bluuebunny/crossref_metadata_2025 huggingface dataset:
Electric Stimulation as an Effective Adjunctive Therapy for Diabetic Foot Ulcer: A Meta-analysis of Randomized Controlled Trials
Authors: Chen Zong , Chen Zhi-You , Liu Wen-Hui , Li Guang-Shuai
Published: October 2020

OBJECTIVE

To evaluate the effectiveness of electric stimulation (ES) for diabetic foot ulcer (DFU) treatment.

METHODS

The authors searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases for randomized clinical trials published through March 2019 that compared the efficacy of ES and standard wound care (SWC) versus SWC alone for DFU treatment. The outcomes were pooled using a random-effects model.

RESULTS

Of the 145 randomized clinical trials initially identified, seven studies (with a total of 274 patients) met the inclusion criteria. The percentage decrease in ulcer area at 4 weeks was significantly greater in patients treated with ES and SWC than SWC alone (standardized mean difference, 1.09; 95% confidence interval, 0.62-1.57; P < .001). The ulcer healing rate at 12 weeks was also significantly faster in the ES group (risk difference, 0.19; 95% confidence interval, 0.06–0.32; P = .005). Subgroup analysis showed comparable efficacies with different waveforms (monophasic vs biphasic).

CONCLUSIONS

Electrical stimulation appears to be an effective adjunctive therapy for accelerating DFU healing.
Accessible and Adaptable Faculty Development to Support Curriculum Reform in Medical Education
Authors: van Schaik Sandrijn M.
Published: October 2020

Contemporary curricular reform in medical education focuses on areas that current physician-educators were likely not exposed to during medical school, such as interprofessional teamwork; informatics; health care systems improvement; and diversity, equity, and inclusion. Thus, faculty may not be ready to support the planned curricular reform without adequate faculty development to acquire the necessary knowledge and skills. In an era with increasing demands on faculty, new approaches that are flexible and adaptable are needed. The University of California, San Francisco, School of Medicine implemented a new curriculum in 2016, which constituted a major curricular overhaul necessitating extensive faculty development. Based on this experience, the author proposes 8 guiding principles for faculty development around curricular reform: (1) create a blueprint to inform design and implementation of faculty development activities; (2) build on existing resources, networks, and communities; (3) target different needs and competency levels for different groups of faculty; (4) encourage cocreation in the workplace; (5) promote collaboration between content experts and faculty developers; (6) tap into faculty’s intrinsic motivation for professional development; (7) develop curriculum leaders and faculty developers; and (8) evaluate for continuous improvement. Each of these principles is illustrated with examples, and when available, supported by references to relevant literature. Considering the current wave of curricular reform, both at the undergraduate and graduate levels, these principles can be useful for other institutions.
Advances in airway management and mechanical ventilation in inhalation injury
Authors: Gigengack Rolf Kristian , Cleffken Berry Igor , Loer Stephan Alexander
Published: October 2020

Purpose of review

Airway management, mechanical ventilation, and treatment of systemic poisoning in burn patients with inhalation injury remains challenging. This review summarizes new concepts as well as open questions.

Recent findings

Several life-threatening complications, such as airway patency impairment and respiratory insufficiency, can arise in burn patients and require adequate and timely airway management. However, unnecessary endotracheal intubation should be avoided. Direct visual inspection via nasolaryngoscopy can guide appropriate airway management decisions. In cases of lower airway injury, bronchoscopy is recommended to remove casts and estimate the extent of the injury in intubated patients. Several mechanical ventilation strategies have been studied. An interesting modality might be high-frequency percussive ventilation. However, to date, there is no sound evidence that patients with inhalation injury should be ventilated with modes other than those applied to non-burn patients. In all burn patients exposed to enclosed fire, carbon monoxide as well as cyanide poisoning should be suspected. Carbon monoxide poisoning should be treated with an inspiratory oxygen fraction of 100%, whereas cyanide poisoning should be treated with hydroxocobalamin.

Burn patients need specialized care that requires specific knowledge about airway management, mechanical ventilation, and carbon monoxide and cyanide poisoning.
Buprenorphine/Naloxone for Opioid Use Disorder Among Alaska Native and American Indian People
Authors: Lillie Kate M. , Shaw Jennifer , Jansen Kelley J. , Garrison Michelle M.
Published: October 2020

Objectives:

Opioid-related disparities are magnified among Alaska Native and American Indian (ANAI) people. Yet, no outcome studies on medication for addiction treatment, an effective treatment in other populations, among ANAI people exist. The objective of this study was to identify variables associated with buprenorphine/naloxone retention among ANAI people with opioid use disorder (OUD).

Methods:

The sample was 240 ANAI adults in Anchorage, Alaska who received buprenorphine/naloxone treatment for an OUD. We gathered data from the electronic health record from January 1, 2015 to December 31, 2019. We used survival analysis to explore possible predictors (demographic variables, psychiatric comorbidity, medical severity, previous opioid prescriptions, previous injury, alcohol use disorder, and co-occurring substance use) of length of treatment retention (in days) while accounting for right censoring.

Results:

We found that 63% of the 240 patients were retained in buprenorphine/naloxone treatment at 90 days, 51% at 6 months, and 40% at 1 year, slightly lower than the general US population. Younger age (hazard ratio 1.69, 95% confidence intervals 1.17–2.45) and co-occurring substance use (hazard ratio 2.95, 95% confidence intervals 1.99–4.38) were associated with increased rate of buprenorphine/naloxone treatment discontinuation.

Conclusions:

Younger patients and those with co-occurring substance use remain at higher risk of discontinuing buprenorphine/naloxone treatment for OUD in this population of ANAI people. Treatment programs serving ANAI people may consider paying special attention to patients with these characteristics to prevent treatment discontinuation. Our study highlights the need to address poly-substance use among ANAI people in treatment.
Can Individuals With Alcohol Use Disorder Sustain Non-abstinent Recovery? Non-abstinent Outcomes 10 Years After Alcohol Use Disorder Treatment
Authors: Witkiewitz Katie , Wilson Adam D. , Roos Corey R. , Swan Julia E. , Votaw Victoria R. , Stein Elena R. , Pearson Matthew R. , Edwards Karlyn A. , Tonigan Jeffrey Scott , Hallgren Kevin A. , Montes Kevin S. , Maisto Stephen A. , Tucker Jalie A.
Published: October 2020

Objective:

Four decades ago, the “controlled drinking” controversy roiled the alcohol field. Data have subsequently accumulated indicating that nonabstinent alcohol use disorder (AUD) recovery is achievable, but questions remain whether it is sustainable long-term. This study examined whether nonabstinent recovery at 3 years after AUD treatment is associated with better functioning at 10 years after treatment.

Methods:

Data were from the 10-year follow-up of Project MATCH (New Mexico site only, n 
= 146; 30.1% female, 58.6% non-White). Recovery was defined by latent profile analyses based on psychosocial functioning and alcohol consumption 3 years after treatment. Drinking practices and consequences, depression, purpose in life, and anger were assessed 10 years after treatment. Distal outcome analyses examined differences in drinking and functional outcomes at 10 years as a function of the 3-year latent profiles. Analyses were preregistered at https://osf.io/3hbxr.

Results:

Four latent profiles identified at 3 years after treatment (ie, low functioning frequent heavy drinkers, low functioning infrequent heavy drinkers, high functioning heavy drinkers, and high functioning infrequent nonheavy drinkers) were significantly associated with outcomes 10 years after treatment. The 2 high functioning profiles at 3 years had the highest level of psychological functioning at 10 years posttreatment, regardless of alcohol consumption level. Abstinence at 3 years did not predict better psychological functioning at 10 years.

Conclusions:

Nonabstinent AUD recovery is possible and is sustainable for up to 10 years after treatment. The current findings align with recent proposals to move beyond relying on alcohol consumption as a central defining feature of AUD recovery.
Mortality Predictors in Elderly Patients With Cardiogenic Shock on Venoarterial Extracorporeal Life Support. Analysis From the Extracorporeal Life Support Organization Registry*
Authors: Kowalewski Mariusz , Zieliński Kamil , Maria Raffa Giuseppe , Meani Paolo , Lo Coco Valeria , Jiritano Federica , Fina Dario , Matteucci Matteo , Chiarini Giovanni , Willers Anne , Simons Jorik , Suwalski Piotr , Gaudino Mario , Di Mauro Michele , Maessen Jos , Lorusso Roberto
Published: October 2020

OBJECTIVES:

Because significantly higher mortality is observed in elderly patients undergoing venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock, decision-making in this setting is challenging. We aimed to elucidate predictors of unfavorable outcomes in these elderly (≥ 70 yr) patients.

DESIGN:

Analysis of international worldwide extracorporeal life support organization registry.

SETTING:

Refractory cardiogenic shock due to various etiologies (cardiac arrest excluded).

PATIENTS:

Elderly patients (≥ 70 yr).

INTERVENTIONS:

Venoarterial extracorporeal membrane oxygenation.

MEASUREMENTS AND MAIN RESULTS:

Three age groups (70–74, 75–79, ≥80 yr) were in-depth analyzed. Uni- and multivariable analysis were performed. From January 1997 to December 2018, 2,644 patients greater than or equal to 70 years (1,395 [52.8%] 70–74 yr old, 858 [32.5%] 75–79 yr, and 391 [14.8%] ≥ 80 yr old) were submitted to venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock with marked increase in the most recent years. Peripheral access was applied in majority of patients. Median extracorporeal membrane oxygenation support duration was 3.5 days (interquartile range: 1.6–6.1 d), (3.9 d [3.7–4.6 d] in patients ≥ 80 yr) (p < 0.001). Weaning from extracorporeal membrane oxygenation was possible in 1,236 patients (46.7%). Overall in-hospital mortality was estimated at 68.3% with highest crude mortality rates observed in 75–79 years old subgroup (70.1%). Complications were mostly cardiovascular and bleeding, without apparent differences between subgroups. Airway pressures, 24-hour pH after extracorporeal membrane oxygenation start, extracorporeal membrane oxygenation duration, and renal replacement therapy were predictive of higher mortality. In-hospital mortality was lower in heart transplantation recipients, posttranscatheter aortic valve replacement, and pulmonary embolism; conversely, higher mortality followed extracorporeal membrane oxygenation institution after coronary artery bypass + valve and in decompensated chronic heart failure, and nearly 100% mortality followed in extracorporeal membrane oxygenation for sepsis.

CONCLUSIONS:

This study confirmed the remarkable increase of venoarterial extracorporeal membrane oxygenation use in elderly affected by refractory cardiogenic shock. Despite in-hospital mortality remains high, venoarterial extracorporeal membrane oxygenation should still be considered in such setting even in elderly patients, since increasing age itself was not linked to increased mortality, whereas several predictors may guide indication and management.
Cardiovascular Disease Screening in Pregnancy
Authors: SHERMAN-BROWN ALICE , HAMEED AFSHAN B.
Published: October 2020

Cardiovascular disease (CVD) has surpassed the traditional causes of pregnancy-related mortality, including hemorrhage and thromboembolism in the United States. CVD accounts for ~15.5% of all pregnancy-related deaths. Pregnancy is a “natural cardiovascular stress test” for a woman. The physiological changes in the maternal hemodynamics that are geared to accommodate the growing needs of the fetal-placental unit may also lead to symptoms that are indistinguishable from those of CVD, especially in the third trimester of pregnancy. It is imperative that an obstetric provider is able to differentiate symptoms of normal pregnancy from those of a pathologic process.
Automated blood pressure measurement in atrial fibrillation: validation process modification and evaluation of a novel professional device which detects atrial fibrillation and adapts its blood pressure measurement algorithm
Authors: Stergiou George S. , Kyriakoulis Konstantinos G. , Bountzona Ioanna , Menti Ariadni , Destounis Antonios , Kalogeropoulos Petros , Kollias Anastasios
Published: October 2020

Objectives:

Blood pressure (BP) measurement in atrial fibrillation (AF) patients is problematic and automated monitors are regarded as inaccurate. The optimal procedure for validating BP monitors in AF is questionable. This study evaluated the accuracy of a novel professional oscillometric upper-arm cuff device (Microlife WatchBP Office), which has an algorithm for detecting AF and then applies an AF-specific BP measurement algorithm. BP variability, which is inherently increased in AF patients, was considered in the analysis.

Methods:

Subjects with sustained AF were included in a validation study using the same arm sequential measurement method of the Universal Standard (ISO 81060-2:2018) for special populations. Analysis was performed in all subjects and separately in those with and without high reference BP variability (>12/8 mmHg SBP/DBP).

Results:

Thirty-five subjects with 105 paired test/reference BP measurements were included (mean age 76.3 ± 8.4 years, reference SBP/DBP 128.2 ± 19.5/72.5 ± 12.1 mmHg, pulse rate 68.3 ± 14.9 bpm). Validation Criterion 1 (mean difference ± SD) was 0.0 ± 7.7/0.2 ± 7.0 mmHg in all 105 BP pairs (threshold ≤5 ± 8 mmHg). Criterion 1 was 0.5 ± 6.1/−0.2 ± 6.8 mmHg in 18 subjects (54 BP pairs) with low reference BP variability and −0.6 ± 9.2/0.6 ± 7.3 mmHg in 17 (51 pairs) with high variability. Criterion 1 did not differ in pulse rate < 70 vs. ≥ 70 bpm Validation Criterion 2 (SD of differences for 35 individuals) was 5.38/6.20 mmHg (SBP/DBP; threshold ≤6.95/6.95).

Conclusion:

A technology which detects AF and activates an AF-specific BP measurement algorithm introduces a challenging solution for clinical practice. Validation of BP monitors in AF patients should not ignore their inherently high BP variability.
The Efficacy of Atropine Combined With Orthokeratology in Slowing Axial Elongation of Myopia Children: A Meta-Analysis
Authors: Gao Canran , Wan Shuling , Zhang Yuting , Han Jing
Published: October 2020

Objectives:

Previous studies have found that atropine can slow axial elongation and control the progression of myopia. Some ongoing trials have applied atropine combined with orthokeratology for myopia control, but few studies explored the effect of the strategy on axial elongation. This meta-analysis made a preliminary evaluation of the effect of atropine combined with orthokeratology on axial elongation to provide a reference for further researches.

Methods:

We performed a specific search on PubMed, EMBASE, Cochrane library, Web of Science, Ovid and Chinese electronic databases of VIP and Wanfang for randomized controlled trials, cohort studies and case-control studies conducted up to December 2019. The weighted mean difference (WMD) of mean change in axial elongation between the combination group of atropine and orthokeratology and the orthokeratology group was used for evaluation. Publication bias was detected using the Funnel plots test.

Results:

A total of five studies involving 341 participants younger than 18 years old met our inclusion criteria. The axial elongation was lower in the combination group of atropine and orthokeratology than that of the orthokeratology group (0.25 vs. 0.35; WMD=−0.09 mm, [95% confidence intervals, −0.15 to −0.04], Z=3.39, P=0.0007).

Conclusions:

This meta-analysis demonstrates atropine combined with orthokeratology is effective in slowing axial elongation in myopia children. This effect may be superior to that of the orthokeratology alone.
Congenital SARS-CoV-2 Infection in a Neonate With Severe Acute Respiratory Syndrome
Authors: Correia Cátia R. , Marçal Mónica , Vieira Filipa , Santos Edmundo , Novais Cristina , Maria Ana Teresa , Malveiro Duarte , Prior Ana Rita , Aguiar Marta , Salazar Anabela , Gouvêa Pinto Constança , Carvalho Rodrigues Luís , Pessanha Maria Ana , Borges Vítor , Isidro Joana , Gomes João Paulo , Duarte Sílvia , Vieira Luís , Costa Inês , Alves Maria João , Calhau Conceição , Guiomar Raquel , Tuna Madalena Lopo
Published: October 2020

Coronavirus disease, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is mainly transmitted through droplets, but other ways of transmission have been hypothesized. We report a case of vertical transmission of SARS-CoV-2 in a preterm born to an infected mother, confirmed by the presence of the virus in the neonatal blood, nasopharyngeal and oropharyngeal swabs collected in the first half an hour of life. The neonate presented with acute respiratory distress, similar to the findings in severely affected adults. This case highlights the importance of pregnancy, labor and neonatal period surveillance of affected mothers and their newborns.
Diagnosis of Hyper IgM syndrome in a Previously Healthy Adolescent Boy Presented with Cutaneous and Cerebral Cryptococcosis
Authors: Athipongarporn Athipat , Ittiwut Chupong , Manuyakorn Wiparat , Assawawiroonhakarn Surapat , Larbcharoensub Noppadol , Shotelersuk Vorasuk
Published: October 2020

X-linked hyper IgM (X-HIGM) syndrome is a combined immunodeficiency disease caused by mutations in the CD40LG gene, leading to a defect in immunoglobulin (Ig) class switching recombination and effector T-cell responses. X-HIGM patients usually present in early life with pyogenic bacterial and opportunistic infections. Herein, we report a previously healthy 13-year-old Thai boy who first presented with cutaneous and meningoencephalitis cryptococcosis. Whole-exome sequencing revealed that he was hemizygous for a missense c.514T>C (p.Tyr172His) in CD40LG, confirming a diagnosis of X-HIGM. This report demonstrates that X-HIGM could have an age of onset in teens and systemic cryptococcosis could be its presenting symptoms.
Epidemiology, Etiology and Clinical Aspects of Childhood Acute Encephalitis in a Tertiary Pediatric Hospital in Costa Rica
Authors: Sevilla-Acosta Fabricio , Gutiérrez-Mata Alfonso , Yock-Corrales Adriana , Bogantes-Ledezma Sixto , Pérez-Corrales Cristian , Camacho-Badilla Kattia
Published: October 2020

Background:

Limited data are available on childhood encephalitis in Latin America. Our study aimed to increase insight on clinical presentation, etiology and outcome of children with acute encephalitis in Costa Rica.

Methods:

We conducted a prospective, observational study during an 8-month period at the Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera” in Costa Rica. Case definition was according to “International Encephalitis Consortium” in children <13 years. We analyzed demographic characteristics, clinical symptoms, neurologic imaging, etiology, treatment and mortality.

Results:

Forty patients were identified. Mean age was 5 years and 57.5% were male. Most frequently neurologic symptoms were altered mental status (100.0%), headache (57.5%) and seizures (52.5%). Etiology was determined in 52.5% of cases. Probable or confirmed viral etiology was identified in 6 cases (15.0%) and bacterial etiology in also 6 cases (15.0%). A possible etiology was identified in 7 cases (17.5%). Autoimmune encephalitis was diagnosed in 2 patients (5.0%). Enterovirus and Streptococcus pneumoniae were the most common confirmed agents. No cases of herpes simplex virus were found. Etiology of 19 cases (47.5%) remained unknown. Sequelae were reported in 45.0% of patients. Mortality rate was 15.0% (6 cases), 3 caused by virus (adenovirus, human herpesvirus 6, enterovirus), 2 by bacteria (S. pneumoniae, Haemophilus influenzae type b) and 1 of unknown etiology. Diffuse cerebral edema was the most important mortality predictor (P < 0.001).

Conclusions:

Acute encephalitis in our study was associated with significant morbidity and mortality. Early and aggressive antiviral, antibiotic and anticerebral edema treatment is necessary when acute encephalitis is suspected.
Endothelial Dysfunction-related Neurological Bleeds with Continuous Flow-Left Ventricular Assist Devices Measured by Digital Thermal Monitor
Authors: Ali Areeba , Uribe Cesar , Araujo-Gutierrez Raquel , Cruz-Solbes Ana S. , Marcos-Abdala Hernan G. , Youker Keith A. , Guha Ashrith , Torre-Amione Guillermo , Nguyen Duc T. , Graviss Edward A. , Cooke John P. , Bhimaraj Arvind
Published: October 2020

Endothelial dysfunction has been demonstrated in patients with Continuous Flow-Left Ventricular Assist Devices (CF-LVADs) but association with adverse events has not been shown. We used a noninvasive, operator-independent device called VENDYS® to assess vasodilatory function based on digital thermal measurements postrelease of a brachial artery occlusion in ambulatory patients with CF-LVAD (n = 56). Aortic valve opening and pulse perception were also documented before the test. Median duration of CF-LVAD support was 438 days. The VENDYS® test generates a vascular reactivity index (VRI). Outcomes for the CF-LVAD patients were compared between VRI < 1 and VRI ≥ 1. The bleeding events were driven primarily by a difference in neurologic bleeds. Multivariate analysis showed that VRI < 1 correlated with future bleeding events (HR: 5.56; P = 0.01). The C-statistic with the VRI dichotomized as above was 0.82. There was a trend toward a worse survival in patients with poor endothelial function. Endothelial vasodilatory dysfunction measured by a simple test utilizing digital thermal monitoring can predict adverse bleeding events in patients with CF-LVADs.
SARS-CoV-2 Versus Influenza-associated Acute Respiratory Distress Syndrome Requiring Veno-venous Extracorporeal Membrane Oxygenation Support
Authors: Cousin Nicolas , Bourel Claire , Carpentier Dorothee , Goutay Julien , Mugnier Agnes , Labreuche Julien , Godeau Elise , Clavier Thomas , Grange Steven , Tamion Fabienne , Durand Arthur , Moussa Mouhamed D. , Duburcq Thibault ,   on behalf of the Lille Intensive Care COVID-19 Group
Published: October 2020

No study has compared patients with COVID-19-related refractory ARDS requiring veno-venous extracorporeal membrane oxygenation (V-V ECMO) to a relevant and homogenous control population. We aimed to compare the outcomes, the clinical characteristics, and the adverse effects of COVID-19 patients to a retrospective cohort of influenza patients. This retrospective case-control study was conducted in the ICUs of Lille and Rouen University Hospitals between January 2014 and May 2020. Two independent cohorts of patients with ARDS requiring V-V ECMO infected with either COVID-19 (n = 30) or influenza (n = 22) were compared. A 3-month follow-up was completed for all patients. Median age of COVID-19 and influenza patients was similar (57 vs. 55 years; p = 0.62). The 28-day mortality rate did not significantly differ between COVID-19 (43.3%) and influenza patients (50%, p = 0.63). There was no significant difference considering the cumulative incidence of ECMO weaning, hospital discharge, and 3-month survival. COVID-19 patients had a lower SAPS II score (58 [37–64] vs. 68 [52–83]; p = 0.039), a higher body mass index (33 [29–38] vs. 30 [26–34] kg/m2; p = 0.05), and were cannulated later (median delay between mechanical support and V-V ECMO 6 vs. 3 days, p = 0.004) compared with influenza patients. No difference in overall adverse events was observed between COVID-19 and influenza patients (70% vs. 95.5% respectively; p = 0.23). Despite differences in clinical presentation before V-V ECMO implantation, 28-day and 3-month mortality rate did not differ between COVID-19 and influenza patients. Considering the lack of specific treatment for COVID-19, V-V ECMO should be considered as a relevant rescue organ support.
Optimal Initial Workup in Patients With Superficial Primary Gastric MALT Lymphoma
Authors: Na Hee Kyong , Won Sung Hyun , Lee Jeong Hoon , Kim Ga Hee , Jung Kee Wook , Ahn Ji Yong , Kim Do Hoon , Choi Kee Don , Song Ho June , Lee Gin Hyug , Jung Hwoon-Yong
Published: October 2020

Background and Aims:

The prognosis of gastric mucosa-associated lymphoid tissue (MALT) lymphoma is favorable, especially in the absence of lymph node metastasis (LNM). We investigated LNM incidence and location in superficial type gastric MALT lymphoma.

Methods:

We performed a retrospective analysis of 450 patients newly diagnosed with gastric MALT lymphoma with tumor infiltration confined to the mucosa or submucosa as evidenced by endoscopic ultrasonography. LNM incidence and location were evaluated.

Results:

Of the 450 patients, most patients (434, 96.4%) were initially LNM negative as confirmed by computed tomography (CT) scanning. Sixteen patients (3.6%) were LNM positive. There was no difference in clinical characteristics between the 2 groups except for the extent of lymphoma involvement and endoscopic findings. Among 41 patients undergoing abdominal/pelvic CT (APCT) only, LNM was detected in 1 (2.4%). There were 8 LNM cases among 238 patients undergoing both APCT and chest CT (3.4%). Among 171 patients undergoing APCT, chest CT, and neck CT, 7 cases of LNM were detected (4.1%). The detection rates for each CT were as follows: abdominal CT, 13/450 (2.9%); chest CT, 6/408 (1.5%); and neck CT, 1/171 (0.6%). Among 6 patients with chest CT-positive findings, 3 showed no evidence of LNM on APCT.

Conclusion:

LNM was an infrequent finding in gastric MALT lymphoma patients with tumor infiltration confined to the mucosa or submucosa. Besides endoscopy and endoscopic ultrasonography, APCT and chest CT are considered as optimal initial workup modalities in patients with assumed primary superficial gastric MALT lymphoma.
Vitamin D in Children With Inflammatory Bowel Disease
Authors: El Amrousy Doaa , El Ashry Heba , Hodeib Hossam , Hassan Samir
Published: October 2020

Background:

Vitamin D has anti-inflammatory and immune regulatory functions.

Goals:

The authors investigated the effect of vitamin D supplementation in children with inflammatory bowel disease (IBD) and hypovitaminosis D on disease activity, quality of life (QOL), inflammatory markers, and cytokines.

Study:

This randomized double-blinded controlled clinical trial included 120 children with IBD and hypovitaminosis D; 22 of them were excluded later. Patients were randomized to receive either oral vitamin D3 in a dose of 2000 IU/day or placebo for 6 months. The primary outcome was to evaluate the effect of vitamin D supplementation on the IBD activity score. The secondary outcomes were to assess the QOL, inflammatory markers, cytokines, the safety of vitamin D, and to correlate serum vitamin D level with various clinical and laboratory variables.

Results:

Vitamin D supplementation significantly decreased the IBD activity score in the vitamin D group compared with the placebo group. Moreover, QOL significantly improved after vitamin D supplementation. Inflammatory markers, for example, erythrocyte sedimentation rate, C-reactive protein, and fecal calprotectin and interleukin-2 IL-12, IL-17, IL-23, and tumor necrosis factor-alpha significantly decreased in the vitamin D group. However, IL-10 significantly increased after vitamin D supplementation. Vitamin D was significantly inversely correlated with the activity score, QOL score, levels of all inflammatory markers, the frequency of hospitalization, and emergency department visits.

Conclusion:

Vitamin D supplementation may have a beneficial effect in children with IBD.
Efficacy and Safety of Modified Dual Therapy as the First-line Regimen for the Treatment of Helicobacter pylori Infection
Authors: Huang Qiuyue , Shi Zongming , Cheng Hong , Ye Hui , Zhang Xuezhi
Published: October 2020

Background:

In an era of antibiotic resistance, modified dual therapy has been paid much attention because of simple drug composition and low resistance of amoxicillin. However, its eradication rate as a first-line regimen remains controversial. This study is to evaluate the efficacy and safety of modified dual therapy for the initial treatment of Helicobacter pylori (H. pylori) infection compared with mainstream first-line therapies.

Methods:

PubMed, the Cochrane Library, and Embase were searched for randomized clinical trials evaluating the efficacy and safety of modified dual therapy as the initial treatment for H. pylori eradication compared with guideline-recommended first-line therapies. A meta-analysis was conducted using Review Manager 5.3 and dichotomous data were estimated by the risk ratio (RR) with the 95% confidence interval (CI). We also performed subgroup analysis according to control groups and studies with antibiotic susceptibility tests.

Results:

Eight studies including 1672 patients with H. pylori infection met the selection criteria and were assessed. The meta-analysis demonstrated that modified dual therapy achieved similar efficacy [85.83% vs. 86.77%, RR 0.99 (95% CI, 0.95-1.03), intention-to-treat analysis; 89.53% vs. 90.45%, RR 0.99 (95% CI, 0.96-1.02), per-protocol analysis] and compliance [95.77% vs. 95.56%, RR 1.00 (95% CI, 0.98-1.02)] compared with recommended first-line regimens. In addition, there were no significant differences in comparing the eradication rate of modified dual therapy with clarithromycin triple therapy, bismuth quadruple therapy, and concomitant therapy, respectively. Subgroup analysis based on the studies with antibiotic susceptibility tests also confirmed a similar efficacy. However, modified dual therapy showed fewer adverse effects [8.70% vs. 22.38%, RR 0.39 (95% CI, 0.28-0.54)], with a significant difference (P<0.00001).

Conclusion:

Modified dual therapy achieved equal efficacy and compliance compared with recommended first-line regimens for H. pylori infection, and generally modified dual therapy showed fewer side effects.
Dietary protein interventions to improve nutritional status in end-stage renal disease patients undergoing hemodialysis
Authors: Hendriks Floris K. , Kooman Jeroen P. , van Loon Luc J.C.
Published: October 2020

Purpose of review

Poor nutritional status is prevalent among end-stage renal disease patients undergoing hemodialysis. Chronic hemodialysis patients show an accelerated decline in skeletal muscle mass and strength, which is associated with higher mortality rates and a reduced quality of life. The current review aims to summarize recent advances regarding underlying causes of muscle loss and interventions that support muscle mass maintenance in patients with chronic hemodialysis.

Recent findings

Muscle maintenance in chronic hemodialysis patients is compromised by low dietary protein intake levels, anabolic resistance of skeletal muscle tissue, sedentary behavior, and amino acid removal during hemodialysis. Studies assessing the effect of increased protein intake on nutritional status generally show beneficial results, especially in hypoalbuminemic chronic hemodialysis patients. The muscle protein synthetic response following protein ingestion in chronic hemodialysis patients may be enhanced through incorporation of structured physical activity and/or concurrent ketoacid ingestion.

A coordinated program that combines nutritional and physical activity interventions is likely required to attenuate the decline in muscle mass and strength of chronic hemodialysis patients. Nephrologists, dieticians, and exercise specialists should collaborate closely to establish guidelines regarding the appropriate quantity and timing of protein ingestion. In addition, they should provide tailored nutritional and physical activity interventions for chronic hemodialysis patients (see video, Supplemental Digital Content 1, Video abstract, http://links.lww.com/COCN/A14).
Noninvasive strategies for colorectal cancer screening: opportunities and limitations
Authors: Lou Susan , Shaukat Aasma
Published: October 2020

Purpose of review

In the United States, only 67% of patients are up to date with colorectal cancer (CRC) screening. While colonoscopy is highly sensitive and specific for CRC and precursor lesion detection and removal, it is invasive, expensive and resource heavy. Hence, there is an unfulfilled need for multiple modality CRC screening that can improve current CRC screening rates and may be resource effective strategies when used in conjunction with a colonoscopy program. Our review highlights the complementary, often underutilized, noninvasive CRC screening methods with a focus on performance, risks, benefits, and recent updates.

Recent findings

Studies demonstrate that fecal immunochemical testing (FIT) is superior to guaiac-based fecal occult blood tests for CRC screening. Studies show superiority of multitarget stool DNA test to FIT in sensitivity, though with concern for decreased specificity in setting of one-time tests. Technical advances continue to improve accuracy of colon capsule endoscopy. There are ongoing studies to characterize often difficult-to-detect high-risk lesions in computed tomography colonography. Septin 9 continues to have suboptimal accuracy for CRC screening, but has been shown to be associated with more advanced, invasive CRC stages.

There are ongoing advances in noninvasive screening modalities for CRC; these should be considered as alternatives to colonoscopy in specific patient populations.
Solitary rectal ulcer syndrome
Authors: Felt-Bersma Richelle J.F.
Published: October 2020

Purpose of review

Solitary rectal ulcer syndrome (SRUS) is a rare disease which can puzzle the gastroenterologist. A review of the syndrome and new treatment options are discussed.

Recent findings

Its association with dyssynergia in general supports an important role for pelvic floor biofeedback, which can be successful in patients with SRUS. No other novel.

Awareness of this benign syndrome is important; endoscopic diagnosis and histological confirmation opens the way to a guided lifestyle therapy with regulation of defecation and pelvic floor biofeedback. A reluctance to proceed to surgery seems warranted.

Video abstract

http://links.lww.com/COG/A34
Posterior glottic stenosis: management and outcomes
Authors: DeHart Austin N. , Richter Gresham T.
Published: October 2020

Purpose of review

Pediatric posterior glottic stenosis (PGS) is a challenging clinical entity with multiple treatment options. This review describes the evaluation of patients with PGS and discusses existing surgical techniques.

Recent findings

PGS secondary to a distinct scar band between the vocal folds can often be effectively managed with endoscopic division and surveillance. More advanced glottic scarring that also involves the interarytenoid mucosa, cricoarytenoid joints, or subglottis merits a more thorough investigation and repair. A postcricoid mucosal advancement flap can be employed in select adolescent or adult PGS, but long-term cricoarytenoid joint mobility is difficult to restore once it has been fixed. Younger pediatric patients have smaller airways and frequent concurrent subglottic stenosis which is better addressed with cartilage grafting.

Surgical success in pediatric PGS depends on careful preoperative airway assessment and the accurate characterization of airway stenosis. A surgical technique should be chosen based on the severity and extent of stenosis.
Knowledge of Endometrial Cancer Risk Factors in a General Gynecologic Population
Authors: Washington Christina R. , Haggerty Ashley , Ronner Wanda , Neff Pamela M. , Ko Emily M.
Published: October 2020

(Abstracted from Gynecol Oncol 2020;158:137–142)

Obesity is a preventable condition that is associated with heart disease, diabetes, certain types of cancer, and innumerable other conditions causing significant morbidity and mortality in the United States. Despite that type 1 endometrial cancer (EC) was the first cancer to be associated with obesity, many women are unaware of the evidence-based association between obesity and EC.
In Vitro Fertilization and Risk for Hypertensive Disorders of Pregnancy: Associations With Treatment Parameters
Authors: Luke Barbara , Brown Morton B. , Eisenberg Michael L. , Callan Caitriona , Botting Beverley J. , Pacey Allan , Sutcliffe Alastair G. , Baker Valerie L.
Published: October 2020

(Abstracted from Am J Obstet Gynecol 2020;222:350.e1–350.e13)

With an increasing proportion of pregnancies being conceived using assisted-reproductive technology, important changes to in vitro fertilization (IVF) such as the use of cryopreserved oocytes or embryos have been made. It is now established that adverse maternal and infant perinatal outcomes are associated with both assisted reproductive technologies and subfertility.
Skull Fracture Patterns and Morphologies Among Fatal Motorcycle Traffic Accident Victims in Vietnam
Authors: Anh Nguyen Tuan , Hung Luu Sy , Xuan Nguyen Thanh , Lap Phan Duc , Tuan Dinh Thanh , Kien Vu Duy
Published: October 2020

We aim to describe morphological structures of skull fractures and relevant factors in motorcycle accident victims in Vietnam. This work represents a retrospective cross-sectional study based on forensic reports of fatal motorcycle accident victims. Between January 2013 and August 2019, a total of 226 fatal motorcycle accident patients with skull fracture diagnoses were enrolled. Linear and depressed fractures were the common patterns (46.0% and 37.2% of cases, respectively), whereas stellate (11.5%) fractures were rare. Fractures of the temporal bone (68.6% of cases) and basilar skull (60.6%) were the most common, whereas fractures of the parietal bone were the least common (9.7%). Two or more patterns of skull fracture were recorded in 25.5% of cases, and 2 or more fracture locations were recorded in 76.6% of cases. Fractures of the parietal bone were associated with victims not wearing a helmet. In addition, fractures of the basilar skull were more likely to occur among victims with alcohol consumption. We found the common pattern of skull fractures was linear and depressed fractures, and the common location of skull fractures was temporal and basilar bone. Further studies that include larger sample sizes and collect more information should be conducted to better understand relationships between skull fractures and related factors.
Point-of-Care Ultrasound for Central Venous Assessment in the Emergency Department
Authors: Pandya Lori , Cooper Michael , Patel Nishit , Leonard David , Fernandes Neil , Spear Dave , Nesiama Jo-Ann
Published: October 2020

Objectives

The objective of this study was to estimate the width, height, and depth of the femoral vein (FV) and internal jugular vein (IJV), both sites of potential central line placement in children, using point-of-care ultrasound.

Methods

This was a prospective observational study. Point-of-care ultrasound was used to measure the width, height, and depth of the right FV and IJV in 100 children. The primary outcome was a comparison of the widths of the FV and the IJV in the same child. Our primary hypothesis was that the IJV would be wider than the FV. Secondary outcome measures included comparison of the heights and depths the FV and IJV and description of vessel overlap frequency between the 2 sites.

Results

A total of 106 children were enrolled, with 6 subjects excluded, and equally divided into 5 age groups (0–30 days, 1–24 months, 2–5 years, 6–11 years, and 12–17 years). The FV/IJV width ratios (95% confidence interval) by age were 0.58 (0.49–0.68), 0.53 (0.43–0.66), 0.57 (0.49–0.67), 0.68 (0.55–0.85), and 0.73 (0.62–0.85), all P < 0.002. The FV/IJV height ratios were <1 in all age groups, with P < 0.003 in the 4 youngest age groups. The FV/IJV depth ratios were >1 in 6 to 11 years (P = 0.018) and 12 to 17 years (P < 0.001).

Conclusions

The IJV was significantly wider and taller than the FV in the same child in all age groups. The FV was significantly deeper than the IJV in children 6 years and older. This supports the use of the IJV as a potential site when placing ultrasound-guided central lines in children.
Schistosoma mansoni Infection Is Associated With a Higher Probability of Tuberculosis Disease in HIV-Infected Adults in Kenya
Authors: McLaughlin Taryn A. , Nizam Azhar , Hayara Felix Odhiambo , Ouma Gregory Sadat , Campbell Angela , Khayumbi Jeremiah , Ongalo Joshua , Ouma Samuel Gurrion , Shah N. Sarita , Altman John D. , Kaushal Deepak , Rengarajan Jyothi , Ernst Joel D. , Blumberg Henry M. , Waller Lance A. , Gandhi Neel R. , Day Cheryl L. , Benkeser David
Published: October 2020

Background:

Helminth infections can modulate immunity toMycobacterium tuberculosis(Mtb). However, the effect of helminths, includingSchistosoma mansoni(SM),on Mtb infection outcomes is less clear. Furthermore, HIV is a known risk factor for tuberculosis (TB) disease and has been implicated in SM pathogenesis. Therefore, it is important to evaluate whether HIV modifies the association between SM and Mtb infection.

Setting:

HIV-infected and HIV-uninfected adults were enrolled in Kisumu County, Kenya, between 2014 and 2017 and categorized into 3 groups based on Mtb infection status: Mtb-uninfected healthy controls, latent TB infection (LTBI), and active TB disease. Participants were subsequently evaluated for infection with SM.

Methods:

We used targeted minimum loss estimation and super learning to estimate a covariate-adjusted association between SM and Mtb infection outcomes, defined as the probability of being Mtb-uninfected healthy controls, LTBI, or TB. HIV status was evaluated as an effect modifier of this association.

Results:

SM was not associated with differences in baseline demographic or clinical features of participants in this study, nor with additional parasitic infections. Covariate-adjusted analyses indicated that infection with SM was associated with a 4% higher estimated proportion of active TB cases in HIV-uninfected individuals and a 14% higher estimated proportion of active TB cases in HIV-infected individuals. There were no differences in estimated proportions of LTBI cases.

Conclusions:

We provide evidence that SM infection is associated with a higher probability of active TB disease, particularly in HIV-infected individuals.
Cardiovascular Risk Factors and Coronary Calcification in a Middle-aged Dutch Population
Authors: Xia Congying , Vonder Marleen , Sidorenkov Grigory , Den Dekker Martijn , Oudkerk Matthijs , van Bolhuis Jurjen N. , Pelgrim Gert J. , Rook Mieneke , de Bock Geertruida H. , van der Harst Pim , Vliegenthart Rozemarijn
Published: October 2020

Purpose:

To assess the presence of coronary artery calcium (CAC) and its association with cardiovascular risk factors and Systematic COronary Risk Evaluation (SCORE) risk in a middle-aged Dutch population.

Methods:

Classic cardiovascular risk factors and CAC were analyzed in 4083 participants aged 45 to 60 years (57.9% women) from the population-based ImaLife study. CAC scores were quantified on noncontrast cardiac CT scans. Age-specific and sex-specific distribution of CAC categories (0, 1 to 99, 100 to 299, ≥300) and percentiles were determined. SCORE risk categories (<1%, ≥1% to 5%, and ≥5%) were compared with CAC distribution. Population attributable fractions (PAFs) of classic risk factors for CAC were estimated.

Results:

CAC was present in 54.5% male and 26.5% female participants. The percentage of individuals with CAC increased with increasing age. Mean SCORE was 2.0% in men and 0.7% in women. In SCORE <1%, 32.7% of men and 17.1% of women had CAC. In men with SCORE ≥5%, 26.9% had no CAC. Only 0.1% of women had SCORE ≥5%. PAF of classic risk factors for CAC was 18.5% in men and 31.4% in women. PAF was highest for hypertension (in men 8.0%, 95% confidence interval, 4.2%-11.8%; in women 13.1%, 95% confidence interval, 7.9%-18.2%) followed by hypercholesterolemia and obesity.

Conclusion:

In this middle-aged cohort, more than half of the men and a quarter of the women had CAC. One out of 4 men at high risk (SCORE ≥5%) could be placed into a lower risk category owing to absence of CAC. Thus, adding CAC scoring to SCORE could have considerable effect on cardiovascular risk classification. Elimination of exposure to classic risk factors could reduce limited proportion of CAC in a middle-aged population.
Treatment Strategies of Complications of Breast Implants Associated With Ventriculoperitoneal Shunts
Authors: Orfahli Lynn M. , Alleyne Brendan J. , Patel Anooj , Isakov Raymond , Papay Francis A. , Gurunian Raffi
Published: October 2020

Breast augmentation is among the most commonly performed cosmetic procedures in the United States. As these patients age or develop comorbidities, surgeons across many other disciplines will inevitably encounter these patients in their own practices. Consequently, surgeons must be aware of the potential interactions between breast implants and devices commonly used in their fields. This case, the second of its kind encountered by our own department, describes a woman who suffered one such interaction: migration and coiling of a ventriculoperitoneal shunt around her breast implant. A systematic review was conducted to characterize breast-related ventriculoperitoneal shunt complications reported in the literature and generate an algorithm for management of the most commonly reported scenarios. Recognition of potential complications will aid surgeons in appropriate operative planning and prevention of these adverse events.
Surgical and Patient-Reported Outcomes in Patients With PEEK Versus Titanium Cranioplasty Reconstruction
Authors: Asaad Malke , Taslakian Editt N. , Banuelos Joseph , Abu-Ghname Amjed , Bite Uldis , Mardini Samir , Van Gompel Jamie J. , Sharaf Basel
Published: October 2020

Background:

Several materials are available for cranioplasty reconstruction and consensus regarding the ideal material is lacking. The goal of this study is to present surgical and patient-reported outcomes with PEEK versus Titanium alloplastic cranioplasty.

Methods:

A retrospective review of all patients who underwent alloplastic cranioplasty with PEEK or Titanium from 2010 to 2017 was conducted. Patient demographics and complications were abstracted and analyzed. Information regarding patient-reported outcomes was collected through a telephone survey.

Results:

A total of 72 patients (median age 55 years) who underwent 77 cranioplasties were identified (38% PEEK, n = 29; 62% Titanium, n = 48). Overall complication rates were similar between the PEEK (24%, n = 7) and Titanium groups (23%, n = 11), P = 0.902. Similarly, implant failure was similar between the 2 groups (7% in PEEK (n = 2), 13% in Titanium (n = 6), P = 0.703). History of radiation was associated with increased rate of infection in patients with Titanium mesh cranioplasty (38% in radiated patients (n = 3), 3% in nonradiated patients (n = 1), P = 0.012) but not PEEK implants (0% infection rate in radiated patients (n = 0), 15% in nonradiated patients (n = 4), P = 1.000). A total of 24 patients (33% response rate) participated in the telephone survey. All PEEK cranioplasty patients who responded to our survey (n = 13) reported good to excellent satisfaction, while 72% of our titanium mesh cohort (n = 8) described good or excellent satisfaction and 27% (n = 3) reported acceptable result.

Conclusion:

Cranial reconstruction is associated with high satisfaction among cranioplasty patients with PEEK or Titanium showing comparable complications, failure, and patient-reported satisfaction rates. Patients with history of radiotherapy demonstrated a higher infection rate when titanium mesh was used.