bluuebunny/crossref_metadata_2025 huggingface dataset:
Using a Plastic Drape to Reduce Hypothermia in Premature Neonates During Peripherally Inserted Central Catheter Placement
Authors: Phan Huong (Kelle) T. , McIntyre Teresa M.
Published: June 2021

Background:

Premature neonates require assisted heating devices for thermoregulation in the neonatal intensive care unit (NICU). Traditional use of a cloth blanket and cloth towels during peripherally inserted central catheter (PICC) placement may hinder heat transfer from the assisted heating mechanisms, increasing the risk for neonatal hypothermia.

Purpose:

This quality improvement project's goal was to reduce the hypothermia rate in very low birth-weight (VLBW) neonates by replacing cloth blanket/towels with a plastic drape during PICC placement.

Methods:

The FOCUS-PDSA method was used to implement the intervention (plastic drape) over 3 months, during 58 PICC procedures in a level 3 NICU. A pre-/posttest design was used to evaluate the impact of the intervention on hypothermia rates compared with a baseline cloth group and a concurrent cloth cohort.

Results:

After the 3-month implementation period, the hypothermia rate for the intervention group was lower than that for the baseline cloth group (5.2% and 11.3%, respectively), but this difference was not statistically significant. Post-PICC hypothermia rates were significantly lower for the intervention group than for the concurrent cloth cohort (P = .004).

Implications for Practice:

Preliminary evidence demonstrated the plastic drape reduced the hypothermia rate in the NICU for VLBW neonates during PICC placement compared with cloth blanket/towels. A plastic drape shows promise in improving nursing practice by providing improved thermoregulation for premature neonates during PICC placement.

Implications for Research:

Further research is recommended to replicate findings with larger samples of PICC insertions, using a plastic drape in the operating room and other NICU procedures.
Music Therapy and Family-Integrated Care in the NICU
Authors: Corrigan Maxwell , Keeler Jason , Miller Harriet , Naylor Christine , Diaz Ann
Published: June 2021

Background:

Family-integrated care in the neonatal intensive care unit (NICU) is the criterion standard. Parent–infant bonding may be an indicator of successful family involvement. Music therapy (MT) is a growing service in the NICU, with interventions to support meaningful family involvement and improve bonding.

Purpose:

To study the effects of heartbeat-music interventions to support mother–infant bonding in the NICU and explore experiences of mothers participating in MT.

Methods:

Parallel-group randomized trial (MT vs standard care) to compare Mother-to-Infant Bonding Scale (MIBS) scores from baseline to 1 week postenrollment. MT included 2 heartbeat-music interventions (recorded maternal lullaby and heartbeat for infants, and recorded infant heartbeat and preferred music for mothers). Five mothers were randomly asked to complete a survey regarding their experiences with MT services.

Results:

One hundred mothers enrolled. In total, 44.3% completed the MIBS follow-up. Covarying out baseline MIBS, one-way analysis of covariance found no statistical difference between groups for MIBS 1-week follow-up (MT: mean = 0.64, SD = 1.6; standard care: mean = 0.57, SD = 1.5; P = .60) but underpowered in post hoc. Comforting, family cohesion, and personal growth and development themes emerged in qualitative analysis of survey responses.

Implications for Practice:

MT remains a viable service for purposefully including parents in the care of their NICU infants. Nurses and music therapists must work closely to successfully implement meaningful interventions such as heartbeat-music.

Implications for Research:

Heartbeat-music interventions should be further studied for diverse applications, including family integration, family coping, and bereavement.
Postoperative Outcomes in Diabetic Pediatric Orthopaedic Surgery Patients: A National Database Study
Authors: Farahani Farzam , Ahn Junho , Nakonezny Paul A. , Wukich Dane K. , Wimberly Robert L. , Riccio Anthony I.
Published: June 2021

Background:

Although the negative effects of diabetes mellitus (DM) on operative outcomes in orthopaedic surgery is a well-studied topic in adults, little is known about the impact of this disease in children undergoing orthopaedic procedures. This study aims to describe the postoperative complications in pediatric orthopaedic surgery patients with DM.

Methods:

Pediatric patients with insulin-dependent diabetes mellitus (IDDM) and non–insulin-dependent diabetes mellitus (NIDDM) were retrospectively identified while selecting for elective orthopaedic surgery cases from the American College of Surgeons National Surgical Quality Improvement Program Pediatric (ACS-NSQIP-Pediatric) database from 2012 to 2015. Univariate and multivariate analyses were performed to describe and assess outcomes when compared with nondiabetic patients undergoing similar procedures.

Results:

Of the 17,647 patients identified, 105 (0.60%) had DM. Of those 105 patients, 68 had IDDM and 37 had NIDDM. The median age of DM patients was 13.8 years (11.9 to 15.5 y) and 37.1% of all DM patients were male. Comparing DM to non-DM patients, no significant differences were noted in the overall complications (1.4% vs. 1.9%, P>0.05) or reoperation rates (1.2% vs. 1.9%, P>0.05); however, DM patients did have a higher occurrence of unplanned readmissions (4.8% vs. 1.7%; P=0.037). Diabetic patients were statistically more likely to have an unplanned readmission with 30 days (adjusted odds ratio=3.34; 95% confidence interval=1.21-9.24, P=0.021). when comparing IDDM to NIDDM, there was no significant difference in outcomes. Comparing NIDDM to non-DM patients, there was an increased incidence of nerve injury (5.6% vs. 0.18%; P=0.023), readmission rate (11.1% vs. 1.8%; P=0.043), and reoperation rate (11.1% vs. 1%; P=0.013) in nonspinal procedures and an increased incidence of pulmonary embolism (10% vs. 0%; P=0.002) in spinal arthrodesis procedures. NIDDM predicted longer hospital stays (adjusted odds ratio=1.49; 95% confidence interval=1.04, 2.14; P=0.028) compared with nondiabetic patients in extremity deformity procedures.

Conclusions:

The 30-day complication, reoperation, and readmission rates for NIDDM patients were higher than that of non-DM patients. Furthermore, NIDDM is a predictor of longer hospital stays while DM is a predictor of unplanned readmissions. No statistical differences were noted when comparing outcomes of NIDDM to IDDM patients.

Level of Evidence:

Level III.
Nonossifying Fibroma of the Distal Tibia: Predictors of Fracture and Management Algorithm
Authors: Baghdadi Soroush , Nguyen Jie C. , Arkader Alexandre
Published: June 2021

Background:

Nonossifying fibroma (NOF) is a common benign lesion in children and adolescents. This study investigated the risk of pathologic fracture in NOF lesions of the distal tibial based on anatomic location, clinical symptomatology, and imaging features, in order to propose an algorithm for the management of such lesions.

Methods:

In an IRB-approved retrospective case-control study, all patients diagnosed with NOF between 2010 and 2017 were extracted from our database. Patients below 18 years of age at the time of diagnosis and with lesions involving the distal tibia were included. Demographic data, the reason for visit, and the mechanism of injury were recorded. Radiographs were reviewed to record the size (absolute and relative to bone width) and location of each lesion. Computed tomography and magnetic resonance imaging examinations were also reviewed when available. Two authors graded all lesions using the Ritschl classification and determined the presence of 2 novel signs: the syndesmosis sign and the Pac-Man sign.

Results:

A total of 84 patients were included in the final analysis, of which 25 were in the fracture group and 59 in the nonfracture group. None of the patients in the fracture group was previously diagnosed with NOF, but nine (36%) patients had symptoms for >6 months preceding the fracture. Ankle sprain was the most common reason for visit in the nonfracture group. The lateral location of the lesion in the distal tibia (P=0.001), size (P<0.001 for both absolute and relative values), Ritschl stage (P=0.003), syndesmosis sign (P=0.005), and the Pac-Man sign (P=0.002) were significant predictors of fracture. All measurements had almost-perfect to perfect inter-rater agreements.

Conclusions:

The most significant imaging risk factors for fracture are a larger size, Ritschl stage B, and the presence of cortical thinning on anteroposterior or lateral radiographs. We introduced 2 signs for these distal tibial NOFs, a scoring system, and a management algorithm that is based on radiographs alone but incorporates advanced imaging findings in equivocal cases.

Level of Evidence:

Therapeutic Level III—case-control study.
MINIMAL GAS VITRECTOMY WITH SCLERAL BUCKLE TO MINIMIZE RETINAL DISPLACEMENT IN RHEGMATOGENOUS RETINAL DETACHMENT WITH INFERIOR BREAKS
Authors: Muni Rajeev H. , Bansal Aditya , Lee Wei Wei , Escaf Luis C.
Published: June 2021

Purpose:

To present a novel technique, minimal gas vitrectomy with scleral buckle, as a means of potentially minimizing retinal displacement compared with standard vitrectomy or vitrectomy/scleral buckle for select cases.

Methods:

A patient with right macula-off retinal detachment and retinal breaks at 7 o'clock and 10 o'clock underwent a 23-gauge pars plana vitrectomy, localization, and cryopexy of the breaks along with an inferior temporal segmental scleral buckle. No air–fluid exchange was performed. Suturing of sclerotomies, anterior chamber paracentesis of 0.3 mL, and intravitreal injection of 0.6 mL pure sulfur hexafluoride were then performed. The patient was advised to perform the steamroller maneuver with initial face-down positioning for 6 hours.

Results:

The patient achieved retinal reattachment, and postoperative wide-field fundus autofluorescence imaging demonstrated high-integrity retinal attachment with no retinal displacement.

Conclusion:

The minimal gas vitrectomy with scleral buckle technique has the potential to minimize retinal displacement in cases with inferior break(s) by using a small volume expansile gas tamponade and localized scleral buckle compared with standard vitrectomy or vitrectomy/scleral buckle with a full gas fill.
Design of Prosthetic Arm Based on Myoelectric Control
Authors: Ibrahim Mohamed Satti , Al-Bdawi Maimona Mohammed , Bilal Tagwa Saber , Garma Bushara Fatehia Bushara
Published: June 2021

Absence of an upper limb leads to severe impairments in everyday life, which can further influence the social and mental state. For these reasons, early developments in cosmetic and body-driven prostheses date some centuries ago, and they have been evolving ever since. Following the end of World War II, rapid developments in technology resulted in powered myoelectric hand prosthetics. A design of prosthetic arm based on myoelectric was created. The design incorporates movement of arm in flexion and extension. The signal was acquired from biceps above the elbow joint using Ag-AgCl electrode. The proposed design contains signal conditioning circuit, microcontroller, motor drivers, and motor as part of the major components to control arm movement. Control algorithm by using a microcontroller is presented.
Evidence-Based Introduction of Large-Scale Medical Technology Into Healthcare Through Test of Chance and Proof of Concept
Authors: Ngoie Jean , Nabi Ghulam , Huang Zhihong , Joseph James , Bartlett William , Bhushan Shetty
Published: June 2021

Traditional or “off the shelf” or “out of box” method of acquisition of medical devices and technology is currently being challenged by clinical users. As hardware, connectivity, and Health information systems (HISs) are becoming the key enablers of delivery of integrated patient monitoring; there is an increasing requirement for a coproductive approach to the choice and implementation of patient monitoring systems. The complexity of the clinical environment requires a collaboration of many stakeholders with a common focus and shared goals to ensure the correct choices and outcomes are delivered to satisfy requirements of clinical users and the wider system. Implementation of change through operationalization of such technologies is, however, complicated by regulation, accreditation, and standards requirements. In response to these and other issues, clinical engineers are recommending that the safest, efficient, and most effective approach to introduction of new systems is to conduct a test of change prior to major acquisitions of medical devices and systems that carry organization-wide clinical impact. The proposed approach is consistent with the Plan-Do-Study-Act cycle improvement model. In this case study, neonatal intensive care unit was used to assess the introduction of an “integrated patient monitoring system” into NHS Tayside.
Weight Loss-Associated Decreases in Medical Care Expenditures for Commercially Insured Patients With Chronic Conditions
Authors: Thorpe Kenneth , Toles Anastasia , Shah Bimal , Schneider Jennifer , Bravata Dena M.
Published: June 2021

Objective:

Savings associated with weight loss for populations with chronic conditions are poorly understood. The purpose of this study was to estimate medical expenditure savings associated with weight loss among commercially insured adults with chronic medical conditions.

Methods: The:

2001–2015 Medical Expenditure Panel Survey data were used to estimate the effect of changes in body mass index (BMI) on health expenditures from instrumental variable regression models.

Results:

Decreases in annual medical expenditures associated with a reduction in BMI of 1 kg/m2 varied by condition (eg, $289 for back pain and $752 for diabetes). The greater the weight loss, the greater the savings. The higher the baseline BMI, the greater the savings for similar levels of weight loss.

Conclusions:

The detailed estimates of savings for populations with chronic conditions can be used by employers to evaluate the cost-effectiveness of weight management interventions.
A Bilayered, Electrospun Poly(Glycerol-Sebacate)/Polyurethane-Polyurethane Scaffold for Engineering of Endothelial Basement Membrane
Authors: Rekabgardan Mahmood , Rahmani Mahya , Soleimani Masoud , HosSein Zadeh Simzar , Roozafzoon Reza , Parandakh Azim , Khani Mohammad-Mehdi
Published: June 2021

In the cardiovascular system, heart valves and vessels are subjected to continuous cyclic mechanical loadings due to the pulsatile nature of blood flow. Hence, in leveraging tissue engineering (TE) strategies to regenerate such a system, the candidate scaffold should not only be biocompatible with the desired biodegradation rate, but it should also be mechanically competent to provide a supportive structure for facilitating stem cells retention, growth, and differentiation. To this end, herein, we introduced a novel scaffold composed of poly(glycerol-sebacate) (PGS) and polyurethane (PU), which comprises of two layers: an electrospun pure PU layer beneath another electrospun PGS/PU layer with a different ratio of PGS to PU (3:2, 1:1, 2:3 Wt:Wt). The electrospun PGS/PU-PU scaffold was mechanically competent and showed intended hydrophilicity and a good biodegradation rate. Moreover, the PGS/PU-PU scaffold indicated cell viability and proliferation within ten days of in vitro cell culture and upon 7 day vascular endothelial growth factor (VEGF) stimulation, supported endothelial differentiation of mesenchymal stem cells by significant overexpression of platelet-endothelial cell adhesion molecule-1, von Willebrand factor, and VEGF receptor 2. The results of this study could be implemented in cardiovascular TE strategies when regeneration of blood vessel or heart valve is desired.
First-in-Man Use of the Percutaneous 10F Reitan Catheter Pump for Cardiorenal Syndrome
Authors: Napp Lars Christian , Mariani Silvia , Ruhparwar Arjang , Schmack Bastian , Keeble Thomas R. , Reitan Oyvind , Hanke Jasmin S. , Dogan Guenes , Hiss Marcus , Bauersachs Johann , Haverich Axel , Schmitto Jan D.
Published: June 2021

Cardiorenal syndrome worsens outcome in patients with decompensated chronic heart failure, and complicates recompensation by medical therapy. Mechanical circulatory support has the potential to improve renal function, and likely mitigates diuretic resistance in patients with severe cardiorenal syndrome. The Reitan catheter pump (RCP) is a novel temporary percutaneous circulatory support system for reducing cardiac afterload and increasing renal preload. Here, we report on the first-in-man use of the 10F-version of the RCP device, which was associated with favorable effects on hemodynamics and diuresis. Further investigation to evaluate safety and efficacy of this promising approach is warranted.
Smartphone based blood pressure measurement: accuracy of the OptiBP mobile application according to the AAMI/ESH/ISO universal validation protocol
Authors: Degott Jean , Ghajarzadeh-Wurzner Arlene , Hofmann Gregory , Proença Martin , Bonnier Guillaume , Lemkaddem Alia , Lemay Mathieu , Christen Urvan , Knebel Jean-François , Durgnat Virginie , Burnier Michel , Wuerzner Gregoire , Schoettker Patrick
Published: June 2021

Objective

The aim of this study was to assess the accuracy of the OptiBP mobile application based on an optical signal recorded by placing the patient’s fingertip on a smartphone’s camera to estimate blood pressure (BP). Measurements were carried out in a general population according to existing standards of the Association for the Advancement of Medical Instrumentation (AAMI), the European Society of Hypertension (ESH) and the International Organization for Standardization (ISO).

Methods

Participants were recruited during a scheduled appointment at the hypertension clinic of Lausanne University Hospital in Switzerland. Age, gender and BP distribution were collected to fulfill AAMI/ESH/ISO universal standards. Both auscultatory BP references and OptiBP were measured and compared using the opposite arm simultaneous method as described in the 81060-2:2018 ISO norm.

Results

A total of 353 paired recordings from 91 subjects were analyzed. For validation criterion 1, the mean ± SD between OptiBP and reference BP recordings was respectively 0.5 ± 7.7 mmHg and 0.4 ± 4.6 mmHg for SBP and DBP. For validation criterion 2, the SD of the averaged BP differences between OptiBP and reference BP per subject was 6.3 mmHg and 3.5 mmHg for SBP and DBP. OptiBP acceptance rate was 85%.

Conclusion

The smartphone embedded OptiBP cuffless mobile application fulfills the validation requirements of AAMI/ESH/ISO universal standards in a general population for the measurement of SBP and DBP.
What is the leaky gut? Clinical considerations in humans
Authors: Camilleri Michael
Published: June 2021

Purpose of review

To review the components of the intestinal barrier, the practical measurements of intestinal permeability, and the clinical conditions associated with altered intestinal barrier function, and to summarize the effects of dietary substances that fortify or weaken the intestinal barrier.

Recent findings

The intestinal barrier includes surface mucus, epithelial layer, and immune defense mechanisms. Transport across the epithelium may result from increased paracellular transport, apoptosis, or transcellular permeability. Assessment of the intestinal barrier requires measurements beyond the transport across the epithelial layer or the measurement of tight junction expression. Barrier function is most meaningfully tested in vivo using orally administered probe molecules; other approaches are performed in vitro using mucosal biopsies from humans, or exposing colonic mucosa from rats or mice or cell layers to extracts of colonic mucosa or stool from patients. Dietary factors can influence intestinal leakiness: fortifying the barrier with vitamins A and D, zinc, short-chain fatty acids, methionine, glutamine, and probiotics; weakening of the barrier has been reported with fat, bile acids, emulsifiers, and gliadin. Intestinal mucosal leakiness in ‘stress’ disorders such as major burns is reversed with enteral glutamine.

Inflammatory or ulcerating intestinal diseases result in leakiness of the gut barrier; however, no such disease has been cured by simply normalizing intestinal barrier function. Similarly, it is still unproven that restoring barrier function (reversing ‘leaky gut’) can ameliorate clinical manifestations in nonulcerating gastrointestinal disease or systemic or neurological diseases. On the other hand, dietary and enteral interventions can fortify the intestinal barrier in stress-associated states.
Survey of provider perceptions of enhanced recovery after surgery and perioperative surgical home protocols at a tertiary care hospital
Authors: Beal Eliza W. , Reyes Joshua-Paolo C. , Denham Zachary , Abdel-Rasoul Mahmoud , Rasoul Eyad , Humeidan Michelle L.
Published: June 2021

Enhanced recovery after surgery (ERAS) and perioperative surgical home (PSH) initiatives are widely utilized to improve quality of patient care. Despite their established benefits, implementation still has significant barriers. We developed a survey for perioperative clinicians to gather information on perception and knowledge of ERAS/PSH programs to guide future expansion of these programs at our institution. The survey included questions about familiarity with ERAS/PSH and perceived value, perceived barriers to protocol implementation, preferred learning methods and prioritization of various ERAS/PSH protocol elements into care delivery and provider education. Faculty surgeons and anesthesiologists, in addition to advanced practice nurses and postgraduate physician trainees in the Departments of Surgery and Anesthesiology were asked to complete the survey. Overall survey participation was 25% (223/888). About half of survey respondents had provided care to a patient on an ERAS/PSH protocol, and a majority felt at least somewhat knowledgeable about ERAS/PSH protocols. Perception of the value of ERAS/PSH was positive. Participants were enthusiastic about on-going learning, with multimodal pain management being the topic of most interest and learning by direct participation in care of protocol patients being the favored educational approach. A significant majority of participants felt that upcoming health providers should receive formal ERAS/PSH education as part of their training. Based on our survey results, we plan to explore teaching methods that successfully engage learners of all levels of clinical expertise and also overcome the major barriers to gaining knowledge about ERAS/PSH identified by study participants, most notably lack of time for busy clinicians.
A case report of prenatal diagnosis of fetal alloimmune thrombocytopenia
Authors: Fu Jing , Yao Ruojin , Yong Wenjing
Published: June 2021

Rationale:

Fetal alloimmune thrombocytopenia (FAIT) is a serious life-threatening disease caused by platelet-antigen incompatibility between the mother and fetus. FAIT can lead to fetal thrombocytopenia, intracranial hemorrhage (ICH), fetal death and severe neurological disorders after birth. Noninvasive prenatal diagnosis technology has not been widely used in China, and thus few cases of FAIT can be diagnosed prenatally. In this study, we report a case of prenatal diagnosis and treatment of FAIT.

Patient concerns:

A 29-year-old female was admitted at 32 weeks’ gestational age (GA). Fetal ultrasound at 32 weeks’ GA showed a hemorrhagic focus area in the left lateral ventricle and the sign of severe fetal anemia. Hence, fetal umbilical cord puncture was ordered to identify the etiology.

Diagnoses:

The fetal cord blood test revealed a normal hemoglobin level but severe fetal thrombocytopenia (platelet count, 23 × 109/L). Antibodies of human platelet antigens and human leukocyte antigens between mother and fetus were positive, and thus the diagnosis of FAIT was confirmed.

Interventions:

The patient refused intravenous immunoglobulin (IVIG) therapy owing to financial consideration. She was treated with dexamethasone acetate tablets (Xianju Company, China) 0.75 mg twice a day until delivery and cesarean section was performed at 34 weeks’ GA. The newborn received postnatal anti-platelet antibody treatment.

Outcomes:

The platelet count of the newborn progressively decreased until the third day after birth and it increased to normal level after postnatal treatment. The neonatal cerebral ultrasound showed the area of hemorrhage was in the process of absorption. During the postnatal one-year follow-up, the neonate showed normal developmental milestones and had no abnormal signs of neurological symptoms.

Lessons:

For FAIT, the fetal umbilical cord puncture can be carried out by skilled fetal medical teams. Dexamethasone acetate tablets can be an alternative choice for patients from underdeveloped areas.
Clinicopathological analysis and genomic profiling of a rare histiocyte-rich rhabdomyoblastic tumor
Authors: Xia Yan , Li Ye , Gong Peng , Jiang Huifeng , Zhang Xianbin
Published: June 2021

Rationale:

Skeletal muscle tumors are traditionally classified as rhabdomyomas or rhabdomyosarcomas. However, some soft tissue tumors cannot easily be identified as benign or malignant. We report a case of a histiocyte-rich rhabdomyoblastic tumor, with pathologic characteristics distinct from either rhabdomyoma or rhabdomyosarcoma. In contrast to rhabdomyosarcomas, the tumor cells exhibited low mitotic activity, lacking obvious morphologic atypia. Clinically, the tumor followed a very indolent course. Overall, the tumor did not fit classification criteria for either benign or malignant.

Patient concerns:

A 58-year-old Chinese man was admitted to Qilu Hospital on September 8, 2018, with a >20 year history of a mass in the middle of the left thigh. A few months prior to admission, he had experienced the pain from the mass extending to the distal left lower extremity. He had no prior history of significant disease or relevant family history.

Diagnoses:

Microscopically, numerous histiocytes and foamy cells covered the actual tumor cells that were positive for desmin, MyoD1, and myogenin, suggesting striated skeletal muscle cell differentiation. However, cross-striations were not detected in the tumor cells. The tumor was characterized by a non-infiltrative growth pattern and a low level of Ki67. A diagnosis of histiocyte-rich rhabdomyoblastic tumor was suggested.

Interventions:

The thigh mass was surgically resected September 12, 2018.

Outcomes:

The patient recovered well postoperatively, and was free of tumor recurrence or metastasis, followed to September 12, 2020 (23 months).

Lessons:

Histiocyte-rich rhabdomyoblastic tumor cells have minor atypia, indicating possible malignant potential. However, the tumor behavior was quit indolent. Due to the conflicting clinical and pathologic aspects of the tumor, to label it as rhabdomyosarcoma seemed inaccurate, potentially prompting over treatment. Interestingly, mutations were detected in NF1, AXIN2, CHEK2, DNMT3A, KMT2D, and RB1 through next-generation sequencing. These mutations suggest disruptions in Ras signaling, the Wnt pathway, methyltransferases, and the cell cyclepotentially influencing the development of this histiocyte-rich rhabdomyoblastic tumor. This unusual tumor should be incorporated into the WHO Classification of Soft Tissue Tumors owing to its unique characteristics.
CAV1 rs7804372 (T29107A) polymorphism might be a potential risk for digestive cancers
Authors: Chen Pei , Zhang Yu-Ling , Xue Bai , Wang Ji-Ru
Published: June 2021

Background:

Caveolin-1 (CAV1) is an essential structural component of caveolae, regulates cellular processes through complex cellular signaling pathways, and influences tumorigenicity. However, the role of the CAV1 (rs7804372) polymorphism in digestive cancers remains inconclusive. The meta-analysis was performed to evaluate the effect of CAV1 polymorphism on digestive cancer susceptibility and to provide a basis for precise treatment.

Methods:

The databases of PubMed, EMBASE, Google Scholar and CNKI were used to retrieve the published studies on CAV1 (rs7804372) polymorphism and susceptibility to digestive cancers up to June 2020. Two researchers conducted study screening, data extraction, and methodological quality evaluation separately according to inclusion and exclusion criteria. Review Manager 5.3 software was used to conduct the meta-analysis.

Results:

Six case-control studies were enrolled, including 2477 patients with digestive cancers and 2477 healthy controls. The pooled results showed that the CAV1 rs7804372 (T29107A) polymorphism increased the risk of digestive cancer occurrence in the allele (T vs. A: odds ratio (OR) 1.33, 95% confidence interval (CI): 1.15–1.53, P < .01), homozygous (TT vs. AA: OR 1.72, 95% CI: 1.31–2.26, P < .01), heterozygous (TA vs. AA: OR 1.47, 95% CI: 1.21–1.78, P < .01), dominant (TT vs. TA + AA: OR 1.32, 95% CI: 1.18–1.48, P < .01), and recessive comparing models (TT + TA vs. AA: OR 1.61, 95% CI: 1.26–2.07, P < .01).

Conclusion:

Our results indicate that the CAV1 (rs7804372) polymorphism may modify the occurrence of digestive cancers, and the presence of T allele or TT genotype of the CAV1 (rs7804372) may increase the risk of digestive cancers.
Evaluation of efficiency and safety of oral corticosteroid therapy in children patients with exacerbations of asthma
Authors: Chen Zuowu , Zhang Lei , You Jinbing , Wang Jiangjiang , Chen Guilan
Published: June 2021

Background:

Asthma is the most frequently occurring obstructive airway disease, it inflicts the highest morbidity among children. Among the paediatric populace, severe exacerbations of asthma are a common reason behind patient consultations and hospitalizations. Oral corticosteroids are a primary component in the treatment of asthma exacerbations; however, there is controversy regarding how corticosteroids functions.

Methods:

The present review will conduct a search on MEDLINE, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Chinese BioMedical Literature. The search will cover the databases from their beginning to May 2021. The search aims to identify all the randomized controlled studies on oral corticosteroids in treating children with asthma exacerbations. Two independent authors will choose studies, perform data extraction, and use an appropriate tool to assess the bias risk in the selected articles. Moreover, a sensitivity analysis will be performed to assess the robustness of the results. The RevMan (version 5.3) software will be employed to perform data synthesis and statistical analysis.

Results:

This study will examine the efficiency and safeness of oral corticosteroid therapy to treat children with asthma exacerbations by pooling the results of individual studies.

Conclusion:

The findings of this study will provide vigorous evidence to judge whether oral corticosteroid therapy is an efficiency strategy to treat patients with asthmatic exacerbations.

OSF registration number:

May 20, 2021.osf.io/3ghjt. (https://osf.io/3ghjt/).
Focusing on long-term complications of mid-urethral slings among women with stress urinary incontinence as a patient safety improvement measure
Authors: Lin Yi-Hao , Lee Cheng-Kai , Chang Shuenn-Dyh , Chien Pei-Chun , Hsu Yu-Ying , Tseng Ling-Hong
Published: June 2021

Background:

There are 3 different types of mid-urethral sling, retropubic, transobturator and single incision performed for women with stress urinary incontinence. Prior studies comparing these three surgeries merely focused on the successful rate or efficacy. But nevertheless, what is more clinically important dwells upon investigating postoperative complications as a safety improvement measure.

Methods:

A systematic review via PubMed, Ovid, and the Cochrane Database of Systematic Review and studies were applied based on the contents with clearly identified complications. Selected articles were reviewed in scrutiny by 2 individuals to ascertain whether they fulfilled the inclusion criteria: complications measures were clearly defined; data were extracted on study design, perioperative complications, postoperative lower urinary tract symptoms, postoperative pain, dyspareunia, and other specified late complications.

Results:

A total of 55 studies were included in the systemic review. Perioperative complications encompassed bladder perforation, vaginal injury, hemorrhage, hematoma, urinary tract infection. There were postoperative lower urinary tract symptoms including urine retention and de novo urgency. Furthermore, postoperative pain, tape erosion/ extrusion, further stress urinary incontinence surgery, and rarely, deep vein thrombosis and injury of inferior epigastric vessels were also reported.

Conclusions:

Complications of mid-urethral sling are higher than previously thought and it is important to follow up on their long-term outcomes; future research should not neglect to address this issue as a means to improve patient safety.
Cross-cultural adaptation and psychometric validation of the Korean version of rehabilitation complexity scale for the measurement of complex rehabilitation needs
Authors: Lee Hoo Young , Park Jung Hyun , Kim Tae-Woo
Published: June 2021

The aim of this study was to translate and cross-culturally adapt the Rehabilitation Complexity Scale-Extended version 13 (RCS-E v13) to develop the Korean version of the Rehabilitation Complexity Scale (KRCS), and to explore its reliability, and concurrent and construct validity.

This research was an observational study of a series of consecutive rehabilitation inpatients who were previously assessed with KRCS and grouped with the Korean rehabilitation patient group version 1.1 (KRPG v1.1). Translation and cross-cultural adaptation of the RCS-E v13 were implemented according to internationally recognized standards. Four hundred thirty inpatients diagnosed with complex neurological or musculoskeletal disabilities were enrolled. Physiatrists were asked to finish the KRCS at admission and to complete a second time with an interval of a minimum of 3 weeks to a maximum of 4 weeks for reliability evaluation. At discharge, the KRCS was completed a third time to explore constructive validity.

The Cronbach-α was 0.63. The intraclass correlation coefficient values of the total score, Medical, Nursing, Care, Therapy Disciplines, Therapy Intensity, and Especial Needs domains were 0.86, 0.69, 0.84, 0.83, 0.74, 0.74, and 0.79, respectively (P < .01). The scale was repeatable (Spearman rho 0.69–0.86) and correlated strongly with disability measures (Spearman rho 0.37–0.50). Exploratory factor analysis revealed 2 clear factors (“Medical/Nursing” and “Care/Therapy Disciplines/Therapy Intensity/Equipment”). The goodness-of-fit index in the confirmatory factor analysis was 0.87. The KRCS was associated with a higher explanatory power for rehabilitation resources and length of stay than the KRPG v1.1.

Our data suggest that the KRCS is a feasible, reliable, and valid tool that is appropriate for the measurement of clinical complexity in Korean intensive rehabilitation units. Further, it may provide case-mix adjustment to improve the rehabilitation delivery system in Korea.
Relationships between serum levels of lactate dehydrogenase and neurological outcomes of patients who underwent targeted temperature management after out-of-hospital cardiac arrest
Authors: You Yeon Ho , In Yong Nam , Park Jung Soo , Yoo Insool , Kim Seung Whan , Lee Jinwoong , Ryu Seung , Min Jin Hong , Jeong Won Joon , Cho Yong Chul , Oh Se Kwang , Ahn Hong Joon , Kang Chang Shin , Lee Byung Kook , Lee Dong Hun , Lee Dong Hoon , Yu Gyeong Gyu
Published: June 2021

This study aimed to evaluate times for measuring serum lactate dehydrogenase levels (SLLs) to predict neurological prognosis among out-of-hospital cardiac arrest (OHCA) survivors.

This retrospective study examined patients who experienced OHCA treated with targeted temperature management (TTM). The SLLs were evaluated at the return of spontaneous circulation (ROSC) and at 24, 48, and 72 hours later. Neurological outcomes after 3 months were evaluated for relationships with the SLL measurement times.

A total of 95 comatose patients with OHCA were treated using TTM. Seventy three patients were considered eligible, including 31 patients (42%) who experienced good neurological outcomes. There were significant differences between the good and poor outcome groups at most time points (P < .001), except for ROSC (P = .06). The ROSC measurement had a lower area under the receiver operating characteristic curve (AUC: 0.631, 95% confidence interval [CI]: 0.502–0.761) than at 48 hours (AUC: 0.830, 95% CI: 0.736–0.924), at 24 hours (AUC: 0.786, 95% CI: 0.681–0.892), and at 72 hours (AUC: 0.821, 95% CI: 0.724–0.919).

A higher SLL seemingly predicted poor neurological outcomes, with good prognostic values at 48 hours and 72 hours. Prospective studies should be conducted to confirm these results.
Prognostic value of the ALBI grade among patients with single hepatocellular carcinoma without macrovascular invasion
Authors: Chen Wenhao , Zhang Zijian , Fang Xianrui , Xiong Li , Wen Yu , Zhou Jiangjiao , Kong Fanhua , Zou Heng
Published: June 2021

Although evidence for the application of an albumin-bilirubin (ALBI) grading system to assess liver function in hepatocellular carcinoma (HCC) is available, less is known whether it can be applied to determine the prognosis of single HCC with different tumor sizes. This study aimed to address this gap.

Here, we enrolled patients who underwent hepatectomy due to single HCC from 2010 to 2014. Analyses were performed to test the potential of the ALBI grading system to monitor the long-term survival of single HCC subjects with varying tumor sizes.

A total of 265 participants were recruited. The overall survival (OS) among patients whose tumors were ≤7 cm was remarkably higher than those whose tumors were >7 cm. The Cox proportional hazards regression model identified the tumor differentiation grade, ALBI grade, and maximum tumor size as key determinants of OS. The ALBI grade could stratify the patients who had a single tumor ≤7 cm into 2 distinct groups with different prognoses. The OS between ALBI grades 1 and 2 was comparable for patients who had a single tumor >7 cm.

We showed that the ALBI grading system can predict disease outcomes in patients with a single HCC with a tumor size ≤7 cm. However, the ALBI grade may not predict the prognosis of patients with a single tumor >7 cm.
Multicenter analysis and a rapid screening model to predict early novel coronavirus pneumonia using a random forest algorithm
Authors: Bao Suxia , Pan Hong-yi , Zheng Wei , Wu Qing-Qing , Dai Yi-Ning , Sun Nan-Nan , Hui Tian-Chen , Wu Wen-Hao , Huang Yi-Cheng , Chen Guo-Bo , Yin Qiao-Qiao , Wu Li-Juan , Yan Rong , Wang Ming-Shan , Chen Mei-Juan , Zhang Jia-Jie , Yu Li-Xia , Shi Ji-Chan , Fang Nian , Shen Yue-Fei , Xie Xin-Sheng , Ma Chun-Lian , Yu Wan-Jun , Tu Wen-Hui , Ju Bin , Huang Hai-Jun , Tong Yong-Xi , Pan Hong-Ying
Published: June 2021

Early determination of coronavirus disease 2019 (COVID-19) pneumonia from numerous suspected cases is critical for the early isolation and treatment of patients.

The purpose of the study was to develop and validate a rapid screening model to predict early COVID-19 pneumonia from suspected cases using a random forest algorithm in China.

A total of 914 initially suspected COVID-19 pneumonia in multiple centers were prospectively included. The computer-assisted embedding method was used to screen the variables. The random forest algorithm was adopted to build a rapid screening model based on the training set. The screening model was evaluated by the confusion matrix and receiver operating characteristic (ROC) analysis in the validation.

The rapid screening model was set up based on 4 epidemiological features, 3 clinical manifestations, decreased white blood cell count and lymphocytes, and imaging changes on chest X-ray or computed tomography. The area under the ROC curve was 0.956, and the model had a sensitivity of 83.82% and a specificity of 89.57%. The confusion matrix revealed that the prospective screening model had an accuracy of 87.0% for predicting early COVID-19 pneumonia.

Here, we developed and validated a rapid screening model that could predict early COVID-19 pneumonia with high sensitivity and specificity. The use of this model to screen for COVID-19 pneumonia have epidemiological and clinical significance.
Effects of atorvastatin on the insulin resistance in women of polycystic ovary syndrome
Authors: Chen Lin-Lin , Zheng Jian-Hong
Published: June 2021

Background:

Atorvastatin treatment has been suggested as a therapeutic method for women with polycystic ovary syndrome (PCOS) in many clinical studies. Nonetheless, the effects of atorvastatin on insulin resistance in PCOS patients still remain controversial.

Objective:

The aim of this report was to evaluate the effects of atorvastatin therapy on the insulin resistance in the treatment of PCOS compared to that of placebo, in order to confer a reference for clinical practice.

Methods:

Randomized controlled trials (RCTs) of atorvastatin for PCOS published up to August, 2020 were searched. Standardized mean difference (SMD) and 95% confidence interval (CI) were calculated, and heterogeneity was measured by the I
2 test. Sensitivity analysis was also carried out. The outcomes of interest were as follows: fasting glucose concentration, fasting insulin level, homeostasis model assessment of insulin resistance (HOMA-IR) or body mass index (BMI) value.

Results:

Nine RCTs with 406 participants were included. The difference of fasting glucose concentration in PCOS patients between atorvastatin group and placebo group was not statistically significant (8 trials; SMD −0.06, 95% CI −0.31 to 0.20, P = .66). PCOS patients in atorvastatin group had lower fasting insulin level than those in placebo group (7 trials; SMD −1.84, 95% CI −3.06 to −0.62, P < .003). The homeostasis model assessment of insulin resistance (HOMA-IR) value showed significant decrease in the atorvastatin therapy compared to placebo (6 trials; SMD −4.12, 95% CI −6.00 to −2.23, P < .0001). In contrast to placebo, atorvastatin therapy did not decrease the BMI value significantly in PCOS patients (7 trials; SMD 0.12, 95% CI −0.07 to 0.31, P = .22).

Conclusions:

Atorvastatin therapy can reduce insulin resistance in the treatment of patients with PCOS. In addition, further large-sample, multi-center RCTs are needed to identify these findings.
Interobserver agreement and clinical disparity between the Graf method and femoral head coverage measurement in developmental dysplasia of the hip screening
Authors: Chang Wen-Chieh , Hsu Kuei-Hsiang , Lo I.-Fang , Liao Kai-Hao , Su Yu-Ping
Published: June 2021

Ultrasonography is the ideal tool for assessing hip morphology in infants younger than 6-month-old. This study assessed the interobserver agreement and clinical disparities of the 2 most widely used ultrasound (US) methods, the Graf method, and femoral head coverage (FHC) measurement.

A prospective observational study (STROBE compliant) of 2024 newborns was conducted between January 2017 and December 2018. Hip US was conducted on all newborns with abnormal Barlow and Ortolani maneuvers as well as on 50 randomly selected normal newborns. The physical examination and US were performed by a senior pediatric orthopedic surgeon with musculoskeletal sonography certification. Three observers with different levels of experience interpreted the images by using the Graf method and FHC. We analyzed the intraclass correlation coefficient, Cohen kappa, and the disparity between the clinical findings of the 2 methods.

A total of 198 newborns (9.8%) presented with clinical instability, including 193 subluxatable hips in 168 patients (84.8%) and 45 dislocatable/dislocated hips in 30 patients (15.2%). The mean age at US examination was 11.69 days (range: 0–18 days). The intraclass correlation coefficient was .71 (95% CI: 0.55–0.83) for FHC, 0.63 (95% CI: 0.38–0.78) for the alpha angle, and 0.47 (95% CI: 0.16–0.69) for beta angle. The Cohen kappa coefficients of Graf type were 0.19 (95% CI: 0.03–0.35), 0.39 (95% CI: 0.20–0.58), and 0.17 (95% CI: 0.02–0.32) between observers 1 and 2, observers 1 and 3, and observers 2 and 3, respectively. Based on the Graf method, 14% of the stable hips had abnormal USs; by contrast, 19.2% of the subluxatable hips and 17.8% of the dislocatable/dislocated hips had normal Graf morphologies. In USs interpreted using FHC, 16% of stable hips demonstrated abnormal coverage, whereas 13.5% of subluxatable hips and 4.4% of dislocatable/dislocated hips had normal FHC.

Incidence of clinically detectable hip instability was 9.8% among newborns in our series. Both alpha angle and FHC ratio revealed substantial interobserver agreement while beta angle achieved moderate agreement. FHC ratio possesses higher sensitivity and similar specificity compared with the Graf method when screening unstable hips.

Level II, development of diagnostic criteria on basis of consecutive patients
Single-event multilevel surgery in cerebral palsy
Authors: Nahm Nickolas J. , Ludwig Meryl , Thompson Rachel , Rogers Kenneth J. , Imerci Ahmet , Dabney Kirk W. , Miller Freeman , Sees Julieanne P.
Published: June 2021

The aim of this study was to compare outcomes for single-event multilevel surgery (SEMLS) in cerebral palsy (CP) performed by 1 or 2 attending surgeons.

A retrospective review of patients with CP undergoing SEMLS was performed. Patients undergoing SEMLS performed by a single senior surgeon were compared with patients undergoing SEMLS by the same senior surgeon and a consistent second attending surgeon. Due to heterogeneity of the type and quantity of SEMLS procedures included in this study, a scoring system was utilized to stratify patients to low and high surgical burden. The SEMLS events scoring less than 18 points were categorized as low burden surgery and SEMLS scoring 18 or more points were categorized as high burden surgery. Operative time, estimated blood loss, hospital length of stay, and operating room (OR) utilization costs were compared.

In low burden SEMLS, 10 patients had SEMLS performed by a single surgeon and 8 patients had SEMLS performed by 2 surgeons. In high burden SEMLS, 10 patients had SEMLS performed by a single surgeon and 12 patients had SEMLS performed by 2 surgeons. For high burden SEMLS, operative time was decreased by a mean of 69 minutes in cases performed by 2 co-surgeons (P = 0.03). Decreased operative time was associated with an estimated savings of $2484 per SEMLS case. In low burden SEMLS, a trend toward decreased operative time was associated for cases performed by 2 co-surgeons (182 vs 221 minutes, P = 0.11). Decreased operative time was associated with an estimated savings of $1404 per low burden SEMLS case. No difference was found for estimated blood loss or hospital length of stay between groups in high and low burden SEMLS.

Employing 2 attending surgeons in SEMLS decreased operative time and OR utilization cost, particularly in patients with a high surgical burden. These findings support the practice of utilizing 2 attending surgeons for SEMLS in patients with CP.

Level of Evidence: Level III