bluuebunny/crossref_metadata_2025 huggingface dataset:
Mesalazine-related lung disease in a patient with ulcerative colitis
Authors: Huang Po-Han , Kuo Chia-Jung , Lin Chang-Wei , Cheng Yu-Ming , Hu Han-Chung , Lin Chun-Yen , Su Ming-Yao , Chiu Cheng-Tang
Published: November 2018

Rationale:

Mesalazine is widely used to treat inflammatory bowel disease (IBD). However, discriminating between pulmonary manifestations of IBD and drug-related lung disease remains a challenge. There were few case reports of mesalazine-related organizing pneumonia so far.

Patient concerns:

A 75-year-old female was diagnosed with ulcerative colitis and took mesalazine over a period of 2 years and 8 months. She presented with progressive shortness of breath for 3 days and visited our emergency department. Chest radiography showed increased bilateral infiltrates. During hospitalization her clinical condition deteriorated, and she was transferred to our intensive care unit under noninvasive ventilator support.

Diagnosis:

Computed tomography (CT) scan showed diffuse peribronchial and subpleural consolidations in bilateral lungs. Possible etiologies of interstitial lung disease were surveyed, including various infectious diseases and connective tissue diseases. Transbronchial lung biopsy showed characteristic features of organizing pneumonia.

Interventions:

Under the consideration of mesalazine-related lung disease, mesalazine was discontinued early in disease course and steroid therapy was given.

Outcomes:

The patient was discharged from hospital with improved clinical symptoms and radiographic images.

Lessons:

Although this patient suffered a life-threatening adverse event, prompt diagnosis with proper management can result in a favorable outcome.
Investigating the characteristics of echocardiogram, surgical treatment, chromosome and prognosis for fetal right heart enlargement
Authors: Liu Lin , Wang Hong-dan , Cui Cun-ying , Yao Hui-mei , Huang Lei , Li Tao , Fan Tai-bing , Peng Bang-tian , Zhang Lian-zhong
Published: November 2018

The prognosis of right heart enlargement varies according to different etiologies. The purpose of this study was to investigate the characteristics of echocardiogram, surgical treatment, chromosome and prognosis for fetal right heart enlargement.

The foetal echocardiogram was performed on 3987 pregnant women, and then 88 fetuses with right heart enlargement were identified. The data about prenatal and postnatal echocardiograms, postnatal cardiac surgical treatment, karyotype analysis and autopsy after induced labor were analyzed in the 88 fetuses.

Except the 1111 cases that had loss of follow-up, 2876 cases had complete data. Among the 2876 cases, right heart enlargement was identified in 88 fetuses. Of the 88 fetuses, 15 had total atrioventricular septal defect (unbalanced type: right ventricular dominance), 15 Ebstein's anomaly, 18 fallot tetrad, 14 double outlet right ventricle, 13 total anomalous pulmonary venous drainage, and 13 premature closure of ductus arteriosus. Chromosomal abnormality was found in 12 cases.

There are many etiological factors causing right heart enlargement. The prognosis is better in the fetuses with single heart malformation than in the fetuses who have extracardiac malformation or/and chromosomal abnormality besides heart malformation. Fetal echocardiography combined with karyotype analysis can provide important bases for evaluating the prognosis of fetuses with right heart enlargement.
Adult Langerhans’ cell histiocytosis with multisystem involvement
Authors: Kim Seung Soo , Hong Soon Auck , Shin Hyeong Cheol , Hwang Jeong Ah , Jou Sung Shick , Choi Seo-Youn
Published: November 2018

Rationale:

Langerhans’ cell histiocytosis (LCH), also called histiocytosis X, is an uncommon disorder manifesting in a variety of ways. Although LCH can involve various organs including bone, skin, and lymph nodes, multisystem involvement of LCH is rare in adults.

Patient concerns:

A 31-year-old woman first presented to our hospital with left leg pain. She had a history of a 20-kg weight gain over three months.

Diagnoses:

X-ray, magnetic resonance imaging (MRI), computed tomography (CT), and bone scan images revealed enhancing lesions in the left femur and right temporal bone, multiple cystic lesions in the lung, enhancing mass in the pituitary stalk, and fat density lesions in the liver. The patient underwent excisional biopsy for the femoral lesion and histologic examination confirmed the diagnosis of LCH.

Interventions:

Excisional biopsy was performed for the bony lesion in the left femur. She received chemotherapy with vinblastine and prednisolone.

Outcomes:

The patient expired after 21 months from initial admission following recurrent episodes of pneumothorax, pneumonia, and sepsis.

Lessons:

Our case showed LCH involvement in bone, lung, central nervous system (CNS), and liver. Although it is occasionally difficult to discriminate LCH from other disorders, systemic evaluation might be helpful for differential diagnosis. Familiarity with the various multisystemic involvements of LCH on imaging is vital for diagnosing and managing patients in daily practice.
Modified double-stent strategy may be an optimal choice for coronary bifurcation lesions
Authors: Lv Yong-Hui , Guo Chen , Li Min , Zhang Ming-Bo , Wang Zhi-Lu
Published: November 2018

Background and objective:

The modified double-stent and provisional stenting strategies have been widely used in patients with coronary bifurcation lesions, but what is the optimization has not been clearly defined. This meta-analysis is to elucidate the benefits from modified double-stent and provisional stenting strategies in patients with coronary bifurcation lesions.

Methods:

Electronic databases were searched to identify studies comparing the modified double-stent and provisional stenting strategies in patients with coronary bifurcation lesions. The clinical outcomes were divided into early (≤6 months) and late (>6 months) events according to the follow-up duration. The early endpoints included cardiac death, myocardial infarction, target lesion revascularization or target vessel revascularization, and major adverse cardiac events (MACE), and the late endpoints also include stent thrombosis in addition to the early endpoints index. The angiographic endpoint was in-stent restenosis. Data were analyzed by the statistical software RevMan (version 5.3).

Results:

A total of 6 studies involving 1683 patients with coronary bifurcation lesions were included in this meta-analysis, which found that the modified double-stent strategy was associated with a lower risk of cardiac death (odds ratio [OR] = 0.29, 95% confidence intervals [CI] 0.11–0.78, P = .01), myocardial infarction (OR = 0.41, 95% CI 0.21–0.82, P = .01), target lesion revascularization or target vessel revascularization (OR = 0.31, 95% CI 0.15–0.63, P = .001), and MACE (OR = 0.41, 95% CI 0.22–0.74, P = .003) compared with provisional stenting in the early follow-up endpoint events, while the risk of cardiac death and stent thrombosis were similar between both strategies (OR = 0.59, 95% CI 0.31–1.10, P = .09; and OR = 0.62, 95% CI 0.34–1.15, P = .13; respectively) in the late follow-up endpoint events. There were significant differences between both strategies in myocardial infarction (OR = 0.42, 95% CI 0.24–0.75, P = .003), MACE (OR = 0.44, 95% CI 0.31–0.62, P 
< .00001), and target lesion revascularization or target vessel revascularization (OR 0.35, 95% CI 0.25–0.49, P 
< .00001) between both strategies in the late follow-up endpoint events. The risk of in-stent restenosis favored the modified double-stent strategy (OR 0.29, 95% CI 0.20–0.43, P 
< .00001).

Conclusion:

The modified double-stent strategy is associated with excellent clinical and angiographic outcomes except for the occurrence of cardiac death and stent thrombosis late-term outcome compared with provisional stenting strategy in patients with coronary bifurcation lesions. These findings suggest that the modified double-stent strategy can be recommended as an optimization in patients with coronary bifurcation lesions.
Effects of switching ticagrelor to clopidogrel on cardiovascular outcomes in patients with acute coronary syndrome
Authors: Liu Lin , Liao Huocheng , Zhong Sigan , Liu Yan , Xiao Chun
Published: November 2018

Present study was to evaluate whether switching ticagrelor to clopidogrel would impact platelet reactivity and cardiovascular outcomes in acute coronary syndrome (ACS) patients after percutaneous coronary intervention (PCI).

A total of 202 ACS patients after PCI were enrolled and prescribed ticagrelor. Before discharge, 138 (68%) patients were switched to clopidogrel. Peripheral blood was obtained before switching and at 48 hours after switching to measure platelet reactivity. Patients were followed for 30 days to evaluate cardiovascular events.

Compared to ticagrelor group, patients in clopidogrel group were more likely to be male (69.6% vs 65.6%), smokers (34.1% vs 31.3%) and had higher prevalence of hypertension (75.4% vs 71.9%). The frequency of right coronary artery lesion was significantly higher in ticagrelor group (34.4% vs 30.4%). There were no significant differences in baseline platelet reactivity (37.6 ± 5.2% vs 38.4 ± 4.9%). Forty-eight hours after switching to clopidogrel, platelet reactivity in clopidogrel group was significantly higher (46.3 ± 5.6% vs 38.1 ± 5.0%, P <.05). Patients in clopidogrel group had significantly higher incidence of cardiovascular events (3.6% vs 1.6%, P <.05). However, after further adjusted for platelet reactivity at 48 hours of switching, clopidogrel switching was not significantly associated with composite outcomes, with hazard ratio 1.08 (95% confidence interval 0.98–1.21, P = .063), indicating that platelet reactivity was a critical mediator between antiplatelet drug switching and cardiovascular outcomes.

ACS patients after PCI treatment, early switching ticagrelor to clopidogrel results in increased platelet reactivity and higher incidence of short-term cardiovascular events.
A comparison of adductor canal block and femoral nerve block after total-knee arthroplasty regarding analgesic effect, effectiveness of early rehabilitation, and lateral knee pain relief in the early stage
Authors: Tan Zhen , Kang Pengde , Pei FuXing , Shen Bin , Zhou ZongKe , Yang Jing
Published: November 2018

Background:

The aim of this study was to compare the analgesic effect on the lateral and overall knee and early rehabilitation between adductor canal block (ACB) and femoral nerve block (FNB) after total-knee arthroplasty.

Method:

Two hundred patients randomly participated in the study and were divided into the ACB group and FNB group in a randomized manner. All patients received standardized anesthesia and analgesia upon hospitalization. Outcome evaluations included visual analog scale (VAS) scores at rest and during activity, quadriceps strength, range of motion (ROM), total opioid consumption and complication occurrence, sleep interruptions caused by pain, postoperative nausea and vomiting (PONV), and postoperative length of stay (PLOS) before discharge in all groups. In the 90-day postoperative follow-up, we also observed the acute deep periprosthetic joint infection, wound breakdown, readmission, reoperations, inpatient falls, ROM, and patient satisfaction score.

Results:

The lateral knee VAS scores are lower in the FNB group at rest and during activity (2–24 hours postoperatively) compared with those in the ACB group. However, the overall knee VAS score, total opioid consumption and complication occurrence, sleep interruptions caused by pain, and PONV are similar between the FNB and ACB groups. When evaluating early rehabilitation, the quadriceps strength in the ACB group is superior to that in the FNB group 24 hours postoperatively. At 24, 48, and 72 hours postoperatively, ROM in the ACB group is significantly better than that in the FNB group. Furthermore, the ACB group has a shorter PLOS (4.5 ± 0.60 days) than the FNB group (5.3 ± 0.7 days). However, patient satisfaction score, readmission rate, inpatient falls, acute deep periprosthetic joint infection, and wound breakdown are not statistically significantly different between the 2 groups.

Conclusion:

The ACB does not relieve lateral knee pain in the early stage but provides similar analgesic effect and better effectiveness of early rehabilitation compared with FNB in patients undergoing TKA.
Effects of rehabilitation on spontaneous intramedullary spinal cord hemorrhage (hematomyelia) patient without surgery
Authors: Oh Hyun-Min , Nam Tae-Woo , Kim Ju-Hyun , Jung Tae-Du
Published: November 2018

Rationale:

Spontaneous intramedullary spinal cord hemorrhage (hematomyelia) is a rare disease and most cases have specific etiologies such as cavernous malformations and tumor. Most reported cases are about surgical treatment of intramedullary spinal cord hemorrhage, but there are no reports of rehabilitation effectiveness reported. This case reports the first case with positive effect of rehabilitation on a patient with intramedullary spinal cord hemorrhage, who did not undergo surgery.

Patient concerns:

A 79-year old female visited the department of emergency complaining of sudden-onset back pain, weakness and sensory disturbance in both lower extremities and voiding difficulty. The symptoms started 2 weeks prior to her visit.

Diagnoses:

Whole spine magnetic resonance imaging revealed intramedullary spinal cord hemorrhage at the C7-T3 level and preoperative diagnosis was spinal cavernous malformation.

Interventions:

Since the benefit of surgery was presumed to be low on her, she performed rehabilitation, divided into 2 sessions per day and each session took 30 min.

Outcomes:

After 3 months of rehabilitation, numeric pain rating scale of back pain decreased, and Berg Balance Scale score, Korean version of modified Barthel index score improved. On discharge, she was able to walk independently under supervision and void without Foley catheter.

Lessons:

This case suggests that early rehabilitation such as physical therapy is an effective treatment for improving function in patients with intramedullary spinal cord hemorrhage with or without operation
Primary squamous cell carcinoma of the endometrium in a woman of perimenopausal age
Authors: Zhang Chao , Zhang Hongyan , Yang Linqing , Wang Yunfei , Li Xiaoyu , Guo Jinfeng , Xu Jing
Published: November 2018

Rationale:

Primary squamous cell carcinoma of the endometrium (PSCCE) is a rare entity, and only sporadic cases have been reported in the literature since the 1st report in 1892. This report describes a case of a perimenopausal woman with PSCCE.

Patient concerns:

A 47-year-old, human papilloma virus type 16-positive, perimenopausal woman was admitted to our hospital with irregular vaginal bleeding for 6 months and secondary anemia.

Diagnoses:

The patient was diagnosed with stage IIIc primary and moderately differentiated endometrial squamous cell carcinoma.

Interventions:

The patient underwent diagnostic curettage twice and cold knife conization (CKC). Following this total abdominal hysterectomy combined with bilateral adnexectomy and pelvic lymph node, dissection was performed. After the surgery, the patient was treated with radiotherapy and chemotherapy. Tumor markers were followed up regularly after the operation to monitor tumor recurrence and therapeutic effect.

Outcomes:

Ninety-two days after the operation, there was tumor recurrence of the left pelvic cavity and the patient died after 11 months of follow-up.

Lessons:

Intrauterine pathology after the 1st diagnostic curettage suggests that high-grade squamous intraepithelial lesion should make the clinician vigilant and investigate the origin of the lesion. Magnetic resonance imaging scans and tumor markers can be used to confirm the diagnosis as soon as possible and avoid unnecessary interventions like CKC.
Validation of modified fibrosis-4 index for predicting hepatocellular carcinoma in patients with compensated alcoholic liver cirrhosis
Authors: Kim Ji Hyun , Lee Minjong , Park Seung Woo , Kang Myungho , Kim Minjeong , Lee Sang Hoon , Kim Tae Suk , Park Jin Myung , Choi Dae Hee
Published: November 2018

Recently, modified fibrosis-4 index (mFIB-4) and the easy liver fibrosis test (eLIFT) were developed for predicting liver fibrosis in chronic liver disease patients. We evaluated whether the 2 tests can predict hepatocellular carcinoma (HCC) risk in alcoholic liver cirrhosis (ALC) patients.

A retrospective cohort of 924 ALC patients was assessed for HCC development. Four non-invasive serum biomarkers, mFIB-4, the eLIFT score, fibrosis-4 index (FIB-4), and aspartate aminotransferase to platelet ratio index (APRI) were tested using time-dependent analysis of areas under receiver operating characteristic curve (AUROC), DeLong, and log-rank tests.

During a median 4.8 years of follow-up, HCC occurred in 83 patients (9.0%). For predicting HCC development at 3 years, the mFIB-4 showed a significantly higher AUROC than APRI and eLIFT scores (0.71 vs 0.61 and 0.56, respectively, all P < .05). The AUROCs of the mFIB-4 for HCC development were not significantly different from those of the FIB-4. According to the mFIB-4, the risk of HCC development was significantly stratified by low index (≤4)/high index (>4) (P < .001 by log-rank test).

The mFIB-4 showed better predictability of HCC development than APRI and eLIFT scores, and significantly stratified HCC risk in Asian ALC patients.
Quality of care indicators for a resuscitation unit
Authors: Yuguero Oriol , Vena Ana , Forné Carles , Lacasta Jose Daniel , Llobet Cecilia , Abadías Maria José
Published: November 2018

There are lack of indicators of quality of care in resuscitation units of emergency departments. With the aim of proposing a series of indicators to evaluate the quality of care delivered in hospital resuscitation areas, we conducted a descriptive study of 7579 admissions to the resuscitation unit of an emergency department at a Spanish hospital between 2012 and 2016. The proposed indicators were the percentage of patients attending to the emergency department admitted to the resuscitation area by level of triage, the length of stay, the percentage of patients moved to intensive care and surgery at disposition, the mortality in the area or in the emergency department within 24 hours of disposition, and the data completeness. A majority of the patients (62.6%) were men and the median age was 68 years. Over 99% of the required data were recorded. Median length of stay in the resuscitation unit was 0.87 hours (interquartile range, 0.5–1.5). Approximately 80% of patients categorized as an emergency on admission to the emergency department were admitted to the resuscitation unit, although the proportion of urgency patients was higher. The main disposition destination was a trauma cubicle (82.3% of cases). Mortality was 0.41%.

Specific indicators are needed to assess the quality of care delivery in resuscitation units. We believe that our findings will provide new insights into the work done to date in this field.
Effectiveness of intrahospital transportation of mechanically ventilated patients in medical intensive care unit by the rapid response team
Authors: Kwack Won Gun , Yun Miae , Lee Dong Seon , Min Hyunju , Choi Yun Young , Lim Sung Yoon , Kim Youlim , Lee Sang Hoon , Lee Yeon Joo , Park Jong Sun , Cho Young-Jae
Published: November 2018

Critically ill patients could experience various risks including life-threatening events during intrahospital transportation (IHT), with a global incidence of 20% to 79.8%. Evidence on the clinical benefits of the presence of specialized intensive care members such as the rapid response team (RRT) during their transportation is limited. We aimed to elucidate the RRT's effectiveness in promoting patient's safety outcomes during transportation by comparing with those transport by general members.

A single-center retrospective cohort study was conducted from January 2016 to February 2017, including critically ill patients admitted to the medical intensive care unit (ICU) due to respiratory failure under mechanical ventilation. Patients who underwent out-of-ICU transportation supported by RRT members, including a portable ventilator, were categorized as the RRT group, whereas those transported by general members, such as residents or interns, were the general group. Propensity score matching (PSM) was conducted due to several significant differences in the baseline characteristics between the 2 groups. Adverse events were defined as any situation requiring cardiopulmonary resuscitation (CPR), any physiologic deteriorations requiring immediate intervention or equipment dysfunctions.

The median age of the 184 subjects included was 72 (inter quartile range, 62–75) years, and 114 (62.3%) of them were male. Thirty-six (19.6%) transports were supported by RRT, with significant higher APACHE II score than general groups (36.7 ± 6.0 vs 32.4 ± 7.7, P = .002). There was no critical event requiring CPR in both groups. However, adverse events were more frequently observed in the RRT than the general group (27.8% vs 8.1%, P = .001). PSM revealed insignificant difference in adverse events (26.7% vs 10.0%, P = .228).

In critically ill patients in the medical ICU, IHT supported by the RRT did not show a more preventative effect on adverse events than that by the general group.
Pseudohyponatremia in Hypertriglyceridemia-Induced Acute Pancreatitis
Authors: Wang Yuchen , Attar Bashar M. , Abu Omar Yazan , Agrawal Rohit , Demetria Melchor V.
Published: November 2018

Objectives

The relative rarity of hypertriglyceridemia (HTG) as the etiology for acute pancreatitis (AP) delays the final diagnosis of hypertriglyceridemia-induced AP (HTG-AP). This study aimed to explore the diagnostic and prognostic value of pseudohyponatremia in this clinical entity.

Methods

We retrospectively compared 140 patients with HTG-AP and 266 patients of AP of other etiologies. The correlation of presenting hyponatremia and a final diagnosis of HTG-AP is evaluated.

Results

Presenting hyponatremia had an area under curve of 0.926 for predicting the diagnosis of HTG-AP. After dichotomization by the optimal cutoff value of 130 mEq/dL, patients with hyponatremia had a higher prevalence of acute kidney injury (61.9% vs 38.1%, P < 0.001), systemic inflammatory response syndrome (52.2% vs 47.8%, P < 0.001), a higher Ranson criteria (3.0 vs 1.4, P < 0.001), and a higher Bedside Index for Severity of Acute Pancreatitis score (0.69 vs 0.55, P = 0.011).

Conclusions

Presenting hyponatremia is highly efficient in differentiating hypertriglyceridemia from other etiologies of AP. It also demonstrated promising prognostic values in both AP and HTG-AP patients. Therefore, initial serum sodium could potentially provide the first clue of HTG-AP, as well as facilitate risk-stratifying patients to determine treatment allocation.
Burkitt Leukemia With Precursor B-Cell Immunophenotype and Dual Translocation of t(14;18) and t(8;14) in a Child: Case Report and Review of the Literature
Authors: Odaman Al Işik , Bayram Cengiz , Koç Başak , Ersoy Gizem , Pasli Uysalol Ezgi , Aki Hilal , Özdemir Gül Nihal
Published: November 2018

Background:

Burkitt leukemia (BL) with the precursor B-cell immunophenotype is a rarely reported condition. The prognosis of such patients is similar to that of classic BL. However, the combination of chromosomal translocations associated with bcl-2 and c-myc rearrangement has a poor prognosis.

Observations:

An 11-year-old child presented with fever and weakness. Bone marrow aspiration showed morphologically L1 type blasts and flow cytometry analysis was compatible with precursor B-cell immunophenotype. Cytogenetic analysis revealed a combination of t(8;14) and t(14;l8).

Conclusions:

The combination of t(8;14) and t(14;l8) can exhibit different immunophenotypical and morphologic features in leukemias.
Treatment-related Focal Nodular Hyperplasia Mimicking Liver Metastases
Authors: Laino Maria Elena , Monti Serena , Klimstra David S. , Tang Laura H. , Mannelli Lorenzo
Published: November 2018

A 7-year-old patient with a stage 4 neuroblastoma underwent chemotherapy, surgery, myeloablative therapy, external beam radiotherapy, and Isoretinoin treatment. A posttreatment magnetic resonance examination performed administering gadoteric acid as contrast agent showed 2 new hypervascular hepatic lesions, suspicious for metastases. A second magnetic resonance imaging performed using a liver-specific contrast medium (gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid) demonstrated that these lesions were consistent with treatment-related focal nodular hyperplasia.
Population Health Management
Authors: Zander Karen
Published: November 2018

Purpose:

Population health is finally catching up with itself. Before it was known as disease management, it began at New England Medical Center in Boston, MA (now Tufts Medical Center), more than 30 years ago.

Implications for Case Management Practice:

Take-away ideas: (1) population health management is about segmenting and targeting specific patient populations for interventions that are evidence based; (2) there are currently many examples of population health management; (3) population health management will not work without social workers and nurse navigators/care coordinators working side by side.

Primary Practice Setting:

All health care settings.
Combining ALK Fluorescent In Situ Hybridization and Immunohistochemistry to Analyze Multiple Non–Small Cell Lung Carcinoma Samples per Patient Reveals Intermethod and Intersample-discrepant Results
Authors: Lambros Laetitia , Ginestet Florent , Quintin-Roué Isabelle , Le Flahec Glen , Uguen Arnaud
Published: November 2018

ALK inhibitors have improved the therapeutic management of patients with ALK-rearranged advanced non–small cell lung cancers (NSCLC). Several diagnostic methods, mainly fluorescent in situ hybridization (FISH) and immunohistochemistry (IHC), can be used as single or combined tests to detect the so-called “ALK-positive” NSCLC. Intersample and intermethod discrepancies could cause issues with therapeutic consequences in ALK testing. In this article, we report a case series of our real-life experience and issues in combining FISH and IHC in multiple tumor samples per patient to diagnose and treat a subset of “ALK-positive” patients with NSCLC. Among analyses conducted in 40 samples of 18 patients with advanced lung adenocarcinomas, we retrospectively encountered 10 patients with intersample-concordant ALK FISH and IHC results. Discrepant results about FISH and/or IHC were noted between different samples in 8 patients. Therapeutic responses were observed in 5 of 10 crizotinib-treated patients including 1 patient with ALK FISH+ IHC− status and 1 patient with ALK FISH− IHC+ status. Our data highlight the difficulty to predict the response/nonresponse to crizotinib therapy, in patients with advanced NSCLC, not only on the basis of single and multiple tumor samples, but also on the basis of single and combined diagnostic methods.
An Operational Exercise for Disaster Assessment and Emergency Preparedness in South of Iran
Authors: Sheikhbardsiri Hojjat , Yarmohammadian Mohammad H. , Khankeh Hamidreza , Khademipour Gholamreza , Moradian Mohammad Javad , Rastegarfar Behnaz , Rastegar Mohammad Reza
Published: November 2018

Introduction:

Exercise is an important step in preparation and implementation of disaster risk programs. The aim of this research was the development and assessment of an operational exercise for disaster preparedness in southeast Iran.

Methods:

A descriptive cross-sectional study was used to evaluate a 2-day exercise for a level 4 (L-4) scale mock disaster conducted in southeastern Iran in 2017. Seven medical sciences universities participated in the mock disaster exercise: Kerman, Rafsanjan, Bam, Jiroft, Zahedan, Zabol, and Iranshahr medical sciences universities. In total, 990 personnel participated. The disaster preparedness was assessed using a tool designed by the exercise planning team.

Results:

The present research reveals that the universities of medical sciences in the southeastern hub of Iran are properly prepared for emergencies and disasters. This included the Disaster Medical Assistance Teams and the response operational comprehensive plan for emergencies and disasters. The research findings indicated a preparedness score of 79.8%. The mean arrival time at exercise area (Jiroft City) was 4 hours 35 minutes despite the wide area of Kerman and Sistan and Baluchistan provinces. Personnel safety and security, rapid assessment, communications, logistics, warnings, and news confirmation functions showed higher levels of preparedness.

Conclusion:

The Joint Commission on Accreditation of Healthcare Organizations reported that organizations must perform the performance preparedness exercises on different levels and areas twice a year to be properly prepared for responding to emergencies and disasters. This study can be considered a suitable standard guide for health care organizations to execute exercises for the maintenance and promotion of their preparedness for properly responding to emergencies and disasters at L-4.
State Laws and Nonprofit Hospital Community Benefit Spending
Authors: Johnson Emily K. , Hardy Rose , Santos Tatiane , Leider Jonathon P. , Lindrooth Richard C. , Tung Gregory J.
Published: November 2018

Objective:

To determine the association of state laws on nonprofit hospital community benefit spending.

Design:

We used multivariate models to estimate the association between different types of state-level community benefit laws and nonprofit hospital community benefit spending from tax filings.

Setting:

All 50 US states.

Participants:

A total of 2421 nonprofit short-term acute care hospital organizations that filled an internal revenue service Form 990 and Schedule H for calendar during years 2009-2015.

Results:

Between 2009 and 2015, short-term acute care hospitals spent an average of $46 billion per year in total, or $20 million per hospital on community benefit activities. Exposure to a state-level community benefit law of any type was associated with an $8.42 (95% confidence interval: 1.20-15.64) per $1000 of total operating expense greater community benefit spending. Spending amounts and patterns varied on the basis of the type of community benefit law and hospital urbanicity.

Conclusions:

State laws are associated with nonprofit hospital community benefit spending. Policy makers can use community benefit laws to increase nonprofit hospital engagement with public health.
Modern Primary Breast Augmentation: Best Recommendations for Best Results
Authors: Wan Dinah , Rohrich Rod J.
Published: November 2018

Learning Objectives:

After reading this article, the participant should be able to: 1. Develop a practical method for preoperative implant size selection. 2. List characteristics and examples of fourth- and fifth-generation silicone implants. 3. Recognize the differences in “profile” designations across implant manufacturers. 4. Recall updated statistics on breast implant–associated anaplastic large cell lymphoma and describe current guidelines on disease diagnosis and treatment. 5. Apply atraumatic and aseptic surgical techniques in primary breast augmentation.

Modern primary breast augmentation requires an intimate knowledge of the expanding breast implant market, including characteristics of current generation silicone implants and “profile” types. Optimal implant size selection requires balancing patient desires with tissue qualities. Evidence and awareness of breast implant–associated anaplastic large cell lymphoma continue to grow, and patients and surgeons alike should be informed on the most updated facts of the disease entity. Atraumatic surgical technique and aseptic adjuncts are critical in reducing periprosthetic inflammation and contamination, both of which are known instigators of capsular contracture and potentially breast implant–associated anaplastic large cell lymphoma.
Cost-Effectiveness Analysis of Silicone versus Saline Implant-Based Breast Reconstruction Using the BREAST-Q
Authors: Siotos Charalampos , Sarmiento Samuel , McColl Michael , Sacks Justin M. , Manahan Michele A. , Rosson Gedge D. , Cooney Carisa M.
Published: November 2018

Background:

The most common type of breast reconstruction is implant-based breast reconstruction. Implant-based reconstruction has been reported to impact quality-of-life outcomes. Therefore, the authors sought to evaluate the cost-effectiveness of saline versus silicone implants.

Methods:

The authors retrospectively reviewed data from patients who underwent breast reconstruction with saline or silicone implants at their institution. This included type of procedure, acellular dermal matrix use, complications, and number of revisions. Costs were estimated using the Centers for Medicare and Medicaid Services physician fee schedule and hospital costs. Effectiveness was measured using BREAST-Q–adjusted life-years, a measure of years of perfect breast health, based on BREAST-Q data collected before mastectomy and reconstruction and at 12 months after final reconstruction. The incremental cost-effectiveness ratio was obtained for silicone and saline reconstruction.

Results:

The authors identified 134 women, among which 77 (57 percent) underwent silicone and 57 (43 percent) underwent saline breast reconstruction. The cost of saline reconstruction was $1288.23 less compared with silicone. BREAST-Q–adjusted life-years were 28.11 for saline and 23.57 for silicone, demonstrating higher cost-effectiveness for saline. The incremental cost-effectiveness ratio for saline was −$283.48, or $283.48 less per year of perfect breast-related health postreconstruction than silicone.

Conclusions:

The authors’ results indicate that saline breast reconstruction may be more cost-effective compared with silicone at 12 months after final reconstruction. Silicone was both more expensive and less effective than saline. However, given the relatively small cost difference, surgeon and patient preference may be important in determining type of implant used.
Effectiveness of the Multidisciplinary Team Model in Treating Colorectal Cancer
Authors: Lin Wen-Li , Sun Jia-Ling , Chang Shu-Chan , Tsai Tsung-Chih , Wu Pei-Hua , Huang Wen-Tsung , Tsao Chao-Jung , Lin Chien-Liang
Published: November 2018

The multidisciplinary team (MDT) model involves multiple medical professionals providing integrated medical care. Colorectal cancer (CRC) has the highest prevalence of cancer in Taiwan. This study examines and evaluates the survival rates of CRC patients treated under the MDT model. In this retrospective and prospective study, 651 CRC patients were recruited. They were divided into 2 groups: the MDT group and the traditional care (TC) group. The MDT group comprised 326 patients who received care from a MDT. The TC group comprised 325 patients who received care from a TC. The outcome variables were survival rates, follow-up appointment compliance, and 14-day readmission rates. Adopting the MDT model for CRC care increased patient follow-up appointment compliance rates at the first week, first month, and third month (p = .032, p = .007, p = .001, respectively). The model also effectively reduced patients' 14-day readmission rates. The results indicated that the survival rates of the MDT care were superior to those of TC. The adoption of the MDT model to treat CRC effectively enhanced clinical treatment adherence, increased survival rates, and reduced the 14-day readmission rate.
A Partially Structured Postoperative Handoff Protocol Improves Communication in 2 Mixed Surgical Intensive Care Units
Authors: Lane-Fall Meghan B. , Pascual Jose L. , Peifer Hannah G. , Di Taranti Laura J. , Collard Meredith L. , Jablonski Juliane , Gutsche Jacob T. , Halpern Scott D. , Barg Frances K. , Fleisher Lee A.
Published: November 2018

Objective:

To assess the effectiveness of standardizing operating room (OR) to intensive care unit (ICU) handoffs in a mixed surgical population.

Summary of Background Data:

Standardizing OR to ICU handoffs improves information transfer after cardiac surgery, but there is limited evidence in other surgical contexts.

Methods:

This prospective interventional cohort study (NCT02267174) was conducted in 2 surgical ICUs in 2 affiliated hospitals. From 2014 to 2016, we developed, implemented, and assessed the effectiveness of a new standardized handoff protocol requiring bedside clinician communication using an information template. The primary study outcome was number of information omissions out of 13 possible topics, recorded by trained observers. Data were analyzed using descriptive statistics, bivariate analyses, and multivariable regression.

Results:

We observed 165 patient transfers (68 pre-, 97 postintervention). Before standardization, observed handoffs had a mean 4.7 ± 2.9 information omissions each. After standardization, information omissions decreased 21.3% to 3.7 ± 1.9 (P = 0.023). In a pre-specified subanalysis, information omissions for new ICU patients decreased 36.2% from 4.7 ± 3.1 to 3.0 ± 1.6 (P = 0.008, interaction term P = 0.008). The decrement in information omissions was linearly associated with the number of protocol steps followed (P < 0.001). After controlling for patient stability, the intervention was still associated with reduced omissions. Handoff duration increased after standardization from 4.1 ± 3.3 to 8.0 ± 3.9 minutes (P < 0.001). ICU mortality and length of stay did not change postimplementation.

Conclusion:

Standardizing OR to ICU handoffs significantly improved information exchange in 2 mixed surgical ICUs, with a concomitant increase in handoff duration. Additional research is needed to identify barriers to and facilitators of handoff protocol adherence.
Pelvic Organ Prolapse Symptoms in American Samoan Women
Authors: Cohen Kathleen E. , McGarvey Stephen T. , Has Phinnara , Hampton Brittany S.
Published: November 2018

Objectives

American Samoa has one of the highest rates of obesity worldwide, making it a population at high risk for pelvic organ prolapse (POP). The primary objective of this study was to describe the presence of POP symptoms and associated degree of bother in American Samoan women. The secondary objective was to determine which characteristics are associated with POP symptoms in this cohort.

Methods

We performed a cross-sectional survey of women presenting to the waiting room of the emergency department of the Lyndon B. Johnson Tropical Medical Center in Faga'alu, American Samoa from February to March 2017. Questions included self-described characteristics and the Pelvic Organ Prolapse Distress Inventory 6. Univariate distributions were described and comparisons of social and health characteristics were made between women without POP symptoms and those with at least 1 POP symptom.

Results

Two hundred eighty-four women were approached and 225 women completed the survey (79% response rate). The mean (SD) age was 40.5 (14.7), the mean (SD) body mass index was 36.4 (8.7), and the median (range) number of vaginal births was 2 (0–14). A total of 44.2% endorsed at least 1 POP symptom, most commonly pelvic pressure (29.9%) and feeling of incomplete bladder emptying (26.7%). The number of vaginal births was associated with lower abdominal pressure (P = 0.04) and hysterectomy was associated with pelvic heaviness (P = 0.05).

Conclusions

This is the first study investigating POP in American Samoa. Almost half of women reported at least 1 pelvic floor symptom, demonstrating the need for further research on pelvic floor disorders within this high-risk population.
Pelvic Pain and Apical Prolapse Surgery: A Population-Based Retrospective Cohort Study
Authors: Borahay Mostafa A. , Zeybek Burak , Patel Parin , Lin Yu-Li , Kuo Yong-Fang , Kilic Gokhan S.
Published: November 2018

Objectives

The aims of this study were to evaluate the association of preoperative pelvic pain with operative characteristics and the association of patient and operative characteristics with postoperative pain.

Methods

This is a retrospective cohort study utilizing Clinformatics DataMart, a large national commercial insurance database. We collected data for patients older than 18 years who underwent apical prolapse surgery between January 2005 and December 2014. We stratified data by preoperative (prior) pain and analyzed for associations of prior and postoperative pain. Logistic regression analysis was performed using SAS software.

Results

A total of 14,440 patients met inclusion criteria and were analyzed. Patients with prior pain were more likely to have an abdominal (open or laparoscopic) approach, a concomitant hysterectomy, but less likely to have additional repairs or a mesh insertion (P < 0.001). Postoperative pain was less with a concomitant hysterectomy, whether they had prior pain (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.41–0.77) or not (OR, 0.68; 95% CI, 0.56–0.82). Additional vaginal repairs were associated with more postoperative pain for those without prior pain (OR, 1.63; 95% CI, 1.3–2.04). Age older than 45 years was associated with less pain. Length of hospital stay of more than 2 days was associated with more pain.

Conclusions

Patients with prior pain were more likely to undergo an abdominal approach and have a concomitant hysterectomy. Postoperative pain was less with a concomitant hysterectomy, but more with additional vaginal repairs. There is a need to include pain as an outcome in future studies, particularly clinical trials.
Value of Bone Scans in Work-up of Patients With Hepatocellular Carcinoma for Liver Transplant
Authors: Kutaiba Numan , Ardalan Zaid , Patwala Kurvi , Lau Eddie , Goodwin Mark , Gow Paul
Published: November 2018

Background

The purpose of this study was to review the value of bone scans (BS) in the assessment of bone metastases from early-stage hepatocellular carcinoma (HCC) in patients assessed or waiting for liver transplant (LTx).

Methods

We reviewed BS studies performed at our center for patients with early-stage HCC either being assessed for LTx, or on the waiting list for LTx, from January 2010 to May 2017. The BS findings were classified as positive, equivocal, or negative. Correlation with final outcome based on clinical and radiological follow-up was performed.

Results

There were 360 BS performed in 186 patients during the study period with a mean age of 58.7 years (range, 34.9-70.4 years) and most were male patients (161/186 [86.6%]). None of the BSs resulted in delisting of patients from the LTx waiting list. Three BSs were reported as positive for metastases. All 3 were proven to be false positives on follow-up. Fourteen studies reported equivocal findings, none of which were confirmed to be metastases on follow-up. There was 1 false-negative BS: a bone metastasis was detected incidentally on magnetic resonance imaging and proven on biopsy.

Conclusions

We have demonstrated that the diagnostic yield of BS in early HCC patients who are candidates for LTx is minimal, challenging the current inclusion of BS in guidelines for staging these HCC patients.
The Impact of Withdrawal of Maintenance Immunosuppression and Graft Nephrectomy on HLA Sensitization and Calculated Chance of Future Transplant
Authors: Nimmo Ailish M. S. A. , McIntyre Sophie , Turner David M. , Henderson Lorna K. , Battle Richard K.
Published: November 2018

Background

The development of HLA antibodies towards a failing renal allograft is a barrier to retransplantation. This study aimed to compare the formation of HLA donor-specific antibodies (DSA) in patients undergoing graft nephrectomy and in those with a failed graft left in situ who had maintenance immunosuppression (IS) stopped, and assess the relative impact of IS cessation and graft nephrectomy on future relative chance of transplant (R-CoT).

Methods

A single-center retrospective study of patients with failed grafts between 2005 and 2015 was performed. Samples were tested for DSA pre-IS wean, post-IS wean, and post-IS cessation. Nephrectomy patients additionally had samples tested for DSA before and after nephrectomy. Calculated reaction frequency (cRF) was determined at each timepoint and entered into the UK Organ Donation and Transplant R-CoT calculator.

Results

Forty-one patients were included in the study: 24 with nephrectomy and 17 with a failed graft in situ. Patient demographics and duration of IS wean were similar between groups. There was a higher rate of blood transfusion (54% vs 24%) in nephrectomy patients. In patients whose graft remained in situ, cRF rose from 13% pre-IS wean to 40% post-IS wean and 62% after IS cessation. This equated to a reduction in mean R-CoT from 54% to 46% at 5 years. In patients undergoing nephrectomy mean cRF rose from 31% pre-IS wean to 69% post-IS wean and 89% post-IS cessation. Mean R-CoT fell from 54% to 42% at 5 years.

Conclusions

A stepwise increase in cRF with reduced chance of transplant was observed in both groups as IS was withdrawn, with a similar pattern irrespective of graft nephrectomy. Calculated reaction frequency was higher in the nephrectomy group. The risks and benefits of stopping IS need to be carefully considered on an individual basis to maximize chance of future transplant.
CoCo: RNA-seq Read Assignment Correction for Nested Genes and Multimapped Reads
Authors: Deschamps-Francoeur Gabrielle , Boivin Vincent , Elela Sherif Abou , Scott Michelle S
Published: November 2018

Motivation

Next generation sequencing techniques revolutionized the study of RNA expression by permitting whole transcriptome analysis. However, sequencing reads generated from nested and multi-copy genes are often either misassigned or discarded, which greatly reduces both quantification accuracy and gene coverage.

Results

Here we present CoCo, a read assignment pipeline that takes into account the multitude of overlapping and repetitive genes in the transcriptome of higher eukaryotes. CoCo uses a modified annotation file that highlights nested genes and proportionally distributes multimapped reads between repeated sequences. CoCo salvages over 15% of discarded aligned RNA-seq reads and significantly changes the abundance estimates for both coding and non-coding RNA as validated by PCR and bed-graph comparisons.

Availability

The CoCo software is an open source package written in Python and available from http://gitlabscottgroup.med.usherbrooke.ca/scott-group/coco.

Contact

michelle.scott@usherbrooke.ca
On the existence of mechanoreceptors within the neurovascular unit of the rodent and rabbit brain
Authors: Larriva-Sahd Jorge , León-Olea Martha , Vargas-Barroso Víctor , Varela-Echavarría Alfredo , Concha Luis
Published: November 2018

We describe a set of perivascular interneurons (PINs) originating a series of fibro-vesicular complexes (FVCs) throughout the gray matter of the adult rabbit and rat brain. PINs-FVCs are ubiquitous throughout the brain vasculature as defined in Golgi-impregnated specimens. Most PINs consist of small, aspiny cells with local or long (> 1 millimeter) axons that split running with arterial blood vessels. Upon ramification, axons originate FVCs around the roots of the arising vascular branches. Distally, FVCs form paired axons that run parallel to the vessel’s wall until another ramification ensues and a new FVC is formed. This alternating pattern ceases when the capillary diameter narrows (i.e., <8 µm) and axons resolve. FVCs, as visualized by electron microscopy, consist of clusters of anastomotic perivascular bulbs (PVBs) arising from the PIN’s unmyelinated axon. PVBs lie alongside the pre- or -capillary wall, surrounded by end-feet and the extracellular matrix of endothelial cells and pericytes. A PVB contains mitochondria, multivesicular bodies, and granules with a membranous core similar to those observed in Meissner corpuscles and other mechanoreceptors. Some PVBs form asymmetrical, axo-spinous synapses with presumptive adjacent neurons. Antisera to sensory fiber-terminals co-label putative FVCs that are embedded by astrocytic end-feet. Because of the strategic location, ubiquity, and cytological organization of the PIN-FVC, it is suggested that: 1. PIN-FVCs are distributed throughout the mammalian brain vasculature. 2. The PIN-FVC is a putative sensory receptor intrinsic of the neurovascular unit. 3. The PIN-FVC may correspond to an afferent limb of the sensory-motor feed-back controlling local blood flow.