bluuebunny/crossref_metadata_2025 huggingface dataset:
Weekend PTA to DPT Bridge Program: An Innovative Educational Alternative
Authors: George Deborah A. , Dutton Lisa L.
Published: February 2019

Background and Purpose.

Motivated to advance their careers, nontraditional students often choose to return to graduate education. Because of their multiple responsibilities, these students frequently seek alternative educational delivery formats, such as accelerated, hybrid distance, weekend, and bridge programs. In physical therapist (PT) education, bridge programs with online coursework and weekend formats are a relatively new alternative curricular model available for physical therapist assistants (PTAs) who wish to build on their past experiences in a realistic and efficient manner. Thus, this article describes a weekend PTA to Doctor of Physical Therapy bridge program and its outcomes.

Method/Model Description and Evaluation.

The described bridge program has a weekend format, some online coursework, and formal clinical experiences, clustered at the end of the curriculum. All students entering the program possess a baccalaureate degree from a 4-year institution and an associate degree from an accredited PTA program, as well as a minimum of 1 year of practice experience as a PTA. Multiple outcomes were used to evaluate this model, including focus groups, clinical performance instrument ratings, graduation rates, National Physical Therapy Examination pass rates, and alumni surveys.

Outcomes.

The average age of the bridge students was 31.5 years, and the average years of experience as a PTA was 7.08 years. The bridge students demonstrated nontraditional student characteristics such as being married, having one or more children, and living out of state. All but 3 students worked more than 20 hours per week as a PTA while in the program. Motivations for students entering the bridge program, as identified through focus group interviews, included finances, curricular fit, time and delivery structure, backup plan, and health care forces. The bridge students also reported expectations of expanded PT career opportunities, financial stability, autonomy as a health professional, and lifetime friendships with their classmates. Most alumni were satisfied with their overall learning experience and reported being adequately prepared to well prepared with their clinical performance skills. The average rating across all clinical performance instrument skills at the end of the final clinical experience was beyond entry level, the average graduation rate was 93.35%, and the ultimate 2-year National Physical Therapy Examination pass rate was 96.15%.

Discussion and Conclusion.

Major components of the studied model, including experience as PTAs, weekend format, use of online coursework, and clustered clinical experiences, may have interacted to promote positive outcomes for the nontraditional students enrolled in this bridge program. The presented model provides a sound alternative for PTAs seeking to advance their professional development and career.
Extracorporeal Membrane Oxygenation for Massive Pulmonary Embolism as Bridge to Therapy
Authors: Kmiec Lukasz , Philipp Alois , Floerchinger Bernhard , Lubnow Matthias , Unterbuchner Christoph , Creutzenberg Markus , Lunz Dirk , Mueller Thomas , Schmid Christof , Camboni Daniele
Published: February 2019

Pulmonary Embolism (PE) is a common illness in western countries. The purpose of this study is to report the institutional experience with massive PE and Extracorporeal Membrane Oxygenation (ECMO) in inoperable patients on admission. A retrospective analysis using the institutional ECMO-registry including the time between 2006 and 2017 was performed. During the study period, 75 patients (n = 46 patients venoarterial [VA], n = 29 patients venovenous [VV]) were placed on ECMO for massive PE. The primary support for massive PE consists of VA; however, VV support can be applied as well in selected cases as this work demonstrates. In the VA group, more patients (38 vs. 83%, P = 0.001) required mechanical resuscitation whereas in the VV group a more aggressive ventilation before support was noted (e.g. minute ventilation: VA=8.8 ± 3.7 L/min, VV=11.5 ± 4.5 L/min, P = 0.01). Survival to discharge was similar in VV and VA patients (45 vs. 48%, P = 0.9). Patients who received additional therapeutic interventions after stabilization with ECMO – e.g. surgical thrombectomy – displayed a similar survival compared with those being only anticoagulated (44% vs. 49%, P = 0.40). ECMO is feasible for initial stabilization serving as a bridge to therapy in primarily inoperable patients with massive PE. The principal configuration of support is VA; however, VV can be applied as well in selected hemodynamically compromised cases under aggressive ventilation.
Transcutaneous Neuromodulation at ST36 (Zusanli) is More Effective than Transcutaneous Tibial Nerve Stimulation in Treating Constipation
Authors: Wu Gao-jue , Xu Feng , Sun Xiao-meng , Chen Jiande D.Z.
Published: February 2019

Background and Goals:

Combined transcutaneous neuromodulation (TN) at acupoint ST36 (Zusanli) and TN at the posterior tibial nerve (PTN) has been reported effective in treating functional constipation. This study was designed to compare the effectiveness of TN between these 2 points.

Materials and Methods:

Eighteen functional constipation patients (M/F: 9/9) were recruited to participate in a cross-over study with a 2-week TN at ST36 and a 2-week TN at PTN. A bowel movement diary, and the questionnaires of Patient Assessment of Constipation Symptom (PAC-SYM) and Constipation Quality of Life (PAC-QoL) were completed; anorectal manometry and spectral analysis of heart rate variability for assessing the autonomic function were performed.

Results:

(1) Both TN at ST36 and TN at PTN improved constipation-related symptoms (PAC-SYM scores on pre-TN vs. post-TN: 1.4±0.1 vs. 0.6±0.1 for ST36, 1.4±0.1 vs. 0.9±0.1 for PTN, both P≤0.001). (2) TN at ST36, but not TN at PTN, increased the number of weekly spontaneous bowel movements (0.9±0.2 pre-TN vs. 3.5±0.7 post-TN, P<0.001) and decreased the total PAC-QoL score. TN at ST36 was more potent than TN at PTN in improving the PAC-SYM score (decrement 0.8±0.1 vs. 0.5±0.1, P<0.05). (3) TN at ST36 rather than TN at PTN resulted in a reduction in sensation thresholds, including rectal distention for urge (134.1±14.3 mL pre-TN vs. 85.6±6.5 mL post-TN, P<0.01) and maximum tolerance (P<0.05). (4) Both TN at ST36 and TN at PTN significantly increased vagal activity and decreased sympathetic activity (P<0.05).

Conclusions:

TN at ST36 is more potent than TN at PTN in treating constipation and improving constipation-related symptoms and rectal sensation.
Vinpocetine in the treatment of poststroke cognitive dysfunction
Authors: Liu Yang , Yin Yanying , Lu Qiao-li , Dan Ying , Xu Mei-song , Song Ge , Li Chen
Published: February 2019

Background:

Previous clinical trials have reported that vinpocetine can be used for the treatment of cognitive dysfunction. However, its efficacy is still inconclusive. In this systematic review study, we aim to assess its efficacy and safety for the treatment of poststroke cognitive dysfunction (PSCD).

Methods:

We will search the following electronic databases from the inception to the present to evaluate the efficacy and safety of vinpocetine for patients with PSCD. These databases include CENTRAL, EMBASE, MEDILINE, CINAHL, AMED, and four Chinese databases. All randomized controlled trials (RCTs) of vinpocetine for PSCD will be considered for inclusion without the language restrictions. The methodological quality of all included RCTs will be evaluated by the Cochrane risk of bias tool. The 95% confidence intervals will be utilized to calculate the continuous data, the mean difference or standard mean difference, and dichotomous data with risk ratio.

Dissemination and ethics:

The results of this review will be disseminated through peer-reviewed journals. Its results may provide important evidence for the clinical practice, as well as the future studies. It does not require ethical approval, because this systematic review will not involve the individual data.

Systematic review registration:

PROSPERO CRD42018115224.
Staged reconstruction of large skull defects with soft tissue infection after craniectomy using free flap and cranioplasty with a custom-made titanium mesh constructed by 3D-CT-guided 3D printing technology
Authors: Kim Seong Hwan , Lee Seong Joo , Lee Jun Won , Jeong Hii Sun , Suh In Suck
Published: February 2019

Rationale:

A craniectomy, which results in a large skull defect, is performed to decrease the intracranial pressure under conditions such as intracranial hemorrhage and ischemic stroke. When the patient's condition is stabilized, autologous cranioplasty using the bone flap previously removed in the craniectomy is performed. Bone flap infection after the autologous cranioplasty is not uncommon and is difficult to treat. After the infection is controlled, cranioplasty is needed to improve the head deformity and neurologic function. Cranioplasty with a titanium mesh can result in aesthetic improvement and a low infection rate. Using 3-dimensional computed tomography (3D-CT) and 3D printing, titanium mesh is manufactured to fit perfectly on the patient's skull defect.

Patient concerns:

Two patients with large skull defects in the right temple area due to previous craniectomy were referred to our department for reconstruction. They had histories of recurrent infections at the operation site even after removal of the autologous bone flap that had been used for the cranioplasty.

Diagnosis:

Preoperative computed tomography (CT) showed 12×16 cm and 8×8.3 cm skull defect on right temporal area, respectively.

Interventions and outcome:

The infection was controlled by well-vascularized free flap coverage. After the surgery, cranioplasty with custom-made titanium mesh was performed to improve the aesthetic and functional problems of the patients. The contour of the temporal area was symmetric. The patients were satisfied with the results.

Lessons:

Staged reconstruction of large skull defects with soft tissue infection after craniectomy using free flap followed by cranioplasty with titanium mesh on can lead to safe, aesthetic, and satisfactory result.
Approach to diagnosis of factitious disorder with unexplained hemoptysis
Authors: Yue Peng , Zhou Kaiyu , Hua Yimin , Fang Jie , Li Yifei
Published: February 2019

Rationale:

Hemoptysis or hematemesis is a common clinical symptom in adults, but is unusually to be observed in children. Hemoptysis can occur with circulatory diseases, injuries, several types of systemic diseases, or systemic factors including factitious disorder (FD), which is difficult to be diagnosed. Here, we report a case of hemoptysis caused by FD to provide a diagnostic flow chart for such kind of disease.

Patient concerns:

An 11-year-old female patient had a history of hemoptysis or hematemesis for 6 months and suffered with paroxysmal syncope for a month.

Diagnosis and intervention:

A series of examinations had been launched to evaluate any possible malformation or abnormalities of the patient including fiberoptic bronchoscopy, cardiac catheterization, gastroscopy, nasolaryngoscopy, electrocardiogram, electroencephalogram, and enhanced magnetic resonance image of the paranasal sinus. Several methods had been performed and tried to stop hemoptysis such as taking hemostatic medications, lavage of fiberoptic bronchoscopy, and embolism for abnormal bronchial arterial using cardiac catheter. All the interventions, however, failed to achieve our treatment goal. Given that more careful observation during hospitalization had been done, and we suspected the symptom of hemoptysis from this patient might be originated from an FD.

Outcomes:

Based on the diagnosis of FD, targeted psychological intervention was provided by experts. After the treatment completed, the patient did not present hemoptysis anymore.

Lessons:

FD is an uncommon type of disease. This rare case described here is to help us to reconsider the long diagnosis process of hemoptysis with a series of examinations including some invasive procedures, whether all the examinations and interventions are necessary for a nonsevere hemoptysis patient.
Risk factors associated with outcomes of peritoneal dialysis in Taiwan
Authors: Chen Hsiao-Ling , Tarng Der-Cherng , Huang Lian-Hua
Published: February 2019

Peritoneal dialysis (PD) is one option for renal replacement therapy in patients with end-stage renal disease (ESRD). Maintenance of the PD catheter is an important issue for patient outcomes and quality of life. The aim of this retrospective cohort study is to clarify the risk factors of technique failure and outcomes at a single institute in Taiwan.

The study enrolled ESRD patients who had received PD catheters in a tertiary hospital in northern Taiwan. Using a competing risks regression model, we reviewed clinical data and analyzed them in terms of the time to technical failure and clinical outcomes, including PD-related peritonitis and mortality.

A total of 514 patients receiving PD between 2001 and 2013 were enrolled in the study. According to the multivariate analysis model, we found that diabetes mellitus was a risk factor for PD-related peritonitis (subdistribution hazard ratio [SHR] 1.47, 95% confidence interval [CI] 1.06–2.04, P = .021). Female gender and higher serum albumin levels were associated with lower risks of technique failure (SHR 0.67, 95% CI 0.48–0.94, P = .02; SHR 0.75, 95% CI 0.58–0.96, P = .023, respectively), but Gram-negative and polymicrobial infection increased the technique failure rate (SHR 1.68, 95% CI 1.08–2.61, P = .021; SHR 1.93, 95% CI 1.11–3.36, P = .02, respectively). Female gender was a risk factor associated with overall mortality (SHR 6.4, 95% CI 1.42–28.81, P = .016). Higher weekly urea clearance (Kt/V) and weekly creatinine clearance (WCCr) were associated with a lower risk of mortality (SHR 0.1, 95% CI 0.01–0.89, P = .04; SHR 0.97, 95% CI 0.96–0.99, P = .004, respectively).

Diabetes mellitus is a risk factor contributing to PD-related peritonitis. Male patients and lower serum albumin levels were associated with higher rates of technique failure. Female gender, lower Kt/V, and WCCr are risk factors for overall mortality in PD patients.
Postoperative outcomes of patients with chronic obstructive pulmonary disease undergoing coronary artery bypass grafting surgery
Authors: Zhao Hui , Li Lifang , Yang Guang , Gong Jiannan , Ye Lu , Zhi Shuyin , Zhang Xulong , Li Jianqiang
Published: February 2019

Introduction:

Chronic obstructive pulmonary disease (COPD) is a frequent comorbid disease in patients undergoing coronary artery bypass grafting (CABG) surgery, with an incidence ranging from 4% to 20.5%. Conventionally, COPD was recognized as a surgical contraindication to CABG. Because of the recent improvements in surgical techniques, anesthesia, and postoperative management, CABG has been performed more commonly in patients with COPD. However, studies have shown the various effects of COPD on postoperative morbidity and mortality after CABG, and this remains to be well defined.

Objectives:

To compare the postoperative outcomes after CABG between patients with and those without COPD.

Methods:

A systematic search was conducted in the Cochrane Library, PubMed, EmBase, and Ovid databases (until May 10, 2018). Studies comparing perioperative results and mortality outcomes after CABG between patients with and those without COPD were evaluated independently by 2 reviewers to identify the potentially eligible studies. Review Manager and STATA software were used for statistical analyses.

Results:

No significant difference in the mortality rates were found between patients with and those without COPD. COPD was associated with a higher respiratory failure rate (odds ratio [OR] = 4.01; 95% CI: 1.19–13.51, P = .03; P <.001 for heterogeneity), higher pneumonia rate (OR = 2.92; 95% CI: 2.37–3.60, P <.00001; P = .73 for heterogeneity), higher stroke rate (OR = 2.91; 95% CI: 1.37–6.18, P = .005; P = .60 for heterogeneity), higher renal failure rate (OR = 1.60; 95% CI: 1.30–1.97, P <.00001; P = .19 for heterogeneity), and higher wound infection rate (OR = 2.16; 95% CI: 1.21–3.88, P = .01; P = .53 for heterogeneity) after CABG.

Conclusions:

Patients with COPD were at higher risks for developing postoperative morbidities, particularly pneumonia, respiratory failure, stroke, renal failure, and wound infection. Although COPD was not associated with a higher risk of mortality, caution should be taken when a patient with COPD is indicated for CABG, considering the higher odds of postoperative complications involving the respiratory system and others.
The biochemical and genetic diagnosis of lipid disorders
Authors: Schaefer Ernst J. , Geller Andrew S. , Endress Gregory
Published: February 2019

Purpose of review

To examine recent advances in our knowledge on the diagnosis of lipid disorders.

Recent findings

Fasting values above the 99th percentile for direct LDL-cholesterol (LDL-C), lipoprotein(a), and triglycerides are greater than 225 mg/dl, greater than 160 mg/dl, and greater than 500 mg/dl (>5.82, >394, and >5.65 mmol/l), respectively, whereas such values for plasma lathosterol, β-sitosterol, and cholestanol are greater than 8.0, 8.0, and 5.0 mg/l (>0.021, 0.019, and 0.013 mmol/l), respectively. Values below the first percentile for LDL-C are less than 40 mg/dl (<1.03 mmol/l) and for HDL-cholesterol (HDL-C) less than 25 mg/dl (<0.65 mmol/l) in men and less than 30 mg/dl (<0.78 mmol/l) in women, respectively. The above values can predispose to premature CVD, pancreatitis, neurologic disease, and kidney failure, and may be associated with monogenic lipid disorders. In the absence of secondary causes including diabetes or kidney, liver, or thyroid disease, consideration should be given to sequencing the following genes: ABCA1, ABCG5, ABCG8, APOA1, APOA5, APOB, APOC2, APOE, CETP, CYP27A1, GPIHBP1, LCAT, LDLR, LDLRAP1, LIPA, LIPC, LMF1, LPL, MTTP, PCSK9, SCARB1, and STAP1.

Recent data indicate that secondary causes and a wider range of conditions need to be considered in identifying the underlying causes of hypercholesterolemia, hypertriglyceridemia, hyperalphalipoproteinemia, hypobetalipoproteinemia, and HDL deficiency. Identifying such disorders allows for a more precise assessment of prognosis and the formulation of optimal therapy.
Neurotoxicity of general anesthetics in children: evidence and uncertainties
Authors: Bellinger David C. , Calderon Johanna
Published: February 2019

Purpose of review

Compelling evidence in animal models that, under some conditions, general anesthetics and sedatives produce changes in the brain and persistent impairments in learning, memory, and behavior. The present review summarizes recent clinical studies investigating whether the use of these agents in children causes similar neurotoxicities.

Recent findings

Although the results of retrospective studies are somewhat mixed, multiple exposures to general anesthesia were generally found to confer greater risk than single exposures with regard to learning disability, attention deficit hyperactivity disorder, school readiness, and academic achievement. Recent clinical studies, including a large randomized controlled trial, are consistent in confirming that a single exposure in infancy to general anesthesia lasting less than 1 h is not associated with neurodevelopmental impairments in later childhood. These studies do not, however, clarify the potential impacts of longer exposures or multiple exposures.

Given that approximately half of the anesthetic exposures in young US children are 1 h or less in duration, the results of the recent clinical studies are reassuring. Because of the clinical necessity of administering general anesthetics and sedatives for longer periods for many surgical, procedural, or diagnostic purposes, the identification of adjuvants that prevent or reduce the potential neurotoxicity of these agents is an area of active research.
Microscopic/“Backwash” Ileitis and Its Association With Colonic Disease in New Onset Pediatric Ulcerative Colitis
Authors: Najarian Robert M. , Ashworth Lori A. , Wang Helen H. , Bousvaros Athos , Goldsmith Jeffrey D.
Published: February 2019

Background:

Microscopic ileitis and its association with pancolitis in adults with ulcerative colitis (UC) have been described. The incidence of ileitis and associations with colonic disease in pediatric UC have, however, not been thoroughly investigated. This study was undertaken to examine the prevalence of microscopic ileal inflammation at the time of initial diagnosis in a cohort of children with UC.

Methods:

We reviewed colonoscopy and biopsy data at time of diagnosis from 105 children and young adults with treatment naïve UC; ileal and colonic mucosal biopsies were available on all patients. Ileal mucosal biopsies were examined for the presence and severity of ileal inflammation, and other histologic features. Concurrently obtained colonic mucosal biopsies were assessed to define the severity, distribution, and extent of disease; endoscopic and clinical follow‐up data were reviewed.

Results:

A total of 107 ileal mucosal biopsies and 693 corresponding colonic mucosal biopsies were examined. Seventeen of 105 patients (16%) were found to have ileal inflammation (mean age = 10.4 years, 59% girls), 14 (82%) of whom had histologic pancolitis. The presence of ileal inflammation was significantly associated with endoscopic pancolitis (P = 0.02). The association between histologic pancolitis, severity of active inflammation in the cecum, and ascending colon suggested a possible association with ileal inflammation (P = 0.06, 0.07, and 0.08 respectively), but did not reach statistical significance.

Conclusion:

Patients with new onset UC may have microscopic ileal inflammation at time of diagnosis, even if the terminal ileum appears macroscopically normal. The presence of endoscopic pancolitis is associated with the presence of histologic ileitis. In contrast to existing studies in adults, an association between the presence of ileitis and the histologic severity or the histologic extent of colitis was not observed. Children with microscopic ileitis in the context of UC do not need to be reclassified as “indeterminate colitis” or Crohn disease.
Predisposing Conditions to Pediatric Hepatocellular Carcinoma and Association With Outcomes
Authors: Cowell Elizabeth , Patel Kalyani , Heczey Andras , Finegold Milton , Venkatramani Rajkumar , Wu Hao , López‐Terrada Dolores , Miloh Tamir
Published: February 2019

Objectives:

Hepatocellular carcinoma (HCC) has been linked to chronic viral or metabolic liver disease and other conditions. The characteristics of children with HCC have not been fully elucidated and outcomes in children with predisposing liver disease are not well defined.

Methods:

Patients ⩽21 years old with HCC managed at our institution and through external consultation between 1996 and 2016 were included. Demographics, clinical history, and pathology were tabulated. Fisher exact test and Wilcoxon test were employed for subgroup comparison, and survival differences were evaluated by Kaplan‐Meier method.

Results:

Sixty‐one cases of HCC were identified. Seven of 16 patients (44%) at our institution and 18 of 45 consult patients (40%) had a predisposing condition: cryptogenic cirrhosis/steatosis (9), genetic (7), biliary pathology (4), viral hepatitis (1), and other (4). Thirteen of 27 patients with de novo HCC had fibrolamellar HCC. Clinical characteristics were grouped by presence or absence of predisposing conditions: age at diagnosis (7.2 vs 10.2 years, P < 0.05), metastatic disease at presentation (15% vs 44%, P = n.s), and tumor size >4 cm (20% vs 100%, P < 0.05). In patients treated at our institution, 5 of 7 with predisposing conditions received liver transplant and achieved complete remission, whereas only 3 of 9 patients with de novo HCC received curative surgery and this group had decreased median overall survival (P < 0.05).

Conclusions:

The majority of children with HCC did not have predisposing liver or associated disease. These patients were diagnosed later with more advanced stage disease and had significantly decreased overall survival.
Targeted Polo-like Kinase Inhibition Combined With Aurora Kinase Inhibition in Pediatric Acute Leukemia Cells
Authors: Jayanthan Aarthi , Hofmann Bradley , Meier-Stephenson Vanessa , Perinpanayagam Maneka , Dunn Sandra E. , Boklan Jessica , Trippett Tanya M. , Truong Tony H. , Narendran Aru
Published: February 2019

Background:

Recent studies have shown that cell cycle events are tightly controlled by complex and shared activities of a select group of kinases. Among these, polo-like kinases (Plks) are regulatory mitotic proteins that are overexpressed in several types of cancer and are associated with poor prognosis.

Materials and Methods:

We have evaluated, in preclinical in vitro studies, the activity of a panel of Plk inhibitors against cell lines derived from refractory pediatric leukemia, as well as primary leukemia cells, in culture. Through in vitro growth inhibition studies, Western blot analysis for the expression and activation of key regulators of cell growth and survival and gene silencing studies, we specifically examined the ability of these agents to induce cytotoxicity through the activation of apoptosis and their capacity to interact and modulate the expression and phosphorylation of Aurora kinases.

Results:

Our findings show that the various Plk-1 inhibitors in development show potential utility for the treatment of pediatric leukemia and exhibit a wide range of phosphorylation and target modulatory capabilities. Finally, we provide evidence for a complex interregulatory relationship between Plk-1 and Aurora kinases enabling the identification of synergy and biologic correlates of drug combinations targeting the 2 distinct enzyme systems.

Discussion:

This information provide the rationale for the evaluation of Plk-1 as an effective target for therapeutics in refractory pediatric leukemia and indicate compensatory activities between Plk-1 and Aurora kinases, providing insight into some of the complex mechanisms involved in the process of cell division.
Langerhans Cell Histiocytosis Presenting as Enterocolitis and Shock in Neonate
Authors: Barón González de Suso Luisa , Olmedilla Jódar Marta , Pérez Alonso Vanesa , Melgar Bonis Ana
Published: February 2019

Introduction:

Enterocolitis is a relatively common disease in neonatal period that can be a result of many underlying pathologies. One of them, which is an unusual disorder especially in neonatal age and with gastrointestinal involvement, is Langerhans cell histiocytosis (LCH). This case shows a severe neonatal LCH with digestive involvement which required intensive care and had an abnormal presentation, being hard to diagnose attributable to the diversity of symptoms.

Case Report:

Eleven-day-old newborn presented for excessive weight loss followed by deterioration to shock, abdominal distension, digestive bleeding, and purpuric exanthema. Exploratory laparotomy identified aggressive enterocolitis. After stabilization, a significant hepatosplenomegaly persists as well as bicytopenia, pyrexia, and cutaneous lesions evolving tangible purple. LCH was diagnosed through histology of cutaneous biopsy.

Conclusions:

Gastrointestinal involvement in neonatal LCH is infrequent and its symptoms can be really unspecific. It is important to know that the first clinical manifestation is usually dermatologic with very diverse morphologies. Having a high suspect rate will lead us to an early diagnosis with its correspondent impact upon the outcome.
The reemergence of glanders as a zoonotic and occupational infection in Iran and neighboring countries
Authors: Kianfar Niloofar , Ghasemian Abdolmajid , Al-Marzoqi Ali Hussein , Eslami Majid , Vardanjani Hossein Rajabi , Mirforughi Seyede Amene , Vardanjani Hassan Rajabi
Published: February 2019

Glanders is a zoonotic infection, and because of recent outbreaks among Equidae family, the possibility of its reemergence among human populations is a crisis. The causative agent is Burkholderia mallei, a Gram-negative, aerobic and highly contagious bacterium causing severe impacts with low infectious dose transmitted via direct contact to respiratory secretions, skin exudates of animals and fomite. Despite high mortality rate, no proper vaccination has been developed to hinder the infection spread. The disease is more prevalent in Australia and Southeast Asia, but has been eradicated in developed countries. Glanders’ clinical signs include pulmonary and disseminated infection depending upon type of infection. Recent reports and outbreaks from Iran and neighboring countries among horses in 2011 and 2017 (Pakistan, Afghanistan and Kuwait), mules in 2008, 2011 and 2017 (Pakistan and Turkey), donkeys and horses in 2011–2015 (Pakistan) and tiger and camels in 2011 (Iran and Bahrain) is a concern. Animal importation or exportation; particularly by healthy carriers is a key route of B. mallei spread. Thus, infection control strategies, accurate and screening before animals’ import, prevention of animal contacts and development of prompt diagnostic approaches and proper therapeutic strategies are essential. Different forms of glanders have emerged or re-emerged in various animals. The factors leading to the re-emergence of the infection mostly include no specific symptoms and anti-B. mallei antibodies, lack of early diagnosis and vaccination strategies, housing conditions, contact with infected and carrier animals and low infectious dose. Sporadic and endemic remote cases have remained in Asia and Middle Eastern countries. Control strategies should focus on surveillance; identify healthy carriers, quarantine and elimination of all infected animals.
Effect of Acupuncture on Cognitive Function and Quality of Life in Patients With Idiopathic Trigeminal Neuralgia
Authors: Gao Jie , Zhao Chongfa , Jiang Wenchen , Zheng Baosen , He Yongjin
Published: February 2019

To estimate the effect of acupuncture on idiopathic trigeminal neuralgia (ITN), we recruited 116 patients with ITN from December 2016 to April 2018 and further divided into them into two groups: acupuncture intervention group (n = 62) and sham control group (n = 54). Clinical pain, cognitive function, and quality of life (QoL) assessed with the 36-Item Short Form Health Survey (SF-36) were evaluated at the initial time of treatment, at the end of treatment, and 6 weeks after the treatment. Pain intensity, headache, and generalized body pain showed significant decrease both at the end of treatment and after 6 weeks of treatment when compared with initial time. The scores of the cognitive tests (Mini-Mental State Examination, Trail Making Test, Verbal Fluency Test, tracing score, and memory score) and five aspects of the SF-36 assessment (role emotional, general health, body pain, role physical, and mental health scores) showed significant improvement at the end of treatment compared with the initial time. Whereas after 6 weeks of treatment, the Mini-Mental State Examination, memory score, and Trail Making Test-A score and four aspects of the SF-36 assessment (vitality, bodily pain, mental health, and role physical) showed significant improvement when compared with the end of treatment. Acupuncture can be used as an alternative treatment to improve cognitive function and QoL of patients with ITN.
Pre-Kraepelin Names for Mental Disorders
Authors: Blashfield Roger K.
Published: February 2019

Psychiatric classifications before the early 1900s generally are viewed as chaotic and not worthy of analysis. Sixteen different classificatory systems were identified that were pre-World War I and that were pre-Kraepelinian. A total of 827 names were collected from these 16 classifications. As expected, classification unreliability was a problem in these systems. Across the seven American classifications, the average match rate in names was 15% (i.e., 15% of the diagnoses in one system appeared with the same name in another system). The names that were most consistently recognized across these 16 classifications were “mania,” “acute mania,” “chronic mania,” “melancholia,” “general paralysis,” “senile dementia,” “epileptic insanity,” “hysterical insanity,” “moral insanity,” “idiocy,” and “cretinism.” These 11 names summarize 19th century American views of psychopathology.
Is There Anybody Out There? Attachment Style and Interpersonal Facilitators as Protective Factors Against Complicated Grief Among Suicide-Loss Survivors
Authors: Levi-Belz Yossi , Lev-Ari Lilac
Published: February 2019

Losing a loved one to suicide may have detrimental effects, one of them being suffering from complicated grief (CG). To date, no studies have fully examined the psychological processes that delineate the risk and resilience factors that contribute to CG among suicide-loss survivors (SLSs). We hypothesized that social support and self-disclosure would moderate the relationship between attachment styles and CG for SLS. Questionnaires assessing attachment style, self-disclosure, social support, and CG were completed by 156 SLS participants. A regression model revealed that secure attachment negatively predicted CG, but self-disclosure moderated this association. Secure attachment seems to be a resilient factor for CG. However, SLS with low secure attachment but high in self-disclosure ability use this behavior as a way to impede CG. The capacity to seek out other people, to share experiences with them, and to accept comfort from them may offer a means for SLS to better deal with their tragedy.
Hermeneutic Phenomenological Study of Military Nursing Officers
Authors: Conlon Lisa , Wiechula Rick , Garlick Amanda
Published: February 2019

Background

Nurses working in military trauma teams often work in hostile and remote locations. They are faced with the burden of carrying out their duties while ensuring the safety of their patients and themselves in areas of conflict and humanitarian crisis. The stories and experiences of military nurses often go untold. In a phenomenological study, six Australian Defence Force Nursing Officers share their stories of working as members of military trauma teams.

Objectives

The aim of this study was to gain an understanding of the lived experiences of nursing officers when working as a member of a military trauma team.

Methods

A hermeneutic phenomenological approach was used to conduct this research. In-depth interviews were conducted with six participants.

Results

The following themes were identified: telling their stories; the role—who we are and what we do; the environment—it is so different; training—will it ever fully prepare you; working in teams—there’s no “I” in team; and leadership—will the real leader please stand up!

Discussion

This study has provided an insight into the experiences of six Australian military nurses working in trauma teams—experiences that were rarely given voice outside the military. Central to this experience is the need to have these stories told.
Decision Readiness to Disclose Human Immunodeficiency Virus–positive Status to Family Members
Authors: Laschober Tanja C. , Serovich Julianne M. , Brown-Smith Monique J. , Kimberly Judy A. , Lescano Celia M.
Published: February 2019

Background

People living with human immunodeficiency virus (HIV) (PLWH) are faced with the often difficult decision of whether, when, and how to disclose their seropositive status. This study draws on the transtheoretical model of change to examine men and women's decision readiness to disclose their HIV-positive status to family members and to assess predictors (decisional balance and decision self-efficacy) of their decision readiness.

Methods

Cross-sectional data were collected from 346 PLWH—191 males and 155 females. Participants self-reported on their disclosure decision readiness, decisional balance, and decision self-efficacy. Data were analyzed using χ2 tests, general linear models, and multinomial logistic regression models.

Results

Two thirds of PLWH were in the 3 lower stages of decision readiness, with the majority starting to think about disclosure. One third of PLWH were in the 3 higher stages of decision readiness (close to deciding or have made the decision to disclose). Decisional balance and decision self-efficacy predicted decision readiness. Overall, few gender differences emerged.

Conclusions

These findings can help researchers, clinicians, and health care providers to better understand and support PLWH as they move through the decision making process.
Proportion of Incident Human Immunodeficiency Virus Cases Among Men Who Have Sex With Men Attributable to Gonorrhea and Chlamydia: A Modeling Analysis
Authors: Jones Jeb , Weiss Kevin , Mermin Jonathan , Dietz Patricia , Rosenberg Eli S. , Gift Thomas L. , Chesson Harrell , Sullivan Patrick S. , Lyles Cynthia , Bernstein Kyle T. , Jenness Samuel M.
Published: February 2019

Background

Sexually transmitted infections (STIs) are associated with an increased risk of human immunodeficiency virus (HIV) acquisition and transmission. We estimated the proportion of HIV incidence among men who have sex with men attributable to infection with the 2 most common bacterial STIs, Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT).

Methods

We used a stochastic, agent-based model of a sexual network of MSM with cocirculating HIV, NG, and CT infections. Relative risk (RR) multipliers, specific to anatomic site of infection, modified the risk of HIV transmission and acquisition based on STI status. We estimated the effect of NG and CT on HIV incidence overall and on HIV acquisition and HIV transmission separately. Each scenario was simulated for 10 years. The population attributable fraction (PAF) was determined for each combination of RRs by comparing the incidence in the final year of a scenario to a scenario in which the RRs associated with NG and CT were set to 1.0.

Results

Overall, 10.2% (interquartile range [IQR], 7.9–12.4) of HIV infections were attributable to NG/CT infection. Then in sensitivity analyses, the PAF for HIV transmission ranged from 3.1% (IQR, 0.5–5.2) to 20.4% (IQR, 17.8–22.5) and the PAF for HIV acquisition ranged from 2.0% (IQR, −0.7 to 4.3) to 13.8% (IQR, 11.7–16.0).

Conclusions

Despite challenges in estimating the causal impact of NG/CT on HIV risk, modeling is an alternative approach to quantifying plausible ranges of effects given uncertainty in the biological cofactors. Our estimates represent idealized public health interventions in which STI could be maximally prevented, setting targets for real-world STI interventions that seek to reduce HIV incidence.
Novel Interplay Between Sonic Hedgehog and Transforming Growth Factor-β1 in Human Nonalcoholic Steatohepatitis
Authors: Zhou Xingang , Wang Peng , Ma Zhiyuan , Li Man , Teng Xiaoying , Sun Lei , Wan Gang , Li Yang , Guo Limei , Liu Honggang
Published: February 2019

Nonalcoholic steatohepatitis (NASH) has the potential to progress to fibrosis, cirrhosis, and hepatocellular carcinoma. Upregulation of sonic hedgehog (Shh) has been documented in development of NASH through sustained cell stress. At the same time, transforming growth factor-β1 (TGF-β1), which is a central element in fibrogenic reactions in various diseases and sites, has been reported to be associated with hepatic inflammation and fibrotic reaction. To explore crosstalk between Shh and TGF-β1 in the development and progression of NASH, we investigated the expression of both these proteins in 135 human specimens of NASH, 35 fatty liver specimens, 35 specimens of alcoholic steatohepatitis with immunohistochemistry. Shh protein was expressed in the cytoplasm of ballooned hepatocytes with an ubiquitin-like pattern. In addition, a few scattered apoptotic hepatocytes in the inflammatory foci showed homogeneous cytoplasmic Shh expression. TGF-β1 protein was observed mainly in the activated hepatic stellate cells (HSCs) which were located in the inflammatory foci surrounding ballooned hepatocytes. Moreover, the mRNA levels of both Shh and TGF-β1 in the liver biopsy specimens from NASH patients was significantly increased compared with those in fatty liver patients. Statistically, there was a significant association of the expressions of Shh and TGF-β1 proteins in NASH (r=0.6, P<0.05). In addition, increased expression of Shh protein significantly parallels the severity of hepatocellular ballooning, lobular, and portal inflammatory responses and progression of fibrosis in NASH patients. Moreover, we found that much HSCs transformed into myofibroblast-like phenotype and migrated downward to HepG2 hepatocellular carcinoma cells with overexpression of Shh by transwell assay. We also observed overexpression of proteins of Shh and TGF-β1 in cultured activated HSCs with confocal microscopy. These findings strongly suggest there is interplay between Shh and TGF-β1 in hepatic inflammatory reactions. Shh secreted through damaged hepatocytes may result in activation of TGF-β1 and subsequent transformation of HSCs, which together modulate the progression of human NASH.
SERINE-910 Phosphorylated Focal Adhesion Kinase Expression Predicts Better Overall and Disease-free Survival in Melanoma
Authors: Najjar Saleh , Homan Suzanne , Sheehan Christine , Carlson J. Andrew
Published: February 2019

Focal adhesion kinase (FAK) is a cytoplasmic tyrosine kinase that mediates multiple cellular functions such as survival, invasion, and migration. FAK has been found to be over-expressed in various human cancers, including melanoma. FAK molecule has several tyrosine, serine, and threonine phosphorylation sites which have an important regulatory role. Tyrosine phosphorylation of FAK has been extensively studied, however little is known about the role of serine phosphorylation. We sought to examine the frequency and extent of serine-910 phosphorylated FAK (P-FAKSer910) expression in a spectrum of melanocytic proliferations as well as it’s correlation with other histopathologic predictors and its effect on patient’s survival. Clinicopathologic features and immunohistochemical expression of P-FAKSer910 were evaluated in 147 melanocytic proliferations: 73 primary melanoma (PM), 19 metastatic melanoma (MetM), 2 melanoma in situ, and 53 melanocytic nevi (MN). Higher cytoplasmic intensity predicted better overall survival (OS) in PM (χ2=5.69; P=0.034) and was associated with 48% decrease in death risk (HR, 0.52; 95% CI, 0.28-0.95; P=0.036). In contrast, increased nuclear intensity was significantly associated with better disease-free survival (DFS) when stratified by tumor stage Log-rank test, trend of survival (χ2=5.83, P=0.015) and independently on multivariate analysis when subcategorized into 3-tier categories (HR, 0.43; 95% CI, 0.18-0.98; P=0.045). Also, Clark’s level and tumor-infiltrating lymphocytes (TILS) were independent predictors of DFS. Cytoplasmic intensity correlated inversely with American Joint Commission on Cancer stage in primary melanoma cases as well with vascularity in both primary and metastatic melanoma. Nuclear intensity independently correlated negatively with angioinvasion and TILS when subcategorized to 3 tier system. We found American Joint Commission on Cancer tumor stage, Clark’s level, depth, ulceration, TILS, mitosis, angioinvasion, and tumor vascularity predictors of both DFS and OS. There was no significant difference in cytoplasmic or nuclear expression among the major categories of melanocytic proliferation. In this pilot immunohistochemistry-based study, we found P-FAKSer910 expression in melanoma by cytoplasmic intensity to correlate with better OS while nuclear intensity correlated with better DFS.
Iatrogenic Disease of the Genitourinary Tract
Authors: Cathro Helen P.
Published: February 2019

Iatrogenic disease is defined as illness caused by diagnostic procedures or treatment given by health care professionals. More recently described treatment complications involving the genitourinary tract include newly recognized variants of renal carcinoma in the setting of dialysis/end-stage renal disease, treatment effect in genitourinary carcinomas, and medical renal disease caused by drug therapies, including immunotherapy. The objective of this review is to cover iatrogenic inflammatory diseases, pseudotumors and tumors of the kidney, bladder, prostate, testis and paratestis of most interest to surgical pathologists. For this reason, disease caused by the following will not be covered: iatrogenic glomerulonephritis, self-inflicted injury including the introduction of foreign bodies, surgical error, drugs of abuse and herbal medications, and iatrogenic disease in the transplant setting including ischemia/reperfusion injury. Emphasis is placed upon commonly encountered diseases in order to ensure that the review is of utility to practicing pathologists. The clinical context, pathophysiology and histopathology of each disease entity are covered.
90Y-TheraSpheres
Authors: Arnold Christina A. , Pezhouh Maryam K. , Lam-Himlin Dora , Pittman Meredith E. , VandenBussche Christopher , Voltaggio Lysandra
Published: February 2019

Selective internal radiation therapy with 90Y-TheraSphere or 90Y-SIRSphere is used in the treatment of unresectable hepatic malignancies. To the best of our knowledge, this is the first 90Y-TheraSpheres series. BTG International Canada Inc. provided nonradiated microspheres from the Nordion manufacturer. The histologic processed microspheres were colorless, refractile, polarizable, 20 to 30 μm in diameter, and an occasional internal bulls’-eye seen with the condenser out and an internal cross seen with polarized light. Identical microspheres were identified in 15 hepatectomy specimens from four centers between February 2016 and March 2018. The patients were usually male (male=10, female=5) with a mean age of 59 years. All patients had a prior diagnosis of hepatocellular carcinoma (HCC) and documented 90Y-TheraSphere (mean duration from last deployment=32 wk). All surgical pathology specimens in these 15 patients were reviewed, but the microspheres were only identified in the hepatectomy specimens. During manuscript preparation, one case of 90Y-TheraSpheres gastritis was prospectively identified from a separate patient with a history of HCC and 90Y-TheraSpheres. In conclusion, recognition of 90Y-TheraSpheres is important so that one may consider the possibility of a nearby malignancy and or establish the cause of the background inflammatory or radiation-related injury. These structures can be easy to miss because the subtle morphology is distinct from previously reported 90Y-SIRSphere. Clues to the diagnosis include a history of HCC and background radiation change. We report the characteristic morphology as microspheres that overlap in size with 90Y-SIRSphere, but can be differentiated based on 90Y-TheraSpheres’ colorless appearance with occasional internal bulls’-eyes with the condenser out and an internal cross with polarized light.