bluuebunny/crossref_metadata_2025 huggingface dataset:
Empirically derived dietary patterns and ovarian cancer risk: a meta-analysis
Authors: Wang Hai-Fang , Yao Ai-Lin , Sun Yan-Yan , Zhang Ai-Hua
Published: December 2017

Dietary patterns, which reflect overall diet and possible nutrient and food interactions, have been reported to be related to ovarian cancer (OC) risk. However, studies on the relationship between dietary patterns and OC risk have been inconsistent. Thus, we carried out a systematic meta-analysis to assess the relationship between dietary patterns and the risk of OC. Relevant studies are identified by searching the Medline and Embase electronic databases up to December 2016. The Cochrane Q statistic and the I
2 statistical were used to evaluate heterogeneity. A total of 22 studies fulfilled the inclusion criteria and were included in this meta-analysis. There was evidence of a decreased risk for OC in the highest versus the lowest categories of healthy dietary pattern [odds ratio (OR)=0.86; 95% confidence interval (CI): 0.74–0.99; P=0.04]. An increased risk of OC was shown for the highest versus the lowest category of a western-style dietary pattern (OR=1.19; 95% CI: 1.01–1.41; P=0.04). No significant association with OC risk was observed in the highest versus the lowest category of a heavy drinking pattern (OR=0.89; 95% CI: 0.67–1.19; P=0.42). The results of this meta-analysis suggest that a healthy dietary pattern is associated with reduced risk for OC and a western-style dietary pattern is associated with an increased risk of OC. Further studies are needed to confirm our results.
Mitral Valve and Subvalvular Repair for Secondary Mitral Regurgitation
Authors: Mihos Christos G. , Capoulade Romain , Yucel Evin , Xydas Steve , Nappi Francesco , Williams Roy F. , Santana Orlando
Published: December 2017

Secondary mitral regurgitation (MR) is a common finding in patients with dilated cardiomyopathy, and it is associated with poor outcomes. It is the result of incomplete systolic closure of the mitral valve (MV) as a consequence of left ventricular dilatation, papillary muscle displacement with impaired systolic shortening, and mitral leaflet tethering. MV surgery may be performed in cases of significant secondary MR despite guideline-directed medical therapy. However, MV repair, which is most commonly performed with an undersized ring annuloplasty, is associated with a 30–60% recurrence of moderate or greater MR at mid-term follow-up. To improve MV repair durability, several adjunctive subvalvular procedures have been proposed, one of which is the addition of papillary muscle approximation utilizing a papillary muscle sling. Recent studies comparing the outcomes of a conventional undersized ring annuloplasty with a MV repair utilizing a papillary muscle sling have reported a significant reduction in recurrent moderate or severe MR, greater left ventricular reverse remodeling, and improved MV apparatus geometry with the addition of the papillary muscle sling. We present a comprehensive review of the pathophysiology of secondary MR, and the rationale and clinical outcomes of MV repair with papillary muscle sling placement for the treatment of secondary MR.
Major Abdominal and Perianal Surgery in Crohn’s Disease: Long-term Follow-up of Australian Patients With Crohn’s Disease
Authors: Toh James W.T. , Wang Nelson , Young Christopher J. , Rickard Matthew J.F.X. , Keshava Anil , Stewart Peter , Kariyawasam Viraj , Leong Rupert
Published: December 2017

BACKGROUND:

Most patients with Crohn’s disease still require surgery despite significant advances in medical therapy, surveillance, and management strategies.

OBJECTIVE:

The purpose of this study was to assess surgical strategies and outcomes in Crohn’s disease, including surgical recurrence and emergency surgery.

DESIGN:

This was a multicenter, retrospective review of a prospectively collected database.

SETTINGS:

A specialist-referred cohort of patients with Crohn’s disease between 1970 and 2009 was studied.

PATIENTS:

Included were 972 patients with Crohn’s disease who were referred to the Sydney Inflammatory Bowel Disease cohort database.

MAIN OUTCOME MEASURES:

Main outcomes of interest were the rates of major abdominal and perianal surgery between decades (1970–1979, 1980–1989, 1990-1999, and 2000-2009), indications for surgery, types of procedure performed, rate of elective and emergency surgery, risk of surgical recurrence, and predictive factors for surgery.

RESULTS:

Between 1970 and 2009, the overall risks of surgery within 5, 10, and 15 years of diagnosis were 31.7%, 43.3%, and 48.4%. The median time to first surgery from time of diagnosis was 2 years (range, 0–31 years). A total of 6.7% of patients required emergency surgery within 5 years of diagnosis. In total, 8.8% of patients required emergency surgery within 15 years. The overall risk of surgical recurrence was 35.9%. The risk of major abdominal surgery significantly decreased between 2000 and 2009 when compared with the 1970 to 1979 period (OR = 0.49 (95% CI, 0.34–0.70). However, the rate of perianal surgery significantly increased (OR = 5.76 (95% CI, 2.54–13.06)). The main indications for surgery were enteric stricture or obstruction, perianal disease, and intra-abdominal fistulas/abscess. Of the 972 patients over 4 decades, only 11 patients (1.1%) were diagnosed with colorectal cancer.

LIMITATIONS:

This was a specialist-referred cohort, not a population-based study.

CONCLUSIONS:

The rate of major abdominal surgery has decreased, with surgery reserved for more severe and complicated disease. The natural history of patients with more complicated Crohn’s disease and severe phenotypes puts them at higher risk of surgical recurrence and emergency surgery. There has been no reduction in emergency surgery rates and there has been an increase in surgical recurrence despite the reduction in surgical rate morbidity. See Video Abstract at http://links.lww.com/DCR/A483.
Prophylactic Ureteral Catheters for Colectomy: A National Surgical Quality Improvement Program-Based Analysis
Authors: Coakley Kathleen M. , Kasten Kevin R. , Sims Stephanie M. , Prasad Tanushree , Heniford B. Todd , Davis Bradley R.
Published: December 2017

BACKGROUND:

Despite improvement in technique and technology, using prophylactic ureteral catheters to avoid iatrogenic ureteral injury during colectomy remains controversial.

OBJECTIVE:

The aim of this study was to evaluate outcomes and costs attributable to prophylactic ureteral catheters with colectomy.

DESIGN:

This was a retrospective study.

SETTINGS:

The study was conducted at a single tertiary care center.

PATIENTS:

The colectomy-targeted American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2014 was queried.

MAIN OUTCOME MEASURES:

The primary end point was the rate of 30-day ureteral injury after colectomy. Univariate and multivariate analyses determined factors associated with ureteral injury and urinary tract infection in patients undergoing colectomy.

RESULTS:

A total of 51,125 patients were identified with a mean age of 60.9 ± 14.9 years and a BMI of 28.4 ± 6.7 k/m2; 4.90% (n = 2486) of colectomies were performed with prophylactic catheters, and 333 ureteral injuries (0.65%) were identified. Prophylactic ureteral catheters were most commonly used for diverticular disease (42.2%; n = 1048), with injury occurring most often during colectomy for diverticular disease (36.0%; n = 120). Univariate analysis of outcomes demonstrated higher rates of ileus, wound infection, urinary tract infection, urinary tract infection as reason for readmission, superficial site infection, and 30-day readmission in patients with prophylactic ureteral catheter placement. On multivariate analysis, prophylactic ureteral catheter placement was associated with a lower rate of ureteral injury (OR = 0.45 (95% CI, 0.25–0.81)).

LIMITATIONS:

This was a retrospective study using a clinical data set.

CONCLUSIONS:

Here, prophylactic ureteral catheters were used in 4.9% of colectomies and most commonly for diverticulitis. On multivariate analysis, prophylactic catheter placement was associated with a lower rate of ureteral injury. Additional research is needed to delineate patient populations most likely to benefit from prophylactic ureteral stent placement. See Video Abstract at http://links.lww.com/DCR/A482.
Concentration range of serum sex steroids in normal postmenopausal women and those with diagnosis of vulvovaginal atrophy
Authors: Ke Yuyong , Bélanger Alain , Simard Jean-Nicolas , Gonthier Renaud , Martel Céline , Vaillancourt Mario , Labrie Fernand
Published: December 2017

Objective:

The aim of the study was to determine the range of serum sex-related steroids in normal postmenopausal women and in women of the same age with a diagnosis of vulvovaginal atrophy (VVA).

Methods:

Validated mass spectrometry-based assays coupled to gas or liquid chromatography were used over a 10-year period for steroid measurements. Serum samples were obtained in up to 1,512 women aged 55 to 65 years.

Results:

Serum estrone sulfate (E1S) and androsterone glucuronide (ADT-G), the main metabolites of estrogens and androgens, respectively, were 16.9% (P = 0.005) and 16.1% (P = 0.001) higher in women not diagnosed with moderate/severe VVA than those diagnosed with VVA. Serum estrone (E1) was 14.5% (P < 0.0001) higher in women with no diagnosis of VVA, whereas the other steroids did not show meaningful differences. The limited biological significance of serum estradiol (E2) and testosterone is supported by the lack of statistical significance in the serum concentrations of these two steroids between the two groups. Most importantly, for the women without a diagnosis of VVA, the normal upper limit (95th centile) of serum E2 was 9.15 pg/mL (n = 364) and 10.7 pg/mL (n = 67) for a weighted average of 9.99 pg E2/mL. A limit of 10 pg E2/mL has recently been found by two other laboratories. When comparing 50- to 59-year-old and 70- to 79-year-old women, serum E2, E1S, ADT-G, and DHEA were, respectively, 24.4%, 22.6%, 27.0%, and 85.9% higher in the younger group.

Conclusions:

Somewhat higher values, namely, 16.9% and 16.1%, are observed in the serum concentrations of the estrogen (E1S) and androgen (ADT-G) metabolites in normal compared with women with a diagnosis of VVA. Such data indicating a lower estrogenic and androgenic global exposure in women diagnosed with VVA offers an opportunity for the local intravaginal administration of DHEA to replace the deficiency in endogenous DHEA.
Associations between improvement in genitourinary symptoms of menopause and changes in the vaginal ecosystem
Authors: Mitchell Caroline M. , Srinivasan Sujatha , Plantinga Anna , Wu Michael C. , Reed Susan D. , Guthrie Katherine A. , LaCroix Andrea Z. , Fiedler Tina , Munch Matthew , Liu Congzhou , Hoffman Noah G. , Blair Ian A. , Newton Katherine , Freeman Ellen W. , Joffe Hadine , Cohen Lee , Fredricks David N.
Published: December 2017

Objective:

The aim of the study was to identify associations between improvement in genitourinary symptoms of menopause (GSM) and vaginal microbiota, vaginal glycogen, and serum estrogen.

Methods:

Thirty postmenopausal women enrolled in a hot flash treatment trial (oral estradiol vs venlafaxine vs placebo) who reported GSM and provided vaginal swabs at 0, 4, and 8 weeks were studied. Bacterial communities were characterized using deep sequencing targeting the 16S rRNA gene V3-V4 region. Participants selected a most bothersome genitourinary symptom (dryness, discharge, pain, itch/burn, or inability to have sex) and rated severity on a 10-point scale at baseline and 8 weeks. Vaginal glycogen and serum estradiol and estrone were measured at enrollment and 8 weeks. Comparisons according to improvement in most bothersome symptom (MBS) were made using χ2, Wilcoxon signed-rank test, or Hotelling's t test.

Results:

Of 30 participants, 21 (70%) had improvement in MBS over the 8-week study and 9 (30%) had no improvement or worsening of MBS. A higher proportion of women receiving estradiol or venlafaxine reported improvement in MBS (88%, 78%) compared with placebo (54%; P = 0.28). MBS improvement was associated with Lactobacillus-dominant vaginal microbiota at enrollment (57% vs 22%, P = 0.08). Vaginal glycogen, serum estradiol, and estrone significantly increased in women whose MBS improved.

Conclusions:

A larger proportion of women whose MBS improved had a Lactobacillus dominant microbiota at enrollment than those who had no improvement during the trial, though this difference was not statistically significant. Larger trials are needed to determine whether vaginal microbiota modify or mediate treatment responses in women with GSM.
THE OASIS MP-1 SUBSTUDY
Authors: Sadda SriniVas R. , Dugel Pravin U. , Gonzalez Victor H. , Meunier Esmeralda , Kozma Petra
Published: December 2017

Purpose:

To evaluate the effects of ocriplasmin and symptomatic vitreomacular adhesion resolution on visual fixation and macular sensitivity using microperimetry.

Methods:

MP-1 parameters were analyzed from 3 OASIS sites after the use of standardized instruments and testing procedures over 24 months.

Results:

A total of 27 patients (19 ocriplasmin, 8 sham) were evaluated. Mean distance of the preferred fixation locus to the anatomical center was farther in the sham group at baseline and farther in the sham versus ocriplasmin group throughout the study. Retinal sensitivity values were consistently higher in the ocriplasmin versus sham group after Month 3. Fewer patients in the ocriplasmin group had predominantly eccentric fixation at study end compared with the sham group, which also had an increased number of patients with unstable fixation. Patients with vitreomacular adhesion resolution had lower bivariate contour area, fewer relative scotomas, and higher retinal sensitivity parameters at baseline than those with unresolved vitreomacular adhesion.

Conclusion:

Substudy results suggest that fixation and sensitivity parameters tended to be better in the ocriplasmin group than in the sham group over time. The substudy identified parameters that were distinct between patients with and without vitreomacular adhesion resolution, suggesting that microperimetry warrants further study as a relevant biomarker for visual function.
EARLY MICROVASCULAR AND NEURAL CHANGES IN PATIENTS WITH TYPE 1 AND TYPE 2 DIABETES MELLITUS WITHOUT CLINICAL SIGNS OF DIABETIC RETINOPATHY
Authors: Vujosevic Stela , Muraca Andrea , Alkabes Micol , Villani Edoardo , Cavarzeran Fabiano , Rossetti Luca , De Cilla' Stefano
Published: December 2017

Purpose:

To assess and compare early modifications in inner retinal layer thickness and optical coherence tomography angiography parameters in patients with diabetes mellitus (DM) Types 1 and 2 without clinical signs of diabetic retinopathy.

Methods:

Ninety eyes of 90 subjects (24 Type 1 DM, 36 Type 2 DM, and 30 healthy controls) were prospectively evaluated with spectral domain OCT, swept-source OCT angiography, and color fundus photography (on the same day). Retinal nerve fiber layer, ganglion cell layer (GCL+), and nerve fiber layer + GCL+ (GCL++) thickness were automatically determined by the instrument in the 1, 3, and 6 central mm. On OCT angiography, the following parameters were evaluated: area of foveal avascular zone, number of focally dilated endings of the capillaries (detected only on OCT angiography), presence of regular/irregular foveal avascular zone, capillary loss, and capillary network irregularities in the superficial capillary plexus (SCP) and deep capillary plexus (DCP).

Results:

Ganglion cell layer+ (P = 0.0099) and GCL++ (P = 0.0367) were significantly thicker in DM Type 1 versus DM Type 2 in 1 central mm, after adjustment for age and DM duration. The area of foveal avascular zone was significantly larger in DM Type 1 versus controls in both SCP and DCP and in DM Type 1 versus Type 2 only in DCP (P < 0.05 for all); the number of focally dilated endings of the capillaries was higher in DM Type 1 versus controls in both SCP and DCP (P < 0.01 for all); and in DM Type 2 versus controls only in DCP (P = 0.007). Perifoveal capillary loss in SCP and inner retinal layer thickness had the highest correlation in both DM types.

Conclusion:

There are specific neural and microvascular modifications even before clinical signs of diabetic retinopathy in DM Types 1 and 2. Perifoveal capillary loss in the SCP is highly correlated with inner retinal layer. These data may help in characterization of patients at the preclinical stage of diabetic retinopathy.
MULTIMODAL IMAGING OF CHOROIDAL LESIONS IN DISSEMINATED MYCOBACTERIUM CHIMAERA INFECTION AFTER CARDIOTHORACIC SURGERY
Authors: Böni Christian , Al-Sheikh Mayss , Hasse Barbara , Eberhard Roman , Kohler Philipp , Hasler Pascal , Erb Stefan , Hoffmann Matthias , Barthelmes Daniel , Zweifel Sandrine A.
Published: December 2017

Purpose:

To explore morphologic characteristics of choroidal lesions in patients with disseminated Mycobacterium chimaera infection subsequent to open-heart surgery.

Methods:

Nine patients (18 eyes) with systemic M. chimaera infection were reviewed. Activity of choroidal lesions were evaluated using biomicroscopy, fundus autofluorescence, enhanced depth imaging optical coherence tomography, fluorescein angiography/indocyanine green angiography, and optical coherence tomography angiography. Relationships of choroidal findings to systemic disease activity were sought.

Results:

All 9 male patients, aged between 49 and 66 years, were diagnosed with endocarditis and/or aortic graft infection. Mean follow-up was 17.6 months. Four patients had only inactive lesions (mild disease). In all five patients (10 eyes) with progressive ocular disease, indocyanine green angiography was superior to other tests for revealing new lesions and active lesions correlated with hyporeflective choroidal areas on enhanced depth imaging optical coherence tomography. One eye with a large choroidal granuloma developed choroidal neovascularization. Optical coherence tomography angiography showed areas with reduced perfusion at the inner choroid. All 5 patients with progressive ocular disease had evidence of systemic disease activity within ±6 weeks' duration.

Conclusion:

Choroidal manifestation of disseminated M. chimaera infection indicates systemic disease activity. Multimodal imaging is suitable to recognize progressive ocular disease. We propose ophthalmologic screening examinations for patients with M. chimaera infection.
Axial to Centrifugal Continuous Flow LVAD Pump Exchange Using Minimally Invasive Technique
Authors: Pawale Amit A. , Farkash Ariel , Pandis Dimosthenis , Anyanwu Anelechi C.
Published: December 2017

Driveline or device infection may complicate left ventricular assist device implants, and only curative option may be pump exchange. Replacement with similar device may be liable to reinfection, because pump configuration is such that the new device and driveline may partly lie within the pocket of the previous pump. One approach to overcome this is using a different pump design such that the new pump would lie in a different location from the old pump. We describe treatment of severe HeartMate II (Abbott, [St Jude Thoratec Corp], Pleasanton, CA USA) left ventricular assist device infection by minimally invasive exchange to an intrapericardial HVAD (HeartWare International, Inc, Framingham, MA USA) left ventricular assist device.
Pharmacokinetics and Pharmacodynamics of Atazanavir in HIV-1-Infected Children Treated With Atazanavir Powder and Ritonavir
Authors: Sevinsky Heather , Zaru Luna , Wang Reena , Xu Xiaohui , Pikora Cheryl , Correll Todd A. , Eley Timothy
Published: December 2017

Background:

Two clinical studies (PRINCE-1 and -2) in HIV-1-infected children assessed the safety, efficacy and pharmacokinetics of dual nucleos(t)ide reverse transcriptase inhibitor background therapy plus once-daily atazanavir (ATV) powder formulation boosted with ritonavir (ATV + RTV). Here, we present a combined analysis of ATV pharmacokinetics and pharmacodynamics across these studies.

Methods:

Intensive 24-hour pharmacokinetic profiles at steady state compared ATV exposures (area under the concentration–time curve in one dosing interval) in 5 ATV + RTV baseline weight-band dosing categories, with historic data in adults receiving ATV + RTV 300/100 mg capsules. Repeated ATV C
trough measurements over 48 weeks explored relationships between ATV composite C
trough quartiles (CCQs) with virologic efficacy and key safety parameters.

Results:

Of 146 children included in this combined analysis, 49.3% were male, 56.8% were Black/African American and 62.3% were antiretroviral experienced. Proportions with HIV-1 RNA <50 copies/mL at week 48 were 13/32, 24/32, 19/32 and 13/28 in the lowest through highest ATV CCQs, respectively. Mean changes from baseline in total bilirubin at week 48 were +0.3, +0.5, +0.6 and +1.0 mg/dL in the lowest through highest ATV CCQs, respectively. Corresponding proportions with adverse events of hyperbilirubinemia by week 48 were 1/36, 4/36, 5/36 and 13/35, respectively. Changes from baseline in total amylase or electrocardiogram parameters and adverse events of diarrhea did not vary by ATV CCQs.

Conclusions:

Weight-band dosing of ATV + RTV plus optimized dual nucleos(t)ide reverse transcriptase inhibitors in young HIV-1-infected children achieved similar ATV exposure to that in adults; no unexpected safety findings occurred, and with the exception of lower virologic suppression in the lowest ATV CCQ, there was no apparent trend in virologic suppression across ATV CCQs.
Ceftazidime–Avibactam Antimicrobial Activity and Spectrum When Tested Against Gram-negative Organisms From Pediatric Patients
Authors: Sader Helio S. , Huband Michael D. , Duncan Leonard R. , Flamm Robert K.
Published: December 2017

Background:

Ceftazidime–avibactam was approved by the US Food and Drug Administration in 2015 to treat complicated intra-abdominal and urinary tract infections in adults and is under clinical development for treating pediatric patients.

Methods:

Among 53,381 Gram-negative organisms (1 per patient) collected in 2011–2015, 8461 (15.9%) were from pediatric (≤17 years old) patients. The isolates were collected from 82 US medical centers and susceptibility tested against ceftazidime–avibactam (avibactam at fixed 4 μg/mL) and comparators by reference broth microdilution methods. Susceptibility results were stratified by patient age: ≤1 (3671 isolates); 2–5 (1900); 6–12 (1644) and 13–17 years old (1246). Enterobacteriaceae with an extended-spectrum β-lactamase (ESBL) screening-positive phenotype were evaluated by microarray-based assay for genes encoding ESBLs, KPC, NDM and transferable AmpC enzymes.

Results:

Ceftazidime–avibactam inhibited >99.9% of all Enterobacteriaceae at the ≤8 μg/mL susceptible break point and was highly active against ESBL screening–positive phenotype Escherichia coli and Klebsiella pneumoniae. Overall, 83.6% of ESBL screening–positive phenotype K. pneumoniae were susceptible to meropenem. Only 1 of 4724 Enterobacteriaceae (0.02%) isolates was nonsusceptible to ceftazidime–avibactam, an Enterobacter aerogenes with a ceftazidime–avibactam minimum inhibitory concentration (MIC) value of 16 μg/mL and negative results for all β-lactamase tested. Ceftazidime–avibactam was very active against Pseudomonas aeruginosa (MIC50/90, 1/4 μg/mL; 99.1% susceptible), including isolates nonsusceptible to meropenem (94.0% susceptible to ceftazidime–avibactam) or piperacillin–tazobactam (91.7% susceptible) or ceftazidime (89.6% susceptible). Ceftazidime–avibactam activity against P. aeruginosa did not vary substantially among age groups (98.8%–99.3% susceptible) or year of isolation (98.5%–100.0% susceptible).

Conclusions:

Ceftazidime–avibactam was very active against a large collection of Gram-negative bacilli isolated from pediatric patients, including P. aeruginosa and Enterobacteriaceae with an ESBL screening–positive phenotype and resistant to carbapenems.
Abdominal Ultrasound Does Not Reveal Significant Alterations in Patients With Nonceliac Wheat Sensitivity
Authors: Soresi Maurizio , Mansueto Pasquale , Terranova Antonino , D’Alcamo Alberto , La Blasca Francesco , Cavataio Francesca , Iacobucci Rosario , Carroccio Antonio
Published: December 2017

Goals:

The goal of this study was (A) to evaluate abdominal ultrasound signs in nonceliac wheat sensitivity (NCWS) patients for features useful in diagnosis and (B) to compare these aspects with those of celiac patients to assess whether ultrasound can be useful in the differential diagnosis between NCWS and celiac disease (CD).

Background:

NCWS diagnosis is difficult as no biomarkers of this condition have as yet been identified. In CD ultrasound aspects have been identified that have a good diagnostic accuracy.

Study:

We prospectively recruited 45 NCWS patients (11 males, 34 females; mean age 35.7 y). Three control groups were included: (A) 99 age-matched CD patients; (B) 18 patients with seronegative CD; (C) 50 patients with irritable bowel syndrome (IBS) who did not improve on a wheat-free diet. NCWS diagnosis was confirmed on the basis of an elimination diet and double-blind placebo-controlled (DBPC) challenge. Ultrasound sign investigation included: dilatation of the small bowel loops, thickening of the small bowel wall, hyperperistalsis, enlarged mesenteric lymph nodes, ascites, hyposplenism, altered diameter of the portal vein.

Results:

NCWS patients showed a low frequency of pathologic ultrasound findings. Dilated or thickened loops appeared more often in CD patients than in NCWS patients (88.8% vs. 20%; P<0.0001). These US signs were significantly more frequent in seronegative CD than in NCWS patients (both P<0.0001), whereas no difference was found between NCWS patients and IBS controls.

Conclusions:

In NCWS patients’ ultrasound does not show a characteristic pattern which could be helpful for diagnosis. However, US can be useful to differentiate between NCWS and CD patients and especially those with seronegative CD. (ClinicalTrials.gov NCT03017274).
Family planning in inflammatory bowel disease: childlessness and disease-related concerns among female patients
Authors: Walldorf Jens , Brunne Susanne , Gittinger Fleur S. , Michl Patrick
Published: December 2017

Objective

Inflammatory bowel disease (IBD) frequently affects women when family planning and pregnancy (FPP) are important issues. This survey aimed to identify patients with an increased need for medical counselling.

Patients and methods

An internet-based questionnaire was offered to women with IBD. Characteristics in terms of FPP were analysed with respect to sociodemographic and disease-related factors.

Results

Childlessness was frequently reported (64.8% of 443 participants). In women older than 35 years with IBD, childlessness was significantly more prevalent than that in the general population (36.7 vs. 22.9%, odds ratio=1.9, P<0.001). Overall, 44.2% of the women were satisfied with counselling in general, and only 27.3% with the specific advice on FPP. Women younger than 25 years were rarely satisfied with the advice in terms of FPP (18.2%) and demanded an intensified counselling (44.6%). Frequent concerns were the heritability of IBD (all women, 59.2%; mothers, 51.5%; childless, 62.5%, P<0.01), medication during FPP (44.7, 26.1, 52.4%, P<0.01) and miscarriage (38.9, 16.8, 48.7%, P<0.01).

Conclusion

The prevalence of childlessness in women with IBD compared with the general population increases with age. FPP-related worries, especially in terms of heredity, medication and miscarriage, are associated with an increased risk for childlessness. The results underline the importance of qualified counselling as early as possible during the course of the disase.
Western long-term accuracy of serum pepsinogen-based gastric cancer screening
Authors: Castro Clara , Dinis-Ribeiro Mário , Rodrigues António N.G. , Calheiros Tiago , Santos João , Pereira Pedro , Ramos Mariana , Cunha Hugo , Andrade Mara , Costa Anita , Sá Ligia , Antunes Luís , Bento Maria J. , Lomba-Viana Rafael
Published: December 2017

Background

Even though mass gastric cancer screening is controversial in Western countries, diverse strategies have been proposed in intermediate-risk to high-risk areas.

Aim

The aim of this study was to determine the long-term accuracy of the pepsinogen test (PG) for early diagnosis of gastric cancer.

Participants and methods

A cohort of inhabitants from the Northern part of Portugal, aged between 40 and 74 years (n=5913), subjected to the PG test (PGI≤70 ng/ml and PGI/PGII≤3), were followed up between November 2006 and December 2015. The diagnosis of gastric cancer was determined through linkage to the population-based registry of cancer [North Region Cancer Registry of Portugal (RORENO)].

Results

Twenty-six gastric cancers were diagnosed (0.4%): nine (4%) among individuals ‘positive’ for the PG test (n=225) and 15 (0.3%) among those who were ‘negative’ (n=5688) [hazard ratio=12.7; 95% confidence interval (CI): 5.6–28.6]. Individuals with a ‘negative PG test’ had a 3-year risk of gastric cancer of 0.1%, representing a sensitivity of 35% (95% CI: 17–56%), globally, and of 58% (95% CI: 28–85%) at 3 years follow-up. The median survival rate in both groups was over 24 months.

Conclusion

The PG test was found to be suboptimal as a screening test and, if used (before upper gastrointestinal endoscopy), it is mandatory to repeat it after 3 years.
Applying the Ottawa subarachnoid haemorrhage rule on a cohort of emergency department patients with headache
Authors: Chu Kevin H. , Keijzers Gerben , Furyk Jeremy S. , Eley Robert M. , Kinnear Frances B. , Thom Ogilvie N. , Howell Tegwen E. , Mahmoud Ibrahim , Ting Joseph Y.S. , Brown Anthony F.T.
Published: December 2017

Objective

The Ottawa subarachnoid haemorrhage (SAH) rule suggests that alert patients older than 15 years with a severe nontraumatic headache reaching maximum intensity within 1 h and absence of high-risk variables effectively have a SAH ruled out. We aimed to determine the proportion of emergency department (ED) patients with any headache fulfilling the entry criteria for the Ottawa SAH rule.

Patients and methods

The Ottawa SAH rule was applied retrospectively in a substudy of a prospective snapshot of 34 EDs in Queensland, Australia, carried out over 4 weeks in September 2014. Patient aged 18 years and older with a nontraumatic headache of any potential cause were included. Clinical data and results of investigations were collected.

Results

Data were available for 644 (76%) patients. A total of 149 (23.1%, 95% confidence interval: 20.0–26.5%) fulfilled and 495 (76.9%, 95% confidence interval: 73.5–80.0%) did not fulfil the entry criteria. In patients who fulfilled the entry criteria, 30 (<5% overall) did not have any high-risk variables for SAH. In patients who fulfilled the entry criteria and had at least 1 high-risk feature, almost half (46%) received a computed tomographic brain. No SAH were missed.

Conclusion

In this descriptive observational study, the majority of ED patients presenting with a headache did not fulfil the entry criteria for the Ottawa SAH rule. Less than 5% of the patients in this cohort could have SAH excluded on the basis of the rule. More definitive studies are needed to determine an accepted benchmark for the proportion of patients receiving further work-up (computed tomographic brain) after fulfilling the entry criteria for the Ottawa SAH rule.
Surgical treatment of femoroacetabular impingement after slipped capital femoral epiphysis
Authors: Soni Jamil F. , Valenza Weverley R. , Uliana Chistiano S.
Published: December 2017

Purpose of review

Femoroacetabular impingement (FAI) post slipped capital femoral epiphysis (SCFE) may lead to degenerative changes on the hip. We have reviewed the current procedures in the literature, aiming to correct the SCFE to prevent FAI and the ones that treat FAI post SCFE.

Recent findings

The trends of managing moderated or severe SCFE is to correct the displacement by reduction and fixation with articular hematoma decompression in unstable hips and Dunn modified procedure even for unstable and stable situations. However, after FAI is settled, the options are osteochondroplasty by arthroscopy or surgical hip dislocation, associated or not to subtrocanteric osteotomy.

Femoroacetabular impingement may occur in mild slips and certainly occur in cases of moderate and severe slips. The initial management depends on the severity and the stability of the slip.

The modified Dunn procedure is a good option for the treatment of unstable SCFEs. Gentle closed reduction with capsulotomy (Parsch) may be considered whenever the surgeon is not comfortable with the modified Dunn procedure.

Hips with open physis and stable moderate or severe SCFE, the modified Dunn procedure can be indicated. Cases with closed physis are managed with intertrochanteric osteotomy combined with osteoplasty.

In the presence of symptomatic FAI secondary to SCFE, one should consider arthroscopic osteoplasty or surgical hip dislocation (with or without osteotomies) as treatment options.
Simultaneous Pancreas and Kidney Transplantation is Associated With Inferior Long-Term Outcomes in African Americans
Authors: Brooks Joseph T. , Liu Rong , Oliver Madeleine , DeLeonibus Anthony , Mei Jingning , White Donald , Siskind Eric , Ortiz Jorge
Published: December 2017

Objectives

Simultaneous pancreas and kidney transplant (SPK) is the most effective treatment for patients with type 1 diabetes mellitus and renal failure. However, the effect of ethnicity on SPK outcomes is not well understood.

Methods

We studied the influence of recipient ethnicity on SPK using the United Network for Organ Sharing database. A retrospective review of 20,196 SPK patients from 1989 to 2014 was performed. The recipients were divided into 4 groups: 15,833 whites (78.40%), 2708 African Americans (AA) (14.39%), 1456 Hispanics (7.21%), and 199 Asians (0.99%).

Results

Hispanics and Asians experienced the best overall graft and patient outcomes. Both groups demonstrated significantly superior graft and patient survival rates compared with whites at 1, 3, 5, 10, and 15 years (all P < 0.0001). African Americans experienced significantly superior 1- and 3-year patient survival compared with whites (both P < 0.0001). African Americans also experienced significantly superior 1-year kidney and pancreas graft survival compared with whites (P < 0.0001). However, AA experienced significantly inferior patient and allograft outcomes for all other time points compared with whites.

Conclusions

Based on United Network for Organ Sharing data from 1989 to 2014, AA have worse long-term patient and graft survival rates compared with whites, Hispanics, and Asians undergoing SPK.
GALT Deficiency Galactosemia
Authors: Anderson Sharon
Published: December 2017

Galactosemia is an inborn error of galactose metabolism that results from a deficiency in one of three enzymes, uridine diphosphate galactose 4'epimerase, galactokinase, or galactose-1-phosphate uridyltransferase (GALT). This article focuses on classical, clinical variant, and biochemical variant (Duarte) galactosemias caused by GALT enzyme deficiency. A brief overview of galactosemia and newborn screening is presented, followed by detailed information about each of the conditions. Confirmatory testing, acute and long-term management, and outcome for these galactosemia types are discussed as well as the importance of genetic counseling and testing for the infant and family to refine reproductive risk.
Educating Emergency Department Nurses About Miscarriage
Authors: Merrigan Joyce L.
Published: December 2017

Miscarriage is the unwanted ending of a pregnancy before 20 weeks gestation. Women experiencing miscarriage require specialized care from nurses and other healthcare professionals. Many women are dissatisfied with emergency care related to miscarriage and desire honest communication, validation of urgency, and more robust information at discharge. Perinatal bereavement education offers an opportunity for emergency department nurses to acquire specific knowledge and communication skills that assist with understanding the individualized experience of early pregnancy loss. For many women, a miscarriage is devastating, whereas for some, a part of life. Therefore, assessing the meaning of miscarriage is an essential step to providing sensitive, supportive care. Education was offered to emergency department nurses based on a 4-hour Resolve Through Sharing® curriculum. Education focused on knowledge of policy and practice, medical aspects of pregnancy loss, information on how to assess the meaning of the miscarriage, respectful handling and disposition of the remains, and communication strategies to initiate and sustain a meaningful relationship with the woman and her family, within the barriers to care that are exclusive to the emergency department. Participants embraced the information and actively participated in dialogue of an evaluation process to identify needed revisions in current policies and practices for caring for this patient population. Recommendations and guidance for emergency room nurses who care for women experiencing miscarriage are offered.
Maternity Nurses' Perceptions of Implementation of the Ten Steps to Successful Breastfeeding
Authors: Cunningham Emilie M. , Doyle Eva I. , Bowden Rodney G.
Published: December 2017

Objective:

The purpose of this study was to determine maternity nurses' perceptions of implementing the Ten Steps to Successful Breastfeeding.

Methods:

An online survey and a focus group were used to evaluate perceptions of maternity nurses of implementing the Ten Steps to Successful Breastfeeding in an urban Texas hospital at the onset of the project initiation. Responses were transcribed and coded using Nvivo software. Thematic analysis was conducted and consensus was reached among the research team to validate themes.

Results:

Twenty-eight maternity nurses participated. Nurses perceived a number of barriers to implementing the Ten Steps to Successful Breastfeeding including nurse staffing shortages, variations in practice among nurses, different levels of nurse education and knowledge about breastfeeding, lack of parental awareness and knowledge about breastfeeding, culture, and postpartum issues such as maternal fatigue, visitors, and routine required procedures during recovery care that interfered with skin-to-skin positioning. Maternity nurses desired more education about breastfeeding; specifically, a hands-on approach, rather than formal classroom instruction, to be able to promote successful implementation of the Ten Steps.

Conclusions:

More education on breastfeeding for new mothers, their families, and healthcare providers was recommended. Nurse staffing should be adequate to support nurses in their efforts to promote breastfeeding. Skin-to-skin positioning should be integrated into the recovery period. Hospital leadership support for full implementation and policy adherence is essential. Challenges in implementing the Ten Steps were identified along with potential solutions.
Missed Opportunities for Human Immunodeficiency Virus and Syphilis Testing Among Men Who Have Sex With Men in China: A Cross-Sectional Study
Authors: Ong Jason J. , Fu Hongyun , Pan Stephen , Smith M. Kumi , Wu Dan , Wei Chongyi , Cao Bolin , Ma Wei , Yang Ligang , Tang Weiming , Tucker Joseph D.
Published: December 2017

Background

Men who have sex with men (MSM) are at high risk of human immunodeficiency virus (HIV)/syphilis. To inform strategies for dual testing, we describe patterns of HIV/syphilis testing, and examine factors associated with never testing for HIV/syphilis in China.

Methods

An online survey (2016) was completed by MSM from 8 cities: men born biologically male, 16 years or older, and had sex with another man at least once during their lifetime. Demographic, sexual behavioral, and HIV/syphilis testing data were collected. Multivariable multinomial logistic regression identified characteristics associated with men who never tested for HIV/syphilis compared with men who ever tested for both infections.

Results

Overall, 2105 men participated. Among them, 35.1% (738/2105) never tested for HIV/syphilis, and in those ever tested for HIV, only half (54.0%, 709/1312) had tested for syphilis. Relative to men who had ever tested for both infections, those with increased probability of never testing for HIV/syphilis include non-gay sexual identity (prevalence odds ratio [POR] 1.86; 95% confidence interval [CI], 1.45–2.37), not disclosed their sexuality/sexual history with men other than their regular partner (POR, 2.22; 95% CI, 1.75–2.78]) or with health professionals (POR, 11.11; 95% CI, 7.69–14.29), no condomless sex with casual partners in the last 3 months (POR, 1.89; 95% CI, 1.37–2.56), no community engagement in sexual health (POR, 15.16; 95% CI, 9.40–24.45), and mainly met partners offline (POR, 1.49; 95% CI, 1.16–1.92).

Conclusions

There are significant gaps in lifetime testing for HIV/syphilis among Chinese MSM. Strategies to target never testers and integrate syphilis testing within HIV testing services are urgently needed. Future opportunities include point-of-care dual test kits, and testing in China’s expanding primary healthcare system.
SP174 Antibody Lacks Specificity for NRAS Q61R and Cross-Reacts With HRAS and KRAS Q61R Mutant Proteins in Malignant Melanoma
Authors: Felisiak-Goląbek Anna , Inaguma Shingo , Kowalik Artur , Wasąg Bartosz , Wang Zeng-Feng , Zięba Sebastian , Pięciak Liliana , Ryś Janusz , Kopczynski Janusz , Sarlomo-Rikala Maarit , Góźdź Stanislaw , Lasota Jerzy , Miettinen Markku
Published: December 2017

HRAS, KRAS, and NRAS, highly homologous proteins, are often mutationally activated in cancer. Usually, mutations cluster in codons 12, 13, and 61 and are detected by molecular genetic testing of tumor DNA. Recently, immunohistochemistry with SP174 antibody has been introduced to detect NRAS Q61R-mutant protein. Studies on malignant melanomas showed that such an approach could be a viable alternative to molecular genetic testing. This investigation was undertaken to evaluate the value of SP174 immunohistochemistry for detection of NRAS Q61R-mutant isoform. Two hundred ninety-two malignant melanomas were evaluated using Leica Bond-Max automated immunostainer. Twenty-nine tumors (10%) showed positive immunoreactivity. NRAS codon 61 was polymerase chain reaction amplified and sequenced in 24 positive and 92 negative cases using Sanger sequencing, quantitative polymerase chain reaction, and next-generation sequencing approaches. A c.182A>G substitution leading to NRAS Q61R mutation was identified in 22 tumors. Two NRAS wild-type tumors revealed c.182A>G substitutions in H
RAS and KRAS codon 61, respectively. Both mutations were detected by next-generation sequencing and independently confirmed by Sanger sequencing. None of 85 NRAS codon 61 wild-type tumors and 7 NRAS mutants other than Q61R showed immunoreactivity with SP174 antibody. Thus, SP174 antibody was 100% sensitive in detecting NRAS Q61R-mutant isoform in malignant melanoma, but not fully specific as it cross-reacted with HRAS and KRAS Q61R-mutant proteins. Therefore, molecular testing is needed to determine which RAS gene is mutated. The rarity of HRAS and KRAS Q61R mutants in malignant melanoma let previous investigations erroneously conclude that SP174 is specific for NRAS Q61R-mutant protein.
Expression of GHRH-R, a Potentially Targetable Biomarker, in Triple-negative Breast Cancer
Authors: Khanlari Mahsa , Schally Andrew V. , Block Norman L. , Nadji Mehrdad
Published: December 2017

Purpose:

Growth hormone–releasing hormone (GHRH) has been shown to modify the growth behavior of many cancers, including breast. GHRH is produced by tumor cells, acts in an autocrine/paracrine manner, and requires the presence of GHRH receptor (GHRH-R) on the tumor cells to exert its effects. GHRH activity can be effectively blocked by synthetic antagonists of its receptor and hence, the expression of GHRH-R by tumor cells could serve as a predictor of response to GHRH-R antagonist therapy. In this study, we investigated the expression of GHRH-R in triple-negative breast cancers (TNBC). As TNBCs are morphologically and immunophenotypically heterogenous, the staining results were also correlated with the histologic subtypes of these tumors.

Materials and Methods:

On the basis of histomorphology and immunophenotype, 134 cases of primary TNBCs were further subdivided into medullary, metaplastic, apocrine, and invasive ductal carcinomas of no special type (IDC-NST). Immunohistochemistry for GHRH-R was performed on paraffin sections and the staining results were assessed semiquantitatively as negative, low expression, moderate, and high expression.

Results:

Of the 134 TNBCs, 85 were classified as IDC-NST, 25 as metaplastic, 16 as medullary, and 8 as apocrine carcinoma. Overall, positive reaction for GHRH-R was seen in 77 (57%) of tumors including 66 (77.6%) of IDC-NST. All medullary carcinomas were negative for GHRH-R and, with the exception of 1 case with low expression, none of the metaplastic carcinomas expressed GHRH-R (P<0.005).

Conclusions:

A considerable number of TNBCs are positive for GHRH-R as a predictor of potential response to anti-GHRH-R treatment. This expression however, varies considerably between histologic subtypes of triple-negative breast cancers. Although most medullary and metaplastic carcinomas do not express GHRH-R, three fourths of the IDC-NST show a positive reaction. Testing for GHRH-R expression is therefore advisable if anti-GHRH-R therapy is being considered.
Therapeutic Plasma Exchange in Critically Ill Children Requiring Intensive Care
Authors: Cortina Gerard , McRae Rosemary , Chiletti Roberto , Butt Warwick
Published: December 2017

Objective:

To characterize the clinical indications, procedural safety, and outcome of critically ill children requiring therapeutic plasma exchange.

Design:

Retrospective observational study based on a prospective registry.

Setting:

Tertiary and quaternary referral 30-bed PICU.

Patients:

Forty-eight critically ill children who received therapeutic plasma exchange during an 8-year period (2007–2014) were included in the study.

Interventions:

Therapeutic plasma exchange.

Measurements and Main Results:

A total of 48 patients underwent 244 therapeutic plasma exchange sessions. Of those, therapeutic plasma exchange was performed as sole procedure in 193 (79%), in combination with continuous renal replacement therapy in 40 (16.4%) and additional extracorporeal membrane oxygenation in 11 (4.6%) sessions. The most common admission diagnoses were hematologic disorders (30%), solid organ transplantation (20%), neurologic disorders (20%), and rheumatologic disorders (15%). Complications associated with the procedure occurred in 50 (21.2%) therapeutic plasma exchange sessions. Overall, patient survival from ICU was 82%. Although patients requiring therapeutic plasma exchange alone (n = 31; 64%) had a survival rate of 97%, those with additional continuous renal replacement therapy (n = 13; 27%) and extracorporeal membrane oxygenation (n = 4; 8%) had survival rates of 69% and 50%, respectively. Factors associated with increased mortality were lower Pediatric Index of Mortality 2 score, need for mechanical ventilation, higher number of failed organs, and longer ICU stay.

Conclusion:

Our results indicate that, in specialized centers, therapeutic plasma exchange can be performed relatively safely in critically ill children, alone or in combination with continuous renal replacement therapy and extracorporeal membrane oxygenation. Outcome in children requiring therapeutic plasma exchange alone is excellent. However, survival decreases with the number of failed organs and the need for continuous renal replacement therapy and extracorporeal membrane oxygenation.