bluuebunny/crossref_metadata_2025 huggingface dataset:
Experience With 0.1% Tacrolimus Eye Drop for Noninfectious, Non-necrotizing Anterior Scleritis
Authors: Yazu Hiroyuki , Miyazaki Dai , Fujishima Hiroshi
Published: May 2020

Objectives:

To report experience with 0.1% tacrolimus eye drops in the treatment of noninfectious, non-necrotizing anterior scleritis.

Methods:

This prospective, single-arm study included nine patients (4 men and 5 women; mean age=59.4 years, SD=10.5) with anterior scleritis. All patients were first treated with steroids for 1 month and then switched to tacrolimus eye drops alone. We defined baseline as the initiation of tacrolimus eye drops. Hyperemia and pain were scored before each treatment, at 1 and 2 weeks, and at 1 month after initiation of each treatment using 5 grades (0=none; 1+=mild; 2+=moderate; 3+=severe; 4+=extremely severe). Intraocular pressure (IOP) was also measured during treatment with each drug. Safety was assessed based on the severity and the incidence of adverse events.

Results:

The scores of hyperemia and pain had significantly decreased from baseline by 1 week after initiating tacrolimus eye drops (both P<0.05). No significant reduction was observed with steroid treatment throughout the 1-month period in both scores. Tacrolimus eye drops elicited statistically significant differences in mean IOP over the course of treatment (P=0.02). No additional medications were required to provide relief in any of the patients receiving tacrolimus treatment. No patient demonstrated infectious adverse events after initiation of tacrolimus treatment.

Conclusions:

Topical tacrolimus may effectively and immediately reduce clinical signs and symptoms of noninfectious, non-necrotizing anterior scleritis in cases unresponsive to a course of topical steroid.
Antibiotic Resistance and Treatment Options for Multidrug-Resistant Gonorrhea
Authors: Yang Fan , Yan Jing
Published: May 2020

Gonorrhea is a sexually transmitted disease with a high global incidence. Its causative agent, Neisseria gonorrhoeae, has shown a remarkable flexibility to adapt and become resistant to all antimicrobials introduced over the past century for gonococcal therapy. The currently last available first-line therapy that is recommended in most countries is ceftriaxone. However, resistance levels against ceftriaxone are rising globally and incidences of confirmed treatment failure are increasingly encountered, particularly with the global spreading of the ceftriaxone-resistant FC428 clone in recent years. Resistance against most antimicrobials has been the result of adaptive genomic mutations that reduce affinity of the antimicrobial to its target protein or rRNA, although most multidrug-resistant strains also appear to have an upregulated multidrug efflux pump. To ensure gonococcal treatment remains available in the future, alternative therapies are urgently needed. Therefore, both alternative clinically approved antimicrobials and novel antimicrobials have been intensely studied both in gonococcal susceptibility analyses and clinical efficacy trials. Although there have been some limited successes, all studied alternative therapies that reached clinical trials have displayed some shortcomings in their efficacy against pharyngeal infections and/or overlapping resistance determinants with previously or currently used antimicrobials. This review summarizes the development of gonococcal antimicrobial resistance over the past century, describes the mechanisms involved in antimicrobial resistance, and provides an overview of the alternative therapies that have been under investigation this past decade.
Screening-based and Risk-based Strategy for the Prevention of Early-onset Group B Streptococcus/Non-group B Streptococcus Sepsis in the Neonate: A Systematic Review and Meta-analysis
Authors: Li Qiu-ya , Wang Ding-yuan , Li Hong-tian , Liu Jian-meng
Published: May 2020

Background:

Screening-based and risk-based strategies are the 2 strategies for preventing group B streptococcus (GBS) diseases in neonates. We aimed to compare the effects of these 2 strategies in reducing the incidence of early-onset GBS sepsis (GBS-EOS) and their effects on the incidence of non-GBS sepsis.

Methods:

PubMed, Embase, Web of Science and The Cochrane Central Register of Controlled Trials were searched for the period from January 1, 1996, to December 31, 2018. Randomized controlled trials and cohort studies that compared the effects of risk-based and screening-based strategies were eligible for the meta-analysis. The I

2
statistic was used for assessing the statistical heterogeneity across studies. Pooled relative risks (RRs) and corresponding 95% confidence intervals (CIs) were calculated using the random effects model.

Results:

There were 18 cohort studies comparing the incidence of GBS-EOS between the 2 strategies, involving a total of 604,869 newborns and 791 GBS-EOS cases. The heterogeneity across studies was moderate (I

2
= 45%), and the pooled analysis yielded a 55% decreased risk of GBS-EOS for screening-based versus risk-based strategy (RR = 0.45; 95% CI: 0.34–0.59). For total early onset non-GBS sepsis (non-GBS-EOS), 7 studies with low heterogeneity (I

2
= 18%) had a pooled RR of 0.91 (95% CI: 0.74–1.11), whereas for ampicillin resistant Escherichia coli-EOS, a subgroup of non-GBS-EOS, 3 studies with very low heterogeneity (I

2
= 0%) had a pooled RR of 1.28 (95% CI: 0.74–2.21) for screening-based strategy compared with risk-based strategy.

Conclusions:

Compared with risk-based strategy, screening-based prophylaxis was associated with a reduced risk of GBS-EOS.
Children’s Healthcare During Corona Virus Disease 19 Pandemic
Authors: Buonsenso Danilo , Onesimo Roberta , Valentini Piero , Chiaretti Antonio , Gatto Antonio , Attinà Giorgio , Conti Giorgio , Vento Giovanni , Cambieri Andrea , Mercuri Eugenio , Zampino Giuseppe ,   on behalf of the pedCOVID-team
Published: May 2020

The unexpected outbreak of Corona Virus Disease 19 had several consequences worldwide and on the Italian Health System. We report our experience in the reorganization of our Pediatric Department to prevent the risk of infection for both children and staff. We strongly believe that the need to face an unpredictable emergency situation should not affect the quality of the assistance to the non–Corona Virus Disease patients.
Long-term Mortality and Risk of Epilepsy in Children and Young Adults With Brain Abscess
Authors: Bodilsen Jacob , Dalager-Pedersen Michael , Nielsen Henrik
Published: May 2020

Background:

The long-term prognosis of brain abscess is unclear.

Methods:

Using nationwide, population-based medical registries, we included all individuals <20 years of age hospitalized with first-time diagnosis of brain abscess in Denmark from 1982 to 2016. A comparison cohort individually matched for age, sex and residence was identified, as were siblings of all study participants. Next, cumulative incidence curves of mortality and new-onset epilepsy were constructed, and Cox regression was used for analyses of hazard rate ratios (HRRs) with 95% confidence intervals.

Results:

We identified 155 brain abscess patients and 1,550 population controls with median follow-up times of 15 years (interquartile range, 6–25) and 16 years (interquartile range, 11–26). Ear–nose–throat infections (22%) and congenital heart disease (13%) were the most common predisposing conditions for brain abscess. Overall mortality was 21/155 (14%) in brain abscess patients versus 20/1,550 (1%) in population controls. The corresponding HRRs were 150 (95% confidence interval: 19.8–1,116) after 1 year of observation, 24.6 (4.78–127) after 2–5 years and 0.66 (0.09–4.98) after 6–30 years. New-onset epilepsy occurred in 28% of 30-day brain abscess survivors versus 1% in population controls yielding a HRR of 29.6 (14.4–60.8) adjusted for previous head trauma, stroke and cancer. Analyses of sibling cohorts showed that family-related factors did not explain the observed increased risks of death or epilepsy among brain abscess patients.

Conclusions:

Brain abscess is associated with increased risk of mortality for up to 5 years. New-onset epilepsy occurred in 28% of survivors and remained a risk for several years after infection.
Coronavirus Disease 2019 in Newborns and Very Young Infants
Authors: Meslin Pauline , Guiomard Clara , Chouakria Mouna , Porcher Julie , Duquesne Frédérique , Tiprez Catherine , Zemouri Neila
Published: May 2020

We present here a series of 6 infants hospitalized for coronavirus disease 2019 infection from March 14 to March 30, 5 of them are newborns. All 6 patients presented with fever, it was the main symptom for all of them. Only one of them needed oxygen; the others were hospitalized for surveillance but did not need specific care. In our series, coronavirus disease 2019 infection is mostly mild in neonates.
The Collaborative Care Model for Patients With Both Mental Health and Medical Conditions Implemented in Hospital Outpatient Care Settings
Authors: Geist Rose , Versloot Judith , Mansfield Elizabeth , DiEmanuele Michelle , Reid Robert J.
Published: May 2020

With the increased concern regarding the negative impact that care in silos has on patients and the health care system, there is growing interest in integrated models of care especially for individuals with co-occurring physical and mental health conditions. Although generally applied in a community setting, we adapted and implemented an evidence-based integrated model of care, the collaborative care model (CCM) in an adult and a pediatric hospital-based outpatient clinic. Enrolment was criteria based and management was measurement driven. The model is team based and consists of new roles for its members including the patient, the care manager, the primary care clinician, and the psychiatric consultant. A key role was that of the care manager who worked with the patient and engaged primary care. The care manager also organized team-based treatment planning in systematic case reviews that contributed to the care plan. Support for training of the new and changes in roles is underscored. In this communication we comment on our initial experience of applying the CCM to the hospital outpatient setting.
Conversion of Adipose-Derived Stem Cells into Sweat Gland-Like Cells: An In Vitro Phenotypic Study
Authors: Qiang Shuai , Wang Xiao-Meng , Zhang Cheng-Kun , Liu Ying , Xiao Zhi-Bo , Li Qiang , Li Feng-Yong , Zhou Yu
Published: May 2020

Objective:

This study was performed to explore the conversion of adipose-derived stem cells (ADSCs) into sweat gland-like cells for the purpose of sweat gland regeneration.

Methods:

ADSCs and human sweat gland (hSG) cells were isolated, cultured, and identified. The ADSCs were then cultured in combination with epidermal growth factor and/or cocultured with hSG cells in a Transwell coculturing system to transform the ADSCs into hSG-like cells. Phenotypic changes of the ADSCs were examined by morphological observation and immunocytochemical analysis of specific markers.

Results:

The ADSCs showed sweat gland-like morphologic changes and expressed sweat gland markers (cytokeratins 7, 14, and 18).

Conclusion:

These findings revealed that ADSCs can differentiate into hSG-like cells after coculture in a Transwell system and that epidermal growth factor can enhance the efficiency of differentiation. ADSCs may serve as a potential source of cells for sweat gland regeneration.
A Case Report of Inflammatory Disseminated Superficial Porokeratosis: An Eruptive Pruritic Papular Variant of Porokeratosis
Authors: Luo Ling-Ling , Chen Hao , Zeng Xue-Si , Cui Pan-Gen
Published: May 2020

Introduction:

Eruptive pruritic papular porokeratosis (EPPP) is a rare variant of porokeratosis. Several cases of this varient of porokeratosis had been reported.

Here, we reported an old man with this rare kind of porokeratosis which is often eruptive and pruritic.

Case report:

A 72 years-old Chinese man presented to our hospital with intensively pruritic papular lesions on his trunk and limbs. Physical examination showed numerous scattered keratotic papules measuring 35 mm in diameter on his trunk and extremities. Some coalesced into anannular lesion with a slightly raised peripheral red rim. A tissue biopsy revealed the presence of a cornoid lamella. The patient was diagnosed with EPPP. After 3-months’ treatment of antihistamines and topical steroid agents, the lesions and the pruritus were diminished.

Discussion:

EPPP predominantly happens in an old male demographic. Patients with EPPP often develop pruritic papules spread on the body with or without preexisting typical porokeratosis lesions, and the lesions can subside within few months, leaving small brown spots or annular lesions. EPPP has the unique histological characteristic of porokeratosis cornoid lamella. The mechanism of EPPP is still unknown. It is important for clinicians to be aware of a disseminated pruritic papules as a manifestation of EPPP.

Conclusion:

The lesion of porokeratosis can be manifested as eruptive papules with intensive itch. When a patient develops eruptive pruritic papules, it is necessary to consider the possibility of EPPP. Histopathology is necessary for diagnosis.
Music Interventions for Disorders of Consciousness: A Systematic Review and Meta-analysis
Authors: Li Xiaoling , Li Chunlin , Hu Na , Wang Ting
Published: May 2020

BACKGROUND: Quantitative evidence for the effects of music on patients with disorders of consciousness (DOCs) was presented. This study was based on available studies to summarize the effect estimates of music for DOC patients. METHODS: Three electronic databases were searched for studies that investigated the effects of music for DOC patients from start to July 2018. The summary results included functional scale, general physical indexes, electroencephalogram indexes, and favorable outcomes. The weighted mean difference and odds ratio with a corresponding 95% confidence interval were used to calculate continuous and frequency data using a random-effects model. This report adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: Randomized controlled trials (3) and cohort studies (8) involving 201 DOC patients were included. Patients with DOCs receiving music interventions were associated with high levels of California Verbal Learning Test (P = .038) and persistent vegetative state (P < .001), whereas no significant differences were detected for agitated behavior scale (P = .982), Glasgow Coma Scale (P = .216), Mini-Mental State Examination (P = .215), music therapy in a vegetative or minimally conscious state (P = .590), and Stroop (P = 1.000). Furthermore, DOC patients receiving music intervention showed a significantly increased facial expression (P = .003) and reduced systolic blood pressure (P = .036), whereas no significant effects were observed on diastolic blood pressure (P = .777), heart rate (P = .666), oxygen saturation (P = .911), pulse (P = .899), respiratory frequency (P = .427), and temperature (P = .864). Moreover, music did not contribute significantly to electroencephalogram indexes including alpha (α), beta (β), delta (δ), and theta (θ) in the left and right hemispheres (P > .050). Finally, DOC patients receiving music intervention showed an increased incidence of favorable outcomes (P = .015). CONCLUSION: This quantitative meta-analysis indicated that music might play a critical role on the functional scale, general physical indexes, and favorable outcomes for DOC patients. Music therapy can easily be provided at the bedside by nurses working with DOC patients.
Medical Conditions and Crash Risk in Commercial Motor Vehicle Drivers
Authors: Crizzle Alexander M. , Toxopeus Ryan , Alphonsus Khrisha
Published: May 2020

Objective:

The purpose of this study was to examine the association between diagnosed medical conditions and prospective crashes in commercial motor vehicle (CMV) drivers.

Methods:

Three databases (demographics, medical conditions, and crashes) from the Saskatchewan Government Insurance (SGI) were linked and filtered to examine whether various medical diagnoses were associated with prospective crashes from 2007 to 2017. Univariate and cox proportional hazard analysis were calculated for medical conditions and their association with crash risk.

Results:

Crashes occurred on average within 2 years following a medical diagnosis. Between 16% and 21% of drivers with diabetes, vision impairment, sleep apnea and cardiovascular disease crashed post diagnosis.

Conclusions:

Licensing authorities and policy makers should consider further assessment if a CMV driver has been diagnosed with either diabetes or multiple sclerosis.
Right Atrial Cannulation via Thoracotomy for Emergent Extracorporeal Membrane Oxygenation in Pediatric Patients with Prior Sternotomy
Authors: Desai Manan H. , Peer Syed M. , Bukhari Syed M. , Jonas Richard A. , Yerebakan Can
Published: May 2020

Extracorporeal membrane oxygenation (ECMO) is the most common mechanical circulatory support strategy used to treat pediatric patients presenting with low cardiac output or cardiogenic shock. While transthoracic central cannulation is feasible and mostly utilized for early postoperative support, peripheral cannulation is preferred as a primary strategy in the late postoperative period. Redo-sternotomy and venous cannulation are difficult to achieve in patients with occluded peripheral veins or complex venous anatomy like Glenn circulation. In pediatric patients with multiple prior sternotomy and catheterization procedures, vascular access for cannulation is frequently limited. Peripheral cannulation for venoarterial ECMO (VA-ECMO) may be challenging or even impossible. In our case series, four pediatric patients with prior sternotomy underwent right atrial cannulation emergently in patients to secure venous drainage for ECMO support. Extracorporeal membrane oxygenation support could be established rapidly with adequate venous drainage in all cases. We conclude that right atrial cannulation via right thoracotomy can be a useful technique for venous cannulation in cases with prior sternotomy and is particularly useful in cases with Glenn circulation.
Left Ventricle Unloading Through Pulmonary Artery in Patients With Venoarterial Extracorporeal Membrane Oxygenation
Authors: de Pommereau Aurélien , Radu Costin , Boukantar Madjid , Bagate François , Mouillet Gauthier , Folliguet Thierry , Mekontso Dessap Armand , Teiger Emmanuel , Gallet Romain
Published: May 2020

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) initiation for patients with cardiogenic shock or cardiac arrest is an attractive strategy since it provides a quick restoration of organ perfusion. One major limitation of VA-ECMO is left ventricle (LV) distension which is associated with poor prognosis. To prevent or treat LV distension, LV decompression may be required. Current strategies for LV decompression have some contraindications, carry a high risk of complications and, for some of them concerns remain regarding their effectiveness. We here describe our experience in two adult patients treated with VA-ECMO in whom indirect LV unloading using pulmonary artery venting was performed for the prevention and the treatment of LV distension, respectively. The placement of the venting cannula in the pulmonary trunk was quick, easy and safe and was associated with the resolution of LV distension. These results suggest that pulmonary artery venting may be an attractive strategy for indirect LV decompression during VA-ECMO.
Patients with elevated blood pressure or stage 1 hypertension have structural heart disease
Authors: Ghany Reyan , Palacio Ana , Chen Gordon , Dawkins Elissa , Forbes Emancia , Tajiri Thiago , Tamariz Leonardo
Published: May 2020

Background

The 2017 American College of Cardiology (ACC) and the American Heart Association (AHA) recommendations lower the hypertension threshold to 130/80 mmHg and recommends treatment for high-risk patients. Our aim is to determine whether the new blood pressure categories are associated with left ventricular (LV) structural changes and whether echocardiograms can provide risk stratification and help treatment initiation.

Methods

We conducted a cross-sectional study and performed screening echocardiograms to consecutive primary care patients. We calculated the Framingham score to identify patients with a low or intermediate score who had structural heart disease.

We classified everyone as having normal, elevated blood pressure, stage 1 or stage 2 hypertension according to the 2017 ACC/AHA guidelines. We defined structural heart disease as having LV hypertrophy and an abnormal LV mass index.

Results

We included 16 650 patients who underwent a screening echocardiogram and had recorded blood pressure. Out of the 16 650 patients, 1465 patients had a normal blood pressure, 1382 had elevated blood pressure, 1333 had stage 1 hypertension, and the remainder had stage 2 hypertension. The adjusted odds ratios of having structural heart disease for elevated blood pressure and stage 1 hypertension were 1.30; 95% CI, 1.112–1.64; P < 0.01 and 1.69; 95% CI, 1.25–2.30; P < 0.01, respectively. We identified 542 patients with stage 1 hypertension who had a low or intermediate Framingham score and 19% (95% CI, 16–23%) had structural heart disease.

Conclusion

A quarter of patients identified as having elevated blood pressure or stage 1 hypertension have structural heart disease. Screening echocardiograms may help to risk stratify those patients deemed ineligible for treatment.
Effect of blood insulin level on postprandial hypotension in elderly people
Authors: Hu Hui , Qiao Wei , Wang Xi , Wang Yunyun , Li Ying , Wang Kejing , Liu Shuang
Published: May 2020

Objectives

The aim of the study is to discuss the effect of postprandial insulin level on blood pressure in elderly patients by comparing the blood pressure, blood glucose, and insulin levels between patients with postprandial hypotension (PPH) and non-PPH over 80 years old during fasting and within 2 h after meal, and observing the changes of parameters in patients with PPH before and after treatment with acarbose.

Methods and materials

Twenty-five PPH patients and 27 non-PPH patients were selected. The blood pressure, blood glucose, and insulin levels during fasting and within 2 h after meal were monitored. Patients with PPH were treated with acarbose. All parameters were checked one week later.

Results

(1) Preprandial blood pressure in PPH group was significantly higher than that in non-PPH group (152.00 ± 15.62 mmHg vs. 136.40 ± 14.12 mmHg, P < 0.05). (2) The maximum decrease of postprandial systolic blood pressure (SBP) in PPH group was significantly increased compared with that of the control group (32.20 ± 13.19 mmHg vs. 9.67 ± 8.38 mmHg, P < 0.05). The maximum increases of postprandial blood glucose and insulin levels were significantly higher in PPH group than in the control group (P < 0.05). (3) After acarbose treatment, the decrease of postprandial SBP in PPH group was significantly reduced compared with that before treatment (22.67 ± 6.98 mmHg vs. 32.60 ± 9.55 mmHg, P < 0.05); the increase of postprandial blood glucose was also significantly reduced in PPH group (2.37 ± 1.63 mmol/L vs. 3.39 ± 1.62 mmol/L, P < 0.05); the increase of postprandial insulin level was reduced significantly in PPH group (12.09 ± 3.96 mU/L vs. 22.33 ± 1.78 mU/L, P < 0.05). (4) There was no correlation between the maximum decrease of postprandial SBP and the maximum increase of blood glucose (r = −0.008, P = 0.961), but the maximum decrease of postprandial SBP was positively correlated with the maximum increase of insulin (r = 0.381, P = 0.032).

Conclusion

PPH tends to occur in elderly people with elevated basal blood pressure before meal. PPH is associated with an abnormal increase of postprandial insulin secretion. Reducing the increase of postprandial insulin is one of the mechanisms of acarbose in the treatment of PPH.
Simplified dual time point FDG-PET/computed tomography for determining dignity of pancreatic lesions
Authors: Bieg Christian , Mongelli Francesco , Peterli Ralph , Chirindel Alin-Florin , Metzger Jürg , von Flüe Markus , Gass Markus
Published: May 2020

Background

Predicting the dignity of pancreatic lesions is still a diagnostic challenge. The differentiation between benign changes in chronic pancreatitis from pancreatic cancer remains difficult. Therefore, the aim of this study was to evaluate whether early dual time point kinetics of pancreatic lesions in 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) may be helpful to differentiate pancreatic lesions.

Methods

We prospectively analyzed 64 patients (pancreatic cancer n = 45 and chronic pancreatitis n = 19) scheduled for dual time point FDG-PET/computed tomography scan for pancreatic lesions from 2005 to 2014. Studies were performed 60 and 90 minutes after application of 18F-FDG. Histological samples were collected for all patients, either by resection or by biopsy. Semiquantitative analysis was performed using the minimum, the maximum, and the average standardized uptake value (SUV) from the two different sets of images. To increase sensitivity and specificity, a formula addressing the weighting of standardized uptake values was created.

Results

With a sensitivity of 82.6%, specificity of 77.8%, accuracy of 79.7%, positive predictive value of 90.5%, and negative predictive value of 63.6% SUVmax@time1 > 3.45 was the most reliable single quantitative parameter for malignancy of the pancreatic lesions. Weighting of standardized uptake values produced a formula that showed an even better profile.

Conclusions

In patients with suspicious pancreatic lesions, the simplified dual time point FDG-PET/computed tomography may represent a valuable diagnostic tool in characterizing pancreatic lesions.
Child and Parent Mental Health Problems in Pediatric Celiac Disease
Authors: Giannakopoulos Georgios , Margoni Daphne , Chouliaras Giorgos , Panayiotou Joanna , Zellos Aglaia , Papadopoulou Alexandra , Liakopoulou Magda , Chrousos Giorgos , Kanaka‐Gantenbein Christina , Kolaitis Gerasimos , Roma Eleftheria
Published: May 2020

Objectives:

The aim of our study was to estimate the levels of mental health problems in children with celiac disease (CD) along with their parents’ mental health status, to compare these levels with those of healthy controls and to investigate how these problems are affected by a gluten‐free diet (GFD).

Methods:

Our study constituted 50 patients with CD at diagnosis before the initiation of a GFD (age 8.6 ± 3.7 years, group A), 39 patients with CD on a GFD for at least 12 months (age 10.4 ± 3.4 years, group B) and 38 healthy controls (age 7.7 ± 3.8 years, group C), as well as their parents. One of the parents of each child completed the Child Behaviour Checklist (CBCL) and the Symptom Checklist 90 (SCL‐90‐R) to evaluate the children's and parents’ mental health problems, respectively. Twenty patients in group A were reevaluated at least 12 months after initiation of a GFD (group D).

Results:

At diagnosis, CD patients had higher scores in the CBCL for internalizing problems than healthy controls (55.7 ± 10.3 vs 47.9 ± 15.4, P = 0.007) and their parents demonstrated increased severity of mental health problems, including anxiety and depression, than the parents of healthy controls (0.72 ± 0.49 vs 0.54 ± 0.58, P = 0.013).

Conclusions:

CD patients at diagnosis and their parents, had more mental health problems, including anxiety and depression, than healthy controls.
The Association Between Caesarean Section and Inflammatory Bowel Disease in Childhood and Young Adulthood
Authors: Burnett David , Brown Mary Margaret , Otley Anthony , Kuhle Stefan
Published: May 2020

Objective:

The aim of the study was to examine the association of Caesarean section (CS) with inflammatory bowel disease (IBD) in Nova Scotian children.

Methods:

The study consisted of 2 retrospective cohorts in the Canadian province of Nova Scotia: all births between 1988 and 2014 (n = 262,729) linked with a clinical registry of all children diagnosed with IBD at the IWK Health Centre, Halifax (Clinical Cohort) and all births from 1989 to 1993 (n = 42,999) linked with provincial administrative health data (Administrative Cohort). The primary outcome was a diagnosis of IBD; the outcome in the Administrative Cohort was ascertained using a previously validated algorithm. Information on the exposures and confounding variables was obtained from the Nova Scotia Atlee Perinatal Database. The association between CS and time to diagnosis of IBD was examined using survival analysis.

Results:

The population incidence of IBD in the Clinical and Administrative Cohort were 13.0 and 20.6, respectively, per 100,000 person‐years; 23% and 19% of children were born by CS in the 2 cohorts. There was no association of CS with IBD in the 2 cohorts.

Conclusions:

Findings from 2 population‐based cohorts in Atlantic Canada did not provide any evidence for an association between CS and IBD in childhood and young adulthood.
A Micro‐longitudinal Approach to Measuring Medication Adherence in Pediatric Inflammatory Bowel Diseases
Authors: Plevinsky Jill M. , Denson Lee A. , Hellmann Jenny , Minar Phillip , Rosen Michael J. , Hommel Kevin A.
Published: May 2020

Measuring medication adherence in pediatric inflammatory bowel diseases (IBD) is challenging because of complexities in personalized treatment regimens and increased use of biologic mono‐ and combination therapy. Objective measurement of adherence via electronic monitoring is the gold standard; however, it is not useful for daily monitoring when multiple medication formulations (eg, pills, injections, infusions) as well as vitamins/supplements are prescribed. Although validated subjective measures are available, they are not designed for daily use and do not capture day‐to‐day variation in adherence. In the following article, a new approach to measuring adherence regardless of a patient's specific medication regimen is presented. Utilizing a micro‐longitudinal design, 30 days of daily self‐reported medication adherence data was collected from youth with IBD via text message. Results reflect mean adherence rates from studies utilizing pill counts and electronic monitoring, suggesting promise for the use of self‐reported daily diaries to assess medication adherence in pediatric IBD.
Physician Assistant's Knowledge and Confidence Regarding Prescribing Preexposure Prophylaxis for HIV Prevention
Authors: Bunting Samuel R. , Miller Kathleen W. , Chappell Rachel , Goldstein Robert H. , DeJean Olivia
Published: May 2020

Physician assistants (PAs) have an important role to play in increasing preexposure prophylaxis (PrEP) prescriptions. We surveyed PAs regarding knowledge of Centers for Disease Control and Prevention guidelines for PrEP and confidence regarding PrEP. Physician assistants in primary care reported more accurate knowledge and higher confidence. However, knowledge and confidence gaps were present among all PAs, regardless of specialty.
Position Paper
Authors: Davis Gregory G. , Cadwallader Amy B. , Fligner Corinne L. , Gilson Thomas P. , Hall Emma R. , Harshbarger Kent E. , Kronstrand Robert , Mallak Craig T. , McLemore Jerri L. , Middleberg Robert A. , Middleton Owen L. , Nelson Lewis S. , Rogalska Agnieszka , Tonsfeldt Eric , Walterscheid Jeff P. , Winecker Ruth E.
Published: May 2020

The National Association of Medical Examiners convened an expert panel to update the association's evidence-based recommendations for investigating and certifying deaths associated with opioids and other misused substances to improve death certificate and mortality data for public health surveillance. The recommendations are as follows:

1. Autopsy provides the best information on a decedent's medical condition for optimal interpretation of toxicology results, circumstances surrounding death, medical history, and scene findings. The panel considers autopsy an essential component of investigating apparent overdose deaths.

2. Scene investigation includes reconciling prescription information and medication counts. Investigators should note drug paraphernalia or other evidence of using intoxicating substances.

3. Retain blood, urine, and vitreous humor whenever available. Blood from the iliofemoral vein is preferable to blood from more central sites.

4. A toxicological panel should be comprehensive, including potent depressant, stimulant, and antidepressant medications. Detecting novel substances present in the community may require special testing.

5. When death is attributed to a drug or combination of drugs (as cause or contributing factor), the certifier should list the drugs by generic name in the autopsy report and death certificate.

6. The best classification for manner of death in an overdose without any apparent intent of self-harm is “accident.”
Tissue Thickness Interferes With the Estimation of the Immunohistochemical Intensity: Introduction of a Control System for Managing Tissue Thickness
Authors: Masuda Shinobu , Suzuki Ryohei , Kitano Yuriko , Nishimaki Haruna , Kobayashi Hiroko , Nakanishi Yoko , Yokoi Hideo
Published: May 2020

Context and Objective:

The conversion of immunohistochemical (IHC) results from 3-dimensional tissue to a 2-dimensional visual image without considering tissue thickness poses a considerable risk of misleading IHC intensities. The present study aimed to clarify whether tissue thickness interferes with the estimation of IHC staining intensity and to introduce a control system to manage it.

Design:

We prepared cell lines that are used as controls for human epidermal growth factor receptor 2 (HER2) IHC (MDA-MB-231, MDA-MB-175VII, MDA-MV-453, and SK-BR-3), a polyclonal antibody for HER2, an interferometry to measure the tissue thickness of formalin-fixed paraffin-embedded sections, a microscope with a Halogen or an LED light source, a complementary metal-oxide semiconductor camera in which the output signal can be corrected to γ=1, and a program to estimate color elements (hue, saturation, and luminance). It was examined whether tissue thickness interferes with the experimental scoring systems and practical classification of the routine HER2 scoring system.

Results:

A noncellular control was shown to be better than a cellular control for managing tissue thickness. The IHC intensity for HER2 was correlated with tissue thickness (R
2=0.8094), even under the less-standardized condition, but this correlation was better under the improved standardized condition using corrected γ=1 (R
2=0.9282). Discrepancies in practical HER2 scores were increased in sections with thicknesses <2 and >5 μm. A control system to manage tissue thickness was introduced.

Conclusions:

Tissue thickness interferes with the estimation of the IHC intensity of HER2 in both experimental and practical scoring systems. A control system for managing tissue thickness is essential to increase the benefits of IHC as a standardized assay for clinical applications.
Well-Being During Coronavirus Disease 2019: A PICU Practical Perspective
Authors: Donnelly Peter D. , Davidson Mark , Dunlop Neil , McGale Marie , Milligan Eileen , Worrall Mark , Wylie Joanne , Kidson Christopher
Published: May 2020

The importance of promoting well-being for healthcare professionals has never been as important as during the current coronavirus disease 2019 pandemic. It is recognized that the concept of well-being is a multifaceted phenomenon which is influenced by individual, team, and system characteristics. We outline an approach to practically initiating supportive strategies within the PICU using a well-being approach to improve baseline resilience alongside an acute rescue strategy utilizing a peer-support network. These strategies are practical interventions and we share them with the aim of encouraging the international PICU community to use these or other strategies to support their teams. We encourage shared learning and collaboration during these difficult times.
Technological Advances of Magnetic Resonance Imaging in Today's Healthcare Environment
Authors: Nikolaou Konstantin
Published: May 2020

Are we reacting adequately to a constantly changing clinical and scientific environment, regarding our patients, the economy, or new technologies, such as artificial intelligence? The authors of this review article have identified 3 major challenges regarding the use of magnetic resonance imaging (MRI) in our clinical practice today and tomorrow: (1) the need for faster acquisitions, optimized workflows, and higher patient throughput, making MRI broadly available and applicable, also under the light of rising economic pressure; (2) adaptation to the demographic change, tailoring protocols, and procedures to the needs of an aging and multimorbid patient population; and (3) providing quantifiable data, reproducible imaging biomarkers, and integrated artificial intelligence algorithms, to make MRI an integral part of modern precision medicine. The authors conclude that with constant advances in MR technology, workflow and scanning efficiency can be optimized, while providing consistent, high-quality personalized examination results at the same time.
Right Atrial Intimal Sarcoma on 18F-FDG PET/CT
Authors: Janssen Nick , Verheyen Jef , Albert Adrien
Published: May 2020

A right atrial mass was discovered with transthoracic cardiac ultrasound in a complaint-free, 81-year-old man at his yearly cardiological checkup. Further investigation of the mass with transesophageal cardiac ultrasound showed a well-defined nodular mass of approximately 3 × 3 cm, in close proximity to the posterior wall of the right atrium. The patient underwent an 18F-FDG PET/CT, which showed a right atrial mass with very high FDG uptake, suggesting a malignant process. The mass was surgically removed, and anatomopathological assessment revealed an intimal sarcoma, which is a very malignant tumor and an extremely rare occurrence at this location.
PSMA Expression in the Neovasculature Associated With Rectal Adenocarcinoma
Authors: Sonni Ida , Caron Justin , Kishan Amar U. , Muthusamy V. Raman , Calais Jeremie
Published: May 2020

We report the case of a 63-year-old man who underwent MRI and 68Ga-PSMA-11 PET/CT for biochemical recurrence localization after radical prostatectomy (serum PSA, 0.25 ng/mL) and describe the incidental discovery of a rectal adenocarcinoma. Immunohistochemical analysis showed PSMA staining in the tumor-associated neovasculature, but not in normal vasculature, or tumor cells. After surgical removal, he was treated with salvage radiotherapy to the postoperative prostate bed. This case example has several implications: the findings confirm the expression of PSMA in the tumor-associated neovasculature of a rectal cancer, nonprostate cancers’ stroma may represent a potentially relevant target for nuclear theranostics.
Extensive Intraspinal Hypermetabolism Caused by Neurobrucellosis Shown on 18F-FDG PET/CT
Authors: Wu Meiqi , Cui Ruixue , Li Fang , Huo Li , Luo Yaping
Published: May 2020

A 55-year-old man and a 52-year-old man presenting with neurological symptoms were referred for 18F-FDG PET/CT for the underlying malignancy. In both cases, extensive intraspinal hypermetabolism was observed in 18F-FDG PET/CT. The cerebrospinal fluid culture finally confirmed infection of Brucella. This report illustrates that neurobrucellosis may present as intraspinal hypermetabolism on 18F-FDG PET/CT, and thus it should be added to the differential diagnosis.
Is There Any Clinical Value of Adding 123I-Metaiodobenzylguanidine Myocardial Scintigraphy to 123I-Ioflupane (DaTscan) in the Differential Diagnosis of Parkinsonism?
Authors: Stathaki Maria , Koukouraki Sophia , Simos Panagiotis , Boura Iro , Papadaki Emmanouela , Bourogianni Olga , Tsaroucha Angeliki , Kapsoritakis Nikolaos , Mitsias Panayiotis , Spanaki Cleanthe
Published: May 2020

Purpose

The aim of the study is to evaluate the impact of myocardial 123I-metaiodobenzylguanidine (MIBG) in the diagnosis, clinical management, and differential diagnosis of Parkinson disease (PD) and non-PD parkinsonism.

Methods

The study enrolled 41 patients with parkinsonism. An initial diagnosis was reached after thorough clinical and imaging evaluation. After 2 to 5 years of follow-up, a final diagnosis was established. All patients underwent, soon after their initial visit, presynaptic striatal DaT scintigraphy with 123I-FP-CIT (DaTscan) and 123I-MIBG myocardial scintigraphy. DaTscan is not specific to distinguish among different types of neurodegenerative parkinsonism. 123I-MIBG myocardial scintigraphy displays the functional status of cardiac sympathetic nerves, which is reduced in PD/dementia with Lewy bodies (DLB) and normal in atypical parkinsonian syndromes and secondary or nondegenerative parkinsonism.

Results

No patients showed adverse effects during or after both scintigraphies. A positive DaTscan was found in all patients in the PD/DLB group (17/17) and in 15 of 24 patients in the non-PD group. Myocardial 123I-MIBG scintigraphy was associated with lower sensitivity (82% vs 100%) but higher specificity than DaTscan (79% vs 38%) in diagnosis PD/DLB from non-PD parkinsonism. A positive scan result on both techniques, to confirm diagnosis of PD/DLB, significantly improved the specificity of DaTscan, from 38% to 75%, with no reduction in sensitivity.

Conclusions

Myocardial 123I-MIBG imaging provides complementary value to 123I-FP-CIT in the proper diagnosis, treatment plan, and differential diagnosis between PD and other forms of parkinsonism.
Effect of combined washing with heat and microbubbles water on the
quality of fresh-cut lettuce
Authors: Kim Hyo Jin , Park Kyung Min , Jeong Mooncheol , Park Kee Jai , Koo Minseon
Published: May 2020

The effects of different washing techniques, including the combined use of heated
water and microbubbles water, on fresh-cut lettuce leaves (Lactuca
sative var, capitata) were examined. The outer leaves were removed
from the lettuce and cut into squares with dimensions of approximately 1–2 cm.
The lettuce leaf samples were then washed with either tap water (Tap),
microbubbles water (MB, Contains 70% or more of microbubbles with a
diameter of 10μm or less), heated water (HWT, 40°C, 45°C or
50°C), or heated microbubbles water (HWT+MB, 40°C,
45°C or 50°C) for 1 min. After washing, the microbiological
properties (i.e., total viable bacteria, coliform and fungi) and quality of the
samples were measured. The total viable bacteria level of the HWT-50°C
sample was <1 log CFU/g, representing the most effective washing
technique, although the freshness decreased rapidly during storage. In addition,
HWT+MB-40°C treatment was less effective in reducing the
microbiological levels, although the decay rate was maintained at 0% for
the initial 2 d of storage, and showed the lowest value of 11% after 6 d.
Furthermore, the decay rate for the sample treated with MB was
<30% after 10 d, and a similar result was obtained for the
HWT+MB-40°C sample. It was apparent that a combined heat and
microbubbles treatment, and in particular at a temperature of 40°C, was
effective for maintaining the freshness and quality of fresh-cut lettuce during
storage.
Effect of Nepeta cataria extract on the skin
barrier function
Authors: Kim Hyun-Soo
Published: May 2020

Nepeta cataria commonly known as catnip, catswort, catwort, and
catmint, is native to Europe, Asia, and America, and has a history of use in
traditional medicine for a variety of ailments. Although N.
cataria exhibits desirable biological effects, such as
anti-microbial, anti-inflammatory, and anti-tumor activities, the effect of
N. cataria extract on the skin barrier function remains
unknown. Thus, we herein examined the application of functional materials by
testing a variety of physiological activities of N. cataria
extract. N. cataria extract was found to possess a low
cytotoxicity and a high DPPH radical scavenging activity, which resulted in a
significant increase in the transactivation activity of PPAR response elements
(PPREs) such as peroxisome proliferator-activated receptor (PPAR)-α.
Finally, it was found that N. cataria extract promotes the
expression of filaggrin and involucrin, which is related to skin barrier
protection. These results indicate that N. cataria extract may
be an effective comfound for improving the skin barrier function.
Antioxidative and antimutagenic effects of Panicum miliaceum L.
Authors: Park Jeong Seob , Lee Jong Soon , Lee Jeong Ho
Published: May 2020

The antioxidative and antimutagenic effects of a 80% methanol extract of Panicum miliaceum were examined using the 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging assay, determination of the total polyphenol content, and the Ames test using Salmonella typhimurium. The DPPH radical scavenging activity (EC50) and total polyphenol content of the 80% methanol extract of P. miliaceum were 67.43±4.28 μg/mL and 16.26±1.02 mg/g, respectively. The 80% methanol extract was sequentially fractionated using chloroform, n-butanol, and water, and the chloroform fraction was found to exhibit strong antioxidative effects. The antimutagenic effects of P. miliaceum against aflatoxin B1, 3-amino-1,4-dimethyl-5H-pyrido[4,3-b]indole, and 2-aminofluorene were then studied by the Ames test using S. typhimurium TA98 and TA100. The results obtained using the 80% methanol extract (600 μg/plate) and S. typhimurium TA98 and TA100 showed 95.2±2.3 and 89.8±4.5% inhibition of mutations caused by AFB1, respectively. Similarly, the chloroform fraction (200 μg/plate) exhibited a >90% inhibition for both strains. These results therefore indicate that P. miliaceum exhibits both mutagenic and antioxidant activities, thereby rendering it suitable for use in a variety of food materials.
Hidden periods, duration and final size of COVID-19 pandemic
Authors: Nesteruk Igor
Published: May 2020

The SIR (susceptible-infected-removed) model, statistical approach for the parameter identification and the official WHO data about the confirmed cumulative number of cases were used to estimate the characteristics of COVID-19 pandemic in USA, Germany, UK, South Korea and in the world. Epidemic in every country has rather long hidden period before fist cases were confirmed. In particular, the pandemic began in China no later than October, 2019. If current trends continue, the end of the pandemic should be expected no earlier than March 2021, the global number of cases will exceed 5 million.