bluuebunny/crossref_metadata_2025 huggingface dataset:
Free-ranging bats alter thermoregulatory behavior in response to reproductive stage, roost type, and weather
Authors: Bergeson Scott M , Brigham R Mark , O’Keefe Joy M
Published: March 2021

Heterotherms vary their use of torpor and choice of refugia to deal with energetic stresses such as reproductive activity and extreme weather. We hypothesized that a temperate-region bat would vary its use of heterothermy in response to air temperature but use of torpor would also be influenced by reproductive stage and roost choice. To test this hypothesis, we collected data on skin temperatures of female Indiana bats (Myotis sodalis) carrying temperature-sensitive radiotransmitters during the summers of 2013–2015. We also measured internal temperatures and external characteristics of roosts used by these bats. We analyzed the influence of daytime air temperature, roost canopy closure, roost type, and bat reproductive stage, on daily heterothermy index and torpor characteristics of 17 bats during 103 full roost days (data collected consistently from when a bat entered its roost in the morning to when it emerged at night). Our data showed that Indiana bat heterothermy was influenced by reproductive stage, roost choice, and weather. Although they used torpor, pregnant bats were the least heterothermic (daily heterothermy index = 3.3 ± 0.6°C SE), followed by juvenile bats (5.6 ± 0.5°C), lactating bats (5.7 ± 0.5°C), and one postlactating bat (13.2 ± 1.6°C). Air temperature also influenced heterothermy of pregnant bats less than bats of other reproductive stages. Thermoregulatory strategies varied on a continuum from use of normothermia in warm roosts to use of long and deep bouts of torpor in cool roosts. The thermoregulatory strategy used seemed to be determined by potential reproductive costs of torpor and energetic consequences of weather. Because Indiana bats used different degrees of heterothermy throughout the summer maternity season, managers should offer maternity colonies an array of refugia to facilitate varying behaviors in response to weather and energetic demands.
Physician-reported barriers and challenges to antibiotic prescribing in surgical prophylaxis: a structured systematic review
Authors: Gillani Syed Wasif , Vippadapu Prasanna , Gulam Shabaz Mohiuddin
Published: March 2021

Objectives

The purpose of the study is to identify and analyse the barriers in surgical procedures where antibiotic dissipation is habitual.

Methods

Extensive literature search is carried out using different electronic databases (PubMed, Europe PMC, PLoS and Google Scholar) between January 2000 and December 2020. The articles were selected purely based on the inclusion criteria. Only qualitative and cross-sectional studies were selected to reduce the risk of bias. The JBI and AXIS checklists were used to assessed the quality of the enrolled articles. Data extractions were done by using a predesigned standardized data collection form.

Key findings

A total of 2067 articles were electronically retrieved but only 14 articles met the eligibility criteria. About 15 902 healthcare professionals (HCPs) with an average response rate of 64.7% were pooled for evidence synthesis. The majority of respondents (50%) discussed different barriers in their practice site for surgical antibiotic prophylaxis (SAP) administration. Barriers were categorized into four themes: lack of guideline availability and knowledge, lack of adherence to guidelines, lack of guideline knowledge and adherence and physician perceptions or off-label practices. A total of 723 (56.3%) out of 1282 HCPs from nine different studies reported a lack of adherence to guidelines during the perioperative process. The majority of respondents in three studies, 318 (82%) out of 386 HCPs, reported that physicians’ perceptions play a crucial role in prescribing SAP during surgeries.

Conclusion

This study concluded that the barriers within the practice site play a decisive role in SAP optimization and therefore all HCPs are recommended to maintain local/standard guidelines and adhere to them while prescribing SAP.
‘Warma Kuyay (Amor de Niño)’ By Josê María Arguedas: A Dialectic Prelude to Liberation Ecotheology
Authors: Park Moisés
Published: March 2021

José María Arguedas’ Peruvian short story ‘Warma Kuyay (Amor de niño)’ culminates with the punishment of a calf, as a result of the white landlord’s sexual violation of Justina, an indigenous woman. This article argues that that theoretical discussions in ecotheology offer fruitful tools for analysing the story, resonating with Andean cosmologies and enabling us to think more seriously about Arguedas’ intersectional theological thoughts. ‘Warma Kuyay’ prefaces theological ecocriticism, foreseeing current developments in liberation theology which do not just emphasise class, but other categories of identity.
Exploring Hong Kong nurses’ decision-making processes around presenteeism
Authors: Andres E B , Lui J N M , Song W , Johnston J M
Published: March 2021

Background

Presenteeism among nurses is the common behaviour of being physically present at work when one should not be due to personal health and well-being, a stressful work environment, lack of work–life balance, or a sense of professional identity or obligation.

Aims

To explore nurses’ decision-making process related to presenteeism in a large Hong Kong public hospital.

Methods

As part of a larger study on nurse presenteeism in Hong Kong, we conducted focus groups with nurses to understand their considerations related to working sick.

Results

Eleven major themes emerged from the focus groups, which we grouped into three organizational domains reflecting nurses’ decision-making process around presenteeism: consideration for colleagues, organizational factors and professional identity.

Conclusions

Presenteeism was a familiar behaviour among Hong Kong nurses in our study. We found both overlap and divergence with prior presenteeism research in the domains and themes identified. Loyalty to colleagues, written and unwritten rules and professional identity as nurses all seemed to encourage presenteeism among Hong Kong nurses. Organizations seeking to discourage presenteeism should evaluate policies such as sick leave certificates, ensure appropriate coverage for all nurse ranks and address subcultural norms encouraging presenteeism.
Early Empirical Tuberculosis Treatment in HIV-Positive Patients Admitted to Hospital in South Africa: An Observational Cohort Study
Authors: Bresges Carolin , Wilson Douglas , Fielding Katherine , Corbett Elizabeth L , Del-Greco Fabrizia , Grint Daniel , Peters Jurgens , Gupta-Wright Ankur
Published: March 2021

Background

Empirical tuberculosis (TB) treatment in human immunodeficiency virus (HIV)–positive inpatients is common and may undermine the impact of new diagnostics. We sought to describe empirical TB treatment and compare characteristics and outcomes with patients treated for TB after screening.

Methods

This was a retrospective observational cohort study of HIV-positive inpatients treated empirically for TB prior to TB screening. Data on clinical characteristics, investigations, and outcomes were collected from medical records. Comparison cohorts with microbiologically confirmed or empirical TB treatment after TB screening with Xpert MTB/RIF and urine lipoarabinomannan assays were taken from South African Screening for Tuberculosis to Reduce AIDS-Related Mortality in Hospitalized Patients in Africa (STAMP) trial site. In-hospital mortality was compared using a competing-risks analysis adjusted for age, sex, and CD4 cell count.

Results

Between January 2016 and September 2017, 100 patients excluded from STAMP were treated for TB empirically prior to TB screening. After enrollment in STAMP and TB screening, 240 of 1177 (20.4%) patients received TB treatment, of whom 123 had positive TB tests and 117 were treated empirically. Characteristics were similar among early empirically treated patients and those treated after TB screening. 50% of early empirical TB treatment was based on radiological investigations, 22% on cerebrospinal or pleural fluid testing, and 28% on clinical features alone. Only 11 of 100 empirically treated patients had subsequent microbiological confirmation. In-hospital mortality was lower in patients with microbiologically confirmed TB compared to those treated empirically (adjusted subdistribution hazard ratio, 0.5 [95% confidence interval, .3–.9).

Conclusions

Empirical TB treatment remains common in severely ill HIV-positive inpatients. These patients may benefit from TB screening using existing rapid diagnostics, both to improve confirmation of TB disease and reduce overtreatment for TB.
The Ageing Body, Memory-Loss and Suicide in Georgian England
Authors: Sbaraini Ella
Published: March 2021

This article examines why older people were particularly prone to suicide in Georgian England, and argues that their suicidality is best understood through the lens of the ‘ageing body’. By centring on the experiences of the suicidal, it proposes that suicide was not ‘medicalised’ in the way traditionally described in the historiography, being reconceptualised, over the course of the eighteenth century, as a product of lunacy. Instead, it contends that older people often thought that their suicides were a rational response to the struggles of ageing, which included physical decline and embodied memory-loss. To do this, it uses previously unseen coroners’ inquests from across England, in addition to wills and medical writings. It examines these inquests for what they can tell us about the emotional and embodied experiences of older suicidal people, thus contributing to an under-researched aspect of the social history of ageing.
The nature and prevalence of diagnostic testing in mathematics at tertiary-level in Ireland
Authors: Hyland Diarmaid , O’Shea Ann
Published: March 2021

In this study, we conducted a survey of all tertiary level institutions in Ireland to find out how many of them use diagnostic tests, and what kind of mathematical content areas and topics appear on these tests. The information gathered provides an insight into what instructors expect students to know on entry to university and what they expect students to have difficulty with. In total, 12 diagnostic tests from 11 Irish institutions were collected during the study. An item-by-item analysis was carried out on each diagnostic test to determine the content areas and topics that are assessed on the diagnostic tests and to identify any additional knowledge required for successful completion. We compare the tests administered in the university sector and the Institute of Technology (IT) sector of the Irish tertiary level education system. In addition, current diagnostic tests are compared with two tests from the 1980s to see if the level of mathematical preparedness expected of first-year students has changed over time. Our analysis is situated in a discussion of previous research on diagnostic testing both nationally and internationally.
Critical Thinking Medication Storytelling: A Teaching Strategy to Engage Thoughts, Emotions, and Creativity
Authors: Grady Mary , Bell Renee
Published: March 2021

Nursing students struggle to learn medications that their patients have been prescribed, often regurgitating information found in a drug book or on a drug card. Watching students do this led to the development of the Critical Thinking Medication Storytelling assignment. The assignment was designed to bring information to life in a creative and meaningful way, enabling students to see how specific medications interrelate with the patient’s condition. Qualitative results from students revealed that students embraced this teaching strategy; the strategy was effective for acquiring drug knowledge.
Preferred Teaching/Learning Strategies for Graduate Nursing Students in Web-Enhanced Courses
Authors: Harlan Melissa Dawn , Rosenzweig Margaret Quinn , Hoffmann Rosemary Labarbera
Published: March 2021

Background

Advanced and continuing education is essential for maintaining competence. Graduate students have shown an increase in online course enrollment, and similar trends are anticipated among nurses with limited access to on-site education due to the current COVID-19 (coronavirus disease 2019) pandemic. Faculty must utilize preferred teaching/learning strategies to provide high-quality online education courses that engage learners and improve outcomes.

Objectives

This study assessed preferred teaching/learning strategies for graduate students enrolled in at least 1 asynchronous nursing course. Correlational data assessed the relationship between preferred teaching/learning strategies and selected demographic information.

Methods

All graduate nursing students enrolled in at least 1 asynchronous course at the University of Pittsburgh School of Nursing during a 3-month period were invited to participate in a survey to assess preferred teaching/learning methods.

Results

Sixty-six graduate students completed the survey. Most participants were comfortable with computer skills, had previously enrolled in a web-enhanced course, and did not enjoy group work. Preferred teaching/learning strategies included voice-over PowerPoints, simulation, case studies, guest speakers, and faculty communication.

Conclusion

Preferred teaching/learning strategies that incorporate asynchronous and synchronous learning should be developed. These strategies will enhance the knowledge base of nurses in all settings and populations.
A Congener-specific and Mixture Analysis of Plasma Polychlorinated Biphenyl Levels and Incident Breast Cancer
Authors: Parada Humberto , Benmarhnia Tarik , Engel Lawrence S. , Sun Xuezheng , Tse Chiu-Kit , Hoh Eunha , Olshan Andrew F. , Troester Melissa A.
Published: March 2021

Background:

Polychlorinated biphenyls (PCBs), a diverse class of chemicals, are hypothesized mammary carcinogens. We examined plasma levels of 17 PCBs as individual congeners and as a mixture in association with breast cancer using a novel approach based on quantile g-computation.

Methods:

This study included 845 White and 562 Black women who participated in the population-based, case–control Carolina Breast Cancer Study Phase I. Cases (n = 748) were women with a first diagnosis of histologically confirmed, invasive breast cancer residing in 24 counties in central and eastern North Carolina; controls (n = 659) were women without breast cancer from the same counties. PCBs were measured in plasma samples obtained during the study interview. We estimated associations [covariate-adjusted odds ratios (ORs) and 95% confidence intervals (CIs)] between individual PCB congeners and breast cancer using multivariable logistic regression. We assessed PCB mixtures using quantile g-computation and examined effect measure modification by race.

Results:

Comparing highest and lowest tertiles of PCBs resulted in ORs of 1.3 (95% CI = 0.95, 1.8) for congener 74, 1.4 (95% CI = 1.0, 1.9) for 99, 1.3 (95% CI = 0.91, 1.8) for 194, and 1.2 (95% CI = 0.90, 1.7) for 201. Among all women, we estimated a joint effect of the PCB mixture with an OR of 1.3 (95% CI = 0.98, 1.6) per tertile change. In race-stratified analyses, associations for tertiles of PCB mixtures were stronger among Black women (OR = 1.5; 95% CI = 1.0, 2.3) than among White women (OR = 1.1; 95% CI = 0.81, 1.6).

Conclusion:

Our results are consistent with the hypothesis that exposure to PCB mixtures increase the risk of breast cancer, but studies of populations with different exposure profiles are needed.
Quantification of Recirculation During Veno-Venous Extracorporeal Membrane Oxygenation: In Vitro Evaluation of a Thermodilution Technique
Authors: Cipulli Francesco , Battistin Michele , Carlesso Eleonora , Vivona Luigi , Cadringher Paolo , Todaro Serena , Colombo Sebastiano Maria , Lonati Caterina , Fumagalli Roberto , Pesenti Antonio , Grasselli Giacomo , Zanella Alberto
Published: March 2021

Veno-venous extracorporeal membrane oxygenation (vv-ECMO) represents one of the most advanced respiratory support for patients suffering from severe acute respiratory distress syndrome. During vv-ECMO a certain amount of extracorporeal oxygenated blood can flow back from the reinfusion into the drainage cannula without delivering oxygen to the patient. Detection and quantification of this dynamic phenomenon, defined recirculation, are critical to optimize the ECMO efficiency. Our study aimed to measure the recirculation fraction (RF) using a thermodilution technique. We built an in vitro circuit to simulate patients undergoing vv-ECMO (ECMO flow: 1.5, 3, and 4.5 L/min) with different cardiac output, using a recirculation bridge to achieve several known RFs (from 0% to 50%). The RF, computed as the ratio of the area under temperature-time curves (AUC) of the drainage and reinfusion, was significantly related to the set RF (AUC ratio (%) = 0.979 × RF (%) + 0.277%, p < 0.0001), but it was not dependent on tested ECMO and cardiac output values. A Bland–Altman analysis showed an AUC ratio bias (precision) of −0.21% for the overall data. Test-retest reliability showed an intraclass correlation coefficient of 0.993. This study proved the technical feasibility and computation validity of the applied thermodilution technique in computing vv-ECMO RF.
Successful Heart Transplantation Recovered From a Brain-Dead Donor on Veno-Arterial Extracorporeal Membrane Oxygenation Support
Authors: Goldberg Joshua B. , Levine Avi , Ohira Suguru , Spielvogel David , Kai Masashi
Published: March 2021

We describe the successful transplantation of a brain-dead donor supported by veno-arterial extracorporeal membrane oxygenation (VA-ECMO) after cardiac arrest secondary to pulmonary embolism. The donor was a 50-year-old female who developed massive pulmonary embolism complicated by cardiac arrest requiring initiation of VA-ECMO. An initial echocardiogram revealed severe right ventricular dysfunction which recovered after 6 days of VA-ECMO confirmed by transthoracic echocardiogram and right heart catheterization. The heart was transplanted to a 56-year-old male on a left ventricular assist device. At 1-year posttransplant, he continues to have normal graft function. The present case reports the successful transplantation of a brain-dead donor heart recently recovered from pulmonary embolism induced acute right ventricular failure supported by VA-ECMO and represents a potential source of increased donor organs that would otherwise not be utilized.
ER-positive endocervical adenocarcinoma mimicking endometrioid adenocarcinoma in morphology and immunohistochemical profile
Authors: Chen Ruichao , Qin Ping , Luo Qiuping , Yang Wen , Tan Xuexian , Cai Tonghui , Jiang Qingping , Chen Hui
Published: March 2021

Rationale:

Usual-type endocervical adenocarcinoma (ECA), high-risk HPV associated, is the most common type of glandular carcinoma in the endocervix. Mucin-depleted usual-type ECA is 1 end of morphological lineage of usual-type ECA and morphologically may show endometrioid features, which could cause diagnostic challenge with uterine endometrioid adenocarcinoma (EEC) and primary endometrioid ECA, especially in the setting of small biopsy and endocervical curettage (ECC).

Patient concerns:

A 37-year-old women presented with dyspareunia for 1 year, showing atypical glandular cell on a liquid-based Pap TCT examination and positive for HPV16 detection. ECC showed EEC in another hospital based on its “endometrioid” morphology and immunohistochemical profiles (ER/PR/PAX8 strongly positive, though p16 also strongly positive).

Diagnoses:

The specimen of hysterectomy in our hospital displayed a lesion confined to the uterine cervix showing the same morphology and immunohistochemical profiles as ECC. Finally, we successfully performed HPV RNAscope and detected high-risk human papilloma virus (HPV) E6/E7 mRNA particles in tumor cells in situ, which warranted usual-type ECA with mucin-depleted feature, a rare deviation of usual-type of ECA.

Interventions:

The patient underwent total hysterectomy with lymph node dissection.

Outcomes:

To date, 14 months after surgery, the patient is well without recurrence or distant metastasis, and undergoes regular reexamination.

Lessons subsections:

We report a rare case of mucin-depleted usual-type ECA showing overlapping morphological and immunohistochemical profiles with EEC. The pathological diagnosis was confirmed by high-risk HPV RNAscope detection which is superior than immunohistochemistry to identify usual-type ECA, warranting an important role in assisting the diagnosis of morphological vague cases.
Effectiveness of resistance exercises in the treatment of rheumatoid arthritis
Authors: Wen Zhigang , Chai Yi
Published: March 2021

Background:

We aimed to assess the efficacy of resistance exercise in rheumatoid arthritis (RA) in randomized controlled trials (RCTs).

Method:

PubMed, the Cochrane Library, and Embase were searched according to the index words to identify eligible RCTs, and relevant literature sources were also searched. The latest search was done in August 2019. Odds ratios (OR), mean difference (MD), and 95% confidence interval (95% CI) were used to analyze the main outcomes.

Result:

Seventeen RCTs were included in the meta-analysis with 512 patients in the resistance exercise group and 498 patients in the control group. The results showed that compared with the control group, resistance exercise significantly decreased disease activity score in 28 joints (DAS-28) scores (standard mean difference [SMD]: –0.69, 95% CI: –1.26 to –0.11), reduced erythrocyte sedimentation rate (ESR) (SMD: –0.86, 95% CI: –1.65 to –0.07), and shortened the time of 50 ft. walking (SMD: –0.64, 95% CI: –0.99 to –0.28). No significant difference was observed in visual analog scale (VAS) scores (SMD: –0.61, 95% CI: –1.49–0.27) and health assessment questionnaire (HAQ) scores (weighted mean difference: –0.10, 95% CI: –0.26–0.06).

Conclusion:

Resistance exercise showed reducing DAS-28 score, ESR score, and the time of 50 ft. walking in RA patients compared with the control group. However, high quality multicenter RCTs with larger sample sizes to confirm the conclusion.
A bibliometric analysis of segmentectomy versus lobectomy for non-small cell lung cancer research (1992–2019)
Authors: Xu Zhiyun , Gao Xiang , Ren Binhui , Zhang Shuai , Xu Lin
Published: March 2021

Background:

This study intends to create a series of scientific maps to quantitatively estimate hot spots and emerging trends in segmentectomy versus lobectomy for non-small cell lung cancer (NSCLC) research with bibliometric methods.

Methods:

Articles published on segmentectomy versus lobectomy for NSCLC were extracted from the Web of Science Core Collection (WoSCC). Extracted information was analyzed quantitatively using bibliometric analysis by CiteSpace to find hot spots and frontiers in this research area.

Results:

A total of 362 scientific articles on segmentectomy versus lobectomy for NSCLC were collected, and the annual publication rate increased over time from 1992 to 2019. The leading country and the leading institution were the United States and University of Pittsburgh, respectively. Furthermore, the most prolific researchers were, namely, James D. Luketich, Rodney J. Landreneau, Matthew J. Schuchert, Morihito Okada, and David O. Wilson. The analysis of keywords pointed out that carcinoma, bronchogenic carcinoma, limited resection, segmental resection, and morbidity are hot spots and lymph node dissection, minimally invasive surgery, impact, epidemiology, and high risk are research frontiers in this field.

Conclusion:

Publications related to segmentectomy versus lobectomy for NSCLC have made great achievements based on bibliometric analysis in recent years. However, further research and global collaboration are still required. Finally, we find that segmentectomy for the treatment of NSCLC is receiving much more attention from researchers globally compared with lobectomy in this research area.
Immune checkpoint inhibitors in patients with solid tumors and poor performance status
Authors: Kapoor Akhil , Noronha Vanita , Patil Vijay M. , Menon Nandini , Joshi Amit , Abraham George , Prabhash Kumar
Published: March 2021

Immune checkpoint inhibitors (ICIs) are rapidly being incorporated as treatment option either alone or in combination with chemotherapy in most of the solid tumors. Since there is very limited data of ICI in patients with poor performance status (PS) from the real world settings, we performed a retrospective audit of patients who received ICI and report the analysis based on ECOG PS of these patients.

This study is a retrospective audit of a prospectively collected database of patients receiving ICIs for advanced solid tumors in any line between August 2015 and November 2018 at Tata Memorial Hospital, Mumbai, India. All statistical calculations were performed using SPSS statistical software for windows version 20.0.

A total of 155 patients who received ICIs during the specified period were evaluated for this study. Baseline ECOG PS 0–1 (n = 103, 66.4%) patients was associated with median OS 9.1 (95% CI [confidence interval], 4.4-NR) months when compared to ECOG 2–4 (n = 52, 33.5%) which had a median OS of 2.9 (95% CI; 1.8–5.5) months (HR, 1.7, 95% CI, 1.1–2.7, log rank P = .017). The disease control rate for the poor PS group was 34.6%. However, 27.3% patients (95% CI: 20.3–34.3) were still alive at 1 year. Median OS in patients with PS 2 was 3.7 months (95% CI: 0–11.6) as compared to 1.8 months (95% CI: 0.2–3.4) for those with PS 3–4 (HR-2.0; 95% CI: 1.0–3.9, P = .041). The tolerance to ICIs was good with no grade 3/4 toxicities in 44 (84.6%) patients.

Immune checkpoint inhibitors are a safe and effective therapeutic option even in solid tumor patients with poor performance status.
Fungal liver infection mimicking hepatic malignant tumor on contrast enhanced ultrasound
Authors: Yang Jie , Zhang Ya-han , Huang Jia-yan , Lu Qiang
Published: March 2021

Rational:

Fungal liver infection mostly occurs in immunocompromised patients, and is often associated with delayed diagnosis and high mortality rates. Dynamic contrast enhanced imaging is crucial for the diagnosis of fungal liver infection and has been reported having variable manifestations.

Patient concerns:

A 38-year-old Chinese man, with a history of diabetes and chronic hepatitis B, was admitted to our hospital due to prolonged fever of unknown cause. He had a medical history of receiving broad-spectrum antibiotic treatment for pulmonary inflammation at the local hospital. The blood test results showed that the white cell count (14.0 × 109/L) and neutrophil count ratio (77.0%) were subtly elevated. C-reactive protein (92.0 mg/l) and cancer antigen (CA)-125 (904.50 U/ml) were elevated. Non-small cell lung cancer antigen was within the normal limit. Hepatitis B virus DNA load was 3.28 × 103 IU/ml. Sputum and blood cultures were normal. Abdominal ultrasonography (US) found a large heterogeneous mass, with diffused echogenic foci without infiltrating the surrounding vascular, which exhibiting “rapid wash in and out” on contrast-enhanced ultrasound (CEUS).

Diagnosis:

The diagnosis of liver fungal infection was confirmed pathologically via ultrasound-guided biopsy.

Interventions:

Antibiotic and antifungal therapy with imipenem and voriconazole.

Outcomes:

The patient's body temperature had been controlled and the huge mass disappeared on follow-up ultrasound 1-year later.

Lessons:

This case highlights the unusual imaging features of fungal liver infection, presenting as huge heterogeneous mass with diffusive echogenic foci without infiltrating the surrounding vascular on grayscale US and the enhancement pattern of “rapid wash in and out” on CEUS. Additionally, ultrasound-guided biopsy is necessary for the correct diagnosis of suspected liver lesions.
Does washing medical devices before and after use decrease bacterial contamination?
Authors: Nai Gisele Alborghetti , Medina Denis Aloísio Lopes , Martelli Cesar Alberto Talavera , de Oliveira Mayla Silva Cayres , Portelinha Maria Júlia Schadeck , Henriques Bruno Carvalho , Caldeira Isadora Delfino , Almeida Mércia de Carvalho , Eller Lizziane Kretli Winkelstroter , Neto Fausto Viterbo de Oliveira , Marques Mariângela Esther Alencar
Published: March 2021

Surface treatment of medical devices may be a way of avoiding the need for replacement of these devices and the comorbidities associated with infection. The aim of this study was to evaluate whether pre- and postcontamination washing of 2 prostheses with different textures can decrease bacterial contamination.

The following microorganisms were evaluated: Staphylococcus aureus, Staphylococcus epidermidis, Proteus mirabilis and Enterococcus faecalis. Silicone and expanded polytetrafluoroethylene vascular prostheses were used and divided into 3 groups: prostheses contaminated; prostheses contaminated and treated before contamination; and prostheses contaminated and treated after contamination. Treatments were performed with antibiotic solution, chlorhexidine and lidocaine. After one week of incubation, the prostheses were sown in culture medium, which was incubated for 48 hours. The area of colony formation was evaluated by fractal dimension, an image analysis tool.

The antibiotic solution inhibited the growth of S epidermidis and chlorhexidine decrease in 53% the colonization density for S aureus in for both prostheses in the pre-washing. In postcontamination washing, the antibiotic solution inhibited the growth of all bacteria evaluated; there was a 60% decrease in the colonization density of S aureus and absence of colonization for E faecalis with chlorhexidine; and lidocaine inhibited the growth of S aureus in both prostheses.

Antibiotic solution showed the highest efficiency in inhibiting bacterial growth, especially for S epidermidis, in both washings. Lidocaine was able to reduce colonization by S aureus in post-contamination washing, showing that it can be used as an alternative adjuvant treatment in these cases.
Effects of smoking on the optimal effect-site concentration of remifentanil required for preventing cough during anesthetic emergence in male patients undergoing laparoscopic or robotic cholecystectomy
Authors: Kim Ha Yeon , Choi Jong Bum , Lee Eunyoung A. , Kwon Sei Hyuk , Kim Ji Eun , Lee Sook Young
Published: March 2021

Target-controlled infusion of remifentanil is known to reduce cough effectively during emergence from general anesthesia. The effect of smoking on emergence cough remains controversial. Therefore, we aimed to investigate the effect-site concentration (Ce) of remifentanil in the male patients undergoing laparoscopic or robotic cholecystectomy for suppressing emergence cough in smokers and non-smokers.

Twenty smokers and 24 non-smokers (sex, male; age range, 20–65 years) were enrolled in this study. Anesthesia was maintained using sevoflurane and remifentanil. The Ce of remifentanil in 50% (EC50) and 95% (EC95) of the patients required for suppressing emergence cough were determined for each group (smokers and non-smokers) using Dixon up-and-down method and isotonic regression method with a bootstrapping approach.

Dixon up-and-down method revealed that the EC50 value was significantly higher in smokers (3.51 ± 0.60 ng/mL) than in non-smokers (2.71 ± 0.30 ng/mL) (P < 0.001). In smokers and non-smokers, isotonic regression revealed EC50 to be 4.40 (83% CI, 4.17–4.58) ng/mL and 2.58 (83% CI, 2.31–2.87) ng/mL, respectively, and EC95 to be 4.76 (95% CI, 4.73–4.78) ng/mL and 3.15 (95% CI, 3.04–3.18) ng/mL, respectively.

The Ces of remifentanil required to prevent cough during emergence were significantly higher in smokers than in non-smokers. Therefore, clinicians should pay attention to the smoking history of a patient to prevent cough during emergence.
A prospective randomized controlled trial to evaluate effect of chewing gum on postoperative ileus in elderly patient after hip fracture
Authors: Cha Yong-Han , Nam Dae Cheol , Song Sang-Youn , Yoo Jun-Il
Published: March 2021

Factors related to developing postoperative ileus (POI) vary from pharmacologic, inflammatory, hormonal, metabolic, gastrointestinal physiology, neurologic, to psychological factors. Although orthopedic-related incidence of postoperative ileus is about 10%, these studies are limited to spine surgery and pelvic surgery. The purpose of this study was to investigate prevalence of POI and to analyze effect of chewing gum on POI and bowel function in elderly patients after hip fracture surgery.

A prospective randomized controlled trial was conducted at the Gyeongsang National University Hospital. Elderly patients with hip fracture who underwent surgery from March 2017 to June 2018 were eligible to participate. Patients were excluded if they had a mastication disability, impaired cognitive function, previous history of gastrointestinal disease, respiratory disease and low oxygen saturation, hip arthroplasty with causes other than hip fractures, acetabular fractures, periprosthetic fractures, or pathological fractures. Patients with consciousness problem by excessive anesthesia were also excluded. Patients were classified into 2 groups by randomization. Group I received sugar-free gum and were encouraged to chew 6 hours following surgery until the first intestinal gas is released. Group II was given the same postoperative procedure and encouraged to consume water after 6 hours.

After applying exclusion criteria, 74 patients were finally included. Thirty-one patients were classified to Group I and 43 patients were classified to the Group II. Prevalence of POI in all patients with hip fracture was 63.5% (47/74). Prevalence of POI in Group I was statistically significant lower than that in Group II (Group I: 41%, Group II: 79.1%, P = .01)

The prevalence of POI in elderly patients with hip fracture was 63.5%. Chewing gum had a significant effect on reduction of POI in elderly patients with hip fractures.
Clinical characteristics of non-idiopathic pulmonary fibrosis, progressive fibrosing interstitial lung diseases
Authors: Komatsu Masamichi , Yamamoto Hiroshi , Kitaguchi Yoshiaki , Kawakami Satoshi , Matsushita Mina , Uehara Takeshi , Kinjo Takumi , Wada Yosuke , Ichiyama Takashi , Urushihata Kazuhisa , Ushiki Atsuhito , Yasuo Masanori , Hanaoka Masayuki
Published: March 2021

Progressive fibrosing interstitial lung disease (PF-ILD) is a progressive phenotype of fibrosing ILDs with varying definitions and elusive clinical characteristics. We aimed to clarify the clinical features and prognosis of PF-ILD cases based on the deterioration of pulmonary function.

Altogether, 91 consecutive ILD patients who underwent at least 2 pulmonary function tests (PFTs) with an interval of at least 24 months, as the screening period, between January 2009 and December 2015 were retrospectively reviewed. The deterioration of forced vital capacity (FVC) and diffusing capacity of the lung for carbon monoxide (DLco) was calculated based on PFT data and screening period. The definition of PF-ILD was

Medical records of 34 patients with idiopathic pulmonary fibrosis (IPF), 11 patients with non-IPF, PF-ILD, and 46 patients with non-IPF, non-PF-ILD were retrospectively analyzed. Patient characteristics, pharmacologic or non-pharmacologic treatment status, and prognosis were compared between the IPF and non-IPF groups and between the non-IPF, PF-ILD and non-IPF, non-PF-ILD groups.

Eleven patients (19.3%) showed a progressive phenotype in the non-IPF group. The pulmonary function data at the first PFT were worse in non-IPF, PF-ILD patients than in non-IPF, non-PF-ILD patients. There were no differences in the proportion of patients who were observed without pharmacologic treatment or of those receiving pharmacologic treatment between the non-IPF, PF-ILD and non-IPF, non-PF-ILD groups. Low %FVC at the first PFT and the usual interstitial pneumonia-like fibrotic pattern on high-resolution computed tomography were risk factors for PF-ILD in the non-IPF group. The mortality in the non-IPF, PF-ILD group was significantly worse than that of the non-IPF, non-PF-ILD group and was as poor as that of the IPF group. Multivariate logistic analysis showed that aging and low %DLco at the first PFT were risk factors for mortality within the non-IPF group.

The prognosis of non-IPF, PF-ILD patients was as poor as that of IPF patients. Non-IPF, PF-ILD patients require more intensive treatment before disease progression.
Deceleration capacity for rapid risk stratification in patients suffering from acute ischemic stroke
Authors: Duckheim Martin , Gaebler Martin , Mizera Lars , Schreieck Juergen , Poli Sven , Ziemann Ulf , Gawaz Meinrad , Meyer-Zuern Christine S. , Eick Christian
Published: March 2021

Deceleration capacitiy for rapid risk stratification in stroke patients

Cerebral ischemia is a major cause of neurologic deficit and patients suffering from ischemic stroke bear a relevant risk of mortality. Identifying stroke patients at high mortality risk is of crucial clinical relevance. Deceleration capacity of heart rate (DC) as a parameter of cardiac autonomic function is an excellent predictor of mortality in myocardial infarction and heart failure patients.

The aim of our study was to evaluate whether DC provides prognostic information regarding mortality risk in patients with acute ischemic stroke.

From September 2015 to March 2018 we prospectively enrolled consecutive patients presenting at the Stroke Unit of our university hospital with acute ischemic stroke who were in sinus rhythm. In these patients 24 hours-Holter-ECG recordings and evaluation of National Institute of Health Stroke Scale (NIHSS) were performed. DC was calculated according to a previously published algorithm. Primary endpoint was intrahospital mortality.

Eight hundred seventy eight stroke patients were included in the study. Intrahospital mortality was 2.8% (25 patients). Both DC and NIHSS were significantly different between non-survivors and survivors (Mean ± SD: DC: 4.1 ± 2.8 ms vs 6.3 ± 3.3 ms, P < .001) (NIHSS: 7.6 ± 7.1 vs 4.3 ± 5.5, P = .02). DC achieved an area under the curve value (AUC) of 0.708 for predicting intrahospital mortality, while the AUC value of NIHSS was 0.641. In a binary logistic regression analysis, DC, NIHSS and age were independent predictors for intrahospital mortality (DC: HR CI 95%: 0.88 (0.79–0.97); P = .01; NIHSS: HR CI 95%: 1.08 (1.02–1.15); P = .01; Age: HR CI 95%: 1.07 (1.02–1.11); P = .004. The combination of NIHSS, age and DC in a prediction model led to a significant improvement of the AUC, which was 0.757 (P < .001, incremental development index [IDI] 95% CI: 0.037 (0.018–0.057)), compared to the individual risk parameters.

Our study demonstrated that DC is suitable for both objective and independent risk stratification in patients suffering from ischemic stroke. The application of a prediction model combining NIHSS, age and DC is superior to the single markers in identifying patients at high mortality risk.
Inspiratory muscle training for recovered COVID-19 patients after weaning from mechanical ventilation
Authors: Abodonya Ahmed M. , Abdelbasset Walid Kamal , Awad Elsayed A. , Elalfy Ibrahim E. , Salem Hosni A. , Elsayed Shereen H.
Published: March 2021

Background.

To the best of our knowledge, no studies have evaluated the effects of inspiratory muscle training (IMT) on recovered COVID-19 patients after weaning from mechanical ventilation. Therefore, this study assessed the efficacy of IMT on recovered COVID-19 patients following mechanical ventilation.

Methods.

Forty-two recovered COVID-19 patients (33 men and 9 women) weaned from mechanical ventilation with a mean age of 48.05 ± 8.85 years were enrolled in this pilot control clinical study. Twenty-one patients were equipped to 2-week IMT (IMT group) and 21 matched peers were recruited as a control (control group). Forced vital capacity (FVC%), forced expiratory volume in 1 second (FEV1%), dyspnea severity index (DSI), quality of life (QOL), and six-minute walk test (6-MWT) were assessed initially before starting the study intervention and immediately after intervention.

Results.

Significant interaction effects were observed in the IMT when compared to control group, FVC% (F = 5.31, P = .041, ηP
2 = 0.13), FEV1% (F = 4.91, P = .043, ηP
2 = 0.12), DSI (F = 4.56, P = .032, ηP
2 = 0.15), QOL (F = 6.14, P = .021, ηP
2 = 0.17), and 6-MWT (F = 9.34, P = .028, ηP
2 = 0.16). Within-group analysis showed a significant improvement in the IMT group (FVC%, P = .047, FEV1%, P = .039, DSI, P = .001, QOL, P < .001, and 6-MWT, P < .001), whereas the control group displayed nonsignificant changes (P > .05).

Conclusions.

A 2-week IMT improves pulmonary functions, dyspnea, functional performance, and QOL in recovered intensive care unit (ICU) COVID-19 patients after consecutive weaning from mechanical ventilation. IMT program should be encouraged in the COVID-19 management protocol, specifically with ICU patients.
Incidence and risk factors of dementia and the primary subtypes in northern rural China
Authors: Gu Xingzhong , Shi Zhihong , Liu Shuai , Guan Yalin , Lu Hui , Zhang Ying , Zhang Meilin , Liu Shuling , Yue Wei , Wu Hao , Wang Xiaodan , Zhang Yajing , Ji Yong
Published: March 2021

This study was carried out to estimate the incidence and to determine socio-demographic risk factors for dementia among individuals residing in rural northern China.

The current prospective, population-based study was conducted between 2011 and 2016. Follow-up interviews were conducted annually from 2014 to 2016. The study involved 1511 dementia-free individuals aged 60 years or above from rural China. Standard criteria were used to make diagnoses for dementia and Alzheimer disease (AD).

At least one follow up survey was completed with 1181 study participants. At the 5-year follow-up, 127 individuals had developed dementia, 75 had developed AD, and 32 had developed vascular dementia (VaD). With a total of 5649.2 risk years for the sample, the estimated incidence rates per 1000 person-years were 22.48 (95% CI: 18.62, 26.35) for dementia and 13.28 (95% CI: 10.29, 16.26) for AD. Incidence rates for dementia and AD increased with age across the 10-year age groups. Poor education (illiteracy) was an independent risk factor for both AD and VaD. Being engaged in social activities was an independent protective factor for VaD.

The incidence of dementia in rural China was found to be higher than previously reported. Incidence of dementia increased with age, and AD was the most frequent type of dementia. Poor education was associated with a higher risk of VaD and AD. Engagement in social activities was an independent protective factor for VaD.
STROBE-sequencing analysis of the vaginal microecology of 4- to 6-year-old girls in Southwest China
Authors: Zhang Yiduo , Liu Ting , Lin Jingying , Yu Fan , Hu Zhengqiang
Published: March 2021

We investigated the vaginal flora diversity of preschool-aged (ie, 4–6-year-old) girls in southwest China.

Fourteen preschool-aged girls were enrolled in this study. The statuses and differences in their vaginal flora were evaluated by Gram staining, bacterial culturing, and sequencing analysis.

Gram staining and microbial culturing showed that the main vaginal flora of the preschool-aged girls were Gram-negative bacilli, whereas the main vaginal flora of healthy adult controls were large Gram-positive bacilli such as Lactobacillus crispatus. Shannon and Simpson indexes indicated that the bacterial diversity tended to decrease with age. The species abundance heat map showed that the vaginal microecology of the girls differed slightly at different ages but mainly comprised Pseudomonas, Methylobacterium, Sphingomona,s and Escherichia. The functional abundance heat map indicated that the bacterial functions increased with age.

The vaginal microecology of preschool-aged girls differs from that of adults. A comprehensive understanding of the vaginal flora diversity of preschool-aged girls will aid in clinically diagnosing vulvovaginitis in preschool-aged girls.
Improvement of Shen’ge formula on heart function in diastolic heart failure
Authors: Qiu Boyong , Zhao Ping , Shen Lin , Qiao Siyu , Li Guanghao , Deng Bing , Zhou Duan , Wei Yihong
Published: March 2021

Introduction:

Diastolic heart failure (DHF) is an important pathological type of heart failure, that involves multiple organ dysfunction and multiple complications. The prevalence of DHF is high, and effective treatments are lacking. Chinese herbs are an alternative therapy for DHF. Shen’ge formula (SGF) is a classical formula from which patients can benefit, but convincing evidence of its efficacy is lacking. Therefore, we designed this randomized controlled trial protocol.

Methods/design:

This randomized, double-blind, placebo-controlled clinical trial will evaluate the efficacy and safety of SGF in the treatment of DHF. A total of 130 patients with DHF will be enrolled in the trial and treated with SGF granules or placebo for 12 weeks and followed up for 12 weeks. The primary outcome measurement will be to changes in plasma N-terminal brain natriuretic peptide precursor before versus after treatment, while the second primary outcome measurement will be changes in heart function before versus after treatment and the 12-week follow-up period. It will also include echocardiography, a cardiopulmonary exercise test, cardiac function grading, traditional Chinese medicine syndrome score, and the Minnesota Heart Failure Quality of Life Scale. Adverse events will be evaluated throughout the trial.

Discussion:

The results of this trial will demonstrate whether SGF could alleviate symptoms, improve cardiac function, reduce readmission rates, and improve quality of life of patients with DHF.

Trial registration:

Chinese Clinical Trial Register, ChiCTR2000036533, registered on August 24, 2020.
Heartburn in children and adolescents in the presence of functional dyspepsia and/or irritable bowel syndrome correlates with the presence of sleep disturbances, anxiety, and depression
Authors: Colombo Jennifer M. , Deacy Amanda D. , Schurman Jennifer V. , Friesen Craig A.
Published: March 2021

The aim of this study was to assess the relationship of heartburn in pediatric patients with functional dyspepsia (FD) and irritable bowel syndrome (IBS) with gastrointestinal symptoms, sleep disturbances, and psychologic distress.

The overlap in symptoms of FD, IBS, and gastroesophageal reflux disease (GERD) predicts greater symptom severity and decreased quality of life and presents opportunities for improved diagnostic classification and personalized therapeutics.A cross-sectional observational study of 260 pediatric patients with abdominal pain was conducted. Patients completed standardized questionnaires assessing clinical symptoms, sleep quality, and psychologic symptoms during routine clinical care. Questionnaire data were compared for patients reporting heartburn and not reporting heartburn using χ
2 and t tests where appropriate.

Gastrointestinal symptoms were significantly more prevalent among patients with a positive report of heartburn (vs a negative report of heartburn): pain with eating (83% vs 67%, P = .007), bloating (63% vs 44%, P = .005), acid regurgitation (47% vs 24%, P ≤ .001), and chest pain (45% vs 20%, P ≤ .001). Likewise, initiating and maintaining sleep (P = .007), arousal/nightmares (P = .046), sleep-wake transition (P = .001), hyperhidrosis during sleep (P = .016), and anxiety (P = .001) and depression (P = .0018) were also significantly increased in patients who reported heartburn versus patients who did not report heartburn.

Patients with a positive report of heartburn, whether classified as having FD and/or IBS, had increased gastrointestinal symptoms, sleep disturbances, anxiety, and depression than patients with a negative report of heartburn. A better understanding of these associations may allow for personalized treatment for youth with abdominal pain and heartburn as a primary symptom.