bluuebunny/crossref_metadata_2025 huggingface dataset:
Benzodiazepine use disorder: A cross-sectional study at a tertiary care center in Lebanon
Authors: El Zahran Tharwat , Kanaan Elie , Kobeissi Lynn , Bouassi Joseph , Sarieddine Aseel , Carpenter Joseph , Kazzi Ziad , Hitti Eveline
Published: September 2022

Benzodiazepines are medications used for the treatment of multiple conditions including anxiety disorders, insomnia, agitation, and seizures. They are the most prescribed psychiatric medications and the third most misused drugs among adults and adolescents in the US. This study aims to assess the patient utilization patterns and benzodiazepine use disorder among Lebanese patients. A cross-sectional study was performed on Lebanese patients presenting to the Emergency Department of the American University of Beirut Medical Center (AUBMC), between November 11th, 2019, and May 30th, 2020. Institutional review board approved the study, and an informed consent was obtained from patients. A total of 244 patients were included in the final analysis. A total of 154 (63.1%) patients were found to have benzodiazepine use disorder as per the DSM-V criteria with the majority (64%) being females and young adults aged 18 to 40 years. The most common medication was alprazolam, and anxiety was the most common reason for benzodiazepine use. The majority (88%) of patients obtained their medications using a physician’s prescription. More than half of users were not satisfied with the physician’s instructions and lacked knowledge about side effects and abuse potential. The high rate of benzodiazepine misuse among our young adults highlights an important public health concern that requires interventions and policy implementation.
Evaluation efficacy and safety of epidural analgesia in second-trimester induced labor: A single-center, prospective, non-randomized, controlled study
Authors: Zeng Yong , Jiang Tao , Zheng Ya-Hong , He Wen-Rong , Wang Xiao-Wen , Wei Hua , Wang Li , Liu Zu-Rong , Zhang Xu-Feng , Yi Cunjian , Chen Ke-Ming
Published: September 2022

Background:

Second-trimester induced labor in pregnant women was often more likely to suffer from psychological and physiological double pain. However, the analgesic management received less attention, and the optimal analgesic mode for second-trimester induced labor had not been determined. Our objective was to evaluate the feasible of epidural analgesia (EA) in second-trimester induced labor.

Methods:

From January 2020 to December 2021, Primipara who planned to undergo second-trimester induced labor in the First Affiliated Hospital of Yangtze University were collected. The method of labor induction was oral mifepristone + amniotic cavity injection of Ethacridine Lactate. Based on whether or not patients received epidural analgesia, which were divided into EA group (30 cases) and non-EA (NEA) group (30 cases). The primary outcome were visual analog scale (VAS) score of pain and result of follow-up, the secondary outcomes included relative clinical parameter and labor duration.

Results:

Vaginal induction of labor was successful in both groups. There was no statistically significant difference in VAS of pain between the two groups before analgesia (P > .05), but the VAS of pain in the EA group was significantly lower than the NEA group (P < .05) after analgesia or at delivery. The following outcomes showed no statistical difference between two groups: labor duration, postpartum hemorrhage, hemorrhage ≥ 500 mL, intrapartum injury, second days hemoglobin, C-reactive protein, antibiotic therapy days, hospitalizations days, and placenta residue (P > .05). The median hospitalization costs of EA group was 4697.5 yuan, and NEA group was 3673 yuan, the difference was statistically significant (P < .001). No adverse events related to EA occurred during hospitalization, only 3 patients showed mild lumbago and back pain after follow-up to three months postpartum, which was significantly relieved after proper rest.

Conclusion:

EA can significantly reduce the pain of parturients, which may be effective and safe in the second-trimester induced labor.
Effect of different acupuncture and moxibustion methods on functional dyspepsia caused by sequelae of COVID-19: A protocol for systematic review and meta-analysis
Authors: Peng Tianzhong , Huang Xuedi , Zhu Manhua , Hou Xinju , Xiong Yue , Fang Xinyue , Lin Zitong , Liu Lu , Lan Wanning , Lin Xingzhen
Published: September 2022

Background:

Functional dyspepsia (FD) is a group of diseases that cannot be explained after routine clinical examination, and is characterized by postprandial fullness, early satiety, and upper abdominal pain or burning. According to the statistics, FD continues to become one of the high-risk sequelae of coronavirus disease 2019 (COVID-19), affecting patients’ quality of life, increasing psychological burden and increasing economic costs. However, its optimal treatment is still an urgent problem. A large number of studies have shown that acupuncture and moxibustion is effective and safe in the treatment of FD caused by sequelae of COVID-19, which is of research value. Therefore, based on the current literatures, the effectiveness and safety of different acupuncture and moxibustion methods were systematically evaluated to provide possible alternative therapy on FD.

Methods:

Studies search for eligible randomized controlled trials that use different acupuncture and moxibustion methods as the sole treatment on FD and their data extraction will be done by 2 researchers. In case of disagreement, a third researcher will be introduced for arbitration. Mean difference or relative risk with fixed or random effect model in terms of 95% confidence interval will be adopted for the data synthesis. To evaluate the risk of bias, the Cochrane risk of bias assessment tool will be utilized. The sensitivity or subgroup analysis will also be conducted when meeting high heterogeneity (I
2 > 50%).

Results:

This meta-analysis will provide an authentic synthesis of different acupuncture and moxibustion methods on FD caused by sequelae of COVID-19.

Conclusion:

This meta-analysis will evaluate the effect of acupuncture and moxibustion on FD caused by sequelae of COVID-19, providing evidence as to the treatment in these patients.
Blood pressure variability related to early outcome of acute ischemia stroke in a prospective observational study
Authors: Ningning Wang , Ying Hu , Shudong Lin , Zhilong Zhang , Qibo Cai , Yuting Deng , Hao Zhang , Nan Wu , Changchun Qiu , Xiujing Yang , Ming Jin , Jingping Li
Published: September 2022

Hypertension is a well-known risk factor for stroke, but the relationship between blood pressure variation (BPV) and prognosis remains unclear. This prospective observational study assessed the association between BPV and early functional outcomes in acute ischemic stroke patients. A total of 871 patients with acute ischemic stroke within 24 h of symptom onset were recruited from the Third Affiliated Hospital of Qiqihar Medical University between 2013 and 2016. Within 6 days of hospitalization, blood pressure was continuously measured from 8:00 to 9:00 every day, and the coefficient of variation (CV) of blood pressure was calculated (including systolic blood pressure [SBP] and diastolic blood pressure [DBP]). The modified Rankin scale was used to evaluate early functional outcomes at discharge. The coefficients of variation of SBP, DBP, and functional outcomes were included as primary outcome variables. Demographic characteristics and medical history were recorded as secondary outcome variables. We found that a greater CV level of SBP and DBP were associated with the poor early functional outcome at hospital discharge, and the odds ratio (OR) and 95% confidence interval (95%CI) of them were 1.56 (1.04–2.35) and 1.99 (1.31–3.03) respectively. A higher standard deviation (SD) of SBP and DBP significantly increased risk of poor early prognosis, OR (95%CI) was 1.78 (1.17–2.71) and 2.25 (1.47–3.45) respectively. Similar results were observed for SBP and DBP. The larger the range of SBP and DBP, the worse is the prognosis. In conclusion, the present study suggests that high BPV is a risk factor for poor early prognosis in acute ischemic stroke.
Multi-center study of residual gastric volume and bowel preparation after the usage of 1L and 2L polyethylene glycol in Korea
Authors: Park Yong Eun , Jeong Su Jin , Lee Jin , Park Jongha , Yu Seung Jung , Jee Sam Ryong , Kim Tae Oh
Published: September 2022

Background:

In colonoscopy, good bowel preparation is an important factor in determining the quality of colonoscopy. However, an increase in residual gastric volume (RGV) can lead to a higher risk of aspiration pneumonia. Therefore, the purpose of this study was to investigate the factors related to an increase in RGV with the usage of 1L polyethylene glycol (PEG).

Methods:

We prospectively analyzed 268 patients who underwent both gastroscopy and colonoscopy at 2 hospitals from May to October 2021. Bowel preparation was performed using 1L in 127 patients (47.4%) and 2L PEG in 141 patients (52.6%). We investigated the time taken for bowel preparation solutions, the last water intake, total water intake, and RGV, and conducted a survey on taking compliance and satisfaction.

Results:

The level of RGV was significantly increased in the 1L PEG group when compared to the 2L PEG group (1L, 52.26 ± 65.33 vs 2L, 23.55 ± 22.99; P < .001). There was no difference between the 2 groups in the degree of bowel preparation, but there were more bubbles formed in the 1L group (1L, 1.91 ± 2.74 vs 2L, 1.10 ± 2.02; P = .007). In the case of RGV ≥ 50 mL, in multivariate analysis, the risk was higher in water intake within 5 hours and the patients who think the dose is too high (all P < .05).

Conclusion:

Therefore, since RGV is higher in 1L PEG than in 2L PEG, it is necessary to be careful not to take water for at least 5 hours before the test.
Effects of preoperative personal education on shoulder function and lymphedema in patients with breast cancer: A consort
Authors: Byun Hayoung , Jang Yunjeong , Kim Ju-Yeon , Kim Jae-Myung , Lee Chang Han
Published: September 2022

Background:

To compare the incidence and severity of ipsilateral shoulder dysfunction and lymphedema of 2 groups of patients needing to undergo unilateral breast cancer surgery, one of which had only received printed education materials and the other group which had received educational materials plus preoperative education.

Methods:

We selected 61 patients who had been diagnosed with unilateral breast cancer and planned to undergo surgery. Before surgery, patients were randomly assigned, either to a control group that only received printed education materials about exercise for shoulder pain relief and lymphatic edema prevention following breast cancer surgery, or to an experimental group that received the printed education material with personal education. Participants were evaluated at 1, 3, 6, and 12 months after the surgery. To evaluate the impairment of shoulder function, we measured the passive shoulder range of motion (ROM), the degree of pain as visual analog scale (VAS), the short version of the disability of arm, shoulder, and hand (short DASH) scores, and the shoulder pain and disability index (SPADI). We checked arm circumferences to evaluate lymphedema.

Results:

There was no significant difference in demographic or clinical variables between the control and experimental groups. The experimental group showed significantly less limitation in abduction (P = .042) and forward flexion (P = .039) in the 6 months following surgery. Change in the VAS, short DASH, and SPADI scores were 1.633 (P < .001), 2.167 (P < .001), and 4.1 (P = .003) at 1 month following surgery, respectively. These then decreased with time. These changes started before shoulder ROM and arm circumference changes had occurred, which had started 3 months following surgery.

Conclusions:

Preoperative education might be helpful for the prevention of a shoulder ROM limitation, and we need to focus on pain and disability in patients immediately following breast cancer surgery, and then on ROM and lymphedema.
Does the clamping method in local and systemic TXA applications in total knee arthroplasty change the game?: A retrospective comparative cohort study
Authors: Turan Kaya , Muratoğlu Osman Görkem , Ergün Tuğrul , Çabuk Haluk , Ertürer Ramazan Erden
Published: September 2022

Many different methods and drain clamping periods have been described in systemic and local tranexamic acid (TXA) applications, and the superiority of the methods to each other has not been clearly demonstrated. The method of local infusion in combined TXA applications may not alter the Hb drop or total or hidden blood loss. We aim to compare two different combined TXA application methods. We retrospectively analyzed 182 patients who underwent total knee arthroplasty between 2018 and 2021. Patients over 40 years of age who underwent TKA for degenerative knee arthritis were included in the study. Unicondylar, revision, or bilateral arthroplasties and patients with the cardiovascular or cerebrovascular disease were excluded from the study. All patients in the study received 1 g TXA intravenously half an hour before the incision. For the first group, 1 g TXA was given intra-articularly at the drain site after closure, and the clamp was kept closed for 1 hour. In the second group, the drain was clamped for an additional 6 hours, and a 1 g intravenous dose was administered at the 5th hour postoperatively. No local applications were used in the control group. Total, hidden, and visible blood loss (total blood loss, hidden blood loss, visible blood loss), postoperative decreases in hemoglobin and hematocrit level (ΔHgb, ΔHtc), blood transfusion rates, and hospital stay durations were evaluated. There were 72 patients in the first group, 52 in the second, and 58 in control. A total of 37 patients received one or more blood transfusions postoperatively, and there was no statistical difference in the need for blood transfusions between the groups (P = .255). Although a statistically significant difference (P = .001) in total blood loss, hidden blood loss, visible blood loss and ΔHgb values was observed between the groups, the difference between the first and second groups was insignificant (P = .512). The duration of hospital stay was observed to be less in the first and second groups (P = .024). Local and systemic TXA applications were observed to be more effective than only systemic applications in reducing blood loss after total knee arthroplasty, regardless of the local method.
A nomogram for predicting overall survival rate in patients with brain metastatic non-small cell lung cancer
Authors: Peng Shanshan , Xiao Yu , Li Xinjun , Wu Zhanling
Published: September 2022

The purpose was to develop a nomogram for the prediction of the 1- and 2-year overall survival (OS) rates in patients with brain metastatic non-small cell lung cancer (BMNSCLC).

Patients were collected from the Surveillance Epidemiology and End Results program (SEER) and classified into the training and validation groups. Several independent prognostic factors identified by statistical methods were incorporated to establish a predictive nomogram. The concordance index (C-index), the area under the receiver operating characteristics curve (AUC), and calibration curve were applied to estimate predictive ability of the nomogram. To compare the clinical practicability of the nomogram and TNM staging system by decision curve analysis (DCA).

A total of 24,164 eligible patients were collected and assigned into the training (n = 16,916) and validation groups (n = 7248). Based on the prognostic factors, we developed a nomogram with good discriminative ability. The C-indices for training and validation group were 0.727 and 0.728. The AUCs of 1- and 2-year OS rates were both 0.8, and the calibration curves also demonstrated good performance of the nomogram. DCA illustrated that the nomogram provided clinical net benefit compared with the TNM staging system.

We developed a predictive nomogram for more accurate and comprehensive prediction of OS in BMNSCLC patients, which can be a useful and convenient tool for clinicians to make proper clinical decisions, and adjust follow-up management strategies.
High expression of AFAP1-AS1 is associated with poor prognosis of digestive system cancers: A meta-analysis
Authors: Xu Xiaona , Duan Fujiao , Xu Liran , Ng Shiutin , Li Yongwei , Li Yanan , Wang Xiaoge , Long Tianjian , Ding Nana , Xu Erping
Published: September 2022

Background:

Actin filament-associated protein 1 antisense RNA 1 (AFAP1-AS1) is associated with prognosis in many cancers. The aim of this study was to systematically evaluate the potential correlation between AFAP1-AS1 and the prognosis of digestive system cancers (DSC).

Methods:

EMBASE, Web of Science, Cochrane Library, PubMed, Wanfang Data (Chinese), and CNKI (Chinese) were comprehensively searched for literature published from the establishment of the database to September 2021.All case-control studies that met the inclusion criteria were retrieved; additionally manual retrieval and literature tracing was performed. After extracting the relevant data, Revman 5.3.5 software was used for meta-analysis.

Results:

Eighteen studies were included in analyses, high expression of AFAP1-AS1 was significantly correlated with poor prognosis in DSC, including overall survival (HR = 1.93, 95% CI: 1.72–2.17, P < .001) and disease-free survival/progression-free survival (HR = 1.87, 95% CI: 1.56–2.26, P < .001). In addition, the expression of AFAP1-AS1 was significantly correlated with tumor size, tumor stage, and lymph node metastasis.

Conclusion:

High expression of AFAP1-AS1 was associated with poor prognosis in DSC. Therefore, it could be used as a potential marker for evaluating prognosis in DSC
COVID-19-related conspiracy beliefs and their determinants among 18 to 45 years old: A cross-sectional study
Authors: Al-Qudah Mohammad A. , Al-Shaikh Ala’a F. , Hamouri Shadi , Haddad Husam , AbuRashed Samah , Zureikat Zaid A.
Published: September 2022

The existence of conspiracy beliefs has been previously linked to multiple individual traits and factors, such as anxiety, lack of information, education, and social factors. This study aims to explore the factors and variables influencing the individual’s susceptibility to conspiratorial thinking, as well as the impact of COVID-19 conspiracy belief on the adoption of public health and social measures. This study explores the factors influencing the susceptibility to conspiratorial thinking and the impact of conspiracy theories on the adoption of public health and social measures. A sample of university students, fresh-graduates, and mid-career professionals between the age of 18 to 45 years old completed an online survey measuring COVID-19 conspiracy beliefs and stress levels. A total of 2417 completed a survey targeting COVID-19 conspiracy beliefs, perceived stress, and demographic information. The results show that COVID-19 conspiracy beliefs were related to education, unemployment, and COVID-19 level of exposure. Meanwhile, conspiracy beliefs had no relation to the individual’s perceived self-reported stress. Higher conspiracy scores were related to lower adoption of preventive measures and increased hesitancy towards COVID-19 vaccination. Lack of knowledge and misinformation actions play a vital role in the generation of conspiracy theories surrounding the COVID-19 pandemic.
Prevalence and factors associated with COVID-19 among healthcare workers at a university hospital in Thailand
Authors: Sirijatuphat Rujipas , Leelarasamee Amorn , Horthongkham Navin
Published: September 2022

Globally, healthcare workers (HCWs) have a high risk of SARS-CoV-2 infection, but less is known about healthcare workers in Thailand. We estimated the prevalence and risk factors for COVID-19 among HCWs in Bangkok, Thailand. A retrospective cohort study was conducted at a large tertiary care academic hospital in Thailand from May 2020 to May 2021. HCWs that presented with fever and/or acute respiratory tract symptoms who tested with RT-PCR were identified, and their clinical data were collected. There were 1432 HCWs with fever and/or acute respiratory tract symptoms during May 2020 and May 2021. A total of 167 patients were front-line HCWs and 1265 were non-front-line HCWs. Sixty HCWs (4.2%) developed COVID-19; 2 were front-line and 58 were non-front-line HCWs. The prevalence of COVID-19 in front-line HCWs was 1.7% (2/167), and 4.6% (58/1265) in non-front-line HCWs (P = .04). In addition, non-front-line HCWs, non-medical staffs, history of contact with a confirmed COVID-19 case at home/family, unvaccinated status, fair compliance to personal protective equipment (PPE) standard, and initial presentation with pneumonia were significantly more common in HCWs with COVID-19 than those without COVID-19 (P < .05). Front-line HCWs, history of contact with a confirmed COVID-19 case at the clinical care areas in the hospital, vaccinated status, good compliance to PPE standards, and initial presentation with upper respiratory infection were significantly more common in HCWs without COVID-19 than those with COVID-19 (P < .05). Multivariate analysis revealed history of exposure with confirmed COVID-19 case at home or in family, unvaccinated status, non-frontline-HCWs, non-medical staffs, and fair compliance to PPE standard to be independent factors associated with COVID-19 in HCWs. COVID-19 was more common in non-front-line HCWs at this tertiary hospital. Thai guidelines on infection prevention and control for COVID-19 seem to be effective in preventing SARS-CoV-2 transmission. Therefore, the adherence to these recommendations should be encouraged.
Propofol-based total intravenous anesthesia is associated with better survival than desflurane anesthesia in limb-salvage surgery for osteosarcoma: A retrospective analysis
Authors: Sun Ting-Yi , Hsu Chun-Liang , Lee Meei-Shyuan , Yeh Tsu-Te , Lai Hou-Chuan , Wu Ke-Li , Wu Zhi-Fu , Tseng Wei-Cheng
Published: September 2022

Previous studies have demonstrated that anesthetic techniques can affect the outcomes of cancer surgery. We investigated the association between anesthetic techniques and patient outcomes after elective limb-salvage surgery for osteosarcoma (OS). This was a retrospective cohort study of patients who underwent elective limb-salvage surgery for OS between January 2007 and December 2018. Patients were grouped according to the administration of propofol-based total intravenous anesthesia (TIVA) or desflurane (DES) anesthesia. Kaplan–Meier analysis was performed, and survival curves were constructed from the date of surgery to death. Univariate and multivariate Cox regression models were applied to compare the hazard ratios (HRs) for death after propensity matching. Subgroup analyses were done for postoperative recurrence, metastasis, and tumor–node–metastasis (TNM) staging. A total of 30 patients (17 deaths, 56.7%) who received DES anesthesia and 26 (4 deaths, 15.4%) who received TIVA were eligible for analysis. After propensity matching, 22 patients were included in each group. In the matched analysis, patients who received TIVA had better survival with a HR of 0.30 (95% confidence interval [CI], 0.11–0.81; P = .018). Subgroup analyses also showed significantly better survival in the presence of postoperative metastasis (HR, 0.24; 95% CI, 0.06–0.87; P = .030) and with TNM stage II to III (HR, 0.26; 95% CI, 0.09–0.73; P = .011) in the matched TIVA group. In addition, patients administered with TIVA had lower risks of postoperative recurrence and metastasis than those administered with DES anesthesia in the matched analyses. Propofol-based TIVA was associated with better survival in patients who underwent elective limb-salvage surgery for OS than DES anesthesia. Prospective studies are needed to assess the effects of TIVA on oncological outcomes in patients with OS.
Associations between insomnia and central sensitization in cancer survivors undergoing opioid therapy for chronic cancer pain: A STROBE-compliant prospective cohort study
Authors: Akui Chiaki , Kimura Takeshi , Hirose Munetaka
Published: September 2022

Several risk factors for insomnia in cancer patients have been recognized, including chronic pain and treatment with opioid. Although associations between insomnia and central sensitization were previously reported in patients with chronic non-cancer pain, those have not been elucidated among cancer survivors undergoing opioid therapy for chronic cancer pain. To investigate the associations between insomnia and central sensitization among cancer survivors undergoing opioid therapy for chronic cancer pain, consecutive patients undergoing chemotherapy with chronic cancer pain under opioid therapy on an outpatient basis were enrolled from September 2019 to August 2020 and answered questions from the Athens Insomnia Scale (AIS) for assessing insomnia. Pain characteristics, including pain intensity, neuropathic pain, central sensitization assessed using the central sensitization inventory (CSI), opioid use disorder, and pain-related psychological symptoms were also examined. Uni- and multivariate regression analyses were performed to elucidate correlations between the AIS score and these pain characteristics. Of 44 enrolled patients, 20 patients completed to answer all questions. Insomnia was identified in 9 patients (45%). Although AIS scores showed no significant associations with pain intensity, neuropathic pain, opioid use disorder, or psychological symptoms, multivariate regression analysis revealed that CSI scores showed a positive relationship with AIS scores (P = .004). Discrimination was assessed using linear regression analysis which confirmed a significant association between the AIS and CSI scores (P = .002). Insomnia appears to be associated with central sensitization in cancer survivors with chronic cancer pain under opioid therapy.
Radiomics approach based on biphasic CT images well differentiate “early stage” of adrenal metastases from lipid-poor adenomas: A STARD compliant article
Authors: Cao Lixiu , Xu Wengui
Published: September 2022

The aim of the study was to develop an optimal radiomics model based on abdominal contrast-enhanced computed tomography (CECT) for pre-operative differentiation of “early stage” adrenal metastases from lipid-poor adenomas (LPAs). This retrospective study included 188 patients who underwent abdominal CECT (training cohort: LPAs, 68; metastases, 64; validation cohort: LPAs, 29; metastases, 27). Abdominal CECT included plain, arterial, portal, and venous imaging. Clinical and CECT radiological features were assessed and significant features were selected. Radiomic features of the adrenal lesions were extracted from four-phase CECT images. Significant radiomics features were selected using the least absolute shrinkage and selection operator (LASSO) and multivariable logistic regression. The clinical-radiological, unenhanced radiomics, arterial radiomics, portal radiomics, venous radiomics, combined radiomics, and clinical-radiological-radiomics models were established using a support vector machine (SVM). The DeLong test was used to compare the areas under the receiver operating characteristic curves (AUCs) of all models. The AUCs of the unenhanced (0.913), arterial (0.845), portal (0.803), and venous (0.905) radiomics models were all higher than those of the clinical-radiological model (0.788) in the testing dataset. The AUC of the combined radiomics model (incorporating plain and venous radiomics features) was further improved to 0.953, which was significantly higher than portal radiomics model (P = .033) and clinical-radiological model (P = .009), with the highest accuracy (89.13%) and a relatively stable sensitivity (91.67%) and specificity (86.36%). As the optimal model, the combined radiomics model based on biphasic CT images is effective enough to differentiate “early stage” adrenal metastases from LPAs by reducing the radiation dose.
Meta-analysis of the efficacy of probiotics to treat diarrhea
Authors: Wang Fujie , Zhao Ting , Wang Weiwei , Dai Qianqian , Ma Xianghua
Published: September 2022

Background:

To collect the published trials of probiotics in the treatment of diarrhea and to strictly evaluate and systematically analyze the efficacy of probiotics use for the prevention and treatment of patients with diarrhea.

Methods:

We searched domestic and foreign literature published between January 2016 and July 2022 to find randomized control trials that used probiotics to treat diarrhea. Only studies published in English were considered. The quality of the included literatures was assessed by using the methods provided in the Cochrane Handbook. Valid data were extracted and analyzed by meta- analysis using the Software RevMan5.2.

Results:

Total 16 trials and 1585 patients were included. The results of the meta- analysis showed that in comparison with the simple Western medicine treatment group or placebo, the added use of probiotics could improve stool frequency, stool morphology, and related irritable bowel syndrome symptoms.

Conclusion:

The added use of probiotics can further improve clinical outcomes in the patients with diarrhea; however, the implementation of larger and higher quality clinical trials is necessary to verify this conclusion.
Anal and Oral Sex Behaviors Among Young Black Men Who Have Vaginal Sex: Evidence of the Need for Extragenital Testing for Chlamydia and Gonorrhea
Authors: Ratnayake Aneeka , Campbell Mary Beth , Jones Austin , Gomes Gérard , Martin David H. , Kissinger Patricia J.
Published: September 2022

Background

Unprotected oral and anal sex may result in extragenital sexually transmitted infections. The purposes of this study were to describe sexual behaviors, barrier use, and chlamydia/gonorrhea (Ct/GC) positivity among young Black men who have sex with women, and to examine the potential influence of extragenital infections on genital infections.

Methods

Young Black men who had vaginal sex were screened for Ct/GC in New Orleans, LA, from August 14, 2019, to February 29, 2020. Audio/computer-assisted self-interviews were used to collect data on demographics and sexual behaviors. χ
2/Fisher exact or t test/Wilcoxon rank tests were used to assess differences in behaviors by Ct/GC positivity.

Results

Among 373 men studied, 619 female partnerships were reported in the past 2 months. Vaginal sex was reported in all partnerships per study protocol, receiving fellatio in 42.7%, performing cunnilingus in 35.7%, and penile-anal sex in 5.9%. Although 31.4% of the men consistently used condoms for vaginal sex with all partners, consistent barrier use was low during cunnilingus (0.5%) and fellatio (5.1%). Urethral infection rates among all men in the sample were 12.6% for Ct and 1.6% for GC. There was no significant difference in Ct/GC rates between those using and not using condoms consistently during vaginal sex (P = 0.38).

Conclusions

Unprotected oral sex with female partners was common. The high rate of genital infection among men who used condoms consistently for vaginal sex suggests that oral infections could be serving as a reservoir of genital infection. Testing at all sites of exposure for youth who engage in heterosexual sex is merited.
Leveraging Real-world Data to Increase Procedure Room Capacity: A Multidisciplinary Quality Improvement Project
Authors: Feldman Rachel , Low Daniel , Gorbounova Irina , Ambartsumyan Lusine , Martin Lynn
Published: September 2022

Introduction:

In the current healthcare climate, the financial strain created by COVID-19, limited resources, and case backlogs highlight the need to optimize operating and procedure room efficiency and maximize capacity. At Seattle Children’s, a clinical multidisciplinary team developed and implemented a data-driven protocol to improve efficiency in a high-volume gastrointestinal (GI) suite.

Methods:

Key process measures, including all case on-time starts and postanesthesia care unit length of stay, were extracted from the electronic medical record and presented as Statistical Process Control (SPC) charts. Clinicians’ performance was stratified by rational subgrouping to better understand variation in the system. We defined an expert clinician as one who performs beyond 3-sigma limits on funnel plot analyses. We developed clinical protocols based on expert clinician clinical practices. We gave clinicians dynamic, daily feedback on this family of measures through continuously updated SPC charts. This real-world data drove system and individual-level plan-do-check-act improvement cycles.

Results:

Despite significant external challenges over 2 years, procedure volume increased by approximately 25%, on-time starts improved by 36%, turnover time decreased by 34%, and postanesthesia care unit length of stay decreased by 15%. GI laboratory revenue increased by approximately 25% (independent of increased charges per procedure), representing the potential for a $2 million increase in annual revenue.

Conclusions:

A multidisciplinary clinical team improved efficiency metrics in a busy pediatric GI suite. Access to real-world data through continuously updated SPC charts enabled plan-do-check-act cycles that led to measurable improvement. This data access also served to sustain team motivation and engagement.
BLOSSoM: Improving Human Milk Provision in Preterm Infants Through Texting Support
Authors: Hayashi Madoka , Huber Kelly , Rankin Colette , Boyajian Brittany , Martinez Angelena , Grover Theresa , Roosevelt Genie
Published: September 2022

Introduction:

Mother’s own milk (MOM) reduces complications of preterm birth. Despite high initiation rates of expression, half of preterm infants do not receive MOM at discharge. Frequent outreach and a short message service (SMS) have improved MOM provision in term dyads. We aimed to improve MOM provision rate from 61% to >80% by implementing standardized lactation education and Breastfeeding & Lactation Outreach via SMS Supporting Mothers (BLOSSoM).

Methods:

The baseline period was June 2019 to April 2020. A multidisciplinary team implemented PDSA cycles: education/documentation (standardized lactation education and education documentation, May 2020–April 2021), and BLOSSoM (SMS program providing educational texts/videos, reminders, 2-way communication with neonatal intensive care unit (NICU) lactation, May 2021–December 2021). The primary outcome was MOM provision at NICU discharge/transfer for infants younger than 34 weeks, as analyzed on the SPC chart. BLOSSoM participants evaluated the program using a 5-point Likert scale.

Results:

Demographic and clinical characteristics were unchanged among the three periods. However, the monthly MOM provision rate improved from 61% to 81%. Eighty-seven percent of BLOSSoM participants completed the evaluation with 83% rating the program most supportive, 78% rating the videos as the most helpful, followed by team check-ins (54%) and 2-way texting (24%).

Conclusions:

Using a multidisciplinary approach, we improved the monthly MOM provision rate at discharge/transfer for preterm infants. SMS providing educational texts/media and 2-way communication supporting lactating NICU mothers was critical to our success. Providing another method of communication through SMS was well accepted and valued by the majority.
CD4:CD8 Ratio and CD8 Cell Count and Their Prognostic Relevance for Coronary Heart Disease Events and Stroke in Antiretroviral Treated Individuals: The Swiss HIV Cohort Study
Authors: Chammartin Frédérique , Darling Katharine , Abela Irene A. , Battegay Manuel , Furrer Hansjakob , Calmy Alexandra , Bernasconi Enos , Schmid Patrick , Hoffmann Matthias , Bucher Heiner C. ,   and the Swiss HIV Cohort Study
Published: September 2022

Introduction:

HIV infection leads to a persistent expansion of terminally CD8 T cells and CD8 T suppressor cells, a marker of chronic immune activation leading to a low CD4:CD8 ratio that may persist in the presence of potent antiretroviral therapy and regained CD4 helper cells. It remains unclear whether a low CD4:CD8 ratio is associated with cardiovascular diseases.

Methods:

We conducted an observational cohort study to investigate the association of immune depression and activation as characterized by the proxy of the CD4:CD8 ratio on the hazard of coronary heart disease (CHD) and stroke among treated individuals living with HIV, while accounting for viral load and known risk factors for cardiovascular diseases and exposure to abacavir or protease inhibitors. We used Cox proportional hazard models with time-dependent cumulative and lagged exposures to account for time-evolving risk factors and avoid reverse causality.

Results:

CD4, CD8, and CD4:CD8 immunological markers were not associated with an increased hazard for CHD. CD8 cell count lagged at 12 months above 1000 cells per μL increased the hazard of stroke, after adjusting for sociodemographics, cardiovascular risk factors, and exposure to specific types of antiretroviral drugs.

Conclusions:

This analysis of treated HIV-positive individuals within a large cohort with long-term follow-up does not provide evidence for a prognostic role of immune dysregulation regarding CHD. However, increased CD8 cell count may be a moderate risk factor for stroke. Early detection and treatment of HIV-positive individuals are crucial for an optimal immune restoration and a limited CD8 cells expansion.
Health Insurance Coverage, Clinical Outcomes, and Health-Related Quality of Life Among Youth Born to Women Living With HIV
Authors: Lemon Tiffany L. , Tassiopoulos Katherine , Tsai Alexander C. , Cantos Krystal , Escudero Dan , Quinn M.K. , Kacanek Deborah , Berman Claire , Salomon Liz , Nichols Sharon , Chadwick Ellen G. , Seage George R. , Williams Paige L. ,   for the Pediatric HIV/AIDS Cohort Study (PHACS)
Published: September 2022

Background:

Although sustained access to health care is essential, little is known about the relationship between insurance coverage and health among people born to women living with HIV (WLHIV).

Setting:

Prospective cohort studies of youth and young adults born to WLHIV from 2007 to 2019.

Methods:

We used adjusted generalized estimating equation models to estimate mean differences in, and relative risks (RRs) of, health-related quality of life (HR-QoL) and HIV disease measures over time by insurance status. HR-QoL scales with limited variability were dichotomized. Modified Poisson models were used to estimate RRs.

Results:

Six hundred sixty-nine Adolescent Master Protocol (AMP) youth [66% living with perinatally-acquired HIV (PHIV), 72% Black] and 939 AMP Up/AMP Up Lite young adults (89% PHIV, 68% Black) reported insurance. Most were publicly insured (87% youth, 67% young adults). Privately insured young adults living with PHIV had lower risk of antiretroviral therapy nonadherence [adjusted RR (aRR): 0.82, 95% CI: 0.70 to 0.97] than those with public insurance. There was a lower risk of suboptimal role functioning for young adults with private insurance (aRR: 0.58, 95% CI: 0.35 to 0.97) and those unaware of their coverage (aRR: 0.41, 95% CI: 0.21 to 0.78). Young adults with private insurance had higher health perception scores than those with public insurance (adjusted mean difference: 3.87, 95% CI: 0.37 to 7.38). For youth, we observed no differences in HR-QOL and HIV disease measures by insurance.

Conclusion:

These findings suggest meaningful differences in antiretroviral therapy adherence and some HR-QoL outcomes by health insurance coverage among young adults born to WLHIV.
Therapeutic Efficacy of Adipose-Derived Stem Cells Versus Bone Marrow Stromal Cells for Irradiated Mandibular Fracture Repair
Authors: Lynn Jeremy V. , Ranganathan Kavitha , Luby Alexandra O. , Urlaub Kevin M. , Donneys Alexis , Nelson Noah S. , Buchman Steven R.
Published: September 2022

Background

Mesenchymal stem cells have immense potential in applications of bone healing and regeneration. However, few studies have evaluated the therapeutic efficacy of adipose-derived stem cells (ASCs) and bone marrow stromal cells (BMSCs) in irradiated bone. The purpose of this study is to compare the ability of ASCs versus BMSCs to enhance healing outcomes in a murine model of irradiated mandibular fracture repair.

Methods

Forty-eight isogenic male Lewis rats underwent radiation therapy followed by mandibular osteotomy with intraoperative placement of either ASCs or BMSCs. Animals were killed on postoperative day 40. Mandibles were analyzed for union rate, biomechanical strength, vascularity, and mineralization. Groups were compared atP< 0.05 significance.

Results

The ASC and BMSC groups demonstrated 92% and 75% union rates. Compared with the BMSC group, the ASC group demonstrated a trending increase in maximum load (P= 0.095) on biomechanical strength analysis and a significant increase in vessel number (P= 0.001), vessel thickness (P= 0.035), and vessel volume fraction (P= 0.007) on micro–computed tomography angiography analysis. No significant differences in bone mineralization were identified on micro–computed tomography analysis.

Conclusion

This study demonstrates the superior therapeutic efficacy of ASCs over BMSCs in irradiated fracture healing as evidenced by union rate, vascular morphometry, and a trend in biomechanical strength. We posit that the robust vascular response induced by ASCs better recapitulates the sequence and synchronicity of physiologic bone healing compared with BMSCs, thereby improving the reliability of irradiated fracture repair.
The effects of timing of prehospital tranexamic acid on outcomes after traumatic brain injury: Subanalysis of a randomized controlled trial
Authors: Brito Alexandra M.P. , Schreiber Martin A. , El Haddi James , Meier Eric N. , Rowell Susan E.
Published: September 2022

BACKGROUND

Tranexamic acid (TXA) is an antifibrinolytic that has shown some promise in improving outcomes in traumatic brain injury (TBI), but only when given early after injury. We examined the association between timing of prehospital TXA administration and outcomes in patients with moderate to severe TBI.

METHODS

Patients enrolled in the multi-institutional, double-blind randomized prehospital TXA for TBI trial with blunt or penetrating injury and suspected TBI (Glasgow Coma Scale score ≤ 12, SBP ≥90) who received either a 2-g TXA bolus or a 1-g bolus plus 1 g 8 hour infusion within 2 hours of injury were analyzed. Outcomes were compared between early administration (<45 minutes from injury) and late administration ≥45 minutes from injury) using a χ2, Fischer's exact test, t test, or Mann-Whitney U test as indicated. Logistic regression examined time to drug as an independent variable. A p value less than 0.05 was considered significant.

RESULTS

Six hundred forty-nine patients met inclusion criteria (354 early and 259 late). Twenty-eight-day and 6-month mortalities, 6-month Glasgow Outcome Scale–Extended, and disability rating scale scores were not different between early and late administration. Late administration was associated with higher rates of deep venous thrombosis (0.8 vs. 3.4%, p = 0.02), cerebral vasospasm (0% vs. 2%, p = 0.01), as well as prolonged EMS transport and need for a prehospital airway (p < 0.01).

CONCLUSION

In patients with moderate or severe TBI who received TXA within 2 hours of injury, no mortality benefit was observed in those who received treatment within 45 minutes of injury, although lower rates of select complications were seen. These results support protocols that recommend TXA administration within 45 minutes of injury for patients with suspected TBI.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level II.
Challenges in closing the gap between evidence and practice: International survey of institutional surgical stabilization of rib fractures guidelines
Authors: Choi Jeff , Badrinathan Avanti , Shine Ryan , Benz Cecilia , Toia Alyssa , Crown Thomas , Whitbeck Sarah Ann , Kryskow Mark , White Thomas , Kirsch Jordan
Published: September 2022

BACKGROUND

Surgical stabilization of rib fractures (SSRF) has gained increasing interest over the past decade, yet few candidates who could benefit from SSRF undergo operative management. We conducted an international survey of institutional SSRF guidelines comparing congruence between practice and contemporary evidence. We hypothesized that few guidelines reflect comprehensive evidence to facilitate standardized patient selection, operation, and postoperative management.

METHODS

A request for institutional rib fracture guidelines was distributed from the Chest Wall Injury Society. Surgical stabilization of rib fractures–specific guideline contents were extracted using a priori-designed extraction sheets and compared against 28 SSRF evidence-based recommendations outlined by a panel of 14 international experts. Fisher's exact test compared the proportion of strong and weak evidence-based recommendations specified within a majority of institutional guidelines to evaluate whether strength of evidence is associated with implementation.

RESULTS

A total of 36 institutions from 3 countries submitted institutional rib fracture management guidelines, among which 30 had SSRF-specific guidance. Twenty-eight guidelines (93%) listed at least one injury pattern criteria as an indication for SSRF, while 22 (73%) listed pain and 21 (70%) listed impaired respiratory function as other indications. Quantitative pain and respiratory function impairment thresholds that warrant SSRF varied across institutions. Few guidelines specified nonacute indications for SSRF or perioperative considerations. Seven guidelines (23%) detailed postoperative management but recommended timing and interval for follow-up varied. Overall, only 3 of the 28 evidence-based SSRF recommendations were specified within a majority of institutional practice guidelines. There was no statistically significant association (p = 0.99) between the strength of recommendation and implementation within institutional guidelines.

CONCLUSION

Institutional SSRF guidelines do not reflect the totality of evidence available in contemporary literature. Guidelines are especially important for emerging interventions to ensure standardized care delivery and minimize low-value care. Consensus effort is needed to facilitate adoption and dissemination of evidence-based SSRF practices.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level IV.