bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of mechanical resistance to tearing of the anterior lens capsule after staining with different concentrations of trypan blue
Authors: Sándor Gábor L. , Kiss Zoltán , Bocskai Zoltán I. , Tóth Gábor , Temesi Tamás , Nagy Zoltán Z.
Published: January 2020

Purpose:

To evaluate and compare the mechanical resistance to tearing of the anterior lens capsule opening after staining with different concentrations of trypan blue in ex vivo porcine eyes.

Setting:

Semmelweis University, and Budapest University of Technology and Economics, Budapest, Hungary.

Design:

Experimental study.

Methods:

The study comprised 75 porcine eyes. The capsule was unstained in the Control Group (n = 25 eyes), 0.06% trypan blue was used to stain the capsule in Stained 1 Group (n = 25 eyes), and 0.1% trypan blue was used to stain the capsule in Stained 2 Group (n = 25 eyes). After capsulorhexis, the capsule openings were stretched with custom-designed testing equipment until they ruptured. The rupture force (RF), circumference stretching ratio (CSR), and secant modulus at 10 mN (SM10mN) and 50 mN (SM50mN) were evaluated.

Results:

In total, 75 eyes were enrolled. There were no statistically significant differences in the RF (P = .8924) or CSR (P = .3876) among the groups. There were no statistically significant differences in the SM10mN (P = .8215) or SM50mN (P = .4184) among the groups.

Conclusions:

In this porcine eye model, the trypan blue concentrations that are routinely used in cataract surgery had no effect on capsular rim stability.
Comparison of accelerated CXL alone, accelerated CXL-ICRS, and accelerated CXL-TG-PRK in progressive keratoconus and other corneal ectasias
Authors: Singal Neera , Ong Tone Stephan , Stein Raymond , Bujak Matthew C. , Chan Clara C. , Chew Hall F. , El-Defrawy Sherif , Jin Yaping , Kranemann Christoph , Rabinovitch Theodore , Rootman David S. , Slomovic Allan R. , Cohen Ashley , Dai David , Hatch Wendy
Published: January 2020

Purpose:

To compare accelerated corneal crosslinking (CXL) alone, CXL with simultaneous intrastromal corneal ring segments (CXL-ICRS), and CXL with simultaneous topography-guided photorefractive keratectomy (CXL-TG-PRK) in progressive keratoconus, pellucid marginal degeneration (PMD), or laser in situ keratomileusis (LASIK)-induced ectasia.

Setting:

The Kensington Eye Institute and Bochner Eye Institute, Toronto, Canada.

Design:

Prospective nonrandomized interventional study.

Methods:

Visual and topographical outcomes using a comparative analysis adjusting for preoperative maximum keratometry (Kmax) were evaluated 1 year postoperatively.

Results:

Four hundred fifty-two eyes from 375 patients with progressive keratoconus, PMD, or LASIK-induced ectasia that underwent accelerated (9 mW/cm2, 10 minutes) CXL alone (n = 204), CXL-ICRS (n = 126), or CXL-TG-PRK (n = 122) were included. Change in logarithm of the minimum angle of resolution uncorrected distance visual acuity was significant with CXL-ICRS (−0.31; 95% CI, −0.38 to −0.24) and CXL-TG-PRK (−0.16; 95% CI, −0.24 to −0.09), but not with CXL alone. No significant differences in change were found between the 3 groups. Change in corrected distance visual acuity (CDVA) was significant in all 3 groups: −0.12 (95% CI, −0.15 to −0.10) with CXL alone, −0.23 (95% CI, −0.27 to −0.20) with CXL-ICRS, and −0.17 (95% CI, −0.21 to −0.13) with CXL-TG-PRK. Improvement in CDVA was greater with CXL-ICRS than with CXL alone (−0.08 ± 0.02; P < .0001) and CXL-TG-PRK (−0.05 ± 0.02; P = .005). Change in Kmax was significant with CXL-ICRS [−3.21 diopters (D); 95% CI, −3.98 to −2.45] and CXL-TG-PRK (−3.69 D; 95% CI, −4.49 to −2.90), but not with CXL alone (−0.05 D; 95% CI, −0.66 to 0.55).

Conclusions:

CXL alone might be best for keratoconic patients who meet the inclusion criteria. CXL-ICRS might be more effective for eyes with more irregular astigmatism and worse CDVA and CXL-TG-PRK for eyes requiring improvements in irregular astigmatism but still have good CDVA.
Placebo effect in children: the role of expectation and learning
Authors: Gniß Silke , Kappesser Judith , Hermann Christiane
Published: January 2020

Classical conditioning and expectations are well-known underlying mechanisms of placebo hypoalgesia. Only little is known about their differential effect in adults, however, and even less in children. Previous studies in children evoked placebo hypoalgesia either with expectations alone or in combination with classical conditioning and revealed conflicting results. Furthermore, these studies investigated children of different ages making it even more difficult to draw conclusions. This study tried to disentangle classical conditioning and expectations by investigating them separately. To examine age effects, n = 172 children (6-9, 10-13, and 14-17 years) as well as n = 32 adults (> = 18 years) were tested using a heat pain paradigm investigating the effectiveness of creams some of which were bogusly introduced as analgesic. In addition to subjective pain intensity ratings, peripheral physiological measures were recorded. Results showed a successful induction of placebo hypoalgesia by both mechanisms for pain ratings and heart rate acceleration. Placebo hypoalgesia was particularly pronounced in children younger than 14 years. Furthermore, placebo hypoalgesia was more marked in children whose mothers raised the expectations. It was also stronger in participants who noticed a strong pain reduction during learning trials. These results encourage the use of placebo effect in clinical practice, particularly for younger children. They underline the relevance of an initial pain reduction and encourage the inclusion of parents in treatment.
Quantification of neonatal procedural pain severity: a platform for estimating total pain burden in individual infants
Authors: Laudiano-Dray Maria Pureza , Pillai Riddell Rebecca , Jones Laura , Iyer Rajeshwari , Whitehead Kimberley , Fitzgerald Maria , Fabrizi Lorenzo , Meek Judith
Published: January 2020

There is increasing evidence that long-term outcomes for infants born prematurely are adversely affected by repeated exposure to noxious procedures. These interventions vary widely, for example, in the extent of damage caused and duration. Neonatal intensive care unit (NICU) procedures are therefore likely to each contribute differently to the overall pain burden of individual neonates, ultimately having a different impact on their development. For researchers to quantify the procedural pain burden experienced by infants on NICU, we aimed to estimate the pain severity of common NICU procedures using published pain scores. We extracted pain scores over the first minute (pain reactivity) from the literature, using 59 randomized controlled trials for 15 different procedures. Hierarchical cluster analysis of average pain scores resulted in 5 discrete severity groups; mild (n = 1), mild to moderate (n = 3), moderate (n = 7), severe (n = 3), and very severe (n = 1). The estimate of the severity of individual procedures provided new insight into infant pain reactivity which is not always directly related to the invasiveness and duration of a procedure; thus, both heel lance and skin tape removal are moderately painful procedures. This estimate of procedural pain severity, based on pain reactivity scores, provides a novel platform for retrospective quantification of an individual neonate's pain burden due to NICU procedures. The addition of measures that reflect the recovery from each procedure, such as brain activity and behavioural regulation, would further improve estimates of the pain burden of neonatal intensive care.
UC Care Check—A Postoperative Neurosurgery Operating Room Checklist: An Interrupted Time Series Study
Authors: Lau Catherine Y. , Seymann Gregory , Imershein Sarah , Amin Alpesh , Afsarmanesh Nasim , Uppington Jeffrey , Aledia Anna , Pretanvil Sarah , Wilson Bridget , Wong Josefina , Varma Jennifer , Boggan James , Hsu Frank P. K. , Carter Bob , Berger Mitchel , Harrison James D.
Published: January 2020

Background:

The effectiveness of neurosurgical operating room (OR) checklists to improve communication, safety attitudes, and clinical outcomes is uncertain.

Purpose:

To develop, implement, and evaluate a post-operative neurosurgery operating room checklist.

Methods:

Four large academic medical centers participated in this study. We developed an evidence-based checklist to be performed at the end of every adult-planned or emergent surgery in which all team members pause to discuss key elements of the case. We used a prospective interrupted time series study design to assess trends in clinical and cost outcomes. Safety attitudes and communication among OR providers were also assessed.

Results:

There were 11,447 neurosurgical patients in the preintervention and 10,973 in the postintervention periods. After implementation, survey respondents perceived that postoperative checklists were regularly performed, important issues were communicated at the end of each case, and patient safety was consistently reinforced. Observed to expected (O/E) overall mortality rates remained less than one, and 30-day readmission rate, length of stay index, direct cost index, and perioperative venous thromboembolism and hematoma rates remained unchanged as a result of checklist implementation.

Conclusion:

A neurosurgical checklist can improve OR team communication; however, improvements in safety attitudes, clinical outcomes, and health system costs were not observed.
Evaluation of Interventions to Reduce Firefighter Exposures
Authors: Burgess Jefferey L. , Hoppe-Jones Christiane , Griffin Stephanie C. , Zhou Jin J. , Gulotta John J. , Wallentine Darin D. , Moore Paul K. , Valliere Eric A. , Weller Sasha R. , Beitel Shawn C. , Flahr Leanne M. , Littau Sally R. , Dearmon-Moore Devi , Zhai Jing , Jung Alesia M. , Garavito Fernanda , Snyder Shane A.
Published: January 2020

Objective:

Evaluate the effectiveness of firefighter exposure reduction interventions.

Methods:

Fireground interventions included use of self-contained breathing apparatus by engineers, entry team wash down, contaminated equipment isolation, and personnel showering and washing of gear upon return to station. Urinary polycyclic aromatic hydrocarbon metabolites (PAH-OHs) were measured after structural fire responses before and after intervention implementation. Separately, infrared sauna use following live-fire training was compared to standard postfire care in a randomized trial.

Results:

The fireground interventions significantly reduced mean total urinary postfire PAH-OHs in engineers (−40.4%, 95%CI −63.9%, −2.3%) and firefighters (−36.2%, 95%CI −56.7%, −6.0%) but not captains (−11.3% 95%CI −39.4%, 29.9%). Sauna treatment non-significantly reduced total mean PAH-OHs by −43.5% (95%CI −68.8%, 2.2%).

Conclusions:

The selected fireground interventions reduced urinary PAH-OHs in engineers and firefighters. Further evaluation of infrared sauna treatment is needed.
Impact of Circuit Size on Coagulation and Hemolysis Complications in Pediatric Extracorporeal Membrane Oxygenation
Authors: Maul Timothy M. , Aspenleiter Marit , Palmer David , Sharma Mahesh S. , Viegas Melita L. , Wearden Peter D.
Published: January 2020

Extracorporeal membrane oxygenation (ECMO) circuit volume, patient size, and blood flow may influence coagulation and hemolysis complications. We performed a single-center retrospective analysis of ECMO patients over a 6.5 year period. In 299 ECMO runs, 13% required coagulation-associated circuit changes. Respiratory ECMO was associated with coagulation-associated circuit changes [odds ratio (O/R) 2.8,p< 0.05] and developed severe (plasma-free hemoglobin [pfHb] > 100 mg/dl) hemolysis (O/R 2.3,p< 0.05). Severe hemolysis and component changes were associated with hospital mortality (O/R 2.3 and 2.5, respectively,p< 0.05). The activated partial thromboplastin time (aPTT) to residence time (RT) ratio (aPTT/RT) was used as a surrogate for coagulation risk. We found that aPTT/RT > 2.5 more than doubled time to circuit change (3–8 days,p< 0.05), but aPTT/RT > 3 increased bleeding risks and hospital mortality (O/R 1.8;p< 0.1). Hemolysis was associated with patient weight and circuit to patient volume ratio (CPVR) (p< 0.05), but not pump type. Hemolysis slightly increased with transfusion (p= 0.08), and transfusion requirements increased for CPVR >50% (p< 0.1).Our data suggest that pediatric respiratory ECMO patients are more likely to develop coagulation and hemolysis complications, which are associated with increased mortality. This may result from higher inflammatory processes, which affect coagulation and red cell fragility. Minimizing circuit volume, inflammation, and red cell stress may help to reduce these two complications and their associated mortality.
Transition from Conventional Technique to Less Invasive Approach in Left Ventricular Assist Device Implantations
Authors: Özer Tanil , Gunay Deniz , Hancer Hakan , Altas Yerlikhan Ozge , Ozgur Mustafa Mert , Aksut Mehmet , Sarikaya Sabit , Kirali Kaan
Published: January 2020

Surgical treatments for heart failure patients are being increasingly performed every year. While experiences in this field are increasing, transition to alternative surgical approaches to minimize incisions is gaining popularity. However, there are clinics that still avoid performing these techniques. In the current study, we aim to present our experiences in transitioning to a minimally invasive technique by comparing two groups. One group was operated with a minimally invasive technique that has been performed in the learning curve period, while the second was operated with a familiar and standard technique. One hundred twenty patients who were implanted with left ventricular assist devices (LVADs) from April 2015 to January 2019 were retrospectively analyzed. The first 30 LVAD-implanted patients via less invasive approach (since April 2017) were included in group 1, and the last 30 isolated LVAD implanted patients via standard full sternotomy were included in group 2. Early clinical outcomes were compared between these two groups. There were no significant differences between two groups in terms of demographic features and preoperative statuses. Group 1 had significantly lesser mortality rates, cardiopulmonary bypass times, drainages, and blood products. Hospital stays had no significant difference between the groups, while extubation times and ICU stays were significantly lesser in group 1. Left ventricular assist device implantation through thoracotomy and ministernotomy is as feasible as that done through the conventional full sternotomy technique. In this group of patients with a high risk of bleeding, besides providing less hemorrhage, we believe that the surgical procedure was not more difficult than the conventional method.
Comparison of Antithrombin III Products in Pediatric Patients Receiving Extracorporeal Membrane Oxygenation
Authors: Omecene Nicole E. , Kishk Omayma A. , Lardieri Allison B. , Walker L. Kyle , Bhutta Adnan T.
Published: January 2020

The study investigated the safety and efficacy of two antithrombin III (ATIII) products in pediatric patients receiving extracorporeal membrane oxygenation (ECMO) by performing a retrospective analysis of patients who received either recombinant ATIII (rATIII) or human-derived ATIII (hATIII). Twenty-two patients were included in the study from January 2014 to September 2015 and all received unfractionated heparin (UFH) as anticoagulation during ECMO. In total, 86 doses of ATIII were included in the analysis in which 37 doses (43%) were rATIII and 49 doses (57%) were hATIII. Unfractionated heparin rates were also evaluated for all cases (n = 86) at 24 hours post-ATIII supplementation. The UFH rate decreased after the administration of both types of ATIII. However, neither the reduction in UFH rate between the two ATIII products (p = 0.52) nor the UFH rates pre- and post-ATIII supplementation at 24 hours (p = 0.08) reached statistical significance. There was a significant difference in cost favoring the rATIII product (p < 0.0001). An ad-hoc estimation of waste associated with ATIII supplementation showed >$100,000 in financial loss of unused drug. Future studies are warranted to evaluate the efficacy of ATIII supplementation in pediatric ECMO.
High ubiquitin conjugating enzyme E2 T mRNA expression and its prognostic significance in lung adenocarcinoma
Authors: Wu Zeng-Hong , Zhang You-jing , Sun Hai-Ying
Published: January 2020

Lung adenocarcinoma (LUAD) is the most common subtype of lung cancer with a high mortality disease which has been positioned the first and second cancer morbidity of men and women in China, separately. Our study was to assess the prognostic meaningful of ubiquitin conjugating enzyme E2 T (UBE2T) expression in LUAD dependent on data acquired from The Cancer Genome Atlas (TCGA) and so as to increase further knowledge into the biological pathways involved in LUAD pathogenesis related to UBE2T.

Information on gene expression and comparing clinical data were recognized and downloaded from TCGA. Gene set enrichment analysis (GSEA) created an arranged list of all genes s indicated by their connection with UBE2T expression.

Our study cohort included 265 (54.5%) female and 221 (36.0%) male patients. The scatter plot and paired plot showed the difference of UBE2T expression between normal and tumor samples (P < .01). Overall survival (OS) analysis demonstrated that LUAD with UBE2T-high had a more terrible prognosis than that with UBE2T-low (P < .01). Multivariate analysis with the cox proportional hazards model indicated that the expression of UBE2T (hazard ratio [HR]: 1.28; 95% Confidence Interval (CI): 1.06–1.56; P = .011) and stage (HR: 2.02; 95% CI: 1.27–3.21; P = .003) were independent prognostic factors for patients with LUAD. The GSEA results showed that cell cycle, DNA replication, RNA degradation, oxidative phosphorylation, pathogenic Escherichia coli infection, citrate cycle tricarboxylic acid cycle, Alzheimer's disease, P53 signaling pathway, and purine metabolism are differentially enriched in UBE2T high expression phenotype.

Our study found that the expression of UBE2T was significantly increased in LUAD patients and associated with several clinical features. UBE2T may be a potentially useful prognostic molecular biomarker of bad survival in LUAD, while further experimental ought to be performed to demonstrate the biologic effect of UBE2T.
Surgical treatment of recurrent spinal phosphaturic mesenchymal tumor-induced osteomalacia
Authors: Liu Shuzhong , Zhou Xi , Song An , Huo Zhen , Wang Yipeng , Liu Yong
Published: January 2020

Rationale:

Tumor-induced osteomalacia (TIO) is a highly unusual disease with enormous difficulties in clinical diagnosis and curative managements. The objective of this study is to report a very rare case who underwent surgical treatment of recurrent spinal phosphaturic mesenchymal tumor. The management of these unique cases has yet to be further elucidated.

Patient concerns:

A 52-year-old man presented with a 3-year history of back pain and 1-year history of continuous and progressive systemic bone pain. The patient, who had been diagnosed of TIO for 3 years, received surgical treatment of extended resection of spinal phosphaturic mesenchymal tumor at L5. Somatostatin receptor tomography revealed the expression of somatostatin in the spine increased significantly, with high suspicion of recurrent phosphaturic mesenchymal tumor.

Diagnosis:

Magnetic resonance imaging of spine and positron emission tomography-computed tomography showed the mass in L5, which was highly indicative of the recurrent pathogenic tumor. Postoperative pathology confirmed the diagnosis of phosphaturic mesenchymal tumor in the spinal region.

Interventions:

The patient underwent posterior L5 tumor resection, bone cement reconstruction, L4-S1 spinal canal decompression, and L3-S2 internal fixation.

Outcomes:

The patient's symptoms improved significantly after the surgery, and we noticed that his hypophosphatemia was successfully corrected after the 2nd operation. Follow-up at 1 month after surgery revealed no recurrence, and the serum phosphorus level of the patient turned to be normal postoperatively. There were no complications associated with the operation during the follow-up period.

Lessons:

Taken together, the lesion's clinical features, imaging results, and pathologic characteristics are unique. Combined efforts of specialists from orthopedics, endocrinology, nuclear medicine, radiology, pathology, and medical oncology led to the successful diagnosis and management of this patient. TIO, although rare, should be part of the differential diagnosis when the patient has a history of hypophosphatemia and systemic multiple bone pain. We recommend surgical treatment of the phosphaturic mesenchymal tumor in the spinal region. Osteoplasty by bone cement may be a treatment option for patients with TIO who cannot undergo appropriate surgery or decline open surgery.
Efficacy of salbutamol in the treatment of infants with bronchiolitis
Authors: Cai Zhibo , Lin Yan , Liang Jianfeng
Published: January 2020

Background:

To systematically evaluate the clinical efficacy of salbutamol treatment in infants with bronchiolitis.

Methods:

A systematic review and meta-analysis of randomized controlled trials (RCTs) investigating the use of salbutamol in infants with bronchiolitis was performed. The Cochrane Risk of Bias Assessment Tool was used to evaluate the quality of RCTs. Data were extracted and meta-analyzed using STATA version 12.0 (StataCorp, College Station, TX).

Results:

Thirteen RCTs, including a total of 977 participants, were assessed in the present meta-analysis. Results indicated that salbutamol therapy for bronchiolitis in infants led to an increase in respiratory rate (weighted mean difference [WMD] 2.26 [95% confidence interval {CI} 0.36–4.16]) and higher heart rate (WMD 12.15 [95% CI 9.24–15.07]). However, as a selective β2-agonist, salbutamol did not improve the clinical severity score of infants with bronchiolitis (WMD –0.11 [95% CI –0.26 to 0.03]), length of hospital stay (WMD 0.12 [95% CI –0.32 to 0.56]), or oxygen saturation (WMD 0.20 [95% CI –0.35 to 0.75]).

Conclusion:

Based on the results of this systematic review, the use of salbutamol had no effect on bronchiolitis in children <24 months of age. Moreover, the treatment can also lead to side effects, such as high heart rate. As such, salbutamol should not be recommended for treatment of bronchiolitis in infants.
A multi-feature image retrieval scheme for pulmonary nodule diagnosis
Authors: Wei Guohui , Qiu Min , Zhang Kuixing , Li Ming , Wei Dejian , Li Yanjun , Liu Peiyu , Cao Hui , Xing Mengmeng , Yang Feng
Published: January 2020

Deep analysis of radiographic images can quantify the extent of intra-tumoral heterogeneity for personalized medicine.

In this paper, we propose a novel content-based multi-feature image retrieval (CBMFIR) scheme to discriminate pulmonary nodules benign or malignant. Two types of features are applied to represent the pulmonary nodules. With each type of features, a single-feature distance metric model is proposed to measure the similarity of pulmonary nodules. And then, multiple single-feature distance metric models learned from different types of features are combined to a multi-feature distance metric model. Finally, the learned multi-feature distance metric is used to construct a content-based image retrieval (CBIR) scheme to assist the doctors in diagnosis of pulmonary nodules. The classification accuracy and retrieval accuracy are used to evaluate the performance of the scheme.

The classification accuracy is 0.955 ± 0.010, and the retrieval accuracies outperform the comparison methods.

The proposed CBMFIR scheme is effective in diagnosis of pulmonary nodules. Our method can better integrate multiple types of features from pulmonary nodules.
Primary lymphoma of the tibia in children
Authors: Suo Haiqiang , Fu Li , Wang Zhiwei , Liang Hanguang , Xu Zhe , Feng Wei
Published: January 2020

Rationale:

Primary lymphoma of the bones (PLB) is a rare extranodal non-Hodgkin lymphoma (NHL) that is particularly rare in children. The clinical presentation and radiological features of PLB are often nonspecific, making clinical diagnosis challenging and misdiagnosis frequent. Here, we report 2 children with PLB focusing on clinical presentation, differential diagnosis, and treatment outcomes.

Patients concerns:

A 9-year-old boy presented with left knee swelling and pain for 4 months after a fall. He was previously misdiagnosed with traumatic soft tissue injury. The second patient was an 11-year-old boy with a 6-month history of intermittent left knee pain. He was previously misdiagnosed with bone tuberculosis and chronic osteomyelitis.

Diagnoses:

A 9-year-old boy showed an abnormal signal of the left tibia metaphysis, diaphysis, and epiphysis, and tibia with periosteal reactions and surrounding soft tissue swelling. Tumor biopsy and immunohistochemistry confirmed a diagnosis of B-cell lymphoblastic lymphoma.

An 11-year-old boy showed a permeative lesion in the metaphysis and diaphysis of the left proximal tibia. Tumor biopsy and immunohistochemistry confirmed the diagnosis of diffuse large B-cell lymphoma.

Interventions:

Both patients were treated with 6 courses of NHL-Berlin-Frankfurt-Münster-95.

Outcomes:

Both patients are in complete clinical remission with a follow-up of 27 and 18months after treatment, respectively.

Lessons:

PLB is a rare malignancy that is difficult to diagnose, particularly in children. Clinicians should increase the awareness of the disease and consider a differential diagnosis of bone lesions. Chemotherapy combined with radiotherapy is a favorable treatment for children with PLB. Early diagnosis and active treatment can improve patient prognosis.
Evaluation of the correlation between job stress and sleep quality in community nurses
Authors: Deng Xuexue , Liu Xuelian , Fang Ronghua
Published: January 2020

Chronic sleep deprivation may worsen many medical and mental health conditions, causing difficulty in the ability to function at work. Job stress may be a factor that directly correlates with the poorer sleep quality of nurses from different departments in a general hospital. However, epidemiological evaluations of sleep problems among community nurses in China are scarce, and an association between sleep problems and occupational stress has not been investigated. This study investigated the association between nurses’ job stress and sleep quality in a community hospital in China. This cross-sectional study was conducted from September to November 2017 and involved 180 nurses who had worked for more than 1 year in 12 community hospitals. The Job Stress Questionnaire was administered to evaluate occupational stress. The Pittsburgh Sleep Quality Index was used to evaluate sleep disorder status. Logistic regression was performed to investigate the association between job stress and sleep disorder among these community nurses in China. For the 155 nurses who completed the study, the job stress score was 58 ± 18, and 72 nurses (46%) had a Pittsburgh Sleep Quality Index (PSQI > 7). The type of nurse contract and total job stress scores were related to sleep disturbances within the previous month. The job stress scores were negatively associated with sleep quality; in other words, the higher the job stress scores were, the worse the quality of sleep. The logistic regression analysis showed that the type of nurse contract and self-reported job stress were significant factors affecting sleep quality. Sleep disturbances in nurses were highly associated with job difficulty factor, doctor-patient relationships, psychosomatic state, environment or events, promotion or competition and total pressure scores. Sleep problems were prevalent among clinical nurses in community hospitals in China. Occupational stress negatively affects sleep quality in Chinese community nurses; the higher the stress is, the worse the sleep quality.
Methylation of the ataxia telangiectasia mutated gene (ATM) promoter as a radiotherapy outcome biomarker in patients with hepatocellular carcinoma
Authors: Yan Xinjian , Wu Tianyu , Tang Mei , Chen Dongliang , Huang Meiyuan , Zhou Sichun , Zhang Huihui , Yang Xiaoping , Li Gaofeng
Published: January 2020

The goal of this study was to evaluate the contribution of ataxia telangiectasia mutated (ATM) gene promoter methylation to hepatocellular carcinoma (HCC) and the predictive value of radiotherapy outcome. ATM promoter methylation status was detected using methylation-specific PCR in 118 HCC, 50 adjacent liver, and 20 normal liver samples. PCR products were verified by bisulfite sequencing PCR. ATM expression was detected by quantitative PCR (qPCR) and immunohistochemistry (IHC) in 50 paired HCC and adjacent normal tissues and 68 locally advanced HCC biopsy tissues. Furthermore, radiotherapy outcomes in 68 locally advanced HCC patients were determined using European Association for the Study of Liver criteria and survival analysis. The results revealed that the methylation frequency of the ATM promoter was significantly higher in HCC tissues than in normal liver tissues (χ2 = 16.830, P < .001). Quantitative PCR (qPCR) and IHC results showed a significant association between ATM promoter methylation and ATM expression in HCC (χ2 = 10.510, P < .001), and methylated ATM was correlated with lower ATM expression compared with unmethylated ATM (r = 0.356, P < .001). Furthermore, methylation of the ATM promoter was significantly associated with superior outcomes in patients with locally advanced HCC who initially received radiotherapy. Together, these results indicate that ATM promoter methylation might increase the risk of HCC by regulating ATM expression, and thus may function as a potential biomarker for predicting radiotherapy outcomes in HCC patients.
Acupuncture and Moxibustion for restless legs syndrome
Authors: Huang Zhijun , Qingqing Cao , Wenchun Zhang , Zhouhang Wu , Jiankun Ren
Published: January 2020

Introduction:

Previous reviews indicate that the effect of acupuncture and moxibustion (AM) on restless legs syndrome (RLS) remains uncertainty. The results of trials published in the past 12 years may possibly change this situation, but an updated systematic review is not available. We therefore designed this study to systematically assess the effectiveness and safety of AM for treating RLS.

Methods and analysis:

Nine online databases will be searched from inception to October 01 2019; there will be no language restrictions on the included trials. Randomized controlled trials that included patients with RLS receiving AM therapy versus a control group will be included. The selection of studies, risk of bias assessment and data extraction will be conducted by 2 independent researchers. Data synthesis will be performed by using RevMan V.5.2 software with fixed effects model or random effects model, according to the heterogeneity test. The dichotomous data will be presented as risk ratios with 95% confidence intervals (Cis) and the continuous data will be presented as weighted mean differences or standardized mean differences with 95% CIs. Evidence quality will be evaluated by using the grading of recommendations assessment (GRADE), development and evaluation system with low risk, unclear risk, and high risk.

Ethics and dissemination:

This systematic review and meta-analysis is literature research which will not refer to private information and not impair one's health, so, ethical approval is not required. The results of this study will be published in a journal or concerned conferences.

PROSPERO registration number:

CRD42019148325
Jejunal hemolymphangioma
Authors: Teng Yajie , Wang Jie , Xi Qinhua
Published: January 2020

Rationale:

Hemolymphangioma is a benign tumor comprised of the newly-formed lymph spaces and blood vessels, which can usually be found in the head and neck of the affected children. There are few reports regarding cases with hemolymphangioma in small intestine, spleen, esophagus, and other organs.

Patient concerns:

Herein, a 55-year-old woman was presented in this study, she had complained of discomfort in the right upper abdomen for 2 months, and was discovered with a space-occupying lesion in proximal jejunum on computed tomography (CT). Eventually, the lesions were confirmed through double-balloon enteroscopy (DBE) to be located in the jejunum 60 cm away from the Treitz ligament.

Diagnose:

Subsequently, the small intestine was partially resected, and postoperative pathology had confirmed the diagnosis of small intestinal hemolymphangioma.

Interventions:

Excisional surgery of the lesion was planned. On surgery, the lesions were discovered to be about 3∗3 cm to 2∗2 cm when engorged the superficial vessels. No enlarged lymph nodes were seen at the root of the mesentery, and no obvious lesion was observed in the remaining small intestine.

Outcomes:

Follow-up for 6 months showed no recurrence.

Lessons:

Hemolymphangioma lacks typical clinical symptoms, and the correct preoperative diagnosis of hemolymphangioma remains challenging. Due to the increasing use of endoscopic diagnostic techniques, it is expected that hemolymphangioma in gastrointestinal tract may be detected and endoluminal located before surgery more feasibly. This case report aimed to highlight the contributions of CT and DBE to an accurate preoperative diagnosis and surgical strategy planning.
An integrative cognitive rehabilitation using neurologic music therapy in multiple sclerosis
Authors: Impellizzeri Federica , Leonardi Simona , Latella Dèsiréè , Maggio Maria Grazia , Foti Cuzzola Marilena , Russo Margherita , Sessa Edoardo , Bramanti Placido , De Luca Rosaria , Calabrò Rocco Salvatore
Published: January 2020

Background:

Multiple sclerosis (MS) is a demyelinating disease, affecting both the sensorimotor and cognitive systems. The typical pattern of cognitive impairment includes reduced speed of information processing, decreased phonological and semantic speech fluency, deficits in verbal and visual episodic memory, as well as attention and executive dysfunctions. We aimed to investigate the influence of the neurologic music therapy (NMT) on mood, motivation, emotion status, and cognitive functions in patients with MS.

Methods:

Thirty patients with MS were randomly divided in 2 groups: the control group (CG) undergoing conventional cognitive rehabilitation (CCR), 6 times a week for 8 weeks, and the experimental group (EG) undergoing CCR 3 times a week for 8 weeks plus NMT techniques, performed 3 times a week for 8 weeks. All the participants were submitted to the same amount of treatment. Each patient was evaluated before (baseline: T0) and immediately after the end of each training (T1).

Main outcomes measures:

We used as main outcome measure: the brief repeatable battery of neuropsychological test to assess various cognitive abilities; and the multiple sclerosis quality of life-54 (MSQoL-54).

Results:

Both the groups benefit from 8 weeks of CR. In particular, the EG got better results in cognitive function, with regard to selective reminding test long term storage (P < .000), long term retrieval (P = .007), and delayed recall of the 10/36 spatial recall test (P = .001), as compared with the CG. Moreover, the improvement in emotional status, motivation, mood and quality of life (with regard to the mental component; P < .000) was more evident in the EG.

Conclusions:

NMT could be considered a complementary approach to enhance CCR in patients affected by MS.
Nexplanon migration into a subsegmental branch of the pulmonary artery
Authors: Hindy Joya-Rita , Souaid Tarek , Larus Corinne Tuckey , Glanville Joanne , Aboujaoude Ramzi
Published: January 2020

Introduction:

Nexplanon is a 4 cm rod-shaped barium sulphate coated contraceptive implant with a usual subdermal insertion in the inner non-dominant upper arm. Complications proper to subdermal contraceptive implants are unusual and principally localized and minor, comprising infection at the site of implantation, hematoma, abnormal scar development, or local nerve and blood vessel injuries. Infrequently, contraceptive implant migration can happen, though habitually not far from the site of insertion. Pulmonary embolization of the device is remarkably rare and can present with symptoms such as chest pain or dyspnea.

Patient concerns and diagnosis:

We report one of the rare cases of asymptomatic Nexplanon pulmonary embolism in a 26-year-old female.

Interventions and outcomes:

An endovascular intervention successfully retrieved the device from the lateral segment right middle lobe pulmonary artery without any complications.

Conclusion:

Several cases of contraceptive implant migration into the pulmonary artery have been reported to this day. Preventing this life-threatening complication is challenging, and yet, no clear guidelines have been established.
Metastatic small cell neuroendocrine carcinoma of the submandibular gland from the lung
Authors: Lee Dong Hoon , Kim Jo Heon , Yoon Tae Mi , Lee Joon Kyoo , Lim Sang Chul
Published: January 2020

Rationale:

Small cell neuroendocrine carcinoma of the salivary gland is an extremely rare condition. To the best of our knowledge, metastasis of small cell neuroendocrine lung cancer to the submandibular gland has not been reported in the literature.

Patient concern:

An 87-year-old female complained of a left neck mass that enlarged from one month ago.

Diagnosis:

The final diagnosis was diagnosed as a metastatic small cell neuroendocrine carcinoma of the submandibular gland from lung by an immunohistochemistry.

Interventions:

Left submandibular resection was performed under general anesthesia.

Outcomes:

We recommended further evaluation and treatment, but the patient and patient family support team rejected further treatment of her condition. It was confirmed that 3 months after this conclusive diagnosis, the patient died as a result of this condition and disease.

Lessons:

Small cell neuroendocrine carcinoma of the salivary gland is an extremely rare condition. We report a case of metastatic small cell neuroendocrine carcinoma of the submandibular gland from the lung.
Obesity Is More Common in Children Newly Diagnosed With Ulcerative Colitis as Compared to Those With Crohn Disease
Authors: Chandrakumar Abin , Wang Angus , Grover Kanika , El‐Matary Wael
Published: January 2020

Objective:

This prospective observational study aimed to examine the prevalence of obesity in a population‐based cohort of children and young adults newly diagnosed with inflammatory bowel disease (IBD) and assess their outcome in comparison to newly diagnosed normal/underweight patients.

Methods:

Our longitudinal population‐based cohort comprised all children younger than 17 years diagnosed with IBD in the province of Manitoba, Canada between 2012 and 2018. Cox regression model with adjustment for a priori covariates was used to examine the time to first relapse among patients who were obese/overweight at the time of IBD diagnosis in comparison to patients who were normal or underweight.

Results:

A total of 139 patients with IBD were followed up for a median duration of 1.09 (interquartile range: 0.53–2.62) years. Obesity was more common in children newly diagnosed with ulcerative colitis (UC) compared to those with Crohn disease (CD) (12.7% vs 0.0%; P = 0.005). Age at diagnosis poorly correlated with the body mass index z score (R = 0.23; P = 0.01). The proportions of patients who were underweight at the time of IBD diagnosis among patients with UC and CD were 6.3% and 20.0%, respectively (P = 0.01). The time to initial relapse was not found to be significantly associated with weight category at diagnosis in UC (adjusted hazard ratio = 0.77; 95% confidence interval: 0.40–1.63) or CD (adjusted hazard ratio  = 0.83; 95% confidence interval: 0.20–3.51).

Conclusion:

Obesity was more common in children and young adults newly diagnosed with UC. The majority of the underweight children had CD.
Barrett Esophagus and Intestinal Metaplasia of the Gastroesophageal Junction in Children
Authors: Putra Juan , Arva Nicoleta C. , Tan Serena Y. , Melin‐Aldana Hector , Bass Lee M. , Mitchell Paul D. , Fox Victor L. , Goldsmith Jeffrey D.
Published: January 2020

Objectives:

Barrett esophagus (BE) and intestinal metaplasia of gastroesophageal junction (IMGEJ) are rare in the pediatric population. This multi‐institutional retrospective study evaluated the clinicopathologic characteristics and natural history of BE and IMGEJ in children.

Methods:

Data from 20 BE patients (70% boys, mean age: 14.9 years) and 17 IMGEJ patients (71% boys, mean age: 14 years) were retrospectively obtained from chart review. Endoscopic and pathologic findings from index and follow‐up endoscopies were analyzed.

Results:

Most patients (70% BE and 59% IMGEJ) had underlying conditions which put them at risk for gastroesophageal reflux disease. Increased body mass index (BMI) was observed in patients without underlying conditions (BE: 30.1 ± 9.8; IMGEJ: 23.9 ± 6.3) compared with those with underlying conditions (BE: 19.6 ± 7.8; IMGEJ: 16.4 ± 2.1) (BE, P = 0.02; IMGEJ, P = 0.01). Incomplete intestinal metaplasia (IM) was the predominant histology seen in BE (80%) and IMGEJ patients (75%). Dysplasia and malignancy were not identified in the initial and follow‐up biopsies. Concurrent gastric biopsies showed various findings (79% BE and 40% IMGEJ were normal), with 1 IMGEJ patient showing coexisting gastric IM (7%). Follow‐up in 12 BE patients (mean follow‐up time 51.6 months) showed 100% persistent endoscopic disease and 58% persistent IM histologically. Three of 6 IMGEJ patients (mean follow‐up time 24 months) demonstrated endoscopic and histologic features consistent with BE on subsequent procedures. Moreover, a subset of BE (57%) and IMGEJ patients (67%) who underwent endoscopy before initial diagnosis showed nongoblet columnar mucosa above the anatomic gastroesophageal junction.

Conclusions:

Increased BMI may be a risk factor for BE and IMGEJ in pediatric patients without underlying conditions. Nongoblet columnar metaplasia and IMGEJ might represent incomplete forms of BE. Our data suggest that these patients should be closely monitored.
Perinatal Anxiety and Depression in Minority Women
Authors: Gennaro Susan , O'Connor Caitlin , McKay Elizabeth Anne , Gibeau Anne , Aviles Melanie , Hoying Jacqueline , Melnyk Bernadette Mazurek
Published: January 2020

Depression and anxiety are common during pregnancy and are experienced at higher rates among women who are racial and ethnic minorities. Because depression and anxiety influence maternal and infant outcomes, intervening to improve perinatal mental health should be a priority for all healthcare providers. However, in the United States, a number of barriers including lack of mental health providers, lack of perinatal behavioral health systems, and stigma, limit access to care. Universal screening has been recommended and here we examine how universal screening can help nurses improve the mental health of childbearing women. Interventions that are currently in use to improve perinatal anxiety and depression are reviewed and include: psychopharmacology, cognitive behavioral therapy, interpersonal psychotherapy, and mindfulness. Recommendations for future research and healthcare system changes are made.
Comparison of the Sleep Problems Among Adolescents Who Attempted Suicide and Healthy Adolescents
Authors: Yildiz Eren , Sac Rukiye , Işik Ümit , Özaydin Mustafa S. , Taşar Medine Ayşin , Cakir İlyas , Alioglu Bulent
Published: January 2020

The aim of this study was to compare sleep problems among adolescents who attempted suicide and healthy adolescents who never attempted suicide. Adolescents who attempted suicide (study group, n = 103) and healthy adolescents (control group, n = 59) completed a questionnaire prepared by researchers including demographic factors. In addition, the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS) were administered to both groups. The median age was 16 years and 73% were girls, in both groups. The study group had lower rate of attending to school (88.3% vs. 100%; p = 0.001), academic achievement (45.7% vs. 83.1%; p = 0.001), higher rate of smoking (37.9% vs. 13.8%; p = 0.001), socializing problems (31.1% vs. 3.4%; p = 0.001), and appetite changes (57.3% vs. 39.7%; p = 0.032) than controls. The rate of those with PSQI scores 6 or higher was 53.4% in the attempted suicide group and 37.3% in the control group (p = 0.048). Adolescents, classified as sleepy according to the ESS, did not differ significantly between the groups (p = 0.214). Adolescents who attempted suicide had poor sleep quality. It is crucial to examine the kinds of sleep problems adolescents who have attempted suicide have experienced. Among adolescents attending outpatient clinics with poor sleep quality, PSQI can be a useful screening tool. Those with high scores should be evaluated for suicide risk.
Nurses on Boards
Authors: Reid Ponte Patricia
Published: January 2020

In this Inspiration Column, Pat Reid Ponte interviews Lisa J. Sundean, PhD, MHA, RN, associate professor, University of Massachusetts Boston. Dr Sundean has devoted her career to support the inclusion of nurses on boards.
Does Organizational Compassion Matter? A Cross-sectional Survey of Nurses
Authors: Lown Beth A. , Manning Colleen F. , Hassmiller Susan B.
Published: January 2020

OBJECTIVE

To examine factors that influence nurses' perceptions of organizational compassion and their engagement with the organization.

BACKGROUND

Despite agreement about the importance of compassionate healthcare, it is difficult for employees to consistently act compassionately when organizational leaders, managers, and systems of care fail to support compassion as a value.

METHODS

The study used a cross-sectional design, and quantitative and qualitative data were collected through an online survey of nurses.

RESULTS

Higher individual compassion and team compassion were associated with higher perceived organizational compassion, and higher organizational compassion was associated with greater engagement with the hospital. In contrast, high turnover rates and inadequate staffing were associated with lower perceived organizational compassion and lower engagement with one's organization.

CONCLUSIONS

Adequate staffing, resource allocation, and practices that contribute to the sense that one is a supported member of a caring team focused on addressing patients' needs build the capacity for compassion within an organization.