bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of feed intake in early gestation on maternal growth and litter size according to body reserves at weaning of young parity sows
Authors: Mallmann André L , Oliveira Gabriela S , Ulguim Rafael R , Mellagi Ana Paula G , Bernardi Mari L , Orlando Uislei A D , Gonçalves Márcio A D , Cogo Ricardo J , Bortolozzo Fernando P
Published: March 2020

The effect of increasing the feed level (1.8, 2.5, and 3.2 kg/d) during early gestation in parity 1 (PO1) and parity 2 (PO2) sows on maternal growth and litter size was evaluated. A total of 361 sows were group-housed and fed a diet based on a corn–soybean meal (3.15 Mcal Metabolizable Energy (ME) per kg and 0.68% standardized ileal digestible lysine) from day 6 of gestation until day 30. Sows were weighed at weaning and on day 30 of gestation. Farrowing rate, number of total piglets born, piglets born alive, stillborn piglets, and mummified fetuses were recorded at farrowing. The effect of feed level on the total number of piglets born was also evaluated according to classes of body weight (BW), body condition score (BCS), backfat (BF), and caliper unit at weaning for each parity order. There was no evidence for significant effect of the interaction between feed level × parity on the variables related to maternal growth and reproductive performance (P ≥ 0.128). Greater feed levels linearly increased the gains in body condition (i.e., BW, BCS, BF, and caliper unit) between weaning and day 30 of gestation (P < 0.001). Farrowing rate was not influenced by the feed level (P ≥ 0.200) and parity (P ≥ 0.209). The number of total piglets born decreased linearly as the feed level increased (P = 0.041), whereas no evidences for differences were observed on piglets born alive among treatments (P ≥ 0.317), neither between parities (P ≥ 0.904). For PO1 sows, the total piglets born on BW classes (≤183 vs. >183 kg) and on classes of BF (≤11.5 vs. > 11.5 mm) were quadratically affected by the feed levels (P ≤ 0.041). In contrast, the number of total piglets born was marginally affected (linear; P ≤ 0.094) by the feed level in the different classes of BW, BCS, and caliper unit in PO2 sows. There was no evidence for differences for the interaction of feed level and classes of body condition (P ≥ 0.199) for PO2 sows. Similarly, no interactions between feed level and classes of BW, BCS, and BF at weaning were observed (P ≥ 0.233) for PO1 sows; however, the total piglets born were affected by an interaction between feed level and caliper unit class (P = 0.042). In conclusion, increased feed intake from day 6 of gestation until day 30 resulted in increased maternal BW gain but reduced the number of total piglets born. Furthermore, lighter and in a poor BCS PO1 sows at weaning produced fewer total born piglets with no benefits from greater amounts of feed.
Characteristics and Evolution of Microbial Drug Resistance in Burned Patients
Authors: Huang Zhifeng , Gan Yu , Yang Kun , Gao Liangdi , Xiong Bing , Li Hanhua , Niu Xiaohui , Wang Kejian , Lai Wen
Published: March 2020

Wound infection is a serious complication in burn injury, which is a common form of trauma and an important public health issue. We investigated samples from burn and nonburn wounds for microbial characteristics and temporal trends of antibiotic resistance. Wound samples were collected from 369 burned patients and 927 non-burned individuals admitted from 2007 to 2017. Higher frequency of Acinetobacter baumannii, Klebsiella pneumonia, and Pseudomonas aeruginosa was observed in samples from burned individuals when compared to those from non-burned. The prevalence of different groups of bacteria varied when the samples were stratified according to age and sex. The antimicrobial resistance profiles showed a significant difference between burned and non-burned patients. The different temporal trends of antimicrobial resistance rates were also found, which may be critical for the proper selection of antibiotics in burn treatment. The present study suggested that frequent pathogens and antibacterial resistance evolution could differ between burn wounds and other wounds. Therefore, periodic surveillance of antibiotic resistance patterns in the burn unit might help physicians properly select antibiotics for treatment.
Soybean photosynthetic and biomass responses to carbon dioxide concentrations ranging from pre-industrial to the distant future
Authors: Drag David W , Slattery Rebecca , Siebers Matthew , DeLucia Evan H , Ort Donald R , Bernacchi Carl J
Published: March 2020

Increasing atmospheric carbon dioxide concentration ([CO2]) directly impacts C3 plant photosynthesis and productivity, and the rate at which [CO2] is increasing is greater than initially predicted by worst-case scenario climate models. Thus, it is increasingly important to assess the physiological responses of C3 plants, especially those that serve as important crops, to [CO2] beyond the mid-range levels used in traditional experiments. Here, we grew the C3 crop soybean (Glycine max) at eight different [CO2] levels spanning subambient (340 ppm) to the highest level thought plausible (~2000 ppm) in chambers for 5 weeks. Physiological development was delayed and plant height and total leaf area increased at [CO2] levels higher than ambient conditions, with very little difference in these parameters among the elevated [CO2] treatments >900 ppm. Daily photosynthesis initially increased with rising [CO2] but began to level off at ~1000 ppm CO2. Similar results occurred in biomass accumulation. Thus, as [CO2] continues to match or exceed the worst-case emission scenarios, these results indicate that carbon gain, growth, and potentially yield increases will diminish, thereby ultimately constraining the positive impact that continuing increases in atmospheric [CO2] could have on crop productivity and global terrestrial carbon sinks.
Minimally Invasive Management of Civilian Gunshot Wounds to the Lumbar Spine: A Case Series and Technical Report
Authors: Crutcher Clifford L , Wilson John M , DiGiorgio Anthony M , Fannin Erin S , Shields Jessica A , Morrow Kevin D , Tender Gabriel C
Published: March 2020

BACKGROUND

Treatment of penetrating gunshot wounds (GSW) to the spine remains controversial. The decision to operate is often based on surgeon preference and experience. We present a case series of 7 patients who underwent minimally invasive thoracolumbar/sacral decompression and bullet removal at a level 1 trauma center.

OBJECTIVE

To describe the use of minimally invasive techniques to achieve decompression and bullet removal for GSW to the spine.

METHODS

From 2010 to 2017, 7 patients with spinal GSW underwent minimally invasive decompression and bullet removal at an academic level 1 trauma center.

RESULTS

Patient ages ranged from 20 to 55 yr (mean: 31 yr). The mechanisms of injury were GSW to the abdomen/pelvis (n = 6) and direct GSW to the spine (n = 1). Based on the neurological examination, the injuries were characterized as complete (n = 1) or incomplete (n = 6). Decompression and bullet removal were performed using a tubular retractor system. All patients with incomplete injuries who had postdischarge follow-up demonstrated some neurologic recovery. There were no postoperative wound infections, cerebrospinal fluid (CSF) fistulas, or other complications related to the procedure.

CONCLUSION

Minimally invasive decompression and bullet removal is a safe technique that may help reduce the risk of postoperative infections and CSF fistulas in patients with GSW to the lumbar spine compared to the standard open technique. This approach appears to be particularly beneficial in patients with incomplete injuries and neuropathic pain refractory to medical treatment.
Decompression of Cavernous Sinus for Trigeminal Neuropathic Pain From Perineural Spread of Tumor: 2-Dimensional Operative Video
Authors: Morris Thomas W , Hundley Kelsey N , Thomas Kevin O , Lockhart Elijah C , Rodriguez Analiz , Day John D
Published: March 2020

Head and neck malignancies with perineural spread are rare. Patients can present with neuropathic pain and cranial nerve palsies.
1
Skull base approaches for surgical decompression are a consideration for patients to provide symptom relief.
2
We demonstrate a frontotemporal extradural approach for a patient with worsening visual symptoms and refractory neuropathic pain in the V1, V2, and V3 distributions and briefly review the relevant anatomy.
3-7

 A 41-yr-old female with a poorly differentiated carcinoma of the head and neck with an infiltration of the cavernous sinus and perineural spread along the trigeminal nerve presented with severe neuropathic facial pain and anesthesia. She had previously undergone radiosurgery. Magnetic resonance imaging (MRI) demonstrated an interval increase in perineural disease within the cavernous sinus with extension intradurally. Her pain was medically refractory. A 2-dimensional intraoperative video illustrates the microsurgical decompression of her perineural invasion along the skull base as a palliative procedure. The patient recovered well postoperatively and had a symptomatic improvement in her pain and visual symptoms. Her preoperative facial numbness persisted postoperatively as expected. Postoperative imaging demonstrates a gross total resection of the intradural component of the tumor with decompression and expected expansion of the cavernous sinus. Because of the retrospective nature of this report, informed consent was not required. Images within the video have been reproduced from Fukuda et al
4
with permission from © Georg Thieme Verlag KG; and Matsuo et al
5
by permission of the Congress of Neurological Surgeons.
Central Nervous System Reorganization and Pain After Spinal Cord Injury: Possible Targets for Physical Therapy—A Systematic Review of Neuroimaging Studies
Authors: Osinski Thomas , Acapo Sessi , Bensmail Djamel , Bouhassira Didier , Martinez Valéria
Published: March 2020

Background

Pain is one of the main symptoms associated with spinal cord injury (SCI) and can be associated with changes to the central nervous system (CNS).

Purpose

This article provides an overview of the evidence relating to CNS changes (structural and functional) associated with pain in SCIs.

Data Sources

A systematic review was performed, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, on PubMed, Embase, and Web of Science in March 2018.

Study Selection

Studies were selected if they concerned changes in the CNS of patients with SCI, regardless of the type of imagery.

Data Extraction

Data were extracted by 2 blinded reviewers.

Data Synthesis

There is moderate evidence for impaired electroencephalographic function and metabolic abnormalities in the anterior cingulate in patients experiencing pain. There is preliminary evidence that patients with pain have morphological and functional changes to the somatosensory cortex and alterations to thalamic metabolism. There are conflicting data regarding the relationships between lesion characteristics and pain. In contrast, patients without pain can display protective neuroplasticity.

Limitations and Conclusion

Further studies are required to elucidate fully the relationships between pain and neuroplasticity in patients with SCIs. However, current evidence might support the use of physical therapist treatments targeting CNS plasticity in patients with SCI pain.
Emptying the wastebasket: a historical and taxonomic revision of the Jurassic crocodylomorphSteneosaurus
Authors: Johnson Michela M , Young Mark T , Brusatte Stephen L
Published: March 2020

Teleosauroidea is a clade of ancient crocodylomorphs that were integral components of coastal marine environments throughout the Jurassic. For nearly two centuries, one of the most familiar genera of teleosauroids has been Steneosaurus, encompassing nearly every teleosauroid species at some point. However, no type species has been designated for Steneosaurus under ICZN Code rules; the type specimen of the presumed type species S. rostromajorGeoffroy Saint-Hilaire, 1825 (MNHN.RJN 134c-d) is a chimera that has been largely neglected in the literature. Moreover, there is confusion as to which teleosauroid species it pertains to, and the genus Steneosaurus is often recovered as paraphyletic or polyphyletic in phylogenetic analyses. As such, the validity of Steneosaurus is uncertain. Here we formally designate S. rostromajor as the type species of Steneosaurus, designate a lectotype and re-evaluate MNHN.RJN 134c-d. We compare it with several well-known teleosauroids, including Lemmysuchus and ‘S.’ edwardsi. Due to lack of autapomorphic characters, poor preservation and a tortured taxonomic history, we find MNHN.RJN 134c-d to be an undiagnostic and unreliable specimen. Thus, we consider S. rostromajor as a nomen dubium and propose that the genus Steneosaurus is undiagnostic. This has profound implications for teleosauroid phylogenetics, which we will clarify in an upcoming paper.
Extracorporeal Membrane Oxygenation for Respiratory Failure
Authors: Quintel Michael , Bartlett Robert H. , Grocott Michael P. W. , Combes Alain , Ranieri Marco V. , Baiocchi Massimo , Nava Stefano , Brodie Daniel , Camporota Luigi , Vasques Francesco , Busana Mattia , Marini John J. , Gattinoni Luciano
Published: March 2020

This review focuses on the use of veno-venous extracorporeal membrane oxygenation for respiratory failure across all blood flow ranges. Starting with a short overview of historical development, aspects of the physiology of gas exchange (i.e., oxygenation and decarboxylation) during extracorporeal circulation are discussed. The mechanisms of phenomena such as recirculation and shunt playing an important role in daily clinical practice are explained.

Treatment of refractory and symptomatic hypoxemic respiratory failure (e.g., acute respiratory distress syndrome [ARDS]) currently represents the main indication for high-flow veno-venous-extracorporeal membrane oxygenation. On the other hand, lower-flow extracorporeal carbon dioxide removal might potentially help to avoid or attenuate ventilator-induced lung injury by allowing reduction of the energy load (i.e., driving pressure, mechanical power) transmitted to the lungs during mechanical ventilation or spontaneous ventilation. In the latter context, extracorporeal carbon dioxide removal plays an emerging role in the treatment of chronic obstructive pulmonary disease patients during acute exacerbations. Both applications of extracorporeal lung support raise important ethical considerations, such as likelihood of ultimate futility and end-of-life decision-making. The review concludes with a brief overview of potential technical developments and persistent challenges.
A Simple Device and Biplanar Technique to Improve Precision When Templating for Total Joint Arthroplasty
Authors: Chen Foster , Giori Nicholas
Published: March 2020

Accurate templating for arthroplasty procedures depends on reliably estimating image magnification. The authors designed a simple device and technique to accomplish this. It is a wedge with four 25-mm balls staggered at different heights, each representing a potential marker. The proper ball to use as the scaling marker is identified on an orthogonal view on the basis of its relationship with the anatomic feature of interest. Reviewing x-rays with known acetabular component diameters, the authors found that the staggered balls technique had a scaling error of 1.48±0.89%. Assuming a constant 20% magnification for all x-rays resulted in an error of 1.65±1.59%. Although similarly accurate, the difference in precision was found to be significant (P=0.012). The constant magnification method resulted in 2 outliers with >4% error, whereas there were no outliers with the novel technique. Staggered marker balls combined with orthogonal imaging is accurate and improves the precision of estimating radiograph magnification.
Early or Late Bacterial Lung Infection Increases Mortality After Traumatic Brain Injury in Male Mice and Chronically Impairs Monocyte Innate Immune Function
Authors: Doran Sarah J. , Henry Rebecca J. , Shirey Kari Ann , Barrett James P. , Ritzel Rodney M. , Lai Wendy , Blanco Jorge C. , Faden Alan I. , Vogel Stefanie N. , Loane David J.
Published: March 2020

Objectives:

Respiratory infections in the postacute phase of traumatic brain injury impede optimal recovery and contribute substantially to overall morbidity and mortality. This study investigated bidirectional innate immune responses between the injured brain and lung, using a controlled cortical impact model followed by secondary Streptococcus pneumoniae infection in mice.

Design:

Experimental study.

Setting:

Research laboratory.

Subjects:

Adult male C57BL/6J mice.

Interventions:

C57BL/6J mice were subjected to sham surgery or moderate-level controlled cortical impact and infected intranasally with S. pneumoniae (1,500 colony-forming units) or vehicle (phosphate-buffered saline) at 3 or 60 days post-injury.

Main Results:

At 3 days post-injury, S. pneumoniae-infected traumatic brain injury mice (TBI + Sp) had a 25% mortality rate, in contrast to no mortality in S. pneumoniae-infected sham (Sham + Sp) animals. TBI + Sp mice infected 60 days post-injury had a 60% mortality compared with 5% mortality in Sham + Sp mice. In both studies, TBI + Sp mice had poorer motor function recovery compared with TBI + PBS mice. There was increased expression of pro-inflammatory markers in cortex of TBI + Sp compared with TBI + PBS mice after both early and late infection, indicating enhanced post-traumatic neuroinflammation. In addition, monocytes from lungs of TBI + Sp mice were immunosuppressed acutely after traumatic brain injury and could not produce interleukin-1β, tumor necrosis factor-α, or reactive oxygen species. In contrast, after delayed infection monocytes from TBI + Sp mice had higher levels of interleukin-1β, tumor necrosis factor-α, and reactive oxygen species when compared with Sham + Sp mice. Increased bacterial burden and pathology was also found in lungs of TBI + Sp mice.

Conclusions:

Traumatic brain injury causes monocyte functional impairments that may affect the host’s susceptibility to respiratory infections. Chronically injured mice had greater mortality following S. pneumoniae infection, which suggests that respiratory infections even late after traumatic brain injury may pose a more serious threat than is currently appreciated.
Enhancing Interprofessional Communications Training in Internal Medicine. Lessons Drawn From a Systematic Scoping Review From 2000 to 2018
Authors: Ng Cheng Han , Ong Zhi Hao , Koh Jeffery Wei Heng , Ang Rachel Zu Er , Tan Laura Hui Shuen , Tay Kuang Teck , Chin Annelissa Mien Chew , Toh Ying Pin , Zhou Jamie Xuelian , Krishna Lalit Kumar Radha
Published: March 2020

Introduction:

Interprofessional communication (IPC) enhances patient experiences and outcomes and improves well-being and satisfaction among health care professionals. This scoping review seeks to guide design of IPC training in internal medicine.

Methods:

The framework of Arksey and O'Malley (2005) guided this systematic scoping review in internal medicine across PubMed, Embase, CINAHL, Scopus, PsycINFO, ERIC, JSTOR, and Google Scholar databases for publications from the years 2000 to 2018.

Results:

Twenty-two thousand eight hundred seventy-four abstracts were retrieved, 326 full-text articles were reviewed, and 32 articles were included. The themes identified using directed content analysis were indications for an IPC program, training stages, and obstacles. The rationale for IPC programs was to improve interprofessional teamwork and enhance patient care. IPC training occurs in five stages beginning with instilling the role, value, and skills behind IPC and gradually practicing these skills within the clinical setting. The challenges to IPC highlight the need to confront workplace hierarchies and the lack of resources.

Discussion:

The findings of this systematic scoping review also serve to underscore the importance of understanding, evaluating, and influencing the clinical environment and the work environment and the need for new assessment tools that will guide the individualized, longitudinal, competency-based learning process that underpins IPC training.
Activation of EphB receptors contributes to primary sensory neuron excitability by facilitating Ca2+ influx directly or through Src kinase-mediated N-methyl-D-aspartate receptor phosphorylation
Authors: Ma Pingchuan , Chen Peng , Zhou Zhao-Lin , Mo Ru-Fan , Wu Mingzheng , Song Xue-Jun
Published: March 2020

EphrinB-EphB receptor tyrosine kinases have been demonstrated to play important roles in pain processing after peripheral nerve injury. We have previously reported that ephrinB-EphB receptor signaling can regulate excitability and plasticity of neurons in spinal dorsal horn, and thus contribute to spinal central sensitization in neuropathic pain. How EphB receptor activation influences excitability of primary neurons in dorsal root ganglion (DRG), however, remains unknown. Here, we report that EphB receptor activation facilitates calcium influx through N-methyl-D-aspartate receptor (NMDAR) dependent and independent manners. In cultured DRG cells from adult rats, EphB1 and EphB2 receptors were expressed in neurons, but not the glial cells. Bath application of EphB receptor agonist ephrinB2-Fc induced NMDAR-independent Ca2+ influx, which was from the extracellular space rather than endoplasmic reticulum. EphB receptor activation also greatly enhanced NMDAR-dependent Ca2+ influx and NR2B phosphorylation, which was prevented by pretreatment of Src kinase inhibitor PP2. In nerve-injured DRG neurons, elevated expression and activation of EphB1 and EphB2 receptors contributed to the increased intracellular Ca2+ concentration and NMDA-induced Ca2+ influx. Repetitive intrathecal administration of EphB2-Fc inhibited the increased phosphorylation of NR2B and Ca2+-dependent subsequent signals Src, ERK, and CaMKII as well as behaviorally expressed pain after nerve injury. These findings demonstrate that activation of EphB receptors can modulate DRG neuron excitability by facilitating Ca2+ influx directly or through Src kinase activation-mediated NMDA receptor phosphorylation and that EphB receptor activation is critical to DRG neuron hyperexcitability, which has been considered critical to the subsequent spinal central sensitization and neuropathic pain.
Potential Confounding Factors May Influence the Association Between Configurations of the Vertebrobasilar System and the Incidence of Idiopathic Sudden Sensorineural Hearing Loss and Canal Paresis
Authors: Maruyama Ayako , Kawashima Yoshiyuki , Fujikawa Taro , Makabe Ayane , Ito Taku , Takeda Takamori , Tsutsumi Takeshi
Published: March 2020

Objective:

To investigate the impact of configurations of the vertebrobasilar system on the incidence of idiopathic sudden sensorineural hearing loss (ISSNHL) and canal paresis (CP).

Study Design:

Retrospective case review.

Setting:

Tertiary referral center.

Patients:

Two hundred and forty-eight consecutive patients diagnosed with ISSNHL and 152 patients with unilateral CP of an uncertain cause who were managed between January 2011 and December 2017. The contralateral side of 144 patients with Bell's palsy or cerebellopontine angle tumor served as a control.

Interventions:

All patients underwent magnetic resonance cisternography. CP was diagnosed based on caloric testing.

Main Outcome Measures:

1) Branching patterns of the anterior/posterior inferior cerebellar artery (AICA/PICA) in the cerebellopontine angle area. 2) The direction of the basilar artery (BA) curvature. 3) Vertebral artery (VA) dominance.

Results:

The incidence of vascular loops of the AICA/PICA entering the internal acoustic canal was significantly higher on both the affected and unaffected sides in patients with ISSNHL and CP in comparison to controls (p < 0.05). The curved BA was observed more frequently in the ISSNHL and CP groups than in the control group (p < 0.05), whereas the direction of the BA curvature was not associated with the laterality of ISSNHL or CP. The incidence of asymmetric VA in CP patients was significantly higher than that in controls (p = 0.0304), while no significant difference was observed between ISSNHL patients and controls. Remarkably, while the incidence rate of irregular vascular configurations was high in both the ISSNHL and CP groups, there was no marked difference between the affected and unaffected ears of the ISSNHL and CP groups.

Conclusions:

Our results indicate that the vascular configurations of the vertebrobasilar system do not directly cause ISSNHL and CP. Instead, they suggest the presence of confounding factors that influence the vascular configurations and the development of ISSNHL and CP.
False-Positive Cholesteatomas on Non-Echoplanar Diffusion-Weighted Magnetic Resonance Imaging
Authors: Muhonen Ethan G. , Mahboubi Hossein , Moshtaghi Omid , Sahyouni Ronald , Ghavami Yaser , Maducdoc Marlon , Lin Harrison W. , Djalilian Hamid R.
Published: March 2020

Objectives:

To investigate false-positive findings on non-echoplanar (non-EPI) diffusion-weighted magnetic resonance imaging (DWI) in patients under surveillance post-cholesteatoma surgery.

Study Design, Setting, Subjects, and Methods:

A retrospective review was performed on patients diagnosed with cholesteatoma who underwent surgical resection and were then followed by serial non-EPI DWI using half-Fourier acquisition single-shot turbo spin echo (HASTE) sequence. All patients had at least two annual follow-up imaging studies.

Results:

False-positive findings were identified in four patients. The size of the suspected lesions was 4 to 12 mm. Otoendoscopy was used during all primary cases and Argon laser was used in one case. In all cases, the entire cholesteatoma was removed, and no residual disease was detected at the end of the procedures. One patient underwent revision surgery but only cartilage graft was found in the area of concern. All patients had stable or resolved hyperintense areas in the subsequent HASTE sequences.

Conclusion:

False positive findings can occur with non-EPI DWI MRI and patients need to be counseled accordingly before revision surgery. Decreasing intensity and dimension of a suspected lesion and a positive finding in an area other than the location of the initial cholesteatoma may favor a false positive. If a false positive finding is suspected when the surgeon is confident of complete resection of the cholesteatoma, an MRI can be repeated in 6 to 12 months to assess changes in the dimension and intensity of the area of concern. Cartilage grafts may cause restricted diffusion on DWI sequences.
Practical strategy for optimizing the timing of anti-tumor necrosis factor-α therapy in Crohn disease
Authors: Kwak Min Seob , Cha Jae Myung , Ahn Ji Hyun , Chae Min Kyu , Jeong Sara , Lee Hun Hee
Published: March 2020

There is little consensus on the optimal timing of anti-tumor necrosis factor (anti-TNF) therapy to decrease the rates of hospitalization and surgery in Crohn disease (CD). We aimed to assess the real-world outcomes of anti-TNF therapy and estimate the optimal timing of anti-TNF therapy in Korean patients with CD.

Claims data were extracted from the Korean Health Insurance Review and Assessment Service database. Incident patients diagnosed with CD between 2009 and 2016, with at least 1 anti-TNF drug prescription, and with follow-up duration > 6 months were stratified according to the number of relapses prior to initiation of anti-TNF therapy: groups A (≤1 relapse), B (2 relapses), C (3 relapses), and D (≥4 relapses). The cumulative survival curves free from emergency hospitalization (EH) and surgery were compared across groups.

Among the 2173 patients analyzed, the best and worst prognoses were noted in groups A and D, respectively. The incidences of EH and surgery decreased significantly as the use of anti-TNF agents increased. The 5-year rate of hospitalization was significantly lower in group A than in groups C and D (P = .004 and .020, respectively), but similar between groups A and B. The 5-year rate of surgery was lower in group A than in group C (P = .024), but similar among groups A, B, and D.

In Asian patients with CD, anti-TNF therapy reduces the risk of EH and surgery and should be considered before three relapses, regardless of disease duration.
Impact of supraglottic device with assist ventilation under general anesthesia combined with nerve block in uniportal video-assisted thoracoscopic surgery
Authors: Xiang Xiaobing , Zhou Huidan , Wu Yingli , Fang Jun , Lian Yanhong
Published: March 2020

Background:

With the improvement of anesthesia and surgical techniques, supraglottic device with assist ventilation under general anesthesia (GA) combined with nerve block is gradually applied to video-assisted thoracoscopic surgery. However, the safety of assist ventilation has not been fully confirmed, and a large number of samples should be studied in clinical exploration.

Methods:

The subjects included 120 patients, undergoing elective thoracoscopic GA, with American Society of Anesthesiologists (ASA) physical status I or II, were randomly divided into 3 groups, 40 cases in each group. Group T: received double-lumen bronchial intubation, Group I: received intercostal nerve block using a supraglottic device, Group P: received paravertebral nerve block using a supraglottic device. Mean arterial pressure, heart rate, saturation of pulse oximetry and surgical field satisfaction, general anesthetic dosage and recovery time were recorded before induction of GA (T0), at the start of the surgical procedure (T1), 15 minutes later (T2), 30 minutes later (T3), and before the end of the surgical procedure (T4). Static and dynamic pain rating (NRS) and Ramsay sedation score were recorded 2 hours after surgery (T5), 12 hours after surgery (T6), 24 hours after surgery (T7), time to get out of bed, hospitalization time and cost, patient satisfaction and adverse reactions.

Results:

There was no significant difference with the surgical visual field of the 3 groups (P 
> .05). The MAP, HR and SpO2 of the 3 groups were decreased from T2 to T3 compared with T0(P 
< .05). Compared with group T: the total dosage of GA was reduced in group I and group P, the recovery time was shorter, the time to get out of bed was earlier (P 
< .05), the hospitalization time was shortened, the hospitalization cost was lower, and the patient satisfaction was higher (P 
< .05). The static and dynamic NRS scores were lower from T5 to T7 (P 
< .05). Ramsay sedation scores were higher (P < .05), and the incidence of adverse reactions was lower (P 
< .05). Comparison between group I and group P: Dynamic NRS score of group P was lower from T6 to T7 (P 
< .05).

Conclusion:

Supraglottic device with assist ventilation under general anesthesia combined with nerve block in uniportal video-assisted thoracoscopic surgery is safe and feasible.
Partial resection of hypertrophic torus tubarius for recurred snoring
Authors: Kim Jeong-Whun , Rhee Chae Seo , Jung Hahn Jin
Published: March 2020

Sleep-disordered breathing symptoms may recur in some children after successful adenoidectomy. A potential etiology that warrants consideration is torus tubarius hypertrophy (TTH) as well as residual or recurrent adenoid hypertrophy. Here, we report our experience and the treatment outcomes with microscopic coblator-assisted partial resection of TTH.

Seven children who had undergone coblator-assisted partial resection of TTH under microscopy from April 2000 through January 2017 were retrospectively reviewed. The patient age at the time of initial adenotonsillectomy and the interval between the first operation and partial resection of TTH were identified. Lateral cephalometry and scores on the Korean version of the obstructive sleep apnea-18 (KOSA-18) questionnaire were reviewed.

The median age at the time of the first operation was 3.0 years and the average time interval between the first operation and subsequent tubal tonsillectomy was 44.0 months. The average width between the torus tubarius was 2.1 mm preoperatively. Symptoms of sleep-disordered breathing were relieved in all patients after operation. Preoperative and postoperative KOSA-18 scores were 73.5 and 35.5, respectively (P = .024). On polysomnography, the preoperative and postoperative apnea-hypopnea index scores were 22.9 and 4.7, respectively (P = .068). The patients were followed up for an average of 1.3 years. One patient developed a recurrence of symptoms and underwent a revision operation. Complications such as bleeding and nasopharyngeal stenosis were not observed.

Otorhinolaryngologists should keep TTH in mind as one of the differential diagnoses for recurrent upper airway obstruction symptoms after adenoidectomy. Microscopic coblator-assisted partial resection of TTH is likely to be safe and effective.
Expanding pancreas donor pool by evaluation of unallocated organs after brain death
Authors: Kulu Yakup , Khajeh Elias , Ghamarnejad Omid , Nikdad Mohammadsadegh , Sabagh Mohammadsadegh , Ali-Hasan-Al-Saegh Sadeq , Nadalin Silvio , Quante Markus , Pisarski Przemyslaw , Jänigen Bernd , Reißfelder Christoph , Mieth Markus , Morath Christian , Goeppert Benjamin , Schirmacher Peter , Strobel Oliver , Hackert Thilo , Zeier Martin , Springel Rainer , Schleicher Christina , Büchler Markus W. , Mehrabi Arianeb
Published: March 2020

Background:

Pancreas graft quality directly affects morbidity and mortality rates after pancreas transplantation (PTx). The criteria for pancreas graft allocation are restricted, which has decreased the number of available organs. Suitable pancreatic allografts are selected based on donor demographics, medical history, and the transplant surgeon's assessment of organ quality during procurement. Quality is assessed based on macroscopic appearance, which is biased by individual experience and personal skills. Therefore, we aim to assess the histopathological quality of unallocated pancreas organs to determine how many unallocated organs are potentially of suitable quality for PTx.

Methods and analysis:

This is a multicenter cross-sectional explorative study. The demographic data and medical history of donor and cause of rejection of the allocation of graft will be recorded. Organs of included donors will be explanted and macroscopic features such as weight, color, size, and stiffness will be recorded by 2 independent transplant surgeons. A tissue sample of the organ will be fixed for further microscopic assessments. Histopathologic assessments will be performed as soon as a biopsy can be obtained. We will evaluate up to 100 pancreata in this study.

Result:

This study will evaluate the histopathological quality of unallocated pancreas organs from brain-dead donors to determine how many of these unallocated organs were potentially suitable for transplantation based on a histopathologic evaluation of organ quality.

Conclusion:

The comprehensive findings of this study could help to increase the pancreas graft pool, overcome organ shortage, reduce the waiting time, and also increase the number of PTx in the future. Registration number: ClinicalTrials.gov: NCT04127266
Thoracic gout tophus with abdominal wall protrusion
Authors: Kao Yanbing , Wang Zhenyu , Leng Jiali , Qu Zhigang , Zhuang Xinming , Ma Hongyun , Song Qingxu , Liu Zijing , Sun Shuo , Liu Yi
Published: March 2020

Rationale:

A patient presented the abdominal wall protrusion due to tophaceous gout of the spine. Similar cases were not reported in the literature. This study aimed to report a case of tophaceous gout of the spine with abdominal wall protrusion.

Patient concerns:

A 38-year-old male patient had a 10-year history of gout and hyperuricemia. He complained of back pain and abdominal wall protrusion.

Diagnoses:

The patient was diagnosed with tophaceous gout of the spine with abdominal wall weakness caused by T11 nerve root compression.

Interventions:

A semi-lamina decompression was performed at T11-T12. The pathological examination of the specimen demonstrated tophaceous gout of the spine.

Outcomes:

After the surgery, the patient's back pain was completely relieved and the abdominal wall weakness significant improved.

Lessons:

This case highlighted that axial gout could mimic thoracic disk herniation clinically. The abdominal wall weakness might also be due to single T11 nerve compression by the tophaceous gout of the spine. In patients with a history of gout, axial gout should be considered as one of the differential diagnoses.
Is intravenous thrombolysis safe for acute ischemic stroke patients taking warfarin with INR 1.9?
Authors: Li Zhaokun , Su Jing , Zhang Shanshan , Du Hongcai , Tang Yufeng , Duan Jingfeng , Chen Zhonglun
Published: March 2020

Introduction:

Intravenous thrombolysis is not suitable for patients undergoing oral anticoagulants therapy, with INR > 1.7 or PT > 15 s. We described a case of intravenous thrombolysis in a patient with INR 1.9.

Patient concerns:

A 66-year-old female patient was diagnosed with acute appendicitis complicated with atrial fibrillation. Seven days after admission, the patient suffered mixed aphasia with right limb asthenia. The NIHSS score was 11 points. and early infarction and hemorrhagic manifestations were not found in the emergency head CT. Thirty minutes after the onset of symptoms, NIHSS of patient increased from 11 to 14, but the INR was 1.92.

Diagnosis:

Acute ischemic stroke.

Interventions:

The IT therapy was recommended and all the therapy related risks were explained to the patient's parents. Briefly, the patient was given rTPA 38.5 mg. In addition to intravenous thrombolysis, VitK1 40 mg was simultaneously administered.

Outcome:

The patient's symptoms of drowsiness were improved. After 24 hours, all symptoms were stabilized with NIHSS of 2 points, there was a slight language obstruction, and no hemorrhagic transformation in head CT. Three months later, the review showed MRS score of 0, and the patient could take care of herself in daily life.

Conclusion:

The clinical guidelines are still the main reference for guiding clinical practice, and the main thrombolytic standards and contraindications for treatment still need to be conformed. On this basis, for individualized patients, clinicians must accurately judge the cause of acute stroke, to make optimal choice, reduce disability and mortality, and improve quality of life of patients.
Clinical and laboratory markers associated with anti-TNF-alpha trough levels and anti-drug antibodies in patients with inflammatory bowel diseases
Authors: Grinman Ana B. , de Souza Maria das Graças C. , Bouskela Eliete , Carvalho Ana Teresa P. , de Souza Heitor S. P.
Published: March 2020

Monitoring anti-TNF agents in inflammatory bowel disease (IBD) patients may be helpful in optimizing outcomes. We aimed to evaluate potential correlations among demographic, clinical, laboratory, or imaging parameters, as well as serum levels of infliximab (IFX) and adalimumab (ADA) and their respective antibodies, in the clinical management of IBD patients.

A cross-sectional study of 95 patients with Crohn's disease (CD) or ulcerative colitis (UC) in maintenance therapy with infliximab or adalimumab was performed. Drug trough levels and anti-drug levels were determined using ELISA-based assays.

Regarding the serum IFX dosage, patients with higher relative C-reactive protein (CRP) levels had significantly lower relative serum IFX levels (<3 μg/mL) (P = .028). In contrast, higher concentrations of anti-IFX antibodies were found in patients who were not on concomitant immunomodulators (P = .022) and who had more biological-related adverse events (P = .001) and higher levels of CRP (P = .042). Serum CRP levels were also negatively correlated with IFX (CC = −0.315; P = .033) but positively correlated with the presence of IFX antibodies (CC = 0.327; P = .027). Serum albumin dosage showed a positive correlation with levels of both IFX (CC = 0.379; P = .004) and ADA (CC = 0.699; P = .003).

Although anti-TNF-α trough levels and immunogenicity do not show a significant correlation with disease outcome, our results reinforce the use of combination therapy for patients treated with infliximab. Moreover, we confirmed the presence of significant associations between anti-TNF-α trough levels and immunogenicity with body mass index (BMI), the concomitant use of immunomodulators, the rates of side effects, and laboratory markers, including serum albumin and CRP.
A randomized controlled trial for prevention of acute exacerbation of stable chronic obstructive pulmonary disease with acupoint application of traditional Chinese medicine
Authors: Zhang Chuantao , Yang Hongjing , Gan Wenfan , Chen Jun , Yang Yang , Xiao Wei , Long Kunlan , Chen Keling , Huang Qingsong , Gao Peiyang
Published: March 2020

Introduction:

Chronic obstructive pulmonary disease (COPD) is a major public health problem that severely affects the quality of life of patients and may even endanger their lives. Although modern medicine has achieved significant results in relieving the clinical manifestations of COPD, it is difficult to prevent its progression and acute exacerbation entirely. As one of the classic aspects of acupuncture and moxibustion therapy, acupoint application of traditional Chinese medicine (TCM) can improve the clinical efficacy of western medicine in treating COPD. To date, however,there is no high-quality clinical trial to assess the effectiveness of TCM acupoint application directly in preventing acute exacerbation of stable COPD.

Methods:

The study is a randomized, double-blind, placebo-controlled trial, in which 200 stable COPD patients will be randomly and equally divided into the experimental group or control group. Both groups will undergo standard Western medicine treatment; however, the patients in the experimental group will be also treated with TCM acupoint application, while the control group will be given placebo acupoint application. The duration of the treatment will be 1 month and a follow-up for 11 months. The primary outcome will be the number of acute exacerbation episodes of COPD, and the secondary outcomes will include the lung function, St George's Respiratory Questionnaire, COPD Assessment Test, and 6-Minute Walk Test. A safety assessment will also be performed during the trial.

Discussion:

The aim of this study is to evaluate the efficacy and safety of TCM acupoint application in preventing acute exacerbation of stable COPD. Our study will provide sound evidence to support the evidence-based medicine of TCM acupoint application as an additional measure in the prevention of acute exacerbation of stable COPD.

Trial registration:

ChiCTR1900026564, Registered 14 October, 2019
Development and validation of a radiomics model based on T2WI images for preoperative prediction of microsatellite instability status in rectal cancer
Authors: Huang Zixing , Zhang Wei , He Du , Cui Xing , Tian Song , Yin Hongkun , Song Bin
Published: March 2020

Introduction:

Globally, colorectal cancer (CRC) is the third most commonly diagnosed cancer in males and the second in females. Rectal cancer (RC) accounts for about 28% of all newly diagnosed CRC cases. The treatment of choice for locally advanced RC is a combination of surgical resection and chemotherapy and/or radiotherapy. These patients can potentially be cured, but the clinical outcome depends on the tumor biology. Microsatellite instability (MSI) is an important biomarker in CRC, with crucial diagnostic, prognostic, and predictive implications. It is important to develop a noninvasive, repeatable, and reproducible method to reflect the microsatellite status. Magnetic resonance imaging (MRI) has been recommended as the preferred imaging examination for RC in clinical practice by both the National Comprehensive Cancer Network and the European Society for Medical Oncology guidelines. T2WI is the core sequence of MRI scanning protocol for RC. Radiomics, the high-throughput mining of quantitative image features from standard-of-care medical imaging that enables data to be extracted and applied within clinical-decision support systems to improve diagnostic, prognostic, and predictive accuracy, is gaining importance in cancer research.

We proposed a hypothesis: A simple radiomics model based on only T2WI images can accurately evaluate the MSI status of RC preoperatively.

Objective:

To develop a radiomics model based on T2WI images for accurate preoperative diagnosis the MSI status of RC.

Method:

All patients with RC were retrospectively enrolled. The dataset was randomly split into training cohort (70% of all patients) and testing cohort (30% of all patients). The radiomics features will be extracted from T2WI–MR images of the entire primary tumor region. Least absolute shrinkage and selection operator was used to select the most predictive radiomics features. Logistic regression models were constructed in the training/validation cohort to discriminate the MSI status using clinical factors, radiomics features, or their integration. The diagnostic performance of these 3 models was evaluated in the testing cohort based on their area under the curve, sensitivity, specificity, and accuracy.

Discussion:

This study will help us know whether radiomics model based on T2WI images to preoperative identify MSI status of RC.
Surgical management of delayed Gartland type III supracondylar humeral fractures in children
Authors: Li Jin , Rai Saroj , Tang Xin , Ze Renhao , Liu Ruikang , Hong Pan
Published: March 2020

Radial external fixator has been proposed to treat delayed irreducible Gartland type III supracondylar humeral fracture, and this study aims to compare its effects with crossed pinning in a retrospective fashion. Delayed supracondylar humeral fracture is defined as more than 72 hours after injury, 2 or more than 2 times failed attempts of closed reduction can be deemed as irreducible fracture.

Between January 2010 and January 2017, patients of Gartland type III supracondylar fractures of the humerus receiving surgery were all selected and reviewed. Overall, 39 patients fitting the inclusion criteria were chosen for the External Fixator Group and patients for control group of crossed pinning with matched age, sex, and clinical parameters (fracture location, injured side, and fracture type) were selected from the database. Surgery duration, number of intraoperative X-ray images, incidence of ulnar nerve injury, postoperative redisplacement, and function of the elbow joint were recorded and analyzed.

In this study, 39 patients treated with radial external fixator had significantly shorter surgery duration, fewer intraoperative X-ray images, and lower incidence of ulnar nerve injury, and postoperative redisplacement than those receiving crossed pinning. Patients in 2 groups displayed similar range of motion for elbow joint at follow-up.

Radial external fixator is an effective and safe method to treat Gartland type III supracondylar fractures that were diagnosed late.
Exploring the Impact of a Dedicated Education Unit on New Graduate Nurses’ Transition to Practice
Authors: Dimino Kimberly , Louie Kem , Banks Janet , Mahon Emily
Published: March 2020

Adequately preparing new graduate nurses for contemporary practice remains a challenge. This innovative mixed-method study explored the impact of a dedicated education unit on new graduate nurses’ transition to practice. Results indicated that new graduate nurses with dedicated education unit experience were better prepared for contemporary practice compared to their peers with traditional clinical experiences. This study highlights the positive impact collaborative clinical teaching models can have on preparing new graduate nurses for practice.