bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of a Longitudinal Interprofessional Education Passport Program on Nursing Students’ Attitudes Toward Interprofessional Practice
Authors: Laverentz Delois Meyer , Young Elizabeth , Cramer Emily
Published: February 2020

To meet the demands of complex health care systems with multiple professions, it is recommended that nursing students have interprofessional educational experiences throughout the curriculum. We assessed longitudinal changes in nursing students’ attitudes toward interprofessional collaboration in the context of an Interprofessional Education Passport Program. Students were surveyed using the Interprofessional Attitudes Scale at the beginning and end of the two-year curriculum. Students showed significant improvement from baseline to posttest in three of five subscales: Teamwork, Roles, and Responsibilities; Interprofessional Biases; and Community-Centeredness. A longitudinal interprofessional education curriculum may influence students’ attitudes regarding teamwork, roles, responsibilities, and biases.
Development of the Uncertainty Communication Checklist: A Patient-Centered Approach to Patient Discharge From the Emergency Department
Authors: Rising Kristin L. , Powell Rhea E. , Cameron Kenzie A. , Salzman David H. , Papanagnou Dimitrios , Doty Amanda M.B. , Latimer Lori , Piserchia Katherine , McGaghie William C. , McCarthy Danielle M.
Published: February 2020

Clear communication with patients upon emergency department (ED) discharge is important for patient safety during the transition to outpatient care. Over one-third of patients are discharged from the ED with diagnostic uncertainty, yet there is no established approach for effective discharge communication in this scenario. From 2017 to 2019, the authors developed the Uncertainty Communication Checklist for use in simulation-based training and assessment of emergency physician communication skills when discharging patients with diagnostic uncertainty. This development process followed the established 12-step Checklist Development Checklist framework and integrated patient feedback into 6 of the 12 steps. Patient input was included as it has potential to improve patient-centeredness of checklists related to assessment of clinical performance. Focus group patient participants from 2 clinical sites were included: Thomas Jefferson University Hospital, Philadelphia, PA, and Northwestern University Hospital, Chicago, Illinois.

The authors developed a preliminary instrument based on existing checklists, clinical experience, literature review, and input from an expert panel comprising health care professionals and patient advocates. They then refined the instrument based on feedback from 2 waves of patient focus groups, resulting in a final 21-item checklist. The checklist items assess if uncertainty was addressed in each step of the discharge communication, including the following major categories: introduction, test results/ED summary, no/uncertain diagnosis, next steps/follow-up, home care, reasons to return, and general communication skills. Patient input influenced both what items were included and the wording of items in the final checklist. This patient-centered, systematic approach to checklist development is built upon the rigor of the Checklist Development Checklist and provides an illustration of how to integrate patient feedback into the design of assessment tools when appropriate.
Resident-Sensitive Quality Measures in the Pediatric Emergency Department: Exploring Relationships With Supervisor Entrustment and Patient Acuity and Complexity
Authors: Schumacher Daniel J. , Holmboe Eric , Carraccio Carol , Martini Abigail , van der Vleuten Cees , Busari Jamiu , Sobolewski Brad , Byczkowski Terri L.
Published: February 2020

Purpose

This study explores the associations between resident-sensitive quality measures (RSQMs) and supervisor entrustment as well as between RSQMs and patient acuity and complexity for encounters in the pediatric emergency department (PED) in which residents are caring for patients.

Method

Pediatric residents rotating through Cincinnati Children’s Hospital Medical Center PED as well as supervising pediatric emergency medicine faculty and fellows were recruited during the 2017–2018 academic year for the purpose of collecting the following data from the residents’ patient encounters for 3 illnesses (acute asthma exacerbation, bronchiolitis, and closed head injury [CHI]): supervisor entrustment decision rating, RSQMs relevant to the care provided, and supervisor patient acuity and complexity ratings. To measure the association of RSQM composite scores with the other variables of interest, mixed models were used.

Results

A total of 83 residents cared for 110 patients with asthma, 112 with bronchiolitis, and 77 with CHI. Entrustment decision ratings were positively associated with asthma RSQM composite scores (beta coefficient = 0.03; P < .001). There was no significant association between RSQM composite scores and entrustment decision ratings for bronchiolitis or CHI. RSQM composite scores were significantly higher when acuity was also higher and significantly lower when acuity was also lower for both asthma (P < .001) and bronchiolitis (P = .01). However, RSQM composite scores were almost identical between levels of acuity for CHI (P = .94). There were no significant differences in RSQM composite scores when complexity varied.

Conclusion

This study found limited associations between RSQM composite scores and entrustment decision ratings but offers insight into how RSQMs could be used for the purposes of resident assessment and feedback.
Trustworthiness and Professionalism in Academic Medicine
Authors: McCullough Laurence B. , Coverdale John H. , Chervenak Frank A.
Published: February 2020

Trustworthiness is the cornerstone professional virtue in the practice of medicine. The authors’ goals for this Invited Commentary were to provide an account of the professional virtue of trustworthiness and its historical origins as well as to suggest how trustworthiness in a professional curriculum can be taught and assessed. They identified 2 components of trustworthiness that originate in the work of John Gregory (1724–1773) and Thomas Percival (1740–1804), who invented the ethical concept of medicine as a profession. The first is intellectual trust, the commitment to scientific and clinical excellence. The second is moral trust, the primary commitment of physicians and health care organizations to promote and protect the interest of patients while keeping individual and group interests secondary. Teaching should focus first on the mastery and understanding of the conceptual vocabulary of intellectual and moral trust through a range of formats, including modeling by faculty on how they respect and treat patients and learners. Assessment should be behaviorally based and articulated in increasing, observable, and integrated levels of mastery through training. Medical educators and academic leaders also share the responsibility to inculcate and sustain an organizational culture of professionalism that is respectful, critically self-appraising, accountable, and committed to its learners and to the promotion of physician well-being. These proposals can be used by medical educators and academic leaders to assist learners to become and remain trustworthy physicians.
Comparing Patient-reported Outcomes to Patient Satisfaction After a Microdiscectomy for Patient’s With a Lumbar Disk Herniation
Authors: Schroeder Gregory D. , Radcliff Kristen E. , Vaccaro Alexander R. , Murphy Hamadi , Sutton Ryan M. , Lurie Jon D. , Zhao Wenyan , Hilibrand Alan S.
Published: February 2020

Study Design:

A retrospective cohort study.

Objective:

The objective of this study was to determine if patient satisfaction is predicted by improvement in health-related quality of life (HRQOL) metrics.

Summary of Background Data:

Patient satisfaction is becoming an increasingly common proxy for treatment quality; however, the correlation between patient satisfaction and HRQOL outcome metrics following a lumbar disk herniation is unclear.

Methods:

Patients enrolled in the Spine Patient Outcomes Research Trial (SPORT) study were prospectively enrolled at 13 institutions. A retrospective subgroup analysis of prospectively collected data from the SPORT trial was performed. Receiver operating characteristic curves were used to determine if improvement in HRQOL metrics could accurately identify patient satisfaction. HRQOL metrics included: Short Form-36 (SF-36), Oswestry Disability Index (ODI), Sciatica Bothersomeness Index, Back Pain Bothersomeness Scale, and Leg Pain Bothersomeness Scale.

Results:

A total of 709 patients who underwent surgery and 319 patients treated without surgery were included. In the surgical cohort, receiver operating characteristic curve analysis demonstrated that SF-36 Physical Component Summary improvement had moderate accuracy [area under the curve (AUC)=0.77 (95% confidence interval, CI: 0.73–0.82)] at predicting satisfaction at 3 months, and it had excellent accuracy at predicting satisfaction at 2 years [AUC=0.81 (95% CI: 0.77–0.85)] and 4 years [AUC=0.81 (95% CI: 0.76–0.85)]. Absolute Physical Component Summary score had excellent accuracy at 3 months [AUC=0.83 (95% CI: 0.79–0.87)], 2 years [AUC=0.87 (95% CI: 0.84–0.9)] and 4 years [AUC=0.84 (95% CI: 0.8–0.89)]. Similarly improvement in the ODI had moderate accuracy of predicting satisfaction at 3 months [AUC=0.77 (95% CI: 0.72–0.81)], 2 years [AUC=0.78 (95% CI: 0.74–0.82)] and 4 years [AUC=0.78 (95% CI: 0.73–0.83)], and the absolute ODI score had excellent accuracy at 3 months [AUC=0.85 (95% CI: 0.82–0.89)], 2 years [AUC=0.89 (95% CI: 0.86–0.92)], and 4 years [AUC=0.88 (95% CI: 0.85–0.92)].

Conclusions:

HRQOL metrics can accurately predict patient satisfaction with symptoms at 3 months, 2 years, and 4 years after surgical intervention for a lumbar disk herniation. Absolute outcome scores were somewhat more predictive than change scores.
Idiopathic Spinal Cord Herniation Associated With a Thoracic Disc Herniation
Authors: Randhawa Pal S. , Roark Christopher , Case David , Seinfeld Joshua
Published: February 2020

Purpose:

The aim of this publication is to present a case of idiopathic spinal cord herniation (ISCH) associated with a transdural disk herniation, demonstrate an operative technique used to treat this condition and provide an updated review the literature.

Background Context:

ISCH is an infrequent condition that can cause progressive myelopathy leading to severe neurological dysfunction. This condition is characterized by ventral displacement of the spinal cord across a defect in the dura, either congenital or acquired, resulting in vascular compromise and adhesion that subsequently causes injury to the spinal cord. We present the management of such a patient, in addition to a review of the literature regarding management of ISCH.

Methods:

This patient underwent surgery using the dural graft sling technique for repair of the dural defect and restoration of normal spinal cord position within the thecal sac. A review of the literature revealed a total of 171 patients supplemented by our 1 patient, which were then analyzed.

Results:

The majority of patients, treated with a variety of surgical techniques, experienced improvements in symptomatology. Our patient experienced significant improvement in symptomatology.

Conclusions:

Although ISCH is a rare clinical condition that causes myelopathy, patients managed with surgery generally, though not universally, have a favorable neurological outcome. The associated surgical technique video demonstrates the dural sling technique for the treatment of this rare disorder.
Outcomes of Expandable Interbody Devices in Lumbar Fusion
Authors: Jenkins Nathaniel W. , Parrish James M. , Khechen Benjamin , Block Andrew M. , Lalehzarian Simon P. , Brundage Thomas , Hrynewycz Nadia , Iyer Sravisht , Singh Kern
Published: February 2020

Study Design:

This was a systematic review.

Objective:

The objective of this study was to review radiographic, clinical, and surgical outcomes of expandable interbody device implantation following lumbar fusion.

Summary of Background Data:

Few studies have evaluated postsurgical outcomes of expandable implants following lumbar interbody fusion.

Methods:

A systematic review was performed to identify studies investigating expandable intervertebral body devices in lumbar fusion. Radiographic parameters, fusion assessments, patient-reported outcomes (PROs), complications, and revision data were recorded. A comparison of expandable and static devices was performed using a meta-analysis.

Results:

Eleven articles were included. Postoperative improvements for each radiographic parameters for expandable versus static device implantation ranged from: lumbar lordosis, +2.0 to +5.0 degrees (expandable) versus +1.0 to +4.4 degrees (static); segmental lordosis, +1.0 to +5.2 degrees (expandable) versus+1.1 to +2.3 degrees (static); disk height, +0.82 to +4.8 mm (expandable) versus +0.26 to +6.9 mm (static); foraminal height, +0.13 to +2.8 mm (expandable) versus and +0.05 to +3.0 mm (static). Fusion rates ranged from 72.1% at 6 months to 100% at terminal follow-up. Preoperative to final follow-up improvement for the various PROs assessed were: Oswestry Disability Index, −15.4 to −56.3 (expandable) versus −13.6 to −26.3 (static); Visual Analog Scale (VAS) Back, −3.2 to −6.0 (expandable) versus −3.1 to −4.1 (static); and VAS Leg, −2.9 to −7.1 (expandable) −3.0 versus −4.8 (static). Static cages had a reported complication rate ranging from 6.0% to 16.1% and a subsidence rate of 6.0%. Expandable cages had a reported complication rate that ranged from 0.0.% to 10.0% and a subsidence rate of 5.5%–10.0%. A meta-analysis demonstrated a statistically significant difference in the PRO Oswestry Disability Index, but not VAS Back, VAS Leg, or radiographic outcomes (disk height or foraminal height).

Conclusion:

There is no clear evidence for the use of expandable interbody devices over static devices.
Carbon Monoxide Exerts Functional Neuroprotection After Cardiac Arrest Using Extracorporeal Resuscitation in Pigs
Authors: Wollborn Jakob , Steiger Christoph , Doostkam Soroush , Schallner Nils , Schroeter Nils , Kari Fabian A. , Meinel Lorenz , Buerkle Hartmut , Schick Martin A. , Goebel Ulrich
Published: February 2020

Objectives:

Neurologic damage following cardiac arrest remains a major burden for modern resuscitation medicine. Cardiopulmonary resuscitation with extracorporeal circulatory support holds the potential to reduce morbidity and mortality. Furthermore, the endogenous gasotransmitter carbon monoxide attracts attention in reducing cerebral injury. We hypothesize that extracorporeal resuscitation with additional carbon monoxide application reduces neurologic damage.

Design:

Randomized, controlled animal study.

Setting:

University research laboratory.

Subjects:

Landrace-hybrid pigs.

Interventions:

In a porcine model, carbon monoxide was added using a novel extracorporeal releasing system after resuscitation from cardiac arrest.

Measurements and Main Results:

As markers of cerebral function, neuromonitoring modalities (somatosensory-evoked potentials, cerebral oximetry, and transcranial Doppler ultrasound) were used. Histopathologic damage and molecular markers (caspase-3 activity and heme oxygenase-1 expression) were analyzed. Cerebral oximetry showed fast rise in regional oxygen saturation after carbon monoxide treatment at 0.5 hours compared with extracorporeal resuscitation alone (regional cerebral oxygen saturation, 73% ± 3% vs 52% ± 8%; p < 0.05). Median nerve somatosensory-evoked potentials showed improved activity upon carbon monoxide treatment, whereas post–cardiac arrest cerebral perfusion differences were diminished. Histopathologic damage scores were reduced compared with customary resuscitation strategies (hippocampus: sham, 0.4 ± 0.2; cardiopulmonary resuscitation, 1.7 ± 0.4; extracorporeal cardiopulmonary resuscitation, 2.3 ± 0.2; extracorporeal cardiopulmonary resuscitation with carbon monoxide application [CO-E-CPR], 0.9 ± 0.3; p < 0.05). Furthermore, ionized calcium-binding adaptor molecule 1 staining revealed reduced damage patterns upon carbon monoxide treatment. Caspase-3 activity (cardiopulmonary resuscitation, 426 ± 169 pg/mL; extracorporeal cardiopulmonary resuscitation, 240 ± 61 pg/mL; CO-E-CPR, 89 ± 26 pg/mL; p < 0.05) and heme oxygenase-1 (sham, 1 ± 0.1; cardiopulmonary resuscitation, 2.5 ± 0.4; extracorporeal cardiopulmonary resuscitation, 2.4 ± 0.2; CO-E-CPR, 1.4 ± 0.2; p < 0.05) expression were reduced after carbon monoxide exposure.

Conclusions:

Carbon monoxide application during extracorporeal resuscitation reduces injury patterns in neuromonitoring and decreases histopathologic cerebral damage by reducing apoptosis. This may lay the basis for further clinical translation of this highly salutary substance.
Effects of opioid/cannabinoid mixtures on impulsivity and memory in rhesus monkeys
Authors: Minervini Vanessa , France Charles P.
Published: February 2020

The opioid epidemic underscores the need for safer and more effective treatments for pain. Combining opioid receptor agonists with drugs that relieve pain through nonopioid mechanisms could be a useful strategy for reducing the dose of opioid needed to treat pain, thereby reducing risks associated with opioids alone. Opioid/cannabinoid mixtures might be useful in this context; individually, opioids and cannabinoids have modest effects on cognition, and it is important to determine whether those effects occur with mixtures. Delay discounting and delayed matching-to-sample tasks were used to examine effects of the mu-opioid receptor agonist morphine (0.32–5.6 mg/kg), the cannabinoid CB

1
/CB

2
receptor agonist CP55940 (0.0032–0.1 mg/kg), and morphine/CP55940 mixtures on impulsivity (n = 3) and memory (n = 4) in rhesus monkeys. Alone, each drug decreased rate of responding without modifying choice in the delay-discounting task, and morphine/CP55940 mixtures reduced choice of one pellet in a delay dependent manner, with monkeys instead choosing delayed delivery of the larger number of pellets. With the exception of one dose in one monkey, accuracy in the delayed matching-to-sample task was not altered by either drug alone. Morphine/CP55940 mixtures decreased accuracy in two monkeys, but the doses in the mixture were equal to or greater than doses that decreased accuracy or response rate with either drug alone. Rate-decreasing effects of morphine/CP55940 mixtures were additive. These data support the notion that opioid/cannabinoid mixtures that might be effective for treating pain do not have greater, and might have less, adverse effects compared with larger doses of each drug alone.
Lung cancer aggressiveness in an intermittent hypoxia murine model of postmenopausal sleep apnea
Authors: Torres Marta , Martinez-Garcia Miguel Ángel , Campos-Rodriguez Francisco , Gozal David , Montserrat Josep M. , Navajas Daniel , Farré Ramon , Almendros Isaac
Published: February 2020

Objective:

Intermittent hypoxia (IH)—a hallmark of obstructive sleep apnea (OSA)—enhances lung cancer progression in mice via altered host immune responses that are also age and sex-dependent. However, the interactions of menopause with IH on tumor malignant properties remain unexplored. Here, we aimed to investigate lung cancer outcomes in the context of ovariectomy (OVX)-induced menopause in a murine model of OSA.

Methods:

Thirty-four female mice (C57BL/6, 12-week-old) were subjected to bilateral OVX or to Sham intervention. Six months after surgery, mice were pre-exposed to either IH or room air (RA) for 2 weeks. Then, 105 lung carcinoma (LLC1) cells were injected subcutaneously in the left flank, with IH or RA exposures continued for 4 weeks. Tumor weight, tumor invasion, and spontaneous lung metastases were assessed. Tumor-associated macrophages (TAMs) were isolated and subjected to flow cytometry polarity evaluation along with assessment of TAMs modulation of LLC1 proliferation in vitro. To determine the effect of IH and OVX on each experimental variable, a two-way analysis of variance was performed.

Results:

IH and OVX promoted a similar increase in tumor growth (∼2-fold; P = 0.05 and ∼1.74-fold; P < 0.05, respectively), and OVX-IH further increased it. Regarding lung metastasis, the concurrence of OVX in mice exposed to IH enhanced the number of metastases (23.7 ± 8.0) in comparison to those without OVX (7.9 ± 2.8; P < 0.05). The pro-tumoral phenotype of TAMS, assessed as M2/M1 ratio, was increased in OVX (0.06 ± 0.01; P < 0.01) and IH (0.06 ± 0.01; P < 0.01) compared with sham/RA conditions (0.14 ± 0.03). The co-culture of TAMS with naive LLC1 cells enhanced their proliferation only under IH.

Conclusion:

In female mice, both the IH that is characteristically present in OSA and OVX as a menopause model emerge as independent contributors that promote lung cancer aggressiveness and seemingly operate through alterations in the host immune response.
Common transcriptional signatures of neuropathic pain
Authors: Pokhilko Alexandra , Nash Anthony , Cader M. Zameel
Published: February 2020

Abstarct

The dorsal root ganglia (DRG) are key structures in nociception and chronic pain disorders. Several gene expression studies of DRG in preclinical pain models have been performed, but it is unclear if consistent gene changes are identifiable. We, therefore, compared several recent RNA-Seq data sets on the whole DRG in rodent models of nerve injury. Contrary to previous findings, we show hundreds of common differentially expressed genes and high positive correlation between studies, despite model and species differences. We also find, in contrast to previous studies, that 60% of the common rodent gene response after injury is likely to occur in nociceptors of the DRG. Substantial expression changes are observed at a 1-week time-point, with smaller changes in the same genes at a later 3- to 4-week time-point. However, a subset of genes shows a similar magnitude of changes at both early and late time-points, suggesting their potential involvement in the maintenance of chronic pain. These genes are centred around suppression of endogenous opioid signalling. Reversal of this suppression could allow endogenous and exogenous opioids to exert their analgesic functions and may be an important strategy for treating chronic pain disorders. Currently used drugs, such as amitriptyline and duloxetine, do not seem to appropriately modulate many of the critical pain genes and indeed may transcriptionally suppress endogenous opioid signalling further.
Tumor lysis syndrome as a risk factor for very early mortality in HIV-associated non-Hodgkin’s lymphoma: A 10-year single-center experience
Authors: Chang Yea-Yuan , Chang Chih-Hao , Ku Wen-Wei , Gau Jyh-Pyng , Yu Yuan-Bin
Published: February 2020

Background:

Despite the effectiveness of combination antiretroviral therapy, persons living with human immunodeficiency virus (PLWHIV) remain at a high risk of developing non-Hodgkin lymphoma (NHL). We aimed to analyze the demographics and outcomes of the HIV-associated NHLs.

Methods:

Between 2005 and 2014, PLWHIV with NHLs were retrospectively enrolled at a tertiary referral center. Characteristics and survival were reviewed and analyzed.

Results:

Twenty-two HIV-associated NHLs were identified, with a median follow-up of 14 months (range, 0.1-139.7), including eight diffuse large B-cell lymphomas (DLBCLs), eight primary central nervous system lymphomas (PCNSLs), and six Burkitt’s lymphomas (BLs). Nine patients (40.9%) were diagnosed with NHLs and HIV infection concurrently. The prognosis of DLBCL patients tended to be better prognosis than that of BL and PCNSL patients (median overall survival: not reached vs. 3.5 months, p = 0.056). Very early mortality (death within 14 days after NHL diagnosis) was noted in five patients (22.7%), and tumor lysis syndrome (TLS) is a predictive factor for very early mortality among PLWHIV (hazard ratio:11.3, 95% confidence interval: 1.1–114.4, p = 0.04).

Conclusion:

Management of the early treatment phase of HIV-associated NHLs remains a major challenge. Careful intervention to patients with TLS might be the key to improve treatment outcomes.
Human global and population-specific genetic susceptibility to Mycobacterium tuberculosis infection and disease
Authors: Möller Marlo , Kinnear Craig J.
Published: February 2020

Purpose of review

Multiple lines of evidence support a role of the host genetic component in Mycobacterium tuberculosis infection and disease progression. However, genomic studies of tuberculosis susceptibility have been disappointing compared with that of other complex disorders. Recently the field has explored alternative strategies to facilitate locus discovery. Results emanating from these efforts during the last 18 months are addressed in this review.

Recent findings

There has been a renewed focus on the refinement of phenotypic definitions of infection and disease as well as on age-related, sex-specific and population-specific effects. Genome-wide association studies have yielded candidate genes but the findings have not always been transferable to all population groups. Candidate gene association studies remain popular as it is used for GWAS replication and is affordable, particularly in lower and middle-income countries. Pharmacogenetic studies involving tuberculosis drugs may locate variants that can be cost-effectively genotyped to identify individuals at risk of developing adverse events during treatment.

Additional GWAS and candidate gene association studies of crudely defined study participants are unlikely to make further important contributions to the TB susceptibility field. Instead refined phenotyping will allow the elucidation of genetic mechanisms contributing to infection and disease in distinct populations and the calculation of polygenic risk scores.
Electrochemotherapy in the head and neck area: an addition to the treatment armamentarium
Authors: de Bree Remco , Wessel Irene
Published: February 2020

Purpose of review

Electrochemotherapy (ECT) is increasingly used in different settings in head and neck cancer patients when conventional treatment options are not available.

Recent findings

Recent improvements of electroporation and ECT include new advanced electrode probes, the combination with intratumorally injected supraphysiological doses of calcium and an update of the standard operating procedures.

ECT is a treatment modality that combines administration of a chemotherapeutic drug, for example, bleomycin, with electroporation therapy (EPT). EPT uses brief, high-intensity, pulsed electrical currents to enhance the uptake of cytotoxic drugs by producing a transient increase in cell wall permeability. ECT increases the effect of cytostatic drugs, is independent on histology of the lesion, enables treatment to previously treated areas, preserves healthy tissue, has no significant side effects (low-dose chemotherapy) and enables repeated treatments. ECT can be combined with other treatment modalities and is an addition to the current treatment options of head and neck cancer. ECT is not only able to palliate symptoms but can also provide complete responses and curation.
High WHO/ISUP Grade and Unfavorable Architecture, Rather Than Typing of Papillary Renal Cell Carcinoma, May Be Associated With Worse Prognosis
Authors: Yang Chen , Shuch Brian , Kluger Harriet , Humphrey Peter A. , Adeniran Adebowale J.
Published: February 2020

Conflicting data have been published on the prognostic significance of histologic parameters in papillary renal cell carcinoma (PRCC). We conducted a comprehensive evaluation of clinical and histologic parameters in PRCC in nephrectomies and their impact on prognosis, with an emphasis on World Health Organization (WHO)/International Society of Urological Pathology (ISUP) grade, tumor architecture (solid, micropapillary, and hobnail), and PRCC type. A total of 185 PRCC cases were evaluated, 117 (63.2%) type 1, 45 (24.3%) type 2, and 11 (5.9%) mixed type 1 and type 2. Using WHO/ISUP grading criteria, PRCCs were graded as follows: 6 (3.2%) grade 1; 116 (62.7%) grade 2; 61 (33.0%) grade 3; and 2 (1.1%) grade 4. The solid architecture was present in 3 cases (1.6%) and comprised 10%, 10%, and 30% of the tumor area. Micropapillary architecture was present in 10 cases (5.4%), ranging from 5% to 30% of the tumor (mean=11%; median=10%). Hobnail architecture was seen in 9 cases (4.9%), with mean percentage of 23% (median=15%; range: 5% to 50%) involvement of tumor area. Parameters associated with worse disease-free survival (DFS) and overall survival (OS) in the univariate analysis included WHO/ISUP grade, pathologic stage, tumor size, and solid, micropapillary, or hobnail architecture (P<0.05). The pathologic stage and WHO/ISUP grade were significantly associated with both DFS and OS in stepwise multivariate Cox regression analysis (P<0.05). In addition, micropapillary architecture and type 1 histology were linked with an adverse impact on OS (P<0.05). We found no difference in DFS (P=0.8237) and OS (P=0.8222) for type 1 versus type 2 PRCC in our patient cohort. In addition, we performed a meta-analysis with data from studies with reported hazard ratios (HRs) on PRCC type in relation to DFS and OS. We identified 5 studies that reported DFS and found no significant effect for type 2 PRCC (P=0.30; HR=1.43; 95% confidence interval: 0.73-2.80). We identified 7 studies that reported OS and found no significant association between type 2 PRCC and worse OS (P=0.41; HR: 1.21; 95% confidence interval: 0.77-1.91). Our findings suggest that high WHO/ISUP grade and unfavorable architecture (solid, micropapillary, or hobnail), rather than typing of PRCC, are associated with worse outcomes.
Changes in Lid Crease Measurements in Levator Advancement for Ptosis
Authors: Alkeswani Amena , Hataway Felicia , Westbrook Brian , Gulamani Shan , Collawn Sherry S.
Published: February 2020

Purpose

Although previous reports addressed the differences in marginal reflex distance 1 (MRD-1) measurements based on various techniques of levator advancement, eyelid crease measurements have not been studied as markers in perioperative planning. In addition to possible benefits in optimal results for improvement of visual field defects and functional impairment, recent work has suggested that eyelid crease is important in the perception of attractiveness. Therefore, the aims of this study were to determine the change in eyelid crease measurements in levator advancement and to further expand on numerical correlation of levator advancement in preoperative planning to avoid overcorrection or undercorrection.

Methods

The authors performed a retrospective analysis of preoperative and postoperative eye measurements in patients who underwent levator advancement for ptosis between August 2016 and April 2019. This study included 13 patients, all of whom had recorded preoperative and postoperative measurements of MRD-1, whereas 8 of 13 patients had additional preoperative and postoperative measurements of the mid pupil to crease and lateral limbus to crease at the level of mid pupil.

Results

All patients had increased in MRD-1, mid pupil to crease, and lateral limbus to crease measurements postoperatively. The average advancement of 4.8 mm led to an elevation of MRD-1 to 2.6 mm (n = 25) and an improvement in mid pupil to crease distance of 1.9 mm (n = 15) and lateral limbus to crease distance of 2.6 mm (n = 15). No cases of undercorrection or overcorrection were found. All patients reported satisfaction with the results, including improvement in function and quality of life. No infections, hematomas, or other complications were noted postoperatively in any of the patients.

Conclusions

Marginal reflex distance 1 is a consistently reliable planning tool in preoperative assessment of levator advancement, with beneficial patient outcomes including improvement of visual field defects caused by ptosis and satisfaction with cosmetic results. This study is the first to report use of crease measurements (mid pupil to crease and lateral limbus to crease), which may provide additional understanding to the aesthetic value of to the levator advancement.
Revisiting the Relationship Between Hospital Case Volume and Outcomes in Abdominally Based Free Flap Breast Reconstruction
Authors: Chattha Anmol , Chen Austin D. , Muste Justin , Cohen Justin B. , Lee Bernard T. , Lin Samuel J.
Published: February 2020

Background

Increased operative volume has been associated with benefits in patient outcomes for a variety of surgical procedures. In autologous abdominally based breast reconstruction, however, there are few studies assessing the association between procedure volume and patient outcomes. The objectives of this study are to evaluate the associations between abdominal-based free flap breast reconstruction and patient outcomes.

Methods

The 2013–2014 Healthcare Cost and Utilization Project National Inpatient Sample was queried for all female patients with a diagnosis of breast cancer who underwent mastectomy and immediate abdominally based breast reconstruction (deep inferior epigastric perforator or transverse rectus abdominus muscle free flaps). Outcomes included occurrence of major or surgical site in-hospital complications, hospital cost, and length of stay (LOS). High-volume (HV) hospitals were defined as the 90th percentile of annual case volume or higher (>18 cases/y). Multivariate regressions and generalized linear modeling with gamma log-link function were performed to access the outcomes associated with HV hospitals.

Results

Overall, 7145 patients at 473 hospitals were studied; of these, 42.4% of patients were treated at HV hospitals. There were significant differences in unadjusted major complications (2.1% vs 4.3%; P < 0.001) and unadjusted surgical site complications (3.5% vs 6.1%; P < 0.001) between HV and non-HV hospitals. After adjustments for clinical and hospital characteristics, patients treated at HV hospitals were less likely to experience a major complication (odds ratio, 0.488; 95% confidence interval, 0.353–0.675; P < 0.001) or surgical site complication (odds ratio, 0.678; 95% confidence interval, 0.519–0.887; P = 0.005). There was no difference in inpatient cost between HV and non-HV hospitals ($26,822 vs $26,295; marginal cost, $528; P = 0.102); however, HV hospitals had a shorter LOS (4.31 vs 4.40 days; marginal LOS, −0.10 days; P = 0.005).

Conclusions

Hospitals that perform a larger volume of immediate abdominal-based breast reconstructions after mastectomy, when compared with those that perform a lower volume of these procedures, seem to have an associated lower rate of major complications and a shorter LOS. However, these same HV centers demonstrate no decrease in costs. Further research is needed to understand how these HV centers can reduce hospital costs.
Lower hemoglobin concentration decreases time to death in severely anemic patients for whom blood transfusion is not an option
Authors: Guinn Nicole R. , Cooter Mary L. , Weiskopf Richard B.
Published: February 2020

BACKGROUND

Anemia in patients who decline transfusion has been associated with increased morbidity and mortality. We hypothesized that the time to death decreases with increasing severity of anemia in patients for whom transfusion is not an option.

METHODS

With institutional review board approval, a retrospective review of registered adult blood refusal patients with at least one hemoglobin (Hb) value of 12.0 g/dL or less during hospital admission at a single institution from January 2004 to September 2015 was performed. The association of nadir Hb category and time to death (all-cause 30-day mortality) was determined using Kaplan-Meier plots, log rank tests, and Cox proportional hazard models. We investigated if there was a nadir Hb level between the values of 5.0 and 6.0 g/dL at which mortality risk significantly increased and then categorized nadir Hb by the traditional cut points and the newly identified “critical” cut point.

RESULTS

The study population included 1,011 patients. The Cox proportional hazard models showed a more than 50% increase in hazard of death per 1 g/dL decrease in Hb (adjusted hazard ratio [confidence interval], 1.55 [1.40–1.72];p< 0.001). A Hb value of 5.0 g/dL was identified as defining “critical anemia.” We found a strong association between anemia severity level and mortality (p< 0.001). Time to death was shorter (median, 2 days) in patients with critical anemia than in those having higher Hb (median time to death of 4 or 6 days, in severe or moderate anemia).

CONCLUSION

In anemic patients unable to be transfused, critical anemia was associated with a significantly and clinically important reduced time to death.

LEVEL OF EVIDENCE

Prognostic, level III.
Headache and Bilateral Optic Disc Edema as the Initial Manifestation of Vogt–Koyanagi–Harada Disease
Authors: Nichani Prem , Christakis Panos G. , Micieli Jonathan A.
Published: February 2020

A 31-year-old healthy Asian man presented with new headaches and blurred vision. He was found to have bilateral optic disc edema (ODE) and peripapillary subretinal fluid and was initially investigated for causes of raised intracranial pressure. After referral to neuro-ophthalmology, he received a diagnosis of Vogt–Koyanagi–Harada (VKH) disease and his symptoms, ODE, and vision improved promptly with prednisone treatment. HLA typing was performed and returned positive for the HLA-DRB1*04 subtype. Although VKH disease usually presents with granulomatous uveitis or serous retinal detachments, ODE may manifest early in the disease course. Those with ODE in VKH disease are believed to be older and female, but this case demonstrates that these findings were also seen in a young man.
Unconditional care from close maternal kin in the face of parasites
Authors: Poirotte Clémence , Charpentier Marie J. E.
Published: February 2020

Several species mitigate relationships according to their conspecifics' parasite status. Yet, this defence strategy comes with the costs of depriving individuals from valuable social bonds. Animals therefore face a trade-off between the costs of pathogen exposure and the benefits of social relationships. According to the models of social evolution, social bonds are highly kin-biased. However, whether kinship mitigates social avoidance of contagious individuals has never been tested so far. Here, we build on previous research to demonstrate that mandrills (Mandrillus sphinx) modulate social avoidance of contagious individuals according to kinship: individuals do not avoid grooming their close maternal kin when contagious (parasitized with oro-faecally transmitted protozoa), although they do for more distant or non-kin. While individuals' parasite status has seldom been considered as a trait impacting social relationships in animals, this study goes a step beyond by showing that kinship balances the effect of health status on social behaviour in a non-human primate.
Establishing Clinically Significant Patient-reported Outcomes for Diverticular Disease – A Prospective Cohort Study
Authors: Khor Sara , Flum David R. , Strate Lisa L. , Hantouli Mariam N. , Harris Heather H. , Lavallee Danielle C. , Spiegel Brennan MR , Davidson Giana H.
Published: February 2020

Background & Aims

Diverticular disease can undermine health-related quality of life (HRQoL). The diverticulitis quality of life (DV-QOL) instrument was designed and validated to measure the patient-reported burden of diverticular disease. However, in order for the DV-QOL to capture longitudinal outcomes, values reflecting meaningful improvement (i.e., minimal clinically important difference (MCID)) and the patient acceptable symptom state (PASS) need to be established. We sought to establish the MCID and PASS of the DV-QOL, and describe the characteristics of those with DV-QOL above the PASS threshold.

Methods

We performed a prospective cohort study of adults with diverticular disease from 7 centers in Washington and California (2016-2018). Patients were surveyed at baseline, then quarterly up to 30 months. To determine the PASS for DV-QOL, we used an anchor-based approach and performed receiver operating characteristic analyses using baseline data. A range of MCID values were calculated using distribution-based and anchor-based approaches.

Results

The study included 177 patients (mean age 57, 43% female). A PASS threshold of 3.2/10 distinguished between those with and without HRQoL-impacting diverticulitis with acceptable accuracy (area under the curve (AUC) 0.76). A change of 2.2 points in the DV-QOL was the most appropriate MCID: above the measurement error and corresponding to patient perception of importance of change (AUC 0.70). Patients with DV-QOL≥PASS were more often male, younger, had Medicaid, less educated, and had more serious episodes of diverticulitis.

Conclusions

Our study is the first to define MCID and PASS for DV-QOL. These thresholds are critical for measuring the impact of diverticular disease and the evaluation of treatment effectiveness.
Comparative Analysis of Early Dynamic Trends in Novel Coronavirus Outbreak: A Modeling Framework
Authors: Lin Huazhen , Liu Wei , Gao Hong , Nie Jinyu , Fan Qiao
Published: February 2020

Background

The 2019 coronavirus disease (COVID-19) represents a significant public health threat globally. Here we describe efforts to compare epidemic growth, size and peaking time for countries in Asia, Europe, North America, South America and Australia in the early epidemic phase.

Methods

Using the time series of cases reported from January 20, 2020 to February 13, 2020 and transportation data from December 1, 2019 to January 23, 2020 we have built a novel time-varying growth model to predict the epidemic trend in China. We extended our method, using cases reported from January 26, 2020 - or the date of the earliest case reported, to April 9, 2020 to predict future epidemic trend and size in 41 countries. We estimated the impact of control measures on the epidemic trend.

Results

Our time-varying growth model yielded high concordance in the predicted epidemic size and trend with the observed figures in C hina. Among the other 41 countries, the peak time has been observed in 28 countries before or around April 9, 2020; the peak date and epidemic size were highly consistent with our estimates. We predicted the remaining countries would peak in April or May 2020, except India in July and Pakistan in August. The epidemic trajectory would reach the plateau in May or June for the majority of countries in the current wave. Countries that could emerge to be new epidemic centers are India, Pakistan, Brazil, Mexico, and Russia with a prediction of 105 cases for these countries. The effective reproduction number Rt displayed a downward trend with time across countries, revealing the impact of the intervention remeasures i.e. social distancing. Rt remained the highest in the UK (median 2.62) and the US (median 2.19) in the fourth week after the epidemic onset.

Conclusions

New epidemic centers are expected to continue to emerge across the whole world. Greater challenges such as those in the healthcare system would be faced by developing countries in hotspots. A domestic approach to curb the pandemic must align with joint international efforts to effectively control the spread of COVID-19. Our model promotes a reliable transmissibility characterization and epidemic forecasting using the incidence of cases in the early epidemic phase.
Postpartum fluoxetine increases maternal hippocampal IL-1β and decreased plasma tryptophan: clues for efficacy
Authors: Qiu Wansu , Duarte-Guterman Paula , Eid Rand S. , Go Kimberly A. , Lamers Yvonne , Galea Liisa A. M.
Published: February 2020

Perinatal depression (PND) affects approximately 15% of women, andde novopostpartum depression affects approximately 40% of PND cases. Selective serotonin reuptake inhibitors (SSRIs) are a common class of antidepressants prescribed to treat PND. However, the safety and efficacy of SSRIs have been questioned in both clinical and preclinical research. Here, using a preclinical rodent model of postpartum depression, we aim to better understand neuroinflammatory cytokines and tryptophan mechanisms that may be related to SSRIs efficacy. Rodent dams were treated with high corticosterone (CORT; 40mg/kg, s.c.) for 21 days in the postpartum period to simulate depressive-like behaviors in the late postpartum period. Concurrently, a subset of dams was treated with the SSRI, fluoxetine (FLX; 10mg/kg, s.c.), in the postpartum period. We showed, consistent with previous studies, that although maternal FLX treatment prevented CORT-induced disturbances in maternal care behavior during the early postpartum, it failed to prevent the expression of CORT-induced depressive-like behavior in the late postpartum. Furthermore, FLX treatment, regardless of CORT treatment, increased maternal hippocampal IL-1β and decreased maternal plasma tryptophan levels, plasma tryptophan, 4’-pyridoxic acid, and pyridoxal concentrations. Maternal CORT treatment reduced maternal hippocampal TNF-α and IFN-γ levels. Our work suggests that the limited efficacy of FLX in the late postpartum may be associated with elevated levels of the proinflammatory cytokine IL-1β in the maternal hippocampus, decreased plasma tryptophan concentration, and changes in vitamin B6 dependent tryptophan-kynurenine pathway. These findings suggest novel pathways for improving SSRI efficacy in alleviating perinatal depression.

HIGHLIGHTS

Postpartum fluoxetine (FLX) increased interleukin-1β levels in hippocampus

Postpartum corticosterone (CORT) decreased TNF-α and IFN-γ in the hippocampus

Postpartum FLX did not prevent CORT-induced depressive-like behavior

Postpartum FLX prevented CORT-induced changes in maternal behavior

Postpartum FLX decreased plasma tryptophan, 4’-pyridoxic acid, and pyridoxal levels
Epidemiologic and Clinical Characteristics of 91 Hospitalized Patients with COVID-19 in Zhejiang, China: A retrospective, multi-centre case series
Authors: Qian Guo-Qing , Yang Nai-Bin , Ding Feng , Yan Ma Ada Hoi , Wang Zong-Yi , Shen Yue-Fei , Shi Chun-Wei , Lian Xiang , Chu Jin-Guo , Chen Lei , Wang Zhi-Yu , Ren Da-Wei , Li Guo-Xiang , Chen Xue-Qin , Shen Hua-Jiang , Chen Xiao-Min
Published: February 2020

Background

Recent studies have focused initial clinical and Epidemiologic characteristics on the COVID-19, mainly revealing situation in Wuhan, Hubei.

Aim

To reveal more data on the epidemiologic and clinical characteristics of COVID-19 patients outside of Wuhan, in Zhejiang, China.

Design

Retrospective case series.

Methods

88 cases of laboratory-confirmed and 3 cases of clinical-confirmed COVID-19 were admitted to five hospitals in Zhejiang province, China. Data were collected from 20 January 2020 to 11 February 2020.

Results

Of all 91 patients, 88 (96.70%) were laboratory-confirmed COVID-19 with throat swab samples that tested positive for SARS-Cov-2 while 3 (3.30%) were clinical-diagnosed COVID-19 cases. The median age of the patients was 50 (36.5-57) years, and female accounted for 59.34%. In this sample 40 (43.96%) patients had contracted the diseases from local cases, 31 (34.07%) patients had been to Wuhan/Hubei, 8 (8.79%) cases had contacted with people from Wuhan, 11 (12.09%) cases were confirmed aircraft transmission. In particular within the city of Ningbo, 60.52% cases can be traced back to an event held in a temple. The most common symptoms were fever (71.43%), cough (60.44%) and fatigue (43.96%). The median of incubation period was 6 (IQR, 3-8) days and the median time from first visit to a doctor to confirmed diagnosis was 1 (1-2) days. According to the Chest computed tomography scans, 67.03% cases had bilateral pneumonia.

Conclusions

Social activity cluster, family cluster and travel by airplane were how COVID-19 patients get transmitted and could be rapidly diagnosed COVID-19 in Zhejiang.