bluuebunny/crossref_metadata_2025 huggingface dataset:
Trap Location and Premises Condition Influences on Aedes aegypti (Diptera: Culicidae) Catches Using Biogents Sentinel Traps During a ‘Rear and Release’ Program: Implications for Designing Surveillance Programs
Authors: Staunton Kyran M , Yeeles Peter , Townsend Michael , Nowrouzi Somayeh , Paton Christopher J , Trewin Brendan , Pagendam Daniel , Bondarenco Artiom , Devine Gregor J , Snoad Nigel , Beebe Nigel W , Ritchie Scott A
Published: February 2019

As the incidence of arboviral diseases such as dengue, Zika, chikungunya, and yellow fever increases globally, controlling their primary vector, Aedes aegypti (L.) (Diptera: Culicidae), is of greater importance than ever before. Mosquito control programs rely heavily on effective adult surveillance to ensure methodological efficacy. The Biogents Sentinel (BGS) trap is the gold standard for surveilling adult Aedes mosquitoes and is commonly deployed worldwide, including during modern ‘rear and release’ programs. Despite its extensive use, few studies have directly assessed environmental characteristics that affect BGS trap catches, let alone how these influences change during ‘rear and release’ programs. We assessed male and female Ae. aegypti spatial stability, as well as premises condition and trap location influences on BGS trap catches, as part of Debug Innisfail ‘rear and release’ program in northern Australia. We found similar trends in spatial stability of male and female mosquitoes at both weekly and monthly resolutions. From surveillance in locations where no males were released, reduced catches were found at premises that contained somewhat damaged houses and unscreened properties. In addition, when traps were located in areas that were unsheltered, more than 10 m from commonly used sitting areas or more visually complex catches were also negatively affected. In locations where males were released, we found that traps in treatment sites, relative to control sites, displayed increased catches in heavily shaded premises and were inconsistently influenced by differences in house sets and building materials. Such findings have valuable implications for a range of Ae. aegypti surveillance programs.
External Validation of Difficult-to-Treat Resistance Prevalence and Mortality Risk in Gram-Negative Bloodstream Infection Using Electronic Health Record Data From 140 US Hospitals
Authors: Kadri Sameer S , Lai Yi Ling (Elaine) , Ricotta Emily E , Strich Jeffrey R , Babiker Ahmed , Rhee Chanu , Klompas Michael , Dekker John P , Powers John H , Danner Robert L , Adjemian Jennifer ,   NIH Antimicrobial Resistance Outcomes Research Initiative (NIH-ARORI)
Published: February 2019

Difficult-to-treat resistance (DTR; ie, co-resistance to all first-line antibiotics) in gram-negative bloodstream infection (GNBSI) is associated with decreased survival in administrative data models. We externally validated DTR prevalence and associated mortality risk in GNBSI using detailed clinical data from electronic health records to adjust for baseline differences in acute illness severity.
Flexed Posture in Parkinson Disease: Associations With Nonmotor Impairments and Activity Limitations
Authors: Forsyth Aimi L , Joshi Riddhi Y , Canning Colleen G , Allen Natalie E , Paul Serene S
Published: February 2019

Background

People with Parkinson disease (PD) are twice as likely to develop flexed truncal posture as the general older population. Little is known about the mechanisms responsible beyond associations with age, axial motor impairments, and disease severity.

Objective

The objective was to explore: (1) the associations of the nonmotor impairments of PD with flexed posture, and (2) the relationships of flexed posture with activity limitations.

Design

This was a cross-sectional study.

Methods

Seventy people with PD participated. Posture was measured in standing as the distance between the seventh cervical vertebra and a wall. Nonmotor impairments (cognition, depression, pain, fatigue, and proprioception) and activity performance (upper limb activity, bed transfers, respiratory function, and speech volume) were variously assessed using objective measures and self-report questionnaires. Univariate and multivariate regression analyses were performed to ascertain relationships between nonmotor impairments and truncal posture, and between truncal posture and activities.

Results

Greater disease severity, greater axial impairment, poorer spinal proprioception, greater postural fatigue, and male sex were significantly associated with flexed truncal posture. The multivariate model containing these factors in addition to age explained 30% of the variability in flexed truncal posture, with male sex and axial motor impairment continuing to make independent contributions. A significant association was found between greater flexed truncal posture and poorer upper limb activity performance and respiratory function.

Limitations

A limitation to this study was that participants had mild-to-moderate disease severity.

Conclusions

Spinal proprioception and postural fatigue were the only nonmotor impairments to make significant contributions to flexed posture. Given the negative influence of flexed posture on upper limb activity and respiratory function, interventions targeting spinal proprioception and postural awareness should be considered for people with PD who might develop flexed posture.
How Many Days Are Necessary to Represent an Infant's Typical Daily Leg Movement Behavior Using Wearable Sensors?
Authors: Deng Weiyang , Trujillo-Priego Ivan A , Smith Beth A
Published: February 2019

Background

Characteristics of movement can differentiate infants with typical development and infants with or at risk of developmental disabilities. We used wearable sensors to measure infants’ typical movement patterns in the natural environment.

Objective

Our objectives were to determine (1) how many days were sufficient to represent an infant's typical daily performance, and (2) if there was a difference in performance between weekdays and weekend days.

Design

This was a prospective, observational study.

Methods

We used wearable sensors to collect 7 consecutive days of data for leg movement activity, from 10 infants with typical development (1–5 months old). We identified each leg movement, and its average acceleration, peak acceleration, and duration. Bland-Altman plots were used to compare the standard (average of 7 days) with 6 options (1 day, the average of days 1 and 2, through the average of days 1 through 6). Additionally, the average of the first 2 weekdays was compared with the average of 2 weekend days.

Results

The absolute difference between the average of the first 2 days and the standards fell below 10% of the standards (movement rate = 8.5%; duration = 3.7%; average acceleration = 2.8%; peak acceleration = 3.8%, respectively). The mean absolute difference between weekdays and weekends for leg movement rate, duration, average acceleration, and peak acceleration was 11.6%, 3.7%, 7.2%, and 7.3% of the corresponding standard.

Limitations

The small sample size and age range limit extrapolation of the results.

Conclusions

Our results suggest the best option is to collect data for 2 consecutive days and that movement did not differ between weekdays and weekend days. Our results will inform the clinical measurement of full-day infant leg movement for neuromotor assessment and outcome purposes.
Discrete Actions in Information-Constrained Decision Problems
Authors: Jung Junehyuk , Kim Jeong Ho (John) , Matějka Filip , Sims Christopher A
Published: February 2019

Individuals are constantly processing external information and translating it into actions. This draws on limited resources of attention and requires economizing on attention devoted to signals related to economic behaviour. A natural measure of such costs is based on Shannon’s “channel capacity”. Modelling economic agents as constrained by Shannon capacity as they process freely available information turns out to imply that discretely distributed actions, and thus actions that persist across repetitions of the same decision problem, are very likely to emerge in settings that without information costs would imply continuously distributed behaviour. We show how these results apply to the behaviour of an investor choosing portfolio allocations, as well as to some mathematically simpler “tracking” problems that illustrate the mechanism. Trying to use costs of adjustment to explain “stickiness” of actions when interpreting the behaviour in our economic examples would lead to mistaken conclusions.
Product Market Competition and Option Prices
Authors: Morellec Erwan , Zhdanov Alexei
Published: February 2019

Most firms face some form of competition in product markets. The degree of competition a firm faces feeds back into its cash flows and affects the values of the securities it issues. Through its effects on stock prices, product market competition affects the prices of options on equity and leads to an inverse relationship between equity returns and volatility, generating a negative volatility skew in option prices. Using a large sample of U.S. equity options, we provide empirical support for this finding and demonstrate the importance of accounting for product market competition when explaining the cross-sectional variation in option skew.

Received June 28, 2017; editorial decision October 23, 2018 by Editor Andrew Karolyi. Authors have furnished supplementary Internet Appendices, which is available on the Oxford University Press Web site next to the link to the final published paper online.
Diffuse Bronchiectasis Secondary to Chronic Airways Infection: Thin-Section CT Evaluation
Authors: Amadi Chiemezie , Gebhard Robyn , Davis Christopher , King Mark
Published: February 2019

Bronchiectasis and bronchiolectasis are defined as irreversible airways dilation of the central and peripheral bronchi, respectively. Bronchiectasis is a common finding on thin-section (<2 mm) multidetector (volumetric) CT. Bronchiectasis often is encountered in busy radiology practices. Bronchiectasis may be focal, segmental, lobar, or diffuse. There is a heterogeneous group of causes that may lead to irreversible airways dilation, including various causes of recurrent airways infection and inflammation, end-stage lung fibrosis, bronchial obstruction, and chronic rejection in lung transplant patients.1
Acute monoarthritis
Authors: Ellis Jill M.
Published: February 2019

Acute monoarthritis affects a single joint and has many potential underlying causes, including crystal deposition diseases, infection, trauma, and osteoarthritis. A comprehensive health history and physical examination can help narrow the list of differential diagnoses; judicious diagnostic testing can help pinpoint the diagnosis. Clinicians also must be able to recognize which patients require emergency referral to prevent long-term adverse consequences.
What is the role of cannabidiol in refractory epilepsy?
Authors: LaFleur Kathryn M. , Nemec Eric C.
Published: February 2019

The FDA recently approved the first cannabidiol oral medication to treat refractory epilepsy in patients with Dravet syndrome and Lennox-Gastaut syndrome. This article describes the safety and efficacy of cannabidiol treatment in patients with refractory epilepsy.
Trends in total hip arthroplasty
Authors: Aumiller Wade D. , Kleuser Thomas M.
Published: February 2019

This article discusses developments in total hip arthroplasty related to the use of highly cross-linked polyethylene (HXLPE) liner material as the new standard of care for acetabular cup articulation surfaces. The pathologic implications of metal-on-metal hip prostheses in asymptomatic patients also are discussed.
Refractory hypotension with fever revealing checkpoint inhibitor-induced hypophysitis
Authors: Plaçais Léo , Hau Estelle , Delyon Julie , Azoulay Elie , Gautier Jean-Francois , Lebbé Céleste , Baroudjian Barouyr
Published: February 2019

The new era of immunotherapy in cancer has led to a dramatical increase in patients survival but also to the emergence of a new type of immune-mediated toxicities mimicking known diseases but with special features. As the spectrum of checkpoint inhibitors is widening to many types of cancer expressing histological signs of immune blockade, new subtypes of immune-related adverse events are meant to be discovered and classified and among them new life-threatening situations that need to be quickly identified and require urgent treatment. We here report a case of refractory arterial hypotension with fever leading to diagnosis of combined immune-related adverse events associating hypophysitis, thyroiditis and colitis complicated by refractory arterial hypotension with fever.
Accuracy of 6 Commercially Available Activity Monitors in Measuring Heart Rate, Caloric Expenditure, Steps Walked, and Distance Traveled
Authors: Boolani Ali , Towler Christopher , LeCours Baley , Blank Holly , Larue John , Fulk George
Published: February 2019

Purpose:

The purpose of this study was to determine the accuracy of 5 different commercially available activity monitors (AMs) and 1 smartphone application in identifying mean number of steps, mean distance traveled, estimated caloric expenditure, and heart rate (HR).

Methods:

Subjects (N = 120) performed two 6-minute walks (MWs), one at a comfortable pace (C6MW) and the other at a fast pace (F6MW), around an indoor track wearing all 6 AMs and a StepWatch Activity Monitor in the community. Accuracy and agreement between AM-estimated metrics and actual metrics were examined using the intraclass correlation coefficient (ICC2,1) and Bland–Altman technique (BAM).

Results:

The ICC2,1 and BAM varied for all 3 conditions with the Fitbit Zip being the most accurate.

Conclusions:

The AMs exhibited varying degrees of accuracy for identifying steps, calories expended, HR, and distance walked across all different walking conditions. No single AM was accurate across conditions or metrics. Clinicians should be cautious when using data from these AMs to estimate patient activity levels.
Galectin-1 and Galectin-3 and Their Potential Binding Partners in the Dermal Thickening of Keloid Tissues
Authors: Arciniegas Enrique , Carrillo Luz Marina , Rojas Héctor , Ramírez Richard , Chopite Marina
Published: February 2019

Keloids are defined histopathologically as an inflammatory disorder characterized by exhibiting numerous fibroblasts, abnormal vascularization, increased number of proinflammatory immune cells as well as uncontrolled cell proliferation, and exacerbated and disorganized deposition of extracellular matrix (ECM) molecules. Importantly, many of these ECM molecules display N- and O-linked glycan residues and are considered as potential targets for galectin-1 (Gal-1) and galectin-3 (Gal-3). Nevertheless, the presence and localization of Gal-1 and Gal-3 as well as the interactions with some of their binding partners in keloid tissues have not been considered. Here, we show that in the dermal thickening of keloids, versican, syndecan-1, fibronectin, thrombospondin-1, tenascin C, CD44, integrin β1, and N-cadherin were immunolocalized in the elongated fibroblasts that were close to the immune cell infiltrate, attached to collagen bundles, and around the microvasculature and in some immune cells. We also show that Gal-1 and Gal-3 were present in the cytoplasm and along the cell membrane of some fibroblasts and immune and endothelial cells of the dermal thickening. We suggest that Gal-1 and Gal-3, in concert with some of the ECM molecules produced by fibroblasts and by immune cells, counteract the inflammatory response in keloids. We also proposed that Gal-1 and Gal-3 through their binding partners may form a supramolecular structure at the cell surface of fibroblasts, immune cells, endothelial cells, and in the extracellular space that might influence the fibroblast morphology, adhesion, proliferation, migration, and survival as well as the inflammatory responses.
Optic Nerve Head Perfusion Before and After Intravitreal Antivascular Growth Factor Injections Using Optical Coherence Tomography-based Microangiography
Authors: Wen Joanne C. , Chen Chieh-Li , Rezaei Kasra A. , Chao Jennifer R. , Vemulakonda Atma , Luttrell Ian , Wang Ruikang K. , Chen Philip P.
Published: February 2019

Purpose:

To use optical coherence tomography angiography (OCTA) to evaluate the changes in optic nerve head perfusion following intravitreal antivascular endothelial growth factor injections.

Methods:

Preinjection and postinjection intraocular pressure (IOP) and OCTA images were taken of both the injected and uninjected fellow eyes.

Results:

Mean preinjection IOP was 16.6±4.7 mm Hg, which increased to a mean of 40.3±13.0 mm Hg (P<0.0001) during the first postinjection image and remained elevated at 36.1±11.5 mm Hg (P<0.0001) during the second postinjection image. Although no significant change was observed in flux, vessel area density, or normalized flux when comparing the OCTA preinjection and first postinjection images, a significant decrease at the second postinjection image was observed (P=0.03, 0.02, and 0.03, respectively). No significant change was observed in the uninjected fellow eye during the same time period (P=0.47, 0.37, and 0.38, respectively).

Conclusions:

Following an antivascular endothelial growth factor injection, mean IOP increased significantly and OCTA imaging of the optic nerve demonstrated a mild but significant decrease in optic nerve head perfusion parameters. Clinicians performing these injections should be aware of these findings and monitor the status of the optic nerve in patients undergoing injections.
Pain coping skills training for African Americans with osteoarthritis: results of a randomized controlled trial
Authors: Allen Kelli D. , Somers Tamara J. , Campbell Lisa C. , Arbeeva Liubov , Coffman Cynthia J. , Cené Crystal W. , Oddone Eugene Z. , Keefe Francis J.
Published: February 2019

African Americans bear a disproportionate burden of osteoarthritis (OA), but they have been underrepresented in trials of behavioral interventions for pain. This trial examined a culturally tailored pain coping skills training (CST) program, compared to a wait list control group, among 248 African Americans with knee or hip OA. The pain CST program involved 11 telephone-based sessions over 3 months. Outcomes were assessed at baseline, 3 months (primary), and 9 months, and included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale (primary outcome), WOMAC total score and function subscale, PROMIS Pain Interference, Short-Form 12 Mental and Physical Composite Subscales, Coping Strategies Questionnaire—Total Coping Attempts, Pain Catastrophizing Scale, Patient Health Questionnaire-8, Arthritis Self-Efficacy Scale, and Patient Global Impression of Arthritis Symptom Change. Linear mixed models were fit for all outcomes. There were no significant between-group differences in WOMAC pain score at 3 months (−0.63 [95% confidence interval −1.45, 0.18]; P = 0.128) or 9 months (−0.84 [95% confidence interval −1.73, 0.06]; P = 0.068). Among secondary outcomes, at 3 months, there were significant differences, in favor of the CST group, for Coping Strategies Questionnaire Total Coping Attempts, Pain Catastrophizing Scale, Arthritis Self-Efficacy, and Patient Global Impression of Arthritis Symptom Change (P < 0.01). Coping Strategies Questionnaire Total Coping Attempts, Arthritis Self-Efficacy, and Patient Global Assessment Change were also significantly improved at 9 months in the CST group, compared with wait list (P < 0.01). The culturally tailored pain CST program did not significantly reduce pain severity but did improve key measures of pain coping and perceived ability to manage pain among African Americans with OA.
Motivational Interviewing: Improving Confidence With Self-care Management in Postoperative Thoracolumbar Spine Patients
Authors: Scheffel Kimberly , Amidei Christina , Fitzgerald Kathleen A.
Published: February 2019

Patients undergoing thoracic or lumbar spine surgery often lack confidence with self-care management of symptoms contributing to disability, such as pain, lack of sleep, depression, and immobility. The purpose of this pilot study was to examine whether a targeted motivational interview, focused on evidence-based recommendations to manage postoperative symptoms related to thoracolumbar spine surgery, would improve patient confidence with self-care management of their symptom-related disability. A quasiexperimental, 1-group, pretest-posttest design was used on a convenience sample of 15 adult surgical spine patients at a large university spine center. Level of disability was measured using the Oswestry Disability Index (ODI). Confidence with self-care management of symptom-related disability was measured using the Health Confidence Index (HCI). Paired samples t tests were completed on participants’ preintervention and postintervention scores on the HCI and ODI and on each of the 10 items that the ODI questionnaire addresses. The results of the paired samples t test on participants’ HCI scores showed a statistically significant improvement in participants’ confidence with self-care management of symptom-related disability from pretest (mean [SD], 6.73 [2.12]) to posttest (mean [SD], 8.73 [1.43]), conditions: t
14
= −3.80, P = .002. Motivational interviewing is a beneficial intervention for health professionals to incorporate into practice to encourage the implementation of various health promoting behaviors that improve confidence with self-care management of symptoms in postoperative thoracolumbar spine patients.
Opioid Prescribing Education for Physician Assistant Students: A Physician Assistant Educator Survey
Authors: Yorkgitis Brian K. , Garbas Bre , Cole Debra
Published: February 2019

Purpose

The United States is facing an opioid public health crisis. Educating providers is essential for addressing this epidemic. This study sought to understand how physician assistant (PA) programs are educating students in opioid prescribing to avoid addiction.

Methods

An Internet-based survey was sent to PA educators about the current landscape of opioid prescribing education (OPE) and opioid addiction education (OAE) at their institutions.

Results

Eighty-eight completed surveys were analyzed to gauge opioid education in PA school: 49 (55.7%) educators have a mandatory OPE in their curriculum with most dedicating one hour to 3 hours (27, 55.1%) on this topic. Mandatory OAE was noted by 44 (50.0%) educators with one hour to 3 hours dedicated being the most common (24, 54.5%) amount of time. The most common method of instruction for both OPE and OAE was didactic lectures.

Conclusions

While some programs deliver OPE and OAE to PA students, the need exists for more programs to adopt this education.
Impact Testing of Prosthetic Feet for High-Activity Prosthesis Users: A Pilot Study
Authors: Nickel Eric , Voss Gregory , Morin Steve , Koehler-McNicholas Sara , Hendershot Brad D. , Schnall Barri L. , Gravely Amy , Barrons Kyle , Mion Spencer , Hansen Andrew
Published: February 2019

Introduction

There is currently no accepted test standard for prosthetic feet to demonstrate durability to impact loading such as that encountered in physically demanding professions (e.g., construction, farming, or military service). The goal of the study was to build a system to pilot test the impact resilience of a selection of prosthetic feet marketed for high-activity prosthesis users.

Materials and Methods

Three specimens each of nine prosthetic feet (n = 27 total) were selected by prosthetists at the Minneapolis VA Health Care System (with specifications in accordance with an associated human-subjects research study, n = 3). Maximum drop height without failure was used to assess impact resilience. Drop testing was performed using a custom system with an electromagnet to lift and release a weighted frame in increments of 10 cm until failure. The test specimens were organized into three sets, each with one specimen of each foot with the spring category for a particular user mass. Sets A, B, and C were tested with 45.9, 57.8, and 61.5 kg, respectively (101, 127, and 135 lb, respectively) simulating the mass of the user plus an added 22 kg (48 lb) of worn/carried load, then divided by two to represent even load distribution to both legs at impact.

Results

The feet withstood drop heights without failure ranging from 20 cm to 100 cm. The type of foot was found to significantly affect maximum drop height (P = 0.014). Effect sizes for comparisons of individual feet range from 0.15 to 3.17 with the median effect size being 0.94, which is considered “large.”

Conclusions

The test system successfully measures impact resilience and is sensitive to foot type. Large effect sizes indicate substantial differences between prosthetic feet marketed for active prosthesis users.
How to deal with severe acute pancreatitis in the critically ill
Authors: De Waele Elisabeth , Malbrain Manu L.N.G. , Spapen Herbert D.
Published: February 2019

Purpose of review

To review recent literature on the management of patients with severe acute pancreatitis (SAP) admitted to an ICU.

Recent findings

SAP is a devastating disease associated with a high morbidity and mortality. Recent evidence advocates adequate risk assessment and severity prediction (including intra-abdominal pressure monitoring), tailored fluid administration favoring balanced crystalloids, withholding prophylactic antibiotic therapy, and early detection and treatment of extra-pancreatic and fungal infections. Urgent (within 24–48 h after diagnosis) endoscopic retrograde cholangiopancreatography is indicated when persistent biliary obstruction or cholangitis are present. Corticosteroid therapy (mainly dexamethasone) can reduce the need for surgical interventions, length of hospital stay, and mortality. Peritoneal lavage may significantly lower morbidity and mortality. Hemofiltration may offer substantial benefit but more studies are needed to prove its efficacy. Enteral feeding using a polymeric formula and provided early through a nasogastric tube is recommended but has no survival benefit compared with parenteral nutrition. Probiotics could be beneficial, however no clear recommendations can be made.

Management of SAP is multimodal with emphasis on monitoring, adequate fluid resuscitation, avoiding prophylactic use of antibiotics, cause-directed procedures or treatment, and organ support. There is a role for early enteral nutrition including probiotics.
Observation of the curative effect of device-guided rehabilitation on respiratory function in stable patients with chronic obstructive pulmonary disease
Authors: Wang Jing , Guo Shuai , Zeng Ming , Yu Peng , Mo Weiqiang
Published: February 2019

Background:

Chronic obstructive pulmonary disease (COPD) is a serious lung disease for individuals in middle age and especially in old people. The study was aimed to observe the curative effect of device-guided rehabilitation on respiratory functions in stable COPD patients.

Methods:

Sixty-seven stable COPD patients were enrolled and assigned to the experiment group (n = 36) and the control group (n = 31). The conventional pulmonary rehabilitation treatments, including pursed lips breathing (PLB) and abdominal breathing training, were applied in the control group. Respiratory muscle training of the experiment group was performed using the respiratory endurance training device combined with traditional techniques. Both groups were assessed by 6-minute walk test (6MWT), COPD assessment test (CAT), body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index. Besides, the pulmonary function (FVC%, FEVl%) were measured at 6 months before and after treatment.

Results:

After treatment, the 6MWT, CAT, BODE index were significantly increased compared with pre-treatment in both groups (P < .01), but not FVC% and FEVl%. Compared with the control group, the combination therapy in the experiment group could significantly improve the 6MWT (P = .0094), CAT (P = .0071) and BODE index (P = .0064) as well as the changes of 6MWT (P < .01), CAT (P < .01), and BODE index (P < .01) before and after treatment.

Conclusions:

The traditional respiratory training combined with device-guided pulmonary rehabilitation can improve the respiratory muscle function and athletic ability in stable COPD patients.
Association of loss of muscle mass with mortality in liver cirrhosis without or before liver transplantation
Authors: Chang Ke-Vin , Chen Jin-De , Wu Wei-Ting , Huang Kuo-Chin , Han Der-Sheng
Published: February 2019

Background:

Liver cirrhosis is a risk factor for the loss of muscle mass, which is associated with numerous adverse health outcomes. This meta-analysis aimed to examine whether loss of muscle mass was a predictor of increased mortality in cirrhotic patients without or before liver transplantation.

Methods:

Without language restriction, PubMed and Embase were searched for articles published from the earliest records to December 2018 investigating the influence of loss of muscle mass on survival of cirrhotic patients. Those who had undergone liver transplantation and had hepatocellular carcinoma were excluded. The main outcome was the hazard ratio (HR) for the association of mortality with loss of muscle mass, and the secondary outcome was the association of loss of muscle mass with Child-Pugh class and death caused by severe infection.

Results:

The meta-analysis included 16 observational studies, comprising 4070 participants. The pooled crude and adjusted HRs for the association of mortality with loss of muscle mass were 2.05 (95% confidence interval [CI], 1.51–2.78) and 2.36 (95% CI, 1.61–3.46). Using Child-Pugh Class A as reference, the odds ratios (ORs) for the association of loss of muscle mass with Child-Pugh Class B and Class C were 1.68 (95% CI, 0.96–2.92) and 1.94 (95% CI, 0.66–5.65). Patients with loss of muscle mass were likely to have infection-related mortality (OR = 3.38, 95% CI, 0.61–18.88) but the association did not reach statistical significance.

Conclusions:

Loss of muscle mass is associated with mortality in cirrhotic patients without or before liver transplantation. Future studies should be conducted to explore whether exercise and nutritional supplementation can reverse muscle mass loss and improve long-term survival.
Relative efficacy and safety of early lactate clearance-guided therapy resuscitation in patients with sepsis
Authors: Pan Jianzhen , Peng Milin , Liao Chao , Hu Xia , Wang Aimin , Li Xiangmin
Published: February 2019

Objective:

Compelling evidence has shown that aggressive resuscitation bundles are one of the cornerstones of the successful treatment of patients with sepsis. Recent studies suggest that lactate normalization during resuscitation is a more powerful indicator of resuscitative adequacy; however, early lactate clearance-guided therapy is still not recommended. We performed this meta-analysis to evaluate the effect of early lactate clearance-directed therapy as a potentially more effective resuscitation target.

Methods:

Studies were identified using PubMed, Embase, and the Cochrane Library without region, publication type, or language restrictions. Randomized trials were included when they compared the efficacy and safety of lactate clearance-guided resuscitation versus central venous oxygen saturation (ScvO2)-guided therapy. The primary outcome was mortality, and the secondary outcomes were intensive care unit (ICU) stay, length of hospital stay, mechanical ventilation time, Acute Physiology and Chronic Health Evaluation-II (APACHE-II) score, and Sepsis-related Organ Failure Assessment (SOFA) score.

Results:

Seven randomized controlled trials encompassing 1301 cases were reviewed. Compared with guided ScvO2 therapy, early lactate clearance-directed therapy was associated with decreased in-hospital mortality (relative ratio [RR] 0.68, 95% confidence interval [CI] 0.56 to 0.82), shorter ICU stay (mean difference [MD] −1.64 days, 95% CI −3.23 to −0.05), shorter mechanical ventilation time (MD −10.22 hours, 95% CI −15.94 to −4.5), and lower APACHE-II scores (MD −4.47, 95% CI −7.25 to −1.69). However, patients undergoing early lactate clearance-guided therapy had similar lengths of hospital stay and similar SOFA scores.

Conclusions:

As a specific indicator of resuscitation outcome, lactate clearance alone is superior to ScvO2 alone during a standard resuscitation paradigm. The optimal or desired rate of lactate clearance is still a contentious area. To guide resuscitation and normalize lactate levels in patients, repeating lactate measurements every 2 hours until the patient has met a lactate clearance of 10% or greater may be helpful.

Trial registration number:

PROSPERO CRD42018100515.
Systematic review of treatment strategy for recurrent hepatocellular carcinoma
Authors: Wang Hong-Liang , Mo Dun-Chang , Zhong Jian-Hong , Ma Liang , Wu Fei-Xiang , Xiang Bang-De , Li Le-Qun
Published: February 2019

Aims:

The aim of our systematic review was to compare the efficacy of salvage liver transplantation (SLT) versus curative locoregional therapy (CLRT) for patients with recurrent hepatocellular carcinoma (HCC).

Methods:

Studies comparing the SLT with CLRT for patients with recurrent HCC were selected from database of PubMed, EMBASE, and Cochrane library. The outcomes including overall survival, disease-free survival, and complications were abstracted. Individual and pooled odds ratio (OR) with 95% confidence interval of each outcome was analyzed.

Results:

Seven retrospective studies involving 840 patients were included. There is no difference between SLT and CLRT group regarding the1- and 3-year overall survival rates. However, the 5-year overall survival and 1-, 3-, 5-year disease-free survival were significantly higher after SLT than after CLRT (OR = 1.62, 95% CI 1.09–2.39, P = .02; OR = 4.08, 95% CI 1.95–8.54, P = .0002; OR = 3.63, 95% CI 2.21–5.95, P <.00001; OR = 5.71, 95% CI 2.63–12.42, P <.0001, respectively). But CLRT was associated with fewer complications and shorter hospital-stay compared with SLT. For SLT compared with repeat hepatectomy (RH), the subgroup analysis indicated that SLT group had a significantly higher 3- and 5-years disease-free survival than the RH group (OR = 3.23, 95% CI 1.45–7.20, P = .004; OR = 4.79, 95% CI 1.88–12.25, P = .001, respectively).

Conclusion:

The efficacy of SLT may be superior to that of CLRT in the treatment of recurrent HCC. However, considering the similar overall survival rate and current situation of donor shortage, RH is still an important option for recurrence HCC.
Acute fibrinous and organizing pneumonia
Authors: Wang Yuanhui , Li Yuwen , Wang Qian , Zhang Lili , Li Jun , Zhu Chuanlong
Published: February 2019

Rationale:

Acute fibrinous and organizing pneumonia (AFOP) is an uncommon type of acute lung injury associated with infection, connective tissue disorders, drug exposure, and hematologic malignancies.

Patient concerns:

A 53-year-old female presented with intermittent fever, chills, and dry cough since 10 days. Chest computed tomography scan showed multiple bilateral patchy infiltrates. PPD skin test was positive but tuberculosis antibody test and T-SPOT were negative.

Diagnoses:

Histologic examination revealed massive fibrinous exudation with organization within alveolar spaces and scattered neutrophilic infiltrates, which was consistent with AFOP.

Interventions:

This patient was treated with prednisolone therapy.

Outcomes:

Chest radiograph improvement and symptom improvement, including fever and respiratory symptoms, was observed after 2 week of oral prednisolone treatment. After 9-month of treatment, the patient was asymptomatic with stable disease and improved quality of life.

Lessons:

AFOP has unique pathologic manifestations; however, the condition is liable to be misdiagnosed as community-acquired pneumonia ortuberculosis. Antibiotics are ineffective, while some patients show good response to glucocorticoid therapy.
Circulating long noncoding RNA ZNFX1 antisense RNA negatively correlates with disease risk, severity, inflammatory markers, and predicts poor prognosis in sepsis patients
Authors: Xu Yahuan , Shao Bibo
Published: February 2019

This study aimed to investigate the correlation of long noncoding RNA (lncRNA) ZNFX1 antisense RNA (ZFAS1) with disease risk, severity, inflammation markers, and prognosis in sepsis patients.

A total of 202 sepsis patients were consecutively enrolled, and 200 healthy volunteers were also recruited as healthy controls (HCs). Plasma samples of all patients and HCs were collected. LncRNA ZFAS1 expression was determined by quantitative polymerase chain reaction assay and inflammatory cytokines levels were detected by enzyme-linked immunosorbent assay.

The median value of lncRNA ZFAS1 expression in sepsis patients was (0.639 [0.325–1.071]), which was lower compared to HCs (1.957 [0.876–3.245], P < .001], and receiver operating characteristics (ROC) curve revealed that lncRNA ZFAS1 expression had a good diagnostic value for sepsis with area under curve (AUC) of 0.814 (95% confidence interval [CI]: 0.771–0.857). Spearman test disclosed that lncRNA ZFAS1 expression was negatively correlated with Acute Physiology and Chronic Health Evaluation (APACHE) II score (r = −0.505, P < .001), and it was negatively associated with levels of C-creative protein (r = −0.241, P = .001), tumor necrosis factor-α (r = −0.253, P < .001), and interleukin (IL)-6 (r = −0.177, P = .012) while positively associated with IL-10 level (r = 0.173, P = .014). Also, lncRNA ZFAS1 expression was lower in survivor group compared to nonsurvivor group (P < .001), and it presented with a good predictive value on distinguishing nonsurvivors from survivors in sepsis patients with AUC of 0.628 (95% CI: 0.538–0.717).

Circulating lncRNA ZFAS1 expression negatively correlates with disease risk, severity, and inflammatory markers levels, and might predict worse survival in sepsis patients.
Relationship of the ORBIT and HAS-BLED scores with Killip class 3-4 in patients with ST-segment elevation myocardial infarction
Authors: Zhang Qing , Zhou Lei , Cai Hong-Li , Lu Hui-He
Published: February 2019

Heart failure (HF) complicating ST-segment elevation myocardial infarction (STEMI) is recognized as an ominous complication. The HAS-BLED and Outcomes Registry for Better Informed Treatment (ORBIT) scores are used to assess the bleeding risk in patients with anticoagulated atrial fibrillation. This study aimed to investigate the relationship of the ORBIT and HAS-BLED scores with Killip class 3-4 in patients with STEMI.

639 patients with STEMI were enrolled in this study. The ORBIT and HAS-BLED scores were recorded after admission, and all patients were divided into 2 groups: the Killip class 1-2 and Killip class 3-4 groups. Different clinical parameters were compared. The predictive values of the ORBIT and HAS-BLED scores for Killip classes 3 to 4 were assessed using receiver-operating characteristic (ROC) analyses. Univariate and multivariate logistic analyses were used to evaluate the relationships between variables and Killip class 3-4.

The ORBIT and HAS-BLED scores were higher in the Killip class 3-4 group than in the Killip class 1-2 group (P < .05). The areas under the ROC curve of the ORBIT and HAS-BLED scores for predicting the higher Killip classification were 0.818 (95% CI: 0.786–0.847,P < .0001) and 0.674 (95% CI: 0.636–0.710,P < .0001), respectively. In multivariate logistic analysis, the high ORBIT score was positively associated with Killip classes 3 to 4 after adjustment (odds ratio: 2.306, 95% CI: 1.084–4.911,P = .012).

A graded relationship was found in the elevated ORBIT and HAS-BLED scores and Killip classes 3 to 4 in patients with STEMI. The ORBIT score is independently associated with the Killip 3-4 in patients with STEMI.
Therapeutic efficacy of extracorporeal shock wave combined with hyaluronic acid on knee osteoarthritis
Authors: Liu Shi-Chen , Qiao Xiao-Feng , Tang Qing-Xi , Li Xiao-Guang , Yang Jian-Hua , Wang Tian-Qi , Xiao Ya-Jie , Qiao Jian-Min
Published: February 2019

This retrospective study investigated the efficacy and safety of extracorporeal shock wave (EPSW) combined with hyaluronic acid (HA) for patients with knee osteoarthritis (KOA).

This retrospective study included 70 patients with KOA. Of those subjects, 35 of them received EPSW combined HA, and were allocated to a treatment group, while the other 35 participants received HA alone and were allocated to a control group. Patients in both groups were treated for a total of 8 weeks. The primary outcome was measured by visual analog scale (VAS). The secondary outcomes were measured by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and knee injury and osteoarthritis outcome score (KOOS). In addition, adverse events (AEs) were also evaluated. All outcomes were measured before and after the treatment.

After the treatment, patients in the treatment group exhibited better efficacy in VAS (P < .01), WOMAC scale (pain, P < .01; function, P < .01; and stiffness, P < .01), and KOOS scores (pain, P < .01; function in daily living, P < .01; symptoms, P < .01; sport and recreation, P < .01; and quality of life, P < .01), than patients in the control group. In addition, no significant differences regarding the AEs were found between 2 groups.

The findings of this study demonstrated that the efficacy of EPSW combined with HA is superior to the HA alone for patients with KOA.
Low molecular weight heparin monotherapy for recurrent abortion with antiphospholipid system
Authors: Ni Lei , Sun Xue-qian , Zhao Dong-xu , Zhu Zi-wei
Published: February 2019

Background:

Previous clinical studies reported low molecular weight heparin (LMWH) monotherpay has been utilized for the treatment of recurrent abortion (RCA) with antiphospholipid system (APS). However, its efficacy is still inconclusive. This systematic review aims to assess its efficacy and safety for patients with RCA and APS.

Methods:

A systematic literature search for article up to February 2019 will be conducted in 9 databases: Cochrane Library, EMBASE, MEDILINE, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, VIP Information, and Wanfang Data. Inclusion criteria are randomized control trials of LMWH monotherpay for patients with RCA and APS. The Cochrane risk of bias tool will be used to evaluate the methodological quality for each qualified study. The summary results will be showed by using fixed-effects and random-effects models for pooling the data based on the heterogeneity of included studies.

Results:

This systematic review will assess the clinical efficacy and safety of LMWH monotherpay in treating RCA with APS. The primary outcome is pregnancy loss. The secondary outcomes include frequency of preterm delivery, live birth rates, maternal and fetal complications, as well as adverse events.

Conclusion:

The findings of this study will summarize the present evidence to judge whether LMWH monotherpay is an effective therapy for patients with RCA and APS.

Dissemination and ethics:

The findings of this study will be published by through peer-reviewed journals. This study does not needs ethic documents, because it will not analyze individual patient data.

Systematic review registration:

PROSPERO CRD42019121064.
Intrathecal dexmedetomidine can decrease the 95% effective dose of bupivacaine in spinal anesthesia for cesarean section
Authors: Liu Lin , Qian Jing , Shen Bei , Xiao Fei , Shen Huaxiang
Published: February 2019

Background:

Dexmedetomidine (Dex), as an adjuvant, has been reported to prolong the duration of spinal analgesia when adding to local anesthetic. We hypothesized that Dex could enhance the efficiency of intrathecal bupivacaine for spinal anesthesia in cesarean section. The aim of his study is to test our hypothesis that 5 μg Dex could enhance the efficiency of intrathecal bupivacaine and reduce the dose requirement of spinal bupivacaine for patients undergoing cesarean section.

Methods:

Ninety patients with ASA I or II, who underwent cesarean section, were randomized into 2 groups: group D (bupivacaine + 5 μg Dex) and group C (bupivacaine + the same volume of saline). The subsequent dose of spinal bupivacaine was determined by the improved up–down allocation method. The initial dose of bupivacaine in the 2 groups was 4 mg, and the subsequent dose for the following patient was depended on the probability of the current dose. ED95 of spinal bupivacaine was calculated using logistic regression model.

Results:

The ED95 and 95% confidence intervals (95% CI) of spinal hyperbaric bupivacaine in group D and group C were 7.4 mg (95% CI, 5.6–12.4 mg) and 11.0 mg (95% CI, 4.4–56.8 mg), respectively. The duration of sensory block was 120.5 ± 37.0 minutes in Dex group and 70.5 ± 34.5 minutes in Control group, respectively (P < .05). The duration of analgesia was 230.5 ± 40.5 minutes in Dex group and 145.1 ± 28.5 minutes in Control group, respectively (P < .001). The consumption of postoperative rescued sufentanil was significantly lower in Dex group than in the Control group (56.3 ± 9.4 vs 65.9 ± 10.7 μg). There was not significantly different in the patient satisfaction of analgesia, incidence of side effects, neonatal outcomes and neurological deficit between the 2 groups.

Conclusion:

Intrathecal 5 μg Dex enhances the efficacy of spinal bupivacaine by 24% in patients undergoing cesarean section with spinal anesthesia. No additional side effect was observed by adding spinal Dex.
Prognostic role of microvessel density in patients with glioma
Authors: Fan Chaofeng , Zhang Jing , Liu Zhiyong , He Min , Kang Tianyi , Du Ting , Song Yanlin , Fan Yimeng , Xu Jianguo
Published: February 2019

Background:

The aim of this study was to systematically evaluate the prognostic role of microvessel density (MVD) in patients with glioma through performing a meta-analysis.

Methods:

Web of Science, EMBASE, PubMed, Cochrane Library, and China National Knowledge Infrastructure were searched for potentially relevant literature. The study characteristics and relevant data were extracted. Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled to estimate the prognostic role of MVD in patients with glioma.

Results:

Nine studies with 536 patients were included. The pooled HR of higher MVD for overall survival (OS) was 1.64 (95% CI, 1.07–2.50) in patients with glioma. Subgroup analyses were also performed. The pooled HRs of higher MVD in studies from East Asia studies examining high-grade gliomas and studies using anti-CD105 antibodies were 1.99 (95% CI, 1.04–3.80), 1.60 (95% CI, 1.09–2.34) and 2.99 (95% CI, 1.50–5.99), respectively. No significant publication bias was found (P = .592), but significant between-study heterogeneity was observed (I2 = 80.5%, P <.001) in the meta-analysis.

Conclusion:

Our results suggested that higher MVD was associated with worse OS in patients with glioma. The findings may assist future research on antiangiogenic therapy and help predict prognosis in glioma. However, due to the limited number of studies, more well-designed studies are warranted to further verify our results.
Cigarette smoking-induced acute eosinophilic pneumonia
Authors: Liu Xing , Sun Wangyuan , Meng Wenshu , Xiao Yonglong , Feng Ganzhu , Shi Bin
Published: February 2019

Rationale:

Acute eosinophilic pneumonia (AEP) is a rare pulmonary disease, which is characterized by diffuse pulmonary eosinophilia. The pathogenesis remains unknown. Here we report a patient with AEP following a recently acquired habit of smoking.

Patient concerns:

A 21-year-old female presented with fever, dry cough, and acute hypoxic respiratory distress for 2 days. Chest computed tomography showed bilateral ground glass opacities, patchy nodules, and pleural effusions. Blood tests showed a gradually raised peripheral eosinophils level.

Diagnoses:

Bronchoalveolar lavage fluid revealed marked elevation of eosinophils. She was diagnosed with AEP.

Interventions:

Systemic methylprednisolone was immediately used for treatment.

Outcomes:

Her clinical symptoms and chest radiographs improved promptly after treatment.

Lessons:

Cigarette smoking might be an underlying triggering factor of AEP. Diffuse alveolar infiltrates and a gradually increasing peripheral eosinophilia should raise the concern especially in recent smoking patients.