bluuebunny/crossref_metadata_2025 huggingface dataset:
AAV2‐BDNF promotes respiratory axon plasticity and recovery of diaphragm function following spinal cord injury
Authors: Charsar Brittany A. , Brinton Michael A. , Locke Katherine , Chen Anna Y. , Ghosh Biswarup , Urban Mark W. , Komaravolu Sreeya , Krishnamurthy Karthik , Smit Rupert , Pasinelli Piera , Wright Megan C. , Smith George M. , Lepore Angelo C.
Published: October 2019

More than half of spinal cord injury (SCI) cases occur in the cervical region, leading to respiratory dysfunction due to damaged neural circuitry that controls critically important muscles such as the diaphragm. The C3‐C5 spinal cord is the location of phrenic motor neurons (PhMNs) that are responsible for diaphragm activation; PhMNs receive bulbospinal excitatory drive predominately from supraspinal neurons of the rostral ventral respiratory group (rVRG). Cervical SCI results in rVRG axon damage, PhMN denervation, and consequent partial‐to‐complete paralysis of hemidiaphragm. In a rat model of C2 hemisection SCI, we expressed the axon guidance molecule, brain‐derived neurotrophic factor (BDNF), selectively at the location of PhMNs (ipsilateral to lesion) to promote directed growth of rVRG axons toward PhMN targets by performing intraspinal injections of adeno‐associated virus serotype 2 (AAV2)‐BDNF vector. AAV2‐BDNF promoted significant functional diaphragm recovery, as assessed by in vivo electromyography. Within the PhMN pool ipsilateral to injury, AAV2‐BDNF robustly increased sprouting of both spared contralateral‐originating rVRG axons and serotonergic fibers. Furthermore, AAV2‐BDNF significantly increased numbers of putative monosynaptic connections between PhMNs and these sprouting rVRG and serotonergic axons. These findings show that targeting circuit plasticity mechanisms involving the enhancement of synaptic inputs from spared axon populations is a powerful strategy for restoring respiratory function post‐SCI.—Charsar, B. A., Brinton, M. A., Locke, K., Chen, A. Y., Ghosh, B., Urban, M. W., Komaravolu, S., Krishnamurthy, K., Smit, R., Pasinelli, P., Wright, M. C., Smith, G. M., Lepore, A. C. AAV2‐BDNF promotes respiratory axon plasticity and recovery of diaphragm function following spinal cord injury. FASEB J. 33, 13775‐13793 (2019). www.fasebj.org
Why Medical Residents Do (and Don’t) Speak Up About Organizational Barriers and Opportunities to Improve the Quality of Care
Authors: Voogt Judith J. , Kars Marijke C. , van Rensen Elizabeth L.J. , Schneider Margriet M.E. , Noordegraaf Mirko , van der Schaaf Marieke F.
Published: October 2019

Purpose

Medical residents are valuable sources of information about the quality of frontline service delivery, but if they do not speak up, their ideas, opinions, and suggestions for improving their work practices cannot be considered. However, speaking up can be difficult for residents. Therefore, the authors have explored both what helps residents speak up about organizational barriers and opportunities to improve the quality of their work and what hinders them from doing so.

Method

The authors conducted an exploratory qualitative interview study with 27 Dutch medical residents in the Netherlands in 2016. They used the critical incident technique for data collection and the constant comparison method of the Qualitative Analysis Guide of Leuven for data analysis.

Results

Three types of incidents in which residents considered speaking up are described. The authors identified 2 main considerations that influenced residents’ decisions about speaking up: Is it safe to speak up, and is speaking up likely to be effective? Residents’ decisions were influenced by personal, team, and organizational aspects of their situations, such as supervisors’ open attitudes, hierarchy, duration of clinical rotations, organization size, and experiences (either vicarious or their own).

Conclusions

Findings from this study indicate that residents tend to be silent when they encounter organizational barriers or opportunities to improve the quality of their work. Perceived effectiveness and safety are important forces that drive and constrain speaking up. The authors provide important starting points to empower medical residents to speak up about their suggestions for change.
The Not Underrepresented Minorities: Asian Americans, Diversity, and Admissions
Authors: Ko Michelle , Ton Hendry
Published: October 2019

Several lawsuits have recently been filed against U.S. universities; the plaintiffs contend that considerations of race and ethnicity in admissions decisions discriminate against Asian Americans. In prior cases brought by non-Latino whites, the U.S. Supreme Court has upheld these considerations, arguing that they are crucial to a compelling interest to increase diversity. The dissenting opinion, however, concerns the possibility that such policies disadvantage Asian Americans, who are considered overrepresented in higher education. Here, the authors explain how a decision favoring the plaintiffs would affect U.S. medical schools. First, eliminating race and ethnicity in holistic review would undermine efforts to diversify the physician workforce. Second, the restrictions on considering race/ethnicity in admissions decisions would not remedy potential discrimination against Asian Americans that arise from implicit biases. Third, such restrictions would exacerbate the difficulty of addressing the diversity of experiences within Asian American subgroups, including recognizing those who are underrepresented in medicine. The authors propose that medical schools engage Asian Americans in diversity and inclusion efforts and recommend the following strategies: incorporate health equity into the institutional mission and admissions policies, disaggregate data to identify underrepresented Asian subgroups, include Asian Americans in diversity committees and support faculty who make diversity work part of their academic portfolio, and enhance the Asian American faculty pipeline through support and mentorship of students. Asian Americans will soon comprise one-fifth of the U.S. physician workforce and should be welcomed as part of the solution to advancing diversity and inclusion in medicine, not cast as the problem.
Patient Satisfaction With Medical Student Participation in a Longitudinal Integrated Clerkship: A Controlled Trial
Authors: Beard Albertine S. , Candy Amy E. , Anderson Travis J. , Derrico Nicholas P. , Ishani Khalid A. , Gravely Amy A. , Englander Robert , Ercan-Fang Nacide G.
Published: October 2019

Purpose

To determine whether longitudinal student involvement improves patient satisfaction with care.

Method

The authors conducted a satisfaction survey of patients followed by 10 University of Minnesota Medical School students enrolled in 2016–2017 in the Veterans Affairs Longitudinal Undergraduate Medical Education (VALUE) program, a longitudinal integrated clerkship at the Minneapolis Veterans Health Care System. Students were embedded in an ambulatory practice with primary preceptors who assigned students a panel of 14 to 32 patients to follow longitudinally in inpatient and outpatient settings. Control patients, matched on disease severity, were chosen from the preceptor’s panel. Two to five months after the students completed the VALUE program, the authors conducted a phone survey of the VALUE and control patients using a validated, customized questionnaire.

Results

Results are reported from 97 VALUE patients (63% response rate) and 72 controls (47% response rate) who had similar baseline characteristics. Compared with control patients, VALUE patients reported greater satisfaction with explanations provided by their health care provider, their provider’s knowledge of their personal history, and their provider’s looking out for their best interests (P < .05). Patients in the VALUE panel selected the top category more often than control patients for overall satisfaction with their health care (65% vs 43%, P < .05).

Conclusions

The results of this controlled trial demonstrate that VALUE student longitudinal participation in patient care improves patient satisfaction and patient-perceived quality of health care for VALUE patients compared with controls matched by primary care provider and disease severity. These findings may have implications outside the Veterans Administration population.
Is Modified K-line a Powerful Tool of Surgical Decision Making for Patients With Cervical Spondylotic Myelopathy?
Authors: Hirai Takashi , Yoshii Toshitaka , Inose Hiroyuki , Yuasa Masato , Yamada Tsuyoshi , Ushio Shuta , Onuma Hiroaki , Hirai Keigo , Kobayashi Yutaka , Utagawa Kurando , Hashimoto Jun , Kawabata Atsuyuki , Sakai Kenichiro , Kato Tsuyoshi , Kawabata Shigenori , Okawa Atsushi
Published: October 2019

Study Design:

Prospective observational single-center study.

Objective:

To evaluate anterior decompression and fusion (ADF) or posterior surgery (PS) for patients with cervical spondylotic myelopathy (CSM) using the modified K-line (mK-line) and to compare clinical and radiologic outcomes between these 2 techniques.

Summary of Background Data:

The authors have previously reported that insufficient posterior decompression is often seen after laminoplasty for CSM in patients with preoperative anterior clearance of the spinal cord <4 mm on the basis of the mK-line. However, to our knowledge, no study has investigated the role, if any, of the mK-line in surgical decision making for patients with CSM.

Methods:

A total of 87 patients were enrolled who underwent surgery for treatment of CSM between 2011 and 2015 at our hospital and who could be followed up for at least 2 years. ADF was selected as a more favorable procedure than PS in patients with anterior spinal clearance of <4 mm on preoperative midsagittal magnetic resonance imaging. On the basis of the Japanese Orthopedic Association (JOA) scoring system for cervical myelopathy, the rate of recovery of the JOA scores at 2 years after surgery was investigated as a clinical outcome to compare these 2 groups.

Results:

Mean age was 65.1 (±12.9) years in the ADF group (n=26) and 70.5 (±8.6) years in the PS group (n=61). In the PS group, 10 patients underwent posterior decompression with fusion. Mean preoperative and postoperative JOA scores were 10.5 and 14.1 points in the ADF group and 9.8 and 13.1 points in the PS group, respectively, showing no significant difference in recovery rate of JOA score between the ADF (58.9%) and PS (47.1%) groups. However, patients with a minimum interval between the mK-line and the anterior compression factor on the midsagittal image (minimum interval of the spinal cord) <4 mm tended to have unsatisfactory outcomes (recovery rate 29.6%) compared with patients with minimum interval of the spinal cord >4 mm (53.6%, P=0.07) in the PS group.

Conclusion:

Preoperative intervention using the mK-line is useful to predict residual cord compression and might homogenize postoperative clinical outcomes in both anterior surgery and PS.
Could Greater Physical Activity Reduce Population Prevalence and Socioeconomic Inequalities in Children’s Mental Health Problems? A Policy Simulation
Authors: Chigogora Sungano , Pearce Anna , Law Catherine , Viner Russell , Chittleborough Catherine , Griffiths Lucy J. , Hope Steven
Published: October 2019

Background:

One in four children 5–16 years (y) of age shows signs of mental health problems in the United Kingdom; risk is higher in economically disadvantaged groups. Greater physical activity is associated with lower risk of internalizing problems such as depression and anxiety. We simulated the potential impact of population-wide physical activity interventions on overall prevalence of internalizing problems, and by family income. Interventions were based on the World Health Organization (WHO) children’s target of 60 minutes (min) of moderate-to-vigorous physical activity per day and trial evidence.

Methods:

Data were from the UK Millennium Cohort Study, a population-representative cohort of children born in 2000–2002. Household income (5 y) was the exposure; internalizing problems (outcome) were measured using the Strengths and Difficulties Questionnaire (11 y). Of 18,296 singletons, 6,497 had accelerometer physical activity data (mediator, manipulated to simulate interventions) at 7 y. We predicted probabilities of outcome according to exposure in marginal structural models, weighted for attrition and confounding, and adjusted for observed mediator. We then re-estimated probabilities in different physical activity intervention scenarios, assessing income inequalities in internalizing problems with risk ratios (RRs) and differences (RDs) according to income quintile.

Results:

Simulating universal achievement of the WHO target led to little change in prevalence (10% [95% CI = 8%, 12%]) and socioeconomic inequalities in internalizing problems; RR: 2.2 (1.1, 3.4); RD: 8% [5%,13%]). More modest increases in physical activity achieved weaker results.

Conclusions:

Our simulations suggest that large increases in moderate-to-vigorous physical activity in the United Kingdom would have little effect on prevalence and inequalities in child mental health problems.
Minimally Invasive Nasal Sampling in Children Offers Accurate Pneumococcal Colonization Detection
Authors: Nikolaou Elissavet , Blizard Annie , Pojar Sherin , Mitsi Elena , German Esther L. , Reiné Jesús , Hill Helen , McNamara Paul S. , Collins Andrea M. , Ferreira Daniela M. , Jochems Simon P
Published: October 2019

Nasopharyngeal colonization of potential respiratory pathogens such as Streptococcus pneumoniae is the major source of transmission and precursor of invasive disease. Swabbing deeply the nasopharynx, which is currently recommended by World Health Organization, provides accurate pneumococcal detection but is unpleasant. We showed that nasal lining fluid filter strips offer equal detection sensitivity.
Tidal Flow Perfusion for the Artificial Placenta: A Paradigm Shift
Authors: Kading Jacqueline C. , Langley Mark W. , Lautner Gergely , Jeakle Mark M.P. , Toomasian John M. , Fegan Taylor L. , Pfannes Rachel A. , Toor Samantha C. , Reiber Mary A. , Kordell Peter R. , Cornell Marie S. , Bartlett Robert H. , Rojas-Pena Alvaro , Mychaliska George B.
Published: October 2019

The modalities of vascular access for the extracorporeal artificial placenta (AP) have undergone many iterations over the past decade. We hypothesized that single lumen cannulation (SLC) of the jugular vein using tidal flow extracorporeal life (ECLS) support is a feasible alternative to venovenous (VV) umbilical–jugular cannulation and double lumen cannulation (DLC) and can maintain fetal circulation, stable hemodynamics, and adequate gas exchange for 24 hours. After in vitro evaluation of the tidal flow system, six preterm lambs at estimated gestational age 118–124 days (term 145 days) were delivered and underwent VV-ECLS. Three were supported using DLC and three with SLC utilizing tidal flow AP support. Hemodynamics, circuit flow, and gas exchange were monitored. Target fetal parameters were as follows: mean arterial pressure 40–60 mmHg, heart rate 140–240 beats per minute (bpm), SatO2% 60–80%, PaO2 25–50 mmHg, PaCO2 30–55 mmHg, oxygen delivery >5 ml O2/dl/kg/min, and circuit flow 100 ± 25 ml/kg/min. All animals survived 24 hours and maintained fetal circulation with stable hemodynamics and adequate gas exchange. Parameters of the tidal flow group were comparable with those of DLC. Single lumen jugular cannulation using tidal flow is a promising vascular access strategy for AP support. Successful miniaturization holds great potential for clinical translation to support extremely premature infants.
Atypical, milder presentation in a child with CC2D2A and KIDINS220 variants
Authors: Lam Zena , Albaba Shadi , Study DDD , Balasubramanian Meena
Published: October 2019

With the increasing availability and clinical use of exome and whole-genome sequencing, reverse phenotyping is now becoming common practice in clinical genetics. Here, we report a patient identified through the Wellcome Trust Deciphering Developmental Disorders study who has homozygous pathogenic variants in CC2D2A and a de-novo heterozygous pathogenic variant in KIDINS220. He presents with developmental delay, intellectual disability, and oculomotor apraxia. Reverse phenotyping has demonstrated that he likely has a composite phenotype with contributions from both variants. The patient is much more mildly affected than those with Joubert Syndrome or Spastic paraplegia, intellectual disability, nystagmus, and obesity, the conditions associated with CC2D2A and KIDINS220 respectively, and therefore, contributes to the phenotypic variability associated with the two conditions.
Efficacy and safety of Yukgunja-Tang for treating anorexia in patients with cancer
Authors: Kang Hwi-Joong , Jeong Mi-Kyung , Park So-Jung , Jun Hyeong-Joon , Yoo Hwa-Seung
Published: October 2019

Background:

Anorexia is a common cause of malnutrition and is associated with negative effects on the quality of life (QOL) for patients with cancer. Management of appetite is the key to improving both the QOL and the prognosis for such patients. Yukgunja-tang (YGJT) is a traditional herbal medicine extensively prescribed in Korea as a remedy for various gastrointestinal syndromes. Currently, no standardized herbal medicine treatment exists for patients with cancer who are suffering from anorexia after surgery, chemotherapy, and/or radiotherapy. For that reason, this study aims to examine the efficacy and the safety of using YGJT to treat anorexia in such patients and to establish whether or not YGJT can be recommended as the primary therapy.

Methods:

We will enroll 52 cancer patients diagnosed with anorexia. The enrolled participants will be randomly allocated to 2 groups: The control group will receive nutrition counseling, and the YGJT group will receive nutrition counseling and be administered YGJT at a dose of 3 g twice a day for 4 weeks (a total of 56 doses of 3.0 g per dose). The primary outcome of this study is the change in the score on the anorexia/cachexia subscale (A/CS) of the Functional Assessment of Anorexia/Cachexia Therapy (FAACT). The secondary outcomes are the changes in the FAACT score with the A/CS score excluded, the score on the Visual Analogue Scale (VAS) for appetite, the weight and the body mass index (BMI), and laboratory tests for compounds such as leptin, tumor necrosis factor-α (TNF-α), ghrelin, and IL-6. All variables related to the safety assessment, such as vital signs, electrocardiography results, laboratory test results (CBC, chemistry, urine test), and adverse events, will be documented on the case report form (CRF) at every visit.

Conclusion:

This study is the first randomized controlled trial to investigate the efficacy and the safety of using YGJT for treating patients with cancer-related anorexia in Korea. We designed this study based on previous research about YGJT. This study will serve as a pilot and provide data for planning further clinical trials on herbal medicine and cancer-related anorexia.

Trial registration:

Clinical Research Information Service (CRIS), Republic of Korea, ID: KCT0002847. Registered retrospectively on 3 April 2018.
The constitution and functional prediction of the microbiota in necrotizing enterocolitis with a gestational age of over 28 weeks
Authors: Feng JinXing , He Yu , Liu Dong , Li Luquan , Chen Jingyu , Yu Jialin
Published: October 2019

Background:

To explore the features and function of gut microbiota in necrotizing enterocolitis patients over 28 gestational age weeks through a case-control study.

Methods:

Fecal samples from patients with NEC over 28 gestational week age and matched control cases were collected. DNA of the fecal samples was extracted for 16 s rRNA sequencing to estimate the composition of the microbiota. Functional inference analyses were conducted through PICRUSt based on the sequencing raw data.

Results:

There was no significant difference in the total diversity of microbiota between the fecal samples from the patients with NEC and the controls (P = .40). Propionibacterium was more abundant in the NEC cases than in the controls. Conversely, Lactobacillus, Phascolarctobacterium, and Streptococcus_salivarius were found to be more plentiful in the controls through LEfSe analysis. Functional inference analysis revealed that the xenobiotic biodegradation and metabolic activity was lower in the NEC cases than in the controls (P < .05).

Conclusion:

The NEC cohort with a gestational age of over 28 weeks has a different pattern of microbiota compared with the controls. Functional inference analysis indicated that the potential function of the microbiota may also differ between these groups.
Tongue strengthening exercise is effective in improving the oropharyngeal muscles associated with swallowing in community-dwelling older adults in South Korea
Authors: Park Ji-Su , Lee Sang-Hoon , Jung Sang-Hoon , Choi Jong-Bae , Jung Young-Jin
Published: October 2019

Background

Tongue strengthening exercise (TSE) is a remedial method for the training of swallowing-related muscles in the oropharyngeal phase. However, clinical evidence of its effectiveness is insufficient.

Methods

To investigate the effect of TSE on the oropharyngeal muscles associated with swallowing in older adults, in this study, 40 elder adults living in the community were recruited and assigned to 2 groups. The experimental group performed a TSE with a 1-repetition maximum resistance level of 70%. The exercise was divided into an isometric and isotonic part. The control group did not perform an exercise. We measured the muscle strength and thickness of the tongue and suprahyoid muscles using an Iowa Oral Performance Instrument and ultrasonography.

Results

The experimental group showed a statistically significant increase in tongue muscle strength and thickness in the oral phase (P = .001 and <.001, respectively). In the pharyngeal phase, the experimental group showed a statistically significant increase in the mylohyoid and digastric muscles (suprahyoid muscles) (P = .045 and .019, respectively). The control group showed no statistically significant changes.

Conclusion

TSE is effective in increasing the strength and thickness of the oropharyngeal muscles of elder adults and is recommended for those who are vulnerable to swallowing difficulties.
Nomogram to predict overall survival and disease-specific survival with appendiceal mucinous adenocarcinoma
Authors: Yan Qian , Zheng Wen Jiang , Chen Qing Lian , Wang Bo Qing , Luo Hui Yan , Xue Jiao , Wang Xiong Wen
Published: October 2019

To predict the survival of appendiceal mucinous adenocarcinoma (AMA) by prognostic nomogram.

A total of 3234 patients with AMA were collected from the Surveillance, Epidemiology, and End Results (SEER) database from 1973 to 2015. Univariate and multivariate Cox proportional hazards (PH) regression analyses were used to generate independent prognostic factors. These variables were included in the nomogram to predict overall survival (OS) and disease-specific survival (DSS) at 1-, 3-, and 5- years. These data are validated both internally and externally. The consistency index (C-index) and calibration chart were used to estimate the accuracy of the nomogram.

The study cohort was randomly divided into the training (n = 2155) and validation group (n = 1799). According to univariate and multivariate analyses, age at diagnosis, marital status, sex, histological differentiation, SEER extent of disease, number of local lymph nodes examined, whether they were positive, and surgical methods were independent prognostic factors for OS and DSS. These factors were incorporated into the nomogram. Internal validation in the training cohort showed that the C-index values for nomogram predictions of OS and DSS were 0.73 (95% CI 0.70–0.76) and 0.77 (95% CI 0.73–0.81), respectively. Similarly, the corresponding C-index values in the external validation cohort were 0.76 (95% CI 0.70–0.81) and 0.75 (95% CI 0.71–0.80). The Calibration plots revealed that the actual survival and nomogram prediction had a good consistency.

Build a nomogram in the SEER database to predict OS and DSS in patients with AMA. It can provide accurate and personalised survival prediction for clinicians and patients.
Evaluation of MRI and CT parameters to analyze the correlation between disc and facet joint degeneration in the lumbar three-joint complex
Authors: Song Quanwei , Liu Xuqiang , Chen De-jian , Lai Qi , Tang Benyu , Zhang Bin , Dai Min , Wan Zongmiao
Published: October 2019

Lumbar 3-joint complex degeneration is a multifactorial, pathological process. Previous studies included insufficient quantitative analyses to prove the relationship between disc degeneration and facet joint osteoarthritis (OA). We assessed the correlation between intervertebral disc and lumbar facet joint degeneration using computed tomography (CT) and magnetic resonance imaging (MRI) parameters.

A total of 152 participants who underwent conventional MRI and CT in the clinostat position were included in this study. The presence of lumbar disc degeneration was identified using the Pfirrmann grading system, and the presence of lumbar facet joint degeneration was identified using the Weishaupt grading system. Facet tropism was defined as a divergence more than 7° between the facet joint angles of both sides at the same segment. The intervertebral disc heights were also measured.

Most facet joint OA probably appeared at the segment with intervertebral disc degeneration of more than grade III. Facet joint OA was significantly exacerbated with the progression of disc degeneration grade. The intervertebral height significantly decreased with the progression of facet joint degeneration grades, except for grades 0 and 1.

Our current study found that each individual joint degeneration influences the other 2 in the lumbar 3-joint complex. Facet tropism was significantly associated with lumbar disc degeneration. Narrowing of the intervertebral disc height probably aggravates the facet joint degeneration further at the same level.
Traumatic spleen rupture diagnosed during postmortem dissection
Authors: Fomin Dmitrij , Chmieliauskas Sigitas , Petrauskas Vidas , Sumkovskaja Alina , Ginciene Karolina , Laima Sigitas , Jurolaic Eleonora , Stasiuniene Jurgita
Published: October 2019

Spleen is typically injured in blunt abdominal trauma. Spleen injuries make 42% of all blunt abdominal injuries. The aim of this study was to perform a retrospective assessment of the cases of acute and subacute isolated traumatic spleen ruptures.

A retrospective study performed on 50 patients, whose cause of death was isolated spleen rupture and bleeding into the abdominal cavity.

An acute spleen rupture was diagnosed in 47 cases, whereas the rest 3 cases demonstrated a subacute rupture. In cases of acute spleen rupture, the mean weight of spleen was 309.6 g, whereas in 3 cases of subacute rupture the mean weight of the organ achieved 710 g. The mean weight of spleen in the control group with no spleen rupture was 144.7 g.

Recording of the cases of isolated acute and subacute traumatic spleen ruptures and morphological assessment of them are important in forensic pathology science and in clinical practice as well.
Incidence and risk factors for epidural morphine induced pruritus in parturients receiving cesarean section
Authors: Tan Xiao , Shen Le , Wang Lin , Labaciren  , Zhang Yuelun , Zhang Xiuhua , Huang Yuguang
Published: October 2019

This study is designed to clarify the incidence of epidural morphine induced pruritus (EMIP) in Chinese Han and Tibetan parturients after cesarean section (CS) and to identify the correlated risk factors.

This is a prospective multicenter observational study. Follow-up evaluations were performed at 3 hours, 6 hours, 12 hours, 24 hours, and 48 hours after morphine administration. The primary outcome was EMIP incidence. Other details were also recorded for risk factor screening.

Totally 284 parturients receiving CS were enrolled and 247 completed the study. The overall incidence of EMIP was 18.6% (46 in 247). The onset of pruritus was 5.6 ± 4.8 hours (mean ± SD) after morphine administration and the duration of pruritus was 14.0 ± 8.8 hours. Logistic regression models was built with 5 variables, history of allergy, serotonin receptor antagonist administration, I.V. fentanyl administration, epidural morphine volume and VAS pain score. Results of showed that 2 of the variables, history of allergy (P < .001) and serotonin receptor antagonist (P < .05), were significantly correlated with incidence of EMIP.

In conclusion, EMIP incidence in our study was 18.6%. Positive medical history of allergy and not using serotonin receptor antagonist were potential risk factors of EMIP development.

Trial registration: ChiCTR-OPC-17012345
A retrospective cohort study of the prevalence of anxiety and agitation in schizophrenic smokers and the unmet needs of smoking cessation programs
Authors: Hassanzadah Mehgan , Bitar Adib H , Khanfar Nile M , Khasawneh Fadi T , Lutfy Kabirullah , Shankar Gollapudi S
Published: October 2019

Achieving abstinence in schizophrenic smokers using a combination of medications and cognitive behavioral therapy is feasible; however, abstinence rates are significantly lower compared to the general population and studies are scanty. Additionally, maintaining sustained abstinence and preventing relapse is a major limiting factor and represents key tasks in managing tobacco dependence in schizophrenic patients. Several theories have been postulated to explain the higher tendency of tobacco use among schizophrenic individuals. Schizophrenic patients may use nicotine as a “self-medication” strategy to improve negative symptoms of schizophrenia. However, studies suggest that although nicotine may act as an anxiolytic acutely, chronic use of nicotine may lead to increased anxiety with the possibility of increased catecholamines, which is confirmed with the prevalence of tachycardia and hypertension in smokers in general. On this basis, the main objective of our present study was to assess anxiety in schizophrenic smoking and nonsmoking patients by comparing the number of anxiety and agitation episodes and evaluating the amount of antianxiety/antiagitation medication used by each group. A separate objective was to document the unmet needs of smoking cessation programs in treating schizophrenic patients. Consequently, in the present retrospective cohort study, it was observed that schizophrenic smokers tend to have higher anxiety episodes and utilize as-needed medications at a higher frequency compared to nonsmokers for the relief of anxiety and agitation symptoms. Further research is warranted to examine these results on a larger scale.
Comparison between an electronic version of the foot and ankle outcome score and the standard paper version
Authors: Park Jae Yong , Kim Bom Soo , Lee Hyun June , Kim Yu Mi , Kim Hyong Nyun , Kang Hwa Jun , Cho Jae Ho , Choi SeongJu , Choi Youngrak
Published: October 2019

To prove the equivalence of the Korean version of the Foot and Ankle Outcome Score (FAOS) in the printed (PFAOS) vs the electronic (EFAOS) form in a multicenter randomized study.

Overall, 227 patients with ages ranging from 20 to 79 years from 16 dedicated foot and ankle centers were included. Patients were randomized into either a ‘paper first’ group (P-F group, n = 113) or an ‘electronic device (tablet computer) first’ group (E-F group, n = 114). The first evaluation either by paper (P-F group) or tablet (E-F group) was followed by a second evaluation the following day. The difference between the PFAOS and EFAOS results in each group was calculated and analyzed. To evaluate the benefit of each methodology, the time consumed per evaluation was compared and patients were asked which methodology they preferred and which was the easiest to use.

There were no significant differences in age or sex between the groups. An intraclass correlation coefficient (ICC) value of 0.934 (95% confidence interval [CI]: 0.912–0.950, P < .001) was confirmed in PFAOS and EFAOS, showing a significant correlation between the 2 methodologies. EFAOS was completed in a shorter amount of time than PFAOS. The majority of patients agreed that EFAOS was easier to complete than PFAOS.

The paper or electronic forms of the Korean adaptation of FAOS were considered equivalent. The shorter time of completion and the preference for the electronic version over paper by patients deems the electronic FAOS a promising option to consider in future.
Spontaneous rupture of the eyeball due to choroidal metastasis of gastric carcinoma
Authors: Wu Shuang-Qing , Li Qiu-Shi , Zhang Yu , Zhu Li-Wei
Published: October 2019

Rationale:

Although metastatic tumor is the most common intraocular malignancy, choroidal metastasis from gastric cancer is relatively rare. We present the exact course of a spontaneous rupture of the eyeball with choroidal metastasis from gastric carcinoma (GC) and the applied surgical interventions.

Patient concerns:

A 59-year-old male presented with pain and vision loss on his left eye for 6 months. He was diagnosed with GC, for which he received systemic chemotherapy for a year.

Diagnoses:

Preoperative B-scan, color fundus photography, computed tomography, and magnetic resonance imaging showed a choroidal tumor in his left eye. The spontaneous rupture of the corneoscleral limbus from 2 to 5 o’clock, combined secondary glaucoma, exudative retinal detachment and choroidal detachment were found.

Interventions:

The ruptured corneoscleral limbus was sutured and the orbit was lavaged with 0.4% cisplatin during the enucleation.

Outcomes:

Histopathology confirmed high homology of the choroidal metastasis and GC. He survived for 2 months after surgery, without pain or orbital neoplasms.

Lessons:

Choroidal metastasis from GC rapidly progressed to spontaneous rupture of the eyeball. Careful eyeball enucleation followed by orbital lavage with chemotherapeutics may reduce metastasis risk beyond the eyeball. Additional therapeutic interventions should be considered in patients resistant to single systemic chemotherapy.
Infectious keratitis secondary to canaliculitis with concretions
Authors: Chou Yu-Pu , Yeh Po-Han , Tsai Yueh-Ju , Yen Chieh-Hung , Hsiao Ching-Hsi
Published: October 2019

Rationale:

Canaliculitis is a frequently overlooked and misdiagnosed disease. Concurrent corneal ulceration with canaliculitis is uncommon. We report such a case.

Patient concerns:

An 87-year-old woman complained of swelling and pain of the right eye after acute angle closure glaucoma attack. Slit-lamp examination was compatible with the features of infectious keratitis, and the cultures from corneal scrapings grew Streptococcus anginosus later. Hourly topical vancomycin (25 mg/ml) was instilled, then the corneal ulceration improved initially but became stationary after 1-week treatment.

Diagnosis:

Discharge from the upper punctum was noted subsequently and canalicular concretions were found through curettage. The cultures from canalicular discharge and concretions also revealed the presence of S. anginosus. Thus, infectious keratitis secondary to canaliculitis was diagnosed.

Interventions:

Canaliculotomy was performed to remove the large concretion and vancomycin was injected locally.

Outcomes:

The corneal ulceration resolved after canaliculitis was appropriately treated.

Lessons:

Canaliculitis could be a reservoir for organisms that may make compromised corneas liable to infections. Only the appropriate diagnosis and aggressive treatment of canaliculitis leads to the eradication of associated corneal infections.
Surgical treatment of pulmonary artery sling and tracheal stenosis with or without tracheoplasty
Authors: Li Dongxu , Zhou Xu , Li Mengsi , Liu Xiaojing
Published: October 2019

Background:

Pulmonary artery sling (PAS) is rare, often with tracheal stenosis. And the postoperative mortality is high. For now, there is no consensus on the tracheoplasty for the patients with PAS and tracheal stenosis.

Methods:

Studies involving surgical repair of PAS and tracheal stenosis with and without tracheoplasty were identified by searching the PubMed, EMBASE, and the Cochrane Library databases until June 5, 2019. The assessed variables included ventilation time, early and late mortality, and symptom at follow-up. A random-effect/fixed-effect model was used to summarize the estimates of the mean difference (MD)/risk ratio (RR) with 95% confidence interval (CI).

Results:

This study will be submitted to a peer-reviewed journal for publication.

Conclusion:

This study will assess the safety and efficacy of tracheoplasty for patients with PAS and tracheal stenosis, and provide more evidence-based guidance in clinical practice.

PROSPERO registration number:

CRD42019139788.
Risk factors for axillary lymph node metastases in clinical stage T1-2N0M0 breast cancer patients
Authors: Zhang Yuanxin , Li Ji , Fan Yuan , Li Xiaomin , Qiu Juanjuan , Zhu Mou , Li Hongjiang
Published: October 2019

Axillary lymph node metastasis (ALNM) is commonly the earliest detectable clinical manifestation of breast cancer when distant metastasis emerges. This study aimed to explore the influencing factors of ALNM and develop models that can predict its occurrence preoperatively.

Cases of sonographically visible clinical stage T1-2N0M0 breast cancers treated with breast and axillary surgery at West China Hospital were retrospectively reviewed. Univariate and multivariate logistic regression analyses were performed to evaluate associations between ALNM and variables. Decision tree analyses were performed to construct predictive models using the C5.0 packages.

Of the 1671 tumors, 541 (32.9%) showed axillary lymph node positivity on final surgical histopathologic analysis. In multivariate logistic regression analysis, tumor size (P < .001), infiltration of subcutaneous adipose tissue (P < .001), infiltration of the interstitial adipose tissue (P = .031), and tumor quadrant locations (P < .001) were significantly correlated with ALNM. Furthermore, the accuracy in the decision tree model was 69.52%, and the false-negative rate (FNR) was 74.18%. By using the error-cost matrix algorithm, the FNR significantly decreased to 14.75%, particularly for nodes 5, 8, and 13 (FNR: 11.4%, 9.09%, and 14.29% in the training set and 18.1%,14.71%, and 20% in the test set, respectively).

In summary, our study demonstrated that tumor lesion boundary, tumor size, and tumor quadrant locations were the most important factors affecting ALNM in cT1-2N0M0 stage breast cancer. The decision tree built using these variables reached a slightly higher FNR than sentinel lymph node dissection in predicting ALNM in some selected patients.
Cholesterol membrane content has a ubiquitous evolutionary function in immune cell activation: the role of HDL
Authors: Bonacina Fabrizia , Pirillo Angela , Catapano Alberico L. , Norata Giuseppe D.
Published: October 2019

Purpose of review

Cellular cholesterol content influences the structure and function of lipid rafts, plasma membrane microdomains essential for cell signaling and activation. HDL modulate cellular cholesterol efflux, thus limiting cholesterol accumulation and controlling immune cell activation. Aim of this review is to discuss the link between HDL and cellular cholesterol metabolism in immune cells and the therapeutic potential of targeting cholesterol removal from cell membranes.

Recent findings

The inverse relationship between HDL-cholesterol (HDL-C) levels and the risk of cardiovascular disease has been recently challenged by observations linking elevated levels of HDL-C with increased risk of all-cause mortality, infections and autoimmune diseases, paralleled by the failure of clinical trials with HDL-C-raising therapies. These findings suggest that improving HDL function might be more important than merely raising HDL-C levels. New approaches aimed at increasing the ability of HDL to remove cellular cholesterol have been assessed for their effect on immune cells, and the results have suggested that this could be a new effective approach.

Cholesterol removal from plasma membrane by different means affects the activity of immune cells, suggesting that approaches aimed at increasing the ability of HDL to mobilize cholesterol from cells would represent the next step in HDL biology.
Vascularized composite allotransplantation versus solid organ transplantation: innate-adaptive immune interphase
Authors: Kadono Kentaro , Gruszynski Mark , Azari Kodi , Kupiec-Weglinski Jerzy W.
Published: October 2019

Purpose of review

Vascularized composite allotransplantation (VCA), a life-enhancing treatment for patients with complex tissue defects, trauma or illness, expounds upon the foundation of solid organ transplantation (SOT), the gold standard in end-stage organ failure. As innate and adaptive immunity remain the fundamental concern, this review highlights divergent immunobiology responses in VCA and SOT recipients.

Recent findings

Host innate immune activation drives peritransplant tissue ischemia–reperfusion injury (IRI). Despite the direct relationship between ischemia–reperfusion (IR)-stress and cell-mediated acute rejection, the mechanism of how IRI may affect VCA loss needs investigation. With skin grafts being highly immunogenic, the incidence of cell-mediated rejection is higher in VCA than SOT; whereas ex-vivo perfusion may exert cytoprotection against IRI in VCA and SOT. New treatment concepts, such as topical immunosuppression or cell-based tolerogenic therapies, may avoid systemic immunosuppression in VCA. Although antibody-mediated rejection is relatively rare in VCA and its disease seems to be distinct from that in SOT, little is known as to whether and how IRI may influence humoral immune rejection cascade in VCA or SOT.

Further understanding of the innate-adaptive immune crosstalk should contribute to much needed development of novel therapies to improve VCA outcomes, based on strategies established in SOT.
When rubber meets the road: how innate features of adaptive immune cells play critical roles in transplant alloimmunity
Authors: Morris Anna B. , Ford Mandy L.
Published: October 2019

Purpose of review

Studies on adaptive cells have largely focused on features that are specific to adaptive immunity. However, adaptive cells utilize innate cell features to modulate their responses, and this area of T and B-cell biology is understudied. This review will highlight recent work done to understand how innate features of adaptive immune cells modulate alloimmunity.

Recent findings

Over the past year, research has shown that T-cell-expressed danger-associated molecular patterns, Toll-like receptors, complement receptors, and Fc receptors regulate T-cell alloimmunity in a cell-intrinsic manner. Further, IL-17 and p40 of IL-12 have been implicated in the migration of T cells into allografts. Lastly, innate B cells, specifically B1 cells, have been shown to produce clinically relevant autoantibody associated with poor graft outcome.

These data provide evidence that innate features are utilized by adaptive immune cells to control adaptive alloimmunity.
The Nasolabial Fold: A Micro–Computed Tomography Study
Authors: Kwon Hyun-Jin , O Jehoon , Cho Tae-Hyeon , Choi You-Jin , Yang Hun-Mu
Published: October 2019

Background:

The nasolabial fold is known to be a challenging midface feature for aesthetic physicians. However, the steric conformation of the structures related to the nasolabial fold has remained undefined because the composition and topography of this region are highly intricate. Therefore, this study aimed to clarify the three-dimensional structures of the nasolabial fold using micro–computed tomography and verify their detailed composition by means of histologic observation.

Methods:

Twenty-four specimens were collected from the area beside the alae nasi to the area above the oral angle of 12 cadavers (mean age, 80.3 years) bilaterally. Twelve specimens were evaluated by means of phosphotungstic acid contrast staining, and the rest were evaluated by means of histologic staining. All specimens were divided into three regions and analyzed comprehensively.

Results:

The medial region of the nasolabial fold had dense irregular connective tissue intermingled with muscle fibers; the lateral region of the nasolabial fold had numerous fibrous septa with abundant adipose tissue. The levator labii alaeque nasi and the zygomaticus minor were attached to the medial part of the nasolabial fold, and the fascial septa were intermittently tethered to the dermis, lateral to the nasolabial fold. The extension of the adipose tissue within the fascial septa was limited by the lateral border of the muscle attachment.

Conclusions:

Dimensional and distributional alterations of the adipose tissues with senescence could render the nasolabial fold deeper by increasing the depth of the subcutaneous layer, lateral to the fold. Thus, to ameliorate the fold, the adipose tissue, lateral to the fold, or the muscle traction, medial to the fold, should be altered.
Does Breast Implant–Associated ALCL Begin as a Lymphoproliferative Disorder?
Authors: Kadin Marshall E. , Adams William P. , Inghirami Giorgio , Di Napoli Arianna
Published: October 2019

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) has been included as a provisional entity in the revised version of the World Health Organization Classification of Tumors of Haematopoietic and Lymphoid Tissue. To increase opportunities to intervene with early diagnosis, treatment, and possible prevention, it is important to consider that BIA-ALCL may evolve from a preexisting lymphoproliferative disorder characterized by (1) an indolent localized (in situ) disease in approximately 80 percent of reported cases; (2) a requirement for external cytokine stimulation for cell survival; (3) CD30+ cells in some clinically benign seromas/capsules; (4) undetected T-cell clonality in some cases; (5) JAK/STAT mutations in only a minority of cases; and (6) cure by capsulectomy and implant removal in most cases. BIA-ALCL resembles CD30+ cutaneous lymphoproliferative disorder: ALK−, CD30+ anaplastic cells with an aberrant T-cell phenotype; overexpression of oncogenes (JUNB, SATB1, pSTAT3, SOCS3) in lymphomatoid papulosis; frequent apoptosis; complete spontaneous regression in lymphomatoid papulosis; and partial spontaneous regression in cutaneous ALCL. Unlike CD30+ cutaneous lymphoproliferative disorder, BIA-ALCL cannot be readily observed over time to study the different steps in progression to ALCL. BIA-ALCL also shares features of lymphomas of mucosa-associated lymphoid tissue, which are clinically indolent, initially localized, antigen driven, and caused by Gram-negative bacteria. Further studies of cytokines, clonality, mutations, and other biomarkers are needed to identify possible premalignant steps in the evolution of benign late seromas to BIA-ALCL.