bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of fit factors among healthcare providers working in the Emergency Department Center before and after training with three types of N95 and higher filter respirators
Authors: Kim Hongjung , Lee Juncheol , Lee Sanghyun , Oh Jaehoon , Kang Boseung , Lim Tae Ho , Kang Hyunggoo
Published: February 2019

Introduction:

N95 or higher filtering respirators have been recommended in healthcare settings, although there is still a risk of infection due to the improper selection and wearing of respirators. We aimed to assess the effects of training with N95 or higher filter respirators on the protection performance of respirators among healthcare providers in the emergency medical center (EMC).

Methods:

This randomized crossover study evaluated 23 healthcare providers. Quantitative fit tests (QNFTs) were performed before and after training using three types of N95 or higher filter respirators (cup-type, fold-type, valve-type). Training was performed by lecture, real-time feedback, and fit check. The primary outcome was the fit factor, and the secondary outcomes were overall fit factor, adequate protection rate, and respiratory preference.

Results:

Fit factors, overall fit factor, and adequate protection rate were higher after training than before training for the 3 types of respirators (all P < .05). For normal breathing, fit factors before and after training were 121 (10–185) vs 192 (161–200) for cup-type, 200 (39–200) vs 200 (200–200) for fold-type, and 85 (18–157) vs 173 (117–200) for valve-type. For normal breathing, the adequate protection rates before and after training were 62 (0–100) vs 100 (90–100) for cup-type, 100 (0–100) vs 100 (100–100) for fold-type, and 19 (0–100) vs 100 (44–100) for valve-type (all P < .05). The most preferred respirator type was the valve-type (10 persons, 45.5%).

Conclusions:

Training on wearing an N95 or higher respirator improved the protection performance of respirators among healthcare providers working in the EMC. The selection of proper respirators and training would be beneficial to the safety of healthcare providers.
Dental caries among childhood cancer survivors
Authors: Proc Patrycja , Szczepańska Joanna , Herud Anna , Zubowska Małgorzata , Fendler Wojciech , Młynarski Wojciech
Published: February 2019

One of many possible complications of cancer therapy in children is enamel demineralization and such changes in the ion content of dental hard tissues may increase susceptibility to caries. The study aims to assess the prevalence of dental caries among childhood cancer survivors.

A cross-sectional study was conducted on 225 children aged between 4 and 18 years, including 75 cancer patients and 150 sex- and age-matched controls. The cancer survivors were recruited from single pediatric oncology center. The control group was formed from students of randomly selected kindergartens and schools. Dental investigation was held between July 2013 and January 2016, approximately 5 years after the cessation of anticancer treatment (range: 6–155 months). The occurrence of dental caries was assessed with DMF/dmf index (showing the mean number of decayed, missing and filled permanent/deciduous teeth). Univariate statistical approach was performed and P-values < .05 were considered as statistically significant.

The frequency of dental caries was comparable in both groups (85.4% vs 84%). However, the DMF index was higher in cancer patients than in controls: the median and interquartile ranges were 2 (0–4) vs 0 (0–2); P < .01. This correlates with duration of anticancer therapy (r = 0.26; P < .05). Moreover, children who had radiotherapy of the head and neck regions had significantly higher DMF scores than the ones who did not: 4.5 (1–6) vs 2 (0–4); P < .05. Socioeconomic and education status within family also has a significant impact on DMF scores in the cancer group. In conclusion, cancer patients, particularly those with a poor social background, should receive professional dental care as their caries process is more active than that of healthy peers.
Effect of an interactive voice response system on self-management in kidney transplant recipients
Authors: Ganjali Raheleh , Taherzadeh Zhila , Ghorban Sabbagh Mahin , Nazemiyan Fatemeh , Mamdouhi Fereshteh , Tabesh Hamed , Badiee Aval Shapour , Golmakani Reza , Mostafavi Sayyed Mostafa , Eslami Saeid
Published: February 2019

Introduction:

Adherence to a complex and ongoing set of therapeutic recommendations significantly determines short and long-term outcomes after kidney transplantation (KT). Interactive voice response system (IVRS) is a novel phone-based platform which is potentially useful to deliver health behavior interventions.

Objective:

The aims of the study is to describe the development of a theory-driven and educational IVRS investigate the effect of an IVRS on the self-management outcomes in KT recipients as compared with the control group.

Methods:

This study has been designed as a randomized, 2 parallel groups controlled trial. The KT recipients’ older than18 years of age with access to a cellphone will be included. A total of 120 patients will be randomly assigned to the control and intervention groups. The participants in the intervention group will receive completely automatic calls in 3 categories: educational, medication adherence, and reminders by the IVRS, whereas those in the control group will receive usual care. The follow up will be performed within 6 months. The primary outcome will be the medication adherence while patients’ transplant knowledge, health-related quality of life, and rehospitalization rates will be considered as secondary outcomes.

Results:

Thus far, recruitment of participants has not been completed and results will be published in 2019.

Discussion:

The IVRS is potentially useful to help KT recipients improve the self-management outcomes. The hypothesis is using an IVRS intervention makes a significant difference between basel assessment of adherence to immunosuppressive medications scale, 12-item short form survey, second version, kidney transplant understanding tool baseline scores, and those obtained at the end of study.

Trial registration number:

This trial is registered with the Iran Trial Registrar under registration number IRCT20180124038492N1 and registration date 30 January 2018. https://irct.ir/trial/29215
Headache due to spinothalamic tract injury in patients with mild traumatic brain injury
Authors: Jang Sung Ho , Seo You Sung
Published: February 2019

Rationale:

Headache is the most common physical complaint reported by the following traumatic brain injury (TBI). Several studies using diffusion tensor tractography (DTT) have demonstrated that injury of the spinothalamic tract (STT) is a pathogenetic mechanism of central pain following TBI. However, no study of headache due to injury of the STT has been reported.

Patient concerns:

Patient 1 was a 52-year-old female who suffered head trauma resulting from an in-car traffic crash. While sitting in a passenger seat in a moving vehicle, another vehicle suddenly hit the car from the right side. Her head hit the door and she suffered a flexion-hyperextension-rotation injury. She began to feel headaches in both fronto-parieto-occipital areas approximately 2 weeks after the crash. The characteristics and severity of pain were as follows: constant tingling and intermittent stabbing pain without allodynia or hyperalgesia (visual analogue scale score: 7). Patient 2 was a 50-year-old male who suffered head trauma from a flexion-hyperextension injury that occurred after being hit from behind by a vehicle while driving his car. He began to feel headache in both fronto-parieto-occipital areas the day after the crash: constant tingling pain without allodynia or hyperalgesia (visual analogue scale score: 6).

Diagnoses:

The patient 1 was diagnosed as mild TBI due to head flexion-hyperextension-rotation injury. The patient 2 was diagnosed as mild TBI due to head flexion-hyperextension injury.

Interventions:

Clinical assessment and DTT were performed at 5 months (patient 1) and 10 months (patient 2) after the initial injury.

Outcomes:

On DTTs of patient 1 and 2, the STTs showed narrowing in both hemispheres. In addition, discontinuations at the subcortical white matter were observed in both hemispheres in patient 2.

Lessons:

Headache due to injury of the STT was diagnosed in patients with mild TBI. Precise diagnosis of central pain from other types of pain is clinically important because the management of central pain is quite different from those for other types of pain. Our results suggest that headache might be ascribed to the injury of the STT in patients with mild TBI. Therefore, we recommend evaluation of the STT using DTT in patients with mild TBI who complain of headache having the characteristics of neuropathic pain.
Atrioventricular reentrant tachycardia in a child with tricuspid atresia
Authors: Wang Yefeng , Liu Qiming , Deng Xicheng , Xiao Yunbin , Chen Zhi
Published: February 2019

Rationale:

Atrioventricular reentrant tachycardia (AVRT) is the most common supraventricular tachycardia occurring in children. However, in complex congenital heart disease patients with a different heart anatomy and conduction system morphology, accessory pathway modification may be particularly challenging because of distortion of typical anatomic landmarks.

Patient concerns:

A 10-year-old boy with tricuspid atresia and history of bidirectional Glenn operation had recurrent chest distress and palpitation for 3 months. He had multiple hospitalizations for narrow-QRS tachycardia with poor hemodynamic tolerance, despite the use of adenosine and amiodarone.

Diagnoses:

AVRT. Tricuspid atresia with secundum atrial septal defect, large ventricular septal defect, and right ventricular outflow tract stenosis.

Interventions:

Cardiac catheterization, electrophysiological examination, and ablation.

Outcomes:

The child has not had a recurrent AVRT during 6 months of follow-up and is waiting for Fontan operation.

Lessons:

Since there is an increased risk of accessory pathways in patients with tricuspid atresia, all these patients should be checked before the Fontan operation to exclude congenital accessory pathways.
A rare primary Candida parapsilosis infection of the knee joint in a patient without predisposing factors
Authors: Wang Jun , Zhang Zhen , Zhang Miao , Yang Bo , Wang Tengyun , Sun Xuedong , Chen Xiuli , Zhang Min Yi , Guo Zhi Yong , Jiang Xin
Published: February 2019

Rational:

Knee joint infection caused by isolated primary Candida is extremely rare, with only a few cases reported. It occurs most often in patients with predisposing factors (e.g., immunosuppression, malignancy, drug abuse) or fungal invasion during traumatic procedures, including surgery. We report an unusual case of Candida parapsilosis infection in the knee joint with no predisposing factors.

Patient concerns:

A 65-year-old man entered our hospital complaining of persistent pain and mild swelling of the right knee that seriously affected normal walking. There was no obvious cause for his distress.

Diagnosis:

The case was eventually diagnosed as a primary Candida parapsilosis infection which had many diagnostic particularities and difficulties.

Interventions:

Total knee arthroplasty (TKA) was ultimately performed followed by fluconazole coverage.

Outcomes:

The patient showed good clinical performance at the 3- and 6-month follow-up visits and was very satisfied with the therapeutic effect.

Lessons:

If there were suspected symptoms of primary Candida infection cases, imaging and microscopic examinations, tissue cultures, and pathological examination of the puncture knee joint fluid were required.
Observation of changes after peripheral retinal injury by cosmetic laser, using wide-field scanning laser ophthalmoscope
Authors: Kim Rae Young , Ra Ho
Published: February 2019

Rationale:

Increases in cosmetic laser use have led to recent reports of accidental retinal injuries, most of which are limited to the posterior pole. We report a case of peripheral retinal injury caused by a 1064-nm Nd:YAG: neodymium-doped yttrium aluminum garnet.

Patient concerns:

A 27-year-old Asian woman was admitted with scotoma symptoms in her right eye. The patient was a skin care technician. Three days before admission, a laser beam had struck her eye while she was preparing for a laser procedure.

Diagnosis:

During fundus examination, a subretinal hemorrhage with disc diameter (DD) of 4.0 and a preretinal hemorrhage of 2.5 DD in its center were found in the 2 o’clock position of the peripheral retina in the right eye.

Interventions:

We monitored the injury for > 6 months, first using fluorescein angiography, then wide-field scanning laser ophthalmoscopy and optical coherence tomography. Oral steroids and vitamins were administered.

Outcomes:

During the 6-month follow-up period, blood from the initial sub- and preretinal hemorrhage, as well as vitreous hemorrhage, were all absorbed. Retinal detachment was not observed as scar formation and adhesions had occurred. No interventions were considered necessary.

Lessons:

When treating a patient who has experienced laser eye injury, the possibility of peripheral retinal injury should be considered. Peripheral retinal injury caused by 1064-nm Nd:YAG: neodymium-doped yttrium aluminum garnet has a relatively good prognosis, suggesting that it will not progress to retinal detachment.
The use of nonthoracoscopic Nuss procedure for the correction of pectus excavatum by trans-esophageal echocardiography monitoring
Authors: Xu Bing , Xu Ting , Wang Shan , Li Wenhua , He Taozhen , Liu Wenying
Published: February 2019

This study was aimed to review the current experience regarding the correction of pectus excavatum by Nuss procedure with nonthoracoscopic assistance using trans-esophageal echocardiography monitoring.

A total of 172 patients with pectus excavatum were surgically treated from August 2011 to August 2016. The sample size comprised 131 boys and 41 girls and the average age was 13 years and 2 months. A total of 144 cases were initially operated on, whereas 13 subjects exhibited postoperative recurrence following Ravitch repair of a pectus excavatum deformity and 15 cases experienced a history of median sternotomy. The intraoperative Haller index ranged from 3.6 to 14.2 (mean 4.1). The intraoperative TEE monitoring was conducted with middle-esophageal 4-champer view and middle-esophageal Aortic short axis view to detect the injury of heart and of the large vessels by the introducer and Nuss steel bars.

The operation conducted in all patients was successful in the absence of severe complications. The time of operation ranged from 38 to 80 minutes (mean 50 minutes). The bleeding volume during the procedure was between 10 and 40 mL (mean 15 mL). The time from operation to discharge was from 5 to 7 days (mean 6 days). Pneumothorax occurred in 25 cases following the termination of the operation, including 9 cases of needle puncture aspiration and 6 cases of closed drainage. Pleural effusion occurred in 4 cases. No patients suffered from wood infection. Effusion occurred in 9 cases following 6 to 23 months, whereas dressing changes and surgical debridement were evident in 2 and 7 cases, respectively. The bars were removed in 82 of the 172 patients within 3 years. The progression of the thoracic wall was assessed for the period of 8 to 68 months following the surgery, during the follow-up period. The average time period of follow-up was 32 months.

Nuss procedure with nonthoracoscopic assistance with trans-esophageal echocardiography monitoring for the correction of pectus excavatum was safe for all of the cases investigated. It exhibited lesser trauma and required a shorter time period.
The comparison of cognitive function and risk of dementia in CKD patients under peritoneal dialysis and hemodialysis
Authors: Tian Xiaolin , Guo Xiaokun , Xia Xiaoshuang , Yu Haibo , Li Xin , Jiang Aili
Published: February 2019

Backgrounds:

Cognitive functions (CF) decline has been reported in end-stage renal disease (ESRD) patients. However, the influence of dialysis modalities on CF has not been investigated systematically.

Methods:

A systematic literature search was conducted in MEDLINE, Embase, Cochrane library and unpublished database Clinicaltrials.gov to identify the studies comparing the cognitive functions or risk of dementia between hemodialysis (HD) and peritoneal dialysis (PD). After data extraction, quality of studies was assessed using the Newcastle-Ottawa scale. Both qualitative and quantitative analyses were performed.

Results:

After study inclusion, totally 15 cohort or cross-sectional studies were included, comparing the cognitive functions using neuropsychological tests and covering the executive function, memory, orientation, attention, etc. By qualitative analysis, it showed that more studies are inclined to PD compared with HD with better cognitive functions. By quantitative analysis, it showed that PD showed better performance in the tests of Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), stroop interference test and exhibited lower risk of dementia compared with HD.

Conclusions:

In this meta-analysis, we draw preliminary conclusion that patients treated with PD had better cognitive functions and lower dementia risk compared with patients with HD. Still more large-scale and well-conducted prospective cohort studies are needed to draw more convincing conclusions.
A systematic review of clinical outcomes and radiotherapy-associated toxicity in multicatheter accelerated partial breast irradiation
Authors: Lv Yang , He Lin , Wang Chao , Zhang Lijiu , Zhang Biyuan , Song Yuhua
Published: February 2019

Background:

To integrate relevant clinical data of multicatheter accelerated partial breast irradiation (mAPBI) for reaching a comprehensive conclusion.

Methods:

We did 3 meta-analyses for clinical outcomes including 1740 women from 4 articles, for acute radiotherapy (RT)-associated toxicity including 1255 patients from 5 articles, and for late RT-related toxicity involving 1565 patients from 9 papers. Clinical outcomes analyses were stratified by molecular subtypes, lymph nodes status, receptor status, and human epidermal growth factor receptor 2 (HER2) status.

Results:

For the Luminal A/B phenotypes, the disease relapse and failure in survival significantly decreased when compared with triple negative (TN)/HER2-amplified subtypes (P < .00001). The 5-year regional nodal recurrence (RNR), 5-year distant metastasis-free survival (DMFS) and 5-year disease free-survival (DFS) of TN patients were significantly superior to HER2-overexpression patients (P < .00001). The 5-year cause-specific survival (CSS), 5-year DMFS and 5-year overall survival (OS) in women with lymph nodes-negative were significantly improved versus patients with lymph nodes-positive (P = .0001). Conversely, the positive status of HER2 compared with negative one significantly increased the rate of local recurrence (LR) (P = .02). For acute toxicity, the morbidity of dermatitis was significantly higher than hematoma and implant infection (P = .01, P < .0001, respectively). For late toxicity, the occurrences of fibrosis (32%) and telangiectasia (14%) were significantly higher than other complications (P < .0001).

Conclusion:

HER2-enriched subtype compared with other subtypes has significantly increased disease relapse and failure in survival. HER2-positive status is positively associated with an increased incidence of LR. Dermatitis is the most common acute RT-related toxicity and fibrosis is the first rife late RT-related toxicity.
Effect of Kinesio taping on electromyographic activity of leg muscles during gait in children with developmental coordination disorder
Authors: Yam Timothy Tsz Ting , Wong Man Sang , Fong Shirley Siu Ming
Published: February 2019

Objective:

This study aimed to evaluate the effectiveness of Kinesio tape (KT) on lower limb muscle activation pattern in children with developmental coordination disorder (DCD) during walking.

Design:

A parallel-group randomized controlled trial.

Setting:

University laboratory setting.

Participants:

Twenty-five children with DCD were randomly allocated to the KT group (mean age = 7.97 years) and 24 to the control group (mean age = 8.04 years).

Intervention:

KT group received KT application to the quadriceps and gastrocnemius muscles whereas the control group received no intervention.

Measurements:

Peak muscle activation (in percentage of maximal voluntary isometric contraction [%MVIC]) in the lower limbs during gait was measured by means of surface electromyography, electrogoniometry, and foot contact switches.

Results:

Gastrocnemius medialis activation during mid stance (23.46%MVIC, 95% CI = −32.53, −14.39) and late stance phases (3.25%MVIC, 95% CI = −5.67, −0.81) of gait increased after the application of KT in the KT group compared to baseline values. The KT group demonstrated 26.87%MVIC (95% CI = 26.87, 7.11) higher gastrocnemius medialis muscle peak activation during mid stance phase at post-test when compared with the control group. Moreover, gastrocnemius medialis and biceps femoris muscle peak activation during loading response decreased by 8.36%MVIC (95% CI = 2.71, 14.02) and 3.54%MVIC (95% CI = 1.08, 6.01), respectively, in the control group overtime.

Conclusions:

The application of KT on children with DCD had an increased gastrocnemius medialis muscle activation during stance phase. KT could be incorporated into gait re-education programmes to facilitate muscle contraction in these children.
Efficacy of transsphenoidal surgery for pituitary tumor
Authors: Wang Wei-Feng , Yang Lin-Hong , Han Lin , Li Ming-Jun , Xiao Jian-Qi
Published: February 2019

Background:

This systematic review aims to assess the efficacy and safety of transsphenoidal surgery (TPS) for patients with a pituitary tumor (PT).

Methods:

We will retrieve the following electronic databases for randomized controlled trials or case–control studies to assess the effect and safety of TPS for PT: Cochrane Library, EMBASE, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Allied and Complementary Medicine Database, and Chinese Biomedical Literature Database. Each database will be retrieved from the inception to December 20, 2018. The entire process consists of the study selection, data collection, methodology quality assessment, data pooled, and meta-analysis performance. The methodology quality will be assessed by using Cochrane risk of bias tool. The data pooled and meta-analysis will be conducted by using RevMan 5.3 software.

Results:

This study will evaluate the efficacy and safety of TPS for PT. The primary outcome includes total tumor resection rate. The secondary outcomes consist of quality of life, total tumor resection rate, postoperative complication rate, and the rate of functional tumor hormone levels.

Conclusion:

The expected results may provide up-to-date evidence of TPS for the treatment of PT.

PROSPERO registration number:

PROSPERO CRD42018120194.
Isolated third nerve palsy with pupillary involvement resulting from carotid-cavernous sinus fistula
Authors: Lin Hsin-Le , Hu Tzu-Te
Published: February 2019

Rationale:

Isolated third nerve palsy with pupillary involvement caused by a posterior drainage carotid-cavernous sinus fistula (CCF) is relatively rare. Diagnosis of a posterior drainage CCF can often be delayed due to its unapparent congestive signs.

Patient concerns:

Here, we present the case of a young male patient with right-sided CCF, who presented with right-side headache and partial third nerve palsy with pupillary involvement. The diagnosis was confirmed using time-of-flight magnetic resonance angiography (TOF-MRA) and digital subtraction angiography (DSA).

Diagnoses:

A right-sided CCF was detected, which was primarily supplied by the dural branch of the right middle meningeal artery and venous drainage into the right inferior petrosal sinus.

Interventions:

The patient was treated with transarterial coil embolization.

Outcomes:

At 2 months, ride-side headache was significantly improved and ptosis and limited extraocular muscle movement were partially resolved.

Lessons:

CCF might not always present with ocular congestion. Although uncommon, white-eye and painful third nerve palsy with pupillary involvement may be caused by a posterior drainage CCF.
Submucosal 1-tunnel endoscopic resection for treating upper gastrointestinal multiple submucosal tumor originating from the muscularis propria layer
Authors: Wang Haiqin , Tan Yuyong , Huo Jirong , Liu Deliang
Published: February 2019

To explore the feasibility and efficacy of submucosal 1-tunnel endoscopic resection (1-tunnel STER) for the treatment of multiple upper gastrointestinal submucosal tumors (GI-SMTs) originating from the muscularis propria (MP) layer.

A total of 12 patients with multiple upper GI-SMTs (no less than 2 SMTs) who underwent 1-tunnel STER from April 2013 to October 2017 were included. Clinical data on general characteristics, operation-related parameters, adverse events, and follow-up results were recorded and analyzed.

All 12 patients underwent 1-tunnel STER successfully, and the mean operation time was 92.1 ± 40.8 minutes. A total of 30 SMTs were resected, out of which 27 were in the esophagus and 3 were in the stomach. The mean diameter was 15.0 ± 8.2 mm (range, 3–38 mm). All the SMTs were resected en bloc uneventfully. The SMTs comprised 28 leiomyomas and 2 gastric stromal tumors (low risk). No recurrence was noticed during a mean follow-up of 24.9 ± 15.3 months (range, 1–52 months).

One-tunnel STER may serve as a feasible and effective technique for the treatment of multiple upper GI-SMTs originating from the MP layer. A large-scale prospective study is warranted for a confirmative conclusion.
Association of serum high mobility group box 1 levels with disease activity and renal involvement in patients with systemic vasculitis
Authors: Zhu Bin , Li Nanfang , Zhu Qing , Wu Ting , Heizati Mulalibieke , Wang Guoliang , Yao Xiaoguang , Luo Qin , Liu Shasha , Liu Shanshan , Hong Jing
Published: February 2019

High mobility group box 1 (HMGB1) is a kind of proinflammatory mediator that acts as an alarmin when released by dying, injured or activated cells. Previous studies have reported that HMGB1 are closely linked to antineutrophil cytoplasmic antibody-associated vasculitis (AAV). The present study aimed to evaluate whether serum HMGB1 levels were associated with systemic vasculitis (VAs).

The study population consisted of 51 patients with VAs, 46 patients with essential hypertension (EH) and 46 healthy controls (HC). Thirty-five patients with VAs had in active stage and 16 patients with VAs in an inactive stage. Furthermore, 31 patients with VAs had renal involvement, the other 20 patients were selected for without renal involvement. Serum HMGB1 levels were measured by enzyme-linked immunosorbent assay. Associations between serum HMGB1 levels with clinical and laboratory parameters were analyzed.

Serum HMGB1 levels in patients with VAs were significantly higher than in EH and HC (all P < .05), and no difference regarding serum HMGB1 levels could be found between EH and HC (P = .208). Serum HMGB1 levels in VAs patients with active stage were significantly higher than those in HC and VAs patients with inactive stage (all P < .05). Patients with renal involvement and non-renal involvement had increased HMGB1 levels compared with HC (all P < .05). In addition, serum HMGB1 levels were significantly higher in patients with renal involvement compared with non-renal involvement patients (P = .001). Correlation analysis showed that serum HMGB1 levels were positive significant correlated with the Birmingham Vasculitis Activity Score, hypersensitive C reactive protein (Hs-CRP), serum creatinine (Scr) and 24-hour proteinuria (all P < .05). Among the subsets of VAs, serum HMGB1 levels were significantly higher in AAV, polyarteritis nodosa (PAN) and takayasu arteritis (TA) than in HC (all P < .05). More interestingly, serum HMGB1 were significantly higher in patients with PAN compared with AAV and TA patients (all P < .05). Furthermore, there was positive correlation between serum HMGB1 levels and Hs-CRP, Scr, and 24-hour proteinuria in patients with PAN (all P < .05).

Serum HMGB1 levels are increased in patients with VAs compared with HC and EH and can reflect the disease activity and renal involvement.
Inspiring Writing in Nursing
Authors: Ansryan Lianna Z. , Marshall Caroline , Aronow Harriet Udin , Chan Alice , Coleman Bernice
Published: February 2019

Background:

Hospitals are constantly involved in quality improvement and research projects investing considerable money, time, and effort in supporting these projects; however, there is not always a strong enough focus on publishing the results. The challenge lies in engaging clinicians to publish their work. One of the hallmarks of the clinical nurse specialist is mentoring, and this has led to the creation of our Inspiring Writing in Nursing (IWIN) program.

Purpose:

The goal of IWIN cohort was to engage and promote publication submissions from frontline clinicians. The 18-member Nursing Research and Evidence-Driven Practice Council (NR-EDPC) supports more than 3000 nurses in quality and research projects. Two senior librarians support our council and staff. In 2014, we launched our first IWIN cohort to mentor nurses in writing and submitting for publication.

Evaluation:

The NR-EDPC motto “meet them where they are” applies to both location and level of research/EDPC knowledge and skill. An Annual Nursing Research Conference showcases the products of nursing science. The first cohort of IWIN enrolled 11 mentees, and after a yearlong journey, we submitted 5 of 11 manuscripts, 3 withdrew, and 3 are still under revisions. From the 5 submissions, 3 were published, 1 was rejected, and 1 is currently under revision.

Discussion:

With support and the infrastructure of our NR-EDPC, we are launching our second IWIN cohort.
Prevention of Cesarean Delivery Surgical Site Infections
Authors: Shea Sarah K. , Soper David E.
Published: February 2019

Importance

Surgical site infection (SSI) is a common complication of cesarean delivery. Seen in up to 12% of cesarean deliveries, it is a major cause of prolonged hospital stay and a burden to the healthcare system. Interventions and techniques must be identified to decrease the risk of cesarean delivery SSIs.

Objective

We review the categories of SSI, current studies that have focused on various interventions to decrease SSI, and preoperative, intraoperative, and postoperative recommendations for cesarean delivery SSI prevention.

Evidence Acquisition

A thorough search of PubMed for all current literature was performed. Various surgical interventions and techniques were reviewed. We included studies that looked at preoperative, intraoperative, and postoperative interventions for SSI prevention.

Results

We have summarized several surgical interventions and techniques as well as current consensus statements to aid the practitioner in preventing SSIs after cesarean delivery.

Conclusions and Relevance

Upon analysis of current data and consensus statements pertaining to cesarean deliveries, there are certain preoperative, intraoperative, and postoperative interventions and techniques that can be recommended to decrease the risk of cesarean delivery SSI.

Target Audience

Obstetricians and gynecologists; family physicians

Learning Objectives

After completing this CME activity, physicians should be better able to evaluate preoperative considerations when preparing for a cesarean delivery; distinguish the recommended antiseptic choices for preoperative cleansing/prepping before cesarean delivery; propose the appropriate use of prophylactic antibiotics for prevention of cesarean delivery SSI; and select the surgical techniques that have been shown to decrease the risk of cesarean delivery SSI.
Feasibility and Acceptability of Methods to Collect Follow-Up Information From Parents 12 Months After Their Child’s Emergency Admission to Pediatric Intensive Care*
Authors: Pulham Rachel Anne , Wray Jo , Feinstein Yael , Brown Katherine , Pierce Christine , Nadel Simon , Pathan Nazima , Garralda Elena , Ramnarayan Padmanabhan
Published: February 2019

Objectives:

To evaluate the feasibility and acceptability of different methods of collecting follow-up data from parents 12 months after their child’s emergency admission to a PICU.

Design:

Mixed-methods explanatory sequential design.

Setting:

One regional PICU transport service and three PICUs in England.

Patients:

Children undergoing emergency transport to PICU recruited to an ongoing biomarker study whose parents consented to be contacted for follow-up 12 months after PICU admission.

Interventions:

None.

Measurements and Main Results:

Parents or guardians who consented were asked to complete three questionnaires about their child’s functional status, quality of life, and behavior 12 months after PICU admission. Parents were given a choice about method of questionnaire completion: postal, online, or telephone interview and also asked for telephone feedback about the process and the reasons for their choice. Of 486 parents who consented to be contacted at 12 months, 232 were successfully contacted. Consent to receive questionnaires was obtained in 218 of 232 (94%). Of the 218 parents, 102 (47%) chose to complete questionnaires online (with 77% completion rate), 91 (42%) chose to complete postal questionnaires (48% completion rate), and 25 (11%) chose to complete questionnaires by telephone interview (44% completion rate).

Conclusions:

Parents expressed different preferences for follow-up questionnaire completion. Response rates varied by completion method. Understanding and catering for parental preferences is an important factor in maximizing response rates for follow-up studies in intensive care.
Improving perioperative pain management: a preintervention and postintervention study in 7 developing countries
Authors: Zaslansky Ruth , Chapman C. Richard , Baumbach Philipp , Bytyqi Adem , Castro Lopes José M. , Chetty Sean , Kopf Andreas , Li Li , Ern Ming Lim , Olawoye Olayinka , Rizza Parico Jane , Soyannwo Olaitan , Stamenkovic Dusica , Wang Hongwei , Meissner Winfried
Published: February 2019

Introduction:

The burden of untreated postoperative pain is high.

Objective:

This study assessed feasibility of using quality improvement (QI) tools to improve management of perioperative pain in hospitals in multiple developing countries.

Methods:

The International Pain Registry and Developing Countries working groups, from the International Association for the Study of Pain (IASP), sponsored the project and PAIN OUT, a QI and research network, coordinated it, and provided the research tools. The IASP published a call about the project on its website. Principal investigators (PIs) were responsible for implementing a preintervention and postintervention study in 1 to 2 surgical wards in their hospitals, and they were free to choose the QI intervention. Trained surveyors used standardized and validated web-based tools for collecting findings about perioperative pain management and patient reported outcomes (PROs). Four processes and PROs, independent of surgery type, assessed effectiveness of the interventions.

Results:

Forty-three providers responded to the call; 13 applications were selected; and PIs from 8 hospitals, in 14 wards, in 7 countries, completed the study. Interventions focused on teaching providers about pain management. Processes improved in 35% and PROs in 37.5% of wards.

Conclusions:

The project proved useful on multiple levels. It offered PIs a framework and tools to perform QI work and findings to present to colleagues and administration. Management practices and PROs improved on some wards. Interpretation of change proved complex, site-dependent, and related to multiple factors. PAIN OUT gained experience coordinating a multicentre, international QI project. The IASP promoted research, education, and QI work.
Liver Enzyme Elevation in Pregnant Women Receiving Antiretroviral Therapy in the ANRS-French Perinatal Cohort
Authors: Sibiude Jeanne , Warszawski Josiane , Tubiana Roland , Le Chenadec Jérôme , Meier Françoise , Faye Albert , Blanche Stéphane , Mandelbrot Laurent ,   the ANRS-French Perinatal Cohort Study Group
Published: February 2019

Background:

High rates of liver enzyme elevation (LEE) in women receiving antiretroviral treatment (ART) during pregnancy have been reported, but causes remain unclear. We estimated the prevalence and risk factors of LEE in a national prospective multicenter cohort.

Methods:

We studied 5748 pregnant women living with HIV enrolled in the French Perinatal Cohort 2005–2014, treated with ART, with no active hepatitis B or C coinfection. Adjusted hazard ratio (aHR) was estimated using Cox models with ART as time-dependent variable, separately for women on ART at conception and those initiating ART during pregnancy.

Results:

LEE (grade ≥ 1) was observed in 16.7%, grade 3–4 in 2%. Among women with LEE, 6.7% had pre-eclampsia, 9.8% intrahepatic cholestasis of pregnancy, and 1.4% other identified medical causes. Most LEEs (82.2%) were unexplained. In women with unexplained LEE, LEE was the reason for hospitalization in 51 (6%) women, cesarean section in 13 (2%), induction of labor in 3 (0.4%), and change in ART regimen in 49 (6%) women. Unexplained LEE was associated with higher risk of preterm births, P < 0.001. Among women on ART at conception, the risk of unexplained LEE was lower with NNRTI-based regimens than with PI-based regimens: aHR = 0.5 (0.3–0.7), with no difference among the PI drugs. Most women initiating ART during pregnancy were on a PI-based regimen (89%). Among them, LEE was less frequent for women on nelfinavir vs. lopinavir/r [aHR = 0.4 (0.2–0.8)].

Conclusions:

Rates of LEE among pregnant women living with HIV are high and impact obstetrical care management. The possible role of PIs needs further investigation.
Ensuring Sustainability for UK Burns Services
Authors: Brady Chevonne , Edmondson Sarah-Jayne , Murray Alexandra
Published: February 2019

Introduction

Workforce planning is an essential component of organizing any health service. Centralization of burns services pools expertise, although trainees can struggle to achieve adequate exposure to burns training. We aim to review current staffing levels and predict the future consultant numbers required for UK services to remain staffed with appropriately trained surgeons.

Methods

We have compiled a database of all UK burns consultants. Basic demographic data, such as age and sex, were collated. Projected UK population data have been used to estimate whether the number of patients under the care of the UK burns network will change in the coming years. Access to burns fellowship training has also been factored in.

Results

There are 34 burns facilities in the United Kingdom and 86 burns consultants. On average, these consultants are 13 years from retirement age. 22 will reach this age within the next decade. During this time, the UK population is expected to increase by 10%, translating to approximately another 6 consultant posts. Since there are only 2 UK recognized burns fellowships, many of the required consultants will have to seek training abroad.

Conclusions

Workforce planning is essential to avoid a short fall in the number of upcoming burns consultants. Plans must be in place to anticipate additional workload with a 10% population rise. With the current struggles of NHS funding, a comprehensive review of burns workforce planning should be undertaken to ensure that sufficient numbers of trainees are completing appropriate burns-specific training and are ready to fill these posts.
Increased Gastrointestinal Surgical Hospital Burden After Laparoscopic Gastric Bypass for Obesity
Authors: Neermark Søren , Tolstrup Janne Schurmann , Becker Povl Ulrik , Bay-Nielsen Morten , Fromholt-Larsen Jens , Thygesen Lau Caspar , Bisgaard Thue
Published: February 2019

Objective:

To study long-term gastrointestinal surgical hospital burden (hospital readmissions and gastrointestinal surgical procedures) after laparoscopic gastric bypass.

Background:

Little is known about gastrointestinal surgical hospital burden after laparoscopic gastric bypass.

Methods:

Danish patients undergoing laparoscopic gastric bypass (BMI >35–50) from January 1, 2005 to December 31, 2013 were included (100% follow-up). The nonsurgical reference group were individuals with BMI of ≥ 30 drawn from The Danish National Health Surveys from 2005 to 2013. The primary outcome was gastrointestinal surgical hospital burden. Secondary outcome was mortality. Age, body mass index (BMI), gender, and calendar time (time of surgery and nonsurgical survey), diabetes status was adjusted for in a multivariate Poisson regression model.

Results:

13,582 bariatric surgical patients and 45,948 reference individuals were included with a mean follow-up time of 4.7 years (SD 2.4). The incidence rate ratio (IRR) for hospital re-re-admission was 2.17 higher in the intervention group (95% CI 2.04–2.31). Sensitivity analysis showed that patients operated before 2010 had a higher incidence for re-re-admission than after. IRR for surgical gastrointestinal procedures was 6.56 (CI 6.15–6.99) and 3.04 (CI 3.51–4.17) after 1 and 5 years for the intervention group compared with the reference group. Surgery for internal hernia was the most common abdominal procedure. The mortality odds ratio was 0.84 (CI 0.65–0.96).

Conclusions:

Gastrointestinal surgical hospital burden was significantly higher in the first 5 years after gastric bypass compared with a matched nonsurgical reference group of obese citizens
Total Lesion Glycolysis Assessment Identifies a Patient Fraction With a High Cure Rate Among Esophageal Adenocarcinoma Patients Treated With Definitive Chemoradiation
Authors: Harada Kazuto , Wu Carol C. , Wang Xuemei , Mizrak Kaya Dilsa , Amlashi Fatemeh G. , Iwatsuki Masaaki , Blum Murphy Mariela A. , Maru Dipen M. , Weston Brian , Lee Jeffrey H. , Rogers Jane E. , Thomas Irene , Shanbhag Namita , Bhutani Manoop S. , Hofstetter Wayne L. , Nguyen Quynh-Nhu , Ajani Jaffer A.
Published: February 2019

Objective:

We aimed to determine whether tumor metabolism could be prognostic of cure in L-EAC patients who receive definitive chemoradiation.

Summary Background Data:

Patients with inoperable localized esophageal adenocarcinoma (L-EAC) often receive definitive chemoradiation; however, biomarkers and/or imaging variables to prognosticate cure are missing.

Methods:

Two hundred sixty-six patients with L-EAC who had chemoradiation but not surgery were analyzed from the prospectively maintained EAC databases in the Department of Gastrointestinal Medical Oncology at The University of Texas MD Anderson Cancer Center (Texas, USA) between March 2002 and April 2015. Maximum standardized uptake value (SUVmax) and total lesion glycolysis (TLG) from the positron emission tomography data were evaluated.

Results:

Of 266 patients, 253 (95%) were men; the median age was 67 years (range 20–91 yrs) and 153 had poorly differentiated L-EAC. The median SUVmax was 10.3 (range 0–87) and the median TLG was 85.7 (range 0–3227). Both SUVmax and TLG were higher among those with: tumors >5 cm in length, high clinical stage, and high tumor and node categories by TNM staging (all P < 0.0001). Of 234 patients evaluable for cure, 60 (25.6%) achieved cure. In the multivariable logistic regression model, low TLG (but not low SUVmax) was associated with cure (continuous TLG value: odds ratio 0.70, 95% confidence interval (CI) 0.54–0.92). TLG was quantified into 4 quartile categorical variables; first quartile (Q1; <32), second quartile (Q2; 32.0–85.6), third quartile (Q3; 85.6–228.4), and fourth quartile (Q4; >228.4); the cure rate was only 10.3% in Q4 and 5.1% in Q3 but increased to 28.8% in Q2, and 58.6% in Q1. The cross-validation resulted in an average accuracy of prediction score of 0.81 (95% CI, 0.75–0.86).

Conclusions:

In this cross-validated model, 59% of patients in the 1st quartile were cured following definitive chemoradiation. Baseline TLG could be pursued as one of the tools for esophageal preservation.
Neuropathology-driven Whole-genome Sequencing Study Points to Novel Candidate Genes for Healthy Brain Aging
Authors: Alexander John , Ströbel Thomas , Georgitsi Marianthi , Hönigschnabl Selma , Reiner Angelika , Fischer Peter , Tsifintaris Margaritis , Paschou Peristera , Kovacs Gabor G.
Published: February 2019

Purpose:

Understanding the healthy brain aging process is key to uncover the mechanisms that lead to pathologic age-related neurodegeneration, including progression to Alzheimer disease (AD). We aimed to address the issue of pathologic heterogeneity that often underlies a clinical AD diagnosis.

Methods:

We performed a deep whole-genome sequencing study aiming to identify variants that are associated specifically with healthy brain aging.

Patients:

We examined samples from the community-based longitudinal Vienna Transdanubian Aging study comparing neuropathologically “healthy” aging in individuals above 80 years of age with pure AD patients of the same age.

Results:

Focusing on potentially functional variants, we discovered a single variant (rs10149146) that lies on the autophagy-associated TECPR2 gene and was carried by 53.6% of the “healthy” brain elderly individuals (15/28). An additional nonsynonymous variant on the CINP gene (encoding a cell cycle checkpoint protein) was also found in 46% of healthy controls. Both variants are absent from all AD cases. TECPR2 and CINP appear to be “partner” genes in terms of regulation and their associated transcription factors have been previously implicated in AD and neurodegeneration.

Conclusions:

Our study underlines the strength of neuropathology-driven definitions in genetic association studies and points to a potentially neuroprotective effect of key molecules of autophagy and cell cycle control.