bluuebunny/crossref_metadata_2025 huggingface dataset:
Dantrolene Ameliorates Impaired Neurogenesis and Synaptogenesis in Induced Pluripotent Stem Cell Lines Derived from Patients with Alzheimer’s Disease
Authors: Wang Yong , Liang Ge , Liang Shuqing , Mund Rachel , Shi Yun , Wei Huafeng
Published: March 2020

Background

Overactivation of ryanodine receptors and the resulting impaired calcium homeostasis contribute to Alzheimer’s disease–related pathophysiology. This study hypothesized that exposing neuronal progenitors derived from induced pluripotent stems cells of patients with Alzheimer’s disease to dantrolene will increase survival, proliferation, neurogenesis, and synaptogenesis.

Methods

Induced pluripotent stem cells obtained from skin fibroblast of healthy subjects and patients with familial and sporadic Alzheimer’s disease were used. Biochemical and immunohistochemical methods were applied to determine the effects of dantrolene on the viability, proliferation, differentiation, and calcium dynamics of these cells.

Results

Dantrolene promoted cell viability and proliferation in these two cell lines. Compared with the control, differentiation into basal forebrain cholinergic neurons significantly decreased by 10.7% (32.9 ± 3.6% vs. 22.2 ± 2.6%, N = 5, P = 0.004) and 9.2% (32.9 ± 3.6% vs. 23.7 ± 3.1%, N = 5, P = 0.017) in cell lines from sporadic and familial Alzheimer’s patients, respectively, which were abolished by dantrolene. Synapse density was significantly decreased in cortical neurons generated from stem cells of sporadic Alzheimer’s disease by 58.2% (237.0 ± 28.4 vs. 99.0 ± 16.6 arbitrary units, N = 4, P = 0.001) or familial Alzheimer’s disease by 52.3% (237.0 ± 28.4 vs.113.0 ± 34.9 vs. arbitrary units, N = 5, P = 0.001), which was inhibited by dantrolene in the familial cell line. Compared with the control, adenosine triphosphate (30 µM) significantly increased higher peak elevation of cytosolic calcium concentrations in the cell line from sporadic Alzheimer’s patients (84.1 ± 27.0% vs. 140.4 ± 40.2%, N = 5, P = 0.049), which was abolished by the pretreatment of dantrolene. Dantrolene inhibited the decrease of lysosomal vacuolar-type H+-ATPase and the impairment of autophagy activity in these two cell lines from Alzheimer’s disease patients.

Conclusions

Dantrolene ameliorated the impairment of neurogenesis and synaptogenesis, in association with restoring intracellular Ca2+ homeostasis and physiologic autophagy, cell survival, and proliferation in induced pluripotent stem cells and their derived neurons from sporadic and familial Alzheimer’s disease patients.

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What We Already Know about This Topic

What This Article Tells Us That Is New
The Impact of Multiple Comorbid Mental Health Disorders on Health-related Quality of Life Following ACDF
Authors: Mangan John J. , Tadley Madeline , Divi Srikanth N. , Stull Justin D. , Goyal Dhruv K.C. , McKenzie James C. , Casper David S. , Galetta Matthew S. , Kaye Ian D. , Kurd Mark F. , Woods Barrett I. , Radcliff Kris E. , Rihn Jeffery A. , Anderson David G. , Hilibrand Alan S. , Kepler Christopher K. , Vaccaro Alexander R. , Schroeder Gregory D.
Published: March 2020

Study Design:

Retrospective comparative study.

Objective:

The goal was to determine whether comorbid depression and/or anxiety influence outcomes after anterior cervical discectomy and fusion (ACDF) for patients with degenerative cervical pathology.

Background Data:

The role preoperative mental health has on patient reported outcomes after ACDF surgery is not well understood.

Methods:

Patients undergoing elective ACDF for degenerative cervical pathology were identified. Patients were grouped based on their preoperative mental health comorbidities, including patients with no history, depression, anxiety, and those with both depression and anxiety. All preoperative medical treatment for depression and/or anxiety was identified. Outcomes including Physical Component Score (PCS-12), Mental Component Score (MCS-12), Neck Disability Index (NDI), Visual Analogue Scale neck pain score (VAS Neck ), and Visual Analogue Scale arm pain score (VAS Arm) were compared between groups from baseline to postoperative measurements using multiple linear regression analysis—controlling for factors such as age, sex, and body mass index, etc. A P-value <0.05 was considered statistically significant.

Results:

A total of 264 patients were included in the analysis, with an average age of 53 years and mean follow-up of 19.8 months (19.0–20.6). All patients with a diagnosis of depression or anxiety also reported medical treatment for the disease. The group with no depression or anxiety had significantly less baseline disability than the group with 2 mental health diagnoses, in MCS-12 (P=0.009), NDI (P<0.004), VAS Neck (P=0.003), and VAS Arm (P=0.001) scores. Linear regression analysis demonstrated that increasing occurrence of mental health disorders was not a significant predictor of change over time for any of the outcome measures included in the analysis.

Conclusions:

Despite more severe preoperative symptoms, patients with a preoperative mental health disorder(s) demonstrated significant improvement in postoperative outcomes after ACDF. No differences were identified in postoperative outcomes between each of the groups.

Level of Evidence:

Level III.
Sedation Analgesia for Orthopedic Procedures: An Analysis of Cost and Length of Stay in a Level 1 Trauma Center
Authors: Ghasem Alexander D. , Huntley Samuel R. , Butler Alexander J. , Geller Joseph S. , Summers Spencer H. , Dodds Seth D.
Published: March 2020

Orthopedic reductions can be performed using a wide range of sedation types. Ideally, minimal sedation is applied in the emergency department (ED). In our institution, however, conscious sedation is performed in the ED but is largely unavailable in our trauma center (TC). Therefore, we retrospectively evaluated clinical outcomes and monetary costs associated with identical procedures performed in these different locations. A total of 297 patients were identified: 189 were treated in the TC, and 108 were managed in the ED. A subset of patients were matched by age, injury, and Injury Severity Score. Medical charts were reviewed to identify total charges and length of stay (LOS) for patients presenting to the TC versus the ED. Pearson χ2 test or Fisher exact test were used to compare categorical variables while Student t test or Mann-Whitney U test were used to compare continuous variables between the matched groups. Mean LOS for patients presenting to the TC (50.4 h, SD=55.8 h) was higher (P=0.015) than for patients presenting to the ED (13.0 h, SD=9.8 h). Mean procedural charges for patients presenting to the TC ($3,878, SD=$1272) were higher (P=<0.0001) than for patients presenting to the ED ($1500, SD=$514.5). Complication rates and outcomes at follow-up showed no apparent difference. Orthopedic bedside procedures performed under conscious sedation afford advantages over general anesthesia including reduced LOS and diminished patient charges.

Level of Evidence: Level III–therapeutic.
“Locking the Head Technique” For Femoral Head Removal in Intracapsular Neck Femur Fractures
Authors: Ansari Naved F. , Sonawane Dhiraj , Mehta Ajit K. , Pawar Eknath
Published: March 2020

Background:

Intracapsular neck femur fractures are one of the most commonly operated fractures. Head excision is done with engagement of corkscrew, which is a difficult step especially in subcapital type of fractures as the head femur rotates and spins while engaging the corkscrew and slips off and thereby requiring multiple attempts for corkscrew engagement and risking the head with a cut through and damage to the head and the acetabulum. We have a simple technique which can make engaging the corkscrew in the head easier and thereby making the femoral head removal easier and safer.

Technique:

Using a 2 mm guide wire placed in the head after exposure and Locking the Head, to stabilize it before placing the corkscrew then engaging the corkscrew firmly and removing the head with crockscrew with ease.

Discussion:

Improves accuracy of corkscrew fitting in the head and retaining the contour of the head and thereby easing the removal of the head and making the technique easier.
A Portal Adoption Program to Enhance Patient Satisfaction in Primary Care
Authors: Crockett Shelli , Carter-Templeton Heather
Published: March 2020

Patient engagement technologies have become a focal point for defining quality in government and medical practice arenas. Patient portals are recognized as a promising mechanism to foster patient engagement and, as such, have become embedded in major healthcare reform initiatives. Despite sweeping implementation endeavors, portal adoption rates among patients remain low and create a significant gap in quality-based reimbursement. The purpose of this research was to evaluate a 12-week portal adoption program in the primary care setting featuring customized tablets with a patient-centric design for targeted point-of-contact portal registration. This project focused on three objectives: (1) achieve a 75% metric for portal adoption to align with highest tier adopters; (2) evaluate patient satisfaction for measuring perceived ease-of-use and usefulness of system; and (3) assess cost-effectiveness in determining sustainability and potential to replicate the initiative throughout other primary care settings. An outcome evaluation of the program revealed a 90% portal utilization rate, 94% new patient portal adoption rate, and 79% existing patient portal adoption rate during the data collection period. A χ
2 analysis revealed a statistically significant difference in patient satisfaction scoring relative to efficiency, quality of care, and safety of information based on sex and insurance carrier demographics.
Differences of maternal mortality rate between Shanghai and New York city from the perspective of regulatory policy
Authors: Li Li , Li Cheng-Yue , Zhou Qing-Yu , Pu Chuan , Xu Ling-Zhong , Xu Tian-Qiang , Hao Chao , Hu Zhi , Hao Mo
Published: March 2020

Background

Regulatory policy (RP) is known as a major factor to improve health care system performance. A significant difference in maternal mortality rates (MMRs) was observed between New York city (NYC) and Shanghai (SH), both first-class international metropolises. This study aims to adopt a quantitative evaluation model to analyze whether RP differences contribute to the different MMRs of the two cities.

Methods

Based on collection of all publicly released policy documents regarding maternal health in the two cities, we assessed and compared the status of their maternal health care RPs from 2006 to 2017 through a series of quantitative indicators as regulatory elements coverage rate (RECR), departmental responsibility clarity rate (DRCR), and accountability mechanism clarity rate (AMCR), based on two characteristics of comprehensiveness and effectiveness of RPs. Pearson correlation analysis, principal component analysis, and linear regression analysis were used to test the relationships between the indicators and MMR in SH and NYC.

Results

By 2017, disparities of maternal health care RP are found between SH and NYC, from the indicators of RECR (100% vs. 77.0%), DRCR (38.9% vs. 45.1%), and AMCR (29.2% vs. 22.5%). From 2006 to 2017, RECR, DRCR, and AMCR in SH have shown a higher growth of 8.7%, 53.2%, and 45.2%, compared with growth of 25.0%, 12.5%, and 2.9% in NYC. The three indicators were found all negatively correlated with MMR in SH (Coefficients = −0.831, −0.833, and −0.909, and P < 0.01), while only RECR and DRCR had negative correlation with MMR in NYC (Coefficients = −0.736 and −0.683, and P < 0.05). Linear regression showed that the principal components of the three indicators were found with significant impact on MMRs both in SH (R = 0.914, R
2 = 0.836, P < 0.001) and NYC (R = 0.854, R
2 = 0.357, P = 0.04).

Conclusion

Compared with NYC, the more comprehensive and effective maternal health care RPs in SH had a stronger impact on MMR control, which contributed to the differences between the two cities’ MMRs to some extent. The methods and indicators we adopted for assessment are reasonable and comparable.
Erythema Migrans and Interface Changes: More Than a Fortuitous Association
Authors: Tekin Burak , Song Yali , DiCostanzo Damian , Lee Bonnie A.
Published: March 2020

The histology of erythema (chronicum) migrans (ECM) is classically described as a nonspecific perivascular infiltrate with a variable number of plasma cells and eosinophils. However, deviations from this pattern were described, such as focal interface changes or spongiosis, potentially posing a clinicopathological challenge. In this study, cases submitted with a serologically confirmed, clinically unequivocal, or highly suspicious diagnosis of ECM/Lyme disease between January 01, 2016, and September 01, 2018, were retrieved from the electronic database system and reviewed to delineate the histopathologic features of ECM. The series consisted of 14 cases. A superficial perivascular lymphocytic infiltrate was noted in all biopsies, accompanied by a deep and/or interstitial inflammatory infiltrate in 9 cases (64%). The inflammation ranged from relatively sparse to dense and prominent. At least focal interface changes were noted in 12 biopsies (86%). Eosinophils and plasma cells were noted in 7 (50%) and 10 (71%) cases, respectively. From a histologic standpoint, ECM is a protean entity and may manifest with a variable density of perivascular and/or interstitial lymphocytic infiltrate admixed with eosinophils and/or plasma cells and accompanied by focal interface dermatitis. Within the appropriate clinical context, ECM should be considered in the differential diagnosis of focal interface and/or sparse perivascular dermatitis.
TOPOGRAPHIC OPTICAL COHERENCE TOMOGRAPHY SEGMENTATION SHOWS LIMITED ELLIPSOID ZONE RECOVERY IN MILD HYDROXYCHLOROQUINE RETINOPATHY
Authors: de Sisternes Luis , Pham Brandon H. , Durbin Mary , Marmor Michael F.
Published: March 2020

Purpose:

Optical coherence tomography (OCT) cross-sections have shown limited ellipsoid zone (EZ) improvement in mild hydroxychloroquine (HCQ) retinopathy within a few years after drug cessation. However, the extent, functional significance, and stability of such changes over time remain unclear.

Methods:

We created en face EZ maps using automated pixel-by-pixel segmentation for four patients with early-moderate HCQ toxicity followed for 6-8 years after drug cessation. These maps were compared with OCT cross-sections, fundus autofluorescence, and automated 10-2 visual fields.

Results:

One patient had no EZ line loss; one had stable EZ loss throughout follow-up; two showed 30 to 40% reduction in the area of loss, largely in the first 2 years. This limited recovery mostly occurred in regions where the EZ line was only thinned or fragmented; other similar areas did not improve. Fundus autofluorescence hyperfluorescence and visual fields did not show consistent correlation with topography.

Conclusion:

Anatomic EZ recovery, when present, was restricted to regions of mild damage and did not correlate with fundus autofluorescence or improvement in visual fields. Topographic mapping seemed no more sensitive locally than cross-sectional OCT but may aid detection and longitudinal follow-up of toxicity by showing early damage or changes in the macula that could be missed with individual cross-sections.
Clearance of Immunodeficiency-associated Vaccine-derived Poliovirus Infection With Pocapavir
Authors: Copelyn Julie , Hincks Jeffrey R. , Wilmshurst Jo M. , Petersen Wonita , Howard Wayne , Jallow Sabelle , Moonsamy Shelina , Seakamela Lerato , Suchard Melinda , Collett Marc S. , Eley Brian
Published: March 2020

Pocapavir exhibits antiviral activity against both polio and nonpolio enteroviruses. There is limited experience of the use of this investigational drug in young children with enteroviral infection. We describe the successful clearance of prolonged immunodeficiency-associated vaccine-derived type 3 poliovirus infection by pocapavir in an infant with underlying X-linked agammaglobulinemia.
Immunology and ovarian cancers
Authors: Lee Wen-Ling , Wang Peng-Hui
Published: March 2020

The current standard therapy of epithelial ovarian cancer (EOC) is the combination of surgery and multiagent chemotherapy with/without adding targeted therapy. After treatment, response rate is high and nearly all patients can achieve complete remission, even though they are advanced diseases; however, the majority of patients will relapse and subsequently die of diseases within several years after initial treatment. When treatment options are limited, there is the urgent need for new novel therapeutic approaches for precise cancer control. The development of chemoresistance and evading of the anticancer immune response may be one of the important causes contributing to the therapeutic failure, and therefore, it represents a paradigm shift in cancer research. An individual’s immune response and interaction with EOC cells might be one of the key factors for cancer treatment. There are many interventions, including targeting certain type immunogenic EOC-associated antigens, immune checkpoint blockade, and adoptive cellular therapy, which present a profound opportunity to revolutionize EOC treatment. This review will encompass the interaction between EOC and immune system and highlight recent data regarding the research of immunotherapy in EOC.
Risk assessment of dementia after hysterectomy: Analysis of 14-year data from the National Health Insurance Research Database in Taiwan
Authors: Chen Yi-Chun , Oyang Yen-Jen , Lin Tzu-Yun , Sun Wei-Zen
Published: March 2020

Background:

Anesthesia and surgery may increase the risk of dementia in the elderly, but the higher prevalence of dementia in women and other evidence suggest that dementia risk increases in younger women undergoing hysterectomy. In this study, we assessed the risk of dementia after hysterectomy.

Methods:

Hysterectomies registered in the National Health Insurance Research Database from 2000 to 2013 were evaluated using a retrospective generational research method. Multivariate Cox regression analysis was used to assess the effect of age at surgery, anesthesia method, and surgery type on the hazard ratio (HR) for the development of dementia.

Results:

Among 280 308 patients who underwent hysterectomy, 4753 (1.7%) developed dementia. Age at surgery and anesthesia method were associated with the occurrence of dementia, independent of surgery type. Among patients 30–49 years of age, general anesthesia (GA) was associated with a higher risk of dementia than spinal anesthesia (SA). The HR for GA was 2.678 (95% confidence interval [CI] = 1.269–5.650) and the risk of dementia increased by 7.4% for every 1-year increase in age (HR = 1.074; 95% CI = 1.048–1.101). In patients >50 years of age, the HR for GA was 1.206 (95% CI = 1.057–1.376), and the risk of dementia increased by 13.0% for every 1-year increase in age (HR = 1.130; 95% CI = 1.126–1.134).

Conclusion:

The risk of dementia in women who underwent hysterectomy was significantly affected by older age at surgery, and the risk might not increase linearly with age, but show instead an S-curve with exponential increase at about 50 years of age. Although less significant, GA was associated with higher risk than SA, and the effect of the anesthesia method was greater in patients <50 years of age. In contrast, the surgical procedure used was not associated to the risk of dementia.
To Admit or Not to Admit: Emergency Department Discharges After Request for Medicine Admission
Authors: Allaudeen Nazima , Breckenridge Julia S. , Vashi Anita A.
Published: March 2020

Background:

The decision to discharge versus admit a patient from the emergency department (ED) carries significant consequences to the patient and healthcare system.

Methods:

We evaluated all ED visits at a single facility from January 1–December 31, 2015, where the ED provider initially requested admission to medicine; however, following medicine evaluation, the patient was discharged from the ED.

Results:

8.1% of medicine referrals resulted in discharge from the ED after referral for admission. 62.6% lacked documentation by medicine or another consulting service. Patients completed clinic follow-up within 7 or 30 days, 52.8% and 76.0% respectively. Emergency department revisit rates were similar for patients not referred versus referred for admission (8.0% vs. 8.1%, 13.3% vs. 14.6%, and 29.9% vs. 28.9% at 3, 7, and 30 days, respectively p-value > .05). Hospital admission during the follow-up period was also similar for these two groups (1.8% vs. 2.8%, 3.9% vs. 5.7%, and 11.3% vs. 15.0% at 3, 7, and 30 days, respectively p-value > .05).

Conclusions:

Patients discharged from the ED after referral for medicine admission were not at significantly increased risk of subsequent ED revisit or hospital admission compared with nonreferred patients. This study illustrates the opportunity for collaboration between ED and medicine providers to refine disposition plans for patients who may fall into the “gray zone.”
Rising Incidence of Sporadic Vestibular Schwannoma: True Biological Shift Versus Simply Greater Detection
Authors: Marinelli John P. , Lohse Christine M. , Grossardt Brandon R. , Lane John I. , Carlson Matthew L.
Published: March 2020

Objective:

The incidence of sporadic vestibular schwannoma (VS) has increased significantly over recent decades. The rising incidence of VS has been largely attributed to the increasing use of magnetic resonance imaging (MRI), especially with regard to incidentally diagnosed tumors. However, no study to date has directly investigated this supposed etiology beyond the observation that VS incidence rates have risen in the post-MRI era. Therefore, the primary objective of the current study was to characterize the incidence of head MRIs over the previous two decades in Olmsted County, Minnesota and compare this trend to the incidence of asymptomatic, incidentally diagnosed VS over the same time period.

Study Design:

Population-based incidence study.

Setting/Patients:

Using the unique resources of the Rochester Epidemiology Project, procedure codes for head MRIs and diagnostic codes for VS among residents of Olmsted County, Minnesota between Jan 1, 1995 and Dec 31, 2016 were retrieved. Incidence rates of head MRI and incidentally diagnosed VS were calculated on a per-year basis.

Results:

A total of 43,561 head MRIs among 30,002 distinct persons were identified from 1995 to 2016. The incidence of head MRI significantly increased between 1995 and 2003 (p < 0.001), but remained stable between 2004 and 2016 (p = 0.14). Over the same time interval, 25 cases of incidentally diagnosed VS were identified. The incidence of asymptomatic VS increased over time from 0.72 per 100,000 person-years between 1995 and 1999 to 1.29 between 2012 and 2016 (p = 0.058). No plateauing of incidence rates was observed in incidental tumors over the study period. The size of incidentally diagnosed tumors did not change over the study period (p = 0.93), suggesting that the increasing incidence of asymptomatic tumors is not explained by improved diagnostic capability of more recent MRI studies.

Conclusions:

Despite the plateauing of head MRI incidence rates after 2004, the incidence of asymptotic, incidentally diagnosed VS continued to increase. Our findings suggest that there may be additional contributory etiologies for the rising incidence of VS beyond greater detection alone.
Pulse Oximetry Is Unreliable in Patients on Veno-Venous Extracorporeal Membrane Oxygenation Caused by Unrecognized Carboxyhemoglobinemia
Authors: Nisar Saira , Gibson Colin D. , Sokolovic Mladen , Shah Nimesh S.
Published: March 2020

Continuous bedside pulse oximetry (SpO2) is universally used to monitor oxygenation for patients supported on veno-venous extracorporeal membrane oxygenation (VV-ECMO). Yet, elevated carboxyhemoglobin (COHb), a known event in VV-ECMO, diminishes the reliability of SpO2. This retrospective cohort study aims to assess the accuracy of SpO2 compared with oxyhemoglobin (SaO2) and quantify COHb levels by co-oximetry in the VV-ECMO population. Forty patients on VV_ECMO from 2012 to 2017 underwent 1,119 simultaneous SaO2 and SpO2 measurements. Most patients were male (60%) with average age of 46 years. SpO2 overestimated SaO2 values by 2.35% at time of cannulation and 0.0061% for each additional hour on VV-ECMO (p < 0.0001). Twenty-nine (72.5%) patients developed elevated COHb (>3% of hemoglobin saturation) at least once during VV-ECMO support and 602 (40.2%) arterial blood gases yielded elevated COHb levels. Mean duration for ECMO with elevated COHb was 244 hours compared with 98 hours in patients without (p < 0.0048). Patients who developed COHb were younger (mean age 40 vs. 55 years, p < 0.024) and had single-site double-lumen cannulation (odds ratio = 4.5, p = 0.23). At time of cannulation, mean COHb was 2.18% and increased by 0.0054% for each additional hour (p < 0.0001). For every 1% increase in COHb, SaO2 decreased by 1.1% (p < 0.0001). During VV-ECMO, SpO2 often overestimates SaO2 by substantial margins. This is attributable to rising COHb levels proportional to duration on VV-ECMO. In this population where adequate oxygen delivery is often marginal, clinicians should be wary of the reliability of continuous pulse oximetry to assess oxygenation.
EUS-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography (EDGE)
Authors: Tyberg Amy , Kedia Prashant , Tawadros Augustine , Tarnasky Paul R. , Gaidhane Monica , Nieto Jose , Kahaleh Michel
Published: March 2020

Introduction:

Endoscopic ultrasound (EUS)-directed transgastric endoscopic retrograde cholangiopancreatography (EDGE) is a minimally invasive option for pancreaticobiliary access in patients with Roux-en-Y anatomy. The procedure involves creating a fistulous tract between the remnant stomach or jejunum and the bypassed stomach with the deployment of a lumen-apposing metal stent (LAMS), followed by the advancement of an endoscope through the LAMS to perform an ERCP or EUS. It is a technically challenging procedure, requiring skills in EUS, fluoroscopy, and LAMS deployment. The aim of this study was to determine the learning curve for EDGE.

Methods:

Consecutive patients undergoing EDGE by a single operator were included from a prospective registry over 3 years. Demographics, procedure info, postprocedure follow-up data, and adverse events were collected. Nonlinear regression and cumulative sum analyses were conducted for the learning curve. Technical success was defined as the successful creation of the fistulous tract. Clinical success was defined as successful EUS or ERCP via the LAMS.

Results:

Nineteen patients were included (21% male, mean age 58.7 y). Indication included symptomatic biliary stricture (n=6, 32%), choledocholithiasis (n=5, 26%), pancreatitis (n=3, 16%). Technical success was 100%. All patients had a 15 mm LAMS placed, 3 (16%) had cautery-enhanced LAMS. Clinical success was achieved in 18/19 (95%) patients. Fourteen patients had an ERCP, 1 patient had a EUS, and 3 patients had both. Adverse events included 2 cases of bleeding, 1 case of post-ERCP pancreatitis, and 1 jejunal perforation during duodenoscope insertion managed endoscopically.

Median procedure time was 54.5 minutes (range: 31 to 88 min). Cumulative sum chart shows a 54-minute procedure time was achieved at the ninth procedure hence indicating efficiency. Apart from 2 outliers, the procedure duration further reduced with consequent procedures with the last 3 being under 40 minutes indicating that after 25 to 35 procedures a plateau may be reached indicating mastery (nonlinear regression P<0.0001).

Conclusions:

Endoscopists experienced in EDGE are expected to achieve a reduction in procedure time over successive cases, with efficiency reached 54.5 minutes and a learning rate of 9 cases. After 25 to 35 procedures, a plateau may be reached indicating mastery.
Transmission of respiratory tract infections at mass gathering events
Authors: Petersen Eskild , Memish Ziad A. , Zumla Alimuddin , Maani Amal Al
Published: March 2020

Purpose of review

Mass gathering events bring people from across all continents increasing the risk of spread of aerosol transmissible respiratory tract infections. Respiratory tract infections for instance in pilgrims attending the world's largest recurring annual pilgrimage, the Hajj are common. We review recent literature on viral and bacterial infectious diseases with special focus on the Hajj.

Recent findings

The prevalence of bacterial and viral infections continue to increase, because of the acquisition of rhinovirus, coronaviruses (229E, HKU1, OC43), influenza A H1N1,Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureusduring Hajj. Whilst MERS-CoV continues to circulate in the Middle East, no cases of MERS-CoV have yet been identified in pilgrims during Hajj.

Respiratory tract infections are a major cause of morbidity in pilgrims attending mass gathering events. The management of severe respiratory infections should consider investigation and empirical coverage for the most likely agents based on syndromic surveillance data from hosting country and /or other relevant exposure history during events. Pneumococcal and Pertussis vaccines should be recommended for Hajj pilgrims.
Cutaneous nontuberculous mycobacterial infection in Thailand
Authors: Chirasuthat Phatcharawat , Triyangkulsri Korn , Rutnin Suthinee , Chanprapaph Kumutnart , Vachiramon Vasanop
Published: March 2020

A remarkable increase in the prevalence of cutaneous nontuberculous mycobacterial (NTM) infection has occurred worldwide. However, updated data regarding cutaneous NTM infection in Thailand is limited.

This study aim to describe the clinical manifestations, pathogenic organism, and prognostic factors of cutaneous NTM infections among patients living in Thailand.

The electronic medical records of all patients with confirmatory diagnosis of cutaneous NTM infection from either positive cultures or polymerase chain reaction were retrospectively reviewed at a university-based hospital.

From 2011 to 2017, a total of 88 patients with a confirmed diagnosis of cutaneous NTM infection were included. Mycobacterium abscessus was the most common pathogens followed by M haemophilum and M marinum (61.4%, 10.2%, and 8.1%, respectively). Nodule and plaque were 2 most common lesions (26.4% and 25.5%, respectively) and lower leg is the most common site of involvement (50.9%). The majority of patients presented with single lesion (67%). Seven patients (7.9%) had history of surgical procedure and/or cosmetic injection before the development of lesion and all pathogenic organisms in this group were rapidly growing mycobacteria. Sweet's syndrome and erythema nodosum were the 2 most common reactive dermatoses, presented in 3.4% and 2.3%, respectively. The majority of patients infected with cutaneous M haemophilum infections were immunocompromised and lacked history of preceding trauma (77.8%). Patients with cutaneous NTM that receiving less than 3 medications was associated with higher disease relapse (odds ratio 65.86; P = .02).

M abscessus is the most common pathogen of cutaneous NTM infection in Thailand. The prevalence of M haemophilum is increasing and should be particularly cautious in immunocompromised patients. Rapidly growing mycobacteria should be suspected in all cases of procedure-related cutaneous NTM. We recommend at least 3 antibiotics should be considered for cutaneous NTM infection to reduce the rate of relapse.
Association of polymorphisms of preptin, irisin and adropin genes with susceptibility to coronary artery disease and hypertension
Authors: Wang Haidong , Wang Xiaojing , Cao Yuan , Han Wenxiu , Guo Yujin , Yang Guangsheng , Zhang Jun , Jiang Pei
Published: March 2020

Objectives:

Preptin, irisin and adropin are 3 new players in energy regulation that are related body mass index, lipids, glucose and insulin levels which may affect incidence of cardiovascular diseases. The aim of the present study was to evaluate eight single nucleotide polymorphisms (SNPs) of preptin genes (rs1003483, rs1004446, rs2239681, rs680, and rs3741204), irisin (rs16835198 and rs3480) and adropin (rs2281997) gene in patients with coronary artery disease (CAD) and hypertension.

Methods:

This case-control study was carried out on 372 volunteers, which were divided into 3 subgroups including: CAD patients with hypertension (CAD+H+), CAD patients with no hypertension (CAD+H-), and non-hypertensive non-CAD subjects as control group (CAD-H-) as health control. Genomic DNA from whole blood was extracted and eight SNPs were assessed using polymerase chain reaction- ligase detection reaction method.

Results:

A significant difference was found in the genotype and allele frequency of preptin rs1003483 gene in CAD+H+ compared to CAD+H- groups (P = .019 and P = .018, respectively). Allele frequency of rs1003483 was significantly different between CAD+H- groups and healthy control groups (P = .043). There also existed a significant difference the genotype frequency of rs1004446 gene in CAD+H+ compared to CAD+H- groups (P = .027).

Conclusions:

The findings of present study revealed that the preptin rs1003483 and rs1004446 gene polymorphism might serve as predisposing factor in CAD and hypertension.
Dissociation between reduced diaphragm inspiratory motion and normal diaphragm thickening in acute chronic pulmonary obstructive disease exacerbation: a case report
Authors: Kracht Julien , Ogna Adam , Fayssoil Abdallah
Published: March 2020

Introduction:

Patients with chronic pulmonary obstructive disease (COPD) are at risk of acute exacerbation. Diaphragm muscle is classically highly solicited in COPD exacerbation.

Patient concerns:

A COPD patient was admitted because of acute dyspnea with wheezing.

Diagnosis:

acute COPD exacerbation.

Interventions:

A diaphragm ultrasound and a Doppler echocardiography were performed at bedside.

Outcomes:

We measured diaphragm thickening at the apposition zone and diaphragm inspiratory motion from the subcostal view, in addition with classical echocardiographic parameters.

Conclusion:

Despite a normal diaphragm thickening, diaphragm motion during inspiration is reduced in acute COPD exacerbation. These apparently discrepant findings may be explained by the alterations of the respiratory mechanics during COPD exacerbations, which should be considered when evaluating the diaphragmatic function by imaging.
Perioperative prevalence of deep vein thrombosis in patients with percutaneous kyphoplasty
Authors: Fan Wencan , Qiao Tianzhu , You Yongqing , Zhang Jun , Gao Jijian
Published: March 2020

In recent years, deep venous thrombosis (DVT) after spine surgery has received extensive attention, but perioperative prevalence of DVT in patients undergoing percutaneous kyphoplasty (PKP) is lacking.

To assess the perioperative prevalence of deep vein thrombosis (DVT) in patients undergoing PKP with routinely applied ultrasonography.

We reviewed 1113 consecutive patients undergoing PKP from January 2014 to August 2017. The surgical procedure was bilateral PKP. All patients were routinely examined with ultrasonography when admitted to the hospital and on the first post-operative day. Clinical signs of DVT were checked and recorded before examination.

Forty (3.6%) out of 1113 patients were diagnosed with DVT by ultrasonography. Of the 40 detected cases of DVT, only six (0.54%) patients presented with clinical signs of DVT, demonstrating that there were 34 (3.05%) asymptomatic cases. No patient presenting with clinically suspected pulmonary embolism (PE) was observed. Gender, body mass index (BMI), operative time, hypertension, diabetes, heart disease, and lower limb fracture were not significant risk factors for DVT (P > .05). In contrast, patient age, oncologic conditions, DVT history, and paraplegia appeared to be significant risk factors for DVT (P < .01). There was no significant difference in the incidence of DVT found between the three PKP surgical levels (P > .05).

The total incidence of perioperative DVT diagnosed with ultrasonography in patients undergoing PKP was 3.6%, of which only 0.54% was symptomatic cases. It is necessary to assess DVT using ultrasonography during the perioperative procedure of PKP, especially for high-risk patients.

Level of evidence: Level IV.
Clinical nomogram for predicting the survival of patients with cerebral anaplastic gliomas
Authors: Zhao Ye-Yu , Wan Qin-Si , Hao Zheng , Zhu Hua-Xin , Xing Ze-Long , Li Mei-Hua
Published: March 2020

The present study aimed to develop an effective nomogram for predicting the overall survival (OS) of patients with cerebral anaplastic glioma (AG).

This study included 1939 patients diagnosed with AG between 1973 and 2013 who were identified using the Surveillance, Epidemiology, and End Results database. A multivariate Cox regression analysis revealed that age, histology, tumor site, marital status, radiotherapy, and surgery were independent prognostic factors and, thus, these factors were selected to build a clinical nomogram. Harrell's concordance index (C-index) and a calibration curve were formulated to evaluate the discrimination and calibration of the nomogram using bootstrapping.

A nomogram was developed to predict 5- and 9-year OS rates based on 6 independent prognostic factors identified in the training set: age, tumor site, marital status, histology, radiotherapy, and surgery (P < .05). The Harrell's concordance index values of the training and validation sets were 0.776 (0.759–0.793) and 0.766 (0.739–0.792), respectively. The calibration curve exhibited good consistency with the actual observation curve in both sets.

Although the prognostic value of the World Health Organization (WHO) classification has been validated, we developed a novel nomogram based on readily available clinical variables in terms of demographic data, therapeutic modalities, and tumor characteristics to predict the survival of AG patients. When used in combination with the WHO classification system, this clinical nomogram can aid clinicians in making individualized predictions of AG patient survival and improving treatment strategies.
Beneficial effect of statin on preventing contrast-induced acute kidney injury in patients with renal insufficiency
Authors: Cho AJin , Lee Young-Ki , Sohn Seo Young
Published: March 2020

Background:

Renal insufficiency is an important predictor of contrast-induced acute kidney injury (CI-AKI). We performed a meta-analysis to examine the effects of short-term statin therapy on the incidence of CI-AKI, particularly in patients with renal insufficiency.

Methods:

A systematic search was conducted to retrieve randomized controlled trials (RCTs) that investigated the impact of statin pretreatment before administration of contrast media on the development of CI-AKI in patients with mild to moderate renal insufficiency. The primary outcome was development of CI-AKI. The secondary outcome was the incidence ofacute kidney injury requiring hemodialysis.

Results:

Data analysis from 8 RCTs, which included a total of 2313 subjects in the statin-treated group and 2322 in the control group, showed that statin pretreatment was associated with significant reduction of the risk of CI-AKI (relative risk [RR] = 0.59; 95% confidential interval [CI] 0.44–0.79; P = .0003, I
2 = 0%). A beneficial effect of statin on preventing CI-AKI was consistent, regardless of the dose of statin and use of N-acetylcysteine. In subgroup analysis based on baseline estimated glomerular filtration rate (eGFR), patients with baseline eGFR <60 mL/min/1.73 m2 (RR = 0.63; 95% CI 0.41–0.98; P = .04, I
2 = 0%) and 30 < eGFR < 90 mL/min/1.73 m2 (RR = 0.56; 95% CI 0.39–0.82; P = .003, I
2 = 0%) showed significant reduction of risk of CI-AKI.

Conclusion:

Statin pretreatment is effective at preventing CI-AKI and should be considered in patients with preexisting renal insufficiency.
A Secondary Mixed Methods Analysis of a Pay-it-Forward Gonorrhea/Chlamydia Testing Program Among Men Who Have Sex With Men in China
Authors: Li Katherine T. , Huang Wenting , Tang Weiming , Wu Feng , Zhao Yang , Wu Dan , Yang Fan , Zhang Tiange P. , Forastiere Laura , Alexander Marcus , Kumar Navin , Tucker Joseph D.
Published: March 2020

Background

Gonorrhea and chlamydia are common among Chinese men who have sex with men (MSM), but testing rates are low. We developed a pay-it-forward program where men receive a free gonorrhea/chlamydia test and can then donate toward future participants' tests. This study aims to investigate drivers of testing uptake and donation using a mixed methods approach.

Methods

We used a sequential explanatory design to explore drivers of testing uptake and donation unique to pay-it-forward through a quantitative cross-sectional survey and a qualitative thematic analysis of semistructured interviews. We collected data on sociodemographics and perceived benefits of pay-it-forward among men offered the pay-it-forward interventionand analyzed testing uptake and donations using descriptive statistics and logistic regression. We then conducted 30 semistructured interviews with men and coded interview data to identify themes.

Results

Three hundred and one MSM were offered pay-it-forward and 55% (165/301) received gonorrhea/chlamydia testing. Ninety-one percent (150 of 165) donated any amount with a mean of 58.31 ± 53.39 RMB (US $8.61 ± 7.88), or 39% of the standard price of gonorrhea/chlamydia testing. Getting tested was not associated with income, but donations were higher in the highest income bracket (adjusted odds ratio, 7.12; 95% confidence interval, 1.61–31.52). Fifty-eight percent (94 of 162) selected “more MSM can get tested,” and 54% (88 of 162) selected “I can help someone else” as benefits of pay-it-forward. Qualitative themes for drivers of testing and donation included flexible pricing, generosity and reciprocity, and MSM community identity.

Conclusions

Quantitative and qualitative results suggest that this pay-it-forward program may increase gonorrhea/chlamydia testing by reducing cost barriers, leveraging generosity and reciprocity, and mobilizing community altruism.
Social Risk Screening in Pediatric Primary Care Anticipates Acute Care Utilization
Authors: Wurster Ovalle Victoria M. , Beck Andrew F. , Ollberding Nicholas J. , Klein Melissa D.
Published: March 2020

Objective

The aim of the study was to assess whether responses to a standardized social risk screen administered during pediatric well-child visits (WCV) were associated with emergency department (ED) or urgent care (UC) utilization.

Methods

This was a retrospective cohort study of 26,509 children younger than 13 years with a WCV between January 1, 2012, and December 31, 2013. Exposure was positive response(s) on a standardized social risk screening questionnaire at the index WCV. Primary outcome was number of ED or UC visits in the 12 months after the WCV.

Results

The cohort was 50.9% male and 65.7% black, with a median age of 3.6 years. More than 20% had a positive response to at least one question on the social risk screen. For those reporting any social risk, 46.7% had 1 or more EDs or UC visit within 12 months. Each additional reported risk was associated with a 4% increase in the rate of ED utilization (incidence rate ratio = 1.04, 95% confidence interval = 1.02–1.07) and a 16% increase in the rate of hospitalizations (incidence rate ratio = 1.16, 95% confidence interval = 1.08–1.24). Similar patterns were noted for those visiting the ED 4 times or more (adjusted odds ratio = 1.09, 1.03–1.15) and hospitalization 2 times or more (adjusted odds ratio = 1.19, 1.04–1.35) in the year after the WCV. Those who screened positive on food insecurity, safety, and desire to meet with a social worker questions also had higher odds of ED or UC utilization.

Conclusions

Families reporting a social concern on a standardized screen during a WCV had increased acute care utilization in the subsequent year. Identifying socially at-risk families may allow for the creation of more effective strategies to prevent future utilization.
Seymour Fractures
Authors: Rask Dawn M. G. , Wingfield Jessica , Elrick Bryant , Chen Christopher , Lalka Andy , Sibbel Sarah E. , Scott Frank A.
Published: March 2020

Background

Seymour fractures are important to recognize and treat promptly because injuries may result in growth disturbance, nail deformity, or infection. We hypothesize that the administration of antibiotics within 24 hours of injury will be associated with a decreased rate of infection.

Methods

Patients younger than 18 years were included if clinical examination and radiographs demonstrated a Seymour fracture. The timing of antibiotic administration and treatment details were reviewed. The presence of superficial infections or radiographic evidence of osteomyelitis was recorded.

Results

A total of 52 patients with 54 fracture that had greater than 30 days of follow-up and were included in data analysis. The average age at the time of injury was 10.2 years. Thirty-four (63%) of 54 patients were most commonly injured secondary to a crush type mechanism. The overall infection rate was 27.3% (15/54 fractures). Among the 29 fractures that received antibiotics within 24 hours of injury, 2 infections (6.9%) were noted at final follow-up. Delayed administration of antibiotics beyond 24 hours postinjury was observed in 17 fractures and was associated with an increased infection rate of 76.5% (13/17, P = 0.000).

Conclusions

Early administration of antibiotics within 24 hours of injury is associated with a reduction in the development of infections. Patients with delayed antibiotic administration may be at high risk for early superficial infection or osteomyelitis. This study highlights the importance of early identification and appropriate treatment of Seymour fractures including the prompt administration of antibiotics following injury.
Decision-Making in Evidence-Based Practice in Rehabilitation Medicine
Authors: Gutenbrunner Christoph , Nugraha Boya
Published: March 2020

According to the Sackett’s model, evidence-based decision-making in medicine includes the clinical judgment, scientific evidence, and the patient’s values and preferences. In rehabilitation medicine, it is well established that according to the International Classification of Functioning, Disability and Health model, contextual factors (environmental and personal factors) influence a person’s individual level of functioning. This article argues that component of the health system (eg, health insurance coverage, availability of services, treatments, and assistive devices) and the service organization (eg, spectrum and training level of health professionals, availability of diagnostic, and treatment devices) have relevant influence on the decision-making in the individual case. For that reason, it is proposed to add the health system and service organization as a fourth factor to the model of evidence-based decision-making. Taking the influence of it into consideration and to describe it clearly will improve transparency of the decision-making process and the acceptance of health care users. This fourth factor is also relevant for other medical fields. However, the proposed factor and its components need to be discussed and further elucidated scientifically.