bluuebunny/crossref_metadata_2025 huggingface dataset:
What Is the Influence of a Delay to Surgery >24 Hours on the Rate of Red Blood Cell Transfusion in Elderly Patients With Intertrochanteric or Subtrochanteric Hip Fractures Treated With Cephalomedullary Nails?
Authors: Mattisson Leif , Lapidus Lasse J. , Enocson Anders
Published: May 2018

Objectives:

To evaluate the influence of delay to surgery >24 hours on the rate of red blood cell transfusion in a selected population of hip fracture patients.

Design:

Cohort study.

Setting:

Tertiary care university hospital.

Patients:

A consecutive series of 987 patients (714 females) with a mean age of 86.3 (range 50–106) years operated with an intramedullary nail due to an unstable intertrochanteric or subtrochanteric hip fracture.

Intervention:

Patients operated with an intramedullary nail due to an unstable intertrochanteric or subtrochanteric hip fracture.

Main Outcome Measures:

Red blood cell transfusion rate, mortality, and postoperative length of stay were analyzed. Logistic regression analysis was used to adjust for anticoagulants, acetylsalicylic acid class, fracture type, preoperative hemoglobin (Hb) value, and time to surgery. Follow-up time was 1 year.

Results:

There was an increased preoperative transfusion rate among patients delayed for more than 24 hours to surgery (22%), compared with those operated within 24 hours (6.1%) (P < 0.001). After adjusting for anticoagulants, acetylsalicylic acid class, fracture type, preoperative Hb value, and time to surgery, it was found that anticoagulants [relative risk (RR), 2.0; confidence interval (CI), 1.1–3.5] and surgery delayed for more than 24 hours (RR, 3.9; CI, 2.3–6.1) were significantly associated with an increased rate of preoperative transfusions, although an increasing preoperative Hb value was associated with a lower rate of transfusions (RR, 0.3; CI, 0.2–0.4).

Conclusion:

We found an increased rate of preoperative transfusions among patients with unstable intertrochanteric or subtrochanteric hip fractures operated with an intramedullary nail that were delayed for surgery more than 24 hours.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Is First Rib Fracture a Culprit or a Sign of Injury Severity? It Is Both
Authors: Fokin Alexander , Wycech Joanna , Picard Eric , Weisz Russell , Puente Ivan
Published: May 2018

Objectives:

First rib fractures (first RFX) have been correlated with increased morbidity and mortality. Whether this is due to the fracture of the rib itself or due to an increased number of associated injuries remains debatable.

Design:

Retrospective cohort study.

Setting:

Level 1 trauma center.

Patients:

One thousand eighty-nine patients with rib fractures divided into 3 groups: group A (n = 44) with isolated first RFX, group B (n = 116) with first RFX combined with other rib fractures, and group C (n = 929) with rib fractures without first RFX.

Intervention:

None.

Outcome measurements:

Age, sex, Injury Severity Score, mortality, number of ribs fractured (RFX), incidences of flail chest, multiple coinjuries, hospital and intensive care unit lengths of stay, and duration of mechanical ventilation.

Results:

Group A, when compared with group B, had significantly lower Injury Severity Score, RFX, rates of flail chest, pulmonary coinjuries, and shorter hospital length of stay and intensive care unit length of stay. Group A compared with group C had significantly lower age, RFX, rates of flail chest, and hemopneumothorax. In group B, all outcome measurements were significantly higher than those in group C. Incidence of subclavian artery, brachial plexus, and first thoracic vertebra injuries was significantly higher in group A. Frequency of traumatic brain and orthopaedic coinjuries was comparable in both groups with first RFX.

Conclusions:

Isolated first RFX alone are associated with higher incidence of injuries to subclavian structures and the first thoracic vertebrae. When they are combined with fractures of other ribs, the overall severity of trauma expands significantly.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Comparing Radiographic Progression of Bone Healing in Gustilo IIIB Open Tibia Fractures Treated With Muscle Versus Fasciocutaneous Flaps
Authors: Mehta Devan , Abdou Salma , Stranix John T. , Levine Jamie P. , McLaurin Toni , Tejwani Nirmal , Thanik Vishal , Leucht Philipp
Published: May 2018

Objectives:

To investigate how muscle and fasciocutaneous flaps influence the progression of bone healing in acute Gustilo IIIB tibia fractures.

Design:

Retrospective Chart Review.

Setting:

Urban Academic Level I Trauma Center.

Patients/Participants:

Between 2006 and 2016, 39 patients from a database of operatively treated long bone fractures met the inclusion criteria, which consisted of adults with acute Gustilo IIIB tibia shaft fracture requiring flap coverage and having at least 6 months of radiographic follow-up.

Intervention:

Soft tissue coverage for patients with Gustilo IIIB open tibia fractures was performed with either a muscle flap or fasciocutaneous flap.

Main Outcome Measurements:

A radiographic union score for tibia (RUST) fractures, used to evaluate fracture healing, was assigned to patients' radiographs postoperatively, at 3, 6, and 12 months from the initial fracture date. Mean RUST scores at these time points were compared between those of patients with muscle flaps and fasciocutaneous flaps. Union was defined as a RUST score of 10 or higher.

Results:

There was a significant difference (P = 0.026) in the mean RUST score at 6 months between the muscle group (8.54 ± 1.81) and the fasciocutaneous group (6.92 ± 2.46). There was no significant difference in the mean RUST score at 3 months (P = 0.056) and at 12 months (P = 0.947) between the 2 groups. There was also significance in the number of fractures reaching union, favoring muscle flaps, at 6 months (P = 0.020).

Conclusions:

Patients with acute Gustilo IIIB tibia fractures who received muscle flaps have significantly faster radiographic progression of bone healing in the first 6 months than do patients who received fasciocutaneous flaps. Furthermore, according to radiographic evaluation, more Gustilo IIIB tibia fractures receiving muscle flaps reach union by 6 months than those flapped with fasciocutaneous tissue.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Helical Blade Versus Screw Fixation in the Treatment of Hip Fractures With Cephalomedullary Devices: Incidence of Failure and Atypical “Medial Cutout”
Authors: Chapman Talia , Zmistowski Benjamin , Krieg James , Stake Seth , Jones Christopher M. , Levicoff Eric
Published: May 2018

Objective:

To evaluate the rates and mechanisms of failure for cephalomedullary nail fixation using helical blade versus screw fixation and to identify the predictors of failure.

Design:

Retrospective study.

Setting:

Community teaching hospital.

Patients/Participants:

A total of 126 patients were treated with cephalomedullary fixation for low-energy hip fractures.

Intervention:

All procedures used the Trochanteric Fixation Nail (Synthes) with either a helical blade [71 (56.3%)] or screw [55 (43.7%)].

Main Outcome Measurements:

Failures, defined by nonunion, hardware cutout, and need for revision surgery were independently reviewed by a fellowship-trained orthopaedic trauma surgeon for an assessment of reduction quality and hardware placement.

Results:

Seven failures of fixation (5.6%) occurred, all of which used a helical blade. Five failures resulted from medial migration of the helical blade through the femoral head, whereas 2 resulted from typical superolateral cutout and varus collapse. There was no difference in the average tip apex distance between the cases using blade versus screw fixation or between failures and the remainder of the cohort. Basicervical fractures had a significantly higher rate of failure than other fracture patterns.

Conclusions:

This study showed a higher failure rate with use of the blade and supports the use of screw fixation in these fractures. In addition, we confirm an atypical mode of failure, lateral migration of the femoral head with protrusion of the helical blade, which contributes significantly to the overall failure rate of this implant and occurs despite appropriate fracture reduction and hardware placement.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
A Multicenter Observational Study of Family Participation in ICU Rounds
Authors: Au Selena S. , Roze des Ordons Amanda L. , Parsons Leigh Jeanna , Soo Andrea , Guienguere Simon , Bagshaw Sean M. , Stelfox Henry T.
Published: May 2018

Objectives:

Guidelines recommend offering family members of critically ill patients the option to attend interdisciplinary team rounds as a way to improve communication and satisfaction. Uncertainty remains around the benefits and risks.

Design:

We conducted an observational study to describe family participation in ICU rounds and its association with rounding processes.

Setting:

Rounds conducted under the leadership of 33 attending physicians in seven hospitals across three Canadian cities.

Patients:

Three hundred two individual rounds on 210 unique patients were observed.

Interventions:

Quantitative and qualitative data were collected using standardized observational tools.

Measurements and Main Results:

Among the 302 rounds observed, family attended in 68 rounds (23%), were present in ICU but did not attend in 59 rounds (20%), and were absent from the ICU in 175 rounds (58%). The median duration of rounds respectively for these three groups of patients was 20 minutes (interquartile range, 14–26 min), 16 minutes (interquartile range, 13–22 min), and 16 minutes (interquartile range, 10–23 min) (p = 0.01). There were no significant differences in prognostic discussions (35% vs 36% vs 36%; p = 0.99) or bedside teaching (35% vs 37% vs 34%; p = 0.88). The quality of rounds was not significantly associated with family attendance in rounds or presence in the ICU (quality score [1 (low) to 10 (high)] median 8 [interquartile range, 7–8] vs 7 [interquartile range, 6–9] vs 7 [interquartile range, 6–9]; p = 0.11). Qualitative analyses suggested that family attendance may influence relationship building, information gathering, patient and family education, team dynamics, future family meetings, workflow, and shared clinical decision-making.

Conclusions:

Our results suggest family attendance in ICU rounds is associated with longer duration of rounds, but not the frequency of trainee teaching, discussions of prognosis, or quality of rounds. Family attendance in rounds may enhance communication and complement family conferences.
Effect of Interleukin-1 Blockade on Left Ventricular Systolic Performance and Work: A Post Hoc Pooled Analysis of 2 Clinical Trials
Authors: Buckley Leo F. , Carbone Salvatore , Trankle Cory R. , Canada Justin M. , Erdle Claudia Oddi , Regan Jessica A. , Viscusi Michele M. , Kadariya Dinesh , Billingsley Hayley , Arena Ross , Abbate Antonio , Van Tassell Benjamin W.
Published: May 2018

Background:

Interleukin-1 (IL-1) blockade seems to improve anaerobic exercise in patients with systolic heart failure through improved left ventricular (LV) systolic performance. However, it is unclear whether IL-1 blockade affects LV systolic performance.

Methods:

We pooled data from 2 clinical trials of patients with systolic heart failure who were randomized to IL-1 blockade or placebo. We estimated changes in LV systolic performance (LV ejection fraction [LVEF] and end-systolic elastance [LVEes]) and pressure–volume area (PVA), a surrogate of oxygen consumption, after 14 days of treatment.

Results:

LVEF increased from 30% (24%–38%) to 36% (29%–43%) between baseline and day 14 only in anakinra-treated patients (P = 0.03 for within-group change and P = 0.02 for between-group change compared with placebo). LVEes increased from 1.0 mm Hg/mL (0.7–1.5) to 1.3 mm Hg/mL (0.8–1.6) in anakinra-treated patients between baseline and day 14 but not in placebo-treated patients (P = 0.03 for within-group change and P = 0.08 for between-group change). A change in PVA between baseline and 14 days was not detected in either anakinra or placebo patients.

Conclusions:

In this post hoc analysis, LVEes and LVEF increased significantly in patients treated with an IL-1 blocker but not in placebo-treated patients. An effect of IL-1 blockade on calculated PVA was not detected.
Cardioprotective Effects of Metformin
Authors: Driver Christine , Bamitale Kayode D. S. , Kazi Aniessa , Olla Mehnaaz , Nyane Ntsoaki A. , Owira Peter M. O.
Published: May 2018

Metformin, routinely used as first-line drug in the treatment of type 2 diabetes, has been shown to have cardioprotective effects beyond its glycemic control. These have been attributed to increases in Akt concentrations and activation of protein kinases in the RISK pathways, which prevent the mPTP from opening and rupturing it and therefore, protects myocyte viability. In myocardial infarction and subsequent reperfusion, metformin activation of AMPK promotes glycolysis and keeps the mPTP closed. Given as a preconditioning and/or postconditioning agent, metformin has been shown to decrease infarct size and improve survival rates after myocardial infarction. Metformin has further been reported to restore depleted PGC-1α levels and improve mitochondrial biogenesis by increasing phosphorylation of eNOSser1177, which produces NO and leads to reduced vascular inflammation and myocardial injury after ischemia. There is strong evidence suggesting that metformin improves cardiovascular outcomes by influencing metabolic signal transduction pathways. There are growing calls for metformin use to be expanded off-label beyond the traditional glycemic control. We review experimental evidence for metformin's impact on cardiovascular disease and its underlying molecular mechanisms of action and also discuss why significant gains made in experimental conditions have not translated into significant therapeutic applications.
Promotion of Home-Based Exercise Training as Secondary Prevention of Coronary Heart Disease
Authors: Torri Anna , Panzarino Claudia , Scaglione Anna , Modica Maddalena , Bordoni Bruno , Redaelli Raffaella , De Maria Renata , Ferratini Maurizio
Published: May 2018

Background:

Although cardiac rehabilitation (CR) is cost- effective in improving the health of patients with coronary heart disease (CHD), less than half of eligible CHD patients attend a CR program. Innovative web-based technologies might improve CR delivery and utilization. We assessed the feasibility and impact on functional capacity and secondary prevention targets of a long-term web-monitored exercise-based CR maintenance program.

Methods:

Low- to moderate-risk CHD patients were recruited at discharge from inpatient CR after a coronary event or revascularization. We developed an interactive web-based platform for secure home individual access control, monitoring, and validation of exercise training. Of 86 eligible patients, 26 consented to participate in the study intervention (IG). Using a quasi-experimental design, we recruited in parallel 27 eligible patients, unavailable for regular web monitoring, who consented to a follow-up visit as usual care (UC).

Results:

Among IG, active daily data transmission was 100% during month 1, 88% at month 3, and 81% at 6 months, with sustained improvement in self-reported physical activity beginning with the first week after discharge from inpatient CR (2467 [1854-3554] MET-min/wk) to month 3 (3411 [1981-5347] MET-min/wk, P = .019). Both groups showed favorable changes over time in lipid profile, ventricular function, distance walked in 6 min, and quality of life. At 6 mo, IG achieved a significantly higher proportion of cardiovascular risk factor targets than UC (75 ± 20% vs 59 ± 30%, P = .029).

Conclusions:

Our web-based home CR maintenance program was feasible, well-accepted, and effective in improving physical activity during 6 mo and achieved higher overall adherence to cardiovascular risk targets than UC.
Severity Adjusted Risk of Long-term Adverse Sequelae Among Children With Osteomyelitis
Authors: Vorhies John S. , Lindsay Eduardo A. , Tareen Naureen G. , Kellum Rodney J. , Jo Chan Hee , Copley Lawson A.
Published: May 2018

Background:

The purpose of this investigation was to evaluate the risk for long-term, adverse outcomes among children with osteomyelitis.

Methods:

Children with osteomyelitis were prospectively enrolled from 2012 to 2014. Care was accomplished by a multidisciplinary team according to an institutional algorithm. Data were collected to define the severity of illness during the initial hospitalization and assess short, intermediate and long-term outcomes. Clinical examination, radiographic assessment and functional outcome survey administration were performed at a minimum of 2 year follow-up. A comparison cohort analysis was performed according to initial severity of illness score of mild (0–2), moderate (3–6) and severe (7–10).

Results:

Of 195 children enrolled, 139 (71.3%) returned for follow-up at an average of 2.4 years (range, 2.0–5.0 years). Children with severe illness were less likely to have normal radiographs (severe, 4.0%; moderate, 38.2%; mild, 53.2%, P < 0.0001), and more likely to have osteonecrosis, chondrolysis, or deformity (severe, 32.0%; moderate, 5.9%; mild, 1.3%, P < 0.0001). Functional outcome measures did not significantly differ between severity categories. By regression analysis severity of illness score, plus age less than 3 years and Methicillin-resistant Staphylococcus aureus predicted severe sequelae with an area under the curve of 0.8617 and an increasing odds ratio of 1.34 per point of increase in severity score.

Conclusion:

Long-term severe adverse outcomes among children with osteomyelitis occurred in 11 of 139 (7.9%) children and were predicted by initial severity of illness. Other risks that diminished the likelihood of complete resolution or increased the risk of severe sequelae included Methicillin-resistant Staphylcoccus aureus etiology and young age. The majority of children with osteomyelitis do not require long-term follow-up beyond the initial treatment period.
Combination of Nasal and Expanded Skin Swabs Enhances the Detection Rate of Staphylococcus aureus Colonization in Premature Infants
Authors: Wisgrill Lukas , Berger Angelika , Waldhör Thomas , Makristathis Athanasios , Assadian Ojan , Rittenschober-Böhm Judith
Published: May 2018

Nasal cultures are commonly used to detect carriers of Staphylococcus aureus (SA) in infants. Combination of nasal and skin swabs has been shown to enhance the detection rate of SA colonization in adult hospitalized patients. Combining nasal swabs with expanded body skin swabs enhanced detection of SA colonization in premature infants in a tertiary care neonatal department.
Clinical Reasoning: Survey of Teaching Methods and Assessment in Entry-Level Physical Therapist Clinical Education
Authors: Huhn Karen , Black Lisa , Christensen Nicole , Furze Jennifer , Vendrely Ann , Wainwright Susan
Published: May 2018

Background.

Clinical reasoning skills have been identified as an integral part of physical therapist education developed in both the academic and clinical settings. There is limited understanding of clinical instructors (CIs) expectations related to the anticipated level of clinical reasoning (CR) skills achieved by students and how CR is taught and assessed in the clinic.

Objective.

The purpose of this research was to explore how CIs teach and assess student physical therapists' CR skills and garner an understanding of CIs' expectations related to CR skills attained at various levels of clinical experience.

Design.

A descriptive, cross-sectional survey was used to gather data from CIs.

Methods.

Participants identified from an American Physical Therapy Association database of credentialed CIs were asked to complete an 18-question electronically delivered survey.

Results.

A nationwide sample of 749 CIs completed the survey. The data clearly demonstrated that CIs value and recognize the importance of clinical education in the development of CR. They also value the use of engaged discussion and reflection to foster the development of reasoning skills. Most CIs did not expect students to achieve entry-level CR skills during the third year.

Conclusions.

Clinical instructors see the importance of clinical experiences and engaged discussion to foster the development of CR. Further research is needed to understand why most clinical educators did not expect students to achieve “entry-level” CR skills as defined by the Clinical Performance Instrument by the final year of the program.
Prevalence of Extracochlear Electrodes: Computerized Tomography Scans, Cochlear Implant Maps, and Operative Reports
Authors: Holder Jourdan T. , Kessler David M. , Noble Jack H. , Gifford René H. , Labadie Robert F.
Published: May 2018

Objective:

To quantify and compare the number of cochlear implant (CI) electrodes found to be extracochlear on postoperative computerized tomography (CT) scans, the number of basal electrodes deactivated during standard CI mapping (without knowledge of the postoperative CT scan), and the extent of electrode insertion noted by the surgeon.

Study Design:

Retrospective.

Setting:

Academic Medical Center.

Methods:

Two hundred sixty-two patients underwent standard cochlear implantation and postoperative temporal bone CT scanning. Scans were analyzed to determine the number of extracochlear electrodes. Standard CI programming had been completed without knowledge of the extracochlear electrodes identified on the CT. These standard CI maps were reviewed to record the number of deactivated basal electrodes. Lastly, each operative report was reviewed to record the extent of reported electrode insertion.

Results:

13.4% (n = 35) of CIs were found to have at least one electrode outside of the cochlea on the CT scan. Review of CI mapping indicated that audiologists had deactivated extracochlear electrodes in 60% (21) of these cases. Review of operative reports revealed that surgeons correctly indicated the number of extracochlear electrodes in 6% (2) of these cases.

Conclusions:

Extracochlear electrodes were correctly identified audiologically in 60% of cases and in surgical reports in 6% of cases; however, it is possible that at least a portion of these cases involved postoperative electrode migration. Given these findings, postoperative CT scans can provide information regarding basal electrode location, which could help improve programming accuracy, associated frequency allocation, and audibility with appropriate deactivation of extracochlear electrodes.
SOX11, a key oncogenic factor in mantle cell lymphoma
Authors: Beekman Renée , Amador Virginia , Campo Elias
Published: May 2018

Purpose of review

SOX11 has emerged as a key transcription factor in the pathogenesis of mantle cell lymphoma (MCL) whereas it is not expressed in normal B cells or virtually in any other mature B-cell neoplasm. This review will examine the role of SOX11 as a biomarker in MCL, the new information on its transcriptional targets, and the mechanisms regulating its expression in MCL.

Recent findings

SOX11 is highly expressed in conventional MCL, including cyclin D1-negative cases, but it is not expressed in the indolent leukemic nonnodal MCL subtype. These two MCL subtypes also differ in their cell-of-origin, IGHV mutational status and genomic instability. SOX11 promotes tumor growth of MCL cells in vivo and regulates a broad transcriptional program that includes B-cell differentiation pathways and tumor–microenvironment interactions, among others. The mechanisms upregulating SOX11 in MCL are not well understood but are mediated in part by the three-dimensional reconfiguration of the DNA, bringing together a distant enhancer region and the SOX11 promoter.

SOX11 is a relevant element in the pathogenesis of MCL and has been instrumental to identify two distinct clinicobiological subtypes of this tumor. Further studies should clarify the mechanisms mediating its oncogenic potential and leading to its intriguing expression in these tumors.
Precision medicine and lymphoma
Authors: Heward James A. , Kumar Emil A. , Korfi Koorosh , Okosun Jessica , Fitzgibbon Jude
Published: May 2018

Purpose of review

The treatment of the germinal center lymphomas, diffuse large B cell (DLBCL) and follicular lymphoma, has changed little beyond the introduction of immunochemotherapies. However, there exists a substantial group of patients within both diseases for which improvements in care will involve appropriate tailoring of treatment.

Recent findings

DLBCL consists of two major subtypes with striking differences in their clinical outcomes paralleling their underlying genetic heterogeneity. Recent studies have seen advances in the stratification of germinal center lymphomas, through comprehensive profiling of 1001 DLBCLs alongside refinements in the identification of high-risk follicular lymphoma patients using m7-FLIPI and 23G models. A new wave of novel therapeutic agents is now undergoing clinical trials for germinal center lymphomas, with BCR and EZH2 inhibitors demonstrating preferential benefit in subgroups of patients. The emergence of cell-free DNA has raised the possibility of dynamic disease monitoring to potentially mitigate the complexity of spatial and temporal heterogeneity, whilst predicting tumor evolution in real time.

Altogether knowledge of the genomic landscape of germinal center lymphomas is offering welcome opportunities in patient risk stratification and therapeutics. The challenge ahead is to establish how best to combine upfront or dynamic prognostication with precision therapies, while retaining practicality in clinical trials and the real-world setting.
The Esophageal‐Atresia‐Quality‐of‐life Questionnaires
Authors: Dellenmark‐Blom Michaela , Dingemann Jens , Witt Stefanie , Quitmann Julia H. , Jönsson Linus , Gatzinsky Vladimir , Chaplin John E. , Bullinger Monika , Flieder Sofie , Ure Benno M. , Dingemann Carmen , Abrahamsson Kate
Published: May 2018

Objectives:

Esophageal atresia (EA) is a rare malformation characterized of discontinuity of the esophagus, concurrent with or without a tracheoesophageal fistula (TEF). We report the feasibility validity and reliability of a condition‐specific quality‐of‐life (QOL) tool for EA/TEF children, the age‐adapted EA‐QOL‐questionnaires, when used in Sweden and Germany.

Methods:

A total of 124 families of children with EA/TEF participated in the study; 53 parents completed the EA‐QOL‐questionnaire for children aged 2 to 7 years; 62 children/71 parents the EA‐QOL‐questionnaire for children 8 to 17 years. Feasibility was determined from the percentage of missing item responses. Based on clinical data and previously validated generic QOL‐instruments (PedsQL 4.0, DISABKIDS‐12), the final EA‐QOL scores were evaluated against hypotheses of validity (known‐groups/concurrent/convergent) and reliability (internal consistency/retest reliability of scores for 3 weeks). Significant level was P < 0.05.

Results:

In the questionnaire for EA/TEF children aged 2 to 7 years, 16/18 items were completed with missing values <6% (range 0%–7.5%), and in the questionnaire for 8 to 17‐year‐olds, 24/24 child‐reported items (range 0%–4.8%) and 21/24 parent‐reported items (range 0%–7.0%). In both age‐specific EA‐QOL‐questionnaires, desirable standards for known‐groups and concurrent validity were fulfilled; digestive symptoms and feeding difficulties negatively impacted EA‐QOL‐Total‐scores (P < 0.001), and as hypothesized, in 2 to 7‐year‐olds, respiratory symptoms decreased EA‐QOL‐Total‐scores (P = 0.002). Correlations between the EA‐QOL and generic QOL questionnaires supported convergent validity. Internal consistency reliability was satisfactory. The level of agreements of EA‐QOL‐scores between the field‐ and retest study were good to excellent.

Conclusions:

The overall psychometric performance of the EA‐QOL‐questionnaires for EA/TEF children is satisfactory and can enhance outcome evaluations in future research and clinical practice.
Genomic Profile and Pathologic Features of Diffuse Large B-Cell Lymphoma Subtype of Methotrexate-associated Lymphoproliferative Disorder in Rheumatoid Arthritis Patients
Authors: Carreras Joaquim , Yukie Kikuti Yara , Miyaoka Masashi , Hiraiwa Shinichiro , Tomita Sakura , Ikoma Haruka , Kondo Yusuke , Shiraiwa Sawako , Ando Kiyoshi , Sato Shinji , Suzuki Yasuo , Miura Ikuo , Roncador Giovanna , Nakamura Naoya
Published: May 2018

Rheumatoid arthritis patients often develop the diffuse large B-cell lymphoma subtype of methotrexate-associated lymphoproliferative disorder (DLBCLMTX-LPD). We characterized the genomic profile and pathologic characteristics of 20 biopsies using an integrative approach. DLBCLMTX-LPD was associated with extranodal involvement, a high/high-intermediate international prognostic index in 53% of cases, and responded to MTX withdrawal. The phenotype was nongerminal center B-cell in 85% of samples and Epstein-Barr encoding region positive (EBER+) in 65%, with a high proliferation index and intermediate MYC expression levels. The immune microenvironment showed high numbers of CD8+ cytotoxic T lymphocytes and CD163+ M2 macrophages with an (CD163/CD68) M2 ratio of 3.6. Its genomic profile was characterized by 3p12.1-q25.31, 6p25.3, 8q23.1-q24.3, and 12p13.33-q24.33 gains, 6q22.31-q24.1 and 13q21.33-q34 losses, and 1p36.11-p35.3 copy neutral loss-of-heterozygosity. This profile was closer to nongerminal center B-cell DLBCL not-otherwise-specified, but with characteristic 3q, 12q, and 20p gains and lower 9p losses (P<0.05). We successfully verified array results using fluorescent DNA in situ hybridization on PLOD2, MYC, WNT1, and BCL2. Protein immunohistochemistry revealed that DLBCLMTX-LPD expressed high IRF4 (6p25.3) and SELPLG (12q24.11) levels, intermediate TNFRSF14 (1p36.32; the exons 1 to 3 were unmutated), BTLA (3q13.2), PLOD2 (3q24), KLHL6 (3q27.1), and MYC (8q24.21) levels, and low AICDA (12p13.31) and EFNB2 (13q33.3) levels. The correlation between the DNA copy number and protein immunohistochemistry was confirmed for BTLA, PLOD2, and EFNB2. The characteristics of EBER+ versus EBER− cases were similar, with the exception of specific changes: EBER+ cases had higher numbers of CD163+ M2 macrophages and FOXP3+ regulatory T lymphocytes, high programmed cell death 1 ligand 1 expression levels, slightly fewer genomic changes, and 3q and 4p focal gains. In conclusion, DLBCLMTX-LPD has a characteristic genomic profile with 3q and 12 gains, 13q loss, different expression levels of relevant pathogenic biomarkers, and a microenvironment with high numbers of cytotoxic T lymphocytes and M2 macrophages.
Intraductal Papillary Mucinous Neoplasms of Minor Salivary Glands With AKT1 p.Glu17Lys Mutation
Authors: Agaimy Abbas , Mueller Sarina K. , Bumm Klaus , Iro Heinrich , Moskalev Evgeny A. , Hartmann Arndt , Stoehr Robert , Haller Florian
Published: May 2018

The spectrum of low-grade intraductal papillary proliferations of the salivary glands is heterogenous, and reproducible morphologic diagnostic criteria have not yet been established. Recognized types are sialadenoma papilliferum, inverted ductal papilloma, and intraductal papilloma, but some lesions have been possibly included in the morphologic spectrum of cystadenoma or low-grade intraductal carcinomas. We herein present detailed morphologic, immunophenotypic, and genotypic features of 3 minor salivary gland neoplasms affecting 2 men (aged 65 and 71 y) and 1 woman (aged 78 y). They ranged in size from 1 to 2.5 cm. All tumors showed atypical papillary intraductal growth that presented either as uninodular/unicystic lesions (intraductal papilloma-like; n=2) or as a discontinuous growth along the ductal system in a manner similar to pancreatic intraductal papillary mucinous neoplasm (n=1). Variable cytologic and architectural atypia was observed, ranging from bland intraductal papilloma-like features, to areas mimicking atypical ductal hyperplasia and low-grade ductal carcinoma in situ of the breast. Amplicon-based massive parallel sequencing revealed an identical AKT1 p.Glu17Lys mutation in all 3 cases, but absence of concurring mutations in other genes of the RAS or PI3K pathway. This small series represents the first genetic study on salivary intraductal papillary neoplasms. Our cases showed significant variation in the degree of cytologic and architectural atypia, which overlaps with intraductal papillomas at the one end and with low-grade intraductal carcinoma at the other end of the spectrum, suggesting a disease continuum. As the full biological and morphologic characteristics of these ductal papillary lesions remain to be defined, the noncommitted term “intraductal papillary neoplasms” might be more appropriate. Our novel genetic findings mirror similar activating mutations of AKT1 and other PI3K pathway members in intraductal papillary lesions of the breast and anogenital glands.
Bidirectional Prospective Associations Between Cardiac Autonomic Activity and Inflammatory Markers
Authors: Hu Mandy Xian , Lamers Femke , Neijts Melanie , Willemsen Gonneke , de Geus Eco J.C. , Penninx Brenda W.J.H.
Published: May 2018

Objective

Autonomic nervous system (ANS) imbalance has been cross-sectionally associated with inflammatory processes. Longitudinal studies are needed to shed light on the nature of this relationship. We examined cross-sectional and bidirectional prospective associations between cardiac autonomic measures and inflammatory markers.

Methods

Analyses were conducted with baseline (n = 2823), 2-year (n = 2099), and 6-year (n = 1774) data from the Netherlands Study of Depression and Anxiety. To compare the pattern of results, prospective analyses with ANS (during sleep, leisure time, and work) and inflammation were conducted in two data sets from the Netherlands Twin Register measured for 4.9 years (n = 356) and 5.4 years (n = 472). Autonomic nervous system measures were heart rate (HR) and respiratory sinus arrhythmia (RSA). Inflammatory markers were C-reactive protein (CRP) and interleukin (IL)-6.

Results

The Netherlands Study of Depression and Anxiety results showed that higher HR and lower RSA were cross-sectionally significantly associated with higher inflammatory levels. Higher HR predicted higher levels of CRP (B = .065, p < .001) and IL-6 (B = .036, p = .014) at follow-up. Higher CRP levels predicted lower RSA (B = −.024, p = .048) at follow-up. The Netherlands Twin Register results confirmed that higher HR was associated with higher CRP and IL-6 levels 4.9 years later. Higher IL-6 levels predicted higher HR and lower RSA at follow-up.

Conclusions

Autonomic imbalance is associated with higher levels of inflammation. Independent data from two studies converge in evidence that higher HR predicts subsequent higher levels of CRP and IL-6. Inflammatory markers may also predict future ANS activity, but evidence for this was less consistent.
Cross-Sectional and Longitudinal Associations of Systolic Blood Pressure With Quality of Life and Depressive Mood in Older Adults With Cardiovascular Risk Factors: Results From the Observational DIAST-CHF Study
Authors: Herrmann-Lingen Christoph , Meyer Thomas , Bosbach Alexandra , Chavanon Mira-Lynn , Hassoun Lina , Edelmann Frank , Wachter Rolf
Published: May 2018

Objective

Although diagnosed arterial hypertension and antihypertensive medication usually have an adverse impact on quality of life, recent studies suggest that actual blood pressure may be positively related to better well-being. However, data in older patients with cardiovascular risk factors are lacking, for whom such an association may be of particular relevance.

Methods

In 1300 adults aged 50 to 85 years with cardiovascular risk factors (51.5% men, mean age = 65.7 ± 8.2 years) participating in an observational study, we performed standardized measurements of blood pressure and assessed quality of life and depressive symptoms at baseline and 1-year follow-up using the Short Form-36 (SF-36) and the Hospital Anxiety and Depression Scale (HADS).

Results

Bivariate analysis demonstrated that systolic blood pressure was associated with higher SF-36 mental component summary scores (r = 0.100, p < .001) and reduced HADS depression (r = −0.082, p = .003). Multivariate regression models adjusting for age, sex, and disease severity confirmed that higher systolic blood pressure significantly predicted both better mental quality of life (β = 0.070, p = .012) and less depressive mood (β = −0.083, p = .003) at baseline, independently of antihypertensive medication and diagnosed hypertension. Moreover, the beneficial effects of baseline systolic blood pressure remained stable for both summary components of the SF-36 as well as HADS depression at 1-year follow-up. All results remained unchanged, when limiting the analyses to the 1072 patients with diagnosed hypertension.

Conclusions

In older adults with cardiovascular risk factors, higher systolic blood pressure readings are independently related to better quality of life and fewer depressive symptoms in both cross-sectional and longitudinal settings, although the magnitude of the effect sizes is typically small.
Blood Pressure, Emotional Dampening, and Risk Behavior: Implications for Hypertension Development
Authors: McCubbin James A. , Nathan Aaron , Hibdon Melissa A. , Castillo Anastasia V. , Graham Jack G. , Switzer Fred S.
Published: May 2018

Objective

Elevated resting blood pressure (BP) is associated with risk for hypertension and emotional dampening, including reduced responses to emotionally meaningful stimuli. Perception of threat is a critical motivator in avoidance of risky health-damaging behavior. We hypothesize that BP-associated dampening of threat appraisal may increase risk-taking behavior.

Methods

We measured resting BP, perception of affect, and risk behavior in 92 healthy women (n = 49) and men (n = 43) recruited from university students and staff as well as members of the surrounding community. Mean (SE) age for the sample was 21.5 (4.3) year. BP was measured using an automated BP monitor, and risk behavior was assessed with a modified National College Health Risk Behavior Survey. We also measured recognition of affect using the Perception of Affect Task (PAT).

Results

Risk-taking behavior was positively correlated with both systolic (r(89) = .278, p = .008) and diastolic BP (r(89) = .309, p < .003). Regression analyses indicated that the association between risk-taking behavior and BP was not mediated by PAT scores.

Conclusions

Results show that persons with higher resting BP levels report increased risk-taking behavior. PAT scores, while correlated with systolic BP, did not mediate the relationship between BP and risk. The relationship between BP and risk behavior reflects the potential involvement of central nervous system regulation of both BP and emotional responsivity, and its relationship to health-damaging behavior and risk for hypertension.
Comparative Evaluation of Cell Viability Immediately After Osteotomy for Implants With Drills and Piezosurgery: Immunohistochemistry Analysis
Authors: Pereira Cassiano Costa Silva , Batista Fábio Roberto de Souza , Jacob Ricardo Garcia Mureb , Nogueira Lamis Meorin , Carvalho Abrahão Cavalcante Gomes de Souza , Gealh Walter Cristiano , Garcia-Júnior Idelmo Rangel , Okamoto Roberta
Published: May 2018

Objective:

To evaluate the effect of reusing drills and piezosurgery tips during implant osteotomy on immediate bone cell viability through immunohistochemical analysis.

Materials and Methods:

Six male rabbits were divided into 2 groups and then divided into 5 subgroups—correspond to drills and tips used 10, 20, 30, 40, and 50 times, respectively. All animals received 10 osteotomies in each tibia, by use of the classic drilling procedure in one group (G1) and the piezosurgery device in the other group (G2). For immunohistochemical technique were utilized the osteoprotegerin, RANKL, osteocalcin, and caspase 3. Control procedures were performed by omitting the primary antibodies (negative control).

Results:

Bone formation and resorption responses presented in more intense way during the piezosurgery. The expression of osteocalcin had become quite intense in piezosurgery groups, but with reduced immunostaining from the 30th osteotomy. The caspase 3 showed the viability of the osteoblast from the 20th osteotomy with piezosurgery and remained constant until the 50th.

Conclusion:

Piezosurgery provides greater osteoblastic cell viability than the system of conventional drilling.

Clinical Relevance:

This study will provide data so that the authors can recycle the drills and tips for implant placement, thus enabling a better cell viability for osseointegration.
Congenital Calvarial Hemangioma
Authors: Brichacek Michal , Naeem Abdul , Filler Guido , Hammond Robert , Yazdani Arjang , Ranger Adrianna
Published: May 2018

Objectives:

The authors describe a case of congenital calvarial hemangioma successfully managed using propranolol therapy. Presenting symptoms, radiological and pathological features, differential diagnosis, and management of this rare congenital mass are described.

Case Presentation:

A 2-year-old boy presented with a 1-year history of a growing right parietal skull mass. No obvious etiology was apparent. No focal neurological deficits or associated craniofacial anomalies were identified. Plain film imaging demonstrated focal thickening of the right parietal bone with internal trabeculations in a sunburst appearance. Computed tomography (CT) scan showed bone thickening with coarsening of the bony trabeculae, minor irregularity of the outer table, unaffected inner table, and no evidence of aggressive features. A diagnostic biopsy of the lesion was performed in the operating room. Microscopic examination was consistent with hemangioma. Based on histological and radiological features of the lesion, it was identified as a cavernous hemangioma. Medical treatment utilizing propranolol was initiated for over 3 years with interval reduction in the lesion size. MRI head following treatment with propranolol demonstrated reduction of the mass compared to preoperative imaging.

Conclusions:

Although a rare entity, it is important to consider congenital calvarial hemangioma in the differential diagnosis of slow growing skull lesions due to the possibility of complications as a result of the hemangioma's intracranial extension, and the potential for treatment. En bloc resection has classically been described as a treatment for such lesions, although our case demonstrates that medical treatment with propranolol therapy may be appropriate in certain situations.
Delayed Reduction of Zygomatic Arch Fracture: Effectiveness of the Rowe Zygoma Elevator
Authors: Kim Jinwoo , Hwang Woosuk
Published: May 2018

The zygomaticomaxillary complex fractures are common fractures among the all facial fractures, and the zygomatic arch fracture accounts for approximately 10% of all facial fractures. Various routes (Gillies app, Direct cutaneous app, Bicoronal, intraoral) and devices (Foley's ballon catheter, Rowe zygoma elevator, Langenbach, deschamps needle holder, Bone hook) for a surgical intervention of the zygomatic arch have been introduced. However, no study exists that has described an effective method of surgery for zygomatic arch fractures that have been left untreated for a long period, or for unstable reduction that have not been reduced >1 month after surgery. The authors describe the case of a 53-year-old female patient who was diagnosed an unstable reduction of the zygomatic arch, 6 weeks after undergone open reduction and internal fixation for a zygomaticomaxillary complex fracture. The authors had successful outcome for delayed reduction of a zygomatic arch fracture using a Rowe zygoma elevator. And the authors suggest that the Rowe zygoma elevator is an easy and effective method for delayed reduction of a zygomatic arch fracture.
Assessment of a Dedicated Transplant Low Clearance Clinic and Patient Outcomes on Dialysis After Renal Allograft Loss at 2 UK Transplant Centers
Authors: Evans Rhys D.R. , Bekele Soliana , Campbell Samantha M. , Clark Sarah G. , Harris Lauren , Thomas Alice , Jones Gareth L. , Thuraisingham Raj
Published: May 2018

Background

Low clearance transplant clinics (LCTCs) are recommended for the management of recipients with a failing kidney transplant (RFKT) but data to support their use is limited. We conducted a retrospective study to assess management of RFKT at 2 transplant centers, 1 with a LCTC (center A) and 1 without (center B).

Methods

Patients who transitioned to an alternative form of renal replacement therapy (RRT) between January 1, 2012, and November 30, 2016, were included. Patients with graft failure within a year of transplantation or due to an unpredictable acute event were excluded. Clinical data were collected after review of medical records.

Results

One hundred seventy-nine patients (age, 48.6 ± 13.4 years, 99 [55.3%] male, and mean transplant duration 10.3 ± 7.8 years) were included. RRT counseling occurred in 79 (91%) and 68 (74%) patients at centers A and B (P = 0.003), at median 135 (61-319) and 133 (69-260) days before dialysis after graft loss (P = 0.92). Sixty-one (34.1%) patients were waitlisted for retransplantation; 18 (32.7%) nonwaitlisted patients were still undergoing workup at center A compared with 37 (58.7%) at center B (P = 0.028). Preemptive retransplantation occurred in 4 (4.6%) and 5 (5.4%) patients at centers A and B (P = 0.35). At 1 year after initiation of dialysis after graft loss, 11 (15.3%) and 11 (17.2%) patients were retransplanted (P = 0.12), and mortality was 6.6% overall.

Conclusions

A dedicated LCTC improved RRT counseling and transplant work-up but did not lead to improved rates of retransplantation. Earlier consideration of retransplantation in LCTCs is required to improve RFKT outcomes.
More Than Meets the Eye: The Eye and Migraine—What You Need to Know
Authors: Digre Kathleen B.
Published: May 2018

Migraine has long been associated with disturbances of vision, especially migraine with aura. However, the eye plays an important role in sensory processing as well. We have found that the visual quality of life is reduced in migraine. In this review, we discuss how the migraine and eye pain pathways are similar and affect many of the common complaints which are seen in ophthalmology and neuro-ophthalmology offices, such as dry eye and postoperative eye pain. We also review other related phenomena, including visual snow and photophobia, which also are related to altered sensory processing in migraine.
Effects of simulated highway noise on heart rates of larval monarch butterflies,
Danaus plexippus
: implications for roadside habitat suitability
Authors: Davis Andrew K. , Schroeder Hayley , Yeager Ian , Pearce Jana
Published: May 2018

Developed countries around the world are criss-crossed with vast networks of roadways. Conservationists have recently focused attention on roadsides as possible locations for establishing pollinator habitat, with the monarch butterfly (
Danaus plexippus
) featuring prominently in such discussions. However, roadsides are inherently loud, which could negatively affect developing larvae. We conducted a series of experiments testing if simulated highway noise stresses monarch larvae, which we gauged by non-destructive monitoring of heart rates. In two replicated experiments, larvae exposed for 2 h experienced a significant increase in heart rate (16 and 17% elevation), indicating they perceive traffic noise as a stressor. Meanwhile, experiments exposing larvae for either 7 or 12 days to continuous traffic noise both showed no heart rate elevation at the end of larval development, suggesting chronic noise exposure leads to habituation or desensitization. Habituation to stress as larvae may impair reactions to real-world stressors as adults, which could be problematic for a butterfly that undertakes an annual two-month migration that is fraught with dangers. More generally, these results could have far-reaching implications for the billions of insects worldwide that develop near roadways, and argue that further study is needed before promoting roadside habitat for butterfly conservation.