bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes in medical research trends of North Korea after economic sanctions
Authors: Yoon Hai-Jeon , Woo Seon Hee , Kim Daehee , Um Ju Hyun , Park Sae Hyun , Seo Ah Ram
Published: July 2019

Background:

In the 1980s, North Korea established a socialist health care system. However, following the food crisis and the economic sanctions, it is estimated that North Korea's health care system has experienced continuous deterioration. Thus, in the present study, we estimated the current medical research trends of North Korea through an analysis of the medical journal Korean Medicine, published in North Korea.

Methods:

We analyzed the studies in Korean Medicine, which is the only North Korean medical journal accessible to foreigners with more than 30 years of data available, based on PRISMA guidelines. We analyzed the issues of the journal published for a total of 7 years, from 1985 onwards at 5-year intervals until 2015. To evaluate changes in the North Korean medical research trends, we compared and analyzed the issues published before and after the implementation of economic sanctions against North Korea.

Results:

In this study, we analyzed 775 articles of Korean Medicine. Following economic sanctions, the number of publications on approved services (conventional therapy and diagnosis)-related articles was decreased. In contrast, the articles related to non-conventional therapy increased sharply in number. This showed a similar pattern to North Korean medical research trends seen during the food crisis of 1995 to 1997.

Conclusions:

After placement of economic sanctions on North Korea, North Korean medical research trends changed significantly. These could be indirectly estimated results suggesting that recently, the North Korean health care system had deteriorated, similarly to in the food crisis of 1995 to 1997.
bbFISH-ing in the sonication fluid
Authors: Birlutiu Rares Mircea , Birlutiu Victoria , Cismasiu Razvan Silviu , Mihalache Manuela
Published: July 2019

By 2030, the annual number of combined total hip and knee arthroplasty is estimated to reach 3.5 to 4 million in the US alone. In the context of a constant increase of the number of primary and revision total hip and knee arthroplasty, an increased risk of complication is expected. Prosthetic joint infections (PJIs) represent major cause of healthcare expenditure and morbidity. PJI still remain the most common and feared arthroplasty complication. A rapid and correct diagnosis of infection is decisive for a correct therapeutical management. In this setting, the Academic Emergency Hospital Sibiu adopted and implemented, with the beginning of September 2016, a new strategy for the diagnosis of PJIs strategy that uses sonication and beacon-based fluorescent in situ hybridization (bbFISH) technology.

Until November 2017, 40 patients (40 retrieved implants) were enrolled in the study. Sonication fluid (SF) was collected after sonication of the implants, and samples were harvested on aerobic and anaerobic culture media. A bbFISH was used as a rapid method of bacteria detection.

16 patients were diagnosed with PJIs (all 16 patients presented a positive culture of the SF). Comparing bbFISH with culture, 11 samples tested true-positive. As the kit doesn’t contain probes for Pseudomonas fluorescens or Ralstonia pickettii, 4 strains of R pickettii and 1 strain of P fluorescens that was associated with Staphylococcus epidermidis were not detected.

Bacteria culture of SF remains the gold standard. bbFISH holds promise to be a diagnostic tool for rapid identifying of PJIs. The bbFISH assay needs to be optimized for the detection of bacterial strains that are relevant for the PJIs field.
Anterior tibial artery occlusion post total knee arthroplasty
Authors: Li Xin , Song Yang , Wang Jincheng
Published: July 2019

Rationale:

Total knee arthroplasty (TKA) is a globally well-accepted surgery because of its good outcome and safety. Although TKA-associated arterial injuries occur, postoperative anterior tibial artery (ATA) occlusion has not been reported yet. Herein, we present a case of ATA occlusion after TKA.

Patient concerns:

A 42-year-old man with a 6-year history of right knee pain after right patella fracture treated with open reduction was referred to our clinic. Valgus and contracture deformities were detected in the right knee. Severe osteoarthritis (OA) in the right knee and multiple osteochondromas were observed on radiography.

Diagnosis:

On the basis of clinical and imaging findings, the patient was diagnosed with OA and multiple osteochondromas.

Interventions:

TKA was performed in the right knee and the osteochondromas were resected. ATA occlusion was found postoperatively and was treated conservatively.

Outcomes:

Although the right ATA occlusion did not resolve, the patient recovered well postoperatively, with pain relief and recovery of right knee range of motion.

Lessons:

The clinical outcome in a case of ATA occlusion after TKA demonstrates that conservative treatment could be appropriate in this context.
Antibiotic use in cirrhotic children with acute upper gastrointestinal bleeding
Authors: Castillo Lina , Prachuapthunyachart Sittichoke , Hall Mel , Shelby Shaija , Quiros-Tejeira Ruben E. , Vo Hanh D.
Published: July 2019

Prior studies have demonstrated positive impacts of antibiotic use on reducing mortality, rebleeding events, and length of hospitalization in adult cirrhotic patients with acute upper gastrointestinal bleeding (UGIB). We aimed to investigate the use of antibiotics in cirrhotic children with acute UGIB and its impact on patient outcomes.

This was a retrospective study using the Pediatric Health Information System database. Cirrhotic patients aged 0 to 18 years with acute UGIB, admitted between October 2005 and September 2015, were identified based on ICD-9 codes. Patients with no documented endoscopy during admission were excluded.

Forty-four (23 females) cirrhotic children were eligible for data analysis. The median patient age was 6 years. Etiology of acute UGIB included esophageal varices (n = 37), non-variceal bleeding (n = 4), and both (n = 3). A significant proportion of cirrhotic children with acute UGIB (n = 30, 68%) were given intravenous antibiotics within 48 hours of admission. Among children who did not develop bacteremia, 68% received antibiotics vs. 32% who did not (P = .6). The rate of readmission within 30 days of discharge was 7% in patients with antibiotics vs. 21% in those without antibiotics (P = .3).

This study suggested that antibiotic use within 48 hours of admission in cirrhotic children with acute UGIB might have a positive impact on the percentage of children free of bacteremia and the readmission rate. A prospective study should investigate whether prophylactic antibiotics should be targeted only to a subgroup of cirrhotic children with acute UGIB who are particularly at high risk for bacterial infection.
Effects of multiple training modalities in the elderly with subjective memory complaints
Authors: Hsieh Sun-Wung , Hsiao Shih-Fen , Liaw Lih-Jiun , Huang Ling-Chun , Yang Yuan-Han
Published: July 2019

Background:

This study investigated the effects of multiple training modalities (MTM) on senior fitness and neuropsychiatric function in the elderly with subjective memory complaints (SMC).

Methods:

This study was conducted in 24 elderly subjects with Clinical Dementia Rating (CDR) score of 0 and instrument of ascertainment of dementia 8 (AD8) score of <2. The participants were classified into SMC (n = 7) and non-SMC (n = 17).

All were assigned to receive multiple training modalities (1 hour for each training: physical fitness activities, calligraphy or drawing, and meditation) twice a week over a 16-week period.

A series of senior fitness test, and neuropsychiatric tests, namely the Traditional Chinese version Mini-Mental Status Examination (MMSE), Cognitive Assessment Screening Instrument (CASI), and the Center for Epidemiologic Studies Depression Scale (CESD), were conducted before and after the intervention. We compared the differences of pre/posttest-MTM and SMC/non-SMC in senior fitness and the neuropsychological tests.

Results:

There was no significant difference between SMC and non-SMC groups in demographic characteristics. MTM showed significant improvement in senior fitness and CESD, but not in CASI and MMSE. Significant change in recent memory subscale of CASI was only observed in SMC group, whereas improvement of partial senior fitness and CESD were observed in both groups.

Conclusion:

MTM had effects in enhancing senior fitness and improving depressive syndromes in the elderly. MTM contributed to greater improvement in recent memory function in the SMC group than in the non-SMC group.
BNP as a potential biomarker for cardiac damage of breast cancer after radiotherapy: a meta-analysis
Authors: Zhang Cheng , Shi Dan , Yang Ping
Published: July 2019

Background:

To analyze whether BNP could be a potential biomarker for cardiac damage of breast cancer after radiotherapy.

Methods:

PubMed, Web of Science, ProQuest and Medline were searched using the key words “breast cancer” (“breast tumor”, “breast neoplasm”, or “breast carcinoma”), “brain natriuretic peptide” (or BNP) and “radiotherapy” (or “radiation therapy”). Four articles were selected and analyzed using the STATA 12.0 software package. The standard mean difference (SMD) and its standard error for BNP were calculated to assess the relationship between BNP and radiotherapy for breast cancer patients.

Results:

In total, 172 patients with breast cancer were identified. The pooled SMD was -0.233 (95% CI −1.113, −0.057). The pooled estimated SMD for all studies showed obvious significant difference (z = 3.99, P = .000). There was no publication bias.

Conclusions:

This meta-analysis suggested that BNP could be a biomarker of cardiac damage at high heart absorbed doses according to radiotherapy, especially for left breast cancer patients.
Occurrence of second primary malignancies in patients with neuroendocrine tumors of the digestive tract
Authors: Pirozzi Angelo , Riccardi Ferdinando , Arpino Grazia , Mocerino Carmela , Campione Severo , Molino Carlo , Cartenì Giacomo
Published: July 2019

Rationale:

There is an association between the presence of neuroendocrine neoplasms and incremented risk to develop second primary malignancies. This risk is estimated to be 17%. The most common secondary neoplasms were found in the Gastrointestinal and Genitourinary tracts.

Patient concerns:

A 74-year-old Caucasian patient with melaena came to our observation in June 2015. The Esophago-gastro-duodenoscopy exam found a polypoid formation in the duodenal bulb. Histopathological examination showed a well-differentiated neuroendocrine neoplasm (G1).

Diagnosis:

During the follow up for the neuroendocrine neoplasm, a CT scan was performed in August 2016 describing infiltration of the right renal sinus and the third proximal ureter segment with heterogeneous enhancement of vascular structure. An US-guided biopsy was conclusive for a Diffuse Large B Cell Lymphoma. In October 2016, a colonoscopy showed a neoplastic lesion at 20 cm from the anal orifice. The Histology exam was positive for an adenocarcinoma with a desmoplastic stroma infiltration.

Interventions:

In November 2016, the patient underwent a left hemicolectomy: the pathologic staging described a G2 adenocarcinoma pT3N1b. In May 2018, the Octreotide scan was negative. In the same month, the patient started a treatment based on 6 cycles of Rituximab, Oxaliplatin, and Capecitabine due to the persistence of lymphomatous disease and hepatic metastases. In July 2018, other 3 cycles of the same treatment were scheduled.

Outcomes:

In January 2019, due to an increase in liver metastases’ size, it was decided to start a new regimen for the colon cancer with FOLFIRI+Cetuximab. The patient is still in treatment with this regimen in April 2019.

Lessons:

The risk of a second primary tumor is increased among patients older than 70. Therefore, it is necessary to follow them using total body CT scan and endoscopic techniques of gastrointestinal and genitourinary tracts, not only for the evaluation of the neuroendocrine tumor but also for the higher risk to develop other neoplastic diseases.
Platelet distribution width, platelet count, and plateletcrit in diabetic retinopathy
Authors: Ji Shuaifei , Ning Xiaona , Zhang Babo , Shi Heng , Liu Zheng , Zhang Jie
Published: July 2019

Background:

Screening and diagnosis of diabetic retinopathy (DR) mainly depends on fundus examination, which is not an intuitive and simple screening or diagnostic method. Recently, the relationship between platelet parameters and DR has become a hot topic. Whether platelet parameters have clinical value in DR is controversial.

Methods:

Literature was retrieved by formal search of electronic databases (PubMed, Embase, Cochrane library, Scopus, and CNKI) and by hand searching of reference lists of related articles from the beginning of building database to December 2017. Review manager 5.3 was utilized to deal with statistical data. This study was registered at International Prospective Register of Systematic Reviews (number: CRD42018093773).

Results:

This study included 1720 DR patients, 1477 type 2 diabetic mellitus (T2DM) without DR patients and 1456 health controls in 21 eligible studies. We found there was significant increase of platelet distribution width (PDW) level in the comparison of DR versus Control group (standard mean difference [SMD] [95% confidence interval [CI]] = 1.04 [0.68, 1.40]) and DR versus T2DM without DR group (SMD [95% CI] = 0.68 [0.40, 0.95]). For platelet count (PLT), it showed obvious decrease in the comparison of DR versus T2DM without DR group (SMD [95% CI] = −0.26 [−0.49, −0.03]) and no difference in comparison of DR versus Control (SMD [95% CI] = −0.26 [−0.51, −0.00]). Subgroup analysis showed that significant result of PDW level appeared in China and Turkey in all comparisons, while similar results of PLT only in China. In addition, PDW level was different in various DR-subtypes, obvious high level in proliferation DR.

Conclusions:

We concluded that the guiding significance of PDW and PLT in diagnosis and monitor of DR, and especially, application of PDW to PDR management may have potential sense.
Impaired emotional memory and decision-making following primary insomnia
Authors: Chunhua Xi , Jiacui Ding , Xue Li , Kai Wang
Published: July 2019

Previous studies have indicated that sleep plays an important role in emotional memory and decision-making. However, very little attention has been given to emotional memory and decision-making in patients with primary insomnia (PI). We investigated whether PI influences the accuracy of emotional memory and social decision-making.

We examined 25 patients with PI and 20 healthy controls (HC) using an emotional picture memory task and the Iowa Gambling Task (IGT). In the emotional picture memory task, participants completed two testing sessions: an emotional picture evaluation and a delayed recognition phase. During the emotional picture evaluation phase, participants were presented with 48 pictures with different valence (16 positive, 16 neutral, and 16 negative), which they had to evaluate for emotional valence and arousal. During the recognition phase, participants were asked to make a yes/no memory assessment of a set of pictures, which contained the 48 target pictures intermingled with 48 non-target pictures.

The performance of the participants with PI was the same as that of the HC in the emotional picture evaluation task. However, the PI group showed worse recognition of the positive and neutral pictures than did the HC group, although recognition of negative pictures was similar in the 2 groups. In the IGT, participants in the PI group more frequently selected cards from the risky decks as the game progressed and selected more disadvantageous cards than did participants in the HC group after the first block.

Our findings suggest that insomnia had different effects on memory, depending on the valence of the memory. Specifically, memory performance was impaired for positive and neutral items, but the recognition of negative stimuli seemed to be more resistant to the effects of insomnia. Our results also suggest that decision-making, which is known to be mediated by the ventromedial prefrontal cortex, including decision-making under conditions of uncertainty, may be vulnerable in PI.
Microhardness distribution of the tibial diaphysis and test site selection for reference point indentation technique
Authors: Wang Jianzhao , Yin Bing , Liu Guobin , Li Sheng , Zhang Xiaojuan , Hu Zusheng , Wu Weiwei , Zhang Yingze
Published: July 2019

Indentation hardness test is a good in vitro method of bone quality assessment. The purpose of this study is to explore the distribution characteristics of bone tissue microhardness in tibial diaphysis and provide theoretical support for the test site selection of the reference point indentation technique.

Three fresh right tibias were obtained from 3 cadaver donors. The tibial diaphysis was evenly divided into 6 sections. Bone specimens with a thickness of 3 mm were cut from each part. After appropriate management, micro-indentation tests were performed in various regions of the specimens to acquire the microhardness values of the tibial diaphysis. Statistical analysis was performed by randomized block design variance analysis to study the distribution characteristics of bone microhardness.

72 regions were selected for 360 effective indentations. We found that the bone microhardness is inhomogeneous in tibia diaphysis. Mean hardness value of the anterior, medial, posterior, lateral region of tibia diaphysis was 45.58 ± 4.39 Vickers hardness (HV), 52.33 ± 3.93 HV, 54.00 ± 4.21 HV, 52.89 ± 4.44 HV, respectively. The anterior cortex exhibits lower microhardness value than the other regions (P < .001). Within the same region, microhardness varies significantly with positions in the tibial diaphysis. The variations in indentation hardness are bound to have a significant impact on the comparability of different reference point indentation (RPI) studies.

The results of this study indicated the regional microhardness difference in the human tibia diaphysis. The microhardness of different planes in the same region is also inconsistent. Inhomogeneous distribution of indentation microhardness would have considerable influence in the test site selection of RPI technique. The data collected in our study would contribute to the design of highly precise 3D printing implants and bionic bones with gradient elastic modulus.
Efficacy of travoprost for the treatment of patients with glaucoma
Authors: Zhang Xiu-Li , Qin Li
Published: July 2019

Background:

This study will evaluate the efficacy of travoprost for patients with glaucoma systematically.

Methods:

A comprehensive literature search will be carried from following literature sources from inception to the present: Cochrane Library, MEDLINE, EMBASE, Web of Science, Google scholar, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. We will only consider randomized controlled trials on assessing the efficacy and safety of travoprost for glaucoma for inclusion. We will use Cochrane risk of bias tool for the methodological quality assessment for each qualified study. If it is possible, we will pool the outcome data, and will perform meta-analysis.

Results:

This study will systematically evaluate the efficacy and safety of travoprost for glaucoma. Primary outcomes include intraocular pressure (IOP), mean IOP, and mean reduction of IOP. Secondary outcomes consist of diastolic ocular perfusion pressure, central corneal thickness, and quality of life, as measured by 36-Item Short Form Health Survey, and treatment-related adverse events included hyperemia, eye pain, and eye pruritus.

Conclusion:

The findings of the present study will summarize the updated evidence of travoprost for patients with glaucoma.

PROSPERO registration number: PROSPERO CRD42019126956.
Association of atopic dermatitis with obesity via a multi-omics approach
Authors: Son Mi Ju , Yang Geum-Jin , Jo Eun-Heui , Shim Yu-Hwa , Kang Su-Jin , Hong Ji-Eun , Kim Young-Eun , Lee Jung-Eun , Chun Jaemoo , Park Seonghwan , Jung Jeeyoun , Park Min-Cheol
Published: July 2019

Introduction:

Several studies have found that obesity is associated with atopic dermatitis (AD); however, the mechanisms underlying the association are largely unknown. This study aims to assess the association of AD with obesity in the Korean population and verify its mechanism via a multi-omics analysis.

Methods and analysis:

A case–control study will be conducted in the Republic of Korea. A total of 80 subjects, aged 4 to 12 years, matched for age and sex, with body mass index at or above the 85th percentile or at or below the 25th percentile, will be included. Subjects will be assigned to the following 4 groups: obese/overweight with AD, normal/underweight with AD, obese/overweight control, and normal/underweight control. Serum metabolome and immune biomarkers, as well as fecal metabolome and microbiome biomarkers, will be analyzed. Serum eosinophil cationic protein, total serum Immunoglobulin E (IgE), and specific IgE will be analyzed to assess allergic tendency. The SCORing of AD index, the children's dermatology life quality index, body composition analysis, and the Korean gastrointestinal symptom rating scale will be obtained to assess the disease status and severity of the subjects.

Discussion:

The findings of this study are expected to provide evidence of an association between AD and obesity via a gut microbiome-metabolome-immune mechanism. Therefore, it may improve future management strategies for AD.

Trial registration:

This study has been registered at the Korean National Clinical Trial Registry, Clinical Research Information Service (KCT0003630).
Correlation analysis between mechanical power, transforming growth factor-β1, and connective tissue growth factor levels in acute respiratory distress syndrome patients and their clinical significance in pulmonary structural remodeling
Authors: Xie Yongpeng , Wang Yangli , Liu Kexi , Li Xiaomin
Published: July 2019

Background:

To identify the clinical correlations between mechanical power and transforming growth factor-β1 (TGF-β1) and connective tissue growth factor (CTGF) in acute respiratory distress syndrome (ARDS) patients, their clinical significance in pulmonary structural remodeling in ARDS patients was investigated.

Methods:

Ninety-five patients with moderate or severe ARDS, who required mechanical ventilation therapy, were randomly selected among hospitalized patients from January 2017 to February 2019. Their mechanical power was monitored and recorded, the TGF-β1 and CTGF levels were detected by enzyme-linked immunosorbent assay (ELISA), their relevance was analyzed, and the relationship between mechanical power and 28-day survival rate was investigated. According to the high-resolution computed tomography (HRCT) examination, the patients were divided into an ARDS group and an ARDS pulmonary fibrosis (ARDS-PF) group. The differences in mechanical power, TGF-β1, and CTGF between the 2 groups were compared, and the significance of TGF-β1 and CTGF in the diagnosis of ARDS pulmonary interstitial fibrosis were evaluated.

Results:

A significant positive correlation between mechanical power and serum TGF-β1 and CTGF in patients with ARDS was found and the correlation coefficients were 0.424 and 0.581, respectively. The difference between mechanical power and 28-day survival rate was statistically significant (P < .05), while the area under the receiver operating characteristic curves of TGF-β1 and CTGF for the diagnosis of ARDS pulmonary fibrosis was 0.838 and 0.884, respectively (P < .05).

Conclusion:

A significant correlation between mechanical power and serum fibrosis biomarkers TGF-β1 and CTGF in ARDS patients was found, and its level was related to the survival prognosis of patients. Mechanical power, TGF-β1, and CTGF were clinically evaluated for the assessment of lung structural remodeling, such as ARDS pulmonary fibrosis. This study has particular significance to the early prevention of ventilator-induced lung injury and pulmonary fibrosis in patients with ARDS receiving mechanical ventilation.
Therapeutic adherence and coping strategies in patients with multiple sclerosis
Authors: Corallo Francesco , Bonanno Lilla , Di Cara Marcella , Rifici Carmela , Sessa Edoardo , D’Aleo GianGaetano , Lo Buono Viviana , Venuti Giuseppe , Bramanti Placido , Marino Silvia
Published: July 2019

Multiple sclerosis (MS) is a chronic demyelinating autoimmune disorder affecting the central nervous system and targets the myelin sheaths around nerves. Local problem: Medical advances have enabled patients to lead a better quality of life (QoL) than before. However, because of its chronicity and unpredictability, it remains a very challenging disease for both patients and their families, as it involves the continued use of medication to slow down progression. The aim of this study is to assess drug adherence in patients with MS. In particular, we will examine how the way drugs are administered (oral or injective) affects compliance with therapy, including the correlation with coping strategies and the QoL of each patient.

We enrolled 88 patients with MS, divided into 2 groups according to therapy (injective or oral). The Morisky Medication Adherence scale was administered to evaluate adherence to treatment, the MS QoL 54 to estimate mental and physical health, and Brief coping orientation to problems experienced Inventory for coping strategies.

The results showed that in both groups the patients showed a good therapeutic alliance and trust in treatment. In particular, a correlation has been found between therapeutic adherence, adaptive coping strategies, and mental health when drug therapy is administered by injection. In conclusion, this result suggests that for patients receiving injection treatment to have greater adherence to therapy, appropriate coping strategies and good mental health must be developed in order for patients receiving injection therapy to have greater adherence to therapy; they need to develop appropriate coping strategies and good mental health to address this mode of administration successfully.
Nonviral infection-related lymphocytopenia for the prediction of adult sepsis and its persistence indicates a higher mortality
Authors: Jiang Jie , Du Huimin , Su Yanxin , Li Xin , Zhang Jing , Chen Meihao , Ren Guosheng , He Faming , Niu Bailin
Published: July 2019

Sepsis is a life-threatening disease that affects 30 million people worldwide each year. Despite the rapid advances in medical technology and organ support systems, it is still difficult to reduce the mortality rate. Early and rapid diagnosis is crucial to improve the treatment outcome. The aim of this study was to investigate the prediction efficiency of lymphopenia and other clinical markers, such as white blood cell (WBC), neutrophil count (N#), procalcitonin (PCT), and arterial lactic acid (Lac) in the diagnosis and prognosis assessment for adult patients with nonviral infection-related sepsis.

A total of 77 sepsis- and 23 non-sepsis adult patients were enrolled in this study from September 2016 to September 2018. Daily lymphocyte count (Lym) of the patients was calculated until discharge or death. The diagnostic performance of the Lym and other biomarkers were compared using the area under the receiver operating characteristic curve (ROC) value.

The level of Lym was decreased significantly in the sepsis group. Lym had a high diagnostic performance for sepsis, with an area under the curve (AUC) value of 0.971 (95% CI = 0.916–0.994). The diagnostic efficacy of Lym was more significant than WBC, N#, and PCT (P < .001). The results showed that the 28-day mortality rate of patients with continuous Lym <0.76 × 109/L was 39.66%, which significantly higher than patients without persistent lymphocytopenia.

Lym is a promising, low cost, fast, and easily available biomarker for the diagnosis of sepsis. When nonviral infection is suspected and lymphocytopenia level is lower than the optimal cut-off (0.76 × 109/L) value, high vigilance is required for sepsis. The persistence with the lymphocytopenia cut-off value (<0.76 × 109/L) >3 days indicates a higher 28-day mortality rate.
Selection of percutaneous coronary intervention in elderly patients with acute myocardial infarction in tertiary hospital
Authors: Chen Liwei , Han Ling , Luo Jingguang
Published: July 2019

To investigate the status of percutaneous coronary intervention (PCI) in elderly patients with acute myocardial infarction (AMI) and analyze the reasons for not receiving PCI.

A cohort of 387 consecutive hospitalized AMI patients aged ≥80 years were recruited from 2005 to 2014. Their clinical data were collected and analyzed.

Among 387 elderly patients with AMI (190 men and 197 women, mean age 84.1 ± 3.9 years), there were 171 patients with ST-elevation myocardial infarction (STEMI) and 216 patients with non-ST-elevation myocardial infarction (NSTEMI). The emergency and elective PCI treatment rate was 40.6% and 12.1%, respectively, in patients with STEMI; and 1% and 18%, respectively, in patients with NSTEMI. PCI treatment rate of elderly AMI patients enrolled after 2009 showed no significant difference compared to that before 2009 (P > .05). The in-hospital mortality decreased significantly in PCI treatment group. After adjustment for age, sex, and other factors, PCI treatment was identified as the independent protective factors for in-hospital mortality (odds ratio = 0.323, 95% confidence interval 0.147–0.710, P = .005). The main influence factors for not receiving PCI treatment were hemorrhage, severe renal dysfunction, infection, or severe anemia-associated complications, whereas delayed treatment was the important reason for patients not undergoing emergency PCI.

PCI treatment is the independent protective factor for in-hospital mortality of elderly patients with AMI. Due to various complications, PCI treatment rate is still low in elderly patients with AMI and has not been improved recently. Paying attention to performing PCI treatment for elderly patients with AMI has positive significance.
Is pharmacological anticoagulant prophylaxis necessary for adolescent idiopathic scoliosis surgery?
Authors: Kochai Alauddin , Cicekli Ozgur , Bayam Levent , Türker Mehmet , Sariyilmaz Kerim , Erkorkmaz Ünal
Published: July 2019

We report the outcomes of mechanical prophylaxis and chemoprophylaxis in patients who underwent elective surgery for idiopathic adolescent scoliosis (AIS).

We retrospectively studied the patients who underwent posterior spinal instrumentation for AIS. The patients were divided into three groups: Group A low-molecular-weight heparin (LMWH) started at 8 hours after surgery; Group B LMWH started at 24 hr after surgery; Group C did not receive chemoprophylaxis. The data about wound oozing, need for transfusion, preoperative and postoperative hemoglobin level, length of stay in hospital, interval from the surgery to removal of closed suction drainage tube, postoperative blood loss from closed suction drain, deep venous thrombosis (DVT), and pulmonary embolism (PE) were investigated.

The mean age and Lenke classification for all the groups were similar. No DVT or PE was detected in any group. The mean blood loss from the drain was higher in Group A (400 mL) and Group B (450 mL) when compared to Group C (150 mL) (P 
= .001). There were more wound oozing in Groups A (5) and B (6) than in Group C (3) (P 
= .585). Three patients in Group B, 3 patients in Group A, and no patient in Group C had superficial infections. However, there was no statistical difference between the groups (P 
= .182). Postoperative hospital stay was significantly longer in Groups A (6 days) and B (6 days) then in Group C (5 days) (P 
= .001).

Our current study claims that chemoprophylaxis is not necessary for the patients without risk factors after AIS surgery. Early mobilization and mechanoprophylaxis represents adequate prophylaxis in addition to pain management and well hydration in patients’ routine treatment. The complications of chemoprophylaxis are not correlated to the initiation time of prophylaxis.
Comparison of the fenestrated and non-fenestrated Fontan procedures
Authors: Li Dongxu , Li Mengsi , Zhou Xu , An Qi
Published: July 2019

Background:

The benefits of fenestration for patients undergoing Fontan procedure seem controversial at early and late postoperative stages.

Objective:

We aimed to compare the outcomes between the fenestrated and non-fenestrated Fontan procedures.

Methods:

Studies comparing the fenestrated and non-fenestrated Fontan procedures were identified by searching the PubMed, EMBASE, and Cochrane Library databases until July 2018. The assessed variables included postoperative oxygen saturation (SaO2), pulmonary artery pressure, mortality, cardiopulmonary bypass (CPB) time, ventilation time, intensive care unit stay, hospital stay, chest tube duration, protein-losing enteropathy, arrhythmia, and other follow-up outcomes including reintervention, stroke/thrombosis, and peak oxygen consumption. A random-effect/fixed-effect model was used to summarize the estimates of the mean difference (MD)/odds ratio (OR) with 95% confidence interval (CI). Subgroup analysis stratified by early and late outcomes was performed.

Results:

A total of 1929 Fontan patients from 14 studies were included. The early postoperative SaO2 was lower with fenestration than without fenestration (MD −2.52, 95% CI −4.16 to −0.87, P <.05); however, the late postoperative SaO2 showed no difference between the 2 approaches. The CPB time was shorter without fenestration than with fenestration (MD 10.72, 95% CI 2.54–18.9, P <.05); however, the incidence of arrhythmia was lower with fenestration than without fenestration (OR 0.43, 95% CI 0.25–0.75, P <.05). Other variables showed no significant differences between the 2 approaches in Fontan patients.

Conclusion:

Fenestration appears to result in a lower incidence of arrhythmia but with a longer CPB time and lower early SaO2. Other outcomes are comparable between the 2 approaches.
The risk factors of nonunion after intramedullary nailing fixation of femur shaft fracture in middle age patients
Authors: Wu Kuan-Jou , Li Shu-Hao , Yeh Kuang-Ting , Chen Ing-Ho , Lee Ru-Ping , Yu Tzai-Chiu , Peng Cheng-Huan , Liu Kuan-Lin , Yao Ting-Kuo , Wang Jen-Hung , Wu Wen-Tien
Published: July 2019

Although the optimal treatment for femur shaft fracture is intramedullary nailing fixation, nonunion still occurs. We determined the oligotrophic nonunion rate among femur fractures managed operatively and identified risk factors for reoperation. This was a retrospective clinical study. The data of the patients between 40 and 70 years old with diaphyseal femur fracture who have received reamed and interlocked intramedullary nailing fixation in our hospital from February 2014 to April 2018 were collected. They were followed at regular intervals for at least 1 year after the operation. The primary outcome was nonunion of the fracture site that required reoperation in accordance with the radiographic union scale for tibial shaft fracture (RUST), which is a reasonable score system for lower limb diaphyseal fracture. Three of them were hypertrophic nonunion (1.9%) and the other 13 cases were oligotrophic nonunion (8.6%) at postoperative 12 months follow-up. All of the postoperative plain films showed adequate reduction quality. The three hypertrophic nonunion cases were all obese male with fracture site comminution. Fracture at the proximal third junction, hypertension (HTN) and diabetes mellitus (DM) was significantly associated with oligotrophic nonunion of the fracture site from logistic regression analysis. The mean RUST score 3 months after the operation was not significantly different between the union group and nonunion group but was significantly lower 6 months after the operation in the nonunion group. In conclusion, intramedullary nailing of the femur shaft fractures was associated with a low risk of nonunion at the 1-year follow-up in the middle age group. Those with comorbidity such as obese, HTN, and DM, with fracture site at the proximal third junction or comminution should be followed up closely and rehabilitation with cause aggressively. Radiographic scale as the RUST score at postoperative 6 months could be used to predict this complication.
Prophylactic octreotide does not reduce the incidence of postoperative chylothorax following lobectomy
Authors: Zhang Chu , Zhang Hui , Wu Wenbin , Liu Dong , Yang Dunpeng , Zhang Miao , Lu Cuntao
Published: July 2019

Chylothorax after lobectomy is common, lacking reliable preventive measures. Octreotide is widely used for treatment of chyle leakage, but its role in preventing chylothorax has not been estimated. The aim of this study was to evaluate whether prophylactic octreotide could reduce the incidence of postoperative chylothorax.

Patients who underwent lobectomy for lung cancer from January 2016 to September 2018 were retrospectively reviewed. The cases in prophylactic group received octreotide 1 day before the surgery until removal of chest tubes, while those in the control group did not use it unless the diagnosis of chylothorax.

A total of 379 patients were enrolled, with 190 patients in control and 189 cases in prophylactic group. Octreotide was well tolerated in patients who received this agent. No 30-day mortality was indicated. Seven cases in control (3.7%, 7/190) and 3 cases in prophylactic group (1.6%, 3/189) with chylothorax were observed (P = .337). The patients in prophylactic group showed shorter duration of chest drainage ([3.6 ± 1.6] days vs [4.1 ± 2.0] days, P = .006) and reduced drainage volume ([441.8 ± 271.1] mL vs [638.7 ± 463.3] mL, P < .001). In addition, they showed similar stations and numbers of dissected lymph nodes, surgery-related complications, and postoperative hospital stay. Besides, 11 (5.8%, 11/190) patients in control and 6 (3.2%, 6/189) cases in the prophylactic group were readmitted for pleural effusion needing reinsertion of chest tubes (P = .321). Moreover, multivariable logistic analysis showed that induction therapy (odds ratio [OR] =12.03; 95% confidence interval [CI] 3.15–46.03, P < .001) was a risk factor, while high-volume experience of the surgeon (OR = 0.23; 95% CI 0.06–0.97, P = .045) was a preventive factor of surgery-related chylothorax. Additionally, prophylactic octreotide (OR = 0.18; 95% CI 0.11–0.28, P < .001) and perioperative low-fat diet (OR = 0.46; 95% CI 0.29–0.73, P = .001) were negatively associated with the drainage volume of pleural effusion. Furthermore, high-volume experience of the surgeon (OR = 6.03; 95% CI 1.30–27.85, P = .021) and induction therapy (OR = 8.87; 95% CI 2.97–26.48, P < .001) were risk factors of unplanned readmission.

Prophylactic octreotide does not reduce the incidence of postoperative chylothorax or unplanned readmission following anatomic lobectomy. The routine application of octreotide should not be recommended. High-quality trials are required to validate these findings.
Pharmacological interventions for preventing postoperative nausea and vomiting in adult patients undergoing ambulatory surgery
Authors: Choi Geun Joo , Lee Je Jin , Seong Hee-Kyeong , Kang Hyun
Published: July 2019

Background:

We aimed to conduct a systematic review and network meta-analysis (NMA) of published studies to comprehensively compare and rank the efficacy and safety of pharmacological interventions for preventing nausea and vomiting after ambulatory surgery.

Methods:

A systematic and comprehensive search will be performed using the MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and Google Scholar databases, beginning from their inceptions to July and August 2019. Only randomized clinical trials on the efficacy and safety of pharmacologic interventions for preventing nausea and vomiting after ambulatory surgery will be included.

The primary endpoints will be the incidences of postoperative nausea (PON), postoperative vomiting (POV), and postoperative nausea and vomiting (PONV) in the following recovery phases: before discharge (recovery phase I and II), after discharge but within 24 hours following surgery, and after discharge, after the initial 24-hour postoperative period.

The incidences of delayed post-discharge nausea, post-discharge vomiting, and post-discharge nausea and vomiting, which occur after the initial 24-hour postoperative period, severities of PON, POV, and PONV, use of rescue antiemetics, and the incidence of complete response, as well as safety issues, including complications, such as headache, dizziness, and drowsiness, will be also assessed.

We will conduct both pairwise meta-analysis and NMA. We will use surface under the cumulative ranking curve values and rankograms to present the hierarchy of the pharmacologic interventions. A comparison-adjusted funnel plot will be used to assess the presence of small-study effects. The quality of the studies included will be assessed using the risk of bias tool 2.0. All statistical analyses will be performed using Stata SE, version 15.0 (StataCorp, College Station, TX).

Results:

The results of this systematic review and NMA will be published in a peer-reviewed journal.

Conclusion:

This systematic review and NMA will provide comprehensive and convincing evidence summarizing the efficacy and safety of pharmacological interventions for preventing nausea and vomiting after ambulatory surgery.

Trial registration number:

CRD42018103068.
Changes in Hospital Referral Patterns to Skilled Nursing Facilities Under the Hospital Readmissions Reduction Program
Authors: Kim K. Lucy , Li Li , Kuang Meng , Horwitz Leora I. , Desai Sunita M.
Published: July 2019

Background:

The Hospital Readmissions Reduction Program (HRRP) penalizes hospitals for higher-than-expected readmission rates. Almost 20% of Medicare fee-for-service (FFS) patients receive postacute care in skilled nursing facilities (SNFs) after hospitalization. SNF patients have high readmission rates.

Objective:

The objective of this study was to investigate the association between changes in hospital referral patterns to SNFs and HRRP penalty pressure.

Design:

We examined changes in the relationship between penalty pressure and outcomes before versus after HRRP announcement among 2698 hospitals serving 6,936,393 Medicare FFS patients admitted for target conditions: acute myocardial infarction, heart failure, or pneumonia. Hospital-level penalty pressure was the expected penalty rate in the first year of the HRRP multiplied by Medicare discharge share.

Outcomes:

Informal integration measured by the percentage of referrals to hospitals’ most referred SNF; formal integration measured by SNF acquisition; readmission-based quality index of the SNFs to which a hospital referred discharged patients; referral rate to any SNF.

Results:

Hospitals facing the median level of penalty pressure had modest differential increases of 0.3 percentage points in the proportion of referrals to the most referred SNF and a 0.006 SD increase in the average quality index of SNFs referred to. There were no statistically significant differential increases in formal acquisition of SNFs or referral rate to SNF.

Conclusions:

HRRP did not prompt substantial changes in hospital referral patterns to SNFs, although readmissions for patients referred to SNF differentially decreased more than for other patients, warranting investigation of other mechanisms underlying readmissions reduction.
Individual Nurse Productivity in Preparing Patients for Discharge Is Associated With Patient Likelihood of 30-Day Return to Hospital
Authors: Yakusheva Olga , Weiss Marianne E. , Bobay Kathleen L. , Costa Linda , Hughes Ronda G. , Hamilton Morris , Bang James , Buerhaus Peter I.
Published: July 2019

Objective:

Applied to value-based health care, the economic term “individual productivity” refers to the quality of an outcome attributable through a care process to an individual clinician. This study aimed to (1) estimate and describe the discharge preparation productivities of individual acute care nurses and (2) examine the association between the discharge preparation productivity of the discharging nurse and the patient’s likelihood of a 30-day return to hospital [readmission and emergency department (ED) visits].

Research Design:

Secondary analysis of patient-nurse data from a cluster-randomized multisite study of patient discharge readiness and readmission. Patients reported discharge readiness scores; postdischarge outcomes and other variables were extracted from electronic health records. Using the structure-process-outcomes model, we viewed patient readiness for hospital discharge as a proximal outcome of the discharge preparation process and used it to measure nurse productivity in discharge preparation. We viewed hospital return as a distal outcome sensitive to discharge preparation care. Multilevel regression analyses used a split-sample approach and adjusted for patient characteristics.

Subjects:

A total 522 nurses and 29,986 adult (18+ y) patients discharged to home from 31 geographically diverse medical-surgical units between June 15, 2015 and November 30, 2016.

Measures:

Patient discharge readiness was measured using the 8-item short form of Readiness for Hospital Discharge Scale (RHDS). A 30-day hospital return was a categorical variable for an inpatient readmission or an ED visit, versus no hospital return.

Results:

Variability in individual nurse productivity explained 9.07% of variance in patient discharge readiness scores. Nurse productivity was negatively associated with the likelihood of a readmission (−0.48 absolute percentage points, P<0.001) and an ED visit (−0.29 absolute percentage points, P=0.042).

Conclusions:

Variability in individual clinician productivity can have implications for acute care quality patient outcomes.
Trained immunity and atherosclerotic cardiovascular disease
Authors: Riksen Niels P.
Published: July 2019

Purpose of review

The two major challenges in cardiovascular medicine are to refine risk prediction and to improve pharmacological prevention and treatment. The concept of innate immune memory, which is called trained immunity, has the potential to improve clinical practice in these regards.

Recent findings

Monocytes and macrophages have the capability to develop a long-term proinflammatory and proatherogenic phenotype after brief exposure to inflammatory stimuli, such as oxidized low-density lipoprotein particles. This innate immune memory develops because of rewiring of intracellular metabolic pathways and epigenetic reprogramming of histone modifications. The persistence of circulating hyperresponsive monocytes in vivo is explained by the fact that training occurs in myeloid progenitor cells in the bone marrow. Several recent studies reported the presence of monocytes with a trained immune phenotype in patients with established atherosclerosis, and in patients with an increased risk for atherosclerosis because of dyslipoproteinemia.

In monocytes and their bone marrow progenitors, metabolic and epigenetic reprogramming can induce trained immunity, which might contribute to the persistent nonresolving inflammation that characterizes atherosclerosis. These pathways offer exciting novel drug targets to improve the prevention and treatment of cardiovascular disease.