bluuebunny/crossref_metadata_2025 huggingface dataset:
Therapies for cognitive impairment in breast cancer survivors treated with chemotherapy
Authors: Zhang Qiuhua , Gao Xiufei , Liu Shan , Yu Linghong , Zhu Jiayan , Qiu Shengliang
Published: May 2020

Objective:

The aim of this systematic review was to evaluate the effect of therapies for cognitive impairment on patients’ perceived cognitive function in breast cancer survivors with chemotherapy-related cognitive impairment.

Method:

A literature search of PubMed, Embase, and the Cochrane Library was conducted up to April 2019. Search terms included breast cancer, chemotherapy, and cognitive impairment.

Result:

Six randomized controlled trials with a total of 305 patients were included in this review. A total of 6 randomized controlled trials using various treatments (Tibetan sound meditation, donepezil, memory and attention adaptation training, aerobic exercise, acupuncture, Qigong) for chemotherapy-related cognitive impairment met the eligibility criteria and were included. This review showed that meditative interventions (Tibetan sound meditation, Qigong) and cognitive therapy (memory and attention adaptation training) may partially improve some aspects of patients’ perceived (self-reported) cognitive functioning, particularly patients’ perceived cognitive impairment and ability.

Conclusion:

In this systematic review, the results showed that meditative interventions (Tibetan sound meditation, Qigong) and cognitive therapy (memory and attention adaptation training) may be optional therapies. We hope to have more randomized controlled trials to support this result in the future.
The establishment and evaluation of a new model for the prediction of Children B-ALL based on TARGET
Authors: Gao Xiangyu , Liu Wenjun
Published: May 2020

B lymphocytic leukemia (B-ALL) is a hematopoietic malignant disease characterized by an accumulation of early B cells. This study aimed to construct a children B-ALL Nomogram prediction model based on Therapeutically Applicable Research to Generate Effective Treatments database, so as to further guide clinical diagnose and treatment.

Clinical data related to children B-ALL were collected from the TARGET database, among which, the stage II clinical data were used as the prediction model, while the stage I clinical data were utilized as the external verification model. The stage II clinical factors were analyzed through Lasso regression analysis to screen the risk factors for the construction of Nomogram prediction model. In addition, the model prediction capacity and accuracy were verified internally and externally using the ROC curve, C-index and calibration curve, respectively.

A total of 1316 B-ALL children were enrolled in this study. Lasso regression analysis revealed that, Age, Gender, WBC, CNSL, MRD29, BMR, CNS R, BCR-ABL1, BMA29, DS, and DI were the important prognostic risk factors. The C-index values of internal and external verification models were 0.870 and 0.827, respectively, revealing the ideal model discriminating capacity. Besides, the calibration curve had high contact ratio, which suggested favorable consistency between the incidence predicted by the model and the actual incidence. Moreover, the AUC values of the ROC curve were 0.858, 0.787, 0.898, and 0.867, respectively, indicating high model prediction accuracy in predicting the 3- and 5-year survival rates of children with B-ALL.The Nomogram prediction model plotted in this study exhibits favorable prediction capacity and clinical practicability for the survival rate of B-ALL children, which contributes to patients screening and clinical intervention.
Patterns and determinants of short and long birth intervals among women in selected sub-Saharan African countries
Authors: Ajayi Anthony Idowu , Somefun Oluwaseyi Dolapo
Published: May 2020

Optimal birth spacing (defined as a birth spacing of 24–59 months) is incontrovertibly linked to better health outcomes for both mothers and babies. Using the most recent available Demographic and Health Survey data, we examined the patterns and determinants of short and long birth intervals among women in selected sub-Saharan African (SSA) countries.

Reproductive health and sociodemographic data of 98,934 women from 8 SSA countries were analyzed. Unadjusted and adjusted multinomial logistic regression models were used to examine the net relationship between all the independent variables and short and long birth intervals.

Overall, the majority of women in all the countries optimally spaced births. However, a significant proportion of women had short birth intervals in Chad (30.2%) and the Democratic Republic of Congo (Congo DRC) (27.1%). Long birth spacing was more common in Eastern and Southern African countries, with Zimbabwe having the highest rate of long term birth interval (27.0%). Women who were aged 35 years and above in Uganda (RRR = 0.72, CI = 0.60–0.87), Tanzania (RRR = 0.62, CI = 0.49–0.77), Zimbabwe (RRR = 0.52, CI = 0.31–0.85), Nigeria (RRR = 0.82, CI = 0.72–0.94) and Togo (RRR = 0.67, CI = 0.46–0.96) had significantly lower odds of having short birth intervals compared to women aged 15–24 years. Older women (above 34 years) had increased odds for long birth intervals in all countries studied (Chad (RRR = 1.44, CI = 1.18–1.76), Congo DRC (RRR = 1.73, CI = 1.33–2.15), Malawi (RRR = 1.54, CI = 1.23–1.94) Zimbabwe (RRR = 1.95, CI = 1.26–3.02), Nigeria (RRR = 1.85 CI = 1.56–2.20), Togo (RRR = 2.12, CI = 1.46–3.07), Uganda (RRR = 1.48, CI = 1.15–1.91), Tanzania RRR = 2.12, CI = 1.53–2.93).

The analysis suggested that the determinants of long and birth intervals differ and varies from country to country. The pattern of birth spacing found in this study appears to mirror the contraceptive use and fertility rate in the selected SSA countries. Birth intervals intervention addressing short birth intervals should target younger women in SSA, especially in Chad and Congo DRC, while intervention for long birth spacing should prioritize older, educated and wealthy women.
Very late-onset endocarditis complicated by non-significant aortic regurgitation after device closure of perimembranous ventricular septal defect
Authors: Tang Changqing , Zhou Kaiyu , Hua Yimin , Wang Chuan
Published: May 2020

Introduction:

Aortic regurgitation (AR) was recognized as a major, but rare complication after device closure for perimembranous ventricular septal defects (PmVSD). Most of them are temporary and non-significant. Infectious endocarditis (IE) is another extremely rare post-procedure complication of PmVSD. Theoretically, AR could increase risk for post-interventional IE. However, no cases have been documented thus far. We firstly described a case of very late-onset IE associated with non-significant AR after transcatheter closure of PmVSD with modified symmetrical double-disk device, underscoring the need for reassessing long-term prognostic implications of non-significant post-procedure AR after PmVSD occlusion and the most appropriate treatment strategy.

Patient concerns:

A 15-year old male received transcatheter closure of a 6.4 mm sized PmVSD with a 9-mm modified symmetric double-disk occluder (SHAMA) 11 years ago in our hospital. A new-onset mild eccentric AR was noted on transthoracic echocardiography (TTE) examination 1-year post procedure, without progression and heart enlargement. At this time, the child was admitted with a complaint of persistent fever for 16 days and nonresponse to 2-weeks course of amoxicillin and cefoxitin.

Diagnosis:

The diagnosis of post-procedure IE was established since a vegetation (14 × 4 mm) was found to be attached to the tricuspid valve, an anechoic area (8 × 7 mm) on left upper side of ventricular septum and below right aortic sinus, and severe eccentric AR as well as the isolation of Staphylococcus aureus from all three-blood cultures.

Interventions:

Treatment with vancomycin was initially adopted. However, surgical interventions including removal of vegetation, abscess and occluder, closure of VSD with a pericardial patch, tricuspid valvuloplasty, and aortic valvuloplasty were ultimately performed because of recurrent fever and a new-onset complete atrioventricular block 12-days later. The child continued with antibiotic therapy up to six weeks post operation.

Outcomes:

The child's temperature gradually returned to normal with alleviation of AR (mild) and heart block (first degree). The following course was uneventful.

Conclusion:

Late-onset IE could occur following device closure of PmVSD and be associated with post-procedure AR. For non-significant AR after device closure of PmVSD, early surgical intervention could be an alternative for reducing the aggravation of aortic valve damage and the risk of associated IE.
Utility of unenhanced postmortem computed tomography for investigation of in-hospital nontraumatic death in children up to 3 years of age at a single Japanese tertiary care hospital
Authors: Ishida Masanori , Gonoi Wataru , Shirota Go , Abe Hiroyuki , Shintani-Domoto Yukako , Ikemura Masako , Ushiku Tetsuo , Abe Osamu
Published: May 2020

To evaluate the utility of unenhanced postmortem computed tomography (PMCT) for the investigation of in-hospital nontraumatic death in children up to 3 years of age.

This study included the cadavers of children who died from intrinsic diseases before 3 years of age. The major underlying disease and the main organ–disease systems associated with the immediate causes of death were determined by clinical evaluation, PMCT, and autopsy, which were used as a reference standard. The rates of concordance between the former two methods and autopsy were calculated for all cases.

In total, 22 cadavers (12 male and 10 female; mean age, 6.1 ± 8.2 months) were included. The rates of concordance between clinical evaluation/PMCT and autopsy for diagnosis of the major underlying disease and main organ–disease systems associated with the immediate causes of death were 100%/36% (P = .0015) and 59%/41% (P = .37), respectively. In cases where the respiratory system was associated with the immediate cause of death, PMCT showed greater diagnostic sensitivity (90%) than did clinical evaluation (20%). In contrast, the diagnostic sensitivity of PMCT was lower than that of clinical evaluation in cases involving disorders of the cardiac system and multiple organ systems (0% vs 100% for both).

The findings of this study suggest that the use of unenhanced PMCT with clinical evaluation can result in improved detection of the immediate cause of death in select cases of in-hospital nontraumatic death before 3 years of age.
Arthroscopic labral debridement versus labral repair for patients with femoroacetabular impingement
Authors: Wu Zhan-Xiong , Ren Wen-Xia , Ren Yi-Ming , Tian Meng-Qiang
Published: May 2020

Objective:

Femoroacetabular impingement (FAI) is a common cause of hip pain and even tearing of the acetabular labrum in young adults and athletes. Either arthroscopic labral debridement (LD) or labral repair (LR) technique for FAI patients is needed to choose. We conducted this systematic review and meta-analysis to compare the clinical outcomes of arthroscopic LD versus LR intervention.

Methods:

The five studies were acquired from PubMed, Medline, Embase, and Cochrane Library. The data were extracted by two of the coauthors independently and were analyzed by RevMan5.3. Mean differences (MDs), odds ratios (ORs), and 95% confidence intervals (CIs) were calculated. Cochrane Collaboration's Risk of Bias Tool and Newcastle–Ottawa Scale were used to assess risk of bias.

Results:

Four observational studies and one prospective randomized study were assessed. The methodological quality of the trials indicated a low to moderate risk of bias. The pooled results of Non-Arthritic Hip Score (NAHS), failure rate of surgeries and complications showed that the differences were not statistically significant between the two interventions. The difference of modified Harris Hip Score (mHHS), the Visual Analogue Scale (VAS) score and satisfaction rate was statistically significant between LD and LR intervention, and LR treatment was more effective. Sensitivity analysis proved the stability of the pooled results and there were too less included articles to verify the publication bias.

Conclusions:

Hip arthroscopy with either LR or LD is an effective treatment for symptomatic FAI. The difference of mHHS, VAS score, and satisfaction rate was statistically significant between LD and LR intervention, and arthroscopic LR could re-create suction-seal effect, potentially reduce microinstability, which demonstrated a trend toward better clinical efficacy and comparable safety compared with LD. The arthroscopic LR technique is recommended as the optical choice for acetabular labrum tear with FAI.
Motor recovery of hemiparetic leg by improvement of limb-kinetic apraxia in a chronic patient with traumatic brain injury
Authors: Choi Eun Bi , Kim Jun Young , Jang Sung Ho
Published: May 2020

Rationale:

Limb-kinetic apraxia (LKA), a kind of apraxia, means the inability to perform precise and voluntary movements of extremities resulting from injury of the premotor cortex (PMC) or the corticofugal tract (CFT) from the PMC. Diagnosis of LKA is made by observation of movements without specific assessment tools.

Patient concerns:

A 44-year-old male underwent conservative management for traumatic intracerebral hemorrhage in the left basal ganglia and subarachnoid hemorrhage due to a pedestrian-car crash. When he was admitted to the rehabilitation department of a university hospital after 41 months after onset, he presented with right hemiparesis (Medical Research Council (MRC): shoulder abductor; 3, elbow flexor; 3, finger extensor; 0, hip flexor; 2- [range: 30°], knee extensor; 1 and ankle dorsiflexor; 3-). In addition, he exhibited slow, clumsy, and mutilated movements when performing movements of his right ankle.

Diagnoses:

The patient was diagnosed as traumatic brain injury (TBI).

Interventions:

Clinical assessments and DTI were performed at 41 and 44 months after onset. During three months, rehabilitative therapy was performed including dopaminergic drugs (pramipexole 2.5 mg, ropinirole 2.5 mg, and amantadine 300 mg, and carbidopa/levodopa 75 mg/750 mg).

Outcomes:

The right leg weakness slowly recovered during 3 months, until 44 months after the initial injury (MRC: shoulder abductor, 3; elbow flexor, 3; finger extensor, 0; hip flexor, 3; knee extensor, 3; and ankle dorsiflexor, 3+). The fiber number of the right corticospinal tract (CST) was decreased on 44-month diffusion tensor tractography (DTT) (1319) compared with 41-month DTT (1470) and the left CST was not reconstructed on both DTTs. The fiber number of both CRTs were decreased on 44-month DTT (right: 1547, left: 698) than 41-month DTT (right: 3161, left: 1222).

Lessons:

A chronic patient with TBI showed motor recovery of the hemiparetic leg by improvement of LKA after rehabilitation. This results have important implications for neurorehabilitation.
Clinical experience of comprehensive treatment on the balance function of Parkinson's disease
Authors: Li Haitao , Liang Siquan , Yu Yang , Wang Yue , Cheng Yuanyuan , Yang Hechao , Tong Xiaoguang
Published: May 2020

To investigate the effect of multi-disciplinary teamwork on balance performance of Parkinson's disease (PD).

Sixteen primary Parkinson's disease patients (8 male, 8 female) treated with bilateral subthalamic nucleus deep brain stimulation (STN-DBS) were included in the study. The median age of patients was 60.5 years; all patients were in the Hoehn&Yahr (H&Y) 3 stage; the median PD duration of the disease was 9 years. For each patient, multi-disciplinary teamwork treatment including DBS, medication, physical therapy and psychotherapy proceeded. levodopa equivalent daily dose (LEDD, mg/day), life quality (PDQ-39), Motor disability (MDS-UPDRSIII) and balance performance (MDS-UPDRS 3.12, Berg Balance Scale BBS, Limits of Stability LoS) were assessed in different time and status respectively: preoperation (Med-off, Med-on), postoperation (Stim-Off/Med-Off, Stim-On/Med-Off, Stim-On/Med-On), 6 months postoperation (Stim-On/ Med-Off, Stim-On/Med-On) and 12 months postoperation (Stim-On/Med-Off, Stim-On/Med-On).

The LEDD, life quality (PDQ-39) continued to improve during the follow-up, statistical difference were found in both 6 months postoperation and 12 months postoperation compared with preoperation. The Motor disability (MDS-UPDRSIII), balance performance (MDS-UPDRS 3.12, BBS) and the LoS (target acquisition percentage, trunk swing angle standard deviation, time) showed significant improvement in Stim-On/med-Off 6 months postoperation and 12 months postoperation separately compared with Med-Off preoperation.

Multi-disciplinary teamwork for PD patients with STN-DBS could improve balance performance.
To explore the clinical efficacy of Traditional Chinese Medicine bath in the treatment of psoriasis vulgaris with blood-heat syndrome and its effect on related cytokines based on different temperature and different concentration
Authors: Lin Wenxia , Yu Qianying , Qin Yuesi , Dai Li , Xiao Jianhua , Jiao Liang , Liu Shan , Ye Shengzhen , Zhang Jiahao , Chen Mingling
Published: May 2020

Background:

Chinese herbal bath has long been used in the curative treatment of psoriasis vulgaris. However, there is no unified standard protocol for Chinese herbal bath. Many factors affect the curative effect of Chinese herbal bath, such as water temperature, bath concentration, and soaking time. Most studies involving Chinese herbal bath has described the bath generally, and few studies have investigated the factors that might contribute to the efficacy of Chinese herbal bath. Here we describe a protocol to evaluate the efficacy and safety of various bathwater temperatures and herbal concentrations on psoriasis vulgaris, and their effect on serum vascular endothelial growth factor (VEGF), tumor necrosis factor α (TNF-α), interleukin 23 (IL-23), and interleukin 17 (IL-17). These data could be useful for optimizing Chinese herbal bath treatments.

Methods:

In this randomized controlled trial, we planned to recruit 288 hospitalized atients with psoriasis vulgaris aged 18 to 65 years. All participants who meet the inclusion criteria will be randomly assigned to the observation group, the control group, or the basic treatment group. The observation group will be divided into 6 sub-groups according to water temperatures and bath concentrations, designated as observation groups 1 to 6. Thirty-six participants will be assigned to each group. The basic treatment group will be given co-qingdai capsule, po 2 g tid; compound glycyrrhizin tablet, po 75 mg tid; AA Skincare jojoba Oil, us.ext qd. The observation group will be given a Chinese herbal bath at the same time as the basic treatment. The control group will be given ozone hydrotherapy at the same time as the basic treatment. The entire treatment course will last for 2 weeks. The following parameters will be compared in each group, before and 2 weeks after treatment: the psoriasis area and severity index score (PASI), pruritus score, clinical efficacy, and dermatology life quality index score (DLQI); serum levels of serum VEGF, TNF-α, IL-23, and IL-17; and confocal laser scanning microscope images.

Conclusion:

This study will evaluate the efficacy and safety of various Chinese herbal bath conditions (water temperatures and herbal concentrations) on the treatment of psoriasis vulgaris, which will provide an important reference for the operation of Chinese herbal bath.

Trial registration number:

ChiCTR1900027468
Early-onset type 2 diabetes
Authors: Lv Xinlu , Ran Xi , Chen Xiangjun , Luo Ting , Hu Jinbo , Wang Yue , Liu Zhiping , Zhen Qianna , Liu Xiurong , Zheng Li , Tang Ying , Zhao Qinying , Han Shichao , Zhou Yangmei , Luo Wenjin , Yang Lina , Li Qifu , Wang Zhihong
Published: May 2020

We aim to explore the relationship between early-onset diabetes and proliferative diabetic retinopathy (PDR) in type 2 diabetes mellitus (T2DM) patients with microalbuminuria.

A total of 461 T2DM patients with microalbuminuria were enrolled. Subjects were defined as early-onset or late-onset based on the age at which they were diagnosed with diabetes (<40 and ≥40 years, respectively). Medical history, anthropometry, and laboratory indicators were documented. PDR was defined as the presence of any of the following changes on fundus photography: neovascularization, vitreous hemorrhage, or preretinal hemorrhage.

The prevalence of PDR was 6-fold higher in patients with early-onset than late-onset T2DM [(6.1% vs 1.0%), P = .004]. Univariate correlation analysis showed that early-onset diabetes, use of oral hypoglycemic drugs, and insulin therapy were risk factors for PDR. In multivariate logistic analysis, patients with early-onset diabetes exhibited a 7.00-fold [(95% confidence interval 1.40–38.26), P = .019] higher risk of PDR than subjects with late-onset diabetes after adjusting for sex; T2DM duration; systolic blood pressure; total triglyceride; glycated hemoglobin; insulin therapy; and the use of oral hypoglycemic drugs, antihypertensive drugs, and lipid-lowering drugs.

In T2DM patients with microalbuminuria, early-onset diabetes is an independent risk factor for the development of PDR.
Novel coronavirus 2019 (COVID-19)
Authors: Douedi Steven , Miskoff Jeffrey
Published: May 2020

Rationale:

Novel coronavirus 2019 (COVID-19) also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an enveloped, non-segmented positive-sense RNA virus belonging to the beta-coronaviridae family. This virus is known to cause severe bilateral pneumonia and acute respiratory distress syndrome (ARDS) which can lead to difficulty breathing requiring mechanical ventilation and intensive care unit management.

Patient concerns:

A 77-year-old female with a history of hypertension and hyperlipidemia who presented as a transfer to our hospital facility with worsening fevers, cough, and respiratory distress.

Diagnosis:

Chest X-rays revealed bilateral infiltrates worse at the lung bases and CT scan of the chest showed bilateral ground-glass opacities consistent with COVID-19. While our testing revealed a negative COVID-19 result at our institution, the result at a previous hospital returned a positive result.

Interventions:

She was being treated aggressively in the intensive care unit with high dose intravenous ascorbic acid, hydroxychloroquine, and anti-interleukin-6 monoclonal antibody. She also received a loading dose of remdesivir however was unable to complete the course due to organ failure and requirement of vasopressors for hemodynamic stability.

Outcomes:

She remained critically ill and was eventually placed on comfort care as per the family's wishes and passed away.

Lessons:

With a rapidly growing death rate and more than 200,000 confirmed cases worldwide, COVID-19 has become a global pandemic and major hit to our healthcare systems. While several companies have already begun vaccine trials and healthcare facilities have been using a wide-range of medications to treat the virus and symptoms, there is not yet an approved medication regimen for COVID-19 infections. The alarming increase in cases per day adds additional pressure to find a cure and decrease the global health burden and mortality rate.
Clinical features and management of post-necrotizing enterocolitis strictures in infants
Authors: Liu Wei , Wang Yi , Zhu Jin , Zhang Chi , Liu Guobin , Wang Xin , Sun Yanhui , Guo Zhenhua
Published: May 2020

To explore the clinical features and management of post-necrotizing enterocolitis strictures.

Clinical data from 158 patients with post-necrotizing enterocolitis strictures were summarized retrospectively in 4 academic pediatric surgical centers between April 2014 and January 2019. All patients were treated conservatively in the internal medicine department. All patients underwent preoperative X-ray examinations, 146 patients underwent gastrointestinal contrast studies, and 138 patients underwent rectal mucosal biopsies. All of the patients were treated surgically.

Of the 158 patients, 40 of them had necrotizing enterocolitis (NEC) Bell stage Ib, 104 had Bell stage IIa, and 14 had Bell stage IIb. In these patients, the clinical signs of intestinal strictures occurred at mean of 47.8 days after NEC. In 158 patients, 146 underwent barium enema examination, 116 demonstrated intestinal strictures, and 10 demonstrated microcolon and poor development. A total of 138 patients underwent rectal mucosal biopsies, and 5 patients had Hirschsprung disease. Intraoperative exploration showed that intestinal post-NEC strictures occurred in the ileal (17.7%, 28/158) and colon (82.3%, 130/158), including ascending colon, transverse colon and descending colon, and multiple strictures were detected in 36.1% (57/158) patients. Surgical resection of stricture segments in the intestine and primary end-to-end anastomosis were performed in 142 patients, and the remaining 16 patients underwent staged surgeries. In the 146 patients with complete follow-up data, 9 had postoperative adhesions: 4 of them received conservative treatment, and the others underwent a second operation. Fifteen patients were hospitalized 1 to 3 times for malnutrition and dehydration due to repeated diarrhea; these patients eventually recovered and were discharged smoothly. All the other patients had uneventful recoveries without stricture recurrence.

Post-NEC strictures mostly occurred in the colon, and there were some cases of multiple strictures. A gastrointestinal contrast study was the preferred method of examination. Preoperative rectal mucosal biopsy resulted in a diagnosis of Hirschsprung disease, and then a reasonable treatment protocol was chosen. Surgical resection of stricture segments in the intestine and primary end-to-end anastomosis achieved good therapeutic effects with favorable prognoses in these patients.
Comparison between total intravenous anesthesia and balanced anesthesia on postoperative opioid consumption in patients who underwent laparoscopic-assisted distal gastrectomy
Authors: Kim Doo-Hwan , Yun Hye Joo , Park Sooin , Leem Jeong-Gil , Karm Myong-Hwan , Choi Seong-Soo
Published: May 2020

Remifentanil is the most frequently prescribed opioid for total intravenous anesthesia (TIVA) or balanced anesthesia (BA), due to its favorable pharmacological properties. However, several studies have reported opioid-induced hyperalgesia and/or acute tolerance after intraoperatively using remifentanil. In addition, it is imperative to control postoperative pain with lower doses of opioid anesthetic agents. Therefore, we compared the amount of opioid consumption between TIVA with propofol-remifentanil and BA with desflurane-remifentanil, to control postoperative pain in patients who underwent laparoscopic-assisted distal gastrectomy (LADG) with gastroduodenostomy.

We retrospectively evaluated demographic variables (age, gender, height, weight, and smoking habits), the duration of general anesthesia (GA), and intraoperatively administered remifentanil consumption through the electronic medical records of patients who underwent LADG with gastroduodenostomy due to early stomach cancer. The primary outcome was postoperative opioid consumption during postoperative day (POD) 2. The secondary outcomes were the incidence of any rescue opioid analgesics administered, numeric rating scale, and various adverse effects during POD 2. We categorized the data in 2 patient groups to compare TIVA with propofol-remifentanil (TIVA group) to BA with desflurane-remifentanil (BA group) on the postoperative opioid analgesic consumption.

We divided 114 patients into the TIVA (46 patients) and BA (68 patients) groups. Opioid consumption as a primary outcome was significantly higher in the BA group than in the TIVA group during POD 2 except in the post-anesthesia care unit. The cumulative opioid consumption was significantly higher in the BA than in the TIVA group. The incidence of rescue analgesic at POD 2 was higher in the BA than in the TIVA group. In the TIVA group, remifentanil consumption was higher, and the duration of GA was shorter than that in the BA group. No statistically significant differences were observed when comparing other variables.

Our results indicated that the maintenance of GA with TIVA (propofol-remifentanil) reduces opioid consumption for postoperative pain control compared to BA (desflurane-remifentanil) in patients undergoing LADG with gastroduodenostomy.
Efficacy of Upfront Docetaxel With Androgen Deprivation Therapy for Castration-Sensitive Metastatic Prostate Cancer Among Minority Patients
Authors: Pathak Surabhi , Thekkekara Romy , Yadav Udit , Ahmed Ahmed Tarig , Yim Barbara , Lad Thomas E. , Mullane Michael , Batra Kumar Kunnal , Aronow Wilbert S. , Psutka Sarah P.
Published: May 2020

Background:

Upfront docetaxel (UD) with androgen deprivation therapy (ADT) has been demonstrated to improve survival outcomes in metastatic castration-sensitive prostate cancer (mCSPC). However, existing studies have included predominantly Caucasian patients.

Study Question:

To compare the efficacy of addition of UD to ADT in mCSPC to ADT alone among minority patients.

Study Design:

Retrospective study of mCSPC patients.

Measures and Outcomes:

Patients treated with UD and ADT between January 2014 and December 2017 (UD + ADT, n = 44) were compared with those treated with ADT alone between January 2008 and January 2017 (ADT, n = 38); patients of Caucasian ethnicity were excluded. The outcome of interest was progression-free survival (PFS), which was estimated using Kaplan–Meier analysis and Cox proportional hazard analysis.

Results:

Overall, 63 (76.8%) patients were African American and 16 (19.5%) were Hispanic. Fifty-five (67%) patients had high-volume mCSPC. The median follow-up was 14 months [95% confidence interval (CI): 10.4–16.5] for UD + ADT and 42 months (95% CI: 17–66.9) for ADT. Median PFS did not differ between groups: UD + ADT: 16 versus ADT: 18 months [hazard ratio (HR) for UD + ADT = 0.88, 95% CI: 0.48–1.62; P = 0.70]. In patients with high-volume disease, median PFS remained similar (UD + ADT: 16 vs. ADT: 14 months (HR for UD + ADT = 0.64, 95% CI: 0.33–1.25; P = 0.19). On multivariable analysis, prolonged time to nadir PSA, HR = 0.83 (95% CI: 0.76–0.90), was independently associated with PFS. The most common toxicities in UD + ADT were anemia and fatigue. Major limitations include small sample size and potential for selection bias due to the retrospective study design.

Conclusions:

In this retrospective review of a minority mCSPC cohort, UD + ADT was not associated with improved PFS compared with ADT alone. Although further study with larger sample size is needed, these results underscore the importance of ensuring accrual of minorities in clinical trials, reflective of the real-world setting.
Short Versus Long Timing of Flushing of Totally Implantable Venous Access Devices When Not Used Routinely
Authors: Clari Marco , Spoto Maria , Franceschi Giordana , Acuto Martina , Tonella Simone , Caristia Silvia , Buratti Giulia , Gaboardi Samanta , Rasero Laura , Campagna Sara , Busca Erica , Dal Molin Alberto
Published: May 2020

Background

Flushing and locking of totally implantable venous access devices (TIVADs) is recommended to maintain their patency when not in use. Although manufacturers’ recommendations indicate monthly access for TIVAD maintenance, there is a tendency in real life to prolong this interval.

Objectives

To assess the effectiveness of prolonged versus short flushing and locking intervals to prevent TIVAD occlusions in adults with cancer.

Methods

A systematic search was carried out in MEDLINE, EMBASE, CINAHL, and Web of Science. Two reviewers independently selected studies, assessed quality, and extracted data. Study findings were summarized, and a meta-analysis conducted.

Results

Six articles were included in the review, with a total of 1255 participants. Differences in types of cancers, flushing and locking techniques, and volume and concentration of heparin were described. Pooled results from 4 studies showed fewer catheter occlusions in favor of prolonged flushing and locking intervals (relative risk, 0.81), even if not statistically significant (95% confidence interval, 0.41–1.61) with no heterogeneity among studies (I
2 = 0.00%, P = .69). The quality of evidence was very low.

Conclusions

Very low-quality evidence suggests that prolonged schedule flushing and locking intervals has no effect on catheter patency. However, because of low number and poor quality of evidence derived from the studies analyzed, findings of this meta-analysis should be interpreted with caution.

Implications for Practice

No statistically significant difference in occlusion rate between short and long timing of flushing was found. However, further studies are necessary to strengthen the safe implementation of longer intervals in clinical practice.
The Diagnostic Value of the Changes in the Renal Glomerulus in the Postmortem Diagnosis of Freshwater Drownings
Authors: Demirci Tuba , Sener Mustafa Talip , Sahpaz Ahmet , Sener Ebru , Kok Ahmet Nezih
Published: May 2020

Drowning is one of the major causes of unintentional injury death worldwide. As there are no pathomorphological findings specific to the diagnosis of drowning, definitive postmortem diagnosis of drowning continues to be a significant problem in forensic medicine. This study aims to present an additional diagnostic sign in cases of freshwater drowning by investigating the histopathological changes of renal tissue in the postmortem diagnosis of freshwater drowning. For this purpose, 103 cases were investigated in which the causes of death were freshwater drowning (n = 45), traffic accidents (n = 33) and acute myocardial infarction (n = 25). Renal corpuscular structures of selected cases were examined stereologically and histopathologically. Renal corpuscle diameter, renal corpuscle surface area, glomerular tuft surface area, and Bowman space were calculated by stereological method. When compared with the glomeruli of the control group, renal corpuscle diameter, renal corpuscle surface area, glomerular tuft surface area, and Bowman space values of kidney tissues of all freshwater drowning cases were found to be decreased (P< 0.001). These changes may be considered as an essential histopathological finding in postmortem diagnosis of freshwater drowning cases.
An Evaluation of Age-Based Differences in the Demographic Features and Clinical Outcomes of Trauma Rehabilitation Patients
Authors: MacDonald Shannon L. , Robinson Lawrence R.
Published: May 2020

Objective

The aims of the study were to describe potential age-related differences in injury type and mechanism, comorbidities, and physical medicine and rehabilitation–relevant complications in patients admitted after major trauma and to examine whether functional outcomes vary by age group after traumatic injury.

Design

This is a subanalysis of a pre-post study. Individuals admitted to a level 1 trauma center who sustained major trauma were divided into three age groups (young, middle age, and elderly). The demographic, acute care, and rehabilitation factors for these patients were then compared across the three age groups.

Results

Based on an age distribution plot, the age categories were defined as follows: young, 18–39 yrs (n = 120); middle age, 40–64 yrs (n = 124); and elderly, 65 yrs or older (n = 85). Patients 65 yrs or older demonstrated a greater frequency of comorbidities (P < 0.001) and complications (P < 0.001). For individuals admitted to inpatient rehabilitation, admission and discharge functional independence measure scores were lower for the elderly individuals, but functional independence measure change was not significantly different between groups.

Conclusions

Although the elderly trauma patient demonstrates important differences from the younger one, capacity for improvement with rehabilitation seems similar.
Optimizing High-risk Infant Follow-up in Nonresearch-based Paradigms: The New England Follow-up Network
Authors: Litt Jonathan S. , Edwards Erika M. , Lainwala Shabnam , Mercier Charles , Montgomery Angela , O’Reilly Deirdre , Rhein Lawrence , Woythaler Melissa , Hartman Tyler
Published: May 2020

Objectives:

To establish the first regional quality improvement collaborative solely dedicated to follow-through care of high-risk infants after Neonatal intensive care unit (NICU) discharge and to characterize extremely low birth weight (ELBW) follow-up in New England.

Methods:

Eleven of 14 follow-up programs in New England partnered with the Vermont Oxford Network (VON) ELBW project for an initial data collection project. We collected information about the health status and developmental outcomes of infants born ≤1,000 g or younger than 28 weeks 2014–2016 at the 18–24 months corrected for gestational age (CGA) follow-up visit. VON collected and compiled the data.

Results:

Of 993 eligible infants, 516 (52.0%) had follow-up visits. The rehospitalization rate was 33.9%, mostly respiratory illness. Ninety-six children (19.3%) had weight less than 10th percentile and 44 (8.9%) had weight less than third percentile at 18–24 months. Only 170 (61.4%) children had recommended hearing screening after NICU discharge. Forty-six (9.1%) had cerebral palsy; 81 of the 441 infants that completed all 3 sections of the Bayley Scales of Infant Development, third edition (18.4%) had any composite score less than 70. Over half of the social and demographic data were missing.

Conclusion:

Most quality initiatives in neonatology stop at NICU discharge. This first project by the New England Follow-up Network showed a low rate for clinical follow-up. It demonstrated many opportunities to improve postdischarge follow-through specific to NICU-based care. Future projects will aim to improve the quality of follow-through services through collaborative learning, data sharing, and comparative outcomes.
The Efficacy of Breast Implant Irrigant Solutions: A Comparative Analysis Using an In Vitro Model
Authors: Ngaage Ledibabari M. , Elegbede Adekunle , Brao Kristen , Chopra Karan , Gowda Arvind U. , Nam Arthur J. , Ernst Robert K. , Shirtliff Mark E. , Harro Janette , Rasko Yvonne M.
Published: May 2020

Background:

Infections are challenging complications of implant-based breast reconstruction and augmentation. They pose a clinical challenge, with significant economic implications. One proposed solution is implant irrigation at the time of placement. There is no consensus on the optimal irrigant solution.

Methods:

The authors tested the relative efficacy of 10% povidone-iodine, Clorpactin, Prontosan, triple-antibiotic solution, or normal saline (negative control) against two strains each of methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis. Sterile, smooth silicone implant disks were immersed in irrigant solution, then incubated in suspensions of methicillin-resistant S. aureus or S. epidermidis overnight. The disks were rinsed and sonicated to displace adherent bacteria from the implant surface, and the displaced bacteria were quantified. Normalized values were calculated to characterize the relative efficacy of each irrigant.

Results:

Povidone-iodine resulted in reductions of the bacterial load by a factor of 104 to 105 for all strains. Prontosan-treated smooth breast implant disks had a 10-fold reduction in bacterial counts for all but one methicillin-resistant S. aureus strain. In comparison to Prontosan, triple-antibiotic solution demonstrated a trend of greater reduction in methicillin-resistant S. aureus bacterial load and weaker activity against S. epidermidis strains. Clorpactin reduced the recovered colony-forming units for only a single strain of S. epidermidis. Povidone-iodine demonstrated the greatest efficacy against all four strains. However, Clorpactin, triple-antibiotic solution, and Prontosan demonstrated similar efficacies.

Conclusions:

Povidone-iodine was the most efficacious of the irrigants at reducing methicillin-resistant S. aureus and S. epidermidis contamination. Given the recent lifting of the U.S. Food and Drug Administration moratorium, larger clinical studies of povidone-iodine as a breast implant irrigant solution are warranted.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, V.
Projecting the impact of equity-based preexposure prophylaxis implementation on racial disparities in HIV incidence among MSM
Authors: Goedel William C. , Bessey S. , Lurie Mark N. , Biello Katie B. , Sullivan Patrick S. , Nunn Amy S. , Marshall Brandon D.L.
Published: May 2020

Background:

It is unknown what levels of preexposure prophylaxis (PrEP) use are needed to reduce racial disparities in HIV incidence among men who have sex with men (MSM). Using an agent-based model, we quantified the impact of achieving PrEP coverage targets grounded in equity on racial disparities in HIV incidence among MSM in an urban setting in the Southeastern United States.

Methods:

An agent-based model was adapted to simulate HIV transmission in a network of Black/African American and White MSM aged 18–39 years in the Atlanta–Sandy Springs–Roswell metropolitan area over 10 years (2015–2024). Scenarios simulated coverage levels consistent with targets based on the ratio of the number of individuals using PrEP to the number of individuals newly diagnosed in a calendar year (i.e., the ‘PrEP-to-need ratio’), ranging from 1 to 10. Incidence rate ratios and differences were calculated as measures of disparities.

Results:

Without PrEP, the model predicted a rate ratio of 3.82 and a rate difference of 4.50 comparing HIV incidence in Black/African American and White MSM, respectively. Decreases in the rate ratio of at least 50% and in the rate difference of at least 75% were observed in all scenarios in which the PrEP-to-need ratio among Black/African American MSM was 10, regardless of the value among White MSM.

Conclusion:

Significant increases in PrEP use are needed among Black/African American MSM to reduce racial disparities in HIV incidence. PrEP expansion must be coupled with structural interventions to address vulnerability to HIV infection among Black/African American MSM.
Estimating the Population Size of Female Sex Workers in Zimbabwe: Comparison of Estimates Obtained Using Different Methods in Twenty Sites and Development of a National-Level Estimate
Authors: Fearon Elizabeth , Chabata Sungai T. , Magutshwa Sitholubuhle , Ndori-Mharadze Tendayi , Musemburi Sithembile , Chidawanyika Henry , Masendeke Absolom , Napierala Sue , Gonese Elizabeth , Herman Roloff Amy , Tippett Barr Beth A. , Kilmarx Peter H. , Wong-Gruenwald Ramona , Chidiya Samson , Mhangara Mutsa , Hanisch Dagmar , Edwards Jessie K. , Rice Brian , Taramusi Isaac , Mbengeranwa Tendai , Manangazira Portia , Mugurungi Owen , Hargreaves James R. , Cowan Frances M.
Published: May 2020

Background:

National-level population size estimates (PSEs) for hidden populations are required for HIV programming and modelling. Various estimation methods are available at the site-level, but it remains unclear which are optimal and how best to obtain national-level estimates.

Setting:

Zimbabwe.

Methods:

Using 2015–2017 data from respondent-driven sampling (RDS) surveys among female sex workers (FSW) aged 18+ years, mappings, and program records, we calculated PSEs for each of the 20 sites across Zimbabwe, using up to 3 methods per site (service and unique object multipliers, census, and capture-recapture). We compared estimates from different methods, and calculated site medians. We estimated prevalence of sex work at each site using census data available on the number of 15–49-year-old women, generated a list of all “hotspot” sites for sex work nationally, and matched sites into strata in which the prevalence of sex work from sites with PSEs was applied to those without. Directly and indirectly estimated PSEs for all hotspot sites were summed to provide a national-level PSE, incorporating an adjustment accounting for sex work outside hotspots.

Results:

Median site PSEs ranged from 12,863 in Harare to 247 in a rural growth-point. Multiplier methods produced the highest PSEs. We identified 55 hotspots estimated to include 95% of all FSW. FSW nationally were estimated to number 40,491, 1.23% of women aged 15–49 years, (plausibility bounds 28,177–58,797, 0.86–1.79%, those under 18 considered sexually exploited minors).

Conclusion:

There are large numbers of FSW estimated in Zimbabwe. Uncertainty in population size estimation should be reflected in policy-making.
Brief Report: Diminished Coinhibitory Molecule 2B4 Expression Is Associated With Preserved iNKT Cell Phenotype in HIV Long-Term Nonprogressors
Authors: Ansari Abdul W. , Ahmad Fareed , Shankar Esaki M. , Yong Yean K. , Tan Hong Y. , Jacobs Roland , Larsson Marie , Velu Vijayakumar , Kamarulzaman Adeeba , Schmidt Reinhold E.
Published: May 2020

Background:

We have previously shown an association of elevated coinhibitory molecule 2B4 expression with iNKT cells alterations in HIV disease. Herein, we show a comparative analysis of 2B4 expression on iNKT cells of HIV long-term nonprogressors (LTNPs) and progressors.

Methods:

Antiretroviral therapy–naive HIV-seropositive individuals (progressors, n = 16) and LTNPs (n = 10) were recruited for this study. We used multicolor flow cytometry on frozen peripheral blood mononuclear cells to determine iNKT subset frequencies, the levels of coinhibitory 2B4 expression, and intracellular interferon-γ (IFN-γ) production. CD1d tetramer was used to characterize iNKT cells.

Results:

We report significantly lower level of 2B4 expression on bulk LTNPs iNKT cells and on their CD4 subsets compared with HIV progressors. Furthermore, the iNKT cells from LTNPs produced higher amount of IFN-γ than HIV progressors as detected by intracellular cytokine staining. Interestingly, the frequency of 2B4+iNKT cells of progressors but not LTNPs significantly correlates with CD4 T-cell count, HIV viral load, and IFN-γ+ production by iNKT cells.

Conclusion:

Our results suggest that in addition to suppressed HIV replication, diminished 2B4 expression and associated coinhibitory signaling, and substantial production of IFN-γ could contribute to preserved iNKT cell phenotype in LTNPs.