bluuebunny/crossref_metadata_2025 huggingface dataset:
Long‐term prognosis of enteral feeding and parenteral nutrition in a population aged 75 years and older: a population‐based cohort study
Authors: Tsugihashi Yukio , Akahane Manabu , Nakanishi Yasuhiro , Myojin Tomoya , Kubo Shinichiro , Nishioka Yuichi , Noda Tatsuya , Hayashi Shuichiro , Furihata Shiori , Higashino Tsuneyuki , Imamura Tomoaki
Published: January 2021

Background

Enteral feeding and parenteral nutrition (PN) using gastrostomy (GS) and a nasogastric tube feeding (NGT) and PN should be initiated for older patients based on their prognoses. This study aimed to investigate the long-term prognosis of patients aged ≥75 years who underwent enteral feeding via GS and NGT as well as PN.

Methods

A population-based cohort study was conducted using Japan’s universal health insurance claims in the Nara Prefecture. This study enrolled 3,548 patients aged ≥75 years who received GS (N=770), NGT (N=2,370), and PN (N=408) during hospital admissions between April 2014 and March 2016. The GS group was further categorized into secondary GS (N=400) with preceding NGT or PN within 365 days and primary GS (N=370) without preceding NGT or PN groups. In the secondary GS group, 356 (96%) patients received NGT (versus PN). The outcome was mortality within 730 days after receiving GS, NGT, and PN. Cox regression analyses in cases with or without malignant diseases, adjusted for sex, age, comorbidity, and hospital type, were performed to compare mortality in the groups.

Results

Of the 3,548 participants, 2,384 (67%) died within 730 days after the initiation of GS and NGT and PN. The 2-year mortality rates in the secondary GS, primary GS, NGT, and PN groups were 58%, 66%, 68%, and 83% in patients without malignancies and 67%, 71%, 74%, and 87% in those with malignancies, respectively. In the non-malignant group, Cox regression analysis revealed that secondary GS (hazard ratio (HR) = 0.43, 95% CI: 0.34–0.54), primary GS (HR = 0.51, 95% CI: 0.40–0.64), and NGT (HR = 0.71, 95% CI: 0.58-0.87) were statistically significantly associated with lower mortality compared with PN.

Conclusions

Approximately 58% to 87% patients aged ≥75 years died within 730 days after initiation of nutrition through GS, NGT, or PN. Patients with non-malignant diseases who received secondary GS exhibited better 2-year prognosis than those who received NGT or PN. Healthcare professionals should be aware of the effectiveness and limitations of enteral feeding and PN when considering their initiation.
Integrating Xpert MTB/RIF for TB diagnosis in the private sector: evidence from large-scale pilots in Patna and Mumbai, India
Authors: Deo Sarang , Jindal Pankaj , Papineni Sirisha
Published: January 2021

Background

Xpert MTB/RIF (Xpert) has been recommended by WHO as the initial diagnostic test for TB and rifampicin-resistance detection. Existing evidence regarding its uptake is limited to public health systems and corresponding resource and infrastructure challenges. It cannot be readily extended to private providers, who treat more than half of India’s TB cases and demonstrate complex diagnostic behavior.

Methods

We used routine program data collected from November 2014 to April 2017 from large-scale private sector engagement pilots in Mumbai and Patna. It included diagnostic vouchers issued to approximately 150,000 patients by about 1400 providers, aggregated to 18,890 provider-month observations. We constructed three metrics to capture provider behavior with regards to adoption of Xpert and studied their longitudinal variation: (i) Uptake (ordering of test), (ii) Utilization for TB diagnosis, and (iii) Non-adherence to negative results. We estimated multivariate linear regression models to assess heterogeneity in provider behavior based on providers’ prior experience and Xpert testing volumes.

Results

Uptake of Xpert increased considerably in both Mumbai (from 36 to 60.4%) and Patna (from 12.2 to 45.1%). However, utilization of Xpert for TB diagnosis and non-adherence to negative Xpert results did not show systematic trends over time. In regression models, cumulative number of Xpert tests ordered was significantly associated with Xpert uptake in Patna and utilization for diagnosis in Mumbai (p-value< 0.01). Uptake of Xpert and its utilization for diagnosis was predicted to be higher in high-volume providers compared to low-volume providers and this gap was predicted to widen over time.

Conclusions

Private sector engagement led to substantial increase in uptake of Xpert, especially among high-volume providers, but did not show strong evidence of Xpert results being integrated with TB diagnosis. Increasing availability and affordability of a technically superior diagnostic tool may not be sufficient to fundamentally change diagnosis and treatment of TB in the private sector. Behavioral interventions, specifically aimed at, integrating Xpert results into clinical decision making of private providers may be required to impact patient-level outcomes.
Gender difference in quality of life (QoL) among outpatients with schizophrenia in a tertiary care setting
Authors: Shafie Saleha , Samari Ellaisha , Jeyagurunathan Anitha , Abdin Edimansyah , Chang Sherilyn , Chong Siow Ann , Subramaniam Mythily
Published: January 2021

Background

Patients with mental illness report lower quality of life (QoL) compared to the general population. Prior research has found several differences in clinical features and experiences of male and female patients with schizophrenia. Given these differences, it is also important to explore if there are any gender differences in terms of their QoL. This study aimed to investigate differences in QoL between and within each gender among outpatients with schizophrenia in Singapore.

Methods

A total of 140 outpatients were recruited through convenience sampling at the Institute of Mental Health, Singapore. QoL was measured using the brief version of World Health Organization Quality of Life (WHOQOL-BREF) which consists of four domains: physical health, psychological health, social relationships, and environment. QoL scores of males and females were compared using independent t-tests, and multiple linear regressions were used to examine sociodemographic correlates of QoL in the overall sample and within each gender.

Results

There was no significant difference in QoL domain scores between genders. Among males, Indian ethnicity (versus Chinese ethnicity) was positively associated with physical health (β=3.03, p=0.018) while males having Technical Education/ Diploma/ A level education (versus Degree and above) were positively associated with social relationships domain (β=2.46, p=0.047).

Among females, Malay ethnicity (versus Chinese ethnicity) was positively associated with physical health (β=1.95, p=0.026) psychological health (β=3.21, p=0.001) social relationships (β=2.17, p=0.048) and environment (β=2.69, p=0.006) domains, while females who were separated/divorced (versus single) were inversely associated with psychological health (β=− 2.80, p=0.044) and social relationships domains (β=− 4.33, p=0.011). Females who had Secondary and below education (versus Degree and above) were inversely associated with social relationships (β=− 2.29, p=0.028) and environment domains (β=− 1.79, p=0.048).

Conclusions

The findings show the importance of treatments targeting QoL to attend to both the clinical features of the illness as well patient’s sociodemographic characteristics.
The use of inappropriate anal douching tool associates with increased HIV infection among men who have sex with men: a cross-sectional study in Shenyang, China
Authors: Chu Zhen Xing , Shen Guangquan , Hu Qinghai , Wang Hongyi , Zhang Jing , Dong Willa , Jiang Yongjun , Geng Wenqing , Shang Hong , Xu Junjie
Published: January 2021

Background

Rectal douching (RD) is widely practiced by men who have sex with men (MSM), and is associated with increased risk of HIV infection. However, the mechanism of how RD increases the risk of HIV infection is not well understood, and there is limited data on RD behavior in MSM practicing anal sex in China. We examine the purpose of RD, its timing in relation to anal sex, the types of RD products used, and risky sexual behaviors among MSM reporting anal sex.

Methods

Between August 2017 and December 2018, a cross-sectional study was conducted among adult MSM in Shenyang, China. Data were collected on demographics, sexual behaviors, and RD for the most recent sexual intercourse by means of interviewer-administered face-to-face questionnaires. Blood samples were collected to test for antibodies to HIV and syphilis. Multivariable logistic regression models were used to assess the risk factors associated with HIV infection.

Results

A total of 515 eligible MSM participated in this survey (median age: 31 years). During the most recent anal intercourse, 28.3% (146/515) had condomless receptive anal intercourse (CRAI), 21.4% (110/515) practiced serosorting, and more than half (61.6%, 317/515) reported RD before or after anal sex. Of those practicing RD, 96.8% (307/317) conducted RD before sex, while 62.5% (198/317) conducted RD after sex. The douching devices used were primarily shower hoses (85.3%, 262/307), and relatively few MSM used commercial RD products (8.1%, 25/307) before sex. The prevalence of HIV-1 and syphilis was 11.7% and 13.2%, respectively. HIV infection was positively associated with RD, practicing RD before sex, the interaction between RD and CRAI using a shower hose for RD and other risk factors, practicing RD after sex, CRAI, using nitrite inhalants, main sexual role with males as bottom and syphilis infection.

Conclusions

RD is popular among Chinese MSM. Improper noncommercial RD tools use (such as shower hose), the interaction effect between RD and CRAI associated with HIV infection. Public health workers and the MSM community should publicize scientific knowledge and prevention approaches relating to RD and HIV transmission to MSM. We recommend that further studies should be conducted to understand the detailed mechanism between RD and increased HIV prevalence.
Potential effect modification of RTS,S/AS01 malaria vaccine efficacy by household socio-economic status
Authors: Gyaase Stephaney , Asante Kwaku Poku , Adeniji Elisha , Boahen Owusu , Cairns Matthew , Owusu-Agyei Seth
Published: January 2021

Background

In the phase III RTS,S /AS01 trial, significant heterogeneity in efficacy of the vaccine across study sites was seen. Question on whether variations in socio - economic status (SES) of participant contributed to the heterogeinity of the vaccine efficacy (VE) remains unknown.

Methods

Data from the Phase III RTS,S /AS01 trial in children aged 5–17 months in Kintampo were re-analysed. SES of each child was derived from the Kintampo Health and Demographic Surveillance System, using principal component analysis of household assets. Extended Cox regression was used to estimate the interaction between RTS,S/AS01 VE and household SES.

Results

Protective efficacy of the RTS,S/AS0 vaccine significantly varied by participant’s household SES, thus increase in household SES was associated with an increase in protective efficacy (P-value = 0.0041). Effect modification persisted after adjusting for age at first vaccination, gender, distance from community to the health facility, child’s haemoglobin level, household size, place of residence and mothers’ educational level.

Conclusion

Household SES may be a proxy for malaria transmission intensity. The study showed a significant modification of the RTS,S/AS01 malaria vaccine efficacy by the different levels of child’s household socio - economic status.

Trial registration

Efficacy of GSK Biologicals’ candidate malaria vaccine (25049) against malaria disease in infants and children in Africa. NCT00866619 prospectively registered on 20 March 2009.
Depressive, anxiety, and burnout symptoms on health care personnel at a month after COVID-19 outbreak in Indonesia
Authors: Sunjaya Deni Kurniadi , Herawati Dewi Marhaeni Diah , Siregar Adiatma Y. M.
Published: January 2021

Background

Health care personnel (HCP) who demonstrated close contact with Corona virus disease (COVID-19) patients might experience a higher risk of infection and psychological problems. This study aims to explore depressive, anxiety, and burnout symptoms among HCP with a higher risk for psychological trauma.

Methods

This study was a cross-sectional study using secondary data from an online assessment, which was conducted 1 month after the COVID-19 outbreak. A total of 544 respondents from 21 provinces in Indonesia were included. Data on depressive, anxiety, and burnout symptoms were transformed first using the Rasch model and then categorized. Data from HCP in the higher risk group and the lower risk group were analyzed.

Results

A higher percentage of HCP experiencing depressive symptoms (22.8%), anxiety (28.1%), and burnout (26.8%) are found in the higher risk group. The chance for the higher risk group’s HCP to present with moderate and severe depressive symptoms, anxiety, and burnout are: 5.28 (Confidence interval (CI): 2.01–13.89; p < 0.05), 1.36 (CI: 0.09–1.96; p >  0.05), and 3.92 (CI: 2.08–7.40; p < 0.05) times higher, respectively. The probability for patient-induced burnout is 2.13 (CI: 1.51–3.007; p < 0.05) times higher and highest among the other burn out dimensions. The depressive symptoms complained were similar between groups: loneliness, sleep disturbances, difficulty concentrating, and inability to initiate activities. Loneliness demonstrates the highest logit value among the symptoms.

Conclusions

HCP with direct contact and responsibility to treat COVID-19 patients exhibit a higher risk to experience depressive symptoms and burnout. Communication with peers and staying in contact with family needs to be encouraged. Psychological well-being should be considered for high-risk HCP. Incentive or insurance guaranteed by the government or institution is essential as a reward and compensation during this period.
Impact of blended learning on learning outcomes in the public healthcare education course: a review of flipped classroom with team-based learning
Authors: Kang Hee Young , Kim Hae Ran
Published: January 2021

Background

A flipped classroom with team-based learning is a blended educational strategy that guides active learning inside and outside the classroom. This study aimed to verify the effects of this innovative blended educational strategy on knowledge, problem-solving ability, and learning satisfaction of undergraduate nursing students undergoing public healthcare education.

Methods

The subjects were undergraduate nursing students enrolled in H University in South Korea. The experiment was conducted over a period of 8 weeks in the public healthcare course. Two groups, blended learning (A flipped classroom with team-based learning) which was the experimental group and traditional lecture-based classroom group, the control group, were assessed. In the blended learning group, the students had pre-class, in-class (including team-based learning elements), and post-class learning elements. The two groups were compared on the following learning outcomes: knowledge, problem-solving ability, and learning satisfaction.

Results

Results showed that the blended learning instructional methods, in comparison with traditional lectures, enhanced the students’ knowledge, problem-solving ability, and learning satisfaction in the public healthcare course.

Conclusions

This study supports the feasibility of the flipped classroom with team-based learning as a blended learning strategy, able to produce improvements in nursing students’ learning outcomes. Blended learning approaches may be an effective alternative to conventional approaches in nursing education.
A study on causes of cattle liver condemnation at an abattoir in Omdurman area, Khartoum State, Sudan
Authors: Mohamed Darien Kheder Ali
Published: January 2021

Background

Information obtained from abattoirs on the causes of liver condemnation is important in preventing the spread of diseases and for promoting food security. The current study reviews three years (2009 to 2011) postmortem inspection records of cattle slaughtered at an abattoir in Omdurman, Khartoum State, Sudan. The aim was to determine the prevalence of diseases and conditions that lead to liver condemnation.

Results

From a total of 234,175 cattle slaughtered, 8,910 (3.8%) livers were condemned due to several diseases/conditions mainly fasciolosis, cysticercosis, necrosis, abscess, calcification, hemorrhages, liver cirrhosis, hydatidosis, and other miscellaneous causes. Collectively, fasciolosis was the leading cause of liver condemnation and was responsible for 51.6 % of total liver condemnations followed by necrosis (18.6%), and cysticercosis (13.5%).

Conclusions

Because of their zoonotic nature, the observed high frequency of some detected diseases/conditions is thought to pose a public health risk among consumers. This survey could be used as a regional baseline for future monitoring of control programmers against these liver diseases.
Correction to: Usefulness of speckle tracking echocardiography and biomarkers for detecting acute cellular rejection after heart transplantation
Authors: Cruz Cecilia Beatriz Bittencourt Viana , Hajjar Ludhmila A. , Bacal Fernando , Lofrano-Alves Marco S. , Lima Márcio S. M. , Abduch Maria C. , Vieira Marcelo Luiz Campos , Chiang Hsu P. , Salviano Juliana B. C. , da Silva Costa Isabela Bispo Santos , Fukushima Julia Tizue , Sbano Joao C. N. , Mathias Wilson , Tsutsui Jeane M.
Published: January 2021

An amendment to this paper has been published and can be accessed via the original article.
Thirty-three long-term survivors after cytoreductive surgery in patients with peritoneal metastases from colorectal cancer: a retrospective descriptive study
Authors: Kamada Yasuyuki , Hida Koya , Ishibashi Haruaki , Sako Shouzou , Mizumoto Akiyoshi , Ichinose Masumi , Padmanabhan Naveen , Yoshida Shinya , Yonemura Yutaka
Published: January 2021

Background

Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) improves survival in selected patients with peritoneal metastasis (PM) from colorectal cancer (CRC). However, little has been reported on characteristics and clinical course of long-term survivors with CRC-PM beyond 5 years. The objective of this study was to identify the clinical and oncological features affecting long-term survival of CRC-PM after comprehensive treatment.

Methods

Between January 1990 and April 2015, CRC-PM patients who underwent CRS with or without HIPEC in two Japanese tertiary hospitals were analyzed. Clinicopathological parameters and therapeutic details for long-term survivors (patients surviving ≥ 5 years after CRS) were described and compared with those for non-survivors (patients surviving < 5 years).

Results

The study identified 236 patients with CRC-PM who underwent CRS, with a median follow-up period of 2.5 years. Thirty-three patients (14.0%) were considered as long-term survivors. Compared with non-survivors, long-term survivors had a lower median peritoneal cancer index (PCI) [4 (1–27) vs 9 (0–39),p< 0.001]. Complete cytoreduction (CCR-0) was achieved in all long-term survivors, with a significantly higher rate [33/33 (100%) vs 141/203 (69.8%),p< 0.001]. Metachronous onsets of PM were more frequently observed in the long-term survivor group [26/33 (78.8%) vs 103/203 (50.3%),p= 0.018]. Regarding histopathology, long-term survivors more frequently had mucinous adenocarcinoma than non-survivors [8/33 (24.2%) vs 27/203 (13.3%)] and less likely exhibited poorly differentiated or signet ring cell carcinoma [2/33 (6.1%) vs 48/203 (23.7%)] (p< 0.001).

Conclusions

One in seven patients with CRC-PM achieved the long-term milestone after CRS. A long-term survival was associated with the presence of low PCI, CCR-0, metachronous onset, and mucinous histology.
Correction to: The role of microglia membrane potential in chemotaxis
Authors: Laprell Laura , Schulze Christian , Brehme Marie-Luise , Oertner Thomas G.
Published: January 2021

An amendment to this paper has been published and can be accessed via the original article.
Assessment of sexual and reproductive health knowledge and awareness among single unmarried women living in Lebanon: a cross-sectional study
Authors: Hamdanieh Maya , Ftouni Louna , Al Jardali Bara’a , Ftouni Racha , Rawas Chaymaa , Ghotmi Marina , El Zein Mohammad Hussein , Ghazi Sara , Malas Salah
Published: January 2021

Background

Sexual and reproductive health (SRH), a globally recognized fundamental health concern and a basic human right is poorly addressed and seldom researched in the Arab world. Disregarding this aspect of health creates various obstacles to accessing SRH related services and education. This threatens the health of a female, namely through increasing the probability of unplanned pregnancies and unsafe abortions, augmenting the risk of acquiring sexually transmitted infections, and most importantly, increasing the hazard of maternal and neonatal death. Thus, this study aimed to assess the level of SRH related knowledge and awareness among single unmarried women living in Lebanon.

Methods

A descriptive cross-sectional study design was conducted using a self-administered questionnaire in both English and Arabic languages. The questionnaire included 9 sections; socio-demographic characteristics section, sexually transmitted infections (STIs) section, premarital tests section, vaccines section, menstruation and its abnormalities section, pregnancy symptoms and identification section, methods of contraception section, vitamins section, and honeymoon events section.

The questionnaire was distributed among all Lebanese governorates to 491 single unmarried women living in Lebanon aged between 17 and 55 years. Student t-test and Chi-Square test were used to analyze results.

Results

It was found that only 8.8% of all the participants had adequate knowledge. The highest level of SRH related knowledge was about pregnancy (88.0%), and the least was about contraception (13.5%). Most of the knowledgeable participants lived in Beirut governorate (13.6%, n = 8) and had reached universities (10.3%, n = 41), but this was not statistically significant (p-value > 0.05). The effect of a prior visit to a gynecologist was statistically non-significant on the overall level of knowledge (p-value = 0.269).

Conclusion

Due to the inadequate level of knowledge, SRH education campaigns empowered by the Ministry of Public Health in collaboration with primary care physicians and gynecologists, are recommended in both the societal and academic sectors to enhance the awareness level and make SRH knowledge readily available among unmarried women aged between 17 and 55. Knowing the massive role of social media nowadays, the messages they present should contribute to enhancing the level of SRH knowledge and redirect attitudes and behaviors of unmarried females in Lebanon.
Release of pseudosyndactyly in recessive dystrophic epidermolysis bullosa using a dermal regeneration template glove: the Foggia experience
Authors: Lembo Fedele , Parisi Domenico , Cecchino Liberato Roberto , Ciancio Francesco , Innocenti Alessandro , Portincasa Aurelio
Published: January 2021

Background

Epidermolysis bullosa (EB) comprises a heterogeneous group of rare genetic diseases associated with skin blistering caused by minimal trauma. A major and common EB subtype, recessive dystrophic EB (RDEB), is characterized by altered wound healing, inflammatory dysbalance and fibrotic changes associated with reduced to absent collagen VII. Because of its exposed position and its continued use in daily activities, the hand is constantly at risk of microtrauma and is therefore one of the organs most affected by the disease with highly disabling deformities that represent a challenging field in hand surgery practice.

Methods

The authors present their experience in the microsurgical treatment of pseudosyndactylies comparing the classic dressing with vaseline gauze with an innovative “glove protocol” using Integra®dermal regeneration template. The endpoints analyzed were: healing times, hospital stay time, discomfort for the patient, free-recurrence interval, follow-up range and major complications.

Results

A total of 34 procedures were performed on 24 RDEB patients with hand deformities. Compared with the dressing with vaseline gauze, microsurgery followed by application of dermal regeneration template gloves allowed a significant reduction of hospital stay, healing time, and dressing pain as well as an increased recurrence-free interval.

Conclusions

The microsurgical approach followed by our new protocol described in the study has been beneficial in providing consistent and successful long-term results for these patients.
Correction to: Mir-20a-5p induced WTX deficiency promotes gastric cancer progressions through regulating PI3K/AKT signaling pathway
Authors: Li Jian , Ye Danli , Shen Peng , Liu Xiaorong , Zhou Peirong , Zhu Guifang , Xu Yangwei , Fu Yun , Li Xuanqi , Sun Jingbo , Xu Jia , Zhang Qingling
Published: January 2021

An amendment to this paper has been published and can be accessed via the original article.
Primary ovarian angiosarcoma: a rare and recognizable ovarian tumor
Authors: Ye Hong , Lin Min , Li Ruotong , Qin Shuming , Hou Gang , Chen Hongzhi , Li Xiaomei
Published: January 2021

The diagnosis of primary angiosarcoma of ovary is still a challenge as it has no specific clinical symptoms and is easily confused with other malignant neoplasms in morphology. Here, we described a case of primary ovarian angiosarcoma and reviewed the literature. A 47-year-old female showed a left ovary mass. Grossly, the cut surface of the tumor was solid and gray-white with intermediate texture. Some areas were spongy and atropurpureus with a soft texture. Microscopically, the tumor cells were arranged into a variety of different structures with visible hemorrhage. Immunochemically, the tumor cells were positive for CD31, ERG, Fli1, D2–40 and vimentin in a strong and diffused manner. CD34 stain showed focal positivity. Epithelial markers (e.g. CK, CK7, CK8/18 and PAX8) were all negative. Negative immunostaining for SMA, S-100, P53 and calretinin also were detected. The proliferative index (Ki-67) was approximately 40%. After surgery, the patient was treated with radiotherapy, targeted therapy and immunotherapy. In the 9-month follow-up, the patient was survival without evidence of disease. The diagnosis of ovarian angiosarcoma required the careful observation of morphology and the reasonable application of immunohistochemistry. Targeted therapy and immunotherapy are the potential directions for the treatment of angiosarcoma.
Early posttraumatic stress symptoms and levels of distress in trauma patients treated in the resuscitation room: an exploratory study
Authors: Reiner Iris , Beutel Manfred E. , Winter Philipp , Rommens Pol M. , Kuhn Sebastian
Published: January 2021

Background

The aim of the present study was to investigate the incidence of psychological distress and posttraumatic stress symptoms in trauma patients who have been recruited from the resuscitation room. Further, we wanted to explore risk factors for posttraumatic stress symptoms, taking different accident types into account.

Methods

Our sample consisted of 45 patients who have been treated in the resuscitation room and were interviewed within the first ten days after treatment. Type of accident, third party fault, previous mental health problems and pretraumatic stress were examined. Patients were interviewed with respect to their currently felt distress regarding the accident. Posttraumatic stress symptoms were measured with the German version of the Impact of Event Scale. Injury severity was assessed by means of the Injury Severity Score.

Results

Our exploratory and cross-sectional project reveals that more severe injuries were associated with higher distress. However, posttraumatic stress symptoms were predicted by high distress and being involved in a car accident, but not by injury severity.

Conclusions

We identified two potential risk factors for the development of posttraumatic stress in trauma patients recruited from the resuscitation room: Being involved in a car accident and high distress.

Trial registration

The project has been registered at the Study Center of Mental Disorders (SPE) at the University Medical Center Mainz (No: 92072014).
Early hemodynamic assessment using NICOM in patients at risk of developing Sepsis immediately after emergency department triage
Authors: Chukwulebe Steve B. , Gaieski David F. , Bhardwaj Abhishek , Mulugeta-Gordon Lakeisha , Shofer Frances S. , Dean Anthony J.
Published: January 2021

Background

One factor leading to the high mortality rate seen in sepsis is the subtle, dynamic nature of the disease, which can lead to delayed detection and under-resuscitation. This study investigated whether serial hemodynamic parameters obtained from a non-invasive cardiac output monitor (NICOM) predicts disease severity in patients at risk for sepsis.

Methods

Prospective clinical trial of the NICOM device in a convenience sample of adult ED patients at risk for sepsis who did not have obvious organ dysfunction at the time of triage. Hemodynamic data were collected immediately following triage and 2 hours after initial measurement and compared in two outcome groupings: (1) admitted vs. dehydrated, febrile, hypovolemicdischarged patients; (2) infectious vs. non-infectious sources. Receiver operator characteristic (ROC) curves were calculated to determine whether the NICOM values predict hospital admission better than a serum lactate.

Results

50 patients were enrolled, 32 (64 %) were admitted to the hospital. Mean age was 49.5 (± 16.5) years and 62 % were female. There were no significant associations between changes in hemodynamic variables and patient disposition from the ED or diagnosis of infection. Lactate was significantly higher in admitted patients and those with infection (p = 0.01, p = 0.01 respectively). The area under the ROC [95 % Confidence Intervals] for lactate was 0.83 [0.64–0.92] compared to 0.59 [0.41–0.73] for cardiac output (CO), 0.68 [0.49–0.80] for cardiac index (CI), and 0.63 [0.36–0.80] for heart rate (HR) for predicting hospital admission.

Conclusions

CO and CI, obtained at two separate time points, do not help with early disease severity differentiation of patients at risk for severe sepsis. Although mean HR was higher in those patients who were admitted, a serum lactate still served as a better predictor of patient admission from the ED.
Blood purification with a cytokine adsorber for the elimination of myoglobin in critically ill patients with severe rhabdomyolysis
Authors: Scharf Christina , Liebchen Uwe , Paal Michael , Irlbeck Michael , Zoller Michael , Schroeder Ines
Published: January 2021

Background

Rhabdomyolysis is frequently occurring in critically ill patients, resulting in a high risk of acute kidney injury (AKI) and potentially permanent kidney damage due to increased myoglobin levels. The extracorporeal elimination of myoglobin might be an approach to prevent AKI, but its molecular weight of 17 kDa complicates an elimination with conventional dialysis membranes. Question of interest is, if myoglobin can be successfully eliminated with the cytokine adsorber Cytosorb® (CS) integrated in a high-flux dialysis system.

Methods

Patients were included between 10/2014 and 05/2020 in the study population if they had an anuric renal failure with the need of renal replacement therapy, if CS therapy was longer than 90 min and if myoglobin level was > 5.000 ng/ml before treatment. The measurement times of the laboratory values were: d-1 = 24–36 h before CS, d0 = shortly before starting CS and d1 = 12–24 h after starting CS treatment. Statistical analysis were performed with Spearman’s correlation coefficient, Wilcoxon test with associated samples and linear regression analysis.

Results

Forty-three patients were included in the evaluation (median age: 56 years, 77% male patients, 32.6% ECMO therapy, median SAPS II: 80 points and in-hospital mortality: 67%). There was a significant equilateral correlation between creatine kinase (CK) and myoglobin at all measurement points. Furthermore, there was a significant reduction of myoglobin (p = 0.03, 95% confidence interval (CI): − 9030, − 908 ng/ml) during CS treatment, with a median relative reduction of 29%. A higher median reduction of 38% was seen in patients without ongoing rhabdomyolysis (CK decreased during CS treatment, n = 21). In contrast, myoglobin levels did not relevantly change in patients with increasing CK and therefore ongoing rhabdomyolysis (n = 22, median relative reduction 4%). Moreover, there was no significant difference in myoglobin elimination in patients with and without ECMO therapy.

Conclusion

Blood purification with Cytosorb® during high-flux dialysis led to a significant reduction of myoglobin in patients with severe rhabdomyolysis. The effect might be obscured by sustained rhabdomyolysis, which was seen in patients with rising CK during treatment. Prospective clinical trials would be useful in investigating its benefits in avoiding permanent kidney damage.
Effects of controlled hypotension with restrictive transfusion on intraoperative blood loss and systemic oxygen metabolism in elderly patients who underwent lumbar fusion
Authors: Qiu Xiaodong , Tan Zhiying , Tang Wenhao , Ye Hui , Lu Xinjian
Published: January 2021

Background

The effects of restrictive fluid therapy combined with controlled hypotension in the elderly on systemic oxygen metabolism and renal function are clinical concerns. The aim of this study was to evaluate blood loss, oxygen metabolism, and renal function in different levels of controlled hypotension induced by intravenous nitroglycerin, in combination with limited infusion, in elderly patients undergoing posterior lumbar fusion.

Methods

A total of 40 patients, aged 60–75 with ASA grade II or III, who were planned for posterior lumbar fusion were randomly allocated into two groups: experimental group [target mean arterial pressure 65 mmHg (MAP 65) or control group (MAP 75)]. Indicators for blood loss, hemodynamic, systemic oxygen metabolism, and renal function evaluation index were recorded before operation (T0), 1 h after induced hypotension (T1), 2 h after hypotension (T2), and in recovery (T3). We compared changes in these parameters between groups to evaluate the combined effects of controlled hypotension with restrictive infusion.

Results

CI, DO2I, and VO2I were lower in both groups at T1–T3 compared with T0 (p < 0.05). DO2I and VO2I in the MAP 65 group were lower than the MAP 75 group after operation. In both groups, SCysC increased at T1, T2, and T3 (p < 0.05) compared with T0.

Conclusions

Restrictive transfusion and control MAP at 65 mmHg can slightly change in renal function and reduce the risk of insufficient oxygen supply and importantly have no significant effect on blood loss and postoperative complications.

Trial registration

ChiCTR-INR-16008153. Registered on 25 March 2016.
Histological, radiological, and clinical outcomes of sinus floor elevation using a lateral approach for pre-/post-extraction of the severely compromised maxillary molars: a study protocol for a randomized controlled trial
Authors: Yue Zhaoguo , Liu Qi , Zhang Haidong , Yang Jingwen , Hou Jianxia
Published: January 2021

Background

The volume of residual alveolar bone is critical to the survival of dental implants. When the volume of alveolar bone in the posterior maxillary region is less than 4 mm, maxillary sinus floor elevation (MSFE) with the lateral approach is an effective option. Traditionally, this standard approach is usually conducted at 4–6 months after tooth extraction (standard MSFE). However, defective dentition due to extraction can impair mastication during the period of bone remodeling, especially if the molars on both sides are severely compromised and must be extracted. MSFE before extraction (modified MSFE) can take full advantage of residual tooth strength. However, the effectiveness and practicability of the modified MSFE procedure remain unknown. Therefore, the aim of this study was to compare the clinical outcomes of modified vs. standard MSFE, in order to provide references to periodontists.

Methods/design

The study cohort included 25 adult patients (50 surgery sites) recruited from Peking University Hospital and School of Stomatology who met the inclusion criteria. The two sides of each patient will be randomly divided into two groups: a test group-modified MSFE or a control group-standard MSFE. The surgical duration and patient-reported outcomes (visual analog scale for discomfort) will be documented. Clinical indicators, including implant survival rates, mucosal conditions, and complications, will be recorded every 6 months during the 5-year follow-up period. The volume of the alveolar bone and marginal bone level will be assessed radiographically (cone-beam CT and periapical films) every 6 months. Histological analysis of biopsy samples retrieved from both sides will be performed to evaluate the biological features of the bone.

Discussion

The current study will explore the implant survival rates, safety, reliability, effectiveness, and practicability of the modified MSFE procedure. Moreover, the extent of osteogenesis on the sinus floor will also be assessed. The results of this trial will provide strategies for the modified MSFE procedure to achieve ideal clinical outcomes.

Trial registration

International Clinical Trials Registry PlatformChiCTR1900020648. Registered on 1 January 2019
A pictorial review of the utility of CEUS in thoracic biopsies
Authors: Yusuf Gibran T. , Fang Cheng , Tran Sa , Rao Deepak , Bartlett-Pestell Sam , Stefanidis Konstantinos , Huang Dean Y. , Sidhu Paul S.
Published: January 2021

Lung cancer is one of the commonest malignancies worldwide and necessitates both early and personalised treatment. A key requirement is histological sampling with immunohistochemistry obtained usually from percutaneous biopsy. Conventionally thoracic biopsies are performed using CT guidance, but more recently, there has been development of physician led ultrasound biopsy for pleural lesions. Contrast-enhanced ultrasound (CEUS) has been increasingly used in interventional procedures and is able to offer benefits for thoracic biopsies including improving lesional visualisation and characterisation, targeting viable tissue and avoiding critical vascular structures as well as evaluating for the presence of post-procedural complications. This educational review aims to benefits of the role of CEUS in thoracic biopsies.
Severe heat stroke complicated by multiple cerebral infarctions: a case report
Authors: Kamidani Ryo , Okada Hideshi , Kitagawa Yuichiro , Kusuzawa Keigo , Ichihashi Masahiro , Kakino Yoshinori , Oiwa Hideaki , Yasuda Ryu , Fukuta Tetsuya , Yoshiyama Naomasa , Miyake Takahito , Okamoto Haruka , Suzuki Kodai , Yamada Noriaki , Doi Tomoaki , Yoshida Takahiro , Ushikoshi Hiroaki , Kumada Keisuke , Yoshida Shozo , Ogura Shinji
Published: January 2021

Background

Heat-related illnesses include symptoms such as heat syncope/cramps, heat exhaustion, and life-threatening heat stroke. Usually, a heat stroke causes cerebellar ataxia, cognitive impairment, dysphagia, and aphasia. We report a very rare case of a patient who developed severe heat stroke complicated by multiple cerebral infarctions.

Case presentation

An 80-year-old Asian woman was found lying unconscious at her house, with no air conditioner and closed windows; the highest outside temperature was 36.1 °C. She was brought to our hospital unconscious with a high bladder temperature (42.5 °C) and disseminated intravascular coagulation (DIC score 4). She was diagnosed with severe heat stroke and managed with rapid cooling, intravenous fluids therapy, antibiotic therapy, and anti-coagulation therapy for DIC. Anti-coagulation therapy consisted of treatment with recombinant thrombomodulin for 4 days (days 1–4) and recombinant antithrombin for 1 day (day 1). A head computed tomography (CT) and magnetic resonance imaging (MRI) examination were performed on day 3, because she was still unconscious. Diffuse-weighted imaging showed high-signal intensities, indicating multiple lesions. An intracranial magnetic resonance angiography showed normal results. Imaging indicated new multiple cerebellar infarctions complicated with DIC. A tracheotomy was performed on day 9 because her conscious condition had not improved. She was transferred to another hospital for subacute care on day 23.

Conclusions

Early management of heat stroke using anti-DIC, anti-bacterial, and fluid resuscitation therapy can help prevent complications such as intracranial hemorrhaging.
Audio source separation by activity probability detection with maximum correlation and simplex geometry
Authors: Laufer-Goldshtein Bracha , Talmon Ronen , Gannot Sharon
Published: January 2021

Two novel methods for speaker separation of multi-microphone recordings that can also detect speakers with infrequent activity are presented. The proposed methods are based on a statistical model of the probability of activity of the speakers across time. Each method takes a different approach for estimating the activity probabilities. The first method is derived using a linear programming (LP) problem for maximizing the correlation function between different time frames. It is shown that the obtained maxima correspond to frames which contain a single active speaker. Accordingly, we propose an algorithm for successive identification of frames dominated by each speaker. The second method aggregates the correlation values associated with each frame in a correlation vector. We show that these correlation vectors lie in a simplex with vertices that correspond to frames dominated by one of the speakers. In this method, we utilize convex geometry tools to sequentially detect the simplex vertices. The correlation functions associated with single-speaker frames, which are detected by either of the two proposed methods, are used for recovering the activity probabilities. A spatial mask is estimated based on the recovered probabilities and is utilized for separation and enhancement by means of both spatial and spectral processing. Experimental results demonstrate the performance of the proposed methods in various conditions on real-life recordings with different reverberation and noise levels, outperforming a state-of-the-art separation method.
On a degenerate parabolic equation with Newtonian fluid∼non-Newtonian fluid mixed type
Authors: Weng Sujun
Published: January 2021

We study the existence of weak solutions to a Newtonian fluid∼non-Newtonian fluid mixed-type equation $$ {u_{t}}= \operatorname{div} \bigl(b(x,t){ \bigl\vert {\nabla A(u)} \bigr\vert ^{p(x) - 2}}\nabla A(u)+\alpha (x,t)\nabla A(u) \bigr)+f(u,x,t). $$

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Potato extract inhibits lipase activity and ameliorates gut microbiome dysbiosis and weight gain in mice fed a high-fat diet
Authors: Katimbwa Dorsilla Anono , Ma Jinsung , Kim Chang-Kil , Hahn Dongyup , Lim Jinkyu
Published: January 2021

Curtailing the absorption of triglycerides (TGs) is a preferred pathway for treating obesity. Our previous study demonstrated that the water-soluble fraction from potato could inhibit the lipase activity of patatin, one of the major proteins in potato. This aqueous fraction was purified and concentrated by deproteination and reversed-phase chromatography to investigate the effectiveness against obesity. Biochemical analyses indicated that the fraction non-competitively inhibited pancreatic lipase (PLase) with a half-maximal inhibitory concentration of 10.17 µg/mL, and was named as potato-derived lipase inhibitory fraction (PI). Animal studies on C57BL/6 mice showed that in mice fed a high-fat diet (HFD), PI treatment resulted in reductions in body weight gain, adipose fat deposition, and liver TGs, and ameliorated the gut microbiome dysbiosis caused by HFD feeding; meanwhile, orlistat, a well-known lipase inhibitor, diverged the gut microbiome profile in mice fed a HFD. High resolution electronspray ionization-Orbitrap tandem mass spectrometry identified gallic acid, 4-hydroxybenzoic acid, and protocatechuic acid, which are known to have lipase inhibitory activities, in PI. However, these compounds could not reconstitute comparable specific inhibitory activity of PI inferring the existence of another inhibitory compound(s) to be identified in PI.
The Effect of Consuming Carbohydrate With and Without Protein on the Rate of Muscle Glycogen Re-synthesis During Short-Term Post-exercise Recovery: a Systematic Review and Meta-analysis
Authors: Craven Jonathan , Desbrow Ben , Sabapathy Surendran , Bellinger Phillip , McCartney Danielle , Irwin Christopher
Published: January 2021

Background

Rapid restoration of muscle glycogen stores is imperative for athletes undertaking consecutive strenuous exercise sessions with limited recovery time (e.g. ≤ 8 h). Strategies to optimise muscle glycogen re-synthesis in this situation are essential. This two-part systematic review and meta-analysis investigated the effect of consuming carbohydrate (CHO) with and without protein (PRO) on the rate of muscle glycogen re-synthesis during short-term post-exercise recovery (≤ 8 h).

Methods

Studies were identified via the online databases Web of Science and Scopus. Investigations that measured muscle glycogen via needle biopsy during recovery (with the first measurement taken ≤ 30 min post-exercise and at least one additional measure taken ≤ 8 h post-exercise) following a standardised exercise bout (any type) under the following control vs. intervention conditions were included in the meta-analysis: part 1, water (or non-nutrient beverage) vs. CHO, and part 2, CHO vs. CHO+PRO. Publications were examined for methodological quality using the Rosendal scale. Random-effects meta-analyses and meta-regression analyses were conducted to evaluate intervention efficacy.

Results

Overall, 29 trials (n = 246 participants) derived from 21 publications were included in this review. The quality assessment yielded a Rosendal score of 61 ± 8% (mean ± standard deviation). Part 1: 10 trials (n = 86) were reviewed. Ingesting CHO during recovery (1.02 ± 0.4 g·kg body mass (BM)−1 h−1) improved the rate of muscle glycogen re-synthesis compared with water; change in muscle glycogen (MGΔ) re-synthesis rate = 23.5 mmol·kg dm−1 h−1, 95% CI 19.0–27.9, p < 0.001; I2 = 66.8%. A significant positive correlation (R2 = 0.44, p = 0.027) was observed between interval of CHO administration (≤ hourly vs. > hourly) and the mean difference in rate of re-synthesis between treatments. Part 2: 19 trials (n = 160) were reviewed. Ingesting CHO+PRO (CHO: 0.86 ± 0.2 g·kg BM−1 h−1; PRO: 0.27 ± 0.1 g·kg BM−1 h−1) did not improve the rate of muscle glycogen re-synthesis compared to CHO alone (0.95 ± 0.3 g·kg BM−1 h−1); MGΔ re-synthesis rate = 0.4 mmol·kg  dm−1 h−1, 95% CI −2.7 to 3.4, p = 0.805; I2 = 56.4%.

Conclusions

Athletes with limited time for recovery between consecutive exercise sessions should prioritise regular intake of CHO, while co-ingesting PRO with CHO appears unlikely to enhance (or impede) the rate of muscle glycogen re-synthesis.

Trial Registration

Registered at the International Prospective Register of Systematic Reviews (PROSPERO) (identification code CRD42020156841).