bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Outcomes of Self-Expandable Metal Stents for Malignant Rectal Obstruction
Authors: Lee Hyun Jung , Hong Sung Pil , Cheon Jae Hee , Kim Tae Il , Kim Won Ho , Park Soo Jung
Published: December 2017

BACKGROUND:

Self-expandable metal stents are widely used to treat malignant colorectal obstruction. However, data on clinical outcomes of stent placement for rectal obstruction specifically are lacking.

OBJECTIVE:

We aimed to investigate the clinical outcomes of self-expandable metal stents in malignant rectal obstruction in comparison with those in left colonic obstruction and to identify factors associated with clinical failure and complication.

DESIGN:

This was a retrospective study.

SETTINGS:

The study was conducted at a tertiary care center.

PATIENTS:

Between January 2005 and December 2013, medical charts of patients who underwent stent placement for malignant rectal or left colonic obstruction were reviewed retrospectively.

INTERVENTION:

Study intervention included self-expandable metal stent placement.

MAIN OUTCOME MEASURES:

Technical success, clinical success, and complications were measured.

RESULTS:

Technical success rates for the 2 study groups (rectum vs left colon, 93.5% vs 93.1%; p = 0.86) did not differ significantly; however, the clinical success rate was lower in patients with rectal obstruction (85.4% vs 92.1%; p = 0.02). In addition, the complication rate was higher in patients with rectal obstruction (37.4% vs 25.1%; p = 0.01). Patients with rectal obstruction showed higher rates of obstruction because of extracolonic malignancy (33.8% vs 15.8%; p < 0.001) and stent use for palliation (78.6% vs 56.3%; p < 0.001). Multivariate analysis indicated obstruction attributed to extracolonic malignancy and covered stent usage to be independent risk factors for clinical failure. Factors predictive of complications in the palliative group were total obstruction, obstruction because of extracolonic malignancy, and covered stent usage.

LIMITATIONS:

This was a retrospective, single-center study.

CONCLUSIONS:

The efficacy and safety of stent placement for malignant rectal obstruction were comparable with those for left colonic obstruction. However, obstruction attributed to extracolonic malignancy, use of covered stents, and total obstruction negatively impacted clinical outcomes of self-expandable metal stent placement and must be considered by endoscopists. See Video Abstract at http://links.lww.com/DCR/A417.
An Effective Bundled Approach Reduces Surgical Site Infections in a High-Outlier Colorectal Unit
Authors: Gorgun Emre , Rencuzogullari Ahmet , Ozben Volkan , Stocchi Luca , Fraser Thomas , Benlice Cigdem , Hull Tracy
Published: December 2017

BACKGROUND:

Surgical site infections are the most common hospital-acquired infection after colorectal surgery, increasing morbidity, mortality, and hospital costs.

OBJECTIVE:

The purpose of this study was to investigate the impact of preventive measures on colorectal surgical site infection rates in a high-volume institution that performs inherent high-risk procedures.

DESIGN:

This was a prospective cohort study.

SETTINGS:

The study was conducted at a high-volume, specialized colorectal surgery department.

PATIENTS:

The Prospective Surgical Site Infection Prevention Bundle Project included 14 preoperative, intraoperative, and postoperative measures to reduce surgical site infection occurrence after colorectal surgery. Surgical site infections within 30 days of the index operation were examined for patients during the 1-year period after the surgical site infection prevention bundle was implemented. The data collection and outcomes for this period were compared with the year immediately before the implementation of bundle elements. All of the patients who underwent elective colorectal surgery by a total of 17 surgeons were included. The following procedures were excluded from the analysis to obtain a homogeneous patient population: ileostomy closure and anorectal and enterocutaneous fistula repair.

MAIN OUTCOME MEASURES:

Surgical site infection occurring within 30 days of the index operation was measured. Surgical site infection–related outcomes after implementation of the bundle (bundle February 2014 to February 2015) were compared with same period a year before the implementation of bundle elements (prebundle February 2013 to February 2014).

RESULTS:

Between 2013 and 2015, 2250 abdominal colorectal surgical procedures were performed, including 986 (43.8%) during the prebundle period and 1264 (56.2%) after the bundle project. Patient characteristics and comorbidities were similar in both periods. Compliance with preventive measures ranged between 75% and 99% during the bundle period. The overall surgical site infection rate decreased from 11.8% prebundle to 6.6% at the bundle period (P < 0.001). Although a decrease for all types of surgical site infections was observed after the bundle implementation, a significant reduction was achieved in the organ-space subgroup (5.5%–1.7%; P < 0.001).

LIMITATION:

We were unable to predict the specific contributions the constituent bundle interventions made to the surgical site infection reduction.

CONCLUSIONS:

The prospective Surgical Site Infection Prevention Bundle Project resulted in a substantial decline in surgical site infection rates in our department. Collaborative and enduring efforts among multiple providers are critical to achieve a sustained reduction See Video Abstract at http://links.lww.com/DCR/A438.
Comparison of the ARK Immunoassay With High-Performance Liquid Chromatography With Ultraviolet Detection for Therapeutic Drug Monitoring of Linezolid
Authors: Castoldi Simone , Cozzi Valeria , Baldelli Sara , Fucile Serena , Clementi Emilio , Cattaneo Dario
Published: December 2017

Background:

An enzymatic immunoassay is under development by ARK Diagnostics, Inc for the quantification of plasma concentrations of linezolid (LZD). In this study, the authors aimed to assess the performance of this immunoassay using a validated high-performance liquid chromatography (HPLC) ultraviolet method as reference.

Methods:

Within- and between-day in vitro inaccuracy and imprecision of the ARK LZD assay were firstly tested using spiked quality controls (QC) provided by the kit manufacturer. Subsequently, the performance of the immunoassay was verified in vivo by analyzing 170 trough LZD plasma samples from patients on antibiotic therapy.

Results:

Imprecision of the spiked QCs resulted in every instance less than 7.0% and the inaccuracy ranged from −1.5% to 6.6%. The linear correlation between the 2 methods was documented by the Pearson analysis of plasma samples from patients on LZD therapy (coefficient = 0.9619). By Bland–Altman comparison, 8.2% of the patient samples resulted out of the limits ranging from −27.0% to +33.5%, with most of them having LZD concentrations exceeding 10 mg/L.

Conclusions:

Acceptable analytical performance of the ARK LZD immunoassay has been demonstrated both with spiked QC and patients' samples, making it a viable alternative to HPLC for the therapeutic drug monitoring of LZD in clinical practice in laboratory hospitals that do not have HPLC equipment.
Ultra–High Performance Liquid Chromatography Tandem Mass Spectrometry for Cyclosporine Analysis in Human Whole Blood and Comparison With an Antibody-Conjugated Magnetic Immunoassay
Authors: Mei Shenghui , Wang Jiaqing , Chen Di , Zhu Leting , Zhao Ming , Hu Xin , Yang Li , Zhao Zhigang
Published: December 2017

Background:

Various immunoassays have been used for cyclosporine A (CsA) analysis in human whole blood; however, they could not fully satisfy the requirements of criteria for accuracy and specificity in CsA measurement. The liquid chromatography tandem mass spectrometry is a gold method for CsA analysis. The aim of the study was to develop and validate an ultra-high performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS) method for CsA analysis and establish its agreement with an antibody-conjugated magnetic immunoassay (ACMIA) in clinical sample analysis.

Methods:

An UHPLC-MS/MS method for CsA analysis in human whole blood was developed, validated, and applied in 85 samples, which were also tested by ACMIA. The agreement between UHPLC-MS/MS and ACMIA was evaluated by Bland–Altman plot.

Results:

The calibration range was 5–2000 ng/mL. The inaccuracy and imprecision were −4.60% to 5.56% and less than 8.57%, respectively. The internal standard-normalized recovery and matrix factor were 100.4%–110.5% and 93.5%–107.6%, respectively. The measurements of ACMIA and UHPLC-MS/MS were strongly correlated (r > 0.98). Evaluated by Bland–Altman plot, the 95% limit of agreement of the ACMIA:UHPLC-MS/MS ratio was 88.7%–165.6%, and the mean bias of the ratio was 21.1%.

Conclusions:

A rapid, simple, accurate, and reliable UHPLC-MS/MS method for CsA analysis in human whole blood was developed, validated, and applied in 85 samples. On average, 21.1% overestimation was observed in ACMIA compared with that in the UHPLC-MS/MS. Further and larger studies are required to identify whether this degree of variance could be accepted by clinicians.
The Impact of Clostridium difficile Infection on Mortality in Patients With Inflammatory Bowel Disease
Authors: Tariq Raseen , Law Cindy C.Y. , Khanna Sahil , Murthy Sanjay , McCurdy Jeffrey D.
Published: December 2017

Background and Aims:

Clostridium difficile infection (CDI) has been associated with an increased mortality risk among patients with inflammatory bowel disease (IBD) in multiple observational studies. We performed a systematic review and meta-analysis to help clearly define the magnitude of risk in IBD patients with and without CDI, and to assess the risk in individual IBD subtypes.

Methods:

A systematic search of multiple electronic databases was conducted for observational studies reporting the risk of mortality in IBD, stratified by the presence of CDI. Weighted summary estimates were calculated using generalized inverse variance with random-effects model. Study quality was assessed using the Newcastle-Ottawa scale.

Results:

Ten observational studies were identified (8 from North America and 2 from Europe) and included 40,700 IBD patients with CDI and 1,320,764 IBD controls without CDI. Overall, IBD patients with CDI had a higher risk of mortality compared with IBD patients without CDI [odds ratios (OR), 4.39; 95% confidence interval (CI), 3.56-5.42; I
2=93%]. The results were stable in high-quality studies and in hospitalized patients. When patients were stratified by IBD type, CDI was associated with increased mortality in patients with ulcerative colitis (7 studies) (OR, 4.39; 95% CI, 3.44-5.61; I
2), but not in patients with Crohn’s disease (4 studies) (OR, 2.21; 95% CI, 0.84-5.77; I
2). Individual studies were limited by an inability to control for IBD disease activity and therapeutic interventions.

Conclusions:

On the basis of 10 observational studies with at least moderate quality, CDI seems to increase mortality risk in IBD, particularly in ulcerative colitis. These findings are a cause for concern and suggest that CDI should be managed aggressively in patients with IBD.
Noninvasive fibrosis markers and chronic kidney disease among adults with nonalcoholic fatty liver in USA
Authors: Wijarnpreecha Karn , Thongprayoon Charat , Scribani Melissa , Ungprasert Patompong , Cheungpasitporn Wisit
Published: December 2017

Background/Aims

Studies have shown that nonalcoholic fatty liver disease (NAFLD) is associated with an increased risk of chronic kidney disease (CKD). However, it is unknown whether severe liver fibrosis is associated with a higher prevalence of CKD among NAFLD. We examined the diagnostic performance of noninvasive fibrosis markers in identifying prevalent CKD among NAFLD.

Methods

This study represents an analysis of the National Health and Nutrition Examination Survey conducted in the USA between 1988 and 1994. NAFLD was defined by ultrasonographic evidence of hepatic steatosis without other liver diseases. CKD was defined by estimated glomerular filtration rate less than 60 ml/min/1.73 m2. The presence and severity of hepatic fibrosis were determined by the NAFLD fibrosis score (NFS), FIB-4 score, APRI score, and BARD score. Multiple logistic regression was performed to generate odds ratios (ORs) and receiver operating characteristic curves were used to assess the predictive values of each marker.

Results

A total of 4142 individuals with NAFLD were included; 200 (4.8%) had CKD. The area under the receiver operating characteristic curves was 0.77, 0.75, 0.62, and 0.51 for the multivariable equation with FIB-4, NFS, BARD, and APRI score, respectively. Compared with patients with a low probability of developing advanced liver fibrosis, individuals with a high probability of developing fibrosis showed significantly increased odds of CKD as estimated by NFS (adjusted OR: 4.92, 95% confidence interval: 2.96–8.15) and FIB-4 (adjusted OR: 2.27, 95% confidence interval: 1.05–4.52).

Conclusion

Advanced liver fibrosis, defined by NFS and FIB-4 scores, is associated independently with CKD among individuals with NAFLD. FIB-4 is the best predictor of an increased risk of prevalent CKD.
Has the Licensing Act 2003 affected violence rates in England and Wales? A systematic review of hospital and police studies
Authors: Callan Caitríona M. , Boyle Adrian A.
Published: December 2017

Violence has been declining in the UK for two decades, with most assaults being alcohol related. The Licensing Act 2003 (England and Wales) aimed to reduce alcohol-related crime, giving local authorities control over premises licensing. We performed a systematic review of original research with the primary outcome of change in violence rates since the Act’s implementation, including hospital-defined and police-defined measures of violence. Our secondary outcome was temporal distribution of violence. Fifteen studies were included, which were of overall poor quality. Seven found reduced violence rates after the Act’s implementation, three found increased rates and five found no significant change. A subset of nine studies analysed temporal distribution, eight finding displacement of incidents later. This is the most complete analysis to date of the effect of this Act on violence, finding a lack of reliable evidence to answer the research question, but little to suggest that the Act has markedly impacted already-declining violence rates.
Pancreatic Insufficiency in Cystic Fibrosis
Authors: Marson Fernando Augusto Lima , Bertuzzo Carmen Sílvia , de Araujo Tânia Kawasaki , Hortencio Taís Daiene Russo , Ribeiro Antônio Fernando , Ribeiro José Dirceu
Published: December 2017

Objective

Pancreatic insufficiency (PI) in cystic fibrosis (CF) patients is a crucial clinical marker for severity and disease progression. In our study, 125 modifier genes and their SNPs were associated between CF patients with PI or pancreatic sufficiency.

Methods

We prospectively evaluated 214 CF patients admitted at 1 hospital for a 2-year period. The PI status was associated with clinical variables and SNPs related with inflammatory response considering CFTR mutations. Open Array technique was used to perform the SNPs identification.

Results

For PI risk, after correction by multiple test, in CF patients and 2 CFTR mutations class I, II, and/or III, there were 6 SNPs with positive association (P < 0.005). The odds ratio amplitude was 0.087 (95% confidence interval [CI], 0.004–0.544) for rs9870255*CG (CTNNB1 gene) to 11.06 (95% CI, 1.746–252.3) for rs729302*AA (IRF5 gene). For all CF patients at the same time, 9 SNPs showed positive association. The odds ratio amplitude was 0.144 (95% CI, 0.028–0.602) for rs2348071*AA (PSMA3 gene) to 5.809 (95% CI, 1.536–37.54) for rs11702779*AA (RUNX1 gene). In our data, we observed the interaction between CFTR mutations, rs9870255*CTNNB1, rs9378805*IRF4, and rs7664617*KCNIP4 to PI status.

Conclusions

Multiple SNPs in inflammatory response genes showed association with PI considering the CFTR mutations screening.
The −251 A/T Polymorphism in the IL8 Promoter is a Risk Factor for Acute Pancreatitis
Authors: Bishu Shrinivas , Koutroumpakis Efstratios , Mounzer Rawad , Stello Kimberly , Pollock Nijole , Evans Anna , Whitcomb David C. , Papachristou Georgios I.
Published: December 2017

Objectives

Inflammation in the setting of acute pancreatitis (AP) is partially driven by pathogen recognition receptors that recognize damage-associated molecular patterns. Interleukin (IL)-8 is a chemotactic factor produced by pathogen recognition receptor-expressing cells. A single-nucleotide polymorphism in IL8 promoter region (−251 A/T) has been implicated in inflammatory diseases. We examined whether this IL8 polymorphism confers susceptibility to AP.

Methods

Patients with AP (n = 357) were prospectively recruited. Clinical data and blood were collected in subjects and controls (n = 347). Severity was defined following the Revised Atlanta Classification. Genotypes were assessed by quantitative polymerase chain reaction using TaqMan probes.

Results

Patients and controls had similar demographics and had no difference in Hardy-Weinberg (patients, P = 0.29; controls, P = 0.66). Twenty-five percent of patients developed severe AP. Compared with controls, the A/A genotype was more common in AP (P = 0.041; odds ratio, 1.42; 95% confidence interval, 1–1.99). Obese patients with the A/A genotype were more likely to develop mild AP (P = 0.047).

Conclusions

The −251 polymorphism confers susceptibility to AP and disease severity in obese patients. However, its effect is moderate. One potential mechanism for this susceptibility is via increased IL8 production by innate cells, with subsequent enhanced neutrophil influx and pancreatic injury.
Familial Association of Granulocyte‐Macrophage Colony‐Stimulating Factor Autoantibodies in Inflammatory Bowel Disease
Authors: Wright Sandra S. , Trauernicht Anna , Bonkowski Erin , McCall Courtney A. , Maier Elizabeth A. , Bezold Ramona , Lake Kathleen , Chalk Claudia , Trapnell Bruce C. , Kim Mi‐Ok , Kugathasan Subra , Denson Lee A.
Published: December 2017

Objectives:

Elevated granulocyte‐macrophage colony‐stimulating factor auto‐antibodies (GM‐CSF Ab) are associated with increased intestinal permeability and stricturing behavior in Crohn disease (CD). We tested for familial association of serum GM‐CSF Ab level in CD and ulcerative colitis (UC) families.

Methods:

Serum GM‐CSF Ab concentration was determined in 230 pediatric CD probands and 404 of their unaffected parents and siblings, and 45 UC probands and 71 of their unaffected parents and siblings. A linear mixed effects model was used to test for familial association. The intra‐class correlation coefficient (ICC) was used to determine the degree of association of the serum GM‐CSF Ab level within families in comparison with the degree of association among families.

Results:

The median (IQR) serum GM‐CSF Ab concentration was higher in CD probands than in UC probands (1.5 [0.5,5.4] μg/mL vs 0.7 [0.3, 1.6] μg/mL, P = 0.0002). The frequency of elevated serum GM‐CSF Ab concentration ≥1.6 μg/mL was increased in unaffected siblings of CD probands with elevated GM‐CSF Ab, compared with unaffected siblings of CD probands without elevated GM‐CSF Ab (33% vs 13%, respectively, P = 0.04). A similar result was observed within UC families. In families of CD patients, the mean (95th CI) ICC was equal to 0.153 (0.036, 0.275), P = 0.001, whereas in families of UC patients, the mean (95th CI) ICC was equal to 0.27 (0.24, 0.31), P = 0.047.

Conclusions:

These data confirmed familial association of serum GM‐CSF Ab levels. This could be accounted for by either genetic or environmental factors shared within the family.
Yield of Endoscopic Ultrasound in Children and Adolescent With Acute Recurrent Pancreatitis
Authors: Singh Sumit Kumar , Srivastava Anshu , Rai Praveer , Yachha Surender K. , Poddar Ujjal
Published: December 2017

Objectives:

Endoscopic ultrasound (EUS) is an established tool for evaluation of adults with acute recurrent pancreatitis (ARP) whereas data in pediatrics is limited. Our study assessed the role of EUS in identifying etiology including changes of chronic pancreatitis (CP) in children and adolescents with ARP.

Methods:

Children with ARP (≥2 episodes of acute pancreatitis [AP]) were prospectively evaluated with a detailed clinical proforma and EUS. Subjects with known etiology of ARP or CP on ultrasonography/computed tomography and magnetic resonance cholangiopancreatography (MRCP, Cambridge grade ≥3) were excluded. Parenchymal and ductal changes on EUS as per minimal standards terminology (MST) features were noted.

Results:

Thirty‐two children (22 boys, age 14 [8–18] years) with ARP (median of 3 [2–5] episodes of AP) were enrolled. EUS was safe and technically successful in all. Gall bladder sludge was found in 1 (3%) case and none had other pancreatobiliary structural abnormalities. EUS diagnosis of CP (≥4 features) was made in 10/32 (31%) cases. Subjects with CP on EUS had a longer disease duration than those without CP (45 [10–97] vs 22 [8–78] months; P = ns). MRCP was normal in 28 and showed pancreas divisum in 1 case. Three cases had equivocal (Cambridge II) changes at initial MRCP and 2 of them had repeat MRCP, which showed definite (Cambridge IV) CP. All these 3 cases had CP on EUS.

Conclusions:

EUS diagnosed CP (≥4 features) in 31% and biliary abnormality in 3% children with ARP. EUS is safe, sensitive, and useful for early diagnosis of CP in children with ARP.
Interdisciplinary Guidelines for Care of Women Presenting to the Emergency Department With Pregnancy Loss
Authors: Catlin Anita
Published: December 2017

In April 2016, the National Perinatal Association and Kaiser Permanente Northern California Nursing Research Community Benefits Grant sponsored an interdisciplinary summit to explore the needs of women who present with actual or potential pregnancy loss to the emergency department (ED). Thirty-two experts in the field of pregnancy loss, 17 of whom represented their professional organizations, participated. These experts, which included nurses, physicians, social workers, counselors, authors, and parents, worked together to create guidelines for care of women with a pregnancy loss in the ED. Recommendations for ED healthcare providers are included. Emergency department personnel agreed that improvements in care could be offered and were willing to endorse education for their staff. The guidelines delineate how to better provide physical, emotional, and bereavement support at any stage of gestational loss. Administrative support for policies in the ED is essential to ensure the delivery of family-centered, culturally sensitive practices when a pregnancy ends.
Higher Levels of a Cytotoxic Protein, Vaginolysin, in Lactobacillus-Deficient Community State Types at the Vaginal Mucosa
Authors: Nowak Rebecca G. , Randis Tara M. , Desai Purnahamsi , He Xin , Robinson Courtney K. , Rath Jessica M. , Glover Elbert D. , Ratner Adam J. , Ravel Jacques , Brotman Rebecca M.
Published: December 2017

Vaginolysin (VLY), a cytotoxic protein produced by Gardnerella vaginalis, may contribute to bacterial vaginosis. We observed that women with G. vaginalis, low levels of lactobacilli, history of vaginal douching, higher Nugent scores, and higher vaginal pH had increased VLY. Inflammatory markers were not highly expressed with increasing VLY. Vaginolysin's role in bacterial vaginosis warrants further evaluation.
Extracorporeal Cardiopulmonary Resuscitation in the Pediatric Cardiac Population: In Search of a Standard of Care*
Authors: Lasa Javier J. , Jain Parag , Raymond Tia T. , Minard Charles G. , Topjian Alexis , Nadkarni Vinay , Gaies Michael , Bembea Melania , Checchia Paul A. , Shekerdemian Lara S. , Thiagarajan Ravi
Published: December 2017

Objectives:

Although clinical and pharmacologic guidelines exist for the practice of cardiopulmonary resuscitation in children (Pediatric Advanced Life Support), the practice of extracorporeal cardiopulmonary resuscitation in pediatric cardiac patients remains without universally accepted standards. We aim to explore variation in extracorporeal cardiopulmonary resuscitation procedures by surveying clinicians who care for this high-risk patient population.

Design:

A 28-item cross-sectional survey was distributed via a web-based platform to clinicians focusing on cardiopulmonary resuscitation practices and extracorporeal membrane oxygenation team dynamics immediately prior to extracorporeal membrane oxygenation cannulation.

Settings:

Pediatric hospitals providing extracorporeal mechanical support services to patients with congenital and/or acquired heart disease.

Subjects:

Critical care/cardiology specialist physicians, cardiothoracic surgeons, advanced practice nurse practitioners, respiratory therapists, and extracorporeal membrane oxygenation specialists.

Interventions:

None.

Measurements and Main Results:

Survey web links were distributed over a 2-month period with critical care and/or cardiology physicians comprising the majority of respondents (75%). Nearly all respondents practice at academic/teaching institutions (97%), 89% were from U.S./Canadian institutions and 56% reported less than 10 years of clinical experience. During extracorporeal cardiopulmonary resuscitation, a majority of respondents reported adherence to guideline recommendations for epinephrine bolus dosing (64%). Conversely, 19% reported using only one to three epinephrine bolus doses regardless of extracorporeal cardiopulmonary resuscitation duration. Inotropic support is held after extracorporeal membrane oxygenation cannulation “most of the time” by 58% of respondents and 94% report using afterload reducing/antihypertensive agents “some” to “most of the time” after achieving full extracorporeal membrane oxygenation support. Interruptions in chest compressions are common during active cannulation according to 77% of respondents.

Conclusions:

The results of this survey identify wide variability in resuscitative practices during extracorporeal cardiopulmonary resuscitation in the pediatric cardiac population. The deviations from established Pediatric Advanced Life Support CPR guidelines support a call for further inquiry into the pharmacologic and logistical care surrounding extracorporeal cardiopulmonary resuscitation.
Immediate Effects of Simultaneous Application of Transcutaneous Electrical Nerve Stimulation and Ultrasound Phonophoresis on Active Myofascial Trigger Points
Authors: Takla Mary Kamal Nassif , Rezk-Allah Soheir Shethata
Published: December 2017

Objective

The aim of the study was to investigate the efficacy of phonophoresis with combined therapy on active myofascial trigger points.

Participants

One hundred participants with acute mechanical neck pain and at least one active myofascial trigger point in the upper trapezius were randomly assigned into four equal groups.

Intervention

Groups consisted of diclofenac phonophoresis with combined therapy, diclofenac phonophoresis, ultrasound (US) with coupling gel, and sham US and applied for 10 mins over myofascial trigger points.

Measurements

Measurements included pressure pain threshold and active cervical lateral flexion.

Results

There were statistically significant improvements in postintervention pressure pain threshold and range of motion values in treatment groups (P < 0.0001). As for the sham US, no significant difference was found between the preintervention and postintervention values (P > 0.05). Bonferroni correction test revealed that there was a significant difference between all the four groups in pressure pain threshold values (P < 0.0001); however, it was nonsignificant (P > 0.05) for range of motion.

Conclusions

Diclofenac phonophoresis with combined therapy, phonophoresis, and US were all effective in increasing pressure pain threshold values and range of motion. In addition, phonophoresis with combined therapy was shown to be superior over phonophoresis, and phonophoresis was superior over US in terms of reducing pain sensitivity. However, none of the treatment groups were found to be superior over the other in increasing range of motion.
Pathophysiology, clinical presentation, and treatment of coma and acute kidney injury complicating falciparum malaria
Authors: Plewes Katherine , Turner Gareth D.H. , Dondorp Arjen M.
Published: December 2017

Purpose of review

Cerebral impairment and acute kidney injury (AKI) are independent predictors of mortality in both adults and children with severe falciparum malaria. In this review, we present recent advances in understanding the pathophysiology, clinical features, and management of these complications of severe malaria, and discuss future areas of research.

Recent findings

Cerebral malaria and AKI are serious and well recognized complications of severe malaria. Common pathophysiological pathways include impaired microcirculation, due to sequestration of parasitized erythrocytes, systemic inflammatory responses, and endothelial activation. Recent MRI studies show significant brain swelling in both adults and children with evidence of posterior reversible encephalopathy syndrome-like syndrome although targeted interventions including mannitol and dexamethasone are not beneficial. Recent work shows association of cell-free hemoglobin oxidation stress involved in the pathophysiology of AKI in both adults and children. Paracetamol protected renal function likely by inhibiting cell-free-mediated oxidative stress. It is unclear if heme-mediated endothelial activation or oxidative stress is involved in cerebral malaria.

The direct causes of cerebral and kidney dysfunction remain incompletely understood. Optimal treatment involves prompt diagnosis and effective antimalarial treatment with artesunate. Renal replacement therapy reduces mortality in AKI but delayed diagnosis is an issue.
Metal Artifact–Free and Dose-Efficient Computed Tomography Imaging of a Cardiac Prosthetic Valve Using Spectral Shaping of the X-ray Beam: A Case Report
Authors: Schabel Christoph , Sekaran Nishant K. , Wang Andrew , Hurwitz Lynne
Published: December 2017

Bioprosthetic valve (BPV) thrombosis can be challenging to diagnose with cardiac computed tomography owing to metal artifacts of the BPV. In this case report, an optimized metal artifact reduction protocol using a third-generation dual-source multidetector computed tomographic scanner with high kVp (Sn150kVp) and tin (Sn) filtration and high temporal resolution yielded high-quality, artifact-free, dynamic images of a thrombosed mitral BPV.
SUV as a Possible Predictor of Disease Extent and Therapy Duration in Complex Tuberculosis
Authors: Lang David , Huber Helmut , Kaiser Bernhard , Virgolini Irene , Lamprecht Bernd , Gabriel Michael
Published: December 2017

Objective

18F-FDG PET/CT provides information on disease extension and activity in neoplastic and inflammatory conditions. So far, little is known about whether SUVmax of a reference lesion can allow a prognosis to be given regarding patient-specific outcome parameters in complex cases of tuberculosis (TB).

Methods

We retrospectively identified 37 patients (21 men, 16 women; mean age, 50.4 years) who underwent 18F-FDG PET/CT for the evaluation of active TB before treatment initiation. The aims were to examine whether the reference lesion SUVmax differed between patients with standard (≤9 months) and long-term (>9 months) therapy and to define an SUVmax cutoff distinguishing those groups. In addition, we analyzed the prognostic value of SUVmax with regard to estimation of initial disease extent and lesion distribution pattern.

Results

Median therapy duration was 10 months (interquartile range, 3.25 months), and median SUVmax was 8 (interquartile range, 8.54). SUVmax was significantly (P = 0.036) higher in patients treated longer than 9 months (10.1 vs 5.5). When applying a receiver operating characteristic curve analysis, an SUVmax cutoff value of 10 differentiated the standard and the long-term therapy group with a sensitivity of 50% and a specificity of 78.6% (P = 0.087). Higher SUVmax corresponded with a larger number of affected organ systems (P = 0.012 for ≤/>1). Patients with extrathoracic involvement showed significantly higher SUVmax than did patients with limited intrathoracic disease (P = 0.024) and received significantly longer antimycobacterial therapy (P = 0.011).

Conclusions

Reference lesion SUVmax from pretherapy 18F-FDG PET/CT may have prognostic properties in complicated cases of TB, especially regarding therapy duration and disease extent.
Unexpected Detection of Urethral Stone on 18F-NaF PET/CT
Authors: Shao Fuqiang , Chen Li , Wang Yu , Zhang Shumao , Chen Yue
Published: December 2017

A 48-year-old man was referred for an 18F-NaF PET/CT to examine his lower back pain. The images did not identify any osseous lesion. Unexpectedly, the images showed elevated activity in a urethral stone. The patient received urinary surgery for stone removal.
Temporomandibular Joint Ankylosis: Algorithm of Treatment
Authors: Fariña Rodrigo , Canto Loreto , Gunckel Renato , Alister Juan Pablo , Uribe Francisca
Published: December 2017

Temporomandibular joint ankylosis, according to age of onset, causes severe functional and morphological disorders, as well as stunted craniofacial growth and development.

The primary goal of treatment is to resolve the functional and morphological disorders.

Method:

Pre- and posttreatment clinical and cephalometric registries were conducted in 15 patients with temporomandibular joint ankylosis over a 10-year period (2002–2012). All the patients underwent complete removal of the ankylotic block, gap arthroplasty, and ipsilateral coronoidectomy. Distraction osteogenesis was performed on 12 patients.

Results:

Fifteen patients, 8 female and 7 male, ranging from 3 to 30 years of age, were included in this study. The posttreatment follow-up period ranged from 3 to 13 years.

The mean preoperative maximum mouth opening was 3 ± 1.7 mm, and the mean postoperative maximum mouth opening was 36 ± 6.5 mm. The labial inclination with respect to the true horizontal decreased considerably (6.2° ± 2.3° preoperative to 1° ± 1.6° postoperative). A correction of the mandibular deviation was measured at the symphysis with respect to the facial midline (8° ± 2° preoperative to 2° postoperative). Finally, the height ratio of both mandibular rami (the healthy side and the affected side) decreased considerably (1.27 ± 0.05 preoperative to 1.07 ± 0.06 postoperative).

Reankylosis only occurred in 2 patients, who were then successfully treated by means of gap arthroplasty.

Conclusions:

The therapeutic algorithm proposed in the present work provides favorable functional and morphological results. Early and aggressive functional physiotherapy is essential to minimize the risk of reankylosis.
Opioid Use After Discharge in Postoperative Patients
Authors: Feinberg Adina E. , Chesney Tyler R. , Srikandarajah Sanjho , Acuna Sergio A. , McLeod Robin S.
Published: December 2017

Background:

Over the past 2 decades, there has been an increase in opioid use and subsequently, opioid deaths. The amount of opioid prescribed to surgical patients has also increased. The aim of this systematic review was to determine postdischarge opioid consumption in surgical patients compared with the amount of opioid prescribed. Secondary outcomes included adequacy of pain control and disposal methods for unused opioids.

Objective:

The objective of this study is to characterize postdischarge opioid consumption and prescription patterns in surgical patients.

Methods:

A systematic search in MEDLINE and EMBASE identified 11 patient survey studies reporting on postdischarge opioid use in 3525 surgical patients.

Results:

The studies reported on a variety of surgical operations, including abdominal surgery, orthopedic procedures, tooth extraction, and dermatologic procedures. The majority of patients consumed 15 pills or less postdischarge. The proportion of used opioids ranged from 5.6% to 59.1%, with an outlier of 90.1% in pediatric spinal fusion patients. Measured pain scores of those taking opioids ranged between 2 and 5 out of 10 and the majority of patients were satisfied with their pain control. Seventy percent of patients kept the excess opioids. Where planned disposal methods were reported, between 4% and 59% of patients planned proper disposal.

Conclusion:

This study suggests that surgical patients are using substantially less opioid than prescribed. There is a lack of awareness regarding proper disposal of leftover medication, leaving excess opioid that may be used inappropriately by the patient or others. Education for providers and clinical practice guidelines that provide guidance on prescription of outpatient of opioids are required.
Comparison of Endoscopic Ultrasonography Guided Biliary Drainage and Percutaneous Transhepatic Biliary Drainage in the Management of Malignant Obstructive Jaundice After Failed ERCP
Authors: Huang Ping , Zhang Hao , Zhang Xiao-Feng , Lv Wen , Lou Songmei
Published: December 2017

Aims:

The aim of this study is to compare the efficacy and safety of endoscopic ultrasonography guided biliary drainage and percutaneous transhepatic biliary drainage in the management of malignant obstructive jaundice after failed ERCP.

Methods:

We retrospectively analyzed the data of 66 consecutive patients with malignant obstructive jaundice admitted to our hospital between January 2014 and January 2016. Patients were performed endoscopic ultrasonography-guided biliary drainage in 36 cases (group A) and percutaneous transhepatic biliary drainage in 30 cases (group B) according to the results of the draw. Data on the following variables were compared between the 2 groups: the technical success rate, the clinical success rate, complications, length of hospital stay, and hospital costs.

Results:

There was statistically significant difference in the clinical success rate (88.89% vs. 66.67%; χ2=4.84), complications (5.56% vs. 23.33%; χ2=4.39), length of hospital stay (11.54±3.73 d vs. 15.68±6.56 d; t=8.17) and hospital costs (23.52±8.44 thousand yuan vs. 32.81±6.06 thousand yuan; t=16.28) (P<0.05) between group A and group B. The technical success rate was higher in groups A than that in group B, although the difference did not reach statistical significance (94.44% vs. 86.67%; χ2=1.20; P>0.05).

Conclusions:

In the treatment of malignant obstructive jaundice, endoscopic ultrasonography guided biliary drainage is safer and more effective than percutaneous transhepatic biliary drainage when performed by experienced practitioners after failed ERCP. Its more widespread use is recommended.
Palliative care needs of heart failure patients in China: putting people first
Authors: Guo Ping , Harding Richard , Higginson Irene J.
Published: December 2017

Purpose of review

Recognizing the rising prevalence of heart failure in China, patients with heart failure have substantial palliative needs. This review highlights recent evidence on the epidemic of heart failure, identifies needs and potential benefit of palliative care in heart failure, and sets future strategic policy and research directions in China.

Recent findings

Epidemiological studies demonstrate the prevalence of heart failure among women is higher than men in China and increases substantially with age. However, few studies have addressed the palliative needs of Chinese heart failure patients. The main themes from this review include: Healthcare providers should be culturally sensitive whenever assessing symptoms and needs. Locally validated, brief outcome measures are called for to identify symptoms and needs of Chinese heart failure patients. Palliative care should be better integrated into the management of heart failure through increased training for healthcare providers, policy development, financial support, and cultural acceptance of palliative care.

Large-scale epidemiological studies are urgently needed to assess the current situation of heart failure in China, alongside interventional studies to drive the development of innovative palliative care services to address the needs of Chinese heart failure patients.
Heart failure: an underestimated therapeutic target in diabetes
Authors: Marx Nikolaus
Published: December 2017

Heart failure (HF) is a frequent finding in patients with diabetes and is associated with an impaired prognosis with respect to the need for hospitalization as well as mortality. The following article presents an overview of the incidence and prognosis of HF in patients with type 2 diabetes and discusses the effects of various antidiabetic drugs on HF.
The impact of glucose-lowering medications on cardiovascular disease
Authors: Avogaro Angelo , De Kreutzenberg Saula Vigili , Fadini Gian Paolo
Published: December 2017

Patients with type 2 diabetes mellitus die most frequently from cardiovascular disease. Metabolic control is mandatory both for preventing long-term complications and for reducing the negative effects of the exposure of the other risk factors. In this article, we will describe the most commonly used glucose-lowering agents, the pathophysiological mechanisms underlying their cardiovascular protection, the available evidence-based data for this protection, and the contraindications and potential adverse effects.
Heat shock protein 90: its inhibition and function
Authors: Zuehlke Abbey D. , Moses Michael A. , Neckers Len
Published: December 2017

The molecular chaperone heat shock protein 90 (Hsp90) facilitates metastable protein maturation, stabilization of aggregation-prone proteins, quality control of misfolded proteins and assists in keeping proteins in activation-competent conformations. Proteins that rely on Hsp90 for function are delivered to Hsp90 utilizing a co-chaperone–assisted cycle. Co-chaperones play a role in client transfer to Hsp90, Hsp90 ATPase regulation and stabilization of various Hsp90 conformational states. Many of the proteins chaperoned by Hsp90 (Hsp90 clients) are essential for the progression of various diseases, including cancer, Alzheimer's disease and other neurodegenerative diseases, as well as viral and bacterial infections. Given the importance of these clients in different diseases and their dynamic interplay with the chaperone machinery, it has been suggested that targeting Hsp90 and its respective co-chaperones may be an effective method for combating a large range of illnesses.

This article is part of the theme issue ‘Heat shock proteins as modulators and therapeutic targets of chronic disease: an integrated perspective’.
Exercise, heat shock proteins and insulin resistance
Authors: Archer Ashley E. , Von Schulze Alex T. , Geiger Paige C.
Published: December 2017

Best known as chaperones, heat shock proteins (HSPs) also have roles in cell signalling and regulation of metabolism. Rodent studies demonstrate that heat treatment, transgenic overexpression and pharmacological induction of HSP72 prevent high-fat diet-induced glucose intolerance and skeletal muscle insulin resistance. Overexpression of skeletal muscle HSP72 in mice has been shown to increase endurance running capacity nearly twofold and increase mitochondrial content by 50%. A positive correlation between HSP72 mRNA expression and mitochondrial enzyme activity has been observed in human skeletal muscle, and HSP72 expression is markedly decreased in skeletal muscle of insulin resistant and type 2 diabetic patients. In addition, decreased levels of HSP72 correlate with insulin resistance and non-alcoholic fatty liver disease progression in livers from obese patients. These data suggest the targeted induction of HSPs could be a therapeutic approach for preventing metabolic disease by maintaining the body's natural stress response. Exercise elicits a number of metabolic adaptations and is a powerful tool in the prevention and treatment of insulin resistance. Exercise training is also a stimulus for increased HSP expression. Although the underlying mechanism(s) for exercise-induced HSP expression are currently unknown, the HSP response may be critical for the beneficial metabolic effects of exercise. Exercise-induced extracellular HSP release may also contribute to metabolic homeostasis by actively restoring HSP72 content in insulin resistant tissues containing low endogenous levels of HSPs.

This article is part of the theme issue ‘Heat shock proteins as modulators and therapeutic targets of chronic disease: an integrated perspective’.
The role of heat shock proteins and co-chaperones in heart failure
Authors: Ranek Mark J. , Stachowski Marisa J. , Kirk Jonathan A. , Willis Monte S.
Published: December 2017

The ongoing contractile and metabolic demands of the heart require a tight control over protein quality control, including the maintenance of protein folding, turnover and synthesis. In heart disease, increases in mechanical and oxidative stresses, post-translational modifications (e.g., phosphorylation), for example, decrease protein stability to favour misfolding in myocardial infarction, heart failure or ageing. These misfolded proteins are toxic to cardiomyocytes, directly contributing to the common accumulation found in human heart failure. One of the critical class of proteins involved in protecting the heart against these threats are molecular chaperones, including the heat shock protein70 (HSP70), HSP90 and co-chaperones CHIP (carboxy terminus of Hsp70-interacting protein, encoded by theStub1gene) and BAG-3 (BCL2-associated athanogene 3). Here, we review their emerging roles in the maintenance of cardiomyocytes in human and experimental models of heart failure, including their roles in facilitating the removal of misfolded and degraded proteins, inhibiting apoptosis and maintaining the structural integrity of the sarcomere and regulation of nuclear receptors. Furthermore, we discuss emerging evidence of increased expression of extracellular HSP70, HSP90 and BAG-3 in heart failure, with complementary independent roles from intracellular functions with important therapeutic and diagnostic considerations. While our understanding of these major HSPs in heart failure is incomplete, there is a clear potential role for therapeutic modulation of HSPs in heart failure with important contextual considerations to counteract the imbalance of protein damage and endogenous protein quality control systems.

This article is part of the theme issue ‘Heat shock proteins as modulators and therapeutic targets of chronic disease: an integrated perspective’.
The hydrophobin-like OmSSP1 may be an effector in the ericoid mycorrhizal symbiosis
Authors: Casarrubia Salvatore , Daghino Stefania , Kohler Annegret , Morin Emmanuelle , Khouja Hassine-Radhouane , Daguerre Yohann , Veneault-Fourrey Claire , Martin Francis M. , Perotto Silvia , Martino Elena
Published: December 2017

Mutualistic and pathogenic plant-colonizing fungi use effector molecules to manipulate the host cell metabolism to allow plant tissue invasion. Some small secreted proteins (SSPs) have been identified as fungal effectors in both ectomycorrhizal and arbuscular mycorrhizal fungi, but it is currently unknown whether SSPs also play a role as effectors in other mycorrhizal associations. Ericoid mycorrhiza is a specific endomycorrhizal type that involves symbiotic fungi mostly belonging to the Leotiomycetes (Ascomycetes) and plants in the family Ericaceae. Genomic and RNASeq data from the ericoid mycorrhizal fungus Oidiodendron maius led to the identification of several symbiosis-upregulated genes encoding putative SSPs. OmSSP1, the most highly symbiosis up-regulated SSP, was found to share some features with fungal hydrophobins, even though it lacks the Pfam hydrophobin domain. Sequence alignment with other hydrophobins and hydrophobin-like fungal proteins placed OmSSP1 within Class I hydrophobins. However, the predicted features of OmSSP1 may suggest a distinct type of hydrophobin-like proteins. The presence of a predicted signal peptide and a yeast-based signal sequence trap assay demonstrate that OmSSP1 is secreted during symbiosis. OmSSP1 null-mutants showed a reduced capacity to form ericoid mycorrhiza with Vaccinium myrtillus roots, suggesting a role as effectors in the ericoid mycorrhizal interaction.