bluuebunny/crossref_metadata_2025 huggingface dataset:
Acetabular depth, an early predictive factor of acetabular development: MRI in patients with developmental dysplasia of the hip after open reduction
Authors: Kawamura Yoshi , Tetsunaga Tomonori , Akazawa Hirofumi , Yamada Kazuki , Sanki Tomoaki , Sato Yoshihiro , Nakata Eiji , Ozaki Toshifumi
Published: August 2020

Early prediction of future acetabular development is important to determine an additional surgery for developmental dysplasia of the hip (DDH). The purpose of this study was to investigate the predictive factors of acetabular development using MRI. We retrospectively investigated dislocated 40 hips and 34 normal hips in 37 pediatric patients (9 males and 28 females) with DDH who underwent open reduction after walking age. We evaluated the cartilaginous acetabulum and labrum of the patients using coronal MRI T2*-weighted images at 5 years of age. The mean age at the time of surgery was 22 months, and the mean age at the final survey was 19 years. We divided patients into two groups in accordance with the Severin classification at the final follow-up. Groups with good outcomes (affected 26 hips and unaffected 27 hips) and poor outcomes (14 hips and 7 hips) were compared using the MRI parameters on each side. Predictive factors of acetabular development were identified using univariate and multiple logistic regression analyses. Using multiple logistic regression analysis, labral acetabular roof depth and labral hip center distance at 5 years of age represented predictors after open reduction (odds ratio 0.27, P = 0.035; odds ratio 3.4, P = 0.028, respectively) on the affected side, and bony hip center distance represented a predictor on the unaffected side (odds ratio 2.6, P = 0.049). Acetabular development in the unaffected side could be predicted by bony assessment, while acetabular development in the affected side had to be assessed by labrum using MRI.
Improvement of Pulmonary Function Measured by Patient-reported Outcomes in Patients With Spinal Muscular Atrophy After Growth-friendly Instrumentation
Authors: Matsumoto Hiroko , Mueller John , Konigsberg Matthew , Ball Jacob , St. Hilaire Tricia , Pawelek Jeff , Roye David P. , Cahill Patrick , Sturm Peter , Smith John , Thompson George , Sponseller Paul , Skaggs David , Vitale Michael G.
Published: August 2020

Background:

Children with spinal muscular atrophy (SMA) sustain a progressive reduction in pulmonary function (PF) related to both muscular weakness and the concomitant effects of spinal deformity on the thorax. Growth-friendly instrumentation is commonly utilized for younger patients with scoliosis and SMA to halt the progression of spinal curvature, but its effect on PF in these patients has not previously been investigated. Using the change in Early Onset Scoliosis 24-Item Questionnaire (EOSQ-24) PF subdomain scores, the authors will investigate whether PF improves in patients with SMA after a growth-friendly intervention.

Methods:

This was a multicenter retrospective cohort study from 2 international registries of patients with SMA undergoing spinal deformity surgery from 2005 to 2015. Data collected were age, sex, degree of major coronal curve, type of growth-friendly construct, forced vital capacity (FVC), and EOSQ-24 scores at the patient’s preoperative, 1-year postoperative, and 2-year postoperative visits. Differences in EOSQ-24 PF scores and FVC between baseline and postoperative assessment were examined by paired tests.

Results:

A total of 74 patients were identified (mean age, 7.6±2.3 y, major curve 68.1±22.4 degrees, 51.4% female individuals). The mean EOSQ-24 PF scores improved significantly from 70.6 preoperatively to 83.6 at 1 year (P=0.092) and 86.5 at 2 years postoperatively (P=0.020). The scores in patients with rib-based constructs showed steeper increases at 1-year assessments than those in patients with spine-based constructs. The mean paired FVC value decreased from 63.9% predicted preoperatively, to 57.6% predicted at 1 year postoperatively (P=0.035), and 61.9% predicted preoperatively, to 56.3% predicted at 2 years postoperatively (P=0.178).

Conclusions:

Patients with SMA who received growth-friendly instrumentation did experience improvements in PF as measured by EOSQ-24 assessing the caregivers’ perception. Given the uncertain reliability of PFTs in this young population, EOSQ-24 is an important tool for measuring improvements in health-related quality of life.

Level of Evidence:

Level III—retrospective study.
Improving Safety and Efficacy in the Surgical Management of Low-tone Neuromuscular Scoliosis: Integrated Approach With a 2-attending Surgeon Operative Team and Modified Anesthesia Protocol
Authors: Ozhan Mehmet O. , Bakircioglu Sancar , Bekmez Senol , Olgun Zeynep D. , Süzer Anil , Demirkiran Halil G. , Yazici Muharrem
Published: August 2020

Background:

Substantially increased operative time and amount of bleeding may complicate the course of surgical treatment in neuromuscular scoliosis. A well-organized team approach is required to reduce morbidity. The aim of this study is to review our early, short-term surgical outcomes with our new integrated approach that includes a 2-attending surgeon team and modifications in the anesthesia protocol in low-tone neuromuscular scoliosis and compare with a matched cohort of our historic patients.

Methods:

We retrospectively reviewed our patients with (1) neuromuscular scoliosis with collapsing spine deformity, (2) low-tone neuromuscular etiology, (3) multilevel posterior column osteotomies with posterior all pedicle screw spinal fusion, and (4) more than 1-year follow-up. Patients were grouped into 2: group 1 consisted of patients managed with the integrated surgical team approach, group 2 included the matched historic patients.

Results:

There were 16 patients in group 1 and 17 patients in group 2. There was no significant difference between the groups regarding age, sex, body mass index, number of levels fused, major coronal deformity magnitude, pelvic obliquity, number of posterior column osteotomies, or amount of deformity correction. However, significantly shorter operative time (241 vs. 297 min, P=0.006), less intraoperative bleeding (1082 vs. 1852 mL, P=0.001), less intraoperative blood transfusion (2.1 vs. 3.1 U, P=0.028), less postoperative intensive care unit admission (23% vs. 100%, P=0.001), and shorter hospital stay (4.7 vs. 5.9 d, P=0.013) were observed in group 1.

Conclusions:

Our results indicate that spinal deformity surgery in patients with underlying low-tone neuromuscular disease may not be as intimidating as previously thought. Our surgical team approach integrating a 2-attending surgeon operative team, a new anesthetic protocol that includes a modification of perioperative blood management is effective in reducing operative times, blood loss, transfusion rates, intensive care unit admission, and length of hospital stay.

Levels of Evidence:

Level III—retrospective comparative study.
The Majority of Patient-reported Outcome Measures in Pediatric Orthopaedic Research Are Used Without Validation
Authors: Arguelles Gabriel R. , Shin Max , Lebrun Drake G. , Kocher Mininder S. , Baldwin Keith D. , Patel Neeraj M.
Published: August 2020

Background:

Given that patient-reported outcome measures (PROMs) are increasingly used to inform clinical decision-making, it is vital that they are validated, reliable, responsive, and appropriate for the population under study. The purpose of this systematic review was to assess the rate of PROM use in the pediatric orthopaedic literature, characterize whether each use was in the PROM-validated demographic, and analyze the association between bibliometric factors and the use of PROMs with incomplete validation.

Methods:

The Institute for Scientific Information (ISI) Web of Science database was queried for all clinical pediatric orthopaedic studies from 2014 to 2017. All PROMs were recorded for each study independently by 2 reviewers and cross-referenced with the published orthopaedic literature as of 2017 to determine if the PROM had been validated for the study population. PROMs that had not been validated, had been shown to be invalid, or had conflicting validity studies for use in the population of interest were designated as incompletely validated or used without complete validation. The following covariates were recorded for each study: subspecialty, inclusion of a statistician coauthor, sample size, journal, and the journal impact factor. χ2 analysis was used to evaluate the association between categorical variables and the use of at least 1 incompletely validated PROM.

Results:

In total, 1000 articles were screened, yielding 653 studies that met our inclusion criteria. A total of 104/653 (16%) publications-reported PROMs. PROMs were used without complete validation 120/165 (73%) times, and 77/104 (74%) studies used at least 1 PROM without complete validation. The most frequent reasons for incomplete validation were (1) using PROMs that had been validated in adults, but not pediatrics (n=47; 28.5%), and (2) using PROMs that had been designated in the literature as invalid for pediatrics (n=27; 16.4%). The incomplete validation of at least 1 PROM was associated with smaller sample size (P=0.01) and subspecialty (P<0.01). Overall rates of PROM use and the proportion of PROMs used without complete validation were both found to be higher than those previously reported.

Conclusion:

The majority of pediatric orthopaedic studies reporting PROMs used at least 1 PROM without complete validation for their study population.

Level of Evidence:

Level IV—systematic review of level I, II, III, and IV studies.
Helal Metatarsal Osteotomy in Apert Foot
Authors: Casula Ilaria , Guero Stéphane
Published: August 2020

Background:

Apert syndrome is a rare condition characterized by a craniosynostosis associated with complex bilateral malformations of the hands and feet. Although correction of syndactyly of the extremities is largely described, just a few authors have focused their attention on the gradual subluxation of the second metatarsal head during child growth, with hyper pressure, hyperkeratosis on the plantar surface and acute pain leading to walking impairment. The aim of this study is to describe our experience with the Helal metatarsal osteotomy technique on this group of patients. An oblique osteotomy performed dorsal to plantar, proximal to distal on the subluxed metatarsal bone is carried out. No internal bone fixation is needed, but a fundamental hypercorrective bandage is placed under the plantar surface. Immediate full weight-bearing, 24 hours after surgery, is highly recommended.

Methods:

Seventeen feet of 12 patients were treated between 2003 and 2018. Corrective osteotomy was performed on a single bone in 13 patients, on 2 bones in 3 patients, and on 3 bones on 1 patient. The mean follow-up was 5 years, with a physical examination once a year.

Results:

No complication such as infection or delayed wound healing was registered. X-rays taken 3 weeks after surgery showed complete bone consolidation and a correction of the previous plantarflexed position of the metatarsal with consistent reduction of pressure and pain for every patient who was able to wear normal shoes again after surgery.

Conclusion:

The Helal metatarsal osteotomy is a safe, reproducible, and feasible technique that should be considered in cases of painful metatarsal head plantar subluxation in Apert feet.

Level of Evidence:

Level IV.
Comparison of Iliac and Femoral Autograft Practices in Pemberton Pelvic Osteotomy
Authors: Bulut Mehmet , Azboy Ibrahim , Ozkul Emin , Karakurt Lokman
Published: August 2020

Background:

There is no consensus in regard to grafts used after pelvic osteotomy in developmental dysplasia of the hip in the literature. The aim of this study was to compare iliac and femoral autografts used after Pemberton pelvic osteotomy (PPO).

Methods:

In this prospective, randomized study, 60 hips with dysplasia of the hip were included. All patients underwent open reduction, PPO, and femoral shortening osteotomy. Iliac autograft (group I; n=30 hips; mean age, 39.07; range, 18 to 72 mo) and femoral autograft (group II; n=30 hips; mean age, 42.53; range, 19 to 70 mo) were used to fill the iliac osteotomy. The height and width of the iliac and femoral autografts were measured intraoperatively. Anteroposterior pelvic radiographs were obtained on the 45th day, and in the 2nd, 3rd, 6th, and 12th months postoperatively. Acetabular index angle, height of the graft, loss of graft position, graft resorption, operative time, blood loss, and union time were compared between the groups.

Results:

There was a significant difference in each group in terms of loss of graft height between the intraoperative measurement and the postoperative measurement at the 6th week and 3rd month. The intraoperative width of the grafts was significantly greater, loss of graft height was significantly less, and the amount of bleeding was significantly lower in group II (P<0.001 for all 3). However, time to union was significantly shorter in group I (P<0.001). There was no significant difference between the groups in terms of acetabular index angle at the last controls. There were loss of graft position in 2 cases and graft resorption in 1 case for group I, but no such cases occurred for group II.

Conclusions:

Graft height and position loss, donor site morbidity, and graft resorption were less in the femoral autografts group compared with the iliac autografts group in the treatment PPO with femoral shortening osteotomy.

Level of Evidence:

Level II.
Core Outcomes Set for Trials in People With Coronavirus Disease 2019
Authors: Tong Allison , Elliott Julian H. , Azevedo Luciano Cesar , Baumgart Amanda , Bersten Andrew , Cervantes Lilia , Chew Derek P. , Cho Yeoungjee , Cooper Tess , Crowe Sally , Douglas Ivor S. , Evangelidis Nicole , Flemyng Ella , Hannan Elyssa , Horby Peter , Howell Martin , Lee Jaehee , Liu Emma , Lorca Eduardo , Lynch Deena , Marshall John C. , Gonzalez Andrea Matus , McKenzie Anne , Manera Karine E. , McLeod Charlie , Mehta Sangeeta , Mer Mervyn , Morris Andrew Conway , Nseir Saad , Povoa Pedro , Reid Mark , Sakr Yasser , Shen Ning , Smyth Alan R. , Snelling Tom , Strippoli Giovanni FM , Teixeira-Pinto Armando , Torres Antoni , Turner Tari , Viecelli Andrea K. , Webb Steve , Williamson Paula R. , Woc-Colburn Laila , Zhang Junhua , Craig Jonathan C.
Published: August 2020

Objectives:

The outcomes reported in trials in coronavirus disease 2019 are extremely heterogeneous and of uncertain patient relevance, limiting their applicability for clinical decision-making. The aim of this workshop was to establish a core outcomes set for trials in people with suspected or confirmed coronavirus disease 2019.

Design:

Four international online multistakeholder consensus workshops were convened to discuss proposed core outcomes for trials in people with suspected or confirmed coronavirus disease 2019, informed by a survey involving 9,289 respondents from 111 countries. The transcripts were analyzed thematically. The workshop recommendations were used to finalize the core outcomes set.

Setting:

International.

Subjects:

Adults 18 years old and over with confirmed or suspected coronavirus disease 2019, their family members, members of the general public and health professionals (including clinicians, policy makers, regulators, funders, researchers).

Interventions:

None.

Measurements:

None.

Main Results:

Six themes were identified. “Responding to the critical and acute health crisis” reflected the immediate focus on saving lives and preventing life-threatening complications that underpinned the high prioritization of mortality, respiratory failure, and multiple organ failure. “Capturing different settings of care” highlighted the need to minimize the burden on hospitals and to acknowledge outcomes in community settings. “Encompassing the full trajectory and severity of disease” was addressing longer term impacts and the full spectrum of illness (e.g. shortness of breath and recovery). “Distinguishing overlap, correlation and collinearity” meant recognizing that symptoms such as shortness of breath had distinct value and minimizing overlap (e.g. lung function and pneumonia were on the continuum toward respiratory failure). “Recognizing adverse events” refers to the potential harms of new and evolving interventions. “Being cognizant of family and psychosocial wellbeing” reflected the pervasive impacts of coronavirus disease 2019.

Conclusions:

Mortality, respiratory failure, multiple organ failure, shortness of breath, and recovery are critically important outcomes to be consistently reported in coronavirus disease 2019 trials.
TIGIT Can Exert Immunosuppressive Effects on CD8+ T Cells by the CD155/TIGIT Signaling Pathway for Hepatocellular Carcinoma In Vitro
Authors: Zhang Changkun , Wang Yang , Xun Xiaodong , Wang Siqi , Xiang Xiao , Hu Shihua , Cheng Qian , Guo Jinghang , Li Zhao , Zhu Jiye
Published: August 2020

The efficacy of adoptive cellular immunotherapy against cancer cells is limited due to the presence of immunosuppressive cells within the solid tumor microenvironment. The upregulation of certain coinhibitory receptors may lead to exhaustion of the immune effector cells. T-cell immunoglobulin and immunoreceptor tyrosine-based inhibitory motif domain (TIGIT) is an immune inhibitory receptor expressed by regulatory T cells and activated T cells and natural killer cells. The aim of this study was to determine the immunosuppressive effects of CD155/TIGIT signaling on CD8+ T cells of adoptive cellular immunotherapy in hepatocellular carcinoma (HCC). Our studies found that CD155 was overexpressed in HCC, and CD155hi HCC cells upregulated TIGIT on CD8+ T cells, which decreased the secretion of interferon-γ, tumor necrosis factor-α, and interleukin-17A and increased that of interleukin-10 from the effector cells. However, TIGIT blockade or CD155-knockdown reversed the inhibitory effect of HCC cells on CD8+ T-cell effector function. These results indicate that TIGIT can exert an immunosuppressive effect on CD8 T cells by modulating cytokine production through CD155, and is a promising target to optimize adoptive cellular immunotherapy against HCC.
Up-regulation of circular RNA hsa_circ_01844 induces apoptosis and suppresses proliferation and migration of glioblastoma cells
Authors: Zhou Jin-Xu , Chen Ke-Fei , Hu Shuai , Dong Ji-Rong , Wang Hong-Xiang , Su Xin , Wang Yu-Hai , Chu Jun-Sheng
Published: August 2020

Background

Previous studies have demonstrated that various circular RNAs are involved in the malignant proliferation of cancers, such as liver cancer, lung cancer, breast cancer, and others. The potential role of circular RNAs in glioblastoma, however, is still uncertain. In this study, we aimed to study the potential role of hsa_circ_01844 in glioblastoma.

Methods

Using reverse transcription-polymerase chain reaction (RT-PCR) method, hsa_circ_01844 expression was measured in five glioblastoma samples and five normal brain samples. To evaluate the potential function of hsa_circ_01844 in glioblastoma, hsa_circ_01844 was overexpressed in glioblastoma cell lines (U251 and U87 cells). Using these two cell lines, in vitro experiments including the flow cytometry assay, 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide assay, Transwell assay, and cell apoptosis assay were performed to investigate the role of hsa_circ_01844 in glioblastoma. Student t test and one-way analysis of variance were used for statistical analysis.

Results

The expression of circular RNA hsa_circ_01844 was lower in glioblastoma tissues when compared with the normal brain tissues by RT-PCR method (0.034 ± 0.036 vs. 1.630 ± 0.891, P < 0.001). Using two glioblastoma cell lines, we found that overexpression of hsa_circ_01844 in glioblastoma cells suppressed their proliferation, colony formation, migration, and increased the apoptotic rate compared with empty vector group and blank control group (all P < 0.05).

Conclusion

Hsa_circ_01844 shows decreased expression in glioblastoma and its overexpression induces apoptosis and inhibits proliferation, migration, and invasion of glioblastoma cells.
Association of the soluble
CTLA4
with schizophrenia: an observational study
Authors: Cai Lei , Yang Xuhan , Kang Yani , Wen Wen , Zhang Fuquan , Yue Weihua , Zhang Qian , Chen Fangyu , Cao Wen , Yue Jun , Liang Meng , Luo Na , Sui Jing , Fei Chunhua , Tian Lin , Qin Shengying , Wan Chunling , He Lin
Published: August 2020

Objective:

The immune system is involved in the pathogenesis of schizophrenia; here, we aimed to explore the relationship of cytotoxic T lymphocyte antigen 4 (
CTLA4
) with schizophrenia.

Methods:

CTLA4
gene structure was first analyzed, and then rs231779, rs733618, rs231775 and rs3087243 were selected as tag single nucleotide polymorphisms for the linkage disequilibrium blocks in
CTLA4
in the Chinese Han population to study expression quantitative trait loci of
CTLA4
gene in normal brain tissue. Additionally, membrane
CTLA4
(
mCTLA4
) and soluble
CTLA4
(
sCTLA4
) mRNA expression levels were evaluated in peripheral blood mononuclear cells from 65 first-episode schizophrenia patients and 61 healthy controls. This study was approved by the Bioethics Committee of corresponding research institutes (approval No. 20150016) on March 6, 2015 and the principles of the
Declaration of Helsinki
.

Results:

After applying Bonferroni correction to the
P
values, only the minor C allele of rs733618 was significantly associated with increased expression of total
CTLA4
(
P
Bonf.
= 0.019), but not
mCTLA4
(
P
Bonf.
= 0.115), in the hippocampus. The
sCTLA4
expression was significantly decreased in the peripheral blood mononuclear cells of schizophrenia patients compared with healthy controls, while
mCTLA4
was not.

Conclusion:

These results suggest that the soluble form of
CTLA4
may be associated with schizophrenia and that lower
sCTLA4
expression may increase the risk of developing schizophrenia.
The Influence of Intrinsic Motivation on Pay Satisfaction Among Caregivers in Residential Home for the Elderly in China: The Mediating Role of Job Burnout
Authors: WANG Enjian , HU Hongwei , LIU Hongting , MAO Shan , CHANG Ruihua , JIANG Wei
Published: August 2020

Background

According to the theory of compensating differentials, caregivers with high levels of intrinsic motivation should exhibit a higher-than-average satisfaction with their pay. Whereas studies conducted in Western countries have provided empirical evidence for the theory of compensating differentials in various care settings, few studies have been conducted in China that focus on caregivers employed in residential homes for the elderly (RHE). The sociodemographic characteristics of caregivers in China different significantly from their counterparts in Western countries.

Purpose

This study was developed to analyze the mediating role of job burnout to assess the influence of intrinsic motivation on pay satisfaction among caregivers in RHE.

Methods

Structural equation modeling was used to examine the influences of intrinsic motivation on pay satisfaction in a sample of 1,212 caregivers employed in RHE in China by analyzing the mediating role of job burnout.

Results

Intrinsic motivation was found to relate positively to pay satisfaction (β = .11, p < .05). Negative relationships were identified between intrinsic motivation and job burnout (β = −.46, p < .01) and between job burnout and pay satisfaction (β = −.13, p < .01). Job burnout was found to have a significant mediating effect on the relationship between intrinsic motivation and pay satisfaction (β = .06, p < .01).

Conclusions/Implications for Practice

A significant relationship was found between intrinsic motivation and pay satisfaction, with job burnout playing a mediating role in caregivers employed in RHE in China. This research has profound implications for nursing education, practice, and research. First, greater efforts should be focused on instilling nursing values in nursing students to foster intrinsic motivation. Second, nonpecuniary rewards may be offered to caregivers to acknowledge the values of care work and strengthen intrinsic motivation. Third, a supportive working climate should be fostered to reduce job burnout. Fourth, caregivers should be informed of their rights to decent pay and their right to bargain collectively through unions. Fifth, appropriate public policies should be implemented to provide pay for caregivers at levels that recognize and appreciate their intrinsic motivation.
MitraClip Removal During Left Ventricular Assist Device Implantation
Authors: Kiralİ Kaan , Özer Tanil , Altaş Yerlikhan Özge , Aksüt Mehmet , Mert Özgür Mustafa
Published: August 2020

Mitral regurgitation (MR) is an important consequence of heart failure (HF) patients, which increases hospitalization and mortality rates. The MitraClip procedure is increasingly preferred for HF patients with obvious MR to improve MR and related symptoms. In some cases, patients may need further intervention such as left ventricular assist device implantation with the aim of improving progressive clinical deterioration caused by the progression of HF or mitral clip associated complications (i.e., detachment or mitral stenosis). This case study summarizes our two patients who received concomitant mitral clip removal and left ventricular assist device implantation with clinically successful results.
Lean Ad hoc Extracorporeal Membrane Oxygenation Systems for COVID-19
Authors: Hunziker Patrick , Zenklusen Urs
Published: August 2020

Coronavirus disease (COVID-19) is overwhelming hospitals with patients requiring respiratory support, including ventilators and Extracorporeal Membrane Oxygenation (ECMO). Bottlenecks in device availability may contribute to mortality, and limited device availability even in ECMO centers has led to rationing recommendations. Therefore, we explored options for ad hoc construction of venovenous ECMO using readily available components, essentially, large cannulas, membrane oxygenators, and blood pumps. As thousands of certified cardiac Impella pumps are distributed worldwide, we assembled lean ECMO by embedding Impella pumps coaxially in tubes, combined with standard gas exchangers. Ad hoc integration of Impella blood pumps with gas exchange modules, large-bore venous cannulas, regular ECMO tubing, Y-pieces, and connectors led to lean ECMO systems with stable performance over several days. Oxygenation of 2.5–5 L of blood per minute is realistic. Benefit/risk analysis appears favorable if a patient needs respiratory support but required support systems in a center are exhausted. Ad hoc assembly of venovenous ECMO is feasible using Impella blood pumps, results in stable blood flow across gas exchange modules, and thus may offer another opportunity to oxygenate, “recover the lungs” and hopefully save lives in selected patients with severe COVID-19 disease even when conventional life support equipment is exhausted. The lean design also yields inspirations for future ECMO systems.
Appropriate use of multimodality stress testing for chest pain in new patient referrals to cardiologists
Authors: Lam David H. , Tiwana Jasleen , Li Song , Kirkpatrick James N. , Cheng Richard K.
Published: August 2020

Objective

In response to the growing use of imaging-based cardiac stress tests in the evaluation of stable ischemic heart disease, professional societies have developed appropriate use criteria (AUC). AUC will soon be linked to reimbursement of advanced diagnostic imaging for Medicare beneficiaries via Clinical Decision Support Mechanisms (CDSMs). We sought to characterize the frequency and type of stress test utilization for chest pain referrals evaluated by cardiologists and determine appropriateness.

Methods

We conducted a retrospective review of new patient referrals seen by general cardiologists at an academic medical center between 2016 and 2017 for a diagnosis of chest pain or angina. Type of stress test ordered, if any, and its appropriateness (Appropriate, May be appropriate, and Rarely appropriate) were ascertained based on the 2013 multimodality AUC guideline document.

Results

There were 535 total outpatients. After applying exclusion criteria, there were 349 patients in the sample; the average age was 52 ± 15 years and 53% were female. Most chest pain was nonanginal (65%). Pretest probability of CAD was most commonly intermediate (54%). A total of 183 patients (52%) were referred for stress testing. The majority of stress tests were considered appropriate (82%) by AUC.

Conclusion

Most patients referred to cardiologists for evaluation of chest pain or angina had nonanginal chest pain and an intermediate pretest probability of CAD. Stress testing was ordered in about half of these patients and the majority were considered appropriate by AUC. These findings suggest that indiscriminate use of CDSMs may not be warranted.
Colectomy Rates Are Increasing Among Inpatients With Concomitant Ulcerative Colitis and Clostridioides difficile
Authors: Shrestha Manish P. , Taleban Sasha
Published: August 2020

Background:

Clostridioides difficile infection (CDI) is an important cause of inflammatory bowel disease (IBD) exacerbation and is associated with increased risk of hospitalization, colectomy, and mortality. Previous analysis have reported an increasing rate of CDI and associated mortality in IBD patients. We examined the trends in CDI-associated outcomes in hospitalized patients with Crohn’s disease (CD) and ulcerative colitis (UC) over the last decade.

Materials and Methods:

We used data from the National Inpatient Sample to identify patients hospitalized with both CDI and IBD from 2006 to 2014. Outcomes included in-hospital mortality, partial/total colectomy, hospital length of stay, and charges. Analysis included univariate and multivariate regression analysis.

Results:

Between 2006 and 2014, CDI-related hospitalizations increased in both CD (1.6% to 3.2%; P<0.001) and UC (4.9% to 8.6%; P<0.001). CDI-associated mortality in CD and UC patients decreased from 2.4% to 1.2% (P<0.001) and 11.3% to 9.7% (P<0.001), respectively. CDI-associated colectomy rate increased from 4.3% to 8.8% (P<0.001) in UC but decreased from 4.5% to 2.8% (P<0.001) in CD. In multivariable analysis, compared with 2006, there was a nonsignificant decrease in mortality in 2014 in both CD [adjusted odds ratio (AOR) 0.56, 95% confidence interval (CI) 0.25-1.24] and UC (AOR 0.81, 95% CI 0.61-1.07), but a significant increase in colectomy in 2014 only in UC (AOR 2.12, 95% CI 1.46-3.06).

Conclusions:

CDI rates have increased in CD and UC over the last decade. Although there has been a significant increase in colectomies in UC, CDI-associated mortality in CD and UC has not increased over this time.
Single-step endoscopic ultrasound-guided multiple gateway drainage of complex walled-off necrosis with lumen apposing metal stents
Authors: Binda Cecilia , Dabizzi Emanuele , Anderloni Andrea , Cennamo Vincenzo , Fiscaletti Marta , Fugazza Alessandro , Jovine Elio , Ercolani Giorgio , Gasbarrini Antonio , Fabbri Carlo
Published: August 2020

In this study we analyzed the feasibility and safety of single-step multiple transluminal gateway drainage (MTGD) for complex walled-off necrosis (WON) using lumen-apposing metal stents (LAMSs). Six patients underwent endoscopic ultrasound (EUS)-guided MTGD using two LAMSs. Technical success was 100%. The mean procedure time was 29 min. The mean number of direct endoscopic necrosectomy sessions per patient was 2. Two of six patients developed adverse events, which was bleeding in both cases and treated endoscopically and surgically, respectively. The mean hospital stay was 52.5 days. No patients had residual necrosis or WON recurrence. Although the limited number of patients, the single-step MTGD using electrocautery-LAMSs can be considered a feasible and well-tolerated treatment option for patients with complex WON. Nevertheless, larger randomized controlled studies are needed in order to confirm our data and better define the advantages of this technique.
Noninvasive assessment of liver fibrosis in Crohn’s disease patients exposed to methotrexate
Authors: Llaó Jordina , Masnou Helena , Romero Cristina , Bargalló Anna , Gely Cristina , Mañosa Míriam , Gordillo Jordi , Garcia-Planella Esther , Domènech Eugeni
Published: August 2020

Background:

Methotrexate is widely used to treat some inflammatory chronic disorders, though it is hampered by the risk of liver fibrosis. Many recommendations have been made to assess methotrexate-related hepatotoxicity, including liver biopsy. However, other noninvasive methods to assess liver fibrosis have been developed and could be implemented for patients treated with methotrexate.

Aim:

The aim of the study was to compare the prevalence of liver fibrosis by means of noninvasive methods [aspartate transaminase-to-platelet ratio index (APRI) Forns index, and transient elastography] in patients with Crohn’s disease exposed or not to methotrexate, and to identify risk factors for liver fibrosis.

Methods:

Prospective, cross-sectional study. All patients with Crohn’s disease exposed to methotrexate were included and compared to an unselected cohort of outpatients with Crohn’s disease never exposed to methotrexate.

Results:

A total of 84 patients with Crohn’s disease, 56 exposed to methotrexate, and 28 controls, were included. Significant liver fibrosis was found in 7% of methotrexate-exposed patients with Crohn’s disease and 10% of controls as measured by transient elastography, and in 7% of controls as measured by the Forns index. No cases of liver fibrosis were detected by APRI. Only alcohol consumption, diabetes mellitus, and age were associated with significant liver fibrosis.

Conclusions:

Significant liver fibrosis is uncommon among patients with Crohn’s disease, even among those exposed to methotrexate. The risk of liver fibrosis in Crohn’s disease seems to depend on common risk factors for liver disease.
Chromium picolinate balances the metabolic and clinical markers in nonalcoholic fatty liver disease: a randomized, double-blind, placebo-controlled trial
Authors: Kooshki Fateme , Moradi Fardin , Karimi Arash , Niazkar Hamid Reza , Khoshbaten Manouchehr , Maleki Vahid , Pourghassem Gargari Bahram
Published: August 2020

Objective

Nonalcoholic fatty liver disease (NAFLD) is a complicated disease and is considered as a severe global health problem affecting 30% of adults worldwide. The present study aimed to evaluate changes in oxidative stress, adipokines, liver enzyme, and body composition following treatment with chromium picolinate (CrPic) among patients with NAFLD.

Participants and methods

The current randomized, double-blind, placebo-controlled study was conducted on 46 NAFLD patients with the age range of 20–65 years. Patients were randomly classified into two groups, receiving either 400 µg CrPic tablets in two divided doses of 200 µg (23 patients) or placebo (23 patients) daily for 12 weeks. The participants’ body composition and biochemical parameters were evaluated at the baseline and after 12 weeks.

Results

Serum levels of liver enzymes reduced significantly only in the CrPic group (P < 0.05 for all), but not between the groups after the intervention. Besides, there were significant differences between the study groups regarding body weight and body fat mass, total antioxidant capacity, superoxide dismutase, malondialdehyde, leptin, and adiponectin post-intervention (P = 0.017, P = 0.032, P = 0.003, P = 0.023, P = 0.012, P = 0.003, and P = 0.042, respectively). However, glutathione peroxidase and resistin levels did not differ significantly between groups (P = 0.127 and P = 0.688, respectively).

Discussion and conclusion

This study showed that consuming 400 µg/day of CrPic for 12 weeks in patients with NAFLD causes a significant change in leptin, adiponectin, oxidative stress (expect glutathione peroxidase), and body weight, compared to baseline. Nevertheless, it does not affect liver enzymes. Therefore, the CrPic supplementation may improve adipokines, some anthropometric indices, and oxidative stress in patients with NAFLD.
Early histopathologic changes in primary biliary cholangitis: does ‘minimal change’ primary biliary cholangitis exist? A pathologist’s view
Authors: Chatzipantelis Paschalis , Giatromanolaki Alexandra
Published: August 2020

Primary biliary cholangitis (PBC), formerly known as primary biliary cirrhosis, is an autoimmune, slowly progressive, cholestatic liver disease characterized by nonsuppurative destructive cholangitis, and interlobular bile duct destruction. Necroinflammatory activities of the hepatic parenchyma and limiting plates of milder form along with late liver fibrosis may develop. Serum liver tests include elevated serum alkaline phosphatase along with a positive antimitochondrial antibody (AMA) in nearly 95% of patients. Liver biopsies are an important confirmatory and staging tool and are additionally very helpful when AMA is negative. More specifically, the earliest changes in liver biopsy suspicious for PBC can be detected, namely loss of the canals of Hering (CoH), as proposed by various authors recently. CoH loss has been described as an early feature of PBC. We focus on early histologic features of PBC, investigating through the literature the possible role of ‘minimal change’ supporting the clinical diagnosis of PBC, even in the absence of characteristic granulomatous duct destructive lesions.
Consensus document on the management preferences of patients with ulcerative colitis: points to consider and recommendations
Authors: Casellas Francesc , Guinard Vicens Daniel , García-López Santiago , González-Lama Yago , Argüelles-Arias Federico , Barreiro-de Acosta Manuel , Marín Sánchez Laura , Mendive Juan Manuel , Saldaña Roberto , Cabez Ana , Gómez Susana , Loza Estíbaliz
Published: August 2020

Background and aims

Our objective was to define, describe and organize (on the basis of consensus) the patient’s preferences in the management of ulcerative colitis (UC), in order to further incorporate them in daily practice and improve patients satisfaction, adherence to the treatment and quality of care.

Methods

Qualitative study. A narrative literature review in Medline using Mesh and free-text terms was conducted to identify articles on UC patient preferences as well as clinical scenarios that may influence the preferences. The results were presented and discussed in a multidisciplinary nominal group meeting composed of six gastroenterologists, one primary care physician, one nurse practitioner and one expert patient. Key clinical scenarios and patient preferences were then defined, generating a series of points to consider and recommendations. The level of agreement with the final selection of preferences was established following a Delphi process.

Results

The narrative review retrieved 69 articles of qualitative design and moderate quality. The following key clinical scenarios were identified: diagnosis, follow-up, surgery, and special situations/patients profiles such as adolescents or women. Patient preferences were classified into information, treatment (pharmacological and non-pharmacological), follow-up, relations with health professionals, relations with the health system and administration. Finally, 11 recommendations on patient preferences for UC in relation to its management reached the level of agreement established.

Conclusion

The consensual description of patient’s preferences contribute to identify different areas for improvement in healthcare practice.
Endoscopic submucosal dissection of gastric neoplastic lesions in Western countries: systematic review and meta-analysis
Authors: Zullo Angelo , Manta Raffaele , De Francesco Vincenzo , Manfredi Guido , Buscarini Elisabetta , Fiorini Giulia , Vaira Dino , Marmo Riccardo
Published: August 2020

Endoscopic submucosal dissection (ESD) for gastric neoplastic lesions removal is largely performed in Asian countries. Unfortunately, ESD diffusion, particularly for gastric lesion removal, is still limited in Western countries. We performed a systematic review of available data coming from Western centers. The en bloc and the R0 resection rates for all neoplastic lesions, including early gastric cancer (EGC) and dysplasia, were calculated, as well as the curative rate for EGC. Complications and the 1-month mortality rates were computed. A total of 22 studies from Europe (N = 15), Latina America (N = 6), and Canada (N = 1) were retrieved, with 1152 patients and 1210 lesions. The en bloc resection was successful in 96% [95% confidence interval (CI) 93–98] with a significant heterogeneity (I

2
= 63.5%; P < 0.0001). The R0 was achieved in 84% (95% CI 79–89; I

2
= 79.9%; P < 0.001). The resection rate was curative in 72% out of 340 patients with EGC (95% CI 65–79, I

2
= 8%; P = 0.36). Overall, complications occurred in 9.5% of patients, including bleeding (5.8%), perforation (3.4%), and stenosis (0.35%). A total of three (0.26%) patients deceased within 1 month, but none was directly related to the procedure. Lesion recurrence was observed in 38 (3.5%; 95% CI 2.3–4.4) cases, including 21 EGC and 17 dysplasia. In Western countries, the en bloc and the R0 resections were successful in the large majority of cases, whilst the resection was curative in 72% of patients with EGC. The complications rate was acceptably low.
A novel value-based scoring system for endoscopic ultrasound-guided drainage of pancreatic fluid collections: a single-centre comparative study of plastic and lumen-apposing metal stents (NOVA study)
Authors: Parihar Vikrant , Basir Yasir , Nally Deirdre , Mellotte Gregory , Manoharan Thilagraj , Walker Caroline , Ridgway P.F. , Conlon K.C. , Breslin Niall , Harewood Gavin C. , Ryan Barbara M.
Published: August 2020

Objective

Healthcare resources are finite. Value in healthcare can be defined as patient health outcomes achieved per monetary unit spent. Attempts have been made to quantify the value of luminal endoscopy, but there is little in the medical literature describing the value of the complex therapeutic endoscopic activity. This study aimed to characterise the value of endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFCs) with either plastic or lumen-apposing metal stents (LAMSs).

Methods

This is a single-centre, retrospective–prospective comparative study of 39 patients, who underwent EUS-guided PFC drainage between 2009 and 2018. Procedure value was calculated using the formula Q/(T/C), where Q is the quality of procedure adjusted for complications, T procedure duration and C is the complexity adjustment. Quality and complexity were estimated on a 1–4 Likert scale based on the American Society for Gastrointestinal Endoscopy criteria. Time (in minutes) was recorded from the patient entering and leaving the procedure room. Endoscopy time calculated from procedure time was considered a surrogate marker of cost as individual components of procedure cost were not itemized.

Results

Of 39 identified patients who underwent EUS-guided PFC drainage, 11 received double pigtail plastic stents (DPPSs) and 28 received LAMSs. The two groups were comparable in age, gender and aetiology. Nearly 40% of the LAMS interventions were considered high value but only 11% of the plastic stent interventions achieved the same. The difference predominantly was due to a higher rate of complications and longer procedure time.

Conclusion

In this single-centre study, EUS-guided PFC drainage using LAMS was found to be a higher value procedure compared to the use of DPPS.
Mixed histology poses a greater risk for noncurative endoscopic resection in early gastric cancers regardless of the predominant histologic types
Authors: Ozeki Yuichiro , Hirasawa Kingo , Sawada Atsushi , Ikeda Ryosuke , Nishio Masafumi , Fukuchi Takehide , Kobayashi Ryosuke , Makazu Makomo , Sato Chiko , Taguri Masataka , Inayama Yoshiaki , Maeda Shin
Published: August 2020

Objectives

Clinicopathologic characteristics and treatment outcomes of mixed-histological-type (MT) early gastric cancers (EGCs) treated with endoscopic submucosal dissection (ESD) have not been sufficiently elucidated. We aimed to clarify them in comparison with pure-histological-type EGCs.

Methods

We used 3022 consecutive EGCs in 2281 patients treated with ESD from our prospectively maintained database. Cases were stratified into four groups according to the final diagnosis of the resected specimen are as follows: 2780 pure differentiated-type (DT), 127 DT-predominant MT (D-MT), 87 pure undifferentiated-type (UDT), and 28 UDT-predominant MT (U-MT). Clinicopathologic characteristics and treatment outcome were compared between pure DT and D-MT, and between pure UDT and U-MT separately. Risk factors for deep submucosal invasion, lymphovascular invasion, and a final diagnosis of MT were identified using multivariate analysis.

Results

Both D-MT (41.7 vs. 92.0%; P < 0.0001) and U-MT (35.7 vs. 75.9%; P = 0.0002) showed a significantly lower curative resection rate than their pure histologic counterparts. Multivariate analysis revealed that MT was an independent risk factor for deep submucosal (OR 6.55; 95% CI, 4.18–10.14) and lymphovascular (OR 4.74; 95% CI, 2.72–8.29) invasion. Preoperative biopsy results that did not show well-differentiated tubular adenocarcinoma (OR 28.2; 95% CI, 18.9–42.9) were an independent risk factor for a final diagnosis of MT.

Conclusions

MT poses a greater risk for noncurative resection regardless of the predominant histologic types, reflecting more aggressive malignant potential. Although a biopsy examination rarely shows MT, clinicians should consider the possibility of MT when a biopsy examination does not show well-differentiated tubular adenocarcinoma.
Comparative study of allicin-containing quadruple therapy vs. bismuth-containing quadruple therapy for the treatment of Helicobacter pylori infection: a prospective randomized study
Authors: Li Huan , Xia Xiu-Juan , Zhang Lin-Fang , Chi Jing-Shu , Liu Peng , Wu Hao , Xie Xiao-Ran , Tian De-Lin , Kun Kai-Xiao , Gong Ren-jie , Liu Xiao-Ming , Xu Can-Xia
Published: August 2020

Background

Bismuth has antimicrobial activity and can improve the efficacy of triple Helicobacter pylori (H. pylori) therapy. Allicin added to conventional therapy for H. pylori infection also improves H. pylori eradication rates. Thus, this study aims to evaluate and compare the efficacy, safety and tolerability of allicin-containing quadruple therapy and bismuth-containing quadruple therapy and to investigate the factors that affect the eradication rates.

Methods

Two hundred twenty H. pylori-infected patients were included and randomly (1:1) assigned to 14-day quadruple therapy: ilaprazole (5 mg bid), doxycycline (100 mg bid), and furazolidone (100 mg bid) with an allicin soft capsule (40 mg of DATS tid) (IDFA) or colloidal bismuth tartrate (220 mg of elemental bismuth bid) (IDFB). Eradication was confirmed by urea breath tests. Symptom improvement, adverse events, and adherence were assessed by a questionnaire.

Results

In the intention-to-treat and per-protocol analysis, the eradication rates for IDFA and IDFB groups were 87.5% (70/80) vs. 86.3% (69/80, P = 0.815) and 91.9% (68/74) vs. 91.8% (67/73, P = 0.980) as first-line therapies; 83.3% (25/30) vs. 83.3% (25/30, P = 1) and 89.3% (25/28) vs. 88.9% (24/27, P = 1) as second-line therapies. Symptom improvement rates were 96.1% and 97.0% for IDFA and IDFB (P = 1). The adverse event rates were 10.9% in IDFA and 14.5% in IDFB groups (P = 0.418). Nausea occurred frequently in IDFB than IDFA (1.8% vs. 8.2%, P = 0.030). Smoking and sharing utensils significantly affected the efficacy.

Conclusion

Allicin-containing quadruple therapy might be regarded as a promising alternative to bismuth-containing quadruple therapy in H. pylori eradication.