bluuebunny/crossref_metadata_2025 huggingface dataset:
Postural Control While Listening in Younger and Middle-Aged Adults
Authors: Helfer Karen S. , Freyman Richard L. , van Emmerik Richard , Banks Jacob
Published: March 2020

Objectives:

The motivation for this research is to determine whether a listening-while-balancing task would be sensitive to quantifying listening effort in middle age. The premise behind this exploratory work is that a decrease in postural control would be demonstrated in challenging acoustic conditions, more so in middle-aged than in younger adults.

Design:

A dual-task paradigm was employed with speech understanding as one task and postural control as the other. For the speech perception task, participants listened to and repeated back sentences in the presence of other sentences or steady-state noise. Targets and maskers were presented in both spatially-coincident and spatially-separated conditions. The postural control task required participants to stand on a force platform either in normal stance (with feet approximately shoulder-width apart) or in tandem stance (with one foot behind the other). Participants also rated their subjective listening effort at the end of each block of trials.

Results:

Postural control was poorer for both groups of participants when the listening task was completed at a more adverse (vs. less adverse) signal-to-noise ratio. When participants were standing normally, postural control in dual-task conditions was negatively associated with degree of high-frequency hearing loss, with individuals who had higher pure-tone thresholds exhibiting poorer balance. Correlation analyses also indicated that reduced speech recognition ability was associated with poorer postural control in both single- and dual-task conditions. Middle-aged participants exhibited larger dual-task costs when the masker was speech, as compared to when it was noise. Individuals who reported expending greater effort on the listening task exhibited larger dual-task costs when in normal stance.

Conclusions:

Listening under challenging acoustic conditions can have a negative impact on postural control, more so in middle-aged than in younger adults. One explanation for this finding is that the increased effort required to successfully listen in adverse environments leaves fewer resources for maintaining balance, particularly as people age. These results provide preliminary support for using this type of ecologically-valid dual-task paradigm to quantify the costs associated with understanding speech in adverse acoustic environments.
Of Major Complication Types, Only Deep Infections After Spinal Fusion Are Associated With Worse Health-related Outcomes in Children With Cerebral Palsy
Authors: Eguia Francisco , Nhan Derek T. , Shah Suken A. , Jain Amit , Samdani Amer F. , Yaszay Burt , Pahys Joshua M. , Marks Michelle C. , Sponseller Paul D.
Published: March 2020

Study Design.

Retrospective review.

Objective.

The aim of this study was to determine whether major postoperative complications (“complications”) are associated with 2-year improvements in Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) scores after scoliosis surgery, and whether complications and preoperative characteristics predict 2-year improvements in CPCHILD Total score.

Summary of Background Data.

Spinal arthrodesis can halt the progression of spinal deformity in patients with cerebral palsy (CP)-related scoliosis. However, these patients are prone to postoperative complications.

Methods.

Using a multicenter CP registry, we identified 222 patients aged ≤21 years who underwent spinal fusion from 2008 to 2015 and had ≥2-year follow-up. We compared CPCHILD score improvement between 71 patients who had 1 or more complications (“complications group”) versus 151 who did not (“no-complications group”). Complications were deep infections, thromboembolic events, and cardiopulmonary, gastrointestinal, and neurologic complications. Multiple linear regression was used to identify predictors of 2-year postoperative CPCHILD score improvement (alpha = 0.05).

Results.

At 2-year follow-up, the complications group had similar mean improvement in CPCHILD score across all domains compared with the no-complications group (P > 0.05). When stratifying by complication type, deep infection was associated with less improvement in CPCHILD Comfort and Emotions (P = 0.02), Quality of Life (P < 0.01), and Total (P = 0.04) scores. When controlling for Gross Motor Function Classification System subcategory, age, and body mass index, only preoperative CPCHILD Total score and postoperative deep infection (F[4, 176] = 14; P < 0.0001; R
2 = 0.24) predicted 2-year improvement in CPCHILD Total score. Higher preoperative Total score and postoperative deep infection independently predicted less improvement in Total score.

Conclusion.

Postoperative deep infection and higher preoperative CPCHILD Total score independently predicted less improvement in CPCHILD Total score. Other major postoperative complications were not associated with differences in 2-year postoperative improvements in CPCHILD scores across all domains.

Level of Evidence: 3
New Onset Depression and Anxiety After Spinal Fusion Surgery
Authors: Bekeris Janis , Wilson Lauren A. , Fiasconaro Megan , Poeran Jashvant , Liu Jiabin , Girardi Federico , Memtsoudis Stavros G.
Published: March 2020

Study Design.

Retrospective database study.

Objective.

We sought to investigate trends and risk factors for new-onset anxiety and/or depression within 6 months after elective spine surgery.

Summary of Background Data.

Surgery represents a stressful experience associated with a number of physiological and psychological consequences. A subset of patients develop clinically significant symptoms of new-onset anxiety or depression. However, the incidence of and risk factors for these adverse outcomes after spine surgery remain ill-defined.

Methods.

We performed a retrospective analysis including anterior cervical discectomy and fusion and posterior lumbar fusion cases from 2012 to 2015, utilizing the Truven MarketScan database. Primary outcomes were new-onset depression, new-onset anxiety, and new-onset depression and/or anxiety after surgery. Potential risk factors included patient demographics, comorbidities, hospital and procedural characteristics as well as perioperative opioid regimens. Multivariable logistic regression models measured associations between risk factors and outcomes. Odds ratios (OR) were reported and results with P < 0.0167 were considered statistically significant.

Results.

Among 39,495 unique patients, overall incidence of new-onset depression and anxiety was 6% and 11.2%, respectively. In adjusted analyses, significant risk factors across all three outcomes included chronic opioid use (ORs ranging from 1.31 to 2.93; P < 0.01), female sex (ORs ranging from 1.25 to 1.67; P < 0.01), longer length of stay (ORs ranging from 1.05 to 1.08; P < 0.01), and readmission within 6 months of surgery (OR ranging from 1.31 to 1.68; P < 0.01).

Conclusion.

We identified several risk factors contributing to increased odds of new-onset depression and/or anxiety after spine fusion surgery. These data may aid the implementation of preventative measures among identified high-risk patients.

Level of Evidence: 3
Does Obesity Affect Outcomes of Multilevel ACDF as a Treatment for Multilevel Cervical Spondylosis?
Authors: Qi Min , Xu Chen , Cao Peng , Tian Ye , Chen Huajiang , Liu Yang , Yuan Wen
Published: March 2020

Study Design:

This was a retrospective study of the clinical and radiologic outcomes of multilevel anterior cervical discectomy and fusion (ACDF) surgery for multilevel cervical spondylosis patients.

Objective:

In this retrospective study, we intended to determine the relationship of neck circumference, neck length, and body mass index (BMI) with the outcomes of multilevel ACDF surgeries for patients with multilevel cervical spondylosis.

Summary of Background Data:

Obesity has become a worldwide epidemic problem since the beginning of the 21st century. However, no study has focused on how local or whole-body obesity indexes (neck circumference, length of neck, and BMI) are related to the outcome of anterior cervical surgery.

Methods:

A total of 156 consecutive patients with multilevel cervical spondylosis who underwent anterior cervical surgery in our department from 2010 to 2016 were enrolled in our study. Preoperative parameters of patients such as the neck circumference, length of neck, height and weight were measured, and the BMI was also calculated. Neck circumference and length of neck in neutral position ratio was determined as an index for evaluated the neck situation. Preoperative and postoperative neurological functions were evaluated using the neck disability index (NDI) and Japan Orthopedic Association (JOA) scores. Postoperative complications during the follow-up period were also recorded. Correlations between the obesity indexes and the various factors were analyzed.

Results:

The mean follow-up duration was 3.9±1.4 years (2.0–7.3 y). Compared with the preoperative score, the NDI and JOA score had significantly improved. There were 46 patients (29.49%) developed complications after surgery. Patients in the obese group had the highest rate of complications. Neck circumference and length of neck in neutral position ratio, BMI, and number of operation levels were significant risk factors for the occurrence of dysphagia after multilevel ACDF.

Conclusions:

Patients with a higher BMI, larger neck circumference, and shorter neck length may have a longer operation duration, more blood loss, and more postoperative complications. The authors recommended that the presence of obesity and neck circumference and length should be carefully considered in the perioperative risk assessment for a multilevel ACDF surgery.
An Interprofessional Workshop to Enhance De-prescribing Practices Among Health Care Providers
Authors: Zimmerman Kristin M. , Linsky Amy M. , Donohoe Krista L. , Hobgood Sarah E. , Sargent Lana , Salgado Teresa M.
Published: March 2020

Introduction:

De-prescribing is a complex behavior that benefits from a multifaceted approach to learning. We sought to create and deliver a 1-day interprofessional workshop to enhance de-prescribing knowledge and skills among health care professionals.

Methods:

Workshop development was based on the Adult Learning Theory and the Theoretical Domains Framework. The workshop addressed provider-related barriers, was created and delivered by an interprofessional team, and combined didactic and active learning techniques. Targeted participants included physicians, advanced practice providers (nurse practitioners and physician's assistants), pharmacists, and clinic staff. Interprofessional workgroups were created a priori. Participants were asked to complete a postprogram evaluation, including whether they would implement changes to practice, teaching, research, or administrative duties after participation.

Results:

We created an in-person, 5.5 credit hour, interprofessional de-prescribing workshop that comprised six sessions: (1) polypharmacy and de-prescribing overview; (2) identification of potentially inappropriate medications; (3) prioritization of medications for de-prescribing; (4) design and implementation of a de-prescribing plan; (5) principles for a patient-centered approach; and (6) suggestions for successful collaboration. Forty-one participants attended the workshop, and 38 (92.7%) completed the postprogram assessment. Participants felt they were likely to implement changes in practice, teaching, research, or administrative duties, rating themselves with a mean of 9.2 (SD = 1.06) on a 1 to 10 scale. Ultimately, 96.6% would recommend the workshop to others.

Discussion:

Based on participant feedback, the workshop catalyzed intention to change practice, teaching, research, or administrative duties. Other institutions seeking to change the complex behavior of de-prescribing may wish to model this development and delivery strategy.
An Examination of Self-Reported Assessment Activities Documented by Specialist Physicians for Maintenance of Certification
Authors: Lockyer Jocelyn , DiMillo Shanna , Campbell Craig
Published: March 2020

Introduction:

Specialists in a Maintenance of Certification program are required to participate in assessment activities, such as chart audit, simulation, knowledge assessment, and multisource feedback. This study examined data from five different specialties to identify variation in participation in assessment activities, examine differences in the learning stimulated by assessment, assess the frequency and type of planned changes, and assess the association between learning, discussion, and planned changes.

Methods:

E-portfolio data were categorized and analyzed descriptively. Chi-squared tests examined associations.

Results:

A total of 2854 anatomical pathologists, cardiologists, gastroenterologists, ophthalmologists, and orthopedic surgeons provided data about 6063 assessment activities. Although there were differences in the role that learning played by discipline and assessment type, the most common activities documented across all specialties were self-assessment programs (n= 2122), feedback on teaching (n= 1078), personal practice assessments which the physician did themselves (n= 751), annual reviews (n= 682), and reviews by third parties (n= 661). Learning occurred for 93% of the activities and was associated with change. For 2126 activities, there were planned changes. Activities in which there was a discussion with a peer or supervisor were more likely to result in a change.

Conclusions and Discussion:

Although specialists engaged in many types of assessment activities to meet the Maintenance of Certification program requirements, there was variability in how assessment stimulated learning and planned changes. It seems that peer discussion may be an important component in fostering practice change and forming plans for improvement which bears further study.
An Applied Healthcare Data Science Roadmap for Nursing Leaders
Authors: Pruinelli Lisiane , Johnson Steven G. , Fesenmaier Brianna , Winden Tamara J. , Coviak Cynthia , Delaney Connie W.
Published: March 2020

Nurse leaders working with large volumes of interdisciplinary healthcare data are in need of advanced guidance for conducting analytics to improve population outcomes. This article reports the development of a roadmap to help nursing leaders use data science principles and tools to inform decision-making, thus supporting research and approaches in clinical practice that improve healthcare for all. A consensus-building and iterative process was utilized based on the Cross-Industry Standard Process for Data Mining approach to big data science. Using the model, a set of components are described that combine and achieve a process for data science projects applicable to healthcare issues with the potential for improving population health outcomes. The roadmap was tested using a workshop format. The workshop was presented to two audiences: nurse leaders and informatics/healthcare leaders. Results were positive and included suggestions for how to further refine and communicate the roadmap.
Repurposing of clinically approved drugs for treatment of coronavirus disease 2019 in a 2019-novel coronavirus-related coronavirus model
Authors: Fan Hua-Hao , Wang Li-Qin , Liu Wen-Li , An Xiao-Ping , Liu Zhen-Dong , He Xiao-Qi , Song Li-Hua , Tong Yi-Gang
Published: March 2020

Background:

Medicines for the treatment of 2019-novel coronavirus (2019-nCoV) infections are urgently needed. However, drug screening using live 2019-nCoV requires high-level biosafety facilities, which imposes an obstacle for those institutions without such facilities or 2019-nCoV. This study aims to repurpose the clinically approved drugs for the treatment of coronavirus disease 2019 (COVID-19) in a 2019-nCoV-related coronavirus model.

Methods:

A 2019-nCoV-related pangolin coronavirus GX_P2V/pangolin/2017/Guangxi was described. Whether GX_P2V uses angiotensin-converting enzyme 2 (ACE2) as the cell receptor was investigated by using small interfering RNA (siRNA)-mediated silencing of ACE2. The pangolin coronavirus model was used to identify drug candidates for treating 2019-nCoV infection. Two libraries of 2406 clinically approved drugs were screened for their ability to inhibit cytopathic effects on Vero E6 cells by GX_P2V infection. The anti-viral activities and anti-viral mechanisms of potential drugs were further investigated. Viral yields of RNAs and infectious particles were quantified by quantitative real-time polymerase chain reaction (qRT-PCR) and plaque assay, respectively.

Results:

The spike protein of coronavirus GX_P2V shares 92.2% amino acid identity with that of 2019-nCoV isolate Wuhan-hu-1, and uses ACE2 as the receptor for infection just like 2019-nCoV. Three drugs, including cepharanthine (CEP), selamectin, and mefloquine hydrochloride, exhibited complete inhibition of cytopathic effects in cell culture at 10 μmol/L. CEP demonstrated the most potent inhibition of GX_P2V infection, with a concentration for 50% of maximal effect [EC50] of 0.98 μmol/L. The viral RNA yield in cells treated with 10 μmol/L CEP was 15,393-fold lower than in cells without CEP treatment ([6.48 ± 0.02] × 10−4
vs. 1.00 ± 0.12, t = 150.38, P < 0.001) at 72 h post-infection (p.i.). Plaque assays found no production of live viruses in media containing 10 μmol/L CEP at 48 h p.i. Furthermore, we found CEP had potent anti-viral activities against both viral entry (0.46 ± 0.12, vs.1.00 ± 0.37, t = 2.42, P < 0.05) and viral replication ([6.18 ± 0.95] × 10−4
vs. 1.00 ± 0.43, t = 3.98, P < 0.05).

Conclusions:

Our pangolin coronavirus GX_P2V is a workable model for 2019-nCoV research. CEP, selamectin, and mefloquine hydrochloride are potential drugs for treating 2019-nCoV infection. Our results strongly suggest that CEP is a wide-spectrum inhibitor of pan-betacoronavirus, and further study of CEP for treatment of 2019-nCoV infection is warranted.
The Development of Nurses International
Authors: Capone Kathleen , Keating Stacen , Chickering Miriam , Etcher LuAnn
Published: March 2020

Nurses International (NI) is a global faith-based nursing education consulting organization dedicated to relieving suffering in low-resource countries by providing quality educational support to nurses and nursing schools. This article describes its inception by founder Miriam Chickering and details the beginning stages of the development of NI and examples of its work.
Pseudolipomatosis Cutis: A Retrospective Case Series of Skin Biopsies Showing a Distinctive Vacuolar Artifactual Change
Authors: Gupta Vishal , Agarwal Shipra , Ramam M.
Published: March 2020

Pseudolipomatosis cutis is a distinctive artifact characterized by the presence of adipocyte-like vacuoles in the biopsy specimens. We describe this change in a series of skin biopsies clustered over 2 periods, November 2017–December 2017 and February 2019. Hematoxylin and eosin-stained sections from 21 skin biopsies were examined by 2 dermatopathologists. Variable-sized vacuoles were noted in the epidermis, dermis, and/or subcutaneous fat in all biopsies. Vacuoles were seen in the stratum corneum in 2 biopsies, epidermis in 15 biopsies, papillary dermis in 19 biopsies, reticular dermis in 20 biopsies, and subcutis in 9 biopsies. The vacuoles resembled a true histological change in many biopsies: vacuolated keratinocytes (n = 6), basal cell vacuolization (n = 6), foamy histiocytes (n = 12), and adipocytes (n = 20). Other changes included dermal collagen sclerosis and empty ectatic vascular channels. The clustering of this peculiar change in biopsies from patients with unrelated skin diseases that stopped on changing the formalin solution in both instances suggests that it is an artifactual change due to improper tissue fixation.
Morphea With Keloidal Features: A Case Report and Review of the Literature
Authors: Yu Dongfang , Ibarra Barbara S. , Akkurt Zeynep M. , Ahn Christine , Sangüeza Omar P.
Published: March 2020

Keloidal morphea is a rare variant of scleroderma, which often can be clinically confused with keloid or scar formation. We report a 34-year-old woman with a medical history of asthma and Raynaud's phenomenon, presented for the evaluation and management of multiple erythematous hyperpigmented annular plaques reportedly developed after taking trimethoprim/sulfamethoxazole. An initial skin biopsy showed findings supportive of a drug eruption. She was treated with oral prednisone and achieved some improvement. She presented 1 year later with enlargement of the plaques and emergence of new lesions. Skin biopsies revealed an unremarkable epidermis with marked fibrosis of the mid-to-deep dermis with sparing of the papillary dermis, and superficial and deep perivascular and perieccrine lymphoplasmacytic inflammation. Verhoeff–Van Gieson staining demonstrated the loss of elastin fibers within the fibrotic areas of the biopsy specimens, which supported the diagnosis of keloidal morphea. Her laboratory tests were positive for antinuclear antibody (greater than 1:1280). She continued treatment with oral prednisone and topical steroids, and she showed improvement. This case highlights the importance of differentiating keloidal scleroderma from a hypertrophic scar or keloid to reveal an underlying systemic process. A correlation of clinical and histopathological findings is paramount to reach a correct diagnosis, ensure appropriate treatment, and monitor for comorbid disease.
Adherence to the National Comprehensive Cancer Network Criteria of Complete Circumferential Peripheral and Deep Margin Assessment in Treatment of High-Risk Basal and Squamous Cell Carcinoma
Authors: Danesh Melissa J. , Menge Tyler D. , Helliwell Lydia , Mahalingam Meera , Waldman Abigail
Published: March 2020

BACKGROUND

The National Comprehensive Cancer Network (NCCN) has established guidelines for the treatment of keratinocyte carcinomas (KCs). Complete circumferential peripheral and deep margin assessment (CCPDMA) is recommended for “high-risk” tumors that cannot be closed primarily. If flap or grafts are needed and CCPDMA was not used, it is recommended that reconstruction be delayed until achieving clear margins.

OBJECTIVE

To measure provider utilization rates of the NCCN guidelines for high-risk KCs and assess barriers that are limiting adherence.

MATERIALS AND METHODS

A ten-item questionnaire was distributed to NCCN nonmelanoma skin cancer panel members and physicians participating in KC treatment at academic institutions.

RESULTS

Response rate was 49% (57/116). Responses were categorized by practice area: Mohs surgery, pathology, and other specialties: General Dermatology, Otolaryngology, Plastic Surgery, Surgical Oncology, Radiation Oncology, and Oral and Maxillofacial Surgery. Mohs surgeons were most likely to use CCPDMA for tumors meeting NCCN criteria with 14/15 using this technique in a majority of their cases, versus 2/6 pathologists and 10/16 specialists from other fields. Reasons cited for not using CCPDMA included deference to pathologists to determine the appropriate method for margin assessment and logistical difficulty.

CONCLUSION

Further efforts are needed to increase adherence to NCCN's guidelines regarding CCPDMA in KCs.
Evaluation of miR-34b/c polymorphisms to the risk of ischemic stroke
Authors: Wei Guijiang , Liao Changpin , Jian Chongdong , Liang Limei , Liu Jia , Tang Yujin , Wei Yesheng
Published: March 2020

Objectives:

Polymorphisms in microRNA genes are related to the risk of ischemic stroke, but the association between miR-34b/c polymorphisms and the risk of ischemic stroke has not been reported.

Methods:

MiR-34b/c rs2187473 and rs4938723 polymorphisms were genotyped by Snapshot assay among 495 controls and 492 ischemic stroke patients. Expression levels of miR-34b and miR-34c were quantified by real-time PCR. Transcriptional activity of miR-34b/c promoter was measured by luciferase reporter assay.

Results:

Rs4938723 was associated with an increased risk of ischemic stroke in our study (CC versus TT: OR = 2.34, 95% CI = 1.47–3.72, P = 0.001; C versus T: OR = 1.37, 95% CI = 1.12–1.68, P = 0.002; CC versus TT + TC: OR = 2.12, 95% CI = 1.37–3.29, P = 0.001). The expression levels of miR-34b and miR-34c were significantly downregulated in cases by contrast with controls (P < 0.05). Further analysis demonstrated that the expression levels of miR-34b and miR-34c were also downregulated in the individuals carrying rs4938723 CC genotype by contrast with that carrying TT + TC genotypes (P < 0.05). The result of luciferase reporter assay showed that rs4938723C allele decreased the transcriptional activity of miR-34b/c promoter compared with rs4938723 T allele.

Conclusion:

Our study showed a positive relation between the miR-34b/c rs4938723 polymorphism and the risk of ischemic stroke, which indicated that rs4938723 may be used for ischemic stroke prediction or therapy in the future.
NMNAT1-ASSOCIATED CONE–ROD DYSTROPHY: EVIDENCE FOR A SPECTRUM OF FOVEAL MALDEVELOPMENT
Authors: Bedoukian Emma C. , Zhu Xiaosong , Serrano Leona W. , Scoles Drew , Aleman Tomas S.
Published: March 2020

Purpose:

To describe in detail the phenotype of two siblings with biallelic NMNAT1 mutations.

Methods:

A 4-year-old male patient (P1) and his 7-year-old sister (P2), product of a nonconsanguineous union of Egyptian ancestry, underwent a comprehensive ophthalmic examination, retinal imaging with spectral domain optical coherence tomography and near infrared (NIR) fundus autofluorescence (FAF), and full-field electroretinograms (ERG).

Results:

Patients had blurred vision and nystagmus at ∼3 years of age. P2 was hyperopic (+6D). Visual acuity in P1 was 20/100 at age 3 and remained at ∼20/125 at age 4; P2 visual acuity was 20/70 at age 4 and declined to ∼20/200 at age 7. ERGs recorded in P1 showed relatively large rod-mediated responses but nearly undetectable cone signals. There was foveal/parafoveal depigmentation. Spectral domain optical coherence tomography showed hypoplastic foveas, a thin outer nuclear layer centrally but normal thickness beyond the vascular arcades. At the foveal center, cone outer segments were absent and the outer nuclear layer was further hyporreflective. The inner retina was mostly within normal limits. There was central depigmentation on near infrared fundus autofluorescence. Biallelic mutations were identified in NMNAT1: One was previously reported (c.769 G>A; pGlu257Lys), and the other one (c.245T>C; pVal82Ala) was novel.

Conclusion:

NMNAT1 mutations cause a consistent phenotype characterized by early-onset, progressive, cone>rod retinawide dysfunction and predominantly central abnormalities ranging from a hypoplastic to an atrophic fovea, supporting a critical role for NMNAT1 in central retinal development and maintenance. Relatively preserved inner retina and detectable photoreceptors may become therapeutic targets.
Retrospective Study in Children With Necrotizing Pneumonia: Nine Years of Intensive Care Experience
Authors: Blanco-Iglesias Elena , Oñoro Gonzalo , Almodovar-Martín José Luis , García-Salido Alberto , De Lama Caro-Patón Gema , Martínez de Azagra-Garde Amelia , Serrano-González Ana , Casado-Flores Juan
Published: March 2020

Background:

Although necrotizing pneumonia (NN) is one of the most feared complications of community-acquired pneumonia, data in pediatric patients are scarce. The objective of this article is to describe children admitted to pediatric intensive care unit (PICU) because of NN.

Methods:

Retrospective-prospective observational study in children admitted with NN to PICU (from January 1, 2010, to December 31, 2018). The data collected included information on disease epidemiology, PICU management, respiratory assistance and disease evolution.

Results:

Fifty-one children were included, 42 of 51 had received 7-valent or 13-valent pneumococcal vaccine. Median age was 3.2 years (1.9–4.2), 15 of 51 had signs of sepsis at admission. Forty-nine patients presented pleural effusion with drainage in 46. The most common respiratory support modality was high-flow oxygen nasal cannula (17/51). Computed tomography was the gold standard for diagnosis. Etiologic diagnosis was obtained in 34 of 51, and pneumococcus was isolated in 29 of 34. In all of these cases, initial detection was made by capsular antigen in pleural fluid. Children with pneumococcal NN had fewer days of evolution prior to PICU admission (P = 0.041). Cefotaxime with clindamycin was used in 49 of 51. Surgery was necessary in 3 of 51 patients. After PICU discharge, only 5 of 51 were readmitted. There were deaths.

Conclusions:

In our study, the NN was mainly observed in children around 3 years old. The main causal agent was pneumococcus. The evolution towards NN appeared to be faster than in case of other etiologies. Surgery management was unusual. All children required prolonged admissions but had a full clinical recovery.
Pain-related behaviors associated with persistence of mechanical hyperalgesia after antigen-induced arthritis in rats
Authors: Leuchtweis Johannes , Segond von Banchet Gisela , Eitner Annett , Ebbinghaus Matthias , Schaible Hans-Georg
Published: March 2020

Upon transient musculoskeletal diseases, some patients develop persistent pain while others recover from pain. Here, we studied whether such heterogeneity also occurs in rats after recovery from unilateral antigen-induced arthritis (AIA) in the knee joint, and which pain phenotype may predict the course of pain. Typically, inflammatory swelling lasts about 3 weeks. Pain-related behaviors were monitored for 84 days after AIA induction. Unbiased cluster analysis of intragroup differences at day 84 of AIA revealed that about one-third of the rats (cluster 1) showed persistent mechanical hyperalgesia at the injected knee joint, whereas the other rats (cluster 2) had recovered from pain. Retrograde analysis of pain-related behaviors revealed that cluster 1 rats exhibited more severe mechanical hyperalgesia at the injected knee from day 3 of AIA and mechanical hyperalgesia at the contralateral knee. Cluster 1 and 2 rats did not show different inflammatory swelling, secondary mechanical and thermal hyperalgesia at the ipsilateral hindpaw, guarding score, and asymmetry of weight bearing during AIA. Thus, in particular, early severe mechanical hyperalgesia in the inflamed joint and segmental contralateral mechanical hyperalgesia seem to be a risk factor for the development of persistent mechanical hyperalgesia pointing to the importance of spinal mechanisms. However, none of the rats showed an expression of ATF3 in dorsal root ganglion neurons, nor morphological spinal microglia activation thus not suggesting development of neuropathic pain. Both clusters showed a persistent upregulation of pCREB in dorsal root ganglion neurons, inversely correlated with mechanical hyperalgesia at the knee. The role of pCREB needs to be further explored.
Individual variability and sex differences in conditioned pain modulation and the impact of resilience, and conditioning stimulus pain unpleasantness and salience
Authors: Firouzian Shahrzad , Osborne Natalie R. , Cheng Joshua C. , Kim Junseok A. , Bosma Rachael L. , Hemington Kasey S. , Rogachov Anton , Davis Karen D.
Published: March 2020

Distinct pain experiences are shaped both by personal attributes and characteristics of noxious stimuli. An Individual's capacity for endogenous pain inhibition (reflected by conditioned pain modulation [CPM]), their resilience, and the pain unpleasantness and salience of painful stimuli can impact their pain perception. Here, we aimed to determine how individual variability in CPM relates to sex and resilience as personal attributes, and pain unpleasantness and salience of the CPM conditioning stimulus (CS). We evaluated CPM in 106 healthy participants (51 female and 55 male) based on the change in test stimulus pain applied concurrently with a painful CS, both delivered by painful heat. The CS reduced test stimulus pain in only half of the participants (CPM subgroup), but did not do so for the other half (no-CPM subgroup), many who exhibited pain facilitation. A regression model explained CPM effects after accounting for sex, resilience, CS pain unpleasantness and salience. In the CPM subgroup regression model, the CPM effect was positively related to CS pain unpleasantness, while the CPM effect was not related to any variable in the no-CPM subgroup model. Correlation analyses revealed that the CPM effect was anticorrelated with resilience in males with no-CPM. The CPM effect was correlated with CS pain unpleasantness in males with CPM and in females with no-CPM. The CPM effect and CS salience were correlated in the whole group more strongly than in the subgroups. These data reveal that the complexity of contributors to CPM variability include both personal attributes and attributes of the CS.
Catechin inhibiting the H1N1 influenza virus associated with the regulation of autophagy
Authors: Chang Cheng-Chieh , You Huey-Ling , Huang Sheng-Teng
Published: March 2020

Background:

The influenza virus is a highly infectious disease, with a notably rapid transmission rate. Autophagy is triggered by viral infection and is a survival mechanism exerted to maintain cellular homeostasis. Catechin is a representative phenolic acid which exerts anti-inflammatory responses against influenza A virus infection. The aim of this study is to explore the anti–H1N1 influenza virus effects by catechin associated with the restoration of autophagy.

Methods:

XTT assay was used to detect cellular viability. The inhibitory effects on the H1N1 influenza virus were assessed by hemagglutination assay, neuraminidase activity, and quantitative reverse transcription-polymerase chain reaction (qRT-PCR). The protein levels of H1N1 influenza virulence and autophagic markers were detected by Western blot.

Results:

We herein demonstrated that catechin had no cytotoxic effect on both infected and noninfected A549 cells and exerted protective effects on infected A549 cells. The results of the hemagglutination assay, neuraminidase activity, and qRT-PCR to examine viral load demonstrated that catechin effectively inhibited the replication of the H1N1 influenza virus. The virulent M2 protein and viral nucleoprotein were also inhibited after treatment with catechin. As for the autophagic markers, the LC3B protein was notably decreased by catechin in a dose-dependent manner, while the amount of autophagic vacuoles in H1N1 influenza virus–infected cells also decreased after catechin treatment in a dose-dependent manner.

Conclusion:

Collectively, the autophagy activated by the H1N1 influenza virus could be reversed after catechin treatment. This study indicates that catechin effectively inhibits H1N1 viral proliferation and thus may be applied as an adjuvant in future clinical application.
Patient Safety Over Power Hierarchy: A Scoping Review of Healthcare Professionals' Speaking-up Skills Training
Authors: Kim Sara , Appelbaum Nital P. , Baker Neil , Bajwa Nadia M. , Chu Frances , Pal Jay D. , Cochran Nancy E. , Bochatay Naike
Published: March 2020

Communication failures in healthcare constitute a major root cause of adverse events and medical errors. Considerable evidence links failures to raise concerns about patient harm in a timely manner with errors in medication administration, hygiene and isolation, treatment decisions, or invasive procedures. Expressing one's concern while navigating the power hierarchy requires formal training that targets both the speaker's emotional and verbal skills and the receiver's listening skills. We conducted a scoping review to examine the scope and components of training programs that targeted healthcare professionals' speaking-up skills. Out of 9,627 screened studies, 14 studies published between 2005 and 2018 met the inclusion criteria. The majority of the existing training exclusively relied on one-time training, mostly in simulation settings, involving subjects from the same profession. In addition, most studies implicitly referred to positional power as defined by titles; few addressed other forms of power such as personal resources (e.g., expertise, information). Almost none addressed the emotional and psychological dimensions of speaking up. The existing literature provides limited evidence identifying effective training components that positively affect speaking-up behaviors and attitudes. Future opportunities include examining the role of healthcare professionals' conflict engagement style or leaders' behaviors as factors that promote speaking-up behaviors.
Time-based Assessment of Hearing Preservation Rates After Microsurgical Resection of Vestibular Schwannomas: A Systematic Review
Authors: Hunt Anastasia A. , Cass Nathan D. , Coughlin Adam , Gubbels Samuel P.
Published: March 2020

Objective:

To determine short- and intermediate-term hearing preservation rates after microsurgical resection of vestibular schwannoma (VS).

Data Sources:

Systematic review of the Ovid, Cochrane, EMBASE, and Web of Science databases.

Study Selection:

This study was restricted to full-text English-language articles detailing VS resection via the middle cranial fossa or retrosigmoid approaches. Documentation of pre- and posttreatment hearing outcomes with American Academy of Otolaryngology–Head and Neck Surgery, Gardner-Robertson, or word recognition score scales, as well as time to follow-up were required. Duplicate data sets, studies with >10% of patients with neurofibromatosis two, previous or nonsurgical VS treatment, case reports with <five patients, or studies detailing decompressive surgery were excluded.

Data Extraction:

Two authors independently performed full-text reviews to determine study eligibility. Discrepancies were settled by consensus. “Class A/B, I/II” hearing was defined as AAO-HNS Class A or B, Gardner-Robertson Class 1 or 2, or PTA ≤ 50 dB with word recognition score ≥ 50% on audiogram.

Data Synthesis:

Pooled estimates of preserved Class A/B, I/II hearing at last postoperative follow-up.

Conclusions:

Of 1323 reports, 14 were utilized in analyses yielding data from 2,977 patients. Mean follow-up was 52.5 months (SD = 19.9). Class A/B, 1/2 hearing was preserved at last follow-up in 57% of patients. Meta-regression revealed that resection through the middle cranial fossa was associated with preservation of serviceable hearing. Moreover, when preserved in the immediate postoperative period, it seems to be stable over time.
Lateral Wall Electrodes Increase the Rate of Postactivation Nonauditory Percepts
Authors: Kaufman Adam C. , Naples James G. , Bigelow Douglas C. , Eliades Steven J. , Brant Jason A. , Kaufman Hannah S. , Ruckenstein Michael J.
Published: March 2020

Objective:

To evaluate factors influencing the development of nonauditory percepts and facial nerve stimulation after cochlear implant (CI) activation.

Study:

Retrospective cohort study.

Setting:

Tertiary referral center.

Patients:

Over the course of 5 years, 433 consecutive patients were evaluated for CI and 518 ears were implanted. Of those, 497 ears had information regarding CI activation.

Interventions:

Lateral wall electrodes (LWE) or perimodiolar/mid-scalar electrodes (PME) were used during implantation.

Primary Outcome Measure:

Nonauditory percepts and facial nerve stimulation after activation of CI.

Results:

Among the 497 devices, which were activated at our institution, 357 (72%) had LWE while 140 (28%) patients had a PME. Of the patients with LWE, 49 (13.7%) patients experienced some form of nonauditory percept. In comparison, 11 (9.2%) patients with a PME had some form of nonauditory percept (p < 0.05). Among the patients who had an LWE, 33 (9.2%) patients had facial nerve stimulation compared with 6 (4.3%) patients with PME (p < 0.05). Additionally, there were 11 (2.2%) patients with incomplete insertion of the electrode who had a significant increase (p < 0.05) in facial nerve stimulation. The mean number of electrodes requiring programming modification to control symptoms was 2.9.

Conclusions:

The use of LWE and incomplete insertions significantly increase the rate of nonauditory percepts and FNS after activation of CIs. Otic capsule anomalies are an independent risk factor for both.
Dermoid cyst with secretion of CA 19-9 detected by 18F-FDG PET/CT
Authors: Lin Sheng-Che , Yen Ruoh-Fang , Chen Yen-Kung
Published: March 2020

Introduction:

Carbohydrate antigen 19-9 (CA 19-9) is a tumor glycolipid, frequently elevated in the serum of patients due to malignancies from gastrointestinal organs; in particular, the pancreas. This carbohydrate antigen is also expressed in benign diseases.

Patient concerns:

A case of a 27-year-old female who has an unknown origin CA 19-9 elevation for 2 years.

Diagnosis:

After the left ovarian cystectomy and microscopic examination, the final diagnosis is a dermoid cyst. The dermoid cyst shows increased 18F-fluorodeoxyglucose (18F-FDG) uptake in the 18F-FDG positron emission tomography (PET)/computed tomography (CT) study.

Intervention and outcomes:

The laparoscopic oophorocystectomy was performed. It was observed that the patient's CA 19-9 level returned to normal after the surgery 6 months later. This showed that the dermoid cyst was responsible for the abnormal CA 19-9 level.

Conclusion:

In this case, we can learn that the 18F-FDG PET/CT scan has potential use in patients with unknown origin of elevation CA 19-9.
Traumatic laser in situ keratomileusis flap dislocation with epithelial ingrowth, Propionibacterium acnes infection, and diffuse lamellar keratitis
Authors: Chang Yung-Ching , Lee Yuan-Chieh
Published: March 2020

Rationale:

Traumatic flap dislocation might occur anytime after laser in situ keratomileusis (LASIK), but it is rarely concomitantly complicated with epithelial ingrowth, infectious keratitis, and diffuse lamellar keratitis altogether. Here we report a case of traumatic LASIK flap inversion with epithelial ingrowth, Propionibacterium acnes infection, and diffuse lamellar keratitis.

Patient concerns:

A 42-year-old man receiving bilateral LASIK surgery 10 years ago complained of right eye pain for 6 days after twig injury. Temporal flap inversion with epithelial ingrowth and dense infiltration at the interface were noted.

Diagnoses:

Traumatic LASIK flap inversion with epithelial ingrowth, Propionibacterium acnes infection and diffuse lamellar keratitis.

Interventions:

Removal of corneal epithelium around the flap inversion site, flap lifting, scraping of epithelial ingrowth, removal of the dense infiltrate, alcohol soaking, interface irrigation with antibiotics, and flap reposition were performed. Diffuse lamellar keratitis was noted postoperatively. Culture of the infiltrate revealed P acnes. The infiltrate subsided and the cornea cleared up under topical antibiotics and steroid.

Outcomes:

The visual acuity returned to 20/20. No recurrent epithelial ingrowth or infiltrate was noted during the follow-up.

Lessons:

This is the first report of Propionibacterium acnes keratitis after traumatic flap inversion. Although epithelial ingrowth, infectious keratitis, and diffuse lamellar keratitis all developed after the flap inversion, early recognition and proper intervention lead to a good result without sequels.
Clinical and angiographic characteristics of patients with spontaneous reperfusion in ST-segment elevation myocardial infarction
Authors: Wang Jian , He Song-yuan
Published: March 2020

This study aims to investigate the clinical and angiographic characteristics of patients with spontaneous reperfusion in ST-segment elevation myocardial infarction (STEMI).

A total of 519 patients with STEMI were enrolled in this study, who underwent primary percutaneous coronary intervention (PCI) treatments at Beijing Anzhen Hospital from January 2015 to December 2018. The patients were divided into 2 groups according to the TIMI flow grade before primary PCI, the non-spontaneous reperfusion group (TIMI flow grade 0–II) and the spontaneous reperfusion group (TIMI flow grade III). The incidence rate, the clinically relevant factors, and the features of the coronary angiographic lesions of spontaneous reperfusion from the 2 groups were recorded and analyzed.

There were significant differences between the 2 groups in age, CTnI peak value, high thrombus burden, and locations of lesions in the distant of left anterior descending artery (LAD) (P = .000, .000, .002, .000, and .003, respectively). However, there were no significant differences between the groups in other clinic aspects including gender, hypertension, diabetes mellitus, smoking history, hyperlipemia, angina pectoris history, culprit vessel distribution, lesion distribution in left circumflex artery (LCX) and right coronary artery (RCA), and collateral circulation (P > .05 for all).

Compared to the patients without spontaneous reperfusion, patients with spontaneous reperfusion were younger in age, lower in CTnI peak value, and higher in thrombosis burden, with culprit lesions mostly located in the distant of LAD.
Platelet activity with hemoglobin level in patients with hemodialysis
Authors: Kim Jae Min , Kim Jin Sug , Kim Hyung Oh , Lee So Ra , Rhew Jae Hwan , Woo Jong Shin , Cho Jang Hyun , Jeong Kyung Hwan , Kim Weon
Published: March 2020

Background:

VerifyNow (VN; Accumetrics, San Diego, CA) P2Y12 reaction unit (PRU) has an inverse relation with hemoglobin level (Hb). Chronic kidney disease (CKD) is associated with low response to clopidogrel and low Hb. Our aim is to investigate the relation between PRU and Hb, and to assess whether Hb directly affects PRU or not in patients with CKD undergoing hemodialysis (HD).

Methods:

We analyzed the relation between PRU and Hb in 43 HD patients and compared it with a control group of 127 patients with normal renal function. Both groups underwent percutaneous coronary intervention for stable coronary artery disease. We also compared PRU between the 2 groups considering Hb as a confounding factor.

Results:

In the control group, Hb and PRU showed a significant inverse correlation (correlation coefficient r = −0.340; P < .001), but not in the HD group (correlation coefficient r = −0.099; P = .53). PRU was higher in the HD group than the control group after adjusting for the influence of Hb (299.2 [95% confidence interval: 278.4–316.7] vs 248.7 [95% confidence interval: 227.7–269.0]; P < .001), even after propensity score matching (299.2 [95% confidence interval: 278.4–316.7] vs 241.7 [95% confidence interval: 221.8–262.2]; P < .001).

Conclusions:

PRU was higher regardless of lower Hb in CKD on HD patients than normal renal function patients. Therefore, Hb was not crucial factor to decide PRU in CKD on HD patients in this study.