bluuebunny/crossref_metadata_2025 huggingface dataset:
Technology-Supported Interventions for Pregnant Women
Authors: Lee Yaelim , Cho Susie
Published: June 2019

Technology is deeply embedded in daily life; thus, more pregnant women seek information through the Internet and incorporate the use of technological devices during their pregnancies. This systematic review aimed to examine to what extent and how technology-supported interventions were developed and delivered to pregnant women, as well as intervention effects on the targeted outcomes. Electronic data were collected from MEDLINE, CINAHL, and Scopus. Among the 11 selected studies, most were pilot studies to test the feasibility, acceptability, or preliminary effects of technology-supported interventions. The studies included both women with healthy pregnancies and pregnancies complicated by factors including preterm labor, smoking, and alcohol abuse. Most were conducted in the US, and most participants were white or African American. Interventions were primarily developed by research teams and focused on mental health issues including depression, anxiety, and stress. Interventions incorporated the use of technology including computers, mobile phones, and audiovisual aids. The overall interventions were reported to be feasible, acceptable, and beneficial in all the selected studies. Based on the review of literature, suggestions were provided for future research including the need for careful selection of intervention topics and objectives to target women who can benefit more from technology-supported interventions.
Increasing Incidence of Pelvic Sepsis Following Ileal Pouch-Anal Anastomosis for Ulcerative Colitis in Denmark: A Nationwide Cohort Study
Authors: Mark-Christensen Anders , Kjær Mie D. , Ganesalingam Subathra , Qvist Niels , Thorlacius-Ussing Ole , Rosenberg Jacob , Hillingsø Jens G. , Preisler Louise , Laurberg Søren
Published: June 2019

BACKGROUND:

The risk of pelvic sepsis following IPAA for ulcerative colitis may have changed with changes in medical and surgical treatment, but data are scarce.

OBJECTIVES:

This study aims to examine temporal changes in the risk of pelvic sepsis following IPAA for ulcerative colitis and to ascertain risk factors associated with pelvic sepsis.

DESIGN:

This is a nationwide cohort study.

SETTING:

This study was conducted in Denmark from 1996 to 2013.

PATIENTS:

Patients were operated on with an IPAA for ulcerative colitis.

MAIN OUTCOME MEASURES:

Pelvic sepsis was defined and validated as the occurrence of anastomotic leakage, pelvic abscesses or fistulas, or an operation for these conditions, recorded in a nationwide registry. Cumulative risks were calculated by using death as a competing risk. Multivariate Cox regression was used to examine the effects of calendar periods (1996–1999, 2000–2004, 2005–2009, and 2010–2013) on hazards ratios for pelvic sepsis, adjusting for age, sex, comorbidity, annual hospital volume, pelvic sepsis in the 12 months preceding surgery, operative stage (1-, 2-, modified 2-, or 3-stage), laparoscopy, and preoperative treatment with biological medicine within 12 weeks before surgery.

RESULTS:

Of 1456 patients, 244 (16.8%) experienced pelvic sepsis. The 1-year risk increased by calendar period (1996–1999: 2.5%, 2000–2004: 4.5%, 2005–2009: 7.4%, and 2010–2013: 9.6%). The adjusted hazard ratio for pelvic sepsis increased by an average 4.4% (95% CI, 1.3–7.6) per year in the study period. In general, patients were older and had more comorbidities at IPAA in recent years than in earlier years, and more had experienced pelvic sepsis in the 12 months preceding the operation.

LIMITATIONS:

This study was register based. There were no data on important clinical variables to determine the causes of an increased risk over calendar periods.

CONCLUSION:

In this nationwide cohort study, the 1-year risk of pelvic sepsis following primary IPAA for ulcerative colitis increased 4-fold from 1996 to 2013. See Video Abstract at http://links.lww.com/DCR/A956.
Anatomic Distribution of Colorectal Adenocarcinoma in Young Patients
Authors: Lu Pamela , Fields Adam C. , Vise Allison S. , Shabat Galyna , Irani Jennifer L. , Bleday Ronald , Goldberg Joel E. , Melnitchouk Nelya
Published: June 2019

BACKGROUND:

The incidence of colorectal cancer has increased in the younger population. Studies show an increased prevalence of left-sided tumors in younger patients; however, exact anatomic distribution is not known.

OBJECTIVE:

We sought to determine the anatomic distribution of colorectal cancer in young patients and to calculate the proportion of tumors that would be within reach of a flexible sigmoidoscopy.

DESIGN:

The National Cancer Database (2004–2015) was used to identify patients with colorectal cancer.

SETTINGS:

This was a multicenter study using national data.

PATIENTS:

The study included 117,686 patients under the age of 50 years diagnosed with colorectal cancer and 1,331,048 patients over the age of 50 years diagnosed with colorectal cancer.

MAIN OUTCOME MEASURES:

The primary outcome was the proportion of left-sided tumors in patients under the age of 50 years.

RESULTS:

A total of 74.4% of patients under age 50 years and 56.1% of patients over age 50 years had left-sided colorectal cancer.

LIMITATIONS:

The study is a retrospective review and does not exclude young patients who developed colorectal cancer with familial syndromes with a colorectal cancer disposition.

CONCLUSIONS:

A total of 74.4% of colorectal cancers diagnosed before age 50 years are left sided. In light of recent changes to screening recommendations, distribution of disease in young patients is important to both provider and patient education and decision-making. See Video Abstract at http://links.lww.com/DCR/A966.
Efonidipine-Induced Exanthematic Drug Eruption and Literature Review
Authors: Davis Suresh , Raju Anu R. , Thomas Eapen , Cherian Jerin J.
Published: June 2019

We report the case of an elderly woman who developed exanthematic drug eruption after administration of efonidipine. An 84-year-old woman presented to emergency department with complaints of generalized itching and erythema since 4 days. She was on human-soluble insulin since 11 years. In view of her hypertension and left anterior descending artery stenosis, she was initiated on aspirin, clopidogrel, atorvastatin, pantoprazole, nebivolol, aldactone, and efonidipine a week ago. Her presenting complaints were initially managed with parenteral pheniramine maleate and hydrocortisone. She was admitted, and all her medications except antiplatelets and insulin were discontinued. She was prescribed topical beclomethasone and oral antihistamines for better control of her symptoms. To confirm the drug precipitating the reaction, she was rechallenged with efonidipine, 20 mg once daily on the third day of admission. She developed itching 8 hours after administering the medication, and efonidipine was stopped and nebivolol 5 mg once daily was restarted for hypertension. She did not develop any adverse event when the remaining medications were reinitiated. World Health Organization–Uppsala Monitoring Centre causality assessment criteria indicated a “certain” association. To the best of the knowledge of the authors, this is one among the first reported cases of efonidipine-induced exanthematic drug eruption.
A Review of Diagnostic and Therapeutic Dacryoendoscopy
Authors: Singh Swati , Ali Mohammad Javed
Published: June 2019

Dacryoendoscopy examinations are increasingly playing a significant role in the diagnosis and therapies of lacrimal drainage disorders.

Purpose:

To provide a systematic review of the literature on diagnostic and therapeutic indications, techniques, utility, and complications of dacryoendoscopy (DEN).

Methods:

The authors performed a PubMed search of articles published in English/German/Japanese/Chinese on DEN. Data captured include evolution and techniques, diagnostic utility, therapeutic interventions, outcomes, and limitations. Specific emphasis was laid on addressing the current practice patterns and existing lacunae.

Results:

Diagnostic DEN has enabled the exact localization and differentiation of mucosal edema, stenosis, strictures, and obstructions throughout the lacrimal drainage system (LDS). Guided expansion of the stenosis, laser dacryoplasty (LDP) for strictures and microdrill removal of dacryoliths (microdrill dacryoplasty [MDP]) are some of the therapeutic uses of DEN. Successful outcomes of up to 60%–70% were achieved with stenosis anywhere along the LDS with a restenosis rate of 20%. Longer segment of stenosis (>2 mm), presence of enlarged lacrimal sac, history of dacryocystitis, postsaccal stenosis, and complete obstruction were associated with poorer outcomes. Microendoscopic procedures like LDP or MDP achieve canalicular and NLD recanalization with optimal results. DEN guided-probing demonstrated high success rates in cases with an earlier failed probing. Available dacryoendoscopes allow high-quality image capture (15,000 pixels) with multiple ports for additional instrumentation and irrigation.

Conclusions:

Dacryoendoscopic examination of canaliculus and nasolacrimal duct plays a significant role in the diagnosis and management of lacrimal disorders. Further improvements in microendoscopic techniques and instrumentation will expand its clinical usage and give impetus to minimally invasive lacrimal surgeries.
Helicobacter pylori Infection May Be Related to Inflammation and Not to Iron Deficiency Anemia in Hemodialysis Patients
Authors: Ibrahim Hoda Mohamed , El Wahab Ahmed Mohammed Abd , Shahin Dina , El-Kannishy Ghada
Published: June 2019

Introduction

Anemia develops early in the course of chronic kidney disease and is nearly universal in patients with end-stage renal disease. In the general population, observational studies have shown a link between Helicobacter pylori and iron deficiency, often resulting in iron deficiency anemia. This study was conducted to investigate the effect of H. pylori infection in hemodialysis (HD) patients on parameters of iron deficiency anemia. The relation between H. pylori infection and inflammation as well as hepcidin serum level in HD patient was also identified.

Methods

This study included 84 HD patients from dialysis unit in Talkha Central Hospital. Patients were classified into 2 groups according to presence of H. pylori antigen in stool.

Results

Helicobacter pylori stool antigen was positive in 47 patients (55.6%). There was a significant male predominance in H. pylori–infected group. Infection with H. pylori was associated with longer dialysis duration and more dyspeptic symptoms. No significant difference was found between infected and noninfected patients regarding hematocrit, hemoglobin, iron, ferritin, nor transferrin saturation. C-reactive protein was significantly higher in H. pylori–positive group. Hepcidin was also higher in the noninfected group but with no significant difference.

Conclusions

Patients with longer duration of HD, male sex, and the presence of dyspepsia had higher odds to exhibit H. pylori infection. Helicobacter pylori infection did not seem to have an influence on iron deficiency or anemia severity in HD patients and does not have relation with serum hepcidin level. However, H. pylori may to be related to inflammation in HD patients.
A Hail Mary Diagnostic Success
Authors: Dylewski Joe , Domingo Marc-Christian , Thivierge Karine
Published: June 2019

With the advent of newer methodologies, it has become possible to detect previously unsuspected pathogens. We wish to present a case of human granulocytic anaplasmosis that was diagnosed using 16S ribosomal RNA gene sequencing while originally investigating possible culture-negative endocarditis. This case is the first reported in humans from the province of Quebec. A brief review of means of transmission and clinical and laboratory findings as well as treatment is provided.
Acute Amebic Encephalitis in an Allogeneic Hematopoietic Stem-Cell Transplant Recipient
Authors: Molina Alfonso , Winston Drew J. , Haeri Mohammad , Khanlou Negar , Schiller Gary J.
Published: June 2019

Except for cerebral toxoplasmosis, parasitic central nervous system (CNS) infections are extremely rare in allogeneic hematopoietic stem-cell transplant recipients. We report an unusual case of acute amebic encephalitis in an allogeneic hematopoietic stem-cell transplant patient occurring more than 1 year after transplantation. Because the clinical presentation of amebic encephalitis can mimic other more common causes of CNS infection, the diagnosis should be considered whenever more common causes of CNS infection have been excluded.
Identification of Ureaplasma parvum as a Cause of Culture-Negative Septic Monoarthitis Using 16S rRNA Gene Sequencing
Authors: Suknuntha Kran , Lepak Alexander J. , Rehrauer William M. , Chen Derrick J.
Published: June 2019

Ureaplasma species primarily colonize in the human genitourinary tract and are a cause of nongonococcal urethritis. Rare cases of septic arthritis caused by these organisms have been reported in immunocompromised hosts; however, their pathogenic activity in hosts with competent immune status remains unclear. Here, we report a case of septic arthritis caused by Ureaplasma parvum in an adult immunocompetent male patient diagnosed by 16S rRNA gene sequencing.
The association between functional dyspepsia and depression: a meta-analysis of observational studies
Authors: Lin Song , Gao Tao , Sun Chongxiu , Jia Mengru , Liu Chengxia , Ma Aiguo
Published: June 2019

Concomitant functional dyspepsia (FD) and psychosocial stressors have been reported; however, the association between FD and depression remains controversial and no quantitative meta-analysis exists. Published articles were identified through a comprehensive review of PubMed, Embase, and Web of Science from inception to the 8 July 2018. The pooled odds ratios (ORs) with 95% confidence intervals and subgroup analyses were calculated using a random-effects model. Findings for a total of 59 029 individuals were pooled across 23 studies and examined. Our analyses showed a positive association between FD and depression, with an OR of 2.28 (95% confidence interval: 2.02–3.81; I
2=100%). In the subgroup analysis, FD patients in Europe (OR=6.19) were more likely to have depression compared with Asians (OR=2.47); the overall significance results decreased the most in subgroup which the overall significance of the subgroup analyses results decreased the most in studies that adjusted for BMI (OR=1.42). Our meta‐analysis showed a positive association between FD and depression. Further large‐scale prospective cohort studies are needed to investigate the causality between FD and depression.
Systematic review of antibacterial activity of eravacycline: a novel fluorocycline against clinically obtained Gram-negative bacteria
Authors: Khanjani Susan , Sedigh Ebrahim-Saraie Hadi , Malekzadegan Yalda , Halaji Mehrdad , Mojtahedi Ali
Published: June 2019

Eravacycline (TP-434 or 7-fluoro-9-pyrrolidinoacetamido-6-demethyl-6-deoxytetracycline) is a novel fluorocycline antibiotic, which was designed to overcome tetracycline-specific resistance mechanisms. This study aimed to analyze the in-vitro activity of eravacycline against Gram-negative bacteria in published literature, to contribute to the international data on the antimicrobial stewardship programs. A systematic literature review was performed through the electronic databases from January of 2000 to December 2017 to cover all published articles relevant to our scope. Finally, nine studies met our inclusion criteria that were subjected to data extraction and review. The highest activity of eravacycline was against Escherichia coli isolates since in all reports eravacycline at a concentration of 0.5 μg/ml or less inhibited 90% of isolates. In contrast, the lowest activity was seen against Proteeae isolates since except for one report eravacycline at a concentration of at least 2 μg/ml inhibited 90% of isolates. The antibacterial activity of eravacycline against 13 collections of carbapenem-resistant bacteria consists of 1057 isolates was showed that eravacycline at a concentration of 2 μg/ml or less inhibited 90% of isolates. The only exception was for carbapenem-resistant Proteeae which 90% of isolates were inhibited at a concentration of at least 4 μg/ml. In summary, eravacycline has a promising in-vitro antibacterial property against several nosocomial pathogens. This was an encouraging result that provides an option for treatment of infections caused by Gram-negative bacteria, regardless of resistance phenotype. However, further clinical studies are necessitate to provide clinical evidence to support these observations.
Reexamining Nurse Manager Span of Control With a 21st-Century Lens
Authors: Omery Anna , Crawford Cecelia L. , Dechairo-Marino Ann , Quaye Beverly S. , Finkelstein Jim
Published: June 2019

The primary aim of this literature review was to examine the quantity, quality, and consistency of evidence regarding the span of control (SOC) specific to nurse managers. A secondary aim was to meaningfully translate the evidence and offer guidance to 21st-century nurse leaders. The review results were categorized using Donabedian's (2003) Structure-Process-Outcomes model. The Structure-Process-Outcomes approach was used to review the literature and consider SOC recommendations for today's health care environment. Structures outlined the conditions for current SOC, which included material resources, human resources, and organizational characteristics. Processes were defined as activities or actions stemming from identified structures that led to outcomes. Examples included management/administrative activities, as well as frontline staff participation in these tasks. Outcomes were performance measures of human resources, financial, and quality metrics. The review revealed that an SOC model built on a simplistic full-time employment ratio is outdated. Yet, nurse managers remain in their role in the face of these simplistic models despite feelings of inadequacy, exhaustion, and failure because they passionately care about patients and staff. New attitudes and integration of advanced technologies, pioneering tools including SOC assessment tools, and ongoing competency developments will result in different needs of SOC as health care moves deeper into the modern era. This evidence is offered to inform and drive conversations focused on providing optimal nurse manager SOC for maximum effectiveness within unique and ever-evolving care environments.
Ripe for Disruption? Adopting Nurse-Led Data Science and Artificial Intelligence to Predict and Reduce Hospital-Acquired Outcomes in the Learning Health System
Authors: Linnen Daniel T. , Javed Priscilla S. , D'Alfonso Jim N.
Published: June 2019

Nurse leaders are dually responsible for resource stewardship and the delivery of high-quality care. However, methods to identify patient risk for hospital-acquired conditions are often outdated and crude. Although hospitals and health systems have begun to use data science and artificial intelligence in physician-led projects, these innovative methods have not seen adoption in nursing. We propose the Petri dish model, a theoretical hybrid model, which combines population ecology theory and human factors theory to explain the cost/benefit dynamics influencing the slow adoption of data science for hospital-based nursing. The proliferation of nurse-led data science in health systems may be facing several barriers: a scarcity of doctorally prepared nurse scientists with expertise in data science; internal structural inertia; an unaligned national “precision health” strategy; and a federal reimbursement landscape, which constrains—but does not negate the hard dollar business case. Nurse executives have several options: deferring adoption, outsourcing services, and investing in internal infrastructure to develop and implement risk models. The latter offers the best performing models. Progress in nurse-led data science work has been sluggish. Balanced partnerships with physician experts and organizational stakeholders are needed, as is a balanced PhD-DNP research-practice collaboration model.
Addressing Falls Among Older Oncology Patients Through Complexity Science
Authors: Shelby Melissa , Malloch Kathy , Shellenberger Thomas , Byrum Stephanie , Mackie Leah , Dilli Suzanne , Dean Martin Amanda
Published: June 2019

Traditional quality assurance processes provide significant opportunities for positive disruption. Doctor of Nursing Practice (DNP) students are well positioned to apply program learning to large-scale change in complex organizations. This article presents an innovative approach for creating a point-of-care interdisciplinary approach to address high fall risk frequencies in ambulatory oncology clinics using complexity leadership principles. Processes for nurse executives to consider for replication of this approach for other challenging clinical situations are suggested using the emerging competence of DNP educated nurses. Adults with cancer who are older than 65 years are at a higher risk for falls than older adults without cancer. Oncology providers and nurses are not routinely screening, documenting, and preventing falls. A fall injury in an older adult with cancer may not only delay or impact cancer treatment but also result in hospitalization, loss of function, and/or death. Increasing awareness of the impact of falls and implementing change within a large ambulatory health care organization requires an interdisciplinary team approach. Complexity theory supports nonlinear change initiated at the grassroots level to create a dynamic movement to bring forth emergence and adaptation. The use of the Centers for Disease Control and Prevention STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative will enable oncology professionals to screen, assess, and intervene by collaborating, communicating, and coordinating with other health care specialists to introduce a fall prevention quality improvement system process. Nurse executives need to know about STEADI.
Nutritional Status Deterioration Occurs Frequently During Children’s ICU Stay*
Authors: Valla Frédéric V. , Baudin Florent , Gaillard Le Roux Bénédicte , Ford-Chessel Carole , Gervet Elodie , Giraud Céline , Ginhoux Tiphanie , Cour-Andlauer Fleur , Javouhey Etienne , Tume Lyvonne
Published: June 2019

Objectives:

Malnutrition and faltering growth at PICU admission have been related to suboptimal outcomes. However, little is known about nutritional status deterioration during PICU stay, as critical illness is characterized by a profound and complex metabolism shift, which affects energy requirements and protein turnover. We aim to describe faltering growth occurrence during PICU stay.

Design:

Single-center prospective observational study.

Setting:

Twenty-three-bed general PICU, Lyon, France.

Patients:

All critically ill children 0–18 years old with length of stay longer than 5 days were included (September 2013–December 2015).

Interventions:

Weight and height/length were measured at admission, and weight was monitored during PICU stay, in order to calculate body mass index for age z score. Faltering growth was defined as body mass index z score decline over PICU stay. Children admitted during the first year of the study and who presented with faltering growth were followed after PICU discharge for 3 months.

Measurements and Main Results:

We analyzed 579 admissions. Of them, 10.2% presented a body mass index z score decline greater than 1 sd and 27.8% greater than 0.5. Admission severity risk scores and prolonged PICU stay accounted for 4% of the variability in nutritional status deterioration. Follow-up of post-PICU discharge nutritional status showed recovery within 3 months in most patients.

Conclusions:

Nutritional deterioration is frequent and often intense in critically ill children with length of stay greater than 5 days. Future research should focus on how targeted nutritional therapies can minimize PICU faltering growth and improve post-PICU rehabilitation.
Temporal Variability in the Sampling of Vital Sign Data Limits the Accuracy of Patient State Estimation*
Authors: Eytan Danny , Jegatheeswaran Anusha , Mazwi Mjaye L. , Assadi Azadeh , Goodwin Andrew J. , Greer Robert W. , Goodfellow Sebastian D. , Laussen Peter C.
Published: June 2019

Objectives:

Physiologic signals are typically measured continuously in the critical care unit, but only recorded at intermittent time intervals in the patient health record. Low frequency data collection may not accurately reflect the variability and complexity of these signals or the patient’s clinical state. We aimed to characterize how increasing the temporal window size of observation from seconds to hours modifies the measured variability and complexity of basic vital signs.

Design:

Retrospective analysis of signal data acquired between April 1, 2013, and September 30, 2015.

Setting:

Critical care unit at The Hospital for Sick Children, Toronto.

Patients:

Seven hundred forty-seven patients less than or equal to 18 years old (63,814,869 data values), within seven diagnostic/surgical groups.

Interventions:

None.

Measurements and Main Results:

Measures of variability (sd and the absolute differences) and signal complexity (multiscale sample entropy and detrended fluctuation analysis [expressed as the scaling component α]) were calculated for systolic blood pressure, heart rate, and oxygen saturation. The variability of all vital signs increases as the window size increases from seconds to hours at the patient and diagnostic/surgical group level. Significant differences in the magnitude of variability for all time scales within and between groups was demonstrated (p < 0.0001). Variability correlated negatively with patient age for heart rate and oxygen saturation, but positively with systolic blood pressure. Changes in variability and complexity of heart rate and systolic blood pressure from time of admission to discharge were found.

Conclusions:

In critically ill children, the temporal variability of physiologic signals supports higher frequency data capture, and this variability should be accounted for in models of patient state estimation.
Nonenhancing Component of Clear Cell Renal Cell Carcinoma on Computed Tomography Correlates With Tumor Necrosis and Stage and Serves as a Size-Independent Prognostic Biomarker
Authors: Ahmed Firas S. , Akin Oguz , Shaish Hiram , Luk Lyndon , Guo Xiaotao , Yang Hao , Zabor Emily , Ostrovnaya Irina , Hakimi A. Ari , Zhao Binsheng , Schwartz Lawrence H.
Published: June 2019

Objectives

This study aimed to quantify nonenhancing tumor (NT) component in clear cell renal cell carcinoma (ccRCC) and assess its association with histologically defined tumor necrosis, stage, and survival outcomes.

Methods

Among 183 patients with ccRCC, multi-institutional changes in computed tomography attenuation of tumor voxels were used to quantify percent of NT. Associations of NT with histologic tumor necrosis and tumor stage/grade were tested using Wilcoxon signed rank test and with survival outcomes using Kaplan-Meier curves/Cox regression analysis.

Results

Nonenhancing tumor was higher in ccRCC with tumor necrosis (11% vs 7%; P = 0.040) and higher pathological stage (P = 0.042 and P < 0.001, respectively). Patients with greater NT had higher incidence of cancer recurrence after resection (P < 0.001) and cancer-specific mortality (P < 0.001).

Conclusion

Nonenhancing tumor on preoperative computed tomographic scans in patients with ccRCC correlates with tumor necrosis and stage and may serve as an independent imaging prognostic biomarker for cancer recurrence and cancer-specific survival.
Usefulness of Diffusion-Weighted Magnetic Resonance Imaging Using Apparent Diffusion Coefficient Values for Diagnosis of Infantile Hemangioma
Authors: Saito Mioko , Kitami Masahiro , Takase Kei
Published: June 2019

Objective

The objective of this study was to determine whether apparent diffusion coefficient (ADC) values obtained from diffusion-weighted imaging allow differentiation between infantile hemangiomas (IHs) and malignant soft tissue tumors.

Methods

A retrospective review was performed on magnetic resonance images of pediatric patients with IHs and malignant soft tissue tumors from January 2014 to December 2016, which comprised 7 patients with 8 IHs and 6 patients with 6 malignant soft tissue tumors. We calculated and compared the ADC values of each lesion. Receiver operating characteristic curve analysis was performed to determine a cutoff value for the ADC.

Results

There was a statistically significant difference between the ADC values of IHs and those of malignant soft tissue tumors (1.32 [1.27–1.72] × 10−3 mm2/s vs 0.67 [0.57–0.79] × 10−3 mm2/s; P < 0.001), with no overlap between the 2 groups.

Conclusions

The ADC values obtained from diffusion-weighted imaging were useful in differentiating IHs from malignant soft tissue tumors in pediatric patients.
Incidental Detection of Adenocarcinoma in the Neck of the Pancreas by FDG PET Imaging When a Cystic Lesion in the Body of Pancreas Was Evaluated
Authors: Xing Haiqun , Hu Ya , Hou Bo , Huo Li , Zhao Yupei
Published: June 2019

FDG PET/CT and PET/MRI were performed to evaluate a cystic lesion in the body of the pancreas in a 65-year-old man. Neither studies showed abnormally increased activity in the cystic lesion in the body of the pancreas. However, both studies revealed abnormal activity in the neck of the pancreas, which did not show anatomical abnormality and was not suspected prior to the PET imaging. Pathological examination demonstrated that the lesion in the body of the pancreas was a benign duct dilation, whereas the abnormal FDG activity in the neck of the pancreas was due to pancreatic adenocarcinoma.
Ankylosis of the Temporomandibular Joint in Pediatric Patients
Authors: Rozanski Collin , Wood Kasey , Sanati-Mehrizy Paymon , Xu Hope , Taub Peter J.
Published: June 2019

Introduction:

While surgical interventions for temporomandibular joint (TMJ) ankylosis are well-documented, there is lack of consensus regarding the ideal approach in pediatric patients. Surgical interventions include gap arthroplasty, interpositional arthroplasty, or total joint reconstruction.

Methods:

A systematic review of PubMed (Jan 1, 1990–Jan 1, 2017) and Scopus (Jan 1, 1990–Jan 1, 2017) was performed and included studies in English with at least one patient under the age of 18 diagnosed with TMJ ankylosis who underwent surgical correction. Primary outcomes of interest included surgical modality, preoperative maximum interincisal opening (MIO) (MIOpreop), postoperative MIO (MIOpostop), ΔMIO (ΔMIO = MIOpostop – MIOpreop), and complications.

Results:

Twenty-four case series/reports with 176 patients and 227 joints were included. By independent sample t tests MIOpostop (mm) was greater for gap arthroplasty (30.18) compared to reconstruction (27.47) (t = 4.9, P = 0.043), interpositional arthroplasty (32.87) compared to reconstruction (t = 3.25, P = 0.002), but not for gap compared to interpositional (t = −1.9, P = 0.054). ΔMIO (mm) was greater for gap arthroplasty (28.67) compared to reconstruction (22.24) (t = 4.2, P = 0.001), interpositional arthroplasty (28.33) compared to reconstruction (t = 3.27, P = 0.002), but not for interpositional compared to gap (t = 0.29, P = 0.33). Weighted-average follow-up time was 28.37 months (N = 164). 4 of 176 (2.27%) patients reported development of re-ankylosis. There was no significant difference in occurrence of re-ankylosis between interventions.

Conclusions:

Given the technical ease of gap arthroplasty and nonsignificant differences in ΔMIO, MIOpostop, or occurrence of re-ankylosis between gap and interpositional arthroplasty, gap arthroplasty should be considered for primary ankylosis repair in pediatric patients, with emphasis on postoperative physiotherapy to prevent recurrent-ankylosis.
High-Sensitivity Troponin T Predicts Postoperative Cardiogenic Shock Requiring Mechanical Circulatory Support in Patients With Valve Disease
Authors: Duchnowski Piotr , Hryniewiecki Tomasz , Kuśmierczyk Mariusz , Szymański Piotr
Published: June 2019

Background:

Cardiogenic shock is a very serious postoperative complication in patients undergoing heart valve surgery. Mechanical circulatory support is a recognized method of treating patients with this complication. The aim of the presented study was to assess the usefulness of selected biomarkers in predicting the occurrence of postoperative cardiogenic shock requiring mechanical circulatory support.

Methods:

This prospective study was conducted on a group of 712 patients undergoing heart valve surgery. The primary end-point at the intrahospital follow-up was postoperative cardiogenic shock requiring mechanical circulatory support.

Results:

The postoperative cardiogenic shock requiring mechanical circulatory support occurred in 20 patients. At multivariate analysis high-sensitivity Troponin T measured immediately after surgery (OR 1.006; 95% CI 1.002–1.013; P 0.009) remained independent predictor of the primary end point.

Conclusions:

The postoperative hs-TnT can be used to predict a postoperative cardiogenic shock requiring mechanical circulatory support.
Can Surgeons Identify Appendicitis Macroscopically? Results From a Multicentre Prospective Study
Authors: Thong Da Wei , Crouch Stephen , Morgan Samuel , Arthur Thomas
Published: June 2019

Purpose:

The primary outcome was to investigate the accuracy of intraoperative macroscopic diagnosis by the operating surgeon with the results of the subsequent histopathologic examination. The secondary outcome was to identify the predictors of discrepancies between these 2 groups.

Materials and Methods:

A multicentre, prospective, observational study was conducted over a period of 2 months with a 30-day follow-up period. Patients who underwent surgery with the intention of appendicectomy were recruited in the study.

Results:

A total of 1169 patients were recruited. False negatives (FNs) were defined as a normal macroscopic diagnosis but histopathologically appendicitis, whereas false positive otherwise. Overall, FN rates were 22.4%, whereas false positive rates were 8.2%. The seniority of the operating surgeons did not affect the ability to accurately diagnose appendicitis macroscopically (P=0.069). However, consultant surgeons had the lowest FN rate of 15.6%. Females and preoperative ultrasound scan increased odds of FN, whereas preoperative computed tomography decreased the odds of FN appendicectomy.

Conclusion:

Macroscopic identification intraoperatively is inaccurate with a FN rate of 22%.
Removal of retrievable inferior vena cava filters before discharge: Is it associated with increased incidence of pulmonary embolism?
Authors: Robbins Justin M. , Garwe Tabitha , McCarthy Cullen K. , Sarwar Zoona , Gonzalez Robert A. , Zander Tyler L. , Jalla Aditi N. , Conner Keri S. , Stewart Kenneth E. , Albrecht Roxie M.
Published: June 2019

BACKGROUND

Severely injured trauma patients are at high risk of developing deep venous thrombosis and pulmonary emboli (PE), and may have contraindications to prophylactic or therapeutic anticoagulation. Retrievable inferior vena cava filters (rIVCFs) are used to act as a mechanical obstruction to prevent PE in high risk populations and those with deep venous thrombosis who cannot be anticoagulated. The removal rate of rIVCFs is variable in trauma centers, including our previous published rate of 50% to 89%/year. Indwelling filters carry a risk of significant morbidity and the success of retrieval decreases as the dwell time increases. We hypothesized that once patients could receive appropriate prophylactic or therapeutic anticoagulation, rIVCF could be removed before hospital discharge without impact on occurrence or recurrence of PE.

METHODS

All trauma patients with rIVCF placed and removed between January 2006 and August 2018 were reviewed. We collected data from record review from admission to 6 months postfilter removal, including demographics, filter indication, filter type, dwell time, placement and removal complications, antithrombosis medications, location of venous thromboembolism, complications, and discharge disposition. Exposure of interest was timing of filter removal: before (BEF) or after hospital discharge (AFT). The outcome of interest was whether the patient had a documented PE within 6 months of filter removal.

RESULTS

A total of 281 rIVCFs were placed, 218 were eligible for removal, 72.4% (158/218) were retrieved with 63% (100/158) removed before discharge. Mean filter duration was 26 days and 103 days for the before and after groups, respectively. No differences (p > 0.05) were noted in the distribution of demographic and clinical factors except for filter indication (venous thromboembolism indication, 95% in AFT vs. 74% in BEF, p = 0.0043). Postremoval PE rates were 0% BEF and 1% AFT (Fisher's exact test, p = 1.000).

CONCLUSION

Our results suggest that removal of rIVCFs before discharge once patients are appropriately anticoagulated is a safe strategy to improve retrieval rates.

LEVEL OF EVIDENCE

Therapeutic, level V.
Single-lateral cervical radiograph in pediatric trauma is equivalent to multiple views
Authors: Lindholm Erika B. , Malik Archana , Parikh Darshan , Mamdouhi Tara , Alper Lauren , Nanassy Autumn , Ciullo Sean , Arthur L. Grier , Prasad Rajeev , Herman Martin , Grewal Harsh
Published: June 2019

BACKGROUND

Cervical spine injuries (CSI) are rare within the pediatric population. Due to the significant consequences of missed CSI, children are often imaged excessively. In an attempt to decrease imaging of the cervical spine in children, we reviewed abnormal cervical radiographs (XR) to determine if the diagnosis of CSI could be made using a single-lateral cervical radiograph (LAT). Furthermore, we reviewed cervical computed tomography (CT) and magnetic resonance imaging (MRI) to ensure there were no missed CSI.

METHODS

Electronic medical records of trauma patients treated at a Level I Pediatric Trauma Center with abnormal XR findings followed by confirmatory CT or MRI between 2012 and 2017 were reviewed. All abnormal imaging on XR was compared with the LAT. In addition, all abnormal CTs and MRIs were reviewed to ensure there were no false negative XR.

RESULTS

A total of 3,735 XR were performed with 26 abnormal interpretations. All bony CSI were visualized on LAT. Confirmatory imaging found 13 (50%) were false positive and 13 (50%) were true positive. Secondary analysis of CT identified 12 injuries with prior XR; 8 of 12 LAT identifying the injury and 4 of 12 false positive on CT. Secondary analysis of MRI identified nine injuries with prior XR; 5 of 9 LAT identifying the injury. The four false-negative reads on MRI were ligamentous injuries.

CONCLUSION

Radiographs are commonly performed when evaluating CSI. In our population, initial assessment with a single LAT was equivalent to a multiple view XR. On secondary review, the only false-negative LAT reports were due to ligamentous injuries. This data suggests limiting exposure to LAT would accomplish the goal of reducing imaging without missing bony CSI and when ligamentous injury is suspected MRI should be the confirmatory study rather than CT.

LEVEL OF EVIDENCE

Diagnostic Test, level III.
Effect of mass shootings on gun sales—A 20-year perspective
Authors: Callcut Rachael A. , Robles Anamaria M. , Kornblith Lucy Z. , Plevin Rebecca E. , Mell Matthew W.
Published: June 2019

BACKGROUND

Granular data on gun sales has been historically difficult to obtain. In 2016, California (CA) made monthly data from 1996 to 2015 publically available. Control charts are a method to analyze how a process changes over time in response to nonroutine events. We utilized this technique to study the impact of US mass shootings on CA gun sales.

METHODS

Monthly gun sales were provided by the CA Department of Justice and monthly fatalities from the CDC Wonder Death Certificate Registry. Mass shooting events were obtained from after-action reports, news media, and court proceedings. Time-ordered data were analyzed with control charts with 95% confidence intervals (upper control limit, lower control limit) using QiMacros.

RESULTS

Individual gun sales of 9,917,811 occurred in CA with a median monthly rate of 41,324 (range, 20,057–132,903). A median of 263 people lost their lives monthly from firearms (124 homicides, 128 suicides), totaling 53,975 fatalities from 1999 to 2015. Fifteen of 21 current deadliest mass shootings occurred during this study period with 40% from 2012 to 2015. Also, 36 school shootings occurred during the study (mean, 5 deaths; range, 0–33; 6 injuries; range, 0–23) with 31% in 2012 to 2015 at rate of 3 events/year versus 1.4 events/year in the 17 prior years (p < 0.05). Sales were generally consistent from 1996 to 2011 (except post-Columbine, Col). Starting in 2011, sales exceeded the 95% predicted upper control limit every single month. Before October 2011, there was no statistically significant sustained effect of mass shootings on sales (except Col); however, since a statistically significant proportional spike in sales occurred in the months immediately following every single deadliest mass shooting event. Every year since 2012, CA has strengthened gun laws in response to mass shootings yet sales have risen immediately preceding enactment of these laws each January.

CONCLUSION

Gun sales are more frequent since 2012, with an additional increase following both mass shootings and legislative changes enacted in response to these shootings.

LEVEL OF EVIDENCE

Epidemiology, level III.
Risk factors for prescription drug diversion among people living with HIV: a systematic scoping review
Authors: Chibi Buyisile , Torres Neusa F. , Sokhela Zinhle P. , Mashamba-Thompson Tivani P.
Published: June 2019

Background:

In addition to numerous infections and frequent pain constantly affecting people living with HIV (PLWH), various risk factors might contribute to prescription drug diversion. The purpose of the study is to map existing evidence on risk factors contributing to prescription drug diversion among PLWH.

Methods:

Arksey and O’Malley's framework and the recommendation by Levac et al. (2010) guided this study. We searched for relevant literature from the following databases: PubMed; Google Scholar; EBSCOhost (Academic Search Complete, MEDLINE and Newspaper Source), Cochrane, WHO, HIV, ScienceDirect and Open Access Theses and Dissertations. Studies reporting evidence on risk factors contributing to prescription drug diversion and published in the period January 1996 to July 2017 were included. Thematic content analysis was performed to summarize the findings.

Results:

The search identified 734 studies. After full-text screening of the eligible studies, risk factors contributing to prescription drug diversion among PLWH were reported in 20 included studies. It was found that there is limited research on prescription drug diversion among PLWH in low–middle-income countries (LMICs). Risk factors contributing to prescription drug diversion were being a substance user or substance dependent; being male; young in age; being stigmatized; not disclosed HIV status; diagnosed with mental health problems; being HIV infected; poor health and well being; being White; being homeless or not owing a home; having low educational level; having history of diversion, misuse or abuse; in possession of addictive prescriptions; being unemployed and living in high neighbourhood disorder.

Conclusion:

Evidence shows that there is limited research on prescription drug diversion among PLWH in LMICs. The study findings show that the risk factors contributing to prescription drug diversion are related with risk factors for HIV transmission and infection.

PROSPERO registration number:

CRD42017074076.
Evolution of affiliation: patterns of convergence from genomes to behaviour
Authors: Fischer Eva K. , Nowicki Jessica P. , O'Connell Lauren A.
Published: June 2019

Affiliative behaviours have evolved many times across animals. Research on the mechanisms underlying affiliative behaviour demonstrates remarkable convergence across species spanning wide evolutionary distances. Shared mechanisms have been identified with genomic approaches analysing genetic variants and gene expression differences as well as neuroendocrine and molecular approaches exploring the role of hormones and signalling molecules. We review the genomic and neural basis of pair bonding and parental care across diverse taxa to shed light on mechanistic patterns that underpin the convergent evolution of affiliative behaviour. We emphasize that mechanisms underlying convergence in complex phenotypes like affiliation should be evaluated on a continuum, where signatures of convergence may vary across levels of biological organization. In particular, additional comparative studies within and across major vertebrate lineages will be essential in resolving when and why shared neural substrates are repeatedly targeted in the independent evolution of affiliation, and how similar mechanisms are evolutionarily tuned to give rise to species-specific variations in behaviour.

This article is part of the theme issue ‘Convergent evolution in the genomics era: new insights and directions'.
Convergent evolution inArabidopsis halleriandArabidopsis arenosaon calamine metalliferous soils
Authors: Preite Veronica , Sailer Christian , Syllwasschy Lara , Bray Sian , Ahmadi Hassan , Krämer Ute , Yant Levi
Published: June 2019

It is a plausible hypothesis that parallel adaptation events to the same environmental challenge should result in genetic changes of similar or identical effects, depending on the underlying fitness landscapes. However, systematic testing of this is scarce. Here we examine this hypothesis in two closely related plant species,Arabidopsis halleriandArabidopsis arenosa, which co-occur at two calamine metalliferous (M) sites harbouring toxic levels of the heavy metals zinc and cadmium. We conduct individual genome resequencing alongside soil elemental analysis for 64 plants from eight populations on M and non-metalliferous (NM) soils, and identify genomic footprints of selection and local adaptation. Selective sweep and environmental association analyses indicate a modest degree of gene as well as functional network convergence, whereby the proximal molecular factors mediating this convergence mostly differ between site pairs and species. Notably, we observe repeated selection on identical single nucleotide polymorphisms in severalA. hallerigenes at two independently colonized M sites. Our data suggest that species-specific metal handling and other biological features could explain a low degree of convergence between species. The parallel establishment of plant populations on calamine M soils involves convergent evolution, which will probably be more pervasive across sites purposely chosen for maximal similarity in soil composition.

This article is part of the theme issue ‘Convergent evolution in the genomics era: new insights and directions’.