bluuebunny/crossref_metadata_2025 huggingface dataset:
Reflex impairment, physiological stress, and discard mortality of European plaice Pleuronectes platessa in an otter trawl fishery
Authors: Methling Caroline , Skov Peter V. , Madsen Niels
Published: January 2017

The reformed European Common Fisheries Policy introduced a discard ban, with a possibility of exempting species where a high discard survival can be demonstrated. This necessitates a validation of the methods used for estimating the discard mortality of candidate species. In this study, we assess whether reflex impairment can predict short-term mortality in commercially trawled European plaice upon landing and after air exposure of up to 90 min. Sub-lethal stress was assessed by a suite of physiological variables. Over a 10-day period, mortality was monitored for a total of 199 plaice following trawl and air exposure of varying duration, and for 50 control fish scored for reflex impairment on board the vessel. Mortality was only observed in fish exposed to air for >60 min, and averaged 11.1% (95% CI = 7.1–16.3%). Reflex impairment was found to be a significant (P < 0.001) predictor of mortality in a generalized linear model, excluding other initially included variables by using a stepwise method. Plasma cortisol, haematocrit, and plasma osmolality all indicated a profound and increasing level of stress with air exposure, accompanied by a near depletion of muscle phosphocreatine and nucleotides. Fishing site had an unexpected, but significant (p < 0.05) effect on stress levels, which was also reflected in reflex impairment and mortality. Based on these findings, a possible exemption from the discard ban should include considerations on the duration of air exposure.
Movement patterns in women at risk for perinatal depression: use of a
mood-monitoring mobile application in pregnancy
Authors: Faherty Laura J , Hantsoo Liisa , Appleby Dina , Sammel Mary D , Bennett Ian M , Wiebe Douglas J
Published: January 2017

Objectives: To examine, using a smartphone application, whether mood is related to daily movement patterns in pregnant women at risk for perinatal depression.

Materials and Methods: Thirty-six women with elevated depression symptoms (PHQ-9 ≥ 5) in pregnancy used the application for 8 weeks. Mood was reported using application-administered surveys daily (2 questions) and weekly (PHQ-9 and GAD-7). The application measured daily mobility (distance travelled on foot) and travel radius. Generalized linear mixed-effects regression models estimated the association between mood and movement.

Results: Women with milder depression symptoms had a larger daily radius of travel (2.7 miles) than women with more severe symptoms (1.9 miles), P = .04. There was no difference in mobility. A worsening of mood from the prior day was associated with a contracted radius of travel, as was being in the group with more severe symptoms. No significant relationships were found between anxiety and either mobility or radius.

Discussion: We found that the association of mood with radius of travel was more pronounced than its association with mobility. Our study also demonstrated that a change in mood from the prior day was significantly associated with radius but not mood on the same day that mobility and radius were measured.

Conclusion: This study lays the groundwork for future research on how smartphone mood-monitoring applications can combine actively and passively collected data to better understand the relationship between the symptoms of perinatal depression and physical activity that could lead to improved monitoring and novel interventions.
Airway Management With a Stereotactic Headframe In Situ—A Mannequin Study
Authors: Brockerville Melissa , Unger Zoe , Rowland Nathan C. , Sammartino Francesco , Manninen Pirjo H. , Venkatraghavan Lashmi
Published: January 2017

Background:

Stereotactic headframe-based imaging is often needed for target localization during surgery for insertion of deep brain stimulators. A major concern during this surgery is the need for emergency airway management while an awake or sedated patient is in the stereotactic headframe. The aim of our study was to determine the ease of emergency airway management with a stereotactic headframe in situ.

Materials and Methods:

We conducted an observational study using a mannequin. A Leksell stereotactic headframe was placed on a mannequin in the operating room and the frame was fixed to the operating room table. Anesthesia personnel were asked to insert a #4 laryngeal mask and then to intubate the mannequin, using both direct (DL) and video laryngoscopy (VL). In addition, participants were asked to perform the same airway techniques in the mannequin without the headframe. Data were analyzed for time taken for airway management using different devices with and without the headframe. In addition, we compared the time taken to secure the airway between different participant groups.

Results:

Thirty anesthesia personnel (7 residents, 12 fellows, and 11 consultants) participated in the study. With the headframe in situ, 97% of participants were able to insert a laryngeal mask on their first attempt; 93% and 97% of participants were able to intubate the mannequin using DL and VL respectively on their first attempt. Without the stereotactic headframe, all participants were able to insert the laryngeal mask and intubate on the first attempt. The average time taken to insert a laryngeal mask and intubate the mannequin using DL and VL with the headframe in situ was 39.3, 58.6, and 54.8 seconds, respectively.

Conclusions:

Our study showed that both laryngeal mask insertion and tracheal intubation can be performed with a stereotactic headframe in situ. A laryngeal mask is the quickest airway device to insert and can be inserted while the mannequin is in the standard surgical position. Further study is needed to validate the results in patients.
Surgery for Refractory Coccygodynia
Authors: Kleimeyer John P. , Wood Kirkham B. , Lønne Greger , Herzog Tyler , Ju Kevin , Beyer Lisa , Park Christine
Published: January 2017

Study Design.

This is a retrospective cohort study.

Objective.

To evaluate the long-term outcomes for patients with refractory coccygodynia treated with coccygectomy compared to a nonsurgical regimen of sitting aids, physical therapy, medications, and injections.

Summary of Background Data.

The surgical treatment of coccygodynia remains controversial. To date, there has only been one small comparative study of surgical versus nonsurgical treatment.

Methods.

From 2004 to 2014, 109 patients presenting with coccygodynia were treated with either total coccygectomy or a nonsurgical course of sitting aids, physical therapy, anti-inflammatory medications, and injections. All had at least 2 years of symptoms before surgery. The patient principally made the treatment decision, counseled by the treating physician. Before surgery, all subjects underwent at least 2 years of conservative treatment and three-dimensional imaging (computed tomography and/or magnetic resonance imaging). Subjects completed visual analog pain scales, EuroQol five-dimension, components of the PROMIS measure, and a novel Coccygodynia Disability Index evaluation. Work status, complications, and satisfaction were recorded.

Results.

A total of 61 patients received nonsurgical care; eight declined participation and five could not be located. Forty-eight patients underwent total coccygectomy; three declined participation and five could not be located. At an average 4.8 years of follow-up (range: 2–9), the nonsurgical visual analog pain scales was 5 and the surgical 2 (P = 0.001); 79% of surgically treated patients were improved at 2 years versus 43% for the nonsurgical group. EuroQol five-dimension (P = 0.002), Coccygodynia Disability Index (0.01), and PROMIS Pain interference scores (0.02) were also significantly improved in the surgical group. Eleven surgical patients (26%) had complications, all wound related with successful resolution; seven treated with dressing changes and four with surgical debridement.

Conclusion.

Total coccygectomy is a safe and effective surgical treatment of coccygodynia refractory to nonoperative care. Patient-reported outcome measures were improved after surgery compared with nonsurgical management. Postoperative wound care remains a concern.

Level of Evidence: 4
Long-term Pulmonary Function After Open Anterior Thoracolumbar Surgery in Thoracolumbar/Lumbar Idiopathic Adolescent Scoliosis
Authors: Ruiz-Juretschke Cristina , Pizones Javier , Delfino Renato , Sánchez-Mariscal Felisa , Zúñiga Lorenzo , Izquierdo Enrique
Published: January 2017

Study Design.

A prospectively updated, long-term case series analysis.

Objective.

The aim of this study was to report the effect of thoracolumbar anterior open surgery performed during adolescence on adult pulmonary function.

Summary of Background Data.

There seems to be subclinical impairment of pulmonary function in the mid-term (2–5 years) in patients who underwent thoracotomy or thoraco-phreno-laparotomy after adolescent idiopathic scoliosis (AIS) surgery. However, long-term results when patients reach adulthood are lacking.

Methods.

Prospective data of pulmonary function tests (PFTs) on adult patients who underwent anterior open surgery during adolescence due to main thoracolumbar/lumbar curves were collected. Forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and the Tiffeneau index (TI: FEV1/FVC) with a 12-year minimum follow-up were recorded. These figures were compared with reference (predicted) values and preoperative data.

Results.

Twenty-four patients were included. All patients had undergone a thoraco-phreno-laparotomy. None of the patients had pulmonary disease. Mean age was 15.83 years at the time of surgery and the mean follow-up was 18.26 years (12–29 years).

Long-term results of the 24 operated patients (mean ± SD: FVC = 3.3 ± 0.39; FEV1 = 2.6 ± 0.38; TI = 80.3 ± 5.7) showed a similar FVC and slightly worse FEV1 than reference values (FVC = 3.4 ± 0.48; FEV1 = 3.03 ± 0.42; TI = 82.4 ± 1.3), (P = 0.21; P = 0.02; P = 0.3, respectively). Nevertheless, the values were within the normal percent-predicted range for FVC (93.5% ± 11.2) and FEV1 (91.4% ± 12.8). In 14 patients, long-term figures (median ± IQR): FVC = 3.2 ± 0.6; FEV1 = 2.54 ± 0.42; TI = 81.5 ± 11.2) were compared with preoperative values (median ± IQR: FVC = 2.9 ± 0.8; FEV1 = 2.47 ± 0.93; TI = 84.8 ± 34.2), (P = 0.08, P = 0.92, P = 0.026, respectively). Only the TI showed significant differences due to disproportionate improvement of FVC and FEV1 during the follow-up years.

Conclusion.

Thoracolumbar/lumbar AIS patients who underwent a thoraco-phreno-laparotomy during adolescence showed, in the long-term (18 years follow-up), a similar FVC compared with the reference values that was slightly superior than the values before surgery. Despite the lower FEV1 than the reference values and taking into consideration our limitations, the percent-predicted values were within the normal range, indicating no major pulmonary impairment in the long run.

Level of Evidence: 4
Risk Factors for Recurrence After Laparoscopic Ventral Rectopexy
Authors: Fu Cherylin W. P. , Stevenson Andrew R. L.
Published: January 2017

BACKGROUND:

Laparoscopic ventral rectopexy effectively treats posterior compartment prolapse. However, recurrence after laparoscopic ventral rectopexy is poorly understood.

OBJECTIVE:

This study aimed to evaluate factors contributing to recurrence after laparoscopic ventral rectopexy.

DESIGN:

A retrospective cohort analysis was performed of patients who underwent laparoscopic ventral rectopexy between June 2008 and June 2014. Patients presenting with full-thickness rectal prolapse were compared against the rest. Cox proportional hazards regression was used to determine predictors for recurrence. Operative findings of redo cases were evaluated.

SETTINGS:

This study was conducted under the supervision of a single pelvic floor surgeon.

PATIENTS:

A total of 231 patients with a median follow-up of 47 months were included.

MAIN OUTCOME MEASURES:

Clinicopathological risk factors and technical failures contributing to recurrence were analyzed.

RESULTS:

The overall recurrence rate was 11.7% (n = 27). Twenty-five recurrences occurred in patients with full-thickness rectal prolapse, of which 16 were full-thickness recurrences (14.2% (16/113)). Multivariate analyses showed predictors for recurrence to be prolonged pudendal nerve terminal motor latency (HR = 5.57 (95% CI, 1.13 – 27.42); p = 0.04) and the use of synthetic mesh as compared with biologic grafts (HR = 4.24 (95% CI, 1.27–14.20); p = 0.02). Age >70 years and poorer preoperative continence were also associated with recurrence on univariate analysis. Technical failures contributing to recurrence included mesh detachment from the sacral promontory and inadequate midrectal mesh fixation.

LIMITATIONS:

Modifications to the operative technique were made throughout the study period. A postoperative defecating proctogram was not routinely performed.

CONCLUSIONS:

Recurrence after laparoscopic ventral rectopexy is multifactorial, and risk factors are both clinical and technical. The use of biologic grafts was associated with lower recurrence as compared with synthetic mesh. Patients with full-thickness rectal prolapse who are elderly, have poorer baseline continence, and have prolonged pudendal nerve terminal motor latency are at increased risk of recurrence.
Quality Improvement Initiatives in Colorectal Surgery: Value of Physician Feedback
Authors: Waters Joshua A. , Francone Todd , Marcello Peter W. , Roberts Patricia L. , Schoetz David J. , Read Thomas E. , Stafford Caitlin , Ricciardi Rocco
Published: January 2017

BACKGROUND:

The impact of process improvement through surgeon feedback on outcomes is unclear.

OBJECTIVE:

We sought to evaluate the effect of biannual surgeon-specific feedback on outcomes and adherence to departmental and Surgical Care Improvement Project process measures on colorectal surgery outcomes.

DESIGN:

This was a retrospective analysis of prospectively collected 100% capture surgical quality improvement data.

SETTING:

This study was conducted at the department of colorectal surgery at a tertiary care teaching hospital from January 2008 through December 2013.

MAIN OUTCOME MEASURES:

Each surgeon was provided with biannual feedback on process adherence and surgeon-specific outcomes of urinary tract infection, deep vein thrombosis, surgical site infection, anastomotic leak, 30-day readmission, reoperation, and mortality. We recorded adherence to Surgical Care Improvement Project process measures and departmentally implemented measures (ie, anastomotic leak testing) as well as surgeon-specific outcomes.

RESULTS:

We abstracted 7975 operations. There was no difference in demographics, laparoscopy, or blood loss. Adherence to catheter removal increased from 73% to 100% (p < 0.0001), whereas urinary tract infection decreased 52% (p < 0.01). Adherence to thromboprophylaxis administration remained unchanged as did the deep vein thrombosis rate (p = not significant). Adherence to preoperative antibiotic administration increased from 72% to 100% (p < 0.0001), whereas surgical site infection did not change (7.6%–6.6%; p = 0.3). There were 2589 operative encounters with anastomoses. For right-sided anastomoses, the proportion of handsewn anastomoses declined from 19% to 1.5% (p < 0.001). For left-sided anastomoses, without diversion, anastomotic leak testing adherence increased from 88% to 95% (p < 0.01). Overall leak rate decreased from 5.2% to 2.9% (p < 0.05).

LIMITATIONS:

Concurrent process changes make isolation of the impact from individual process improvement changes challenging.

CONCLUSIONS:

Nearly complete adherence to process measures for deep vein thrombosis and surgical site infection did not lead to measureable outcomes improvement. Process measure adherence was associated with decreased rate of anastomotic leak and urinary tract infection. Biannual surgeon-specific feedback of outcomes was associated with improved process measure adherence and improvement in surgical quality.
Ultrasound in Infertility Treatments
Authors: KLENOV VIOLET E. , VAN VOORHIS BRADLEY J.
Published: January 2017

Ultrasound (US) is very useful in diagnosing causes of infertility. Pelvic masses, mullerian anomalies, ovarian reserve, and tubal patency can all be assessed using ultrasonographic techniques. US has also proven to be a very useful aid in managing infertility treatments. In this chapter, we review the uses of US in monitoring follicular development, assessing the endometrium during treatment, and as an aid to embryo transfer during in vitro fertilization.
A Developmental Perspective on Social-Cognition Difficulties in Youth at Clinical High Risk for Psychosis
Authors: Lincoln Sarah Hope , Norkett Emily M. , Frost Katherine H. , Gonzalez-Heydrich Joseph , D’Angelo Eugene J.
Published: January 2017

Learning objectives

After participating in this activity, learners should be better able to:

• Evaluate the evolution of social cognitive abilities as a developmental process

• Assess the evidence regarding social cognition difficulties in youth at clinical high risk for psychosis

Individuals at clinical high risk (CHR) for psychosis exhibit a broad range of difficulties, including impaired social cognition, which may represent a target for early identification and intervention. Several studies have examined various domains of social cognition in CHR individuals. Most focus on adolescent and young adult populations, but given the accumulating evidence that impairment exists before the onset of psychotic disorders, it is critically important to begin to look for these risk markers in younger children. The present article reviews 25 studies on CHR that examine any of the following four domains of social cognition: emotion processing, theory of mind, social perception, or attribution bias. Eligible studies were identified through a comprehensive literature search, conducted using electronic databases, including PubMed/MEDLINE and PsycINFO, and combinations of key social-cognition and CHR search terms. Despite some mixed results, the existing literature establishes that CHR individuals display social-cognitive impairment, though it remains unclear as to how and when that impairment develops. Thus, by using the literature on social cognition in typically developing children as a model and reference, and by looking at the evolution of social-cognitive abilities as a developmental process, our review presents a valuable new perspective that indicates the necessity of further investigation in younger, at-risk populations. Implications for treatment and future research are discussed.
Late Functional Changes Post–Severe Traumatic Brain Injury Are Related to Community Reentry Support: Results From the PariS-TBI Cohort
Authors: Jourdan Claire , Bayen E. , Vallat-Azouvi C. , Ghout I. , Darnoux E. , Azerad S. , Charanton J. , Aegerter P. , Pradat-Diehl P. , Ruet A. , Azouvi P.
Published: January 2017

Objectives:

To explore late functional changes after a traumatic brain injury and their relation to patients' characteristics and reentry support.

Design:

Prospective follow-up of an inception cohort of adults with severe traumatic brain injury recruited in 2005-2007 in the Parisian area, France. One and 4-year assessments were performed by trained neuropsychologists. One-to-4-year change in the Glasgow Outcome Scale—Extended defined 3 groups: “improvement,” “stability,” and “worsening.” Relationships between these groups and patients' characteristics were analyzed.

Results:

Among 504 recruited patients and 245 four-year survivors, 93 participated in both evaluations. Overall Glasgow Outcome Scale—Extended improved by 0.4. Forty percent of the sample improved, 44% were stable, and 16% worsened. Being in a more unfavorable group was related to preinjury alcohol abuse and to higher anxiety and depression at 4 years. Attendance to a specialized community reentry unit was related to higher chances of being in the “improvement” group in univariate analyses and after adjustment for age, time to follow command, preinjury alcohol and occupation, and mood disorders (adjusted odds ratio [OR] = 4.6 [1.1-20]).

Conclusion:

Late functional changes were related to psychosocial variables and to reentry support. The effect of reentry support on late recovery needs to be confirmed by further investigations.
Catechol-O-Methyltransferase Genotypes and Parenting Influence on Long-Term Executive Functioning After Moderate to Severe Early Childhood Traumatic Brain Injury: An Exploratory Study
Authors: Kurowski Brad G. , Treble-Barna Amery , Zang Huaiyu , Zhang Nanhua , Martin Lisa J. , Yeates Keith Owen , Taylor H. Gerry , Wade Shari L.
Published: January 2017

Objectives:

To examine catechol-O-methyltransferase (COMT) rs4680 genotypes as moderators of the effects of parenting style on postinjury changes in parent behavior ratings of executive dysfunction following moderate to severe early childhood traumatic brain injury.

Setting:

Research was conducted in an outpatient setting.

Participants:

Participants included children admitted to hospital with moderate to severe traumatic brain injury (n = 55) or orthopedic injuries (n = 70) between ages 3 and 7 years.

Design:

Prospective cohort followed over 7 years postinjury.

Main Measures:

Parenting Practices Questionnaire and the Behavior Rating Inventory of Executive Functioning obtained at baseline, 6, 12, and 18 months, and 3.5 and 6.8 years postinjury. DNA was collected from saliva samples, purified using the Oragene (DNA Genotek, Ottawa, Ontario, Canada) OG-500 self-collection tubes, and analyzed using TaqMan (Applied Biosystems, Thermo Fisher Scientific, Waltham, Massachusetts) assay protocols to identify the COMT rs4680 polymorphism.

Results:

Linear mixed models revealed a significant genotype × parenting style × time interaction (F = 5.72, P = .02), which suggested that the adverse effects of authoritarian parenting on postinjury development of executive functioning were buffered by the presence of the COMT AA genotype (lower enzyme activity, higher dopamine levels). There were no significant associations of executive functioning with the interaction between genotype and authoritative or permissive parenting ratings.

Conclusion:

The lower activity COMT rs4680 genotype may buffer the negative effect of authoritarian parenting on long-term executive functioning following injury in early childhood. The findings provide preliminary evidence for associations of parenting style with executive dysfunction in children and for a complex interplay of genetic and environmental factors as contributors to decreases in these problems after traumatic injuries in children. Further investigation is warranted to understand the interplay among genetic and environmental factors related to recovery after traumatic brain injury in children.
Corneal Endothelial Cell Density and Morphology in Different Trimesters of Pregnancy
Authors: Örnek Nurgül , Özcan Dağ Zeynep , Örnek Kemal
Published: January 2017

Objectives:

To evaluate corneal endothelial cell density (CD) and morphology in different trimesters of pregnancy.

Methods:

This prospective study included 66 (66 eyes) pregnant women. The patient group was divided into three subgroups comprised of 22 women in the first, second, and third trimesters of pregnancy. An age-matched group of 22 (22 eyes) volunteers served as controls. Corneal measurements were performed using specular microscopy (Noncon Robo SP8000, Konan Medical). Central corneal thickness (CCT) and CD, hexagonal cell ratio (HEX), and coefficient of variation (CV) of the corneal endothelial cell layer of the patients were measured at each trimester.

Results:

Central corneal thickness did not change significantly during the pregnancy compared to controls (P>0.05). Endothelial CD was decreased in the first trimester and increased in the second and third trimesters, but the difference was not significant (P>0.05). Hexagonal cell ratio was decreased significantly in the first trimester (P<0.05). There was an increase in the second and third trimesters, which was not statistically significant (P>0.05). Coefficient of variation was increased significantly in the first trimester and showed a significant decrease in the second and third trimesters (P<0.05, respectively). Endothelial CD had a significant positive correlation with CV and HEX had a negative correlation with CV in the second trimester (r=0.438, P=0.041 and r=−0.822, P<0.001, respectively).

Conclusion:

Central corneal thickness and endothelial CD did not change significantly throughout the pregnancy. Hexagonal cell ratio and CV showed a significant but transient increase in the first trimester.
Corneal Densitometry as a Tool to Measure Epithelial Ingrowth After Laser In Situ Keratomileusis
Authors: Adran Daniel , Vaillancourt Louis , Harissi-Dagher Mona , Kruh Jonathan N. , Syed Zeba A. , Robinson Steven , Melki Samir
Published: January 2017

Purpose:

This study evaluates the correlation between corneal densitometry and epithelial ingrowth (EI) after laser in situ keratomileusis (LASIK).

Methods:

Corneal densitometry of 3 patients who developed EI after LASIK was measured with the Oculus Pentacam. Corneal densitometry readings of each patient were obtained preoperatively and postoperatively after ingrowth was discovered. Densitometry was recorded at the central nest of opacity and at the leading edges of EI.

Results:

For all patients, the most severe stages of EI observed on slit-lamp photographs correlated with the highest densitometry readings, with peak densitometry ranging from 73.3 to 95.1. These values were much higher than preoperative densitometry readings, which ranged from 21.8 to 27.2. In 2 cases, the Pentacam densitometry map revealed progression of EI toward the visual axis that was only faintly detectable or not detectable at all on the corresponding slit-lamp photographs.

Conclusions:

Corneal densitometry seems to be an objective measure of the severity and progression of EI after LASIK.
Kinetics of Angiogenic Responses in Corneal Transplantation
Authors: Inomata Takenori , Mashaghi Alireza , Di Zazzo Antonio , Lee Sang-Mok , Chiang Homer , Dana Reza
Published: January 2017

Purpose:

To delineate and compare the kinetics of corneal angiogenesis after high-risk (HR) versus low-risk (LR) corneal transplantation.

Methods:

In mice, intrastromal sutures were placed in the recipient graft bed 2 weeks before allogeneic transplantation to induce angiogenesis and amplify the risk of graft rejection. Control (LR) graft recipients did not undergo suture placement, and thus the host bed remained avascular at the time of transplantation. Graft hemangiogenesis and opacity scores were evaluated for 8 weeks by slit-lamp biomicroscopy. Immunohistochemistry was used to measure CD31high (blood vessels) and LYVE-1high (lymphatic vessels) cells.

Results:

Biphasic kinetics were observed for hemangiogenesis in both HR and LR transplant recipients using clinical and immunohistochemical assessments. The biphasic kinetics were composed of a rise–fall (phase 1) followed by a second rise (phase 2) in the degree of vessels. Compared with LR recipients, HR recipients showed higher hemangiogenesis (whole cornea and graft) throughout 8 weeks. Analyzing grafts revealed sustained presence of lymphatic vessels in HR recipients; however, lymphatic neovessels regressed in LR recipients 2 weeks posttransplantation. In contrast to HR host beds, the LR host bed microenvironment cannot sustain the growth of lymphatic neovessels in allografts, whereas it can sustain continued hemangiogenesis.

Conclusions:

The sustained presence of lymphatic vessels in HR host beds can facilitate host immunity against allografts and is likely associated with ongoing higher risk of rejection of these grafts in the long term, suggesting that therapeutic interventions targeting inflammation and lymphatic vessels need to be sustained long term in the HR corneal transplant setting.
Effectiveness of Palivizumab in High-risk Infants and Children
Authors: Anderson Evan J. , Carosone-Link Phyllis , Yogev Ram , Yi Jumi , Simões Eric A. F.
Published: January 2017

Background:

Infants with premature birth ≤35 weeks gestational age, chronic lung disease of prematurity and congenital heart disease are at an increased risk for lower respiratory tract infections and hospitalization from respiratory syncytial virus (RSV), which has been shown in randomized trials to be prevented by palivizumab. However, palivizumab effectiveness (PE) has not been studied in a large clinical setting.

Methods:

A multicenter study among high-risk US and Canadian children younger than 24 months hospitalized with lower respiratory tract infection and whose nasopharyngeal aspirates were tested for human metapneumovirus (HMPV) and RSV were the subjects of the trial. We conducted a test-negative case–control study in these subjects to determine PE. We used an inverse propensity score weighted (IPSW) multiple logistic regression model to adjust PE.

Results:

Palivizumab was used in 434 (51%) of 849 eligible children. RSV was identified in 403 (47%) children. The unadjusted PE was 43% [95% confidence interval (CI), 34%–51%)]. After IPSW adjustment, the adjusted PE was 58% (95% CI, 43%–69%). Palivizumab prevented intensive care unit admissions (PE, 62%; 95% CI, 35%–78%). PE for 29–35 weeks gestational age and ≤6 months of chronologic age without chronic lung disease of prematurity or congenital heart disease was 74% (95% CI, 56%–85%).

Conclusions:

Using a test-negative case–control design with RSV molecular detection, palivizumab is shown to prevent RSV hospitalizations and intensive care unit admissions in high-risk infants.
Unsuspected Conjunctival Orbital Dermoid Cyst: Aids in Diagnosis
Authors: Jakobiec Frederick A. , Zakka Fouad R. , Lorch Alice
Published: January 2017

A 25-year-old man with Type 1 diabetes mellitus experienced rapid visual decline and was scheduled for right cataract surgery. At the time of administering an inferotemporal retrobulbar block, a white discharge appeared spontaneously on the surface of the globe. Superotemporally a cyst was found and its contents were subtotally evacuated. Microscopically, eosinophilic, acellular material with chatter artifact and small vacuoles was detected and initially thought to represent a lens choristoma. This material stained moderately with the periodic acid Schiff method and was focally Congo red positive without apple green birefringence; it also stained blue with the Masson trichrome method. Acid-fast staining disclosed the presence of rare vellous hairs. Adherent cells were not epidermal cells (CK5/6−) but conjunctival epithelial cells (CK7+); CD68-positive histiocytes were also identified. The lesion was diagnosed as a disrupted orbital dermoid cyst of conjunctival origin.
Impact of the Opioid Safety Initiative on opioid-related prescribing in veterans
Authors: Lin Lewei A. , Bohnert Amy S.B. , Kerns Robert D. , Clay Michael A. , Ganoczy Dara , Ilgen Mark A.
Published: January 2017

The Veterans Health Administration (VHA) designed the Opioid Safety Initiative (OSI) to help decrease opioid prescribing practices associated with adverse outcomes. Key components included disseminating a dashboard tool that aggregates electronic medical record data to audit real-time opioid-related prescribing and identifying a clinical leader at each facility to implement the tool and promote safer prescribing. This study examines changes associated with OSI implementation in October 2013 among all adult VHA patients who filled outpatient opioid prescriptions. Interrupted time series analyses controlled for baseline trends and examined data from October 2012 to September 2014 to determine the changes after OSI implementation in prescribing of high-dosage opioid regimens (total daily dosages >100 morphine equivalents [MEQ] and >200 MEQ) and concurrent benzodiazepines. Across VHA facilities nationwide, there was a decreasing trend in high-dosage opioid prescribing with 55,722 patients receiving daily opioid dosages >100 MEQ in October 2012, which decreased to 46,780 in September 2014 (16% reduction). The OSI was associated with an additional decrease, compared to pre-OSI trends, of 331 patients per month (95% confidence interval [CI] −378 to −284) receiving opioids >100 MEQ, a decrease of 164 patients per month (95% CI −186 to −142) receiving opioids >200 MEQ, and a decrease of 781 patients per month (95% CI −969 to −593) receiving concurrent benzodiazepines. Implementation of a national health care system-wide initiative was associated with reductions in outpatient prescribing of risky opioid regimens. These findings provide evidence for the potential utility of large-scale interventions to promote safer opioid prescribing.
Sex-Specific Associations Between Self-reported Sleep Duration, Cardiovascular Disease, Hypertension, and Mortality in an Elderly Population
Authors: Broström Anders , Wahlin Ake , Alehagen Urban , Ulander Martin , Johansson Peter
Published: January 2017

Background:

Both short and long sleep durations have been associated to increased mortality. Knowledge about sex-specific differences among elderly regarding associations between sleep duration, cardiovascular health, and mortality is sparse.

Objective:

The aims of this study are to examine the association between self-reported sleep duration and mortality and to investigate whether this association is sex specific and/or moderated by cardiovascular morbidity, and also to explore potential mediators of sleep duration effects on mortality.

Methods:

A population-based, observational, cross-sectional design with 6-year follow-up with mortality as primary outcome was conducted. Self-rated sleep duration, clinical examinations, echocardiography, and blood samples (N-terminal fragment of proBNP) were collected. A total of 675 persons (50% women; mean age, 78 years) were divided into short sleepers (≤6 hours; n = 231), normal sleepers (7–8 hours; n = 338), and long sleepers (≥9 hours; n = 61). Data were subjected to principal component analyses. Cardiovascular disease (CVD) and hypertension factors were extracted and used as moderators and as mediators in the regression analyses.

Results:

During follow-up, 55 short sleepers (24%), 68 normal sleepers (20%), and 21 long sleepers (34%) died. Mediator analyses showed that long sleep was associated with mortality in men (hazard ratio [HR], 1.8; P = .049), independently of CVD and hypertension. In men with short sleep, CVD acted as a moderator of the association with mortality (HR, 4.1; P = .025). However, when using N-terminal fragment of proBNP, this effect became nonsignificant (HR, 3.1; P = .06). In woman, a trend to moderation involving the hypertension factor and short sleep was found (HR, 4.6; P = .09).

Conclusion:

Short and long sleep duration may be seen as risk markers, particularly among older men with cardiovascular morbidity.
Successful Loading of a Bone-Anchored Hearing Implant at 1 Week After Surgery
Authors: Høgsbro Morten , Agger Andreas , Johansen Lars Vendelbo
Published: January 2017

Objective:

To assess implant stability and safety of loading a bone-anchored implant 1 week after surgery. The patients were loaded at 1 week for fast rehabilitation and ease of logistics.

Design:

Single center, prospective cohort study of 25 adults with expected normal skin and bone quality.

Intervention:

Implantation of the Baha BA400 implant system using a linear incision technique without skin thinning. Abutment lengths of 8, 10, and 12 mm were used.

Main Outcome Measures:

Implant stability quotient (ISQ) 0, 7, 14, 30 days and 3, 6, and 12 months postoperatively.

Results:

Twenty-five patients were included, 23 could be followed up for 1 year. Mean ISQ was increasing throughout the observation period with no sign of adverse influence from the early loading. No implants were lost or clinically unstable. Individual ISQ curves fall in two categories—continually increasing ISQ or increasing ISQ with initial dip. ISQ for patients in the initial dip group eventually increased despite the early and continued loading.

Conclusion:

Loading of the implant system under study 1 week after surgery have been successful for 25 patients with expected normal bone quality followed up for 1 year. No implants were lost. All individual ISQ were increasing throughout the study period. The early loading of the implant under study does not seem to influence the osseointegration.
Efficacy, Safety, and Outcomes of Endoscopic Retrograde Cholangiopancreatography With Per-Oral Pancreatoscopy
Authors: Parbhu Sheeva K. , Siddiqui Ali A. , Murphy Megan , Noor Arish , Taylor Linda J. , Mills Alyssa , Adler Douglas G.
Published: January 2017

Introduction:

Per-oral pancreatoscopy can be used for both evaluation and treatment of pancreatic duct stones during endoscopic retrograde cholangiopancreatography, evaluating and treating pancreatic duct strictures of indeterminate etiology, and visual inspection and direct biopsy of pancreatic duct mucosa for diagnosis of intraductal papillary mucinous neoplasm (IPMN). We aim to describe the efficacy, safety, and outcomes of pancreatoscopy in a large, multicenter series of patients.

Materials and Methods:

A multicenter retrospective review was conducted of all patients who underwent per-oral pancreatoscopy at 2 large tertiary-care medical centers. Review of relevant medical records, laboratory data, imaging studies, endoscopic procedure notes, telephone follow-up notes, and progress notes was performed.

Results:

Thirty-three patients underwent 41 pancreatoscopy procedures. Indications included: 20 (48.8%) for diagnosis and treatment of pancreatic duct stones, 16 (39%) for investigation of IPMN, and 5 (12.2%) for evaluation of pancreatic duct strictures.

In 20 procedures performed for stone disease, complete pancreatic duct clearance was achieved in 17 of 20 (85%) cases. Strictures were successfully dilated in 5 of 5 (100%) procedures. Direct visualization and biopsy demonstrated IPMN in 11 of 11 (100%) cases. Adverse events occurred in 3 of 41 (7.3%) of procedures, all of which were mild.

Conclusions:

In this large series, we demonstrate that in patients with difficult to manage stone disease, strictures and possible malignant ductal pathology, pancreatoscopy is an effective and safe tool that can facilitate both diagnosis and effective therapy. Adverse events in our study were mild and within acceptable limits, further demonstrating that this is a safe procedure that should be offered to appropriate patients.
Family history, comorbidity, smoking and other risk factors in microscopic colitis: a case–control study
Authors: Wickbom Anna , Nyhlin Nils , Montgomery Scott M. , Bohr Johan , Tysk Curt
Published: January 2017

Objectives

Data on heredity, risk factors and comorbidity in microscopic colitis, encompassing collagenous colitis (CC) and lymphocytic colitis (LC), are limited.

Aim

The aim was to carry out a case–control study of family history, childhood circumstances, educational level, marital status, smoking and comorbidity in microscopic colitis.

Methods

A postal questionnaire was sent in 2008–2009 to microscopic colitis patients resident in Sweden and three population-based controls per patient, matched for age, sex and municipality.

Results

Some 212 patients and 627 controls participated in the study. There was an association with a family history of microscopic colitis in both CC [odds ratio (OR): 10.3; 95% confidence interval (CI): 2.1–50.4, P=0.004] and LC (OR not estimated, P=0.008). Current smoking was associated with CC [OR: 4.7; 95% CI: 2.4–9.2, P<0.001) and LC (OR: 3.2; 95% CI: 1.6–6.7, P=0.002). The median age at diagnosis was around 10 years earlier in ever-smokers compared with never-smokers.

CC was associated with a history of ulcerative colitis (UC) (OR: 8.7, 95% CI: 2.2–33.7, P=0.002), thyroid disease (OR: 2.3; 95% CI: 1.1–4.5, P=0.02), coeliac disease (OR: 13.1; 95% CI: 2.7–62.7, P=0.001), rheumatic disease (OR 1.9; 95% CI: 1.0–3.5, P=0.042) and previous appendicectomy (OR: 2.2; 95% CI: 1.3–3.8, P=0.003), and LC with UC (OR: 6.8; 95% CI: 1.7–28.0, P=0.008), thyroid disease (OR: 2.4; 95% CI: 1.1–5.4, P=0.037) and coeliac disease (OR: 8.7; 95% CI: 2.8–26.7, P<0.001).

Conclusion

Association with a family history of microscopic colitis indicates that familial factors may be important. The association with a history of UC should be studied further as it may present new insights into the pathogenesis of microscopic colitis and UC.
Diarrhea after allogeneic stem cell transplantation: beyond graft-versus-host disease
Authors: Robak Katarzyna , Zambonelli Joanna , Bilinski Jaroslaw , Basak Grzegorz W.
Published: January 2017

Diarrhea constitutes a frequent and often debilitating complication of allogeneic hematopoietic cell transplantation (alloHCT). Especially when accompanied by jaundice, skin rash, and symptoms of the upper gastrointestinal tract, diarrhea strongly suggests emergence of acute graft-versus-host disease (GvHD), which is a serious immune complication of the procedure, with possible fatal consequences. However, especially when diarrhea occurs as an isolated symptom, the other causes must be excluded before initiation of GvHD treatment with immune-suppressive drugs. In this article, a broad overview of the literature of different causes of diarrhea in the setting of alloHCT is provided, revealing causes and presentations different from those observed in the general population. We discuss gastrointestinal GvHD with a special focus on biomarkers, but also uncover underlying infectious: viral, bacterial, and parasitic as well as toxic causes of diarrhea. Finally, we suggest a practical algorithm of approach to patients with diarrhea after alloHCT, which may help to establish a proper diagnosis and initiate a causative treatment.
Quality of Life and Parental Worrying in a National Cohort of Biliary Atresia Children Living With Their Native Livers
Authors: Lampela Hanna , Pakarinen Mikko P. , Jahnukainen Timo , Jalanko Hannu , Kosola Silja
Published: January 2017

Objectives:

The aim of the study was to evaluate health‐related quality of life (HRQoL) and parental distress in a national cohort of children with biliary atresia (BA) with their native livers in relation to BA complications and HRQoL of normal population controls.

Methods:

We invited all Finnish children with BA surviving with their native livers at age 2 to 18 years to participate in 2009 and in 2014. Parents filled the Pediatric Quality of Life Inventory (PedsQL) proxy questionnaire, a survey of their child's health and evaluated parental distress on a visual‐analog scale from 0 to 7. Overall participation rates were 80% (12/15) for the longitudinal and 83% (20/24) for the cross‐sectional assessment. A control population of 324 children matched for age and sex was randomly picked, and 108 (33%) participated.

Results:

Overall, patients and controls had comparable HRQoL. Patients reported significantly lower scores for school functioning (P = 0.004) as depicted by missing school or day care due to hospital visits. Eighty‐five percent of parents reported extreme worry (7.0) when hearing their child's BA diagnosis. At 6 years after diagnosis, parents reported significantly less worry: median score 3.8 (interquartile range 3.0–5.4, P < 0.001 for difference). Parents of patients with optimal health were less worried than parents whose children's health was suboptimal: median worry score 3.3 (3.0–4.8) versus 5.3 (3.8–5.9), P = 0.05.

Conclusions:

BA patients’ HRQoL was comparable to matched peers in general but reduced by missing school days due to frequent hospital visits. At diagnosis, parents experienced considerable worry that diminished over the years after successful portoenterostomy, especially if the child's health was optimal.
Frequent Infections, Hypotonia, and Anemia in a Breastfed Infant
Authors: Kamoun Fatma , Guirat Rime , Megdich Fatma , Ben Ameur Salma , Kallel Choumous , Hachicha Mongia
Published: January 2017

Vitamin B12 deficiency may be responsible of serious hematologic and neurodevelopmental abnormalities. We report the case of an infant who was hospitalized because of recurrent infections, failure to thrive, hypotonia, and weakness. He was 8 months old and had been exclusively breastfed. Blood cell count showed pancytopenia with megaloblastic bone marrow. The serum IgG concentration was low. Vitamin B12 level was very low and associated with increased urinary methylmalonic acid. Cobalamin deficiency was caused by mother’s unrecognized pernicious anemia. Vitamin B12 supply led to rapid clinical and hematologic improvement.
Acquired TEF in Hodgkin Lymphoma in a Child: A Rare Clinical Association
Authors: Munikoty Vinay , Bhatia Anmol , Bansal Deepak , Das Ashim , Khandelwal Niranjan
Published: January 2017

Background:

Malignancy is the most common etiology of acquired fistulae between the tracheobronchial tree and esophagus. The majority are due to either primary bronchial or esophageal carcinoma, and are typically observed in adult population. The occurrence of tracheoesophageal fistula (TEF) in patients with Hodgkin lymphoma is a rare phenomenon.

Observation:

We report a rare case of Hodgkin lymphoma with TEF in a 10-year-old girl at presentation. She also developed pulmonary tuberculosis later during the follow up. She was fed through a nasogastric tube to avoid aspiration through the fistulous tract. She did well with chemotherapy and anti-tubercular therapy.

Conclusions:

Our case suggests TEF in Hodgkin lymphoma at the time of diagnosis is a rare complication in pediatric age group. Lymphoma-related TEF require far less active intervention, as against esophageal or bronchial malignancy related TEF.
Cytomegalovirus Treatment in Pediatric Hematopoietic Stem Cell Transplant Patients
Authors: Wattles Bethany A. , Kim Abby J. , Cheerva Alexandra C. , Lucas Kenneth G. , Elder Joshua J.
Published: January 2017

Cytomegalovirus (CMV) is a frequent complication of hematopoietic stem cell transplant in pediatric patients, with significant morbidity and mortality. Antiviral drugs are used as prophylactic, preemptive or therapeutic medicines; however, no uniform guidelines exist for the best strategy to prevent CMV disease. Resistance to standard antiviral therapies can lead to further difficulty in managing CMV disease. Studies for investigational therapies are underway and could provide options for treatment of resistant CMV, while limiting toxicities associated with currently used antiviral therapies.
Spontaneous Fracture and Migration of a Totally Implanted Port Device to Pulmonary Artery in Acute Leukemia Child
Authors: Kassar Olfa , Hammami Rania , Ben Dhaou Mahdi , Kammoun Samir , Elloumi Moez
Published: January 2017

Totally implanted port devices are important for the administration of fluid and chemotherapeutic agents. However, their use may be associated with serious complications, such as catheter fracture and embolism. Most data on port catheter embolization consist of isolated case reports. We report a 6-year-old boy with relapse of an acute lymphoblastic leukemia. He presented with dysfunction of his totally implanted port device. Radiologic examination revealed a catheter fracture. Echocardiography showed the catheter embolized into the right ventricle. The catheter was successfully removed from the right ventricle by percutaneous endovascular intervention. During the procedure, it was observed that the catheter fragment was located in the pulmonary artery. Catheter embolism may go undiagnosed for a prolonged period; however, severe systemic clinical signs may develop. Any implanted catheter should be removed after completion of treatment, or should be checked regularly for this complication by periodic standard chest x-ray monitoring.