of poor outcomes, including loss to follow-up, treatment nonadherence, virologic failure, and the resulting increased likelihood of HIV-associated morbidity and mortality and onward transmission of HIV.

Setting and Methods:

Using input from patients, providers, and researchers through in-person focus groups and an online Delphi process, we developed a self-report measure of engagement in care that was validated with 3296 patients from 7 clinics across the United States.

Results:

Results supported a single dimension of engagement in care measured by 10 items. Lower scores on the HIV Index were related to higher depression and anxiety symptoms, greater use of alcohol and stimulants, and increased likelihood of reporting internalized HIV stigma. Higher Index scores were positively associated with self-report measures of antiretroviral therapy adherence, corroborative clinic records documenting appointment attendance, and increased likelihood of recent viral load suppression.

Conclusions:

The HIV Index offers promise as a patient-centered diagnostic and prognostic screener for engagement in care that can be used to trigger interventions to promote better clinical outcomes for persons living with HIV.
Predictors of Long-Term HIV Pre-exposure Prophylaxis Adherence After Study Participation in Men Who Have Sex With Men
Authors: Hoenigl Martin , Hassan Adiba , Moore David J. , Anderson Peter L. , Corado Katya , Dubé Michael P. , Ellorin Eric E. , Blumenthal Jill , Morris Sheldon R. ,   for the California Collaborative Treatment Group (CCTG) 601 Team
Published: March 2019

Background:

Efficacy of HIV pre-exposure prophylaxis (PrEP) among men who have sex with men is well documented in randomized trials. After trial completion, participants are challenged with acquiring PrEP on their own and remaining adherent.

Methods:

This was a follow-up study of the TAPIR randomized controlled multicenter PrEP trial. Participants were contacted after their last TAPIR visit (ie, after study-provided PrEP was discontinued) to attend observational posttrial visits 24 and 48 weeks later. Adherence during TAPIR and posttrial visits was estimated by dried blood spot intracellular tenofovir diphosphate levels (adequate adherence defined as tenofovir diphosphate levels >719 fmol/punch). Binary logistic regression analysis assessed predictors of completing posttrial visits and PrEP adherence among participants completing ≥1 visit.

Results:

Of 395 TAPIR participants who were on PrEP as part of the TAPIR trial for a median of 597 days (range 3–757 days), 122 (31%) completed ≥1 posttrial visit (57% of University of California San Diego participants completed posttrial visits, whereas this was 13% or lower for other study sites). Among participants who completed ≥1 posttrial visit, 57% had adequate adherence posttrial. Significant predictors of adequate adherence posttrial were less problematic substance use, higher risk behavior, and adequate adherence in year 1 of TAPIR.

Conclusion:

More than half of PrEP users followed after trial completion had successfully acquired PrEP and showed adequate adherence. Additional adherence monitoring and intervention measures may be needed for those with low PrEP adherence and problematic substance use during the first year of trial.
Increasing Levels of Serum Heat Shock Protein 70 Precede the Development of AIDS-Defining Non-Hodgkin Lymphoma Among Carriers of HLA-B8-DR3
Authors: Aissani Brahim , Martinez-Maza Otoniel , Kaslow Richard A. , Wiener Howard W. , Bream Jay H. , Stosor Valentina , Martinson Jeremy J. , Jacobson Lisa P. , Shrestha Sadeep
Published: March 2019

Background:

We hypothesized that carriage of presumably high Hsp70-producing gene variants on a specific human major histocompatibility complex haplotype, the 8.1 ancestral haplotype (8.1AH), may predispose HIV-infected individuals to AIDS–non-Hodgkin lymphoma (NHL).

Setting:

We compared serum Hsp70 levels in the years preceding the diagnosis of AIDS-NHL in a matched case–control study (n = 151 pairs) nested in the Multicenter AIDS Cohort Study.

Methods:

We tested the impact of 8.1AH-specific single-nucleotide polymorphism (SNP) and joint SNP–human leukocyte antigen extended haplotypes previously associated with AIDS-NHL in the Multicenter AIDS Cohort Study on the circulating Hsp70 levels in mixed linear models.

Results:

We report elevated serum levels of Hsp70 in the 4 years preceding the diagnosis of AIDS-NHL in cases that carry 8.1AH, but not in noncarrier cases and not in carrier- or non–carrier-matched controls. The strongest predictor of higher serum Hsp70 was the haplotype A-G-A-C formed by SNPs rs537160(A) and rs1270942(G) in the complement factorCFBgene cluster, and rs2072633(A) and rs6467(C) in nearbyRDBPandCYP21A2located 70 Kb apart from the Hsp70 gene cluster. The association with A-G-A-C haplotype (beta = 0.718; standard error = 0.182;P= 0.0002) and with other 8.1AH-specific haplotypes including the high-producing tumor necrosis factor–alpha haplotype rs909253(G)–rs1800629(A) (beta = 0.308; standard error = 0.140;P= 0.032) were observed only with NHL identified as an AIDS-defining condition, but not as a post-AIDS condition, nor in combined AIDS and post-AIDS cases.

Conclusion:

Our combined genetic and functional approach suggests that the altered level of Hsp70 is a correlate of 8.1AH-mediated AIDS-NHL. Further investigation of the Hsp70 gene cluster and nearby loci that are tagged by A-G-A-C could better elucidate the genetic determinants of the malignancy.
Added Value of Ultra–low-dose Computed Tomography, Dose Equivalent to Chest X-Ray Radiography, for Diagnosing Chest Pathology
Authors: Kroft Lucia J.M. , van der Velden Levinia , Girón Irene Hernández , Roelofs Joost J.H. , de Roos Albert , Geleijns Jacob
Published: March 2019

Purpose:

The purpose of this study was to assess the clinical value of ultra–low-dose computed tomography (ULDCT) compared with chest x-ray radiography (CXR) for diagnosing chest pathology.

Materials and Methods:

A total of 200 patients referred for CXR by outpatient clinics or general practitioners were enrolled prospectively. They underwent CXR (posteroanterior and lateral) and ULDCT (120 kV, 3 mAs) on the same day. In-room time and effective dose were recorded for each examination. Studies were categorized whether they were diagnostic or not, relevant radiologic diagnostic findings were reported, and confidence for diagnosis was recorded by a Likert scale. Differences in diagnostic confidence and effect on management decision were compared.

Results:

In-room time was <2 minutes for CXR and <3 minutes for ULDCT. Effective dose was 0.040 mSv for CXR and 0.071 mSv for ULDCT. CXR was considered diagnostic in 98% and ULDCT in 100%. The mean perceived confidence for diagnosis was 88±12% with CXR and 98±2% with ULDCT (P<0.0001), whereas discrepant findings between CXR and ULDCT were found in 101 of 200 patients. As compared with CXR, ULDCT had added value for management decisions in 40 of 200 patients.

Conclusions:

ULDCT provided added value to the radiologist by improved perceived confidence with a reduction in false-positive and false-negative CXR investigations that had management implications in 20% of patients. The effective dose of ULDCT will not be a limiting factor for introducing ULDCT of the chest on a broad scale in clinical practice.
What Do Plastic Surgery Patients Think of Financial Conflicts of Interest and the Sunshine Act?
Authors: Lopez Joseph , Naved Bilal A. , Pradeep Tejus , Pineault Kevin , Purvis Taylor , Macmillan Alexandra , Slezak Sheri , May James W. , Dorafshar Amir H.
Published: March 2019

Background

The purpose of this study was to evaluate patients' views of conflicts of interest (COI) and their comprehension of recent legislation known as the Physician Payments Sunshine Act. This report constitutes the first evaluation of plastic surgery patients' views on COI and the government-mandated Sunshine Act.

Methods

This cross-sectional study invited patients at an academic, general plastic surgery outpatient clinic to complete an anonymous survey. The survey contained 25 questions that assessed respondents' perceptions of physician COI and awareness of the Sunshine Act. Analyses were performed to examine whether perspectives on COI and the Sunshine Act varied by level of education or age.

Results

A total of 361 individuals completed the survey (90% response rate). More than half of respondents with an opinion believed that COI would affect their physician's clinical decision-making (n = 152, 52.9%). Although almost three fourths (n = 196, 71.2%) believed that COI should be regulated and COI information reported to a government agency, the majority were not aware of the Sunshine Act before this survey (n = 277, 81.2%) and had never accessed the database (n = 327, 95.9%). More than half of patients (n = 161, 59.2%) stated that they would access a publicly available database with physicians' COI information. A larger proportion of older and educated patients believed that regulation of physicians' COI was important (P < 0.001).

Conclusions

Awareness of and access to plastic surgeon COI information is low among plastic surgery patients. Older and more educated patients believed that transparency regarding COI is important with regard to their clinical care.
Digital Pulley Reconstruction Using Pulley Allografts
Authors: Martinez Roberto A. , Liston Jared , Archual Anthony J. , Gui Jane , Drake David B. , DeGeorge Brent R.
Published: March 2019

Background

The safety and feasibility of sterile, acellular pulley allografts in reconstruction has been previously demonstrated. Comparisons with tendon-based techniques for pulley reconstruction have not been reported. We hypothesized that the use of allograft pulleys would result in reduced procedural time and equivalent clinical outcomes as compared with traditional tendon-based reconstructive techniques.

Methods

All cases of pulley reconstruction using either allograft pulleys or tendon-based pulley reconstruction between November 2013 and November 2015 were reviewed. Patients who underwent concomitant procedures were excluded. Patient demographics, comorbidities, operative details (tourniquet and total operative times, number of pulleys repaired), postoperative complications (surgical site infection, reoperation, stiffness, and persistent pain), disability of the arm, shoulder and hand scores, and follow-up data were recorded. A P value of <0.05 was considered significant.

Results

Fifteen pulleys in 10 patients were reconstructed: 5 tendon-based and 5 with allograft. Average length of follow-up was 12.5 ± 2.9 months. There was no difference in patient demographic factors or comorbidities between groups. The most common indication for surgery was trauma. Four of 5 patients in the allograft group had multiple pulleys reconstructed versus 1 in the tendon-based group. One patient in the tendon-based group required reoperation versus 0 in the allograft group. Total operative and tourniquet times were significantly reduced in the allograft group (46 ± 5.5 vs 89 ± 12.9 minutes and 34 ± 6.8 vs 63 ± 5.3 minutes; P = 0.015 and 0.014). Postoperative disability of the arm, shoulder and hand scores were lower in the allograft group (56.8 vs 3.6, P = 0.11). There was no significant difference in postoperative range of motion between groups.

Conclusion

Pulley reconstruction with allograft is an efficient, technically feasible, reconstructive technique that adheres to the principle of replacing like with like, while eliminating donor site morbidity. Overall operative and tourniquet times were significantly shorter using allograft pulleys for pulley reconstruction.
Microsurgical Reconstruction of the Smile
Authors: Sue Gloria R. , Ho Oscar H.
Published: March 2019

Background

Facial paralysis is a significant problem with functional, psychological, and esthetic consequences. Free muscle transfer for reanimation of the smile has been established as the preferred reconstructive method. However, little has been reported on the complications after this procedure. We sought to perform a critical analysis of these complications and their ultimate outcomes.

Methods

A retrospective review was performed on consecutive patients undergoing microsurgical reconstruction of the smile by the senior author from 2013 through 2017. Patient demographics including age, race, body mass index, and medical comorbidities were recorded. The cause of facial palsy and type of microsurgical reconstruction were assessed. Patient outcomes including complications and management of the complication were analyzed. All statistical analyses were performed using nonparametric analyses.

Results

We identified 17 patients who underwent microsurgical reconstruction of the smile, with 1 patient undergoing bilateral procedures, for a total of 18 microsurgical smile reanimation procedures performed. Sixteen of these were 1-stage reconstructions with the coaptation of the nerve to the masseter, whereas 2 were 2-stage reconstructions using cross-facial nerve grafts. The gracilis muscle was used as the donor muscle in all cases. The patients had a median age of 26.5 and a median follow-up of 1.04 years from surgery. There were no major early complications observed in our cohort. Eight (44.4%) reanimations developed a minor complication that required subsequent reoperation. The reoperations were performed at a median of 0.97 years after the microsurgical procedure. The most common indication for reoperation was lateral retraction of the insertion of the transplanted muscle, which occurred in 5 (62.5%) patients. One patient underwent surgical exploration for an abrupt loss of transplanted muscle function after trauma to the cheek. Another patient had less than expected transplanted muscle activity at 1 year postoperatively and underwent exploration of the cross-facial nerve graft and a neurorrhaphy revision. Lastly, 1 patient developed significant rhytids over the transplanted muscle secondary to tethering of the skin to the underlying muscle. This patient underwent 2 subsequent revisions, with placement of acellular dermal matrix between the muscle and skin and fat grafting. All patients had functional animation of the transplanted muscle postoperatively.

Conclusions

Complications occurred in 44.4% of patients undergoing microsurgical reanimation of the smile. Most complications were minor in nature and were readily addressed with advancement of the transplanted muscle. All patients in our series had muscle function after the muscle transplantation.
Contribution of the Use of a Pen-Type Endoscope to Evaluate and Treat Ears Simultaneously During Cleft Palate Surgery in Late Presented Cases
Authors: Guneren Ethem , Ture Nurullah , Karabekmez Furkan Erol , Zahir Khalique
Published: March 2019

Background:

The prevalence of secretory otitis media is very high among the nonoperated cleft palate patients.

Methods:

Ninety-one cleft palate operations were performed on late presented cases in Sudan, Africa. The surgeries were performed according to the Veau–Wardill–Kilner push-back technique. A laptop connected pen-type endoscopic camera was used to evaluate the tympanic membrane and address middle ear disease in all patients simultaneously. The procedure was performed after removing wax from the external auditory canal. A small incision was made with a myringotomy knife through the layers of the tympanic membrane if any sign of fluid collection was observed, after which the middle ear effusion was evacuated and the ventilation tube was inserted.

Results:

This procedure was undertaken in 182 ears; 41 ears (22.5%) were healthy, 19 ears (10.5%) had chronic perforations, 122 ears (67%) underwent myringotomy procedures, and 54 (44.2%) were treated by inserting a ventilation tube. Despite the challenging work environment, standard monitoring facilities were available and all operations were completed with no early complications.

Conclusion:

The pen-type camera instead of an operating microscope was a tremendous contribution, as it was easy to handle and contributed to the good outcomes. The use of this technique is strongly recommended in surgical camps.

Level of Evidence: III
Rare Intrasellar Arachnoid Cyst Distinguishing From Other Benign Cystic Lesions and its Surgical Strategies
Authors: Chen Binghong , Miao Yifeng , Hu Yaomin , Liao Yu , Tu Mei , Yang Xi , Qiu Yongming
Published: March 2019

The study reported a case of an intrasellar arachnoid cyst with visual disturbances as the main symptom. Arachnoid cyst is a common intracranial benign space-occupying lesion, but rarely seen in intrasellar region with less than 100 cases reported available in English language literature. Therefore, it is still controversial about the diagnosis and treatment of such patients. This article reviewed previous literature and discussed the differential diagnosis and surgical strategies of intrasellar arachnoid cyst in combination with our own case.
Does Maxillary Advancement Influence the Nasolabial Angle?
Authors: Shmuly Tom , Chaushu Gabreial , Allon Dror Michael
Published: March 2019

Purpose:

To know whether there is a correlation between maxillary advancement and the nasolabial angle change allows to preoperatively predict the precise affect a planned maxillary advancement will have over the nasolabial angle. The aim of this study was to determine the relationship between the maxillary advancement and the nasolabial angle.

Methods:

The study is a retrospective analysis of 32 patients (12 males and 20 females, mean age 21 ± 3.4 years) who underwent a maxillary advancement. Lateral cephalometric radiographs were taken preoperatively and postoperatively. The lateral cephalograms were traced. Measurements were evaluated statistically using paired sample t-test and Pearson's correlation test.

Results:

The mean maxillary advancement was 4.81 ± 3.01 mm with a mean vertical change of −0.28 ± 2.80 mm. The nasolabial angle decreased by a mean of 3.78 ± 9.64° with statistical significance of P = 0.03 using a paired sample t-test, however using Pearson's correlation test, no direct correlation between maxillary advancement and the nasolabial angle was found. Furthermore, the study contains a review of the literature from the last 25 years, which shows that in most studies there was no correlation and in some patients even opposite results.

Conclusion:

Maxillary advancement might influence the nasolabial angle; however, preoperatively predicting the influence a maxillary advancement will have over the nasolabial angle is difficult, and further studies need to be conducted.
Aneurysms Arising From the Fenestrated Middle Cerebral Artery
Authors: Xue Xiying , Li Yunlong , Yin Yingchun , Yuan Xunhui , Xiao Hang , Wei Lin
Published: March 2019

Intracranial artery fenestration is segmental duplication of the lumen into 2 distinct channels and is known to have a low angiographical incidence of 0.3 to 0.9%. Intracranial artery fenestration is frequently associated with aneurysms, and aneurysms arising at the site of fenestrated middle cerebral artery (MCA) is extremely rare. To our best knowledge, there are only 10 such patients have been reported. Herein, the authors describe the 11th case of aneurysm arising from the fenestrated MCA. As the characteristics of fenestrated MCA aneurysms has not been well determined until now, these interesting patients are investigated and summarized.
Internal Jugular Vein Thrombosis With Serious Cervical Necrotizing Fasciitis
Authors: Zhang Wenhao , Qian Wentao , Shi Huimin , Zhang Weijie , Chen Minjie , Liang Xiang , Cai Xieyi
Published: March 2019

Internal jugular vein thrombosis (IJVT) is a rare complication of cervical necrotizing fasciitis (CNF) which may lead to life threat. This article reports a patient with severe CNF complicated with IJVT, and combined with the literature to analyze the diagnosis and treatment of CNF and IJVT.
Vascularized Combined with Nonvascularized Fibula Flap for Mandibular Reconstruction: Preliminary Results of a Novel Technique
Authors: Lin Bo , Yang Hongyu , Yang Huijun , Shen Shiyue
Published: March 2019

Background:

Repair of long-span mandibular defects with vascularized free fibular grafts is now a routine procedure. Vertical discrepancy between a graft segment and the occlusal plane can be resolved through several options, including delayed onlay bone graft, iliac bone reconstruction, fibula distraction, and double-barrel fibula flap grafts. The present study (level of evidence: level IV, case series) introduces a new method for mandibular augmentation, wherein a vascularized fibular segment was used to simulate the superior alveolar ridge of the neomandible, whereas a nonvascularized fibular segment was used to reconstruct the inferior border.

Methods:

Patients who underwent mandibular reconstruction with this technique between January 2014 and May 2017 were retrospectively reviewed for complications, vertical height, bone resorption rates, and crown to implant (C/I) ratios.

Results:

The study included 10 patients. Flap loss occurred in 1 patient. A sufficiently long vascular pedicle could be maintained when the average fibular length was up to 15.3 cm to reconstruct long-span mandibular defects. Mean height of the neomandible at 2 weeks and 1 year after surgery was 34.1 and 29.4 mm, respectively. Mean resorption rates of vascularized and nonvascularized fibulas were 10.3% and 3.4%, respectively, at 1 year after surgery. Dental implants were placed in 4 patients with a mean C/I ratio of 1:1.15.

Conclusion:

The present method to reconstruct the alveolar ridge and basal portion of the mandible with vascularized and nonvascularized fibular flaps was safe and effective. It provided sufficient vertical height for lip support and implantation as well as adequate length for long-span mandibular reconstruction.
Treatment of Large Scars in Children Using Artificial Dermis and Scalp Skin Grafting
Authors: Wang Qian , Wang Min , Xu Yuan , Ni Xiao-Dong , Cang Zheng-Qiang , Yuan Si-Ming
Published: March 2019

Background and Objectives:

Large scars formed after burns injury can seriously hamper appearance and function in children. Surgical resection of scars and secondary skin or flap grafting often brings severe damages to donor sites, which may lead to physiological and psychological development disorders in children. Here, we introduce the use of artificial dermis and skin grafts from scalps to treat large scars in children to minimize the donor site morbidity.

Methods:

A retrospective char review was performed including 7 children with large scars between January 2016 and December 2017. First, the scars were resected, and artificial dermis was applied to the secondary wounds. Twelve days later, outer silicone membrane was removed. Another 2 days later, scalp skin grafts of 0.3 mm were transplanted to the wounds. Manchester Scar Scale and Visual Analog Scale were used to evaluate scar appearance before and after the treatment respectively. One special patient with extensive scars was treated twice at an interval of 1 year. The first therapy was performed with both conventional method of resection and skin grafting and the new method described above. In the second therapy, 4 samples were taken from 4 different sites—the normal skin, scars, the skin where artificial dermis and scalp skin grafting were performed, and the skin where only scalp skin grafting was performed. H-E staining, Masson staining, Aldehyde fuchsin staining, and scanning electron microscopy were used for histological observation.

Results:

All skin grafts survived well. The Manchester Scar Scale score of the graft area was significantly reduced (P < 0.01) after the treatment. Histological examination showed obviously better dermis arrangement where artificial dermis and scalp grafting was performed.

Conclusion:

The therapy achieves better appearances and minimizes donor site morbidity. It is beneficial to physical and psychological development of children and provides an alternative to treat children with large scars.