bluuebunny/crossref_metadata_2025 huggingface dataset:
Dietary management of blood glucose in medical critically ill patients with overweight/obesity
Authors: Srinath Reshmi , Mechanick Jeffrey I.
Published: February 2020

Purpose of review

As the obesity epidemic continues, there is a greater proportion of patients with overweight, obesity, and other forms of adiposity-based chronic disease that require intensive care. Nutrition therapy in the ICU is a vital part of critical care but can be challenging in this setting because of the increased risk of stress hyperglycemia and adverse impact of obesity- and diabetes-related complications.

Recent findings

Current guidelines favor early nutritional therapy with a hypocaloric, high-protein diet in patients with overweight/obesity. More aggressive protein intake may be useful in those with greater severity of overweight/obesity with an upper limit of 3 g/kg ideal body weight per day. Although there is no specific recommendation, choosing enteral formulas with higher fat content and slower digesting carbohydrates may assist with glucose control. Supplementation with immunonutrients is recommended, given their known benefits in obesity and in reducing inflammation, but must be done in an individualized manner.

Aggressive nutritional therapy is crucial in patients with overweight/obesity to support ongoing metabolic demands. Although a hypocaloric high-protein feeding strategy is a starting point, nutritional therapy should be approached in an individualized manner taking into account age, weight and BMI, basal metabolism, nutrition status, complications, and comorbidities.
Prenatal high-low impact exercise program supported by pelvic floor muscle education and training decreases the life impact of postnatal urinary incontinence
Authors: Szumilewicz Anna , Kuchta Agnieszka , Kranich Monika , Dornowski Marcin , Jastrzębski Zbigniew
Published: February 2020

Background:

Pregnancy and high impact exercise may cause postnatal urinary incontinence. We aimed to evaluate the life impact of postnatal urinary incontinence in women attending prenatal, high-low impact exercise program, supported by pelvic floor muscle education and training, in comparison to controls.

Methods:

It was a quasiexperimental trial among 260 postpartum Caucasian women (age 29 ± 4 years; mean ± standard deviation). The training group (n = 133) attended a high-low impact exercise and educational program from the 2nd trimester of pregnancy until birth, 3 times a week. We educated this group to contract and relax pelvic floor muscles with surface electromyography biofeedback and instructed how to exercise postpartum. Control women (n = 127) did not get any intervention. All women reported on the life impact of urinary incontinence 2 months and 1 year postpartum using the Incontinence Impact Questionnaire (IIQ).

Results:

Training group started regular pelvic floor muscle exercises substantially earlier postpartum than controls (P < .001). Significantly less training women reported the life impact of urinary incontinence both 2 months (P = .03) and 1 year postpartum (P = .005). Two months after birth, for the symptomatic women the IIQ scores were significantly lower in the training than in the control women (median [Me] = 9.4 vs Me = 18.9; P = .002). Between the 1st and 2nd assessments the number of women affected by incontinence symptoms decreased by 38% in the training group and by 20% in the controls.

Conclusion:

High-low impact activities supported by pelvic floor muscle exercises and education should be promoted among pregnant, physically active women. Such activities may help women to continue high-intensity exercise with the simultaneous prevention of postnatal urinary incontinence.

Thy study was registered at ISRCTN under the title “Pelvic floor muscle training with surface electromyography” (DOI 10.1186/ISRCTN92265528).
Plasma cells and lymphoid aggregates in sleeve gastrectomy specimens
Authors: Chakhachiro Zaher , Saroufim Maya , Safadi Bassem , Attieh Michel , Assaf Nada , Shamseddine Ghassan , Tamim Hani , Boulos Fouad
Published: February 2020

Lymphoid follicles/aggregates in gastric biopsies have been traditionally linked to Helicobacter pylori gastritis, and less commonly to other inflammatory and neoplastic conditions. The frequency of such aggregates in normal stomachs has yet to be adequately evaluated. This is especially relevant when it comes to diagnosing non-specific chronic gastritis in biopsy specimens with chronic inflammation but no evidence of H pylori infection. Sleeve gastrectomies represent an opportunity to study adequately preserved gastric mucosa in patients who are otherwise asymptomatic and lack a history of gastric disease.

To study sleeve gastrectomy specimens to quantify the amount of lymphoid follicles/aggregates and lymphocytic infiltration in normal stomachs.

Sixty-eight bariatric sleeve gastrectomies and 13 control specimens from Whipple resections were examined for multiple histologic features including type, quantity, and distribution of chronic inflammation and lymphoid follicles/aggregates. Presence of H pylori was documented by both Hematoxylin and eosin-stained (H&E) and immunohistochemistry (IHC). Clinical information including age, sex, medication intake, prior endoscopy, and/or H pylori infection was recorded. The patient population was divided in 2 groups, H pylori negative versus H pylori positive, and statistical analysis was performed by a biostatistician.

Two hundred sixty three fundic sections from 68 bariatric patients were examined. Fifty three patients were found to be H pylori-negative, compared with 15 who were positive for H pylori. Among the H pylori-negative group, the average number of lymphoid aggregates was 3.33, compared with an average of 6.26 in the H pylori positive group (the difference was statistically significant with a P-value of .008). The average number of plasma cells per high power field was 2.15 in the H pylori negative group, compared and average of 5.07 in the H pylori positive group (the difference was also statistically significant with a P-value <.001). Clinically, 10 of the 53 H pylori-negative patients had esophagogastroduodenoscopy (EGD) that showed endoscopic mild non-erosive gastric erythema. The remaining had no documentation of symptoms or medication intake, including Non-steroidal anti-inflammatory drugs (NSAIDs) and Proton Pump Inhibitors (PPI).

Our results suggest that the presence of lymphoid aggregates and plasma cells infiltration can be a normal finding in otherwise normal gastric mucosa, though more pronounced in H pylori infected patients.
Effect of acupoint therapies on prostatitis
Authors: Zhu Kun , Shen Yifeng , Zhu Yi , Li Lan , You Yaodong
Published: February 2020

Background:

Prostatitis is a common urinary infectious disease. Acupoint therapies, including massage, acupuncture, acupoints injection, acupressure, and moxibustion, showed clinical and long-lasting benefits for prostatitis, but the efficiency of acupoint therapies was poorly evaluated. The current review is attempted to evaluate the efficacy and safety of the different acupoint-based therapies for prostatitis.

Methods:

Randomized controlled trials (RCTs) assessing acupoint therapies for prostatitis are included in the following databases: Web of Science, PubMed, Science Direct, Wan Fang Data Knowledge Service Platform, Chinese Biomedical Literature Database (CBM), Chinese Scientific Journal Database (VIP database), China National Knowledge Infrastructure (CNKI), and EMBASE. All RCTs on acupoint or related interventions will be included we will also conduct unpublished academic research data. Databases will be searched from inception to Dec 2019. Study inclusion, data extraction, and quality assessment will be performed independently by 2 reviewers. Assessment of risk of bias and data synthesis will be performed by RevMan 5.3 software. Cochrane criteria for risk-of-bias will be used to assess the methodological quality of the trials.

Results:

According to the data of effective rate, quality of life, the cure rate, the recurrent rate, and the complications rate, this study will provide an evidence-based review of acupoint therapies for prostatitis.

Conclusion:

This systematic review will evaluate the efficacy, and safety of the different acupoint-based therapies for prostatitis, we will recommend which acupoint therapies may be considered as the effective treatment for prostatitis, and show how it might work.

PROSPERO registration number:

DOI 10.17605/OSF.IO/H7KQJ.
The effect of bone morphogenetic protein 2 composite materials combined with cannulated screws in treatment of acute displaced femoral neck fractures
Authors: Gao Hongwei , Xing Deguo , Liu Zhonghao , Zheng Jiachun , Xiong Zhenggang , Gong Mingzhi , Liu Lan
Published: February 2020

The risk of avascular necrosis (AVN) and nonunion after treatment of displaced femoral neck fractures is increased in patients aged <60 years. Therefore we established a new protocol for closed reduction and internal fixation (CRIF) using cannulated screws combined with bone morphogenetic protein 2 (BMP-2) composite materials to treat acute femoral neck fractures.

This study enrolled 78 patients with acute femoral neck fractures between April 2014 and September 2016. We treated 46 patients with a mean age of 43.8 years in study group. These patients were treated by CRIF combined with BMP-2 composite materials. In control group, there were 32 patients with a mean age of 42.09 years. The patients were treated by CRIF without BMP-2. The duration between presentation and surgery, operative time, Harris score and complications were recorded.

In study group, 43 patients were followed up with an average of 31.3 months. One patient suffered nonunion and three patients presented AVN. In control group, 28 patients were followed up with an average of 32.3 months, the rate of AVN and fracture nonunion were 25% (7/28) and 21.4% (6/28) respectively, significantly higher than those in study group (P < .05).

Acute displaced femoral neck fractures can be treated with CRIF and BMP-2 composite materials in a minimally invasive manner. This technique was reproducible and had fewer complications.
AA amyloidosis associated with Castleman disease
Authors: Bernabei Luca , Waxman Adam , Caponetti Gabriel , Fajgenbaum David C. , Weiss Brendan M.
Published: February 2020

Rationale:

AA amyloidosis (AA) is caused by a wide variety of inflammatory states, but is infrequently associated with Castleman disease (CD). CD describes a heterogeneous group of hematologic disorders that share characteristic lymph node histopathology. CD can present with a solitary enlarged lymph node (unicentric CD, UCD) or with multicentric lymphadenopathy (MCD), constitutional symptoms, cytopenias, and multiple organ dysfunction due to an interleukin-6 driven cytokine storm.

Patient Concerns:

We are reporting a case of a 26-year-old woman with no significant past medical history who presented with a 3-month history of fatigue and an unintentional 20-pound weight loss.

Diagnosis:

A CT-scan of the abdomen and pelvis revealed hepatosplenomegaly and a mesenteric mass. Congo Red staining from a liver biopsy showed apple-green birefringence and serum markers were suggestive of an inflammatory process. Post-excision examination of the resected mass revealed a reactive lymph node with follicular hyperplasia with kappa and lambda stains showing polyclonal plasmacytosis consistent with CD.

Interventions:

The patient underwent surgery to remove the affected lymph node.

Outcomes:

IL-6, anemia, leukocytosis, and thrombocytosis resolved or normalized 2 weeks after resection; creatinine normalized 9 months postsurgery. Twenty two months post-surgery her IFN-γ normalized, her fatigue resolved, her proteinuria was reduced by >90% and she had returned to her baseline weight.

Lessons:

Our case and literature review suggest that patients presenting with UCD or MCD along with organ failure should prompt consideration of concurrent AA amyloidosis.
Oxycodone preemptive analgesia after endoscopic plasma total adenotonsillectomy in children
Authors: Wu Jiang , Gui Qi , Wang Jinlin , Ye Jingjing , Xia Zhongfang , Wang Shufen , Liu Feng , Kong Fanli , Zhong Liang
Published: February 2020

Background:

Endoscopic tonsillectomy is associated with postoperative pain. Postoperative pain management remains to be improved in children. We aimed to investigate oxycodone preemptive analgesia in children undergoing endoscopic plasma total adenotonsillectomy.

Methods:

166 children with adenotonsillar hypertrophy were recruited at Wuhan Children's Hospital between 08/2016 and 03/2017. They were randomly assigned to receive SPOA (postoperative sufentanil), SPEA+SPOA (preemptive sufentanil and postoperative sufentanil), and OPEA+SPOA (preemptive oxycodone and postoperative sufentanil). The primary endpoint was serum c-fos levels. The secondary endpoints were the response entropy (RE) value, Pediatric Anesthesia Emergence Delirium (PAED) score, FLACC score, and adverse events.

Results:

c-fos mRNA levels were increased significantly after surgery in the SPOA and SPEA+SPOA groups (P < .05). Postoperatively, c-fos mRNA levels were higher in the SPOA group compared with the OPEA+SPOA group (P = .044). The RE values increased in all groups after surgery (P < .05). At extubation, RE values were higher in the SPOA group compared with the SPEA+SPOA and OPEA+SPOA groups (P < .05). The PAED scores were higher in the SPOA group compared with the OPEA+SPOA group (P = .045). In the SPOA group, the FLACC scores were decreased at 24 h after surgery vs 4 hours (P = .044). Prediction probability (Pk) values indicated that RE and c-fos mRNA levels were quantitative predictors for early postoperative stress reaction after surgery.

Conclusions:

The subanalgesic dose of oxycodone (0.1 mg/kg) as preemptive analgesia could improve pain after endoscopic plasma total adenotonsillectomy in children.
Assessment of mental health among nursing staff at different levels
Authors: Du Man-Li , Deng Wan-Xin , Sun Wen , Chien Ching-Wen , Tung Tao-Hsin , Zou Xin-Chun
Published: February 2020

To assess the mental health of nurses and to find the post responsibility and psychological status of clinical nurses.

A total of 447 nursing staff at different levels in a teaching hospital was assessed by nursing post responsibility scale and mental symptom checklist (SCL-90) then compared with each other. The study period was from April 1, 2018 to April 30, 2018.

There was a positive correlation between the responsibility of post and interpersonal relationship (r = 0.11, P < .05), depression (r = 0.10, P < .05) and hostility (r = 0.10, P < .05). Post risk was negatively correlated with somatization (r = −0.10, P < .05), job involvement scope and communication ability were negatively correlated (r = −0.11, P < .05). Based on the multiple linear regression, knowledge and skills (β = −0.20, P = .02) and risks of the post (β=0.20, P < .01) both significantly related to SCL-90 total score.

In conclusion, knowledge and skills and risks of the post associated with mental health of clinical nurses. The sustainable development of nursing post responsibility requires healthy physiological and mental health.
Serum leptin, resistin, and adiponectin levels in obese and non-obese patients with newly diagnosed type 2 diabetes mellitus
Authors: Liu Wei , Zhou Xianghai , Li Yufeng , Zhang Simin , Cai Xiaoling , Zhang Rui , Gong Siqian , Han Xueyao , Ji Linong
Published: February 2020

Disturbances in adipocytokine profiles can contribute to peripheral insulin resistance and impairment of insulin production, which are 2 primary pathophysiological mechanisms involved in type 2 diabetes mellitus (T2DM). Previous studies of disturbed adipocytokine profiles have resulted in ambiguous findings; therefore, we conducted the current study comparing leptin, resistin, and adiponectin concentrations in patients with newly diagnosed T2DM who had normal body mass index (BMI) and those who were obese.

We studied a population-based cohort of healthy participants and those with newly diagnosed T2DM. A normal BMI group was randomly selected; age- and sex-matched obese participants were recruited. Circulating leptin, resistin, and adiponectin concentrations were measured and compared between groups using analysis of variance; binary logistic regression analysis was then performed to compare the normal BMI and obese groups.

In total, 85 healthy participants and 38 patients with diabetes (19 with normal BMI and 17 who were obese) were enrolled. After adjustment for BMI and waist circumference, the median leptin concentration was higher in the obese group (6.77 (3.89–10.73) ng/mL) than in the normal BMI group (1.69 (0.80–3.89) ng/mL) (P = .007), whereas the median adiponectin concentration was lower in the obese group (1.03 (0.75–2.36) μg/mL vs 3.36 (0.59–7.63) μg/mL, P = .03). In addition, the adiponectin/leptin ratio was higher in the normal BMI group (145.6 (41.3–495.9) ng/mL) than in the obese group (20.55 (8.74–36.94) ng/mL, P = .002).

Compared with the normal BMI T2DM group, the obese T2DM group exhibited a disturbed adipocytokine profile in the form of a significantly increased leptin concentration and reduced adiponectin level. Further studies are needed to determine the causal relationship for this difference and evaluate its importance for personalized diabetic treatment.
Modified extrapedicular kyphoplasty for the treatment of lumbar compression fracture
Authors: Wang Li-Min , Liu Feng-Yu , Lu Kuan , Liu Zhao , Hou Shu-Bing , Sun Xian-Ze
Published: February 2020

Rationale:

Traditionally, transpedicular approach was used in the treatment of osteoporotic lumbar compression fracture. In order to avoid the risks of pedicle disruption and spinal canal intrusion, extrapedicular approache has been attempted. The aim of the article is to present the modified extrapedicular kyphoplasty technique for the treatment of osteoporotic lumbar compression fracture.

Patient concerns:

A 62-year-old woman suffered from severe low back pain after an accidental fall 10 days ago. Low back pain was obvious when turning over and getting out of bed. It was not relieved after bed rest and conservative treatment. Visual analog scale (VAS) of low back pain was 8 points and Oswestry disability index score was 80%.

Diagnosis:

Magnetic resonance imaging showed osteoporotic vertebral compression fracture of L2 and L3.

Interventions:

We performed modified extrapedicular kyphoplasty for the patient. The technique has a standardized operating procedure. The puncture point of skin is determined according to preoperative computer tomography and X-ray. The puncture point of vertebral body is located at the outer upper edge of the pedicle. The puncture direction is from the upper edge of the pedicle to the lower edge of the contralateral pedicle.

Outcomes:

The operation time was 20 minutes. The intraoperative blood loss was 5 mL. The amount of bone cement was 4 mL in L2 and 5 mL in L3. VAS of low back pain was 2 points in 1 day after surgery. Preoperative symptoms were significantly improved.

Lessons

: Modified extrapedicular kyphoplasty is a safe and effective technique for the treatment of osteoporotic lumbar compression fracture, which should be promoted and applied.
Total thyroidectomy versus lobectomy for papillary thyroid cancer
Authors: Zhang Chi , Li Yanshuang , Li Jiyu , Chen Xiao
Published: February 2020

Background:

This systematic review and meta-analysis collected data for evaluating the effect of surgical extent on overall survival (OS) and recurrence-free survival (RFS) in patients with papillary thyroid cancer (PTC).

Methods:

We searched the PubMed, Embase, and Cochrane Library databases. The included studies compared two groups of patients with PTC: the total thyroidectomy (TT) group and the lobectomy (LT) group. The combined hazard ratio (HR) was calculated.

Results:

Thirteen studies were included in the present study. The TT and LT groups had similar OS results (HR = 1.04; 95% CI: 0.90–1.21; P = .60). In the subgroup analysis, the combined HR of the ≤1 cm group and the 1.0 to 2.0 cm group showed that TT had no advantage with regard to OS compared to LT. In the 2.0 to 4.0 cm group, TT provided better OS than LT (HR = 0.88; 95% CI: 0.79–0.99; P = .03). Patients who underwent TT had a better RFS outcome than those who underwent LT (HR = 0.56; 95% CI: 0.41–0.77; P < .0001). In the subgroup analysis, both the ≤1 cm group and >1 cm group that underwent TT were associated with better RFS.

Conclusions:

Our meta-analysis suggested that LT increased the risk of recurrence in PTC patients with tumors ≤1.0 cm and in PTC patients with tumors >1.0 cm. More importantly, LT was associated with higher mortality in PTC patients with 2.0 to 4.0 cm tumors. Caution is warranted when LT is performed in this group of patients.
Pharmacopuncture for the management of musculoskeletal diseases
Authors: Hwang Ji Hye , Ku Jaseung , Jeong Jin-Ho
Published: February 2020

Background:

Musculoskeletal disorders are the main reason for people to seek counseling and use of complementary and alternative medicine. Although pharmacopuncture is used to treat various diseases in traditional medicine, it is most often applied to treat musculoskeletal conditions. Here, we will review systematically the clinical evidence for the effectiveness and safety of pharmacopuncture for musculoskeletal diseases.

Methods:

A total of 13 databases will be searched for studies uploaded from January 2014 to December 2018 that investigated the treatment of musculoskeletal diseases. These databases are MEDLINE, EMBASE, AMED, Cochrane Library, CINAHL, 4 Korean databases, 2 Chinese database, and 2 Japanese databases. The methodological quality of randomized controlled trials will be analyzed using the Cochrane Collaboration tool to assess risk of bias, and the confidence in the cumulative evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) instrument.

Ethics and dissemination:

This systematic review will be published in a peer-reviewed journal and disseminated electronically and in print. To inform and guide healthcare practices, the review will be updated.

Registration number:

CRD42019148795.
Renal insufficiency plays a crucial association factor in severe knee osteoarthritis-induced pain in patients with total knee replacement
Authors: Chio Chung-Ching , Siu Man-Kit , Tai Yu-Ting , Chen Tyng-Guey , Ho Wei-Pin , Chen Jui-Tai , Tsai Hsiao-Chien , Chen Ruei-Ming
Published: February 2020

Pain, the main symptom of osteoarthritis (OA), can lead to functional disability in patients with knee OA. Understanding the association factors related to knee pain is important since preventing OA-induced disabilities can be achieved by modifying these pain-associated issues. Therefore, this study was aimed to investigate the association factors for OA-induced knee pain in Taiwanese patients who received total knee replacements (TKR).

In this retrospective study, 357 subjects who had undergone TKR at the Taipei Municipal Wan-Fang Hospital were recruited. The distribution of pain severity among patients with knee OA was evaluated. Demographic data and clinical parameters were analyzed to determine relationships between these variables and the severity of knee OA pain.

Of the 357 patients studied, 54% and 33% had moderate and severe knee pain, respectively. Furthermore, a multivariate logistic regression analysis revealed that serum creatinine (>1.5 mg/dL) and an estimated glomerular filtration rate (eGFR) (<60 mL/min/1.73 m2) were significantly associated with severe knee pain in OA patients. A significant correlation between severe knee pain and serum creatinine or eGFR was demonstrated by Pearson correlations.

Taken together, the renal insufficiency defined by an elevated serum creatinine or a low eGFR in OA patients who required TKR was associated with severe knee pain. These variables must be considered while treating knee OA pain, especially in those patients with severe pain.
Lipoprotein removal mechanisms and aging: implications for the cardiovascular health of the elderly
Authors: Maranhão Raul C. , Pala Daniela , Freitas Fatima R.
Published: February 2020

Purpose of review

The speed of removal from the plasma of apolipoprotein B-containing lipoproteins, for example, chylomicrons, VLDL and LDL is determinant of the plasma concentration of these lipoproteins, is influenced by genetic features and ambient factors, and has implications in atherogenesis. As aging increases the clinical complications of atherosclerosis, it is important to appraise the status of the removal mechanisms in elderly individuals.

Recent findings

Removal of triglyceride-rich lipoproteins remnants is delayed but the triglyceride breakdown is unchanged in elderly individuals. The discovery of PCSK9, enzyme that degrades LDL receptors, and the recent observation that PCSK9 is elevated in the elderly raises another hypothesis to account for the increased LDL-cholesterol levels in the elderly. The removal of cholesterol from cells by HDL, the first step of cholesterol reverse transport is also less efficient in the elderly, which may compromise the body cholesterol homeostasis.

Aging determines reduction of the efficiency of lipoprotein plasma removal mechanisms, which is implicated in increased incidence of cardia complications. Moreover, aging is frequently accompanied by physical activity reduction, weight gain, and metabolic disturbances that can further decrease the efficacy of the removal mechanisms. This knowledge is important for promoting cardiovascular health in the elderly and prolonging survival.
Infratemporal fossa surgical approaches to primary/recurrent malignancies of salivary origin: paradigm surgical shift, patient selection, and oncologic outcomes
Authors: Bradley Patrick J.
Published: February 2020

Purpose of review

To review, the surgical approaches available on diagnosing a patient with salivary gland malignancy in the infratemporal fossa (ITF). To comment on patient evaluation and method of treatment selection. To identify and report on patient outcome data and make recommendations on future needs.

Recent findings

There is a need to define the anatomic boundaries contents of the ITF, masticator space, parapharyngeal space (PPS), pterygopalatine fossa, ventral skull base, and paramedian skull base, as evidence from publications. The pathological subtypes identified mainly include adenoid cystic and mucoepidermoid carcinomas. The source of these tumours originates from primary disease in the sinonasal tract and nasopharynx superiorly, and the PPS/deep lobe of parotid inferiorly. Current surgical options available, in suitable selected patient, available in tertiary head and neck cancer hospitals, which have available facilities and staffing is the endoscopic endonasal approach. This approach offers patients a ‘complete margin-free surgical excision’, minimal complications, shorter hospital stay, and no delay with commencement of any adjuvant treatment compared with the traditional ‘open transcutaneous’ approach.

The current evidence specifically to the surgical management of salivary gland malignancy involving the ITF is sparse, with great difficult identifying treated patients and their details among a heterogeneous group of patients with many lesions. There is a need for patient data that have specific pathologic conditions to be amalgamated from such centers and publish on outcome events.
Analysis of Symptomatic Marginal Ulcers in Patients Who Underwent Pancreaticoduodenectomy for Periampullary Tumors
Authors: Park Yejong , Hwang Dae Wook , Lee Jae Hoon , Song Ki Byung , Jun Eunsung , Lee Woohyung , Kwon Jaewoo , Kim Song Cheol
Published: February 2020

Object

The objectives are to investigate the incidence and risk factors associated with symptomatic marginal ulcer (sMU) and analyze their relationship with the use of prophylactic proton pump inhibitors (PPIs) after pancreaticoduodenectomy.

Methods

Clinical postoperative outcomes of 72 sMU and 1266 non-sMU were compared and analyzed. We performed a subanalysis of 72 patients with sMU diagnosed within (n = 18) and after 4 months (n = 54). The risk factors associated with sMU incidence were analyzed.

Results

Of the 1338 patients, 72 (5.4%) were diagnosed as having sMU. Eighteen patients (25.0%) were diagnosed during the first 4 months, and 48 (66.7%), within 16 months. Cumulative sMU incidence differed according to the duration of prophylactic PPI use (≥4 months: 7.1% vs <4 months: 10.1%, P < 0.001). The duration of prophylactic PPI use was identified as a risk factor in the multivariable analysis (hazard ratio, 2.294; 95% confidence interval, 1.436–3.664; P = 0.001).

Conclusions

Two-thirds or more of the patients were diagnosed as having sMU within 16 months after surgery. The duration of the prophylactic PPI use was an independent risk factor. We recommend the use of prophylactic PPI for more than 16 months after pancreaticoduodenectomy for periampullary tumors.
Natural Course and Treatment of Pancreatic Exocrine Insufficiency in a Nationwide Cohort of Chronic Pancreatitis
Authors: Kempeneers Marinus A. , Ahmed Ali Usama , Issa Yama , van Goor Harry , Drenth Joost P. H. , van Dullemen Hendrik M. , van Hooft Jeanin E. , Poen Alexander C. , van Veldhuisen Sophie L. , Besselink Marc G. , van Santvoort Hjalmar C. , Bruno Marco J. , Boermeester Marja A.
Published: February 2020

Objectives

Pancreatic exocrine insufficiency (PEI) is a common complication of chronic pancreatitis. However, little is known about the natural course of PEI and the effect of pancreatic enzyme replacement therapy on symptoms. The aim of this study was to evaluate the natural course and treatment of PEI in a nationwide cohort of patients with chronic pancreatitis.

Methods

Patients with chronic pancreatitis were selected from the multicenter Dutch Chronic Pancreatitis Registry. Patients were classified in 3 groups: definite PEI, potential PEI, and no PEI. Definite PEI and no PEI were compared regarding the course of disease, symptoms, treatment, and quality of life.

Results

Nine hundred eighty-seven patients were included from 29 centers, of which 304 patients (31%) had definite PEI; 451 (46%), potentially PEI; and 232 (24%), no PEI. Patients with definite PEI had significantly more malabsorption symptoms, a lower body mass index, and aberrant defecation. Lowered quality of life was not independently associated with PEI. Of the PEI patients using pancreatic enzyme replacement therapy, 47% still reported steatorrhea.

Conclusions

Pancreatic exocrine insufficiency is associated with malabsorption symptoms and a lower body mass index. Some form of pancreatic enzyme replacement therapy is reasonably effective in alleviating malabsorption symptoms, but improvement of treatment is needed.
Exogenous Secretin Improves Parenteral Nutrition‐associated Liver Disease in Rats
Authors: Cao Xuehui , Feng Feng , Liu Xuelai , Sun Chi , Yang Xiaofeng , Fang Yanbin , Li Suolin
Published: February 2020

Objectives:

Intestinal failure‐associated liver disease (IFALD) is a feared and life‐threatening complication in neonates with intestinal failure (IF) receiving long‐term total parenteral nutrition (TPN). This study aims to investigate the effect of exogenous secretin on liver pathology and hepatic function in a rat model of PN‐associated liver disease (PNALD).

Methods:

Male Sprague‐Dawley rats underwent right jugular venous catheterization to receive 14‐day continuous TPN therapy. All rats were allocated into 3 groups: the Control group (n = 8) did not have surgery or TPN and was fed standard rat chow ad libitum; the TPN group (n = 8) underwent catheter insertion and TPN treatment; and the TPN/S group (n = 8) also underwent catheter insertion, TPN treatment, and exogenous secretin treatment (2.5 nmol · kg−1 · day−1) daily. Fourteen days after initial surgery, we collected the animals’ liver and blood samples for further test.

Results:

The TPN/S group had diminished direct bilirubin (TPN, 2.1 ± 0.7 μmol/L; TPN/S, 1.5 ± 0.2 μmol/L) and liver total bile acid levels (TPN, 144.5 ± 21.2 μmol/L; TPN/S, 123.4 ± 10.4 μmol/L) and improved histological outcomes compared with those in the TPN group. Exogenous secretin also enhanced the canalicular transporter (BSEP, 0.5‐fold, P = 0.011) and inhibited the basolateral transporter (OSTA, −0.48‐fold, P = 0.002; OSTB, −0.6‐fold, P = 0.013) of liver bile acid.

Conclusions:

In this animal model of PNALD, secretin may improve cholestasis by enhancing canalicular transport, inhibiting the basolateral export of liver bile acid, and eventually decreasing the total bile acid level in the liver. Exogenous secretin treatment may potentially prevent and treat IFALD in IF patients relying on long‐term TPN therapy.
Factors Impacting Time to Engraftment in Patients With High-risk Neuroblastoma Following Autologous Stem Cell Transplant
Authors: Hillier Kirsty , Cheng W. Susan , Whittle Sarah B. , Krance Robert , Foster Jennifer H.
Published: February 2020

Background:

Despite advances in supportive measures, myeloablative chemotherapy with stem cell rescue remains limited by toxicity and treatment-related mortality. The purpose of this study was to identify factors influencing the rate of hematopoietic recovery following autologous stem cell transplant in high-risk neuroblastoma.

Procedure:

We retrospectively studied 54 patients with high-risk neuroblastoma who received a single autologous stem cell transplant between 2006 and 2016. Race, sex, conditioning regimen, chemotherapy delays and bone marrow involvement were analyzed using Kaplan-Meier Log-Rank test while the amount of cells infused, age, and length of hospital stay were analyzed using univariate Cox Proportional Hazards Regression.

Results:

The conditioning regimen administered was significant (P=0.016) for time to engraftment of neutrophils, with busulfan/melphalan (Bu/Mel) at 16.6 days, and carboplatin/etoposide/melphalan at 12.1 days. A delay of chemotherapy during induction (n=24) was significant (P<0.001) for time to platelet engraftment of >75,000/µL. Female patients had a longer time to engraftment (P=0.029).

Conclusion:

Patients receiving Bu/Mel as a conditioning regimen, patients who had a delay in induction chemotherapy and patients of female sex were found to be significant for delayed engraftment of neutrophils, platelets, and hemoglobin, respectively, in patients with high-risk neuroblastoma undergoing autologous stem cell transplant. Knowing these factors may lead to new expectations and possible interventions to decrease the morbidity and mortality of treatment and recovery.
Relation Between Cardiac T2* Values and Electrocardiographic Parameters in Children With Transfusion-dependent Thalassemia
Authors: Aggarwal Priyanka , Kumar Ishan , Jain Anubha , Verma Ashish , Gupta Vineeta
Published: February 2020

Background/Objectives:

Cardiac T2* magnetic resonance imaging (MRI) is the gold standard to determine myocardial iron overload. As availability of Cardiac T2* is not uniform across developing nations, our strategy was to identify a more accessible and cost effective tool to assess myocardial iron accumulation. As children with transfusion-dependent thalassemia also experience various electrocardiographic abnormalities, we performed electrocardiography (ECG) as well as Cardiac T2* MRI on all children registered in our thalassemia unit.

Materials and Methods:

Forty-eight transfusion-dependent thalassemia children with transfusion burden ≥12 times/y (6 to 19 y) in the Thalassemia Unit of the Division of Hematology Oncology, Department of Pediatrics were enrolled. Patients were divided into 3 groups based on severity of T2* value, that is group I (T2*<10), group II (T2* 10 to 20), group III (T2*>20). A T2* value >20 was taken as normal. ECG and serum ferritin was also performed on the day of MRI.

Results:

Among the various ECG parameters, QRS duration, and QTc interval were significantly increased if cardiac iron overload was high with a P-value of 0.036 and 0.000, respectively. Also, high serum ferritin predicted a decline in T2* value with a P-value of 0.001. QT interval and QTc interval significantly correlated inversely with T2* (P=0.042, r=−0.295 and P=0.002, r=−0.446, respectively) but not QRS duration (P=0.05, r=−0.282). Serum ferritin also was found to have a significant inverse correlation with T2* value (P=0.000, r=−0.497).

Conclusions:

Abnormalities on ECG, that is prolongation of QRS duration, QT interval, and QTc interval were significantly associated with cardiac iron overload, that is decrease in the value of Cardiac T2* in our study.
Nursing Students' Mindsets Matter
Authors: Williams Cheryl A.
Published: February 2020

Background

Dweck's growth mindset model, as a cognitive psychology model, details how various individuals perceive intelligence and academic ability. The growth mindset model has demonstrated academic success in students across many disciplines for more than 30 years.

Problem

The growth mindset model has not been examined in prelicensure nursing education.

Approach

This article introduces the growth mindset model, highlights differences and implications on learning between the 2 mindsets, and offers suggestions to cultivate the growth mindset model in nursing education.

Conclusions

Given the scholastic merits attributed to the growth mindset model, a closer investigation into the potential integration of the model into nursing education may be warranted.
Chlamydia trachomatis Is Associated With Medically Indicated Preterm Birth and Preeclampsia in Young Pregnant Women
Authors: Hill Ashley V. , Perez-Patron Maria , Tekwe Carmen D. , Menon Ramkumar , Hairrell Deanna , Taylor Brandie D.
Published: February 2020

Background

Studies on Chlamydia trachomatis–associated pregnancy outcomes are largely conflicting, ignoring the heterogeneous natures of pregnancy complications and potential effect modification by maternal age. This study determined if prenatal C. trachomatis infection is associated with preterm birth (PTB) and preeclampsia subtypes.

Methods

A retrospective cohort study was conducted using 22,772 singleton pregnancies with a prenatal C. trachomatis diagnostic test. Spontaneous and medically indicated PTBs, and term and preterm preeclampsia were outcomes. Modified Poisson regression calculated relative risk (RR) and 95% confidence intervals (CI) with propensity score adjustments stratified by maternal ages <25 and ≥25 years.

Results

Overall, C. trachomatis was significantly associated with term preeclampsia (adjusted RR [RRadj], 1.88; 95% CI, 1.38–2.57). Among young women (age <25 years), C. trachomatis was significantly associated with medically indicated PTB (RRadj, 2.29; 95% CI, 1.38–3.78) and term preeclampsia (RRadj, 1.57; 95% CI, 1.05–2.36) in propensity-adjusted models. No significant associations in older women were detected.

Conclusion

C. trachomatis was associated with medically indicated PTB and term preeclampsia in young women. Associations between chlamydia and perinatal outcomes may depend on the subtype of PTB and preeclampsia, which should be investigated through mechanistic studies.
Partner Notification Among Persons With Early Syphilis in Shenzhen, China, 2011–2017: Implications for Practice and Policy
Authors: Wang Cheng , Zhao Peizhen , Tang Weiming , Smith M. Kumi , Ong Jason J. , Wong Ngai Sze , Fu Hongyun , Tucker Joseph D. , Zheng Heping , Luo Zhenzhou , Yang Bin
Published: February 2020

Background

Partner notification (PN) is an essential component of syphilis control and is recommended by Chinese Sexually Transmitted Disease guidelines. However, in China, studies examining local practice are limited. This study evaluated PN outcomes among persons with early syphilis infection in an urban district in China.

Methods

From 2011 to 2017, persons diagnosed with early syphilis were asked to participate in an evaluation of supportive patient referral partner services for all recent sex partners, and the contact and case finding indices were determined in Nanshan District, Shenzhen, China.

Results

During the study period, 642 index patients with early syphilis reported 1749 sex partners. Of those partners, 678 were potentially contactable and 525 (30%) were contacted. The overall contact index was 0.82. Among the 1749 partners reported, 1108 (63%) were described as casual partners, and only 37 (3%) were contacted (contact index 0.13) compared with 641 partners who were either spouses and regular partners (contact index, 1.37). Among those 525 partners contacted, 418 (80%) were tested, and 205 (39%) were diagnosed with and treated for syphilis. Among those, 9 (4%) were primary, 26 (13%) were secondary, 16 (8%) were early latent, and 154 (49%) were other syphilis infections. The overall case finding index was 0.29.

Conclusions

There is a need to improve PN practices in China, which include developing operational guidelines of PN and to develop and evaluate novel PN ways like using Internet-based strategy.
Detection of Three Sexually Transmitted Infections by Anatomic Site: Evidence From an Internet-Based Screening Program
Authors: Jordan Nikki N. , Jett-Goheen Mary , Hsieh Yu-Hsiang , Gaydos Joel C. , Gaydos Charlotte A.
Published: February 2020

Urogenital and rectal specimens collected from the “IWantTheKit” Internet-based sexually transmitted infection screening program were evaluated for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. Of 881 paired specimens submitted from August 2013 to December 2016, 15.0% (n = 132) tested positive for 1 or more sexually transmitted infections, of which 50.8% (n = 67) were identified exclusively through rectal testing.
Evaluation of an Online Educational Tool to Improve Postresuscitation Debriefing in the Emergency Department
Authors: Eaton Patricia L. , Mullan Paul C. , Papa Linda , Chen Jerome Gene , Cramm Kelly , Buning Brian , Vazifedan Tuzraj , Zinns Lauren E.
Published: February 2020

Objective

Postresuscitation debriefing (PRD) addresses Accreditation Council for Graduate Medical Education core competencies and is recommended by the American Heart Association. Postresuscitation debriefing improves resuscitation outcomes, promotes team morale, supports emotional well-being, and reduces burnout. Despite these benefits, PRD occurs infrequently. Commonly cited barriers to PRD include lack of training and comfort in facilitating PRD. We are unaware of any video-based educational tools that train physicians in PRD. We aimed to evaluate the impact of an educational tool on the frequency of PRD using a before- and after-study design.

Methods

We created and distributed a 20-minute, video-based educational tool via youtube.com on PRD to pediatric emergency medicine (EM) fellows, pediatric EM attendings, senior EM residents, and EM attending physicians. Participants completed web-based surveys before, immediately after, and 3 months after watching the tool. We analyzed the effects of participation on PRD knowledge, comfort conducting PRD, and frequency of PRD performance.

Results

Thirty-five (63%) of 56 participants completed all 3 surveys. Participation in our study showed significant improvements in reported frequency of performing PRD (23% presurvey, 38% follow-up survey; 95% confidence interval [CI], 2%–29%; P = 0.03), perceived knowledge of PRD (odds ratio, 6.1; 95% CI, 3.05–12.29; P < 0.001), and comfort in conducting PRD (odds ratio, 3.7; 95% CI, 1.96–7.03; P < 0.001). Most respondents (94%) reported that the tool was worthwhile. Most (83%) would recommend the tool to colleagues, and 86% reported positive effects on their teams with PRD.

Conclusions

Implementation of a video-based educational tool on PRD in the emergency department was associated with increased provider report of PRD frequency, knowledge, and comfort level.
Variation in Prehospital Protocols for Pediatric Seizure Within the United States
Authors: Ramgopal Sriram , McCans Kerry , Martin-Gill Christian , Owusu-Ansah Sylvia
Published: February 2020

Objective

The objective of this study was to compare statewide prehospital protocols for the management of pediatric seizures.

Methods

We performed a descriptive analysis comparing statewide protocols for emergency medical services management of pediatric seizures within the United States, excluding states for which no statewide protocol/model was available. We compared antiepileptic drugs (AEDs), routes and doses of administration, and differences in febrile seizure management.

Results

Of 50 states, 34 had either statewide protocols or models and were included. All had a protocol for the management of seizures and provided specific recommendations for the management of pediatric seizures. Twelve states (35%) preferentially recommended midazolam over other benzodiazepines. Thirty-two (94%) of 34 allowed for use of midazolam, with variable use of other AEDs. All allowed for use of intramuscular AED. Twenty-six (77%) allowed for intranasal AED. Nine (27%) allowed emergency medical services to administer a patient's own abortive AED, and 6 (18%) allowed for use of a patient's vagal nerve stimulator, when present. There was a wide variability with respect to dosing ranges for medications. Thirty-two (94%) of 34 included blood glucose measurement within the protocol. Twenty-one protocols (62%) provided recommendations for febrile seizures, including recommending active/passive cooling (8/34, 24%) and antipyretic administration (9/34, 26%).

Conclusions

All statewide protocols carried specific guidelines for the prehospital management of pediatric seizures; however, there was wide variability with respect to specific AEDs, routes of administration, and drug dosages. In addition to broader availability of statewide guidance, areas of potential protocol improvement and research include AED dose optimization, reprioritization of blood glucose, and greater emphasis on intranasal or intramuscular medication dosing.
The Parent Perspective on Return Visits to the Pediatric Emergency Department
Authors: Litwin Sasha P. , Diallo Mamadou , Ostrow Olivia
Published: February 2020

Objectives

Return visits to the pediatric emergency department (ED) give insight into the unmet needs of patients and families. The aim of this study was to capture the parent perspective on factors contributing to return visits to the pediatric ED.

Methods

This is a prospective cohort study consisting of an 11-item survey that was administered to parents of children who had a return visit to the ED less than 72 hours from their initial visit. Surveys were distributed over an 8-month period between November 2015 and June 2016.

Results

The primary reason parents report for returning to the ED is that their child had ongoing or worsening symptoms (55%). Parents were satisfied with the care they received at the initial ED visit (89% report excellent, very good or good care). For parents who report that the initial visit could have been improved, they report wanting more tests done (54%), a better follow-up plan arranged by the ED (31%), consultation with a specialist (26%), admission to hospital on the initial visit (26%), and better communication and more time spent with the ED physician (21%). The majority (97%) of parents reported that their child has a primary care provider, and 39% of parents brought their child to a health care provider for the same problem in the 7 days before their return visit to the ED.

Conclusions

The parent perspective gives important insights into the reasons for return visits to the pediatric ED. Conclusions from this study will help inform future quality improvement initiatives that direct health care resources to provide high value care to patients and families.