bluuebunny/crossref_metadata_2025 huggingface dataset:
Dexmedetomidine as an Adjuvant to Local Anesthetics in Transversus Abdominis Plane Block
Authors: Sun Qianchuang , Liu Shuyan , Wu Huiying , Ma He , Liu Wei , Fang Meidan , Liu Kexiang , Pan Zhenxiang
Published: November 2018

Objectives:

The objective of this meta-analysis was to evaluate the analgesic effects of dexmedetomidine (DEX) in transversus abdominis plane (TAP) blocks for abdominal surgery.

Methods:

Electronic databases, including PubMed, EMBASE, Chinese National Knowledge Infrastructure (CNKI), Wan Fang, and the Cochrane Library, were conducted to collect the randomized controlled trials (RCTs) from inception to March 2018. RCTs investigating the impact of adding DEX to local anesthetics for TAP blocks were included in this analysis. Pain scores (at rest and movement), opioid consumption, the duration of the TAP block and the common adverse effects were analyzed.

Results:

Twenty published trials including 1212 patients met the inclusion criteria. The addition of DEX significantly reduced pain scores 8 hours postoperatively at rest (WMD, −0.78; 95% CI, −1.27 to −0.30;P=0.001), 4 hours postoperatively on movement (WMD, −1.13; 95% CI, −1.65 to −0.60;P<0.001), and opioid consumption (WMD, −13.71; 95% CI, −17.83 to −9.60;P<0.001) when compared with control group. Furthermore, perineural DEX significantly prolonged the duration of the TAP block (WMD, 3.33; 95% CI, 2.85 to 3.82;P<0.001). It did not affect the incidence of postoperative nausea and vomiting, hypotension, bradycardia, somnolence, or pruritus.

Conclusions:

DEX is a potential anesthetic adjuvant that can facilitate better postoperative analgesia, reduce postoperative analgesic requirements, and prolong the local anesthetic effect when administered in TAP blocks.
Amisulpride for the Rescue Treatment of Postoperative Nausea or Vomiting in Patients Failing Prophylaxis
Authors: Habib Ashraf S. , Kranke Peter , Bergese Sergio D. , Chung Frances , Ayad Sabry , Siddiqui Naveed , Motsch Johann , Leiman David G. , Melson Timothy I. , Diemunsch Pierre , Fox Gabriel M. , Candiotti Keith A.
Published: November 2018

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Although antiemetics are commonly used to prevent postoperative nausea or vomiting, the failure rate is appreciable and there is currently no generally accepted standard for rescue treatment of postoperative nausea or vomiting after failed prophylaxis. This prospective, randomized, double-blind, parallel-group, placebo-controlled, multicenter study was designed to test the hypothesis that intravenous amisulpride, a dopamine D2/D3-antagonist, is superior to placebo at treating established postoperative nausea or vomiting after failed prophylaxis.

Methods

A total of 2,285 adult patients undergoing surgery under general inhalational anesthesia and receiving standard antiemetic prophylaxis were enrolled at 23 sites in Canada, France, Germany, and the United States. Of these, 702 patients experienced postoperative nausea or vomiting in the 24-h period after surgery and were randomized to receive a single dose of 5 or 10 mg intravenous amisulpride or matching placebo. The primary endpoint was complete response, defined as no emesis or rescue antiemetic use for 24 h after study drug administration, excluding emesis in the first 30 min. Secondary endpoints included incidence of emesis and rescue medication use, nausea burden, time to treatment failure, and length of stay in postanesthesia care unit and hospital.

Results

Complete response occurred in significantly more patients receiving 10 mg amisulpride (96 of 230, 41.7%) than placebo (67 of 235, 28.5%), a 13.2% difference (95% CI, 4.6 to 21.8; odds ratio, 1.80; P = 0.006). A 5-mg dose of amisulpride did not show a significant benefit (80 of 237, 33.8%); the difference from placebo was 5.2% (95% CI, 3.1 to 13.6; odds ratio, 1.24; P = 0.109). The total number of adverse events recorded and proportion of patients with at least one adverse event were comparable between the placebo and amisulpride groups. No clinically relevant toxicities were observed.

Conclusions

A single 10-mg dose of intravenous amisulpride was safe and more effective than placebo at treating established postoperative nausea or vomiting in patients failing postoperative nausea or vomiting prophylaxis.
Does Symmetric Thoracic Fusion Make a Difference in Lenke 1 A/B AIS Patients?
Authors: Zhao Zhihui , Liu Zhen , Hu Zongshan , Tseng Changchun , Li Jie , Shi Benlong , Qiu Yong , Zhu Zezhang
Published: November 2018

Study Design.

A retrospective study.

Objective.

The aim of this study was to compare the long-term outcomes of correction surgery for Lenke 1 A/B scoliosis among those with symmetric fusion (SF), upper-dominant fusion (UF), and lower-dominant fusion (LF) in adolescent idiopathic scoliosis (AIS).

Summary of Background Data.

Symmetric fusion, defined as equal number of vertebral levels included in instrumented fusion above and below the apical vertebra or disc of the primary curve, was a new concept raised in AIS selective fusion. Previous study showed that similar correction the effect on clinical outcomes of this fusion style.

Methods.

Preoperative, postoperative, and last follow-up radiographs of 117 consecutive patients with Lenke type 1A/B curves who underwent posterior selective thoracic instrumentation surgery were analyzed. Patients were divided into two groups (SF and nonsymmetric fusion [NSF]). Patients in NSF was further divided into two groups UF (more vertebrate was fused above the apex) and LF (more vertebrate was fused below the apex). Clinical outcomes and coronal decompensation including adding-on and trunk shift were analyzed and compared among three groups.

Results.

There was no significant difference between SF and NSF in magnitude of preoperative main thoracic curve (P = 0.69) and correction rate (P = 0.50). Distal adding-on was observed in 21 patients (17.9%), and coronal decompensation was observed in eight patients (6.8%) in all at final follow up. No significant differences were found between the two groups regarding adding-on phenomenon (P = 0.64) and coronal imbalance (P = 0.72). Significantly higher rates of adding-on were found in UF compared with SF and LF (P < 0.001). In a subgroup analysis between UF and LF in NSF patients, significant differences were found between two subgroups in the rate of trunk shift (P = 0.038). No significant differences in SRS-22 scores were observed among the three groups.

Conclusion.

In Lenke 1A/B AIS with posterior selective fusion, SF provides no significant differences from NSF. However, in NSF, UF was found to be high risky of adding-on phenomenon.

Level of Evidence: 3
Timing of Prophylactic Anticoagulation and Its Effect on Thromboembolic Events After Surgery for Metastatic Tumors of the Spine
Authors: De la Garza Ramos Rafael , Longo Michael , Gelfand Yaroslav , Echt Murray , Kinon Merritt D. , Yassari Reza
Published: November 2018

Study Design.

Retrospective cohort study.

Objective.

To investigate the effect of timing of initiation of prophylactic anticoagulation (AC) on the incidence of venous thromboembolism (VTE) after surgery for metastatic tumors of the spine.

Summary of Background Data.

VTE is a known complication in patients undergoing surgery for metastatic spine disease. However, there is limited data on the use of prophylactic AC in this population and its impact on the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE), as well as the risk of epidural hematoma.

Methods.

A retrospective review of our institutional neurosurgical spine database for the years 2012 through 2018 was performed. Patients who underwent surgery for metastatic tumors were identified. The development of VTE within 30 days was examined, as well as the occurrence of epidural hematoma. The incidence of VTE was compared between patients receiving “early” (within postoperative days 1–3) and “delayed” prophylactic AC (on or after postoperative day 4).

Results.

Sixty-five consecutive patients were identified (mean age 57, 62% male). The overall rate of VTE was 16.9%—all of whom had DVTs with a 3.1% rate of nonfatal PE (two patients also developed PE). From the overall cohort, 36 of 65 (56%) received prophylactic AC in addition to mechanical prophylaxis—22 in the early group (61.1%) and 14 in the delayed group (38.9%). The risk of VTE was 9.1% in the early group and 35.7% in the delayed group (26.6% absolute risk reduction; P = 0.049); there was one case of epidural hematoma (1.5%). On multivariate analysis, delayed prophylactic AC was found to significantly increase the odds of VTE development (OR 6.43; 95% CI, 1.01–41.2; P = 0.049).

Conclusion.

The findings of this study suggest that administration of prophylactic AC between days 1 and 3 after surgery for metastatic tumors of the spine may significantly reduce the risk of postoperative thromboembolic events.

Level of Evidence: 4
Arthroscopic Treatment of Lateral Elbow Pain Mimicking Lateral Epicondylitis: Long-term Follow-up of a Unique Surgical Protocol
Authors: Sochol Kristen M. , London Daniel A. , Rothenberg Edward S. , Hausman Michael R.
Published: November 2018

Hypothesis and/or Background:

The failure rate of extensor carpi radialis brevis debridement for refractory lateral epicondylitis is reported around 15%. Our novel arthroscopic treatment is predicated on the hypothesis that lateral epicondylitis is an intra-articular problem related to a variation of the capsule-meniscal anatomy that impinges on the radiocapitellar joint. We report long-term outcomes of 35 patients treated with a novel arthroscopic resection of their capsulosynovial fringe.

Methods:

All patients failed nonoperative treatment but had temporary improvement with an intra-articular injection. Arthroscopic treatment involved resecting the meniscus and the proximal edge of the orbicular ligament, followed by a tendon-sparing anterolateral capsulectomy. 35 patients underwent evaluation on average 9.2 years after surgery. Outcome measures included VAS, DASH, and questions on return to sports, satisfaction, and perceived benefit of surgery.

Results:

Median pain scores improved from 8 of 10 preoperatively to 0 of 10 postoperatively. This change was clinically and statistically significant, with 1 patient still requiring pain medication. Median DASH score at final follow-up was 1. Overall, 30 patients rated their postoperative outcome as much better, 5 rated it as better, and 0 reported their symptoms to be unchanged or worsened. All 35 patients stated they were happy they underwent the procedure and perceived a benefit. Totally, 4 of 35 patients had postoperative complications (2 with ulnar nerve symptoms, 2 with persistent pain), with one requiring revision surgery for persistent pain.

Discussion and/or Conclusions:

We report promising long-term clinical and functional results of a novel arthroscopic resection of the capsulosynovial complex in lateral epicondylitis.
Technical Tip: Talar Neck Fixation Strategy Based on Fracture Variants
Authors: Nicholson Jamie A. , Holland George , Kumar Senthil C. , Clayton Robert A.E.
Published: November 2018

Numerous fixation techniques have been described for the talar neck but there is a lack of consensus on a superior method. We present a reliable observation of the morphology of talar neck fractures and demonstrate how this can be used to justify a pragmatic fixation method. The “anatomic” versus the “surgical” neck can be determined from the routine preoperative imaging. Appreciation of which fracture variant is present guides the fixation strategy as outlined. Our department has adopted this fixation principle over a 5-year period for a consecutive series of 8 talar neck fractures. Over our series we have not observed any loss in reduction or avascular necrosis. We would propose that talar neck fixation should be based on the location of the primary fracture line and the presence of medial comminution.
Mobile Media Device Use is Associated with Expressive Language Delay in 18-Month-Old Children
Authors: van den Heuvel Meta , Ma Julia , Borkhoff Cornelia M. , Koroshegyi Christine , Dai David W. H. , Parkin Patricia C. , Maguire Jonathon L. , Birken Catherine S. ,   on behalf of the TARGet Kids! Collaboration
Published: November 2018

Objective:

The objective was to examine the association between mobile media device use and communication delays in 18-month-old children.

Methods:

A cross-sectional study was conducted from September 2011 and December 2015 within the TARGet Kids! primary care research network. Children were included if parents reported their child's mobile media device use and completed a validated questionnaire for communication delay at the 18-month well child visit. Mobile media device use was measured using a parent-reported survey instrument. Daily mobile media device use was calculated as a weighted average of typical weekday and weekend day mobile media device use. Two communication outcomes were investigated: (1) expressive speech delay and (2) other communication delays, as measured by the Infant Toddler Checklist.

Results:

The study sample included 893 children (mean age 18.7 months, 54.1% male). Most parents reported 0 minutes per day of mobile media device use in their children (n = 693, 77.6%). Among children whose parents reported any mobile media device use (n = 200, 22.4%), the median daily mobile media device use was 15.7 minutes (range 1.4–300). The prevalence of parent-reported expressive speech delay was 6.6%, and the prevalence of other parent-reported communication delays was 8.8%. For children who used a mobile media device, each additional 30-minute increase in daily mobile media device use was associated with increased odds of parent-reported expressive speech delay (ORa= 2.33, 95% confidence interval, 1.25–4.82). No relationship was observed between mobile media device use and other parent-reported communication delays.

Conclusion:

Our study demonstrated a significant association between mobile media device use and parent-reported expressive speech delay in 18-month-old children.
Decreasing menopausal symptoms of Asian American breast cancer survivors through a technology-based information and coaching/support program
Authors: Im Eun-Ok , Kim Sangmi , Lee Chiyoung , Chee Eunice , Mao Jun J. , Chee Wonshik
Published: November 2018

Objective:

One of the most prevalent and distressing symptoms after breast cancer treatment is menopausal symptoms. Asian American breast cancer survivors have lower quality of life and often receive inadequate management of menopausal symptoms compared to other racial/ethnic groups. Technology-based programs could be a solution to fill the gap in care. The purpose of this study was to test the efficacy of a technology-based information and coaching/support program on menopausal symptoms of Asian American breast cancer survivors.

Methods:

This study adopted a randomized pretest/post-test group design among 91 Asian American breast cancer survivors (42 in an intervention group who used the program and the American Cancer Society Web site and 49 in a control group who used only the American Cancer Society Web site). The intervention was a theory-driven and culturally tailored intervention program that aimed to provide information and coaching/support using computers and mobile devices. Multiple instruments were used to measure background characteristics and menopausal symptoms at pretest, post 1-month, and post 3 months. An intent-to-treat linear mixed-model growth curve analysis was used to analyze the data.

Results:

The intervention group showed a significant decrease in the distress scores of menopausal symptoms over time: physical (β = −0.07, P = 0.08), psychological (β = −0.13, P = 0.05), psychosomatic (β = −0.17, P = 0.06), and total symptoms (β = −0.19, P = 0.01). Theory-based variables including attitudes, social influences, and self-efficacy partially mediated the impact of the intervention on the distress scores of menopausal symptoms (P < 0.10).

Conclusions:

The program was effective in alleviating menopausal symptoms of Asian American breast cancer survivors.
CHANGES IN VISUAL ACUITY AND PHOTORECEPTOR DENSITY USING ADAPTIVE OPTICS AFTER RETINAL DETACHMENT REPAIR
Authors: Potic Jelena , Bergin Ciara , Giacuzzo Clarice , Daruich Alejandra , Pournaras Jean-Antoine , Kowalczuk Laura , Behar-Cohen Francine , Konstantinidis Lazaros , Wolfensberger Thomas J.
Published: November 2018

Purpose:

To quantify changes in photoreceptor density using adaptive optics fundus camera in patients after retinal detachment (RD) and to correlate them with macular involvement and best-corrected visual acuity.

Methods:

At 1 and 3 months (M1 and M3) after vitrectomy, 194 patients underwent adaptive optics imagery in both eyes, at 5 locations, that we matched between time points using anatomical landmarks. Twenty-two patients (10 fovea-OFF [OFF] and 12 fovea-ON [ON]) had matched and analyzable adaptive optics images. We used analysis of variance for repeated measures.

Results:

Best-corrected visual acuity (logarithm of the minimum angle of resolution and Snellen equivalent [SE]) was significantly different between OFF and ON RDs at baseline: 2.0 (2.3–0.95) (SE: 20/2000) versus 0 (0.1–0) (SE: 20/20); at M1: 0.35 (0.5–0.1) (SE: 20/40) versus 0.05 (0–0.1) (SE: 20/25); and at M3: 0.25 (0.3–0.1) (SE: 20/32) versus 0 (0–0) (SE: 20/20). We observed that cone density was stable in fellow eyes between M1 and M3 (P = 0.67); decreased in treated eyes than in fellow eyes (P < 0.05); and increased postoperatively in the ON group (P = 0.02) but not in the OFF group (P = 0.97). Visual acuity and RD type were independently correlated with cone density (P = 0.004, P = 0.000).

Conclusion:

Postoperative cone density was reduced in OFF RD, but also in the ON group, although the drop recovered during the 3-month follow-up. Cone density was significantly correlated with both visual acuity and type of RD at both time points.
OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FEATURES OF SUBRETINAL FIBROSIS AFTER MYOPIC NEOVASCULARIZATION
Authors: Milani Paolo , Pellegrini Marco , Massacesi Amedeo , Scotti Fabrizio , Moschini Stefania , Setaccioli Marco , Secondi Roberta , Bergamini Fulvio
Published: November 2018

Purpose:

To describe the optical coherence tomography (OCT) angiography features of subretinal fibrosis in eyes with myopic choroidal neovascularization after natural evolution or secondary to intravitreal anti–vascular endothelial growth factor therapy.

Methods:

Retrospective observational case series. All eyes underwent a multimodal imaging examination including fluorescein angiography, spectral domain OCT, OCT angiography, and en face OCT.

Results:

Twenty-five eyes of 25 patients with mean age of 56.4 ± 14.9 were included in the study. Subretinal fibrosis was diagnosed at mean 30 (range 6–116) months before inclusion. Within the subretinal fibrosis, an abnormal vascular network was observed in 20/25 (80%) eyes, located typically in the outer retina (18/20, 90%) or the choriocapillaris (14/20, 70%) segmentation. The most prevalent patterns were “round tangle” and “tapered tangle.” On en face OCT, the subretinal fibrosis was evidenced in 24/25 (96%) eyes, most prevalently in the outer retina (21/25, 84%) and in the choriocapillaris (18/25, 72%), where main feature was white-hyperreflective (20/21, 95%) and dark-hyporeflective (17/18, 94%) appearance, respectively. The presence of subretinal fibrosis on en face OCT was positively correlated with the presence of abnormal vascular network on OCT angiography in 61% of the cases (P = 0.005).

Conclusion:

Subretinal fibrosis secondary to myopic choroidal neovascularization frequently contains blood flow within a persistent abnormal vascular network as assessed by OCT angiography.
Vection Responses in Patients With Early Glaucoma
Authors: Brin Taylor A. , Tarita-Nistor Luminita , González Esther G. , Trope Graham E. , Steinbach Martin J.
Published: November 2018

Purpose:

Our lab has previously shown that patients with early glaucoma have longer vection latencies than controls. We attempted to explain this finding using a combined index of structure and function (CSFI), as proposed by Medeiros and colleagues. The CSFI estimates the proportion of retinal ganglion cell loss.

Methods:

Roll and circular vection were evoked using a back-projected screen (experiment 1) and the Oculus Rift system (experiment 2). Vection latency and duration were measured using a button response box. In experiment 1, tilt angles were measured with a tilt sensor, whereas subjective tilt was determined using a joystick attached to a protractor. In experiment 2, subjective vection strength was rated on a 1 to 10 scale. These measurements were compared with the CSFI, which utilizes visual field and optical coherence tomography data.

Results:

For experiment 1 we tested 22 patients (mean age, 70.3±6 y) with glaucoma and 18 controls (mean age, 54.6±9 y); and for experiment 2 we tested 24 patients (mean age, 71.1 ±5 y) and 23 controls (mean age 61.4±10 y), but not all patients experienced vection. In both experiments, vection latency was significantly longer for patients than for controls (smallest P=0.02). The CSFI was not related to vection latency, duration, or objective and subjective measures of vection strength (smallest P=0.06) in either experiment.

Conclusions:

Two experiments have replicated the finding that vection responses are longer in patients with glaucoma than in controls; however, the CSFI is not related to vection responses.
Sonographic Assessment of Optic Disc Cupping and its Diagnostic Performance in Glaucoma
Authors: Chaurasia Shweta , Garg Rajiv , Beri Sarita , Pakhare Abhijit
Published: November 2018

Purpose:

The purpose of this study was to assess the optic cup diameter sonographically in glaucoma patients and in the normal population and correlate it with their photographic parameters to propose a cut-off value as a predictive index of glaucoma.

Methods:

A total of 95/50 primary open-angle glaucoma and 87/44 control patients with clear media underwent visual field assessment, fundus photography, and B-scan ultrasound. Photographic vertical cup diameter (PVCD) of cases and controls were recorded after magnification correction using the Bengtsson formula. Sonographic vertical cup diameter (SVCD) was measured in the vertical transverse position.

Results:

The mean SVCD was 1.13±0.23 mm in glaucoma and 0.72±0.25 mm in controls (P=0.001). The mean PVCD was 1.024±0.199 mm in glaucoma and 0.636±0.217 mm in controls (P=0.001). A strong correlation between PVCD and SVCD in both groups was found (correlation coefficient r=0.857; P=0.001; glaucoma and r=0.795; P=0.001; control). SVCD had a positive correlation with vertical cup disc ratio (r=0.675; P=0.001 in glaucoma patients) and (r=0.797; P=0.001 in controls) cup area (r=0.798; P=0.001; glaucoma) and (r=0.727, P=0.001; control) a negative correlation with vertical neuroretinal rim diameter (r=−0.5187; P=0.000; glaucoma patients) and (r=−0.699; P=0.001; controls). No correlation of SVCD was found with severity of field grade changes. The receiving operative curve analysis was performed, and Youden’s optimal cut-off method was used to find a cut-off value for SVCD, which came out to be 1.06, with 65.3% (95% confidence interval, 54.8-74.7) sensitivity and 94.3% (95% confidence interval, 87.1-97.1) specificity.

Conclusions:

The sonographic evaluation of the optic cup is a reliable noninvasive procedure and a potentially useful tool in the assessment of nonviewable suspected glaucomatous cups.
Veterans Health Administration's Physician Assistant Primary Care Residency: An Evaluation of the First 3 Years
Authors: Latini David M. , Cole D. Shawn , Woodmansee Denni , Bailey R. Keith , Berner Krista , Breitinger Petar , Carrejo Maurita , Domagalski Jason , McAdow Lurie , Palmer Shelia , VanRuiswyk Jerry , Hettler Debbie , Jones Kenneth R. , Sanders Karen
Published: November 2018

Purpose

Results from an evaluation of a 12-month postgraduate Veterans Health Administration (VHA) residency in primary care for physician assistants (PAs).

Methods

Descriptive and open-ended data were collected to describe the experience of faculty and trainees participating in the first 3 years of this pilot residency. Quantitative data were summarized using descriptive statistics. Text data were transcribed and reviewed for common themes across residency sites and respondents. Data were collected at 2 time points—the end of the first year and the beginning of year 4.

Results

In the first 3 years of the program, 18 residents were enrolled at 6 sites, with 89% completing the residency. At the second time point, 8 more residents were enrolled. Residents were primarily female (69%). Of the residents completing the program, 56% obtained VHA employment, and 75% of the current residents planned to work for the VHA upon completing the program. Program infrastructure, such as written curriculum, a dedicated administrative staff, and written evaluations for trainees, was more common at the second time point. Recurring themes included the importance of establishing relationships with potential applicants, preceptors, medical center leadership, and trainees to support the program and the importance of securing resources such as space and protected time for faculty.

Conclusions

Although postgraduate residency programs are less common for PAs than for some other health professions, our data suggest that a one-year residency can provide training for new graduates to help solidify their clinical experience and facilitate their transition to practice.
Transtibial Socket Design, Interface, and Suspension: A Clinical Practice Guideline
Authors: Stevens Phillip M. , DePalma Russell R. , Wurdeman Shane R.
Published: November 2018

Materials

N/A

Methods

The guideline is based upon the best available evidence as it relates to socket design, interface, and suspension of definitive transtibial prostheses. Where possible, recommendations are drawn from systematic review and meta-analysis. Where this standard is unavailable, alternate academic literature has been used to support individual recommendations.

Results

Recommendation 1: The static and dynamic pressure distribution of the residual limb within the socket are essential considerations in patient comfort, function and well-being.

Recommendation 2: Total surface bearing sockets are indicated to decrease fitting times and enable higher activity levels.

Recommendation 3: Compared to traditional foam-based interfaces, viscoelastic interface liners are indicated to decrease dependence on walking aides, improve suspension, improve load distribution, decrease pain and increase comfort.

Recommendation 4: Among modern suspension options, vacuum assisted suspension (VAS) sockets permits the least amount of pistoning within the socket, followed by suction suspension and then pin-lock suspension. The traditional suspension options of supracondylar, cuff and sleeve suspension provide comparatively compromised suspension.

Recommendation 5: VAS sockets are indicated to decrease daily limb volume changes of the limb in the socket while facilitating more favorable pressure distribution during gait.

Recommendation 6: VAS sockets require both awareness and compliance on the part of the end user and are not universally indicated.

Conclusions

These clinical practice guidelines summarize the available evidence related to the socket design, interface, and suspension of definitive transitibial prostheses. The noted clinical practice guidelines are meant to serve on as “guides.” They may not apply to all patients and clinical situations.
An exploration of the deleterious effects of hyperoxemia on the morbidity and mortality of hospitalized adult patients
Authors: Cimino Kelly M.
Published: November 2018

Background and purpose:

To explore the deleterious effects of hyperoxia due to liberal oxygen use and clarify the significance of overuse and effects on morbidity and mortality in adult hospitalized patients. This literature review is also intended to bring awareness to nurse practitioners regarding the iatrogenic harm caused by excessive oxygenation and promote individualized patient care.

Methods:

A review of existing literature was conducted using PubMed and CINAHL databases. The keywords “hyperoxia”, “hyperoxemia”, “oxygen toxicity,” and “excessive oxygenation” were used to yield articles for consideration.

Results:

Of the six studies compared for this review, five identified positive correlations between hyperoxia and adverse outcomes. The sixth study found no significant differences in morbidity or mortality with the use of liberal oxygenation versus a more conventional approach.

Conclusions:

Overwhelming evidence suggests that states of hyperoxemia lead to increased mortality and morbidity. However, there is considerable variability on the threshold at which hyperoxia occurs. Further research is required to define levels of hyperoxia to better protect patients from iatrogenic harm.

Implications for practice:

Nurse practitioners in all specialties can increase awareness of the dangers of excessive oxygenation and effect a change in practice through education.
Relationship Between Tinnitus Loudness Measure by Visual Analogue Scale and Psychoacoustic Matching of Tinnitus Loudness
Authors: Raj-Koziak Danuta , Gos Elżbieta , Świerniak Weronika , Karpiesz Lucyna , Niedziałek Iwona , Włodarczyk Elżbieta , Skarżyński Henryk , Skarżyński Piotr H.
Published: November 2018

Objective:

The aim of the study was to assess the relationship between psychoacoustic matches of tinnitus loudness and tinnitus loudness measured with a visual analogue scale (VAS) in patients with normal hearing and patients with hearing loss.

Study Design:

Cross-sectional study.

Patients:

A clinical group of 140 adult patients (46.4% women, 53.6% men) aged from 19 to 81 years old who had had tinnitus for at least 6 months were included in the study. The most frequent reported localization of their tinnitus sensation was bilateral (48.6%); 40% experienced unilateral tinnitus; and 11.4% heard tinnitus in the head.

Methods:

All participants were first asked to complete a VAS to indicate their tinnitus loudness. Hearing thresholds were then determined for each patient at frequencies from 0.125 to 8 kHz; loudness and frequency of the tinnitus were also matched psychoacoustically.

Results:

Tinnitus loudness measured in dB SL was significantly lower in patients with bilateral hearing loss than in patients with unilateral hearing loss or in patients with normal hearing. Tinnitus loudness measured with VAS was significantly higher in patients with bilateral hearing loss than in patients with normal hearing. In patients with normal hearing there was a relationship between psychoacoustic matches of tinnitus loudness and tinnitus loudness measured with VAS, but this relationship did not hold for the hearing loss patients.

Conclusions:

The VAS scale for tinnitus loudness does not generally correspond to psychoacoustic measures of tinnitus loudness. It is only indicative for tinnitus patients who have normal hearing.
Lymphocyte hydrogen sulfide production predicts intravenous immunoglobulin resistance in children with Kawasaki disease
Authors: Lin Jing , Zhao Huacai , Jiao Fuyong , Ma Lei , Ma Le
Published: November 2018

The aim of the study was to identify whether lymphocyte hydrogen sulfide production is a potential biomarker to predict intravenous immunoglobulin (IVIG) resistance in children with Kawasaki disease (KD).

This preliminary, single-center, case–control study conducted between June 2016 and March 2018 in Shaanxi Provincial People's Hospital, 85 children (50 with KD and 35 healthy controls) were included. Laboratory biomarkers were collected from the medical records. All patients with KD received 1 g/kg/d IVIG for 2 days and 30–50 mg/kg/d oral aspirin. The aspirin dose was reduced from 3 to 5 mg/kg/d after body temperature normalized. Plasma hydrogen sulfide levels were detected using sulfide electrode. Lymphocyte hydrogen sulfide levels were detected using the human hydrogen sulfide ELISA kits at the acute stage.

Of 50 patients with KD, 31 and 19 were diagnosed with complete KD (cKD) and incomplete KD (iKD), respectively. Eleven patients with KD were resistant to IVIG treatment. The laboratory biomarker findings and levels of plasma and lymphocyte hydrogen sulfide were significantly different between the patients with KD and control group (P < .001). Moreover, lymphocyte hydrogen sulfide production was significantly greater in IVIG-resistant patients than in the IVIG-responsive patients, both in cKD and iKD (P = .018 and P < .001 respectively). Receiver operating characteristic curve indicated that when the lymphocyte hydrogen sulfide production was >15.285 nmol/min/108 lymphocytes, the sensitivity and specificity for predicting IVIG resistance were 90.9% and 76.9%, respectively.

Lymphocyte hydrogen sulfide production could serve as a predictor of the therapeutic efficacy of IVIG in children with KD.
Comorbidities, risk, and socioeconomic factors of uninsured cancer survivors
Authors: Mirza Abu-Sayeef , Pabbathi Smitha , Lu Yuanyuan , Ayoubi Noura , Ewing Aldenise , Jaglal Michael , Roetzheim Richard
Published: November 2018

Cancer patients can be well-connected to resources during treatment but become lost to follow-up and subsequently may receive treatment in free clinics for chronic morbidities. Few studies have examined outcomes for uninsured patients with cancer histories in free clinics, but research examining socioeconomic determinants emphasizes poor cancer outcomes for patients with lower socioeconomic statuses (SES).

Demographic data and chronic disease measures were extracted from medical charts of patients treated in 8 free clinics in 2016 in Tampa Bay. Descriptive statistics and Pearson correlation coefficients were used to demonstrate relationships between socioeconomic factors, cancer diagnoses, and comorbidities. Charlson Comorbidity Index (CCI) was used to assess mortality risk and severity of disease burden.

The histories of 4804 uninsured patients were evaluated, identifying 86 (1.7%) as having had cancer. They were predominantly female (65.1%) and significantly older than those without cancer histories. Average duration from initial diagnosis was approximately 8.53 years (standard deviation [SD] 7.55). Overall, cancer patients had higher CCI scores (3.04 [1.928 SD] versus 0.90 [1.209 SD]; P <.001); thus reflecting more weighted comorbidities than patients without cancer (P <.001). Other factors of chronic disease including obesity and substance abuse correlated with cancer history.

Among uninsured patients, those with cancer histories had greater mortality risk by CCI than those without. Chronic conditions such as diabetes, cerebrovascular disease, and chronic pulmonary disease existed in patients with cancer histories, affecting their mortality risk. Uninsured patients with a history of cancer are in greater need for chronic disease management and prevention.
Interleukin-6 for early diagnosis of neonatal sepsis with premature rupture of the membranes
Authors: Qiu Xia , Zhang Li , Tong Yu , Qu Yi , Wang Huiqing , Mu Dezhi
Published: November 2018

Background:

Premature rupture of the membranes (PROM) is the principal risk factor for neonatal sepsis. Interleukin-6 (IL-6) has been investigated for early diagnosis of neonatal sepsis, but not for diagnosis of neonatal sepsis with PROM. The objective of this study is to investigate the early diagnostic value of IL-6 for neonatal sepsis with PROM.

Methods:

The literature was searched using PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wan Fang, VIP, and CBM databases until March 2018. Each study was evaluated using Quality Assessment of Diagnostic Accuracy Studies tool-2. We used a bivariate diagnostic random-effects model.

Results:

The overall pooled sensitivity, specificity, positive likelihood rate, negative likelihood rate, diagnostic odds ratio, and area under the summary receiver operating characteristic curve were 0.85 (95% confidence interval [CI]: 0.81–0.91), 0.88 (95% CI: 0.86–0.91), 9.94 (95% CI: 4.27–23.15), 0.14 (95% CI: 0.06–0.32), 79.26 (95% CI: 23.42–268.26), and 0.9473, respectively, which showed high accuracy in diagnosing neonatal sepsis with PROM. The types of sepsis might be connected with the source of heterogeneity (P = .0351).

Conclusion:

IL-6 is therefore a sensitive and specific diagnostic marker for the early diagnosis of neonatal sepsis with PROM.
Efficacy and safety of alfacalcidol in Chinese postmenopausal women aged over 65 with osteoporosis or osteopenia
Authors: Li Nan , Jiang Yan , He Shuli , Zhao Zhen , Sun Jing , Li Mei , Wang Ou , Xing Xiaoping , Xia Weibo
Published: November 2018

This study aimed to explore the therapeutic efficacy and safety of alfacalcidol among Chinese postmenopausal women (age >65 years) with osteoporosis or osteopenia.

A total of 62 postmenopausal women with osteoporosis or osteopenia (>65 years) were recruited from urban residential community of Beijing. The patients daily took oral calcium and alfacalcidol (Alpha D3, 1 μg) for 9 months. Safety and efficacy assessments were performed at baseline and regular intervals. Alfacalcidol was adjusted to a daily dose of 0.5 μg in case of hypercalcemia or hypercalciuria.

A significant improvement in “timed up and go test” and “chair rising test” was achieved 3 months after treatment. Significant decreases in bone turnover markers were observed 3 months after the treatment and lasted throughout the study. Nineteen patients discontinued due to adverse events (17 hypercalciuria, 1 hydronephrosis, and 1 stomach ache), while alfacalcidol was adjusted to a daily dose of 0.5 μg in 18 patients (29.0%). Increased serum creatinine was observed when compared to baseline (P <.001), but all the values were in normal range.

The treatment with 1 μg alfacalcidol can significantly improve muscle function and bone metabolism. Regular monitoring of urine calcium and timely dosage-adjustments are very important to guarantee the safety of alfacalcidol treatment in Chinese menopausal women.
Three mutations of adult type 1 Gaucher disease found in a Chinese patient
Authors: Du Xiaoli , Ding Qian , Chen Qi , Guo Pengxiang , Wang Qing
Published: November 2018

Rationale:

Gaucher disease (GD), characterized by glucosylceramide accumulation in the macrophage-monocyte system, is caused by glucosidase b acid (GBA) gene mutations which lead to the deficiency of lysosomal enzyme glucocerebrosidase. The mutation spectrum of GBA in Chinese patients is quite different from those seen in Jewish and non-Jewish Caucasian patients. Thus, it is relatively hard to diagnose GD in Chinese.

Patient concerns:

A 24-year-old Chinese female with intermittent abdominal distension and progressive decrease in strength but without neurologic symptoms was initially referred for femoral head necrosis on the right feet. Laboratory examinations results indicated panhematopenia. Bone marrow aspiration smear and biopsy specimen found typical “wrinkled” Gaucher cells. Molecular-genetic testing of GBA gene revealed 3 mutations including R159W (c. 475 C > T), V1230G (c. 689T > G), and G241A (c. 721G > A).

Diagnoses:

On the basis of these findings and clinical manifestations, the final diagnosis of type 1 GD was made.

Interventions:

Enzyme replacement therapy (ERT) with velaglucerase α was carried out after the diagnosis of type 1 GD.

Outcomes:

The platelet and hemoglobin levels were restored by ERT.

Lessons:

To our knowledge, this is the first report of GD patient carrying 3 mutations in Chinese. These mutations in GBA in the present case imply a potential pool of patients with GD with this mutation in Chinese.
Equipment failure of intravenous syringe pump detected by increase in Narcotrend stage
Authors: Niu Kai , Guo Chunjie , Han Chunying , Teng Shiyong
Published: November 2018

Rationale:

Awareness is the recovery of consciousness during general anesthesia. It occurs when patients under general anesthesia receive inadequate anesthetic medications to maintain unconsciousness during surgery. Equipment failure is a common cause of intraoperative awareness.

Patient concerns:

A 16-year-old boy, 85 kg in weight, was admitted to our hospital for thyroglossal cystectomy under general anesthesia. Six minutes after the intubation, we noted that the Narcotrend index indicated a condition of light anesthesia and the patient was observed to be in tears.

Diagnosis:

Improper positioning of the syringe fixing clamp on the CP700TCI infusion pump caused equipment failure and light anesthesia.

Interventions:

Bolus of 50 mg propofol and 2 mg midazolam were administered manually by syringe, and inhalation of 2% sevoflurane was supplemented. Infusion pump was replaced.

Outcomes:

The Narcotrend index of the patient returned to state of deep anesthesia following manual administration of the anesthetic medications. Following the surgery, the patient had an uneventful recovery, and did not present with evidence of awareness.

Lessons:

Users of the CP700TCI syringe pump should pay attention to the position of the syringe fixing clamp. Anesthesiologists should check all the equipment according to a defined checklist prior to anesthesia. Narcotrend monitor could help to detect light anesthesia and prevent potential awareness.
Effects of motivational methods on oral hygiene of orthodontic patients
Authors: Huang Jing , Yao Yunxia , Jiang Jiuhui , Li Cuiying
Published: November 2018

Objective:

The aim of our study was to qualitatively and quantitatively synthesize the evidence regarding ways to improve motivation of oral hygiene among orthodontic patients with fixed appliances and identify the effects of motivational methods via comparing the oral hygiene condition before and after the motivations.

Methods:

An electronic search was conducted in PubMed, Ovid, Embase, and the Crochrane Library for relevant random controlled trials (RCT) and clinical controlled trial (CCT) published before May 1st, 2017 with manual search in addition. Search and selection of studies, quality assessment, data extraction and synthesis was completed by 2 reviewers independently. Plaque index (PI) and gingival index (GI) at 1, 3, 6-month were pooled with Review Manager 5.3. Bias of included studies was evaluated.

Results:

In total, 12 studies fulfilled the inclusion criteria of this systematic review, of which, 5 were included in the meta-analysis. Motivational methods had statistically significant advantage regarding PI in the experimental group over control group at 1, 3, 6-month, while GI was significantly better controlled in the study group at 3, 6-month. The quality of included studies was moderate.

Conclusion:

It is worthy for orthodontists to put in additional efforts to motivate patients to maintain good oral hygiene throughout the entire treatment process.
Cerebrospinal fluid rhinorrhea in a bilateral frontal decompressive craniectomy patient caused by strenuous activity
Authors: Wang Guangming , Sun Lichao , Li Wenchen , Yu Jinlu
Published: November 2018

Rationale:

Iatrogenic cerebrospinal fluid (CSF) rhinorrhea in a bilateral frontal decompressive craniectomy patient triggered by strenuous sport is rare. To the best of our knowledge, no similar case has yet been reported.

Patient concerns:

Herein, we report a case of CSF rhinorrhea in a 37-year-old man. He had previously suffered a traumatic brain injury in a traffic accident, and a subsequent bilateral frontal decompressive craniectomy operation was performed. Based on the frontal skull defect peculiarity, strenuous exercise may have caused drastic CSF pressure waves to tear the dura mater of the anterior skull base, resulting in CSF rhinorrhea.

Diagnoses:

The thin-slice computerized tomography (CT) images revealed a frontal skull defect and the open frontal sinus. In addition, in the opened frontal sinus, low-density liquid-filled areas were visible.

Interventions:

During surgery, the torn dura was carefully repaired, and the frontal sinus was filled with temporal muscle, fascia, and fibrin glue. A simultaneous cranioplasty was performed.

Outcomes:

The patient was followed-up postoperatively for 12 months to date without rhinorrhea recurrence. Recovery was uneventful.

Lessons:

Patients with skull defects should avoid strenuous sports, and cranioplasty should be performed as early as possible in order to decrease the likelihood of a dural tear and prevent the occurrence of CSF leakage. After cranioplasty, the skull should be restored to a closed state to reduce the damaging effects of CSF waves during movement. It is important to maintain normal intracranial pressure to reduce the recurrence rate of CSF rhinorrhea.
The effects of tonsillectomy by low-temperature plasma on the growth development and psychological behavior in children with obstructive sleep apnea hypopnea syndrome
Authors: Cao Ying-Chun , Wang Xiang-Yun , Xu Wei-Wei , Li Jian-Dong , Yu Qiu-Hong
Published: November 2018

We investigated the effects of tonsillectomy by low-temperature plasma on the growth development and psychological behavior in children with obstructive sleep apnea hypopnea syndrome (OSAHS).

This study included 72 moderate and severe OSAHS children with tonsils or adenoids hypertrophy, which were randomly assigned into either the study group (n = 36) or the control group (n = 36). Patients in study group underwent tonsillectomy by low-temperature plasma, while in the control group underwent tonsil-pecking, then the efficacy were compared.

The time of surgery, VAS scores on postoperative day 1, 3, and 7 were significantly lower in the study group than in the control group, and the efficiency was significantly higher in the study group than the control group (P = .018). In the study group, the BMI was lower, the score of C-WISC (VIQ, PIQ, and FIQ) was higher, the score of CBCL social competence was higher and the score of behavioral questions was lower than that in the control group; differences were statistically significant (P = .022). The serum levels of IgA, IgG, and IgM, as well as the percentage of T lymphocytes, between the study group and the control group were not significantly different (P = .132).

Tonsillectomy by low-temperature plasma was effective on the treatment of children with severe OSAHS, and could improve growth development and psychological behavior.
The combination of Caprini risk assessment scale and thrombotic biomarkers to evaluate the risk of venous thromboembolism in critically ill patients
Authors: Fu Yang , Liu Yumei , Chen Si , Jin Yaxiong , Jiang Hong
Published: November 2018

To evaluate the correlation between the Caprini risk assessment scale and plasma thrombosis biomarkers and estimate the validity of this method in identifying critically ill patients at high risk of venous thromboembolism (VTE).

Patients with VTE who were admitted to the intensive care unit (ICU) department of West China Hospital SiChuan University from October 2016 to October 2017 were enrolled in this case–control study. We retrieved relative clinical data and laboratory test results included in the Caprini risk assessment scale to calculate the Caprini score and compared thrombosis biomarkers between various risk stratifications (low, moderate, high, and highest).

A total of 151 critically ill patients were enrolled in our research, including 47 VTE and 94 non-VTE patients. The differences in Caprini score and levels of thrombosis biomarkers between the VTE and control group were significant. Thrombomodulin (TM) was positively correlated with Caprini score (R-value was .451, P < .05). Based on the receiver operating characteristic analysis, TM, tissue plasminogen activator-inhibitor complexes, D-dimer, and fibrinogen degradation products had a certain diagnostic efficiency in distinguishing VTE from others (P < .05). Using the logistic regression model, we identified that 5 risk factors, namely drinking history, major surgery (>3 hours), swollen legs (current), TM, and D-dimer, were independent factors for the occurrence of VTE in critically ill patients admitted in the ICU.

Thrombosis markers were positively correlated with Caprini risk stratification. The combination of plasma markers and Caprini risk assessment scale can further increase the predictive value in critically ill patients with VTE.