Button Battery Safety: Industry and Academic Partnerships to Drive Change.
*Esophagus; Advisory Committees; Button battery; Coin cell battery; Disc battery; Electric Power Supplies/adverse effects/*standards; Esophageal; Foreign Bodies/etiology/*prevention & control/*surgery; Foreign body; Humans; Injury prevention; Pediatrics; Product Labeling/standards
The pediatric button battery (BB) hazard has been recognized for several decades. In 2012, the National Button Battery Task Force was established, and most manufacturers have improved warning labels, more secure packaging, and made BB compartments in products are more secure. Tissue neutralization before BB removal (ie, honey or sucralfate/Carafate(R)) is an effective way to reduce the rate of BB injury. In absence of visible perforation, 0.25% sterile acetic acid esophageal tissue irrigation at time of BB removal is recommended as a neutralization strategy to mitigate injury progression. Future BB design changes could eliminate esophageal tissue injury.
Jatana Kris R; Chao Silas; Jacobs Ian N; Litovitz Toby
Otolaryngologic clinics of North America
2019
2019-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.otc.2018.08.009" target="_blank" rel="noreferrer noopener">10.1016/j.otc.2018.08.009</a>
Feasibility of a team based prognosis and treatment goal discussion (T-PAT) with women diagnosed with advanced breast cancer.
*Advanced cancer survivorship; *Advanced care planning; *Clinician-patient communication; *Prognosis discussion
OBJECTIVE: To assess the feasibility of a team-based prognosis and treatment goal discussion for women living with advanced breast cancer. METHODS: Female patients diagnosed with advanced breast cancer (n = 25) participated in a mixed methods study that evaluated the feasibility and effects of a planned and structured prognosis discussion. Audio analysis of the intervention appointments was conducted to assess intervention feasibility. Patient self-reports of prognosis related beliefs and treatment preferences were compared across intervention and usual care groups. RESULTS: Most patients found the T-PAT appointment challenging but worthwhile. Intervention uptake by clinicians was good, but some fidelity disruptions were noted. T-PAT participants were more likely to hold realistic beliefs about disease curability after the appointment. CONCLUSION: Productive prognosis discussions can be delivered effectively by a practice-based clinical team within a semi-structured patient education appointment. It was perceived by patients with advanced breast cancer as both valuable and acceptable. T-PAT clinicians found the intervention easy to deliver. PRACTICE IMPLICATIONS: Regular implementation of T-PAT may help clinicians' build prognosis discussion communication skills. T-PAT documentation provides valuable information that can be used to tailor ongoing care.
Step Mary M; Ferber Gretchen A; Downs-Holmes Catherine; Silverman Paula
Patient education and counseling
2019
2019-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.pec.2018.08.016" target="_blank" rel="noreferrer noopener">10.1016/j.pec.2018.08.016</a>
Kratom exposures reported to United States poison control centers: 2011-2017.
dietary supplement; Kratom; National Poison Data System; poison control center; poisoning
CONTEXT: Kratom, or Mitragyna speciosa, is a plant indigenous to Southeast Asia that has gained national attention in the United States for its increased use in the self-management of opioid withdrawal and pain, as well as for concerns about its safety. METHODS: This study analyzes exposures to kratom reported to poison control centers (PCCs) in the United States during 2011-2017 from the National Poison Data System (NPDS). DISCUSSION: From 2011 through 2017, 1807 kratom exposures were reported to United States PCCs. Almost two-thirds (65.0%) of these exposures occurred during 2016-2017. Most exposures occurred among adults \textgreater/=20 years (88.9%), males (70.8%), at a residence (86.1%), and were intentional (74.3%). Among first-ranked kratom exposures, 31.8% resulted in admission to a health care facility (HCF) and 51.9% in a serious medical outcome. Multiple-substance exposures were associated with greater odds of admission to a HCF (OR: 2.80; 95% CI: 2.21-3.55) and a serious medical outcome (OR: 2.25; 95% CI: 1.77-2.85) compared with single-substance exposures. There were 11 deaths associated with kratom exposure, including two that occurred after exposure to kratom only. Among kratom-only exposures, 86.1% resulted in one or more clinical effects. The most common clinical effects were agitation/irritability (22.9%) and tachycardia (21.4%). There were seven neonatal exposures, including five experiencing withdrawal. CONCLUSIONS: Kratom is associated with a variety of serious medical outcomes, especially when used with other substances. More research is needed to define the human response to kratom. Increased regulation of kratom products would help guarantee product quality and safety. Individuals who choose to use kratom should be educated about its potential risks, including the dangers of using it in combination with other substances.
Post Sara; Spiller Henry A; Chounthirath Thitphalak; Smith Gary A
Clinical toxicology (Philadelphia, Pa.)
2019
2019-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1080/15563650.2019.1569236" target="_blank" rel="noreferrer noopener">10.1080/15563650.2019.1569236</a>
Homozygosity for a mutation affecting the catalytic domain of tyrosyl-tRNA synthetase (YARS) causes multisystem disease.
Aminoacyl-tRNA synthetases (ARSs) are critical for protein translation. Pathogenic variants of ARSs have been previously associated with peripheral neuropathy and multisystem disease in heterozygotes and homozygotes, respectively. We report seven related children homozygous for a novel mutation in tyrosyl-tRNA synthetase (YARS, c.499C \textgreater A, p.Pro167Thr) identified by whole exome sequencing. This variant lies within a highly conserved interface required for protein homodimerization, an essential step in YARS catalytic function. Affected children expressed a more severe phenotype than previously reported, including poor growth, developmental delay, brain dysmyelination, sensorineural hearing loss, nystagmus, progressive cholestatic liver disease, pancreatic insufficiency, hypoglycemia, anemia, intermittent proteinuria, recurrent bloodstream infections and chronic pulmonary disease. Related adults heterozygous for YARS p.Pro167Thr showed no evidence of peripheral neuropathy on electromyography, in contrast to previous reports for other YARS variants. Analysis of YARS p.Pro167Thr in yeast complementation assays revealed a loss-of-function, hypomorphic allele that significantly impaired growth. Recombinant YARS p.Pro167Thr demonstrated normal subcellular localization, but greatly diminished ability to homodimerize in human embryonic kidney cells. This work adds to a rapidly growing body of research emphasizing the importance of ARSs in multisystem disease and significantly expands the allelic and clinical heterogeneity of YARS-associated human disease. A deeper understanding of the role of YARS in human disease may inspire innovative therapies and improve care of affected patients.
Williams Katie B; Brigatti Karlla W; Puffenberger Erik G; Gonzaga-Jauregui Claudia; Griffin Laurie B; Martinez Erick D; Wenger Olivia K; Yoder Mark A; Kandula Vinay V R; Fox Michael D; Demczko Matthew M; Poskitt Laura; Furuya Katryn N; Reid Jeffrey G; Overton John D; Baras Aris; Miles Lili; Radhakrishnan Kadakkal; Carson Vincent J; Antonellis Anthony; Jinks Robert N; Strauss Kevin A
Human molecular genetics
2019
2019-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1093/hmg/ddy344" target="_blank" rel="noreferrer noopener">10.1093/hmg/ddy344</a>
Utility of Intracardiac Echocardiography to Diagnose Infective Endocarditis.
infective endocarditis; intracardiac echography; prosthetic valve
Infective endocarditis (IE) can lead to significant morbidity and mortality without appropriate treatment. Modified Duke Criteria are accepted by many professional societies to establish the diagnosis of IE, and cardiac imaging is one of the major diagnostic criteria. Transesophageal echocardiography is an algorithmic escalation to diagnose IE when transthoracic echo does not appreciate a positive finding. In patients with contraindications to transesophageal echocardiography, cardiac magnetic resonance imaging, cardiac computed tomography (CT), cardiac CT angiography, and fluorodeoxyglucose positron emission tomography with CT or CT angiography may be alternative diagnostic tools. However, these imaging modalities have their own limitations such as local unavailability, the presence of non-magnetic resonance imaging compatible implants, or impaired renal function. Intracardiac echocardiography could be a considerable alternative under those circumstances.
Yang Ying Chi; Aung Thein Tun; Khan Sarah; Wase Abdul
Journal of investigative medicine high impact case reports
2019
2019-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/2324709618822075" target="_blank" rel="noreferrer noopener">10.1177/2324709618822075</a>
Combined use of minimal access craniotomy, intraoperative magnetic resonance imaging, and awake functional mapping for the resection of gliomas in 61 patients.
ADC = apparent diffusion coefficient; awake craniotomy; awake functional mapping; DTI = diffusion tensor imaging; DVT = deep vein thrombosis; DWI = diffusion-weighted imaging; ECoG = electrocorticography; EMR = electronic medical record; EOR = extent of resection; fMRI = functional MRI; glioma resection; iMRI; iMRI = intraoperative MRI; IMRIS = iMRI suite; intraoperative magnetic resonance imaging; IV = intravenous; KPS = Karnofsky Performance Scale; LMA = laryngeal mask airway; minimal access craniotomy; MPRAGE = magnetization prepared rapid gradient echo; oncology; OR = operating room; SMA = supplementary motor area; surgical technique
OBJECTIVECurrent management of gliomas involves a multidisciplinary approach, including a combination of maximal safe resection, radiotherapy, and chemotherapy. The use of intraoperative MRI (iMRI) helps to maximize extent of resection (EOR), and use of awake functional mapping supports preservation of eloquent areas of the brain. This study reports on the combined use of these surgical adjuncts.METHODSThe authors performed a retrospective review of patients with gliomas who underwent minimal access craniotomy in their iMRI suite (IMRIS) with awake functional mapping between 2010 and 2017. Patient demographics, tumor characteristics, intraoperative and postoperative adverse events, and treatment details were obtained. Volumetric analysis of preoperative tumor volume as well as intraoperative and postoperative residual volumes was performed.RESULTSA total of 61 patients requiring 62 tumor resections met the inclusion criteria. Of the tumors resected, 45.9% were WHO grade I or II and 54.1% were WHO grade III or IV. Intraoperative neurophysiological monitoring modalities included speech alone in 23 cases (37.1%), motor alone in 24 (38.7%), and both speech and motor in 15 (24.2%). Intraoperative MRI demonstrated residual tumor in 48 cases (77.4%), 41 (85.4%) of whom underwent further resection. Median EOR on iMRI and postoperative MRI was 86.0% and 98.5%, respectively, with a mean difference of 10% and a median difference of 10.5% (p \textless 0.001). Seventeen of 62 cases achieved an increased EOR \textgreater 15% related to use of iMRI. Seventeen (60.7%) of 28 low-grade gliomas and 10 (30.3%) of 33 high-grade gliomas achieved complete resection. Significant intraoperative events included at least temporary new or worsened speech alteration in 7 of 38 cases who underwent speech mapping (18.4%), new or worsened weakness in 7 of 39 cases who underwent motor mapping (18.0%), numbness in 2 cases (3.2%), agitation in 2 (3.2%), and seizures in 2 (3.2%). Among the patients with new intraoperative deficits, 2 had residual speech difficulty, and 2 had weakness postoperatively, which improved to baseline strength by 6 months.CONCLUSIONSIn this retrospective case series, the combined use of iMRI and awake functional mapping was demonstrated to be safe and feasible. This combined approach allows one to achieve the dual goals of maximal tumor removal and minimal functional consequences in patients undergoing glioma resection.
Whiting Benjamin B; Lee Bryan S; Mahadev Vaidehi; Borghei-Razavi Hamid; Ahuja Sanchit; Jia Xuefei; Mohammadi Alireza M; Barnett Gene H; Angelov Lilyana; Rajan Shobana; Avitsian Rafi; Vogelbaum Michael A
Journal of neurosurgery
2019
2019-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3171/2018.9.JNS181802" target="_blank" rel="noreferrer noopener">10.3171/2018.9.JNS181802</a>
Adjuvant Chemotherapy in Uterine Leiomyosarcoma: Trends and Factors Impacting Usage.
Neoplasm Staging; Odds Ratio; Age Factors; Survival; Confidence Intervals; Neoplasm Metastasis; Human; Multiple Regression; Chemotherapy; Chemoradiotherapy; Cox Proportional Hazards Model; Kaplan-Meier Estimator; Uterine Neoplasms – Diagnosis; Lymph Nodes – Pathology; Adjuvant – Trends; Adjuvant – Utilization; Leiomyosarcoma – Diagnosis; Leiomyosarcoma – Prognosis; Leiomyosarcoma – Therapy; Uterine Neoplasms – Prognosis; Uterine Neoplasms – Therapy
Objectives. The benefit of adjuvant chemotherapy in patients with localized uterine leiomyosarcoma (LMS) remains unclear due to a lack of randomized studies and data only from small retrospective series to rely on. We sought to identify factors associated with the administration of chemotherapy and to determine the trends in the usage of adjuvant chemotherapy in patients with nonmetastatic uterine LMS. Methods. Patients diagnosed with nonmetastatic uterine LMS between 2004 and 2014 were identified from the National Cancer Database (NCDB). Multiple regression was used to determine factors with a significant impact on patient receipt of chemotherapy. Kaplan–Meier curves and the Cox model were used to determine the effect of adjuvant chemotherapy on overall survival (OS). Results. 2,732 uterine LMS patients were identified. Patients older than 65 were less likely to receive chemotherapy than their younger counterparts. Patients with stage I or stage II cancer were less likely to receive chemotherapy, whereas individuals with positive regional lymph nodes and those who had received radiation were more likely. In this cohort, adjuvant chemotherapy had no significant impact on OS (HR, 1.04; 95% CI, 0.90–1.22; P=0.5768). However, administration of chemotherapy significantly increased from 2004 to 2014 (P\textless0.0001). Conclusions. Expected tumor characteristics such as higher stage of tumor were associated with receipt of chemotherapy. Although adjuvant chemotherapy demonstrated no benefit over observation on OS in patients with nonmetastatic LMS, the number of patients being treated with chemotherapy continued to increase from 2004 to 2014.
Patel Dhara; Handorf Elizabeth; von Mehren Margaret; Martin Lainie; Movva Sujana
Sarcoma
2019
2019-02-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1155/2019/3561501" target="_blank" rel="noreferrer noopener">10.1155/2019/3561501</a>
Occurrence of never events after total joint arthroplasty in the United States.
Total knee arthroplasty; Hospital-acquired condition; Medical quality; National Inpatient Sample; Never events; Total hip arthroplasty; Total joint arthroplasty
BACKGROUND: Total joint arthroplasty (TJA) is a major orthopedic procedure associated with substantial morbidity and mortality. Never events (NEs) are harmful hospital-acquired conditions (HACs) that are preventable. METHODS: Information on hospital admissions with TJA was collected from the National Inpatient Sample (NIS) from 2003 to 2012. NIS was queried to identify NE applicable to TJA patients based on the HAC definition listed by the Centers for Medicare and Medicaid Services (CMS). NEs were further compared before and after 2008 to evaluate the effect of the new CMS non-reimbursement policy on their incidence. RESULTS: A total of 8,176,774 patients were admitted with TJA from 2003 to 2012. 108,668 patients of these (1.33%) had >/= 1 NE. The most prevalent NE was fall and trauma (0.7%). Significant multivariable predictors with higher odds of developing at least one NE included weekend admission [odds ratio (99.9% CI), 4.3 (3.1, 5.8), p < 0.001] and weight loss [odds ratio (99.9% CI), 2.8 (2.2, 3.5), p < 0.001]. A temporal comparison of NE before and after 2008 revealed a decrease in total NE occurrence after 2008 when the CMS announced discontinuing payment for NE (1.39% vs. 1.25%, p < 0.001). After adjustment for potential confounding risk factors, NE after TJA was significantly associated with an increased mortality (p < 0.001), a longer hospital stay (p < 0.001), and higher total hospitalization charges (p < 0.001). CONCLUSIONS: These data demonstrated that NE in TJA patients was predictive of an increased mortality, length of hospital stay, and hospitalization costs. This study established baseline NE rates in the TJA patient population to use as benchmarks and identified target areas for quality improvement in US.
Tsai Allen J
Archives of orthopaedic and trauma surgery
2019
2019-03
<a href="http://doi.org/10.1007/s00402-019-03156-0" target="_blank" rel="noreferrer noopener">10.1007/s00402-019-03156-0</a>
Interactive Effects of Infant Gestational Age and Infant Fussiness on the Risk of Maternal Depressive Symptoms in a Nationally Representative Sample.
ECLS-B (Early Childhood Longitudinal Survey-Birth Cohort); Infant Fussiness; Maternal depressive symptoms; Moderate/Late Preterm
OBJECTIVE: To examine the interactive effects of gestational age and infant fussiness on the risk of maternal depressive symptoms in a nationally representative sample. METHODS: Sample included 8200 children from the Early Childhood Longitudinal Study, Birth Cohort. Gestational age categories were: very preterm (VPT, 24-31 weeks), moderate/late preterm (MLPT, 32-36 weeks) and full-term (FT, 37-41 weeks). Maternal depressive symptoms (categorized as non-depressed/mild/moderate-severe), from the modified Center for Epidemiological Studies Depression Questionnaire, and infant fussiness (categorized as fussy/ not fussy) were assessed at 9 months from parent-report questionnaires. We examined the interactive effects of infant fussiness and gestational age categories, and estimated adjusted odds ratios (aOR) and 95% confidence intervals (CI) of maternal depressive symptoms using multinomial logistic regression. RESULTS: Infant fussiness interacted with gestational age categories in predicting maternal depressive symptoms (p=.04), with severity varying by gestational age and infant fussiness. Compared with mothers of VPT infants without fussiness, mothers of VPT infants with fussiness had higher odds of mild depressive symptoms (aOR=2.32, 95%CI [1.19, 4.53]). Similarly, compared with mothers of MLPT and FT infants without fussiness, mothers of fussy MLPT and FT infants had higher odds of moderate-severe symptoms (aOR=2.30, 95%CI [1.40, 3.80], and aOR=1.74, 95%CI [1.40, 2.16] respectively). CONCLUSIONS: Mothers of MLPT and FT infants with fussiness had increased odds of moderate-severe depressive symptoms, and mothers of VPT infants with fussiness had increased risk of mild symptoms. Early screening for infant fussiness in preterm and full-term infants may help identify mothers with depressive symptoms in need of support.
Quist Megan; Kaciroti Niko; Poehlmann-Tynan Julie; Weeks Heidi M; Asta Katharine; Singh Priya; Shah Prachi E
Academic pediatrics
2019
2019-03
<a href="http://doi.org/10.1016/j.acap.2019.02.015" target="_blank" rel="noreferrer noopener">10.1016/j.acap.2019.02.015</a>
Effective utilization of non-invasive enteroscopy.
Deep enteroscopy; Intraoperative enteroscopy; Obscure gastrointestinal bleeding; Small bowel bleeding; Small bowel endoscopy; Video capsule endoscopy
Tsai Allen J
American journal of surgery
2019
2019-04
<a href="http://doi.org/10.1016/j.amjsurg.2018.05.001" target="_blank" rel="noreferrer noopener">10.1016/j.amjsurg.2018.05.001</a>
Circulating NT-proBNP but not soluble corin levels were associated with preeclampsia in pregnancy-associated hypertension.
NT-proBNP; Corin; Preeclampsia
BACKGROUND: Corin is a serine protease known to convert B-type natriuretic peptide (BNP) prohormone into BNP and its amino-terminal fragment (NT-proBNP). In mice lacking corin, high blood pressure and proteinuria were found at late gestational stages, with associated delayed trophoblast invasion and impaired spiral artery remodeling in the uterus. We hypothesize that both NT-proBNP and soluble corin elevation predict the presence of preeclampsia in pregnant patients with hypertension. METHODS: We prospectively enrolled 149 pregnant women with a history of chronic hypertension or gestational hypertension presenting at a tertiary-care hospital. We compared plasma NT-proBNP and soluble corin concentrations based on their preeclamptic status. RESULTS: In our study cohort, 62 patients with preeclampsia had lower gestational age than 87 patients without preeclampsia (33.3+/-3 versus 36.6+/-3weeks; P<.001), otherwise the baseline characteristics were similar. We observed higher NT-proBNP concentrations in patients with preeclampsia compared to those without preeclampsia (304.3 [96.34, 570.4] vs. 60.8 [35.61, 136.8] ng/L, P<.001), with no differences between chronic and gestational hypertension. However, the concentration of corin was not statistically different between the two groups (1756 [1214, 2133] vs. 1571 [1171, 1961] ng/L, P=.1087). ROC curve analysis demonstrated stronger predictive value of NT-proBNP compared to soluble corin in predicting the presence of preeclampsia in our study population (AUC 0.7406 vs. 0.5789, P<.0001). CONCLUSION: While corin may contribute to mechanistic underpinnings of the development of preeclampsia in animal models, soluble corin likely has no diagnostic role in human pregnancies for preeclampsia beyond natriuretic peptide levels.
Kumari Meera; Kovach Tracy; Sheehy Brendan; Zabell Allyson; Morales Rommel; Moodley Sangithan Jules; Shah Yogesh G; Maroo Praful V; Maroo Anjli P; Tang W H Wilson
Clinical biochemistry
2019
2019-03
<a href="http://doi.org/10.1016/j.clinbiochem.2019.03.005" target="_blank" rel="noreferrer noopener">10.1016/j.clinbiochem.2019.03.005</a>
Platelet-rich plasma for androgenetic alopecia: A review of the literature and proposed treatment protocol.
alopecia; plasma; androgenetic; platelet; rich
Androgenetic alopecia (AGA) is a common hair loss disorder caused by genetic and hormonal factors that are characterized by androgen-related progressive thinning of scalp hair in a defined pattern. By the age of 60 years, 45% of men and 35% of women develop AGA. Currently, U.S. Food and Drug Administration-approved treatments for AGA include oral finasteride and topical minoxidil. Due to the limited number of effective therapies for AGA, platelet-rich plasma (PRP) has become an effective alternative treatment. PRP is an autologous concentration of platelets in plasma with numerous growth factors that contribute to hair regeneration. The growth factors contained within the alpha granules of platelets act on stem cells in the bulge area of the hair follicles and stimulate the development of new follicles along with neovascularization. PRP has become a promising treatment modality for AGA. Although there have been several studies previously reported, a standard practice for PRP preparation and administration as well as a method to evaluate results have not been established. This literature review was conducted to evaluate the effectiveness of PRP for AGA and discuss the various treatment protocols that have been proposed.
Stevens J; Khetarpal S
International journal of women's dermatology
2019
2019-02
<a href="http://doi.org/10.1016/j.ijwd.2018.08.004" target="_blank" rel="noreferrer noopener">10.1016/j.ijwd.2018.08.004</a>
Carotid Endarterectomy and Carotid Artery Stenting in a Predominantly Symptomatic Real-World Patient Population.
Carotid; Endarterectomy; Outcomes; Restenosis; Stenting
OBJECTIVE: Carotid endarterectomy (CEA) and carotid angioplasty and stenting (CAS) are well established treatments that have been shown to decrease stroke recurrence in patients with underlying carotid artery disease. We assessed clinical outcome, safety and restenosis rates for patients who underwent standardized CEA or CAS at our tertiary care center using patient selection criteria based on available scientific evidence. METHODS: Retrospective chart review of patients who underwent CEA or CAS between 2009 and 2016. RESULTS: In total, 314 cases (204 CEA and 110 CAS) were analyzed. Patients were predominantly non-Hispanic Caucasian (84.4%), males (61.1%) with hypertension (86.9%) and hyperlipidemia (81.8%). Most patients (84.5%) had symptomatic carotid disease. No significant differences were observed in median post-operative NIHSS and mRS scores based on pre-treatment symptomatic status, or treatment modality (CEA vs CAS). Most patients (85.9%) had favorable outcomes (mRS 0-2) at a median follow-up of 11.7 months (IQR 1.8- 28.8). The perioperative complication rate was low (3.2%), and permanent neurologic deficit was seen in only 3 patients (1%). Restenosis was found in 7.3% without significant difference between CEA and CAS at last follow-up. Restenosis was asymptomatic in the majority of patients. CONCLUSIONS: Our findings in a real-world predominantly symptomatic cohort demonstrate that favorable patient outcomes, and low restenosis and complication rates can be achieved with both CEA and CAS by the utilization of a consistent institutional patient selection and treatment process.
Howie Benjamin A; Witek Alex M; Hussain M Shazam; Bain Mark D; Toth Gabor
World neurosurgery
2019
2019-04
<a href="http://doi.org/10.1016/j.wneu.2019.03.254" target="_blank" rel="noreferrer noopener">10.1016/j.wneu.2019.03.254</a>
Powered muscle stimulators: an investigation into newly FDA 510(k) approved devices marketed for muscle toning and esthetic benefit.
premarket approval; 510(k); abdominal muscles; MAUDE; muscle blood flow; Muscle conditioning; muscle toning; pain relief; slendertone; transcutaneous electrical muscle stimulation
INTRODUCTION: Powered muscle stimulators have been popularized in recent years due to their muscle toning effects. This study aims to describe marketing trends and reporting of adverse effects of powered muscle stimulators. METHODS: We performed a cross-sectional retrospective analysis of records from the United States FDA database for 510(k) premarket approval of powered muscle stimulators between January 1, 2000 and December 31, 2018. The FDA MAUDE database was reviewed for adverse events reported with device usage. RESULTS: One hundred and seventeen devices received 510(k) premarket approval between 2000 and 2018, with the first approval occurring in 2001. Initially, devices were marketed to assist with muscle toning and strengthening, but more recent indications include the treatment of pain, increased local muscle blood circulation, and prevention of post-surgical venous thrombosis. Thirty-six adverse event reports have been submitted and published in the MAUDE database over the past 10 years by 11% of manufacturers. DISCUSSION: Powered muscle stimulators are growing increasingly popular amongst consumers and healthcare providers due to their ease of use and perceived esthetic, muscle strength, and pain relief benefits. Additional investigation to determine optimal treatment parameters and potential adverse effects is necessary due to the growing popularity of these devices.
Manudhane Albert P; Wang Sophie; Ezaldein Harib H; Scott Jeffrey F
The Journal of dermatological treatment
2019
2019-02
<a href="http://doi.org/10.1080/09546634.2019.1587148" target="_blank" rel="noreferrer noopener">10.1080/09546634.2019.1587148</a>
Kratom exposures reported to United States poison control centers: 2011-2017.
dietary supplement; Kratom; National Poison Data System; poison control center; poisoning
CONTEXT: Kratom, or Mitragyna speciosa, is a plant indigenous to Southeast Asia that has gained national attention in the United States for its increased use in the self-management of opioid withdrawal and pain, as well as for concerns about its safety. METHODS: This study analyzes exposures to kratom reported to poison control centers (PCCs) in the United States during 2011-2017 from the National Poison Data System (NPDS). DISCUSSION: From 2011 through 2017, 1807 kratom exposures were reported to United States PCCs. Almost two-thirds (65.0%) of these exposures occurred during 2016-2017. Most exposures occurred among adults >/=20 years (88.9%), males (70.8%), at a residence (86.1%), and were intentional (74.3%). Among first-ranked kratom exposures, 31.8% resulted in admission to a health care facility (HCF) and 51.9% in a serious medical outcome. Multiple-substance exposures were associated with greater odds of admission to a HCF (OR: 2.80; 95% CI: 2.21-3.55) and a serious medical outcome (OR: 2.25; 95% CI: 1.77-2.85) compared with single-substance exposures. There were 11 deaths associated with kratom exposure, including two that occurred after exposure to kratom only. Among kratom-only exposures, 86.1% resulted in one or more clinical effects. The most common clinical effects were agitation/irritability (22.9%) and tachycardia (21.4%). There were seven neonatal exposures, including five experiencing withdrawal. CONCLUSIONS: Kratom is associated with a variety of serious medical outcomes, especially when used with other substances. More research is needed to define the human response to kratom. Increased regulation of kratom products would help guarantee product quality and safety. Individuals who choose to use kratom should be educated about its potential risks, including the dangers of using it in combination with other substances.
Post Sara; Spiller Henry A; Chounthirath Thitphalak; Smith Gary A
Clinical toxicology (Philadelphia, Pa.)
2019
2019-02
<a href="http://doi.org/10.1080/15563650.2019.1569236" target="_blank" rel="noreferrer noopener">10.1080/15563650.2019.1569236</a>
Home-based Cognitive Prehabilitation in Older Surgical Patients: A Feasibility Study.
BACKGROUND: Cognitive training is beneficial in various clinical settings, although its perioperative feasibility and impact remain unknown. The objective of this pilot study was to determine the feasibility of home-based cognitive prehabilitation before major surgery in older adults. MATERIALS AND METHODS: Sixty-one patients were enrolled, randomized, and allocated to either a home-based preoperative cognitive training regimen or no training before surgery. Outcomes included postoperative delirium incidence (primary outcome; assessed with the 3D-Confusion Assessment Method), perioperative cognitive function based on NIH Toolbox measures, hospital length of stay, and physical therapy session participation. Reasons for declining enrollment were reported, as were reasons for opting out of the training program. RESULTS: Postoperative delirium incidence was 6 of 23 (26%) in the prehabilitation group compared with 5 of 29 (17%) in the control group (P=0.507). There were no significant differences between groups in NIH Toolbox cognitive function scoring, hospital length of stay, or physical therapy participation rates. Study feasibility data were also collected and reported. The most common reasons for declining enrollment were lack of computer access (n=19), time commitment (n=9), and feeling overwhelmed (n=9). In the training group, only 5 of 29 (17%) included patients were able to complete the prescribed 7 days of training, and 14 of 29 (48%) opted out of training once home. Most common reasons were feeling overwhelmed (n=4) and computer difficulties (n=3). CONCLUSIONS: Short-term, home-based cognitive training before surgery is unlikely to be feasible for many older patients. Barriers to training include feeling overwhelmed, technical issues with training, and preoperative time commitment.
Vlisides Phillip E; Das Abhijit R; Thompson Allie M; Kunkler Bryan; Zierau Mackenzie; Cantley Michael J; McKinney Amy M; Giordani Bruno
Journal of neurosurgical anesthesiology
2019
2019-04
<a href="http://doi.org/10.1097/ANA.0000000000000569" target="_blank" rel="noreferrer noopener">10.1097/ANA.0000000000000569</a>
Vision-related Performance and Quality of Life of Patients With Rapid Glaucoma Progression.
PURPOSE: The purpose of this study was to determine how clinical measures, performance-based measures and subjective assessments of vision-related quality of life (VRQoL) are affected in patients with rapid glaucoma progression. METHODS: Prospective longitudinal study that included 153 patients diagnosed with moderate glaucoma. A subset of patients that presented with rapid glaucoma progression (n=22), defined as visual field (VF) mean deviation (MD) loss >2.0 dB/y, were compared with patients with nonrapid progression (n=131). Groups were compared using t tests, chi, or Fisher exact test. Main outcome measures were visual acuity (VA), VF MD, retinal nerve fiber layer thickness (RNFL), contrast sensitivity (CS), Compressed Assessment of Ability Related to Vision (CAARV), and Rasch calibrated National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) scores. RESULTS: At baseline, patients who progressed rapidly had lower measurements of VA (P=0.041), VF MD (P<0.001), Pelli-Robson score (P=0.004), Spaeth/Richman Contrast Sensitivity (SPARCS) score (P=0.001), RNFL thickness (P=0.009), CAARV total score (P<0.001), and NEI-VFQ-25 composite score (P=0.03). A multivariable logistic regression was performed and showed VF MD to be the only baseline independent predictor of rapid progression. After 1 year, patients who progressed rapidly also had a significant decrease in SPARCS score (P=0.04). CONCLUSIONS: Factors associated with rapid glaucoma progression included worse VF MD decreased scores of performance-based measures and subjectively worse VRQoL. After 1 year, rapid progressors had a significant reduction in contrast sensitivity as measured by SPARCS.
Waisbourd Michael; Sanvicente Carina T; Coleman Haley M; Sieburth Rebecca; Zhan Tingting; Gogte Priyanka; Muhire Remy S Manzi; Wizov Sheryl S; Moster Marlene R; Pro Michael J; Fudemberg Scott J; Mantravadi Anand V; Myers Jonathan S; Katz L Jay; Hark Lisa A; Spaeth George L
Journal of glaucoma
2019
2019-03
<a href="http://doi.org/10.1097/IJG.0000000000001179" target="_blank" rel="noreferrer noopener">10.1097/IJG.0000000000001179</a>
Adjuvant Chemotherapy in Uterine Leiomyosarcoma: Trends and Factors Impacting Usage.
Objectives: The benefit of adjuvant chemotherapy in patients with localized uterine leiomyosarcoma (LMS) remains unclear due to a lack of randomized studies and data only from small retrospective series to rely on. We sought to identify factors associated with the administration of chemotherapy and to determine the trends in the usage of adjuvant chemotherapy in patients with nonmetastatic uterine LMS. Methods: Patients diagnosed with nonmetastatic uterine LMS between 2004 and 2014 were identified from the National Cancer Database (NCDB). Multiple regression was used to determine factors with a significant impact on patient receipt of chemotherapy. Kaplan-Meier curves and the Cox model were used to determine the effect of adjuvant chemotherapy on overall survival (OS). Results: 2,732 uterine LMS patients were identified. Patients older than 65 were less likely to receive chemotherapy than their younger counterparts. Patients with stage I or stage II cancer were less likely to receive chemotherapy, whereas individuals with positive regional lymph nodes and those who had received radiation were more likely. In this cohort, adjuvant chemotherapy had no significant impact on OS (HR, 1.04; 95% CI, 0.90-1.22; P=0.5768). However, administration of chemotherapy significantly increased from 2004 to 2014 (P < 0.0001). Conclusions: Expected tumor characteristics such as higher stage of tumor were associated with receipt of chemotherapy. Although adjuvant chemotherapy demonstrated no benefit over observation on OS in patients with nonmetastatic LMS, the number of patients being treated with chemotherapy continued to increase from 2004 to 2014.
Patel Dhara; Handorf Elizabeth; von Mehren Margaret; Martin Lainie; Movva Sujana
Sarcoma
2019
2019
<a href="http://doi.org/10.1155/2019/3561501" target="_blank" rel="noreferrer noopener">10.1155/2019/3561501</a>
Enhancing Therapeutic Efficacy of Oncolytic Herpes Simplex Virus-1 with Integrin beta1 Blocking Antibody OS2966.
Integrin beta1 receptor, expressed on the surface of tumor cells and macrophages in the tumor microenvironment (TME), has been implicated in both tumor progression as well as resistance to multiple modalities of therapy. OS2966 is the first clinical-ready humanized monoclonal antibody to block integrin beta1 and was recently orphan designated by FDA Office of Orphan Products Development (OOPD). Here, we tested therapeutic potential of OS2966-mediated integrin beta1 blockade to enhance the efficacy of oncolytic herpes simplex virus-1 (oHSV) through evaluation of virus replication, tumor cell killing efficiency, effect on the antiviral signaling pathway, co-culture assays of oHSV-infected cells with macrophages, and in vivo bioluminescence imaging on mammary fat pad triple negative breast cancer xenograft and subcutaneous and intracranial glioma xenografts. OS2966 treatment decreased interferon signaling and pro-inflammatory cytokine induction in oHSV-treated tumor cells and inhibited migration of macrophages, resulting in enhanced oHSV replication and cytotoxicity. OS2966 treatment also significantly enhanced oHSV replication and oHSV-mediated anti-tumor efficacy in orthotopic xenograft models including triple negative breast cancer and glioblastoma. The results demonstrated the synergistic potential of the combinatory treatment approach with OS2966 to improve anti-tumor efficacy of conventional oHSV therapy.
Lee Tae Jin; Nair Mitra; Banasavadi-Siddegowda Yeshavanth Kumar; Liu Joseph; Nallanagulagari Tejaswini; Jaime-Ramirez Alena Cristina; Guo Jeffrey Yunhua; Quadri Haroon; Zhang Jianying; Bockhorst Kurt H; Aghi Manish K; Carbonell W Shawn; Kaur Balveen; Yoo Ji Young
Molecular cancer therapeutics
2019
2019-03
<a href="http://doi.org/10.1158/1535-7163.MCT-18-0953" target="_blank" rel="noreferrer noopener">10.1158/1535-7163.MCT-18-0953</a>
Comparing radiomic classifiers and classifier ensembles for detection of peripheral zone prostate tumors on T2-weighted MRI: a multi-site study.
*Prostate cancer; *Classifiers; *Comparison; *MRI; *Radiomics
BACKGROUND: For most computer-aided diagnosis (CAD) problems involving prostate cancer detection via medical imaging data, the choice of classifier has been largely ad hoc, or been motivated by classifier comparison studies that have involved large synthetic datasets. More significantly, it is currently unknown how classifier choices and trends generalize across multiple institutions, due to heterogeneous acquisition and intensity characteristics (especially when considering MR imaging data). In this work, we empirically evaluate and compare a number of different classifiers and classifier ensembles in a multi-site setting, for voxel-wise detection of prostate cancer (PCa) using radiomic texture features derived from high-resolution in vivo T2-weighted (T2w) MRI. METHODS: Twelve different supervised classifier schemes: Quadratic Discriminant Analysis (QDA), Support Vector Machines (SVMs), naive Bayes, Decision Trees (DTs), and their ensemble variants (bagging, boosting), were compared in terms of classification accuracy as well as execution time. Our study utilized 85 prostate cancer T2w MRI datasets acquired from across 3 different institutions (1 for discovery, 2 for independent validation), from patients who later underwent radical prostatectomy. Surrogate ground truth for disease extent on MRI was established by expert annotation of pre-operative MRI through spatial correlation with corresponding ex vivo whole-mount histology sections. Classifier accuracy in detecting PCa extent on MRI on a per-voxel basis was evaluated via area under the ROC curve. RESULTS: The boosted DT classifier yielded the highest cross-validated AUC (= 0.744) for detecting PCa in the discovery cohort. However, in independent validation, the boosted QDA classifier was identified as the most accurate and robust for voxel-wise detection of PCa extent (AUCs of 0.735, 0.683, 0.768 across the 3 sites). The next most accurate and robust classifier was the single QDA classifier, which also enjoyed the advantage of significantly lower computation times compared to any of the other methods. CONCLUSIONS: Our results therefore suggest that simpler classifiers (such as QDA and its ensemble variants) may be more robust, accurate, and efficient for prostate cancer CAD problems, especially in the context of multi-site validation.
Viswanath Satish E; Chirra Prathyush V; Yim Michael C; Rofsky Neil M; Purysko Andrei S; Rosen Mark A; Bloch B Nicolas; Madabhushi Anant
BMC medical imaging
2019
2019-02
<a href="http://doi.org/10.1186/s12880-019-0308-6" target="_blank" rel="noreferrer noopener">10.1186/s12880-019-0308-6</a>
Comparison of multiparametric MRI-based and transrectal ultrasound-based preplans with intraoperative ultrasound-based planning for low dose rate interstitial prostate seed implantation
brachytherapy; LDR; MRI; multiparametric; prostate; TRUS
PURPOSE: Transrectal ultrasound images are routinely acquired for low dose rate (LDR) prostate brachytherapy dosimetric preplanning (pTRUS), although diagnostic multiparametric magnetic resonance imaging (mpMRI) may serve this purpose as well. We compared the predictive abilities of TRUS vs MRI relative to intraoperative TRUS (iTRUS) to assess the role of mpMRI in brachytherapy preplanning. MATERIALS AND METHODS: Retrospective analysis was performed on 32 patients who underwent iTRUS-guided prostate LDR brachytherapy as either mono- or combination therapy. 56.3% had pTRUS-only volume studies and 43.7% had both 3T-mpMRI and pTRUS preplanning. MRI was used for preplanning and its image fusion with iTRUS was also used for intraoperative guidance of seed placement. Differences in gland volume, seed number, and activity and procedure time were examined, as well as the identification of lesions suspicious for tumor foci. Pearson correlation coefficient and Fisher's Z test were used to estimate associations between continuous measures. RESULTS: There was good correlation of planning volumes between iTRUS and either pTRUS or MRI (r = 0.89, r = 0.77), not impacted by the addition of hormonal therapy (P = 0.65, P = 0.33). Both consistently predicted intraoperative seed number (r = 0.87, r = 0.86). MRI/TRUS fusion did not significantly increase surgical or anesthesia time (P = 0.10, P = 0.46). mpMRI revealed suspicious focal lesions in 11 of 14 cases not visible on pTRUS, that when correlated with histopathology, were incorporated into the plan. CONCLUSIONS: Relative to pTRUS, MRI yielded reliable preplanning measures, supporting the role of MRI-only LDR treatment planning. mpMRI carries numerous diagnostic, staging and preplanning advantages that facilitate better patient selection and delivery of novel dose escalation and targeted therapy, with no additional surgical or anesthesia time. Prospective studies assessing its impact on treatment planning and delivery can serve to establish mpMRI as the standard of care in LDR prostate brachytherapy planning.
Fredman Elisha T; Traughber Bryan J; Gross Andrew; Podder Tarun; Colussi Valdir; Vinkler Robert; Machtay Mitchell; Ellis Rodney J
Journal of Applied Clinical Medical Physics
2019
2019-06
<a href="http://doi.org/10.1002/acm2.12592" target="_blank" rel="noreferrer noopener">10.1002/acm2.12592</a>
Intra- and interreader reproducibility of PI-RADSv2: A multireader study
MRI; PI-RADS; prostate cancer; reader reproducibility
BACKGROUND: The Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) has been in use since 2015; while interreader reproducibility has been studied, there has been a paucity of studies investigating the intrareader reproducibility of PI-RADSv2. PURPOSE: To evaluate both intra- and interreader reproducibility of PI-RADSv2 in the assessment of intraprostatic lesions using multiparametric magnetic resonance imaging (mpMRI). STUDY TYPE: Retrospective. POPULATION/SUBJECTS: In all, 102 consecutive biopsy-naïve patients who underwent prostate MRI and subsequent MR/transrectal ultrasonography (MR/TRUS)-guided biopsy. FIELD STRENGTH/SEQUENCES: Prostate mpMRI at 3T using endorectal with phased array surface coils (TW MRI, DW MRI with ADC maps and b2000 DW MRI, DCE MRI). ASSESSMENT: Previously detected and biopsied lesions were scored by four readers from four different institutions using PI-RADSv2. Readers scored lesions during two readout rounds with a 4-week washout period. STATISTICAL TESTS: Kappa (κ) statistics and specific agreement (Po ) were calculated to quantify intra- and interreader reproducibility of PI-RADSv2 scoring. Lesion measurement agreement was calculated using the intraclass correlation coefficient (ICC). RESULTS: Overall intrareader reproducibility was moderate to substantial (κ = 0.43-0.67, Po = 0.60-0.77), while overall interreader reproducibility was poor to moderate (κ = 0.24, Po = 46). Readers with more experience showed greater interreader reproducibility than readers with intermediate experience in the whole prostate (P = 0.026) and peripheral zone (P = 0.002). Sequence-specific interreader agreement for all readers was similar to the overall PI-RADSv2 score, with κ = 0.24, 0.24, and 0.23 and Po = 0.47, 0.44, and 0.54 in T2 -weighted, diffusion-weighted imaging (DWI), and dynamic contrast-enhanced (DCE), respectively. Overall intrareader and interreader ICC for lesion measurement was 0.82 and 0.71, respectively. DATA CONCLUSION: PI-RADSv2 provides moderate intrareader reproducibility, poor interreader reproducibility, and moderate interreader lesion measurement reproducibility. These findings suggest a need for more standardized reader training in prostate MRI. LEVEL OF EVIDENCE: 2 Technical Efficacy: Stage 2.
Smith Clayton P; Harmon Stephanie A; Barrett Tristan; Bittencourt Leonardo K; Law Yan Mee; Shebel Haytham; An Julie Y; Czarniecki Marcin; Mehralivand Sherif; Coskun Mehmet; Wood Bradford J; Pinto Peter A; Shih Joanna H; Choyke Peter L; Turkbey Baris
Journal of magnetic resonance imaging: JMRI
2019
2019-06
<a href="http://doi.org/10.1002/jmri.26555" target="_blank" rel="noreferrer noopener">10.1002/jmri.26555</a>
Disparities in osteoporosis by race/ethnicity, education, work status, immigrant status, and economic status in the United States
Disparity; Employment; Ethnicity; Immigration: Economic status; National Health and Nutrition Examination Survey; NHANES; Osteoporosis; Race; Work status
AIMS: Osteoporosis is one of the most common bone health diseases affecting older adults in US. Addressing disparities in osteoporosis will help to enhance the quality of bone care in the nation's bone health programs. MATERIALS & METHODS: We used the data of adult participants of the National Health and Nutrition Examination Survey with reported bone mineral density measured during the periods of 2005-2010 and 2013-2014 to examine disparities in osteoporosis based on race/ethnicity, educational attainment, work status, immigrant status, and economic status in US. RESULTS: Based on educational attainment, the age- and sex-standardized osteoporosis prevalence (SOP) was highest among those with less than a high school education (HSE) (5.1%, 95% CI (CI): 4.3%-5.9%), whereas it was lowest among those with more than HSE (3.2%, CI: 2.7%-3.6%). Based on work status, SOP was highest among unemployed participants (5.4%, CI: 1.9%-8.9%), whereas it was lowest among working participants (2%, CI: 1.6%-2.4%). Based on immigrant status, SOP was highest among non-citizens (6.4%, CI: 5%-7.8%), whereas it was lowest among those born in US (3.4%, CI: 3.1%-3.7%). Based on economic status, SOP was highest among those with poverty-to-income ratio (PIR) <1 (5.5%, CI: 4.4%-6.5%), whereas it was lowest among those with PIR ≥ 4 (2.4%, CI: 1.9%-2.9%). CONCLUSIONS: Osteoporosis was more prevalent among US adults who were non-citizens, less educated, unemployed, and had lower income. The observed disparities suggest a need for interventions to promote better quality bone care among the socioeconomically disadvantaged groups.
Tsai Allen J
European Journal of Internal Medicine
2019
2019-06
<a href="http://doi.org/10.1016/j.ejim.2019.04.011" target="_blank" rel="noreferrer noopener">10.1016/j.ejim.2019.04.011</a>
Linear morphea: Clinical characteristics, disease course, and treatment of the Morphea in Adults and Children cohort
en coup de sabre; linear morphea; localized scleroderma; MAC cohort; Morphea in Adults and Children cohort; Parry-Romberg syndrome; quality of life
BACKGROUND: Prospective, longitudinal studies examining the features of linear morphea are limited. OBJECTIVE: To utilize the Morphea in Adults and Children cohort to determine clinical characteristics, impact on life quality, and disease course of linear morphea in a prospective, longitudinal manner. METHODS: Characteristics of linear morphea versus other subtypes were compared in a cross-sectional manner. Next, linear morphea participants were examined in depth over a 3-year period. RESULTS: Linear morphea was the most common morphea subtype (50.1%, 291/581) in the cohort. Deep involvement was more common in linear (64.3%, 187/291) than other morphea subtypes. Linear morphea participants with deep involvement were more likely to have a limitation in range of motion (28.6%, 55/192) than those without (11.1%, 11/99, P < .001). Adult-onset disease occurred in 32.6% (95/291) of those with linear morphea. Frequency of deep involvement was similar between pediatric (66.8%, 131/196) and adult-onset linear morphea (58.9%, 56/95, P = .19). Quality of life and disease activity scores improved over time, while damage stabilized with treatment. LIMITATIONS: Results of the study are associative, and the University of Texas Southwestern Medical Center is a tertiary referral center. CONCLUSION: A substantial number of linear morphea patients have adult-onset disease. In all age groups, linear morphea with deep involvement was associated with functional limitations.
Kunzler Elaine; Florez-Pollack Stephanie; Teske Noelle; O'Brien Jack; Prasad Smriti; Jacobe Heidi
Journal of the American Academy of Dermatology
2019
2019-06
<a href="http://doi.org/10.1016/j.jaad.2019.01.050" target="_blank" rel="noreferrer noopener">10.1016/j.jaad.2019.01.050</a>
Validity and efficiency of a smartphone-based electronic data collection tool for operative data in rotator cuff repair
data processing; electronic medical record; implant documentation; rotator cuff repair; Shoulder; web-based operative report
BACKGROUND: This study tested validity and efficiency of Orthopaedic Minimal Data Set (OrthoMiDaS) Episode of Care (OME). METHODS: We analyzed 100 isolated rotator cuff repair cases in the OME database. Surgeons completed a traditional operative note and OME report. A blinded reviewer extracted data from operative notes and implant logs in electronic medical records by manual chart review. OME and electronic medical record data were compared with data counts and agreement between 40 variables of rotator cuff disease and repair procedures. Data counts were assessed using raw percentages and McNemar test (with continuity correction). Agreement of categorical variables was analyzed using Cohen κ (unweighted) and of numerical variables using the concordance correlation coefficient (CCC). Efficiency was assessed by median time to complete. RESULTS: OME database had significantly higher data counts for 25% (10/40) of variables. A high level of proportional and statistical agreement was demonstrated between the data. Among 35 categorical variables, proportional agreement was perfect for 17%, almost perfect (0.81 ≤ κ ≤ 1.00) for 37%, substantial (0.61 ≤ κ ≤ 0.80) for 20%, moderate (0.41 ≤ κ ≤ 0.60) for 14%, fair (0.21 ≤ κ ≤ 0.40) for 6%, and slight (0.0 ≤ κ ≤ 0.20) for 6%. Of 5 numerical variables, agreement was almost perfect (CCC > 0.99) for 20% and poor (CCC < 0.90) for 80%. Median OME completion time was 161.5 seconds (interquartile range, 116-224.5). CONCLUSION: OME is an efficient, valid tool for collecting comprehensive, standardized data on rotator cuff repair.
Sahoo Sambit; Mohr Jill; Strnad Gregory J; Vega Jose; Jones Morgan; Schickendantz Mark; Farrow Lutul; Spindler Kurt P; Iannotti Joseph P; Ricchetti Eric T; Derwin Kathleen A
Journal of Shoulder and Elbow Surgery
2019
2019-07
<a href="http://doi.org/10.1016/j.jse.2018.12.009" target="_blank" rel="noreferrer noopener">10.1016/j.jse.2018.12.009</a>
Recurrent pseudoaneurysm after carotid endarterectomy
Angioplasty; Bovine patch; Carotid endarterectomy; Complication; Infection; Pseudoaneurysm
Pseudoaneurysms and patch infections are known complications of carotid endarterectomy with patch angioplasty. Although they are rare occurrences, they carry high morbidity and almost uniformly require surgical intervention. Infectious pathogens are often gram-positive bacteria, most commonly Staphylococcus species, whereas gram-negative infections are less frequently observed. We present a case of recurrent pseudoaneurysm in a patient who had a carotid endarterectomy with bovine pericardial patch angioplasty complicated by Pasteurella multocida infection. This case demonstrates the need for recognition and consideration of a broad differential of pathogens in evaluating and treating vascular infections.
Azouz Vitali; Fahmy Joseph N; Kornbau Craig; Petrinec Drazen
Journal of Vascular Surgery Cases and Innovative Techniques
2019
2019-06
<a href="http://doi.org/10.1016/j.jvscit.2018.12.010" target="_blank" rel="noreferrer noopener">10.1016/j.jvscit.2018.12.010</a>
A review of the FDA's 510(k) approvals process for electromagnetic devices used in body contouring
acne vulgaris; cellulite; cutaneous lesions; Electromagnetic devices; facial wrinkles; Google Trends; hair reduction; laser skin resurfacing; pigmented lesions; premarket approval; RF energy; vascular lesions
Introduction: Greater demand for noninvasive techniques to reduce cellulite and contour the body has led to the growth of electromagnetic and radiofrequency devices. In this study, we aimed to characterize the evolution and safety of electromagnetic devices marketed in the U.S. over the last two decades. Methods: We examined records from a U.S. FDA database documenting premarket approval of electromagnetic devices between January 1, 2000 and October 31, 2018. Additionally, we searched the Manufacturer and User Facility Device Experience (MAUDE) database for reports of adverse events. Results: Thirty-one devices were approved from 2012-2018. Initially marketed to temporarily reduce muscle pain and cellulite, indications for these devices have expanded. The MAUDE database revealed 61 reports of adverse events including acute skin damage, dyspigmentation, infection, hair growth, scarring, and others. Discussion: Although electromagnetic devices are gaining increasing public attention and marketed to be safe, the frequency and types of adverse events are not well-documented. Importantly, the MAUDE database has limitations including submission of incomplete, inaccurate, untimely, or unverified data make determining the true number of adverse events difficult. Further investigation is greatly needed to define appropriate parameters and outcomes for the use of electromagnetic devices in body contouring and skin enhancement.
Wang Sophie; Manudhane Albert; Ezaldein Harib H; Scott Jeffrey F
The Journal of Dermatological Treatment
2019
2019-06
<a href="http://doi.org/10.1080/09546634.2019.1566589" target="_blank" rel="noreferrer noopener">10.1080/09546634.2019.1566589</a>
A smart decision: smartphone use for operative data collection in arthroscopic shoulder instability surgery
electronic medical record; information standardization; outcomes; shoulder instability; smartphone
OBJECTIVE: This study tested validity, accuracy, and efficiency of the Orthopaedic Minimal Data Set Episode of Care (OME) compared with traditional operative report in arthroscopic surgery for shoulder instability. As of November 2017, OME had successfully captured baseline data on 97% of 18 700 eligible cases. MATERIALS AND METHODS: This study analyzes 100 cases entered into OME through smartphones by 12 surgeons at an institution from February to October 2015. A blinded reviewer extracted the same variables from operative report into a separate database. Completion rates and agreement were compared. They were assessed using raw percentages and McNemar's test (with continuity correction). Agreement between nominal variables was assessed by unweighted Cohen's kappa and a concordance correlation coefficient measured agreement between continuous variables. Efficiency was assessed by median time to complete. RESULTS: Of 37 variables, OME demonstrated equal or higher completion rates for all but 1 and had significantly higher capture rates for 49% (n = 18; P < .05). Of 33 nominal variables, raw proportional agreement was ≥0.90 for 76% (n = 25). Raw proportional agreement was perfect for 15% (n = 5); no agreement statistic could be calculated due to a single variable in operative note and OME. Calculated agreement statistic was substantial or better (κ > 0.61) for 51% (n = 17) for the 33 nominal variables. All continuous variables assessed (n = 4) demonstrated poor agreement (concordance correlation coefficient <0.90). Median time for completing OME was 103.5 (interquartile range, 80.5-151) seconds. CONCLUSIONS: The OME smartphone data capture system routinely captured more data than operative report and demonstrated acceptable agreement for nearly all nominal variables, yet took <2 minutes to complete on average.
Mohr Jill; Strnad Gregory J; Farrow Lutul; Heinlein Kate; Hettrich Carolyn M; Jones Morgan; Miniaci Anthony; Ricchetti Eric; Rosneck James; Schickendantz Mark; Saluan Paul; Vega Jose F; Spindler Kurt P; Group Cleveland Clinic O M E Sports Health
Journal of the American Medical Informatics Association: JAMIA
2019
2019-06
<a href="http://doi.org/10.1093/jamia/ocz074" target="_blank" rel="noreferrer noopener">10.1093/jamia/ocz074</a>
oHSV therapy increases trametinib access to brain tumors and sensitizes them in vivo
glioblastoma (GBM); oncolytic herpes simplex virus-1 (oHSV); RAS-RAF-MEK-ERK signaling; Trametinib; Tumor necrosis factor α (TNFα)
BACKGROUND: Hyperactivation of the RAS-RAF-MEK-ERK signaling pathway is exploited by glioma cells to promote their growth and evade apoptosis. MEK activation in tumor cells can increase replication of ICP34.5-deleted HSV-1 viruses, but paradoxically its activation in tumor-associated macrophages promotes a pro-inflammatory signaling that can inhibit virus replication and propagation. Here we investigated effect of blocking MEK signaling in conjunction with oncolytic HSV-1 (oHSV) for brain tumors. METHODS: Infected glioma cells co-cultured with microglia or macrophages treated with or without trametinib were used to test trametinib effect on macrophages/microglia. ELISA, western blotting, and flow cytometry were utilized to evaluate the effect of the combination therapy. Pharmacokinetic (PK) analysis of mouse plasma and brain tissue was used to evaluate trametinib delivery to the CNS. Intracranial human and mouse glioma-bearing immune deficient and immune competent mice were used to evaluate the anti-tumor efficacy. RESULT: oHSV treatment rescued trametinib-mediated feed-back reactivation of the MAPK signaling pathway in glioma. In vivo, PK analysis revealed enhanced blood-brain barrier penentration of trametnib after oHSV treatment. Trametinib, a MEK Kinase inhibitor, treatment led to a significant reduction in microglia- and macrophage-derived TNFα secretion in response to oHSV-treatment and increased survival of glioma-bearing mice. Despite the reduced TNFα production observed in vivo, the combination treatment activated CD8+ T cell-mediated immunity, and increased survival in a glioma-bearing immune-competent mouse model. CONCLUSION: This study provides a rationale for combining oHSV with trametinib for the treatment of brain tumors.
Yoo Ji Young; Swanner Jessica; Otani Yoshihiro; Nair Mitra; Park Flora; Banasavadi-Siddegowda Yeshavanth; Liu Joseph; Jaime-Ramirez Alena Cristina; Hong Bangxing; Geng Feng; Guo Deliang; Bystry Darlene; Pelphs Mitch; Quadri Haroon; Lee Tae Jin; Kaur Balveen
Neuro-Oncology
2019
2019-05
<a href="http://doi.org/10.1093/neuonc/noz079" target="_blank" rel="noreferrer noopener">10.1093/neuonc/noz079</a>
Is resection for solitary ≤5 cm intrahepatic cholangiocarcinoma an independent prognostic factor for survival?
Tsai Allen J
Surgery
2019
2019-04
<a href="http://doi.org/10.1016/j.surg.2018.05.058" target="_blank" rel="noreferrer noopener">10.1016/j.surg.2018.05.058</a>
Anatomy, Bony Pelvis and Lower Limb, Superficial Peroneal (Fibular) Nerve
The superficial peroneal nerve is also known as the superior fibular nerve. The superficial peroneal nerve originates from the common peroneal nerve alongside the deep peroneal nerve. The superficial peroneal nerve is the smaller of the two nerves.[1] The common peroneal nerve is comprised of fibers from spinal nerves L4 through S1 which itself originates from the bifurcation of the sciatic nerve which is composed of nerve fibers from spinal nerves L4 through S3. The sciatic nerve terminates and bifurcates at the apex of the popliteal fossa and becomes the common peroneal nerve and the tibial nerve as it wraps around the fibular neck.[2][3] After bifurcation from the common peroneal, the superficial peroneal nerve courses within the peroneus longus muscle.[1] This nerve thus provides motor innervation to the peroneus longus muscle. Additionally, the nerve also innervates the peroneus brevis muscle.[1] The nerve exits through the peroneal muscles on the anterolateral aspect of the lower half of the lower leg approximately 12 cm above the ankle joint at a defect in the crural fascia also known as the deep fascia of the leg.[1] The remainder of the nerve has sensory function provided by two branches inferiorly which are known as the medial dorsal cutaneous nerve (the larger of the two branches) and the intermediate dorsal cutaneous nerve. These nerves provide sensory innervation to the anterolateral aspect of the leg, the dorsum of the foot, and the dorsal aspect of the toes with the exception of the first web space.[1] The first web space is innervated by the dorsal peroneal nerve.[4]
Garrett Alexandrea; Geiger Zachary
StatPearls
2019
1905-7
<a href="https://www.ncbi.nlm.nih.gov/books/NBK534793/">https://www.ncbi.nlm.nih.gov/books/NBK534793/</a>
PREVALENCE OF MYOCARDITIS AND PERICARDITIS AMONG CHEST PAIN PATIENTS WITH A NORMAL ISCHEMIC EVALUATION
Cardiovascular System & Cardiology
Background Although stress-echo (SE), nuclear myocardial stress perfusion imaging (MPI) and coronary arteriography are used to detect atherosclerosis, they are not well suited for diagnosing inflammatory heart disease. Cardiac MRI (CMR) is uniquely capable of detecting myocardial and pericardial edema, a hallmark of inflammation. As the myocardium and pericardium are contiguous, myocarditis and pericarditis often coexist. This study assessed the prevalence of myocarditis and pericarditis in patients with chest pain and a negative ischemic evaluation, using CMR. Methods An institutional cardiac imaging database was queried for patients with chest pain who underwent CMR after a normal ischemic evaluation. CMR criteria for inflammation included myocardial/pericardial enhancement on T2 STIR, early gadolinium enhancement, increased T1 mapping relaxation time, increased T2 mapping relaxation time, and delayed gadolinium enhancement. At least 2 of these findings were required for a diagnosis of myocarditis or pericarditis. The prevalence of myocarditis/pericarditis was computed for patients with a negative SE, MPI or CMR stress study separately. Results There were 1,476 patients with chest pain and negative ischemic evaluation. Of 149 patients with a normal SE, 10 (6.8%) had evidence of myocarditis. Of these 10 patients, nine (90%) were female. These same 10 patients (100%) also had coexisting pericarditis (10% male, 90% female). Of 403 patients with a normal MPI, 29 (7.2%) had myocarditis. 22 of these 29 (75.9%) also had CMR findings of pericarditis. Of 924 patients with a normal CMR stress perfusion study, 63 (6.8%) had myocarditis on CMR. Of these 63 patients, 48 (76.2%) had CMR evidence of pericarditis as well. Conclusion This study suggests a 7% prevalence of underlying myocarditis in patients presenting with chest pain and a negative ischemic evaluation. Additionally, 78% of these patients had evidence of coexisting pericarditis. Females with normal stress-echo results are more likely to have a missed diagnoses of acute myocarditis and pericarditis. These data emphasize the value of CMR for diagnosing underlying myocarditis and pericarditis, after a negative ischemic evaluation.
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Poster Contributions Poster Hall, Hall F Sunday, March 17, 2019, 9:45 a.m.-10:30 a.m.
Session Title: Non Invasive Imaging: MR 3
Abstract Category: 29. Non Invasive Imaging: MR Presentation Number: 1227-338
Behbahani-Nejad O; Boland S; Raghavendran R; Mikolich B; Tondapu V; Mikolich J R
Journal of the American College of Cardiology
2019
2019-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s0735-1097(19)32182-5" target="_blank" rel="noreferrer noopener">10.1016/s0735-1097(19)32182-5</a>
A Retrospective Cohort Study of Narrow Band UVB Phototherapy for the Treatment of Uremic Pruritus in Aging Patients at an Academic Tertiary Care Center
Geriatrics & Gerontology
Meeting abstract D99 presented at the 2019 Annual Scientific Meeting of the American-Geriatrics-Society (AGS)
Binod J; Araoye E; Kim N
Journal of the American Geriatrics Society
2019
2019-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
n/a
Habits of Nervous Tension and Premature Mortality in Johns Hopkins Medical School Graduates
Geriatrics & Gerontology
D137 Student Presentation at the American Geriatrics Society 2019 Annual Meeting
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BACKGROUND Psychosocial habits in mid-early life have been shown to affect mortality in later life. Negative responses to stress in people who have stressful careers can have a negative impact on quality of life decades later. A previous study demonstrated that a higher Habits of Nervous Tension (HNT) score correlated to a higher likelihood of suicide among a medical school graduate cohort. It was also found that irritability (RR= 5.5; 95% CI 1.76;17.17) and urinary frequency (RR=3.3; 95% CI 1.07;10.32) were the highest predictors of suicide. Our purpose was to re-evaluate this association using 20 years of additional follow-up in the study and encompassing overall mortality. METHODS The Johns Hopkins Precursors Study is an ongoing cohort study of medical school graduates. Participants attended Johns Hopkins medical school between the years 1946-1964 (n=1,337) and completed the HNT questionnaire while in medical school, and psychosocial habits are annually recorded through mailed questionnaires. Mortality was recorded by access of public records for death certificates. Parametric survival analyses of HNT scores comprised of 25 questions associated with age of death. RESULTS N=1,337 participants contributed 75,069 person-years to the analysis. An overall higher HNT score is not associated with increased mortality (HR=.99; 95% CI .9533;1.03). However, when reporting individual questions of the HNT scale, individuals who reported more exhaustion (HR=.64; 95% CI .46;.89) or tremulousness (HR=.75; 95% CI .57;.99) had shorter lifespan, whereas individuals reporting philosophic effort (HR=1.46; 95% CI 1.05;2.04) were more likely to live longer. CONCLUSION Findings from our study suggest that exhaustion and philosophic effort may be a stress coping mechanism that reduces risk of premature death, whereas tremulousness and exhaustion was associated with a higher chance.
Bucci D; Gross A
Journal of the American Geriatrics Society
2019
2019-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/jgs.15898" target="_blank" rel="noreferrer noopener">10.1111/jgs.15898</a>
Nivolumab and Amiodorane-Induced Interstitial Lung Disease (ILD) in a Patient with Metastatic Melanoma
Respiratory System; General & Internal Medicine
Thematic Poster Session, ATS Conference 2019. Presented as part of session A39: Drug Related Case Reports
Burgei J; Dasgupta R; Kim I; Makkar H
American Journal of Respiratory and Critical Care Medicine
2019
2019
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
https://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2019.199.1_MeetingAbstracts.A1489
Preserving patient autonomy among older adults with cognitive impairment: Clinician strategies during primary care visits
Geriatrics & Gerontology
2019 Annual Scientific Meeting of the American-Geriatrics-Society (AGS)
Chapman M B; Boyd C M; Phung A; Smith D A; Green A R
Journal of the American Geriatrics Society
2019
2019-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
n/a
The Effects of Depression on Postoperative Outcomes for Patients Undergoing Abdominal Surgery
Geriatrics & Gerontology
Annual Scientific Meeting of the American-Geriatrics-Society (AGS)
Corsi G; Gearhart S; Zaman M
Journal of the American Geriatrics Society
2019
2019-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
n/a
364 Emotional triggers to pain in a patient with cutaneous leiomyomas associated with Reed syndrome
Dermatology
A 39 y/o man presented with hundreds of painful, flesh-colored <0.1 to 12 mm papules and nodules on his right forearm, upper arm, shoulder, and chest. The lesions began around puberty and gradually grew and spread. Throbbing/stabbing pain was caused by touch, pressure, sleep, wind, physical activity, swimming, showering, sweating, and changes in pressure and temperature. Piloerection also caused excruciating pain and occurred with sexual intercourse, strong emotions, scary movies, and classical music. Two punch biopsies revealed circumscribed nodular lesions in the dermis with fascicles of smooth muscle with elongated blunt nuclei and fibrillar eosinophilic cytoplasm. No significant atypia or atypical mitoses were noted. This was consistent with cutaneous pilar leiomyomata. Genetic testing revealed fumarate hydratase (FH) gene inactivation. Reed Syndrome, also known as hereditary leiomyomatosis and renal cell cancer syndrome (HLRCC), is an autosomal dominant disease in which the FH gene is inactivated. HLRCC has been reported in 200 families worldwide. It predisposes patients to cutaneous leiomyomas, uterine leiomyomas, and renal cell carcinomas. Unique in this case was the age, location, and emotional triggers to pain. Cutaneous leiomyomas typically present at a mean age of 25 and involve the extensor surfaces, trunk, face, and neck. Previous reports have described pain with stress, strong emotions, light touch, and cold temperatures. Our patient added significant detail to emotional triggers. Local excision provided relief but was followed by recurrence. A clinical trial of Botox was offered but rejected in fear of receiving the placebo and pain at injection site. Our patient is managed by a pain clinic with oxycodone 5 mg/acetaminophen 325 mg and a topical cream that includes ketamine, diclofenac, baclofen, gabapentin, cyclobenzaprine, and bupivacaine. This regimen improved our patient’s functional status. Our patient’s emotional triggers allowed us to understand the impact of his illness and provided us with a useful metric to measure pain control and functional improvement.
Farid Y; Mostow E N
Journal of Investigative Dermatology
2019
2019-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.jid.2019.03.440" target="_blank" rel="noreferrer noopener">10.1016/j.jid.2019.03.440</a>
866 Patient with paroxysmal nocturnal hemoglobinuria (PNH) and aplastic anemia presenting with progressive purpuric nodules
Dermatology
A 44 y/o woman with PNH and aplastic anemia presented with 5 months of progressive painful purpuric nodules. Examination revealed firm, pink to purple, tender nodules in her lower and upper extremities and trunk. Biopsy revealed an edematous dermis, focal erythrocyte extravasation, and rare vessels with fibrin thrombi. The subcutis showed adipocyte necrosis with fibrin deposition, hemorrhage, and abscess formation. Special stains and cultures were negative for fungi, bacteria, and mycobacteria. D-Dimer was significantly elevated. The patient was diagnosed with thrombotic vasculopathy secondary to PNH. PNH is rare diagnosis that may result as a complication of bone marrow disease. In this disorder, the patient acquires a mutation in the phosphatidylinositol glycan A (PIGA) gene that impairs synthesis of the GPI anchor protein on erythrocytes, leukocytes, and platelets. This results in impaired attachment of CD55 and CD59 proteins, which protect cells from complement mediated lysis. Complement mediated lysis leads to platelet aggregation and venous thrombosis, in addition to Coombs negative hemolytic anemia and pancytopenia. Thromboemboli are the leading cause of death in PNH patients and can result in dermatologic findings. Biopsy in our patient showed thrombosis and skin necrosis with no indication of vasculitis. Other presentations include hemorrhagic bullae formation, purpura fulminans, and painful ecchymotic plaques. Our treatment plan was to continue prednisone, resume eculizumab and cyclosporine, and add enoxaparin (based on her mild thrombocytopenia). Eculizumab is used in the treatment of PNH as it inhibits terminal complement formation. Our patient’s condition improved within 3 months. Testing for PNH is recommended in patients with unexplained thromboses and young patients with unusual site thrombosis (intrabdominal, cerebral, and dermal veins), hemolysis, and/or any cytopenia. Discovery of underlying PNH will modify the treatment plan and improve patient prognosis.
Farid Y; Schneider S; Warren C; Vij A
Journal of Investigative Dermatology
2019
2019-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.jid.2019.03.942" target="_blank" rel="noreferrer noopener">10.1016/j.jid.2019.03.942</a>
A Pilot Study Assessing the Feasibility of a Remote Telemedicine Delirium Assessment Tool
Geriatrics & Gerontology
Poster Presentation at the 2019 Annual Meeting of the American Delirium Society
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Objective: Assessment of delirium outside of the hospital setting is currently limited, as clinical assessments for delirium require a face-to-face encounter. This limits the ability to feasibly perform frequent delirium assessments in the post-discharge setting. We sought to examine the acceptability of a remote videoconference-based delirium assessment tool in an older population. Methods: We conducted a prospective pilot study at the UNC Geriatric Specialty Outpatient Clinic from June-August 2018. Investigators utilized HIPAA-compliant doxy.me videoconferencing services on a tablet device to assess subjects for delirium with the 3-minute Diagnostic Interview for Confusion Assessment Method (3D-CAM). Subjects were then assessed face-to-face with the 3D-CAM. We obtained qualitative data on the acceptability of the tablet-based diagnostic tool through surveys and an open-ended interview. We also compared the results of the face-to-face assessments with the remote assessments to assess test validity. Results: We enrolled 30 subjects (median age 77.80 years; 87% female, 100% white and non-Hispanic). Face-to-face delirium assessments were consistent with remotely performed delirium assessments in terms of diagnosis. A bipolar Likert scale revealed overall videoconferencing interface satisfaction with the subject’s average rating of 8.16 and above on a scale of 0-9 with higher scores indicating more satisfaction. A one-way ANOVA revealed no significant difference in mean responses in any domain by age category. Conclusions: The use of telemedicine in assessment of delirium in older adults is promising. Remote videoconferencing-based delirium assessment is an acceptable method for delirium assessment in the clinic setting. Our next step will be to assess the acceptability and validity of this assessment method in the home setting.
Gudhe R; Busby-Whitehead J; Tirtanadi K; Khairat S; Austin C
Journal of the American Geriatrics Society
2019
2019-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
n/a