bluuebunny/crossref_metadata_2025 huggingface dataset:
Retrospective Review for Medication Dose Errors in Pediatric Emergency Department Medication Orders That Bypassed Pharmacist Review
Authors: Todd Sarah E. , Thompson A. Jill , Russell W. Scott
Published: January 2020

Objective

To identify and evaluate dose errors on medication orders that bypassed pharmacist verification in a pediatric emergency department (PED).

Methods

Descriptive, retrospective study about dose errors in an academic PED over 1 year. A report of automatically verified orders (those that bypassed pharmacist verification) was obtained from the electronic medical record. Potential medication dose errors were defined as those greater than 20% above or below standard dose ranges by age or weight. A retrospective chart review was performed for all identified dose errors. For orders deemed erroneous, additional metrics collected included order time of day and day of week and provider training level.

Results

A total of 46,185 medication orders were placed; 32,928 (71%) bypassed pharmacist review. Altogether, 676 orders (2%) were outside standard dose ranges. Ondansetron represented 569 of the 676 orders; most were doses rounded down to 4 mg and technically qualifying as underdoses, but were attributed to practice variance and not further analyzed. The number of orders deemed potentially erroneous was 107: most were wrong dose (75 overdose and 21 underdose), 5 were wrong patient, and 6 were wrong formulation. Ibuprofen, benzodiazepine, and corticosteroid orders had the most errors. No errors resulted in identifiable harm to the patient: 49 were near misses, and 47 reached the patient with no evident harm.

Conclusions

The overall number of dose errors in autoverified orders was low. Certain medications or ordering modalities may be targeted to enhance patient safety and satisfaction.
Molecular Imaging of Newly Diagnosed Prostate Cancer
Authors: Williams Scott
Published: January 2020

Positron emission tomography (PET) is a valuable imaging in evaluating many malignancies. There are various molecular imaging tracers that are currently being utilized with prostate cancer (PC). Several PET agents imaging different molecular processes in PC have reached the clinic. While all of these agents have demonstrated an advantage over conventional imaging, there are considerable differences in the performance of each in staging newly diagnosed PC. In this article, we review the current updates available of different PET tracers, with a strong focus on the emerging role of prostate-specific membrane antigen PET in the management of newly diagnosed PC.
Autonomic Modulation of Cardiac Activity Across Levels of Sleep Depth in Individuals With Depression and Sleep Complaints
Authors: Saad Mysa , Ray Laura B. , Bradley-Garcia Meenakshie , Palamarchuk Iryna S. , Gholamrezaei Ali , Douglass Alan , Lee Elliott K. , Soucy Louis , Robillard Rebecca
Published: January 2020

Objective

We assessed mean heart rate (HR) and HR variability (HRV) across wake, rapid eye movement (REM) sleep, and non-REM (NREM) sleep, and across varying levels of NREM sleep depth in individuals with depression and sleep complaints.

Methods

Retrospective polysomnographic data were obtained for 25 individuals diagnosed as having depression (84% female; mean age = 33.8 ± 12.2 years) and 31 mentally healthy controls (58.1% female; mean age = 37.2 ± 12.4 years). All were free of psychotropic and cardiovascular medication, cardiovascular disease, and sleep-related breathing disorders. HR and time-domain HRV parameters were computed on 30-second electrocardiography segments and averaged across the night for each stage of sleep and wake.

Results

Compared with the control group, the depression group had higher HR across wake, REM, and all levels of NREM depth (F(1,51) = 6.3, p = .015). Significant group by sleep stage interactions were found for HRV parameters: SD of normal-to-normal intervals (SDNN; F(2.1,107.7) = 4.4, p = .014) and root mean square differences of successive R-R intervals (RMSSD; F(2.2,113.5) = 3.2, p = .041). No significant group difference was found for SDNN or RMSSD during wake (all, p ≥ .32). However, compared with the control group, the depression group had significantly lower SDNN in REM (p = .040) and all NREM stages (all p ≤ .045), and lower RMSSD during NREM 2 (p = .033) and NREM 3 (p = .034).

Conclusions

This study suggests that the abnormalities in autonomic cardiac regulation associated with depression and sleep problems are more prominent during sleep, especially NREM sleep, than during wake. This may be due to abnormalities in parasympathetic modulation of cardiac activity.
Stable Incidence and Poor Survival for HIV-Related Burkitt Lymphoma Among the US Veteran Population During the Antiretroviral Era
Authors: Clark Eva , Royse Kathryn E. , Dong Yongquan , Chang Elaine , Raychaudhury Suchismita , Kramer Jennifer , White Donna L. , Chiao Elizabeth
Published: January 2020

Background:

Despite advances in diagnosis and treatment of both HIV and Burkitt lymphoma (BL), persons living with HIV remain at high risk for BL. We conducted this study to evaluate if there have been any changes in the risk of or survival after BL diagnosis among persons living with HIV during the antiretroviral era.

Setting:

Veterans living with HIV (VLWH) and age-matched HIV-negative controls receiving care between 1999 and 2016 were retrospectively identified using Veterans Health Administration electronic medical records.

Methods:

We identified BL diagnoses through Veterans Health Administration Cancer Registry review and International Classification of Diseases, Ninth/Tenth Revisions, codes, and we extracted demographic, lifestyle, and clinical variables from electronic medical record. We estimated hazard ratios (HR) and 95% confidence intervals (CIs) for BL risk and survival using Cox proportional models.

Results:

We identified 45,299 VLWH. Eighty-four developed BL (incidence rate = 21.2 per 100,000 person years; CI: 17.1 to 26.3). Median CD4 count at BL diagnosis was 238 cells per milliliter (SD: 324.74) and increased over time. Survival was truncated in VLWH with BL (P < 0.05). The risk of BL in VLWH was 38% less in blacks compared with whites (HR: 0.620; CI: 0.393 to 0.979; P = 0.0401). VLWH with an undetectable viral load for at least 40% of follow-up were 74% less likely to develop BL (HR: 0.261; CI: 0.143 to 0.478; P < 0.0001) and 86% less likely to die after diagnosis (HR: 0.141; CI: 0.058 to 0.348; P < 0.0001).

Conclusions:

BL incidence among VLWH did not improve between 2000 and 2016. Survival after BL diagnosis in VLWH remains dismal as compared with their HIV-negative counterparts, although veterans with prolonged periods of undetectable viral load had improved prognosis.
Risk of Toxicity After Initiating Immune Checkpoint Inhibitor Treatment in Patients With Rheumatoid Arthritis
Authors: Efuni Elizaveta , Cytryn Samuel , Boland Patrick , Niewold Timothy B. , Pavlick Anna , Weber Jeffrey , Sandigursky Sabina
Published: January 2020

Introduction

Immune checkpoint inhibitors (ICIs) are increasingly used to treat advanced cancer. Rheumatoid arthritis (RA) is associated with an increased risk of malignancies; however, patients with RA have been excluded from ICI trials. In this study, we evaluated risk of toxicity after initiation of ICI treatment in RA patients.

Methods

We conducted a single-institution, medical records review analysis to assess the incidence of immune-related adverse events (irAEs) and autoimmune disease (AID) flares among patients with AIDs treated with ICIs from 2011 to 2018. A subgroup analysis for RA patients was performed with frequencies of irAEs and AID flares reported.

Results

Twenty-two patients with RA who were treated with ICI for malignancy were identified. At the time of ICI initiation, 86% had inactive RA disease activity. Immune-related adverse events occurred in 7 (32%) of patients, with 2 (9%) developing grade 3 (i.e., severe) irAEs. Immune checkpoint inhibitors were temporarily discontinued because of irAEs in 5 patients (23%), and permanently in 1 patient. Rheumatoid arthritis flares occurred in 12 patients (55%). Of those, 10 (83%) received oral corticosteroids with an adequate treatment response.

Conclusions

Our analysis suggests that irAEs following ICI treatment are not increased among RA patients compared with other cancer patients. Heightened RA disease activity during ICI treatment is common, but most adverse events are manageable with oral corticosteroids, and few require permanent ICI discontinuation. A close collaboration between the oncologist and rheumatologist is advisable when considering ICIs in patients with RA.
Safety Analysis of Iobitridol as a Nonionic Contrast Medium
Authors: Gorodetski Boris , Heine Oliver , Wolf Michael , Collettini Federico , Hamm Bernd , Darmon-Kern Elisabeth , Penzkofer Tobias
Published: January 2020

Objectives

Our study sought to reevaluate the safety and diagnostic efficacy of iobitridol as a nonionic contrast medium after almost 20 years of use.

Materials and methods

This noninterventional postmarketing surveillance noncontrolled, multicenter (168 centers in Germany) study enrolled 94,960 patients receiving intravenous or intra-arterial iobitridol. The majority of the adjusted population (n = 92,550, 98.2%) underwent either computed tomography examination (n = 46,502, 49.3%) or intravenous urography (n = 46,048, 48.8%). A standardized questionnaire was used to ascertain patient's information, known risk factors, renal function status, premedication, type of examination, injection of contrast agent, imaging quality, diagnostic value, and safety.

Results

A total of 469 patients (0.49%) experienced an adverse event (AE), and 24 patients (0.025%) reported a serious AE (SAE). All patients recovered and no fatal event occurred. The prevalence of AE was significantly higher in patients with at least one risk factor, with premedication, with a history of AE, in female and patients younger than 60 years old (P < 0.05). Presence of at least one risk factor is the only predictive factor for the prevalence of SAE (P = 0.042). In patients with a history of AE, premedication did not significantly lower the AE rate (P = 0.737). No statistically significant difference in the prevalence of AE between the different combination of cortisone and/or antihistamines as pretreatment was found.

Conclusions

Iobitridol is a safe contrast medium with a high tolerability and efficacy. Presence of risk factors such as cardiovascular diseases, allergies, or asthma was the only significant predictive factor for an AE and an SAE. Premedication did not significantly lower the occurrence of an AE and an SAE.
Role of 68Ga–Prostate-Specific Membrane Antigen PET/CT in Disease Assessment in Glioblastoma Within 48 Hours of Surgery
Authors: Gupta Manoj , Choudhury Partha Sarathi , Premsagar Ishwar Chandra , Gairola Munish , Ahlawat Parveen
Published: January 2020

Within 48 hours after surgery, disease assessment in glioblastoma is a challenge for both the clinician and the radiologist. Certain technical and logistical issues prevail in this period. 68Ga–prostate-specific membrane antigen PET/CT is a known molecular imaging marker in prostate cancer. Its role in high-grade gliomas has been recently discussed. We present a case of a 39-year-old man with recurrence glioblastoma of the right frontal lobe and underwent resurgery. After surgery, 68Ga–prostate-specific membrane antigen PET/CT showed residual disease along the posterior and inferior margin of the postoperative cavity.
The Hot Pleura
Authors: Qureshi Pir Abdul Ahad Aziz , Asghar Namra , Bashir Humayun , Niazi Imran Khalid , Akhtar Noreen
Published: January 2020

Renal cell carcinoma (RCC) is the most common solid renal malignancy that metastasizes typically to lungs, bones, liver, adrenals, and lymph nodes. Isolated pleural metastases of RCC are extremely rare, with only few cases reported in the literature. We report one such case of a 60-year-old woman, a known case of RCC of the left kidney who underwent nephrectomy, and on follow-up, PET/CT scan revealed diffuse thick nodular hypermetabolic left pleural thickening, which was later biopsied and turned out to be pleural metastases from RCC. No other site of metastases was found.
Primary Hepatocellular Carcinoma With Intense 68Ga-PSMA Uptake But Slight 18F-FDG Uptake on PET/CT Imaging
Authors: Erhamamci Seval , Aslan Nesrin
Published: January 2020

68Ga-PSMA PET/CT imaging is an emerging imaging modality in prostate cancer. PSMA expression is also reported for nonprostate malignancies, including primary hepatocellular carcinoma. Herein, we present a case of a 74-year-ald man with recently diagnosed hepatocellular carcinoma who was referred for 18F-FDG PET/CT imaging for initial staging. The patient underwent 18F-FDG PET/CT as part of staging procedure; he also underwent 68Ga-PSMA PET/CT. PET/CT images revealed only slight 18F-FDG uptake in the liver lesion, but intense 68Ga-PSMA uptake, without any metastatic lesion seen elsewhere in the body.
Rare Esophageal Leptomeningeal Metastases Detected on 18F-FDG PET/CT
Authors: Lu Yang , Wang Linghua , Ajani Jaffer A.
Published: January 2020

A 62-year-old man with a history of locally advanced poorly differentiated adenocarcinoma of the gastroesophageal junction had received induction chemotherapy and concurrent chemoradiation. A 6-month follow-up FDG PET/CT revealed nearly resolved primary malignancy, but new hypermetabolic mediastinal lymph node metastasis and abnormal hypermetabolism in the cerebellum region. Brain MRI and lumbar puncture confirmed leptomeningeal metastasis.
Clinically Applied Anatomy
Authors: Sinha Sumedha R. , Entezampour Mo , Davis Kendrick , Vyas Raj M.
Published: January 2020

Purpose

Today, medical education emphasizes clinical applications of anatomic knowledge. In 2014, we instituted Clinically Applied Anatomy (CAA) within first-year Human Gross Anatomy at our university. The course was designed and overseen by academic plastic surgery. We hypothesized CAA would positively impact students' understanding, performance, and interest in human anatomy.

Methods

From 2014 to 2018, 13 CAA case-based didactics were integrated into the anatomy curriculum without changing the total anatomy-related student hours; each emphasized the clinical relevance of overlooked (or memorized) anatomic detail. Clinically Applied Anatomy instructors led associated clinical cadaver dissections. Upon course completion, students from each participating class were anonymously surveyed.

Results

One hundred sixty-four students completed the survey (75% response). Eighty-six percent reported CAA increased mastery of human anatomy, 77% stated CAA improved examination performance, 87% agreed CAA increased interest in anatomy itself, and 96% reported CAA increased their critical thinking of how understanding anatomy affects clinical care. Nearly half (49.4%) responded that CAA increased interest in applying for a procedurally oriented residency. When considering future integration of CAA into the medical school curriculum, 9% of students wanted less CAA, 61% wanted the same, and 30% wanted more.

Conclusions

Clinically Applied Anatomy significantly impacts medical students' anatomy education. Currently, 17 CAA faculty from 7 departments/divisions participate in all 26 of our school's anatomy sessions. As per our institution, we advocate this cost-effective and impactful initiative be led by academic plastic surgeons. These clinicians possess broad and specialized anatomic expertise as well as the leadership and interdisciplinary working relationships needed to enroll a multidisciplinary team of clinical educators.
Evaluation and Factors of Quality of Life Among Patients With Neurofibromatosis Type 1–Associated Craniofacial Plexiform Neurofibromas
Authors: Ren Jie-Yi , Gu Yi-Hui , Wei Cheng-Jiang , Huang Xin , Xu Xiang-Wen , Gu Bin , Zan Tao , Wang Zhi-Chao , Li Qing-Feng
Published: January 2020

Objectives:

The aim was to evaluate overall quality of life (QOL) and investigate impact factors in Chinese neurofibromatosis type 1 (NF1) patients, particularly in those with craniofacial plexiform neurofibromas (pNFs).

Methods:

The Impact of NF1 on quality of life (INF1-QOL) Questionnaire were completed from a department of plastic and reconstructive surgery by 27 patients. Patients were 3 to 49 years of age. The correlation between subdomains were calculated using Pearson correlation. The difference between groups were evaluated using Fisher exactt-test.Pvalue <0.05 were considered significant.

Results:

In age group of craniofacial pNFs, significant difference presented in cosmetic appearance, role and outlook on life and general QOL. Higher impact on general QOL in adults (6/8) than children (1/7) pointed to more impaired QOL in adults, as well as 2 subdomains including appearance, role and outlook on life. The patients who have more than 50 cutaneous neurofibromas (cNFs) (6/7) presented a significantly greater negative impact on the role and outlook of life. No statistically significant difference of QOL were detected between craniofacial and non-craniofacial pNFs patients.

Conclusions:

Age and cNFs were 2 main factors that have a negative impact on QOL in craniofacial pNFs patients. Adults reported lower QOL in cosmetic appearance, the role and outlook of life and general QOL. Patients with more than 50 cNFs reported more negative impact on the role and outlook of life. A multidiscipline management for these patients is required, including psychosocial intervention.
Postoperative Complications of Box-Shift Osteotomy for Orbital Hypertelorism
Authors: Jiang Taoran , Yu Zheyuan , Chi Tzu-Yang , Kang Bo Kyoung , Gao Jiaman , Wei Min , Yuan Jie , Xu Liang , Duan Huichuan , Mu Xiongzheng , Cao Dejun
Published: January 2020

Objective:

To summarize and analyze the postoperative complications of box-shift osteotomy performed at our center for Chinese orbital hypertelorism patients from 2008 to 2017.

Method:

This retrospective study reviews the records of 78 patients with complete medical records and at least 2 years of postoperative follow-up data. Both radiologic and anthropometric assessments were conducted before, 1 month after and 2 years after surgery to evaluate the bony and soft-tissue alterations. Postoperative complications were recorded during hospitalization and at each follow-up visit and divided into 3 groups: acute complications that occurred within 1 month after surgery; early complications that occurred within 6 months after surgery; and long-term complications that occurred within 2 years after surgery.

Results:

Both bony and soft-tissue alterations were significant at 1 month after surgery. The acute complications that occurred in our center included infection (12.8%), cerebrospinal fluid leakage (29.5%), epilepsy (2.6%), and nasal tip skin necrosis (1.3%). The early complications included strabismus (11.5%) and nasolacrimal duct obstruction (3.8%). The long-term complications included insufficient correction (55.1%), palpable metal implants (92.3%) and a drooping nasal tip (33.9%). Due to the insufficient correction and the continued growth of rib graft, the difference in the hypertelorism index and nasal length, between one month and 2 years postoperatively were statistically significant (P < 0.01). Other radiographic and anthropometric measurements changed with growth without a significance difference between 1 month and 2 years after surgery.

Conclusion:

In this study, we recorded all postoperative complications of box-shift osteotomy. The challenge of our future work is to identify methods for decreasing the incidence of these complications.
A Rare Instance of Primary Oncocytic Schneiderian Papilloma of Middle Ear and Eustachian Tube With a Combined Trans Oto and Nasal Approach Resection
Authors: Fu Ze-Ming , Zhao Li-Ping , Guo Ying-Yuan , Guan Guo-Fang
Published: January 2020

Oncocytic Schneiderian papillomas are rare tumours which usually arise in the sinonasal region. This paper presents, to the authors’ knowledge, the first reported case of oncocytic Schneiderian papilloma arising primarily from the middle ear and eustachian tube. The resection of the tumor was performed with an endoscopic approach of combined trans oto and nasal. Oncocytic Schneiderian papilloma in the middle ear and eustachian tube is extremely rare as a primary lesion and challenging to manage. Very few documents have provided guide of resection using the endoscopic approach when this tumor extends to involve the eustachian tube. Our study illustrates that the endoscopic approach of combined trans oto and nasal is a good choice for tumor resection of middle ear and eustachian tube.
Method of Reducing Thoracic Deformity in Auricular Reconstruction
Authors: Dong Weiwei , Song Yupeng , Jiang Haiyue , He Leren , Pan Bo , Yang Qinghua
Published: January 2020

Autologous costal cartilage graft is an important material in orthopedic surgery. However, postoperative deformity of costal cartilage in donors is also a matter of concern. In our clinical experience, the preservation of the intercostal perichondrium, the replantation of part of the costal cartilage, and wearing an elastic chest strap for half a year are all ways to avoid thoracic deformity. Methods by which to avoid thoracic deformity is still the focus of our efforts.
Review of Preferential Suspicious Genes in Microtia Patients Through Various Approaches
Authors: Lu Meng , Lu Xiaosheng , Jiang Haiyue , Pan Bo
Published: January 2020

Recently, an increasing trend of the birth prevalence of anotia/microtia is observed in China, contributed by changes of social environment and lifestyle. There seems to be no major breakthroughs in exact pathogenesis of microtia, though the research results related to molecular genetics unceasingly appear. In this review, the authors focus on the results of various research methods which the authors regard as the preferential suspicious gene pool to facilitate the exploration of the pathogenic genes of microtia, knowing that the mechanism of microtia is very complicated. The advantages and limitations of these various approaches will also be systematically delineated. The authors believe that this review will give a deep insight in the genetic research of microtia and help plastic surgeons manage congenital microtia more effectively.
Inverse Correlation Between Incidence and Mortality of Acute Kidney Injury in Critically Ill Patients: A Systematic Review
Authors: Komaru Yohei , Inokuchi Ryota , Iwagami Masao , Hamasaki Yoshifumi , Nangaku Masaomi , Doi Kent
Published: January 2020

Background:

The reported incidence and mortality of acute kidney injury (AKI) in patients in intensive care units (ICUs) is remarkably different even with standardized AKI criteria. The aim of this study was to investigate the correlation between the incidence and mortality of patients with AKI in ICUs.

Methods:

We systematically reviewed clinical studies regarding adult ICU patients with AKI using Kidney Disease: Improving Global Outcomes-equivalent criteria from 2004 to May 1, 2018. We searched MEDLINE, EMBASE, and Cochrane Library to investigate the correlation between the incidence and mortality of patients with AKI in each cohort. Studies with small number of participants (less than 500) were excluded. The correlation between the incidence of AKI and mortality of patients was evaluated using a regression model.

Results:

Our review yielded 76 cohorts, comprising 564,455 patients in ICU (median age, 60.5 years; men, 59.5%). The mortality of all patients did not correlate with the incidence of AKI in each cohort; however, the mortality of patients with AKI significantly decreased [squared correlation coefficient (R2) = 0.18, regression coefficient (β) = −0.25, P < 0.001] as the incidence of AKI increased. This correlation was also observed in a subgroup analysis limited to the clinical setting of general ICUs, and among patients with mild or severe AKI.

Conclusions:

An inverse correlation between the incidence of AKI and the mortality of patients with AKI may indicate an advantage of frequent AKI occurrence, possibly because of increased awareness and larger exposure to AKIs; further study is needed, however, to confirm the causality.

Trial registration:

The protocol was registered in PROSPERO database (CRD 42019129322).
Method for Establishing Continuous Reinfusion of Succus Entericus in Complex High-output Fistula
Authors: Niu Dong-Guang , Yang Fan , Tian Wei-Liang , Huang Qian , Zhao Yun-Zhao , Li Chen , Ding Lian-An , Fang Hong-Chun
Published: January 2020

To establish a continuous reinfusion of succus entericus and enteral nutrition (EN) in complex high-output fistula (HOF). Percutaneous puncture and catheterization technique was used to establish continuous reinfusion of succus entericus and EN in complex HOF. From May 2010 to June 2018, 21 patients with complex HOF used continuous reinfusion of succus entericus and EN. Six of them were completely cured, and 15 cases were cured after definitive surgery. Percutaneous puncture and catheterization technique was shown to be a useful and effective method for establishing continuous reinfusion of succus entericus and EN in patients with complex HOF. This method can prevent succus entericus loss and remove the barrier to implementing EN in HOF.
Hybrid Laparoendoscopic-Radiologic Procedure for Laparoscopic Cholecystectomy Complicated With Choledocolithiasis
Authors: Tian Daguang , Zhu Hong , Wei Xiaoping
Published: January 2020

Purpose:

The removal of common bile duct stones (CBDS) is routinely performed as either a 1-stage or 2-stage procedure. Despite many developments in both methods, the optimal approach has not been established to date. This study aimed to investigate the value and short-term outcomes of hybrid laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) combined with intraoperative endoscopic nasobiliary drainage (IO-ENBD) after primary duct closure (PDC) and intraoperative cholangiography (IOC) in patients with concomitant gallbladder stones (GBS) and CBDS.

Materials and Methods:

Forty-seven patients with GBS and CBDS who underwent LC and LCBDE, PDC with IO-ENBD, and IOC were retrospectively enrolled. Stone characteristics and removal, operative data, and postoperative outcomes were recorded and analyzed.

Results:

A total of 46 (97.87%) procedures were completed without conversion to open surgery. The mean operating time was 127.15±8.36 minutes (range, 97 to 158 min). Three patients (6.38%) had residual stones during IOC but achieved 100% stone clearance eventually. Postoperative pancreatitis and bile leakage rates were 4.26% and 2.13%, respectively.

Conclusion:

A hybrid procedure combining LC and LCBDE, PDC with IO-ENBD, and IOC is safe and feasible for concomitant GBS and CBDS.
Pediatric extremity vascular trauma: It matters where it is treated
Authors: Prieto James M. , Van Gent Jan Michael , Calvo Richard Y. , Checchi Kyle D. , Wessels Lyndsey E. , Sise Michael J. , Sise C. Beth , Bansal Vishal , Martin Matthew J. , Ignacio Romeo C.
Published: January 2020

BACKGROUND

Extremity vascular injuries in children are rare events that present unique therapeutic challenges. The absence of a pediatric-specific protocol for definitive care of these injuries risks variability in treatment practices and outcomes. Using a nationwide data set, we investigated variations in the management and outcomes of pediatric patients with peripheral vascular trauma and characterized differences based on hospital category.

METHODS

Retrospective cohort study using the American College of Surgeons (ACS) National Trauma Data Bank to identify patients 16 years or younger with extremity vascular trauma admitted in calendar year 2016. Hospitals were categorized as ACS-verified pediatric trauma centers (Level I or II), ACS-verified adult trauma centers (Level I or II), or other hospitals (all other trauma centers and nondesignated hospitals). Patient data were evaluated by hospital category.

RESULTS

Among 164,882 pediatric admissions, 702 patients were identified for analysis. There were 430 (61.3%) patients with upper-extremity injuries, 270 (38.5%) with lower-extremity injuries, and 2 (0.2%) had both. Mean age was 11.5 years, and 51.6% were blunt-injured. Overall, 40.2% were admitted to pediatric trauma centers, 28.9% to adult trauma centers, and 30.9% to other hospitals. Hospitals without ACS trauma center verification had a significantly higher amputation rate than any ACS-verified adult or pediatric center (p = 0.013).

CONCLUSION

The incidence of pediatric extremity vascular injury is low. Hospitals with ACS trauma center verification have greater pediatric limb salvage rates than those without verification. Future study should seek to identify specific regional or resource-related factors that contribute to this disparity.

LEVEL OF EVIDENCE

Epidemiological, level III.
An analysis of overtriage and undertriage by advanced life support transport in a mature trauma system
Authors: Yoder Austin , Bradburn Eric H. , Morgan Madison E. , Vernon Tawnya M. , Bresz Kellie E. , Gross Brian W. , Cook Alan D. , Rogers Frederick B.
Published: January 2020

BACKGROUND

While issues regarding triage of severely injured trauma patients are well publicized, little information exists concerning the difference between triage rates for patients transported by advanced life support (ALS) and basic life support (BLS). We sought to analyze statewide trends in undertriage (UT) and overtriage (OT) to address this question, hypothesizing that there would be a difference between the UT and OT rates for ALS compared with BLS over a 13-year period.

METHODS

All patients submitted to Pennsylvania Trauma Outcomes Study database from 2003 to 2015 were analyzed. Undertriage was defined as not calling a trauma alert for patients with an Injury Severity Score (ISS) of 16 or greater. Overtriage was defined as calling a trauma alert for patients with an ISS of 9 or less. A logistic regression was used to assess mortality between triage groups in ALS and BLS. A multinomial logistic regression assessed the adjusted impact of ALS versus BLS transport on UT and OT versus normal triage while controlling for age, sex, Glasgow Coma Scale, systolic blood pressure (SBP), pulse, Shock Index and injury year.

RESULTS

A total of 462,830 patients met inclusion criteria, of which 115,825 had an ISS of 16 or greater and 257,855 had an ISS of 9 or less. Both ALS and BLS had significantly increased mortality when patients were undertriaged compared with the reference group. Multivariate analysis in the form of a multinomial logistic regression revealed that patients transported by ALS had a decreased adjusted rate of undertriage (relative risk ratio, 0.92; 95% confidence interval, 0.87–0.97; p = 0.003) and an increased adjusted rate of OT (relative risk ratio, 1.59; 95% confidence interval, 1.54–1.64; p < 0.001) compared with patients transported by BLS.

CONCLUSION

Compared with their BLS counterparts, while UT is significantly lower, OT is substantially higher in ALS—further increasing the high levels of resource (over)utilization in trauma patients. Undertriage in both ALS and BLS are associated with increased mortality rates. Additional education, especially in the BLS provider, on identifying the major trauma victim may be warranted based on the results of this study.

LEVEL OF EVIDENCE

Epidemiological, Level III.
Effects of Light Therapy on Osteoarthritis and Its Sequelae in Aging and Older Adults
Authors: Bridges Michael , Hilliard Jeremy , Chui Kevin
Published: January 2020

Objective:

To assess the effectiveness of therapeutic phototherapy including laser, light-emitting diode, and supraluminous diode energy, in the management of osteoarthritis in aging and older adults.

Methods:

A systematic review of PubMed and CINAHL was completed using the following search terms and their associated abbreviations: laser, supraluminous diode (SLD), or light-emitting diode (LED) combined with therapy, intervention, or treatment. We included randomized controlled trials published between January 1, 2008, and December 31, 2018, written in English, and included human subjects who had a central tendency for age greater than or equal to 50 years.

Results:

Twenty-two randomized controlled trials met our search criteria. Multiple pathologies were evaluated including knee osteoarthritis (n = 20), total hip arthroplasty (n = 1), and hand osteoarthritis (n = 1). Of these 22 studies, 2 compared laser to control, 8 compared laser to sham or placebo, 1 compared laser to therapeutic exercise, 1 compared laser with exercise to control, 3 compared laser paired with exercise to exercise only, 4 compared laser with exercise to placebo with exercise, 3 compared laser to other modalities, 3 compared laser with other modalities to other modalities, 1 compared laser with other modalities to exercise with other modalities, 1 compared laser with exercise and glucosamine/chondroitin sulfate (GCS) to GCS and exercise as well as placebo and exercise, 1 compared laser intensities, and 2 compared laser used with ultrasound (US) to placebo as well as combination laser/US with exercise to placebo and only the combination laser/US unit. As demonstrated by this variability, a meta-analysis was not appropriate. Studies on knee osteoarthritis varied slightly in their results, but the majority of groups that received laser showed significant improvements in pain, function, and quality of life when compared with placebo or control. High-intensity laser demonstrated larger improvements when compared with low-level laser therapy. Histological studies found significant changes in some of the markers associated with tissue healing favoring the laser treatment groups.

Conclusion:

The studies included all used a form of laser in their light therapy treatment protocols. There is some evidence that light therapy may provide statistically significant improvements in pain, function, and quality of life; however, results varied from study to study. Further research is needed to better evaluate the parameters associated with laser when used to treat conditions associated with osteoarthritis that affect aging and older adults.
Chronic and Acute Low Back Pain and Its Relationship to the Sacral X-Axis, Leg Length Changes, Sciatica, Abdominal Pain, Idiopathic Scoliosis, and Incontinence
Authors: DonTigny Richard L.
Published: January 2020

Several interactive pelvic axes occur during activities of weight-bearing and ambulation. Flexion and extension of the symmetrical innominates occur on the sacral x-axis with weight-bearing. Normal asymmetric innominate rotation occurs on the innominate axis at the pubic symphysis during weight-bearing with normal ambulation. Oblique sacral movement occurs on an oblique sacral axis concurrent with asymmetric innominate movement. Acute and chronic low back pain is commonly caused by a bilateral symmetrical or oblique anterior innominate rotation on the sacrum on an acetabular axis, usually while lifting, bending, lowering, shoveling, sweeping, a pendulous abdomen, during pregnancy, or with a postural forward head. The innominates are caused to sublux slightly cephalad and laterally on the sacral x-axis at the posterior inferior iliac spine (PIIS). This is a measurable movement that puts a rotational shear on the bilateral sacral x-axis and separates the sacral origins of both the gluteus maximus and the piriformis from their ileal origins resulting in pain across the mid-buttocks into the trochanter, down the tensor fascia lata into the lateral knee causing piriformis syndrome, pain across the buttock from the PIIS to the trochanter, a sciatic neuritis or a pseudosciatica. In all probability, true sciatica is probably not from the disc but rather caused where the sciatic nerve exits just below or sometimes through the compromised piriformis. A specific abdominal pain may also accompany acute or chronic low back pain as may an idiopathic scoliosis. An associated posterior movement of the ischial tuberosities can approximate the distal sacrum, loosen muscles of the pelvic floor, decrease kinetic tension on the sacrotuberous ligaments, and cause some degree of incontinence. Dysfunction is all initiated at the sacral x-axes. This is corrected effectively simply with a manual bilateral posterior innominate rotation that reverses all and various symptoms leaving the patient free of pain. Many areas of dysfunction are described, but not all.
Association Between Gait, Cognition, and Gray Matter Volumes in Mild Cognitive Impairment and Healthy Controls
Authors: Cosentino Elena , Palmer Katie , Della Pietà Camilla , Mitolo Micaela , Meneghello Francesca , Levedianos Giorgio , Iaia Vincenzo , Venneri Annalena
Published: January 2020

Aims:

To assess the correlation between cognitive functioning and 3 gait parameters (gait speed, cadence, and stride length) in persons with mild cognitive impairment (MCI) and cognitively healthy controls and investigate linear correlations between gait and gray matter volumes.

Materials and Methods:

Participants were recruited at IRCCS San Camillo Hospital, Venice, Italy (MCI=43; age-matched controls=43). Participants underwent comprehensive neuropsychological assessment. Gait speed, cadence, and stride length, were assessed with the BTS FREEMG 300 device. Three-dimensional (3D) T1-weighted MR images were acquired using a 1.5 T Philips Achieva MRI system with a Turbo Field Echo sequence.

Results:

In MCI there was a positive correlation between gait speed and memory tests (P<0.05). In controls all 3 gait parameters correlated with executive functioning (P<0.01). Temporal and limbic areas (ie, superior temporal gyrus, thalamus and parahippocampal gyrus) were associated with gait parameters in MCI whereas in controls the associations were with frontal areas (ie, middle, inferior, and superior frontal gyrus) and in the cerebellum (anterior and posterior lobe).

Conclusions:

Our results highlight a distinct pattern of association between gray matter volume and gait parameters in MCI patients and controls (temporal areas in MCI and frontal areas in healthy elderly), suggesting a relationship between dementia-related pathology and gait dysfunction.
Perceptions and Life Experiences of Patients With Wound Healing by Secondary Intention After the Removal of Thoracic Drainage Tube
Authors: Chen Yi , Wang Xun , Ding Wei , Wu Linzhu , Zhao Xuehua
Published: January 2020

PURPOSE:

The purpose of this study was to explore the perceptions and experiences of patients with wound healing by secondary intention after the removal of a thoracic drainage tube.

DESIGN:

A qualitative phenomenological study.

SUBJECTS AND SETTING:

After removal of the tube, patients who were attending a nursing clinic that provides WOC care to a population of around 1 million people in Suzhou, China, were invited to participate.

METHODS:

Semistructured interviews were digitally audio-recorded and transcribed verbatim. Analysis of data was performed using Colaizzi's 7-step thematic analysis.

RESULTS:

Three major themes emerged from the interviews, namely, emotional stress response, impaired social function, and increased disease burden.

CONCLUSION:

Patients with wound healing by secondary intention after the removal of the drainage tube perceived they experienced an emotional stress reaction accompanied by increased psychological and economic burden. They also experienced impaired social function. There is a critical need to develop health education plans for use during the pre- and postoperative periods to reduce emotional, social, and economic consequences associated with delayed wound healing.
Image of Electroconvulsive Therapy in YouTube Videos
Authors: Genc Esra Sena , Wu Hanjing Emily , Pinjari Omar F. , Fernandez Luis A. , Henchcliffe Blake E. , Husain Mustafa , Selek Salih
Published: January 2020

Objectives

Image of electroconvulsive therapy (ECT) in TV shows and movies have been studied before. However, there is no study about image of ECT on YouTube as one of the most commonly used social media platforms for disseminating health information. Our study aims to study the image of ECT in YouTube videos.

Methods

Key word “Electroconvulsive therapy and ECT” were used to search on Youtube.com and only videos over 50,000 view counts and in English were selected. Above videos were reviewed by an ECT physician and were classified into neutral, negative, and positive groups based on the image of ECT.

Results

There were 41 YouTube videos selected based on the criteria as stated above, among which 14 were unrelated with ECT treatment, 8 were neutral, 9 were positive, and 10 were reflecting negative image about ECT. There was no significant difference among view counts of the positive, negative and neutral videos (χ2 = 2.746, P = 0.253). Furthermore, the most viewed 3 videos showed negative image of ECT. Additionally, only 6 videos showed the modified ECT and one showed both modified and nonmodified ECT.

Conclusions

This is the first study conducted on image of ECT in YouTube videos. We found the stigma against ECT may persist in digital video platforms, such as YouTube.
Robertkochia solimangrovi sp. nov., isolated from mangrove soil, and emended description of the genus Robertkochia
Authors: Lam Ming Quan , Vodovnik Maša , Zorec Maša , Chen Sye Jinn , Goh Kian Mau , Yahya Adibah , Md Salleh Madihah , Ibrahim Zaharah , Tokiman Lili , McQueen-Mason Simon J. , Bruce Neil C. , Chong Chun Shiong
Published: January 2020

To date, there is sparse information for the genus

Robertkochia

with

Robertkochia marina

CC-AMO-30DT as the only described member. We report here a new species isolated from mangrove soil collected at Malaysia Tanjung Piai National Park and perform polyphasic characterization to determine its taxonomic position. Strain CL23T is a Gram-negative, yellow-pigmented, strictly aerobic, catalase-positive and oxidase-positive bacterium. The optimal growth conditions were determined to be at pH 7.0, 30–37 °C and in 1–2 % (w/v) NaCl. The major respiratory quinone was menaquinone-6 (MK-6) and the highly abundant polar lipids were four unidentified lipids, a phosphatidylethanolamine and two unidentified aminolipids. The 16S rRNA gene similarity between strain CL23T and

R. marina

CC-AMO-30DT is 96.67 %. Strain CL23T and

R. marina

CC-AMO-30DT clustered together and were distinguished from taxa of closely related genera in 16S rRNA gene phylogenetic analysis. Genome sequencing revealed that strain CL23T has a genome size of 4.4 Mbp and a G+C content of 40.72 mol%. Overall genome related indexes including digital DNA–DNA hybridization value and average nucleotide identity are 17.70 % and approximately 70%, below the cutoffs of 70 and 95%, respectively, indicated that strain CL23T is a distinct species from

R. marina

CC-AMO-30DT. Collectively, based on the phenotypic, chemotaxonomic, phylogenetic and genomic evidences presented here, strain CL23T is proposed to represent a new species with the name Robertkochia solimangrovi sp. nov. (KCTC 72252T=LMG 31418T). An emended description of the genus

Robertkochia

is also proposed.
Implicit and explicit motor learning interventions for gait in people after stroke: a process evaluation of a randomized controlled trial
Authors: Jie Li-Juan , Kleynen Melanie , Meijer Kenneth , Beurskens Anna , Braun Susy
Published: January 2020

Background

Gait training within stroke rehabilitation can be applied using implicit or explicit motor learning approaches. Explicit learning is a more conscious approach to learning, in which many detailed instructions about the movement are provided to the learner. Implicit learning strives to take place in a more automatic manner, without much knowledge of the underlying facts and rules of the movement.

Objective

To evaluate whether the implicit and explicit motor learning walking interventions for people after stroke delivered in a randomized controlled trial were performed as intended (fidelity) and to report the therapist and participant experiences with regard to feasibility.

Methods

Fidelity was assessed by evaluating the dose delivered (number of therapy sessions) and content of instructions (explicit rules) that were collected through the therapist logs and audio recordings of the training sessions. The therapist and participant experiences were assessed by means of self-developed questionnaires.

Results

79 people were included of which seven people (9%) dropped out. The remaining participants all received the required minimum of seven sessions. Overall therapists adhered to the intervention guideline. On average 5.2 and 0.4 explicit rules were used within the explicit and implicit group respectively. Therapists and participants were generally positive about the feasibility but frequent comments were made by the therapists regarding “therapy time restrictions” and “tendency of the participants to develop explicit rules”.

Conclusion

Delivery of the implicit and explicit motor learning walking interventions were successful in terms of fidelity. Therapists and participants were generally positive about the feasibility of the intervention.
Convergent cross-sectional and longitudinal evidence for gaming-cue specific posterior parietal dysregulations in early stages of Internet Gaming Disorder
Authors: Yu Fangwen , Sariyska Rayna , Lachmann Bernd , Wang Qianqian , Reuter Martin , Weber Bernd , Trautner Peter , Yao Shuxia , Montag Christian , Becker Benjamin
Published: January 2020

Exaggerated reactivity to drug-cues and emotional dysregulations represent key symptoms of early stages of substance use disorders. The diagnostic criteria for (Internet) Gaming Disorder strongly resemble symptoms for substance-related addictions. However, previous cross-sections studies revealed inconsistent results with respect to neural cue reactivity and emotional dysregulations in these populations. To this end the present fMRI study applied a combined cross-sectional and prospective longitudinal design in excessive online gamers (n=37) and gaming-naïve controls (n=67). To separate gaming-associated changes from predisposing factors, gaming-naive subjects were randomly assigned to 6 weeks of daily Internet gaming or a non-gaming condition. At baseline and after the training subjects underwent an fMRI paradigm presenting gaming-related cues and non-gaming related emotional stimuli. Cross-sectional comparisons revealed gaming-cue specific enhanced valence attribution and neural reactivity in a parietal network, including the posterior cingulate/precuneus in excessive gamers as compared to gaming naïve-controls. Prospective analysis revealed that six weeks of gaming elevated valence ratings as well as neural cue-reactivity in a similar parietal network, specifically the posterior cingulate/precuneus in previously gaming-naïve controls. Together, the prospective longitudinal design did not reveal supporting evidence for altered emotional processing of non-gaming associated stimuli in excessive gamers while convergent evidence for increased emotional and neural reactivity to gaming-associated stimuli was observed. Findings suggest that exaggerated neural reactivity in posterior parietal regions engaged in self-referential processing already occur during early stages of regular gaming probably promoting continued engagement in gaming behavior.