bluuebunny/crossref_metadata_2025 huggingface dataset:
Personality assessment in orthopaedic residency programs: A cross-sectional survey study
Authors: Salazar Dane , McGregor Patrick Cole , Varsanik Mary Alyssa , Perry Michael , Schiff Adam
Published: January 2020

Background:

The use of personality-based assessments has become common practice across industries outside of medicine. Although widely used in the corporate arena, the use of personality testing in medicine is comparatively unexplored. The objective of this study was to investigate the prevalence of personality assessment tools used by orthopaedic residency programs.

Methods:

Survey invitations were sent to 154 orthopaedic residency program directors from around the United States. The survey queried the use of personality assessment tools in each residency program. Participants also were asked their sentiments regarding the potential utility of personality assessment in their respective programs.

Results:

Of the 47 respondents, 42 program directors indicated they do not use any personality assessment in their residency program. Of the five directors answering in the affirmative, three use personality assessment to identify potential problems, two use it for mentorship selection and for investigational purposes. One director uses personality assessment in the evaluation of residency applicants. No program directors use the information to select clinical service teams. A majority indicated they are at least somewhat familiar with the Myers-Briggs personality inventory.

Conclusions:

Personality assessment is not a widely used tool in orthopaedic residency programs, with nearly 90% of program directors indicating they do not use it in their programs. However, nearly 70% of respondents indicated there is some utility for the use of personality testing in their residency. Future studies will be needed to further elucidate the barriers to wider spread utilization of personality assessment.

Level of Evidence:

Level IV.
Translational medicine: Challenges and new orthopaedic vision (Mediouni-Model)
Authors: Mediouni Mohamed , Madiouni Riadh , Gardner Michael , Vaughan Neil
Published: January 2020

In North America and three European countries translational medicine (TM) funding has taken center stage as the National Institutes of Health (NIH), for example, has come to recognize that delays are commonplace in completing clinical trials based on benchside advancements. Recently, there are several illustrative examples whereby the translation of research had untoward outcomes requiring immediate action. Focus more on three-dimensional (3D) simulation, biomarkers, and artificial intelligence may allow orthopaedic surgeons to predict the ideal practices before orthopaedic surgery. Using the best medical imaging techniques may improve the accuracy and precision of tumor resections. This article is directed at young surgeon scientists and in particular orthopaedic residents and all other junior physicians in training to help them better understand TM and position themselves on career paths and hospital systems that strive for optimal TM. It serves to hasten the movement of knowledge garnered from the benchside and move it quickly to the bedside. Communication is ongoing in a bidirectional format. It is anticipated that more and more medical centers and institutions will adopt TM models of healthcare delivery.
Influence of Demographic Characteristics and Muscle Strength on the Occupational Fatigue Exhaustion Recovery Scale in Career Firefighters
Authors: Giuliani Hayden K. , Gerstner Gena R. , Mota Jacob A. , Ryan Eric D.
Published: January 2020

Objective:

Little is known regarding how individual characteristics and changes in muscle strength across a shift cycle are associated with the Occupational Fatigue Exhaustion Recovery scale in career firefighters.

Methods:

Thirty-two career firefighters completed lower body maximal strength testing prior to and following three 24-hour on-off shifts. Demographic data were collected prior to the first shift and the OFER15 questionnaire was completed following the last shift.

Results:

Increased age was associated with greater acute and chronic fatigue and poorer recovery. A positive percent change in strength following a shift cycle was related to better recovery. Age was the only significant predictor of acute and chronic fatigue, while age and the change in strength were significant predictors of inter-shift recovery.

Conclusions:

Increased age influences all dimensions of work-related fatigue, with changes in muscle strength influencing inter-shift recovery in career firefighters.
Choosing the right inhaler for the right patient: Considerations for effective management of patients with chronic obstructive pulmonary disease or asthma
Authors: Hoy Haley , O'Keefe Louise
Published: January 2020

Background and purpose:

Effective management of chronic respiratory disorders such as chronic obstructive pulmonary disease and asthma necessitates that patients inhale their medication. However, lack of detailed guidelines on the technological and mechanical functions of inhalers limits the ability of health care providers (HCPs) to personalize inhaler choice for patients. Numerous types of inhalers are currently available which offer their own distinct advantages and disadvantages. Independent of the drug class, the choice of inhaler may be influenced by many factors (e.g., inhaler attributes and the efficiency with which it delivers the medication, patient characteristics and preferences, dosing regimen, clinical setting, and support available for both patients and HCPs). This article attempts to summarize the inhalation technology and factors influencing inhaler choice and use and to provide an approach for matching the right inhaler to the right patient.

Conclusions:

Identifying factors related to inhaler choice is critical to ensuring adherence to treatment and patients' ability to use their inhaler correctly.

Implications for practice:

This review will help HCPs engage their patients in decision-making for inhaler choice and facilitate selection of the correct inhaler for each patient (i.e., one that they will use).
Occupational lung diseases in the 21st century: the changing landscape and future challenges
Authors: Fazen Louis E. , Linde Brian , Redlich Carrie A.
Published: January 2020

Purpose of review

Occupational exposures remain an underrecognized and preventable cause of lung disease in high-income countries. The present review highlights the emergence of cleaning-related respiratory disease and the re-emergence of silicosis as examples of trends in occupational lung diseases in the 21st century.

Recent findings

Employment trends, such as the shift from large-scale manufacturing to a service economy, the growth of the healthcare sector, and changing consumer products have changed the spectrum of work-related lung diseases. Following decades of progress in reducing traditional hazards such as silica in U.S. workplaces, cases of advanced silicosis have recently re-emerged with the production of engineered stone countertops. With growth in the healthcare and service sectors in the United States, cleaning products have become an important cause of work-related asthma and have recently been associated with an increased risk of chronic obstructive pulmonary disease (COPD) in women. However, these occupational lung diseases largely go unrecognized by practicing clinicians.

The present article highlights how changes in the economy and work structure can lead to new patterns of inhalational workplace hazards and respiratory disease, including cleaning-related respiratory disease and silicosis. Pulmonary clinicians need to be able to recognize and diagnose these occupational lung diseases, which requires a high index of suspicion and a careful occupational history.
Effects of protective factors on the depressive status of elderly people in Taiwan
Authors: Li Yang-Tzu , Tung Tao-Hsin
Published: January 2020

This study was conducted to examine the effect of protective factors on the relationship between crisis episodes and depression in the elderly population in Taiwan.

In this study, the Taiwan Longitudinal Study on Aging was used as basis for a cross-sectional secondary data analysis. After eliminating respondents below the age of 65 years and those with missing values, 2426 samples were collected. Predictive variables, such as crisis episodes, personal resources, family ties, social participation, and social support, were investigated, and the dependent variable of “depression status” was measured using the Center for Epidemiologic Studies Depression scale.

According to the results of regression analysis, the protective factors of self-assessed health (ß = −0.290, P < .001), instrumental support (ß = −0.153, P < .001), financial satisfaction (ß = −0.126, P < .001), emotional support (ß = −0.101, P < .001), crisis episodes (ß = 0.087, P < .001), support satisfaction (ß = −0.081, P < .001), leisure participation (ß = −0.053, P < .05), family ties (ß = −0.048, P < .05), and community participation (ß = −0.042, P < .05) had a significant effect on depression status. Moreover, leisure participation had a moderating effect on the relationship between crisis episodes and depression (ß = −0.07, P < .01). In addition, according to path analysis results, family ties had a significant negative predictive power on depression (β = −0.225, P < .001), as did social support (β = −0.978, P < .001). The predictive power of crisis episodes on depression through social support was 0.197 (−0.201 × −0.978 = 0.197, P < .001), and it was −0.324 (−0.331 × −0.978 = −0.324, P < .001) through social participation, which indicated that social support plays a mediating role between crisis episodes and depression and between social participation and depression.

Strengthening effective protective factors can improve the resilience of elderly people and enable them to cope with dilemmas rapidly and effectively when faced with crisis episodes as well as restore their health status and enjoy a satisfactory life.
Moxibustion for primary dysmenorrhea
Authors: Wu Xiao , Gan Lu , Zhang Yong , Chen Bailu , Luo Jing , Yan Jue , Chen Guiquan
Published: January 2020

Background:

Primary dysmenorrhea (PD) is one of the most common gynecological complaint among menstruating females. Acupuncture has been employed to relieve the pain-based symptoms and to avoid the side effects of conventional medication, especially, moxibustion has confirmed as an effective, convenient, and safe treatment for various types of menstrual pain. The purpose of this study is to systematically assess the effect and safety of moxibustion for treating PD.

Methods and analysis:

The following databases will be searched from their inception to December 2019: PubMed, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Wan-Fang Databases, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Citation Information by National Institute of Informatics, Chinese Scientific Journal Database. Two reviewers will search these databases, select data and evaluate the quality of studies separately. The methodological quality will be measured by the Cochrane risk of bias tool. The primary outcome is the pain degree evaluation including visual analog scale, numerical visual scale, verbal rating scale, Cox retrospective symptom scale, or any other scale used to evaluate the level of pain. And the response rate involved overall reduction in symptoms. The adverse effects, quality of life will be assessed as secondary outcomes. Risk ratio for dichotomous data and mean differences with a 95% confidence interval for continuous data will be adopted to express the effect and safety of moxibustion for PD.

Trial registration number:

PROSPERO CRD42019130141.
Effect of eight-section brocade on bone mineral density in middle age and elderly people
Authors: Tian Tianzhao , Cai Yingfeng , Zhou Jianpeng , Liu Baoxin , Chen Liye , Shi Min , Liang Haodong
Published: January 2020

Background:

Physical therapy have an important role in preventing and managing osteoporosis (OP). A number of randomized controlled studies have indicated that eight-section brocade (ESB) could increase bone mass and alleviate pain, particularly in older women. However, there is no systematic review evaluating safety and efficacy of ESB.

Methods:

Relevant studies involving eight-section brocade in middle-aged and elderly individuals with osteoporosis were systematically identified from electronic databases, including EMBASE, PubMed, the Cochrane Library Chinese National Knowledge Infrastructure, Chinese Science and Technology Periodicals Database, Chinese BioMedical Database, and Wanfang Data. Inclusion criteria are randomised controlled trials of eight-section brocade that examine function and bone metabolism in middle-aged and elderly individuals with OP. The primary outcome measures will be bone mineral density (BMD), balance capacity, pain score, and adverse event including fracture during exercise. Review Manager (Revman Version 5.3) software will be used for data synthesis, sensitivity analysis, meta regression, subgroup analysis, and risk of bias assessment. A funnel plot will be developed to evaluate reporting bias and Begg and Egger tests will be used to assess funnel plot symmetries. We will use the Grading of Recommendations Assessment, Development and Evaluation system to assess the quality of evidence.

Results:

This paper will systematically review the existing evidence, assessing the safety and effect of eight-section brocade in middle-aged and elderly individuals with OP.

Conclusion:

The results of this review may help to establish a better approach to prevention of osteoporosis and osteoporotic fractures in high-risk groups and to provide reliableevidence for its further application.

Ethics and dissemination:

Our aim is to publish this systematic review in a peer-reviewed journal. Our findings will provide information about the safety of ESB exercises and their effect on BMD of middle-aged and elderly individuals. This review will not require ethical approval as there are no issues about participant privacy.
An investigation into the avoidability of adverse drug reactions using the LAAT and modified Hallas tools
Authors: Danjuma Mohammed Ibn-Mas’ud , Shokri Shaikha Al , Abubeker Ibrahim Y. , Malik Ashraf El , Abdallah Ibtihal Mahmoud Hassan , Shafei Mohamed Nabil El , Fatima Haajra , Mahmoud Mohamed , Hussain Tanweer , Maghoub Yahya , Sajid Jamal , Zouki Abdel Naser El
Published: January 2020

An adverse drug reactions avoidability tool called the Liverpool ADR avoidability assessment tool (LAAT) was recently developed (for research purposes), and subsequently validated with mixed interrater reliability (IRR). We investigated the comparative IRR of this tool in an inpatient cohort to ascertain its practical application in this setting.

The patient population was comprised of 44 ADR drug pairs drawn from an observational prospective cohort of patents with ADR attending a Weill Cornell Medicine-affiliated tertiary medical Centre in Doha Qatar (Hamad General Hospital). Using the LAAT, and modified Hallas tools, 4 independent raters (2 Clinical Pharmacologists, and 2 General Physicians) assessed and scored the 44 ADR-drug pairs. Agreement proportions between the rating pairs were evaluated as well individual/overall kappa statistics and intraclass correlation coefficients. We evaluated the weight of each of the 7 questions on the LAAT tool to ascertain its determinative role.

Across 44 ADR-drug pairs, the overall median Fleiss kappa using the LAAT, and modified Hallas tools were 0.67 (interquartile range (IQR) 0.55, 0.76), 0.36 (IQR, 0.23–0.71) respectively. The overall percentage pairwise agreement with the LAAT and modified Hallas tools were 78.5%, and 62.2% respectively. Exact pairwise agreement occurred in 37 out of 44 (range 0.71–1), and 27 of 44 (0.53–0.77) ADR-drug pairs using the LAAT and modified Hallas tools respectively. Using the LAAT tool, the overall intraclass correlation coefficient was 0.68 (CI 0.55, 0.79), and 0.37 (CI 0.22, 0.53) with the modified Hallas tool.

We report a higher proportion of “possible” and “definite” avoidability outcomes of adverse drug reactions compared with the modified Hallas, or that reported by developers of the LAAT tool. Although initially developed for research purposes, our report has suggested for the first time a potential applicability of this tool in clinical environment as well.
Erectile dysfunction and associated risk factors in male patients with ischemic stroke
Authors: Dai Hengheng , Wang Jisheng , Zhao Qi , Ma Jianxiong , Gong Xihao , Wang Lu , Bao Binghao , Li Haisong , Wang Bin
Published: January 2020

Patients with ischemic stroke (IS) often suffered from the problem of erectile dysfunction (ED) and psychological disease. However, they are often ignored because these symptoms are more obvious in the convalescent stage of stroke, which affects the quality of sexual life of patients. This study aimed to investigate the incidence of ED, sexual quality of life, and mental state of patients after stroke, as well as analyze the relevant risk factors affecting their psychological status.

A total of 361 IS patients were enrolled. The international erectile function index-5 scale was used to diagnose ED. Accordingly, the patients were divided into ED group and non-ED group. Magnetic resonance imaging was used to evaluate the brain lesions of patients. We assessed neurological deficits by the National Institutes of Health Stroke Scale score and patient health questionnaire-9 (PHQ-9) and general anxiety disorder-7 (GAD-7) were used to evaluate the depression and anxiety. The differences between the ED group and the non-ED group clinical factors were compared.

The response rate was 88.6% (n = 320), and more than two-thirds of patients reported ED (77.8%). Patients with ED had higher PHQ-9 (8.40 ± 4.18 vs 4.94 ± 3.73, P < .01) and GAD-7 (6.73 ± 3.56 vs 4.51 ± 3.35, P < .01) scores, were more likely to have the frontal lobe (75.1% vs 49.3%, P < .01) and lateral ventricle (69.8% vs 53.5%, P = .01) lesions, with hypertension (75.1% vs 46.5%, P < .01) and hyperlipidemia (48.2% vs 25.4%), and on antihypertensive (67.9% vs 35.25, P < .01) and hypolipidemic drug (43.4% vs 16.9%, P < .01). Multivariate logistic regression analysis showed that antihypertensive drug (odds ratio [OR]: 2.50, 95% confidence interval [CI]: 1.02–6.10, P = .04), depression (OR: 1.18, 95% CI: 1.06–1.32, P < .01) and anxiety (OR: 1.13, 95% CI: 1.01–1.27, P = .04) might be the independent risk factors for ED group.

ED is more common in male IS patients. Antihypertensive drug, depression and anxiety are the main factors affecting ED.
Is the bone fusion affected by Modic-2 changes in single-level anterior cervical discectomy and fusion?
Authors: Huang Kangkang , Hong Ying , Liu Hao , Duan Yuchen , Wang Beiyu , Chen Hua , Ding Chen , Rong Xin , Wu Tingkui
Published: January 2020

To explore the impact of Modic changes (MCs) on bone fusion after single-level anterior cervical discectomy and fusion (ACDF) with a zero-profile implant (the Zero-P implant system).

From November 2014 to November 2017, a total of 116 patients who underwent single-level ACDF with the Zero-P implant were divided into two groups according to MRI showing type 2 MCs (MC2) or no MCs (i.e., the MC2 group and the NMC group, respectively). A total of 92 (79.3%) patients were classified into the NMC group, and 24 (20.7%) patients were classified into the MC2 group. The clinical outcomes and fusion rates were retrospectively evaluated between the 2 groups preoperatively and postoperatively at 3, 6, and 12 months, and the final follow-up.

The Japanese Orthopedic Association (JOA) scores and the visual analogue scale (VAS) scores of neck pain were significantly improved compared to the preoperative scores in both the NMC and MC2 groups (P < .05). However, there were no differences in JOA or VAS scores between the 2 groups (P > .05). The fusion rates of the NMC and MC2 groups at 3, 6, and 12 months postoperatively, and the final follow-up were 33.7% and 12.5%, 77.2% and 54.2%, 89.1% and 87.5%, and 97.8% and 95.8%, respectively. The fusion rates were significantly lower at 3 and 6 months after surgery in the MC2 group than in the NMC group (P < .05).

The presence of MC2 did not affect the clinical outcome but delayed the fusion time following ACDF with the Zero-P implant system.

Level of Evidence is Level 3.
A good response to glucocorticoid for Henoch–Schönlein purpura with abdominal pain and gastrointestinal bleeding in an adult
Authors: Yi Fangfang , Bai Zhaohui , Li Yingying , Xu Xiangbo , Guo Xiaozhong , Qi Xingshun
Published: January 2020

Rationale:

Henoch–Schönlein purpura (HSP) is a small-vessel vasculitis that has been extensively studied in children, but little is known about its natural history in adults. There is no consensus regarding the treatment of glucocorticosteroids use for HSP. The efficacy of glucocorticoid for preventing from severe complications or relapse is also controversial in HSP.

Patient concerns:

A 21-year-old male was admitted to the hospital due to abdominal pain for more than 20 days, hematochezia for more than 10 days, and rash for 2 days.

Diagnoses:

The diagnosis of HSP is based on the European League against Rheumatism and the Paediatric Rheumatology European Society in 2006.

Interventions:

The patient received glucocorticosteroids treatment for 17 days at the time of first hospitalization.

Outcomes:

The abdominal pain and hematochezia completely disappeared on the 6th day after the use of glucocorticosteroids, and purpura completely disappeared on the 8th day.

Lessons:

Our patient has a good response to glucocorticoid. Glucocorticosteroids may be effective for the treatment of HSP.
Effective/cost effective interventions of child mental health problems in low- and middle-income countries (LAMIC)
Authors: Grande Antonio Jose , Ribeiro Wagner Silva , Faustino Christine , de Miranda Claudio Torres , Mcdaid David , Fry Andra , de Moraes Silvia Helena Mendonça , de Oliveira Sandra Maria do Valle Leone , de Farias Joni Marcio , de Tarso Coelho Jardim Paulo , King Derek , Silva Valter , Ziebold Carolina , Evans-Lacko Sara
Published: January 2020

Background:

This systematic review protocol aims to examine the evidence of effectiveness and cost-effectiveness of interventions for children and adolescents with, or at risk of developing mental disorders in low- and middle-income countries (LAMICs).

Methods:

We will search Medline Ovid, EMBASE Ovid, PsycINFO Ovid, CINAHL, LILACS, BDENF and IBECS. We will include randomised and non-randomised controlled trials, economic modelling studies and economic evaluations. Participants are 6 to 18 year-old children and adolescents who live in a LAMIC and who present with, or are at high risk of developing, one or more of the conditions: depression, anxiety, behavioural disorders, eating disorders, psychosis, substance abuse, autism and intellectual disabilities as defined by the DSM-V. Interventions which address suicide, self-harm will also be included, if identified during the extraction process. We will include in person or e-health interventions which have some evidence of effectiveness (in relation to clinical and/or functional outcomes) and which have been delivered to young people in LAMICs. We will consider a wide range of delivery channels (e.g., in person, web-based or virtual, phone), different practitioners (healthcare practitioners, teachers, lay health care providers) and sectors (i.e., primary, secondary and tertiary health care, education, guardianship councils). In the pilot of screening procedures, 5% of all references will be screened by two reviewers. Divergences will be resolved by one expert in mental health research. Reviewers will be retrained afterwards to ensure reliability. The remaining 95% will be screened by one reviewer. Covidence web-based tool will be used to perform screening of references and full text paper, and data extraction.

Results:

The protocol of this systematic review will be disseminated in a peer-reviewed journal and presented at relevant conferences. The results will be presented descriptively and, if possible, meta-analysis will be conducted. Ethical approval is not needed for anonymised secondary data.

Conclusion:

the systematic review could help health specialists and other professionals to identify evidence-based strategies to deal with child and adolescents with mental health conditions.
Uterus transplant graft's arterial atherosclerotic remodeling veracity
Authors: Novotny Robert , Chlupac Jaroslav , Kristek Jakub , Pit’ha Jan , Chmel Roman , Sticova Eva , Janousek Libor , Fronek Jiri
Published: January 2020

Background:

Uterus transplantation is a complex, multi-step experimental procedure used for the treatment of uterus absence or uterus anomaly that prevents embryo implantation or pregnancy completion.

Method:

To date, only 51 uterus transplants worldwide had been performed. When simplified, it is vascularized composite allograft transplantation. While it is still an experimental procedure with encouraging results for the future, there are still many issues that have to be clarified. The most serious complications of uterus transplantation are graft rejection or grafts vascular failure.

Results:

So far, no reference to the atherosclerotic arterial infiltration of the uterus arteries was suggested and studied as one of the main causes of graft's failure.

Conclusion:

In this review we summarized current knowledge and possible role of uterus arterial damage, including atherosclerotic changes on the graft's survival.
Fever after varus derotational osteotomy is common, but not a risk factor for infection
Authors: Obana Kyle K. , Lin Adrian J. , Yang Joshua , Ryan Deirdre D. , Goldstein Rachel Y. , Kay Robert M.
Published: January 2020

Postoperative fever in pediatric patients following reconstructive hip surgery is of unknown significance. This study identifies the prevalence of postoperative fever after corrective hip surgery, its relationship to infection, and whether preventative use of anti-pyretics affects patient outcomes.

Overall, 222 patients who underwent a varus derotational osteotomy (VDRO) between 11/1/2004 to 8/1/2014 with minimum 6 months follow up were retrospectively identified. Variables included diagnosis, inpatient stay, daily maximum temperature, duration of fever, fever workup, and administration of scheduled anti-pyretics. Fever was defined as temperature ≥38°C.

In total, 123/222 (55.4%) and 70/222 (31.5%) had postoperative fevers of ≥38°C and ≥38.5°C, respectively. Average inpatient stay was 2.7 days postoperatively. Temperature (mean = 38.0°C) was greatest on postoperative day 1 (POD1), and 43.7% of patients had T ≥38°C on POD1. Anti-pyretics did not influence the duration of fever. Anti-pyretics on the day of surgery (POD0) did not influence the incidence of fever. Acetaminophen on POD0 significantly reduced likelihood of fever on POD1 (P = .02). Average length of fevers ≥38°C and 38.5°C were 8.4 and 4.2 hours, respectively. 3/18 (16.7%) fever workups administered were positive. Postoperative fever did not predict infection. 9/222 (4/1%) patients had postoperative infection - 5/123 (4.1%) with fever ≥38°C and 4/70 (5.7%) with fever ≥38.5°C. Rates of infection in patients with and without fevers were not significantly different (P = .97 for T ≥38°C and P = .38, for T ≥38.5°C).

Though common, postoperative fever does not increase risk of infection. The low prevalence of positive cultures indicates routine fever workups can safely be avoided in most patients.

Level of Evidence: III, retrospective comparative study
Development of a CT imaging phantom of anthromorphic lung using fused deposition modeling 3D printing
Authors: Hong Dayeong , Lee Sangwook , Kim Guk Bae , Lee Sang Min , Kim Namkug , Seo Joon Beom
Published: January 2020

Development of patient-specific CT imaging phantoms with randomly incorporated lesions of various shapes and sizes for calibrating image intensity and validating quantitative measurement software is very challenging. In this investigation, a physical phantom that accurately represents a patient's specific anatomy and the intensity of lung CT images at the voxel level will be fabricated using fused deposition modeling (FDM) 3D printing. Segmentation and modeling of a patient's CT data were performed by an expert and the results were confirmed by a thoracic radiologist with more than 20 years of experience. This facilitated the extraction of the details of the patient's anatomy; various kinds of nodules with different shapes and sizes were randomly added to the modeled lung for evaluating the size-accuracy of the quantification software. To achieve these Hounsfield Units (HU) ranges for the corresponding voxels in acquired CT scans, the infill ratios of FDM 3D printing were controlled. Based on CT scans of the 3D printed phantoms, the measured HU for normal pulmonary parenchyma, ground glass opacity (GGO), and solid nodules were determined to be within target HU ranges. The accuracy of the mean absolute difference and the mean relative difference of nodules were less than 0.55 ± 0.30 mm and 3.72 ± 1.64% (mean difference ± 95 CI), respectively. Patient-specific CT imaging phantoms were designed and manufactured using an FDM printer, which could be applied for the precise calibration of CT intensity and the validation of image quantification software.
Serum zinc concentration and quality of life in chronic liver diseases
Authors: Nishikawa Hiroki , Enomoto Hirayuki , Yoh Kazunori , Iwata Yoshinori , Sakai Yoshiyuki , Kishino Kyohei , Ikeda Naoto , Takashima Tomoyuki , Aizawa Nobuhiro , Takata Ryo , Hasegawa Kunihiro , Ishii Noriko , Yuri Yukihisa , Nishimura Takashi , Iijima Hiroko , Nishiguchi Shuhei
Published: January 2020

Health related quality of life (HRQOL) in chronic liver disease (CLD) patients has been attracting much attention these days because it is closely associated with clinical outcomes in CLD patients. HRQOL has become established as an important concept and target for research and practice in the fields of medicine. A critique of HRQOL research is the lack of conceptual clarity and a common definition of HRQOL. Using a clear definition of HRQOL may increase the conceptual understanding. In this study, we aimed to elucidate the association between serum zinc (Zn) level and HRQOL as assessed by the Beck Depression Inventory-2nd edition (BDI-II), Pittsburgh Sleep Quality Index Japanese version (PSQI-J) and the 36-Item Short Form Health Survey (SF-36) in CLD patients (n = 322, median age = 65 years, 121 liver cirrhosis (LC) patients (37.6%)). The median serum Zn level for all cases was 73.2 μg/dl. The median BDI-II score and PSQI-J score were 6 and 5, respectively. Patients with higher BDI-II score tended to have lower serum Zn level compared with those with lower BDI-II score. Similar tendencies were observed in patients with higher PSQI-J score. In the SF-36, physical functioning, role physical and physical component summary score significantly correlated with serum Zn level regardless of age, liver disease etiology and the LC status. While mental health and mental component summary score did not significantly correlate with serum Zn level regardless of age, liver disease etiology and the LC status. In conclusion, serum Zn level can be a useful marker for decreased HRQOL in patients with CLDs, especially for physical components.
Bone cement spacer: a novel technique for treating a complicated case of developmental dysplasia of the hip with an injured acetabulum
Authors: Alsiddiky Abdulmonem , Alatassi Raheef , Alfayez Saud , Alhuzaimi Fahad , Alqarni Mahdi
Published: January 2020

Rationale:

Developmental dysplasia of the hip (DDH) has an incidence of 5 per 1000 newborns and its management depends on various factors. We present a rare case of DDH with soft tissue obliteration and a bony prominence in the center of the acetabulum after failed open reduction and acetabuloplasty.

Patient concerns:

A 20-month-old girl presented to our clinic with right hip stiffness after undergoing open reduction and acetabuloplasty at another hospital.

Diagnoses:

The diagnosis of DDH was made using a computed tomography scan that revealed a right hip dislocation with soft tissue obliteration and a bony prominence in the center of the acetabulum.

Interventions:

We used a novel technique for treating the rare presentation of complicated DDH with massive soft tissue obliteration and bony prominence in the center of the acetabulum after failed open reduction and acetabuloplasty. The right hip was surgically explored. The acetabulum was deepened and resurfaced. Bone cement was applied over the acetabulum to prevent future ankylosis.

Outcomes:

At the follow-up 7 years after the last surgery, the patient had regained full range of motion and a properly reduced right hip with optimal acetabular coverage on radiographs.

Lessons:

Care must be taken in any patient with DDH who presents with hip redislocation after open reduction. If deepening and resurfacing of the acetabulum are required, bone cement could be used as a temporary spacer for 8 weeks; this was key in treating our patient.
High rates of ineligibility for participation in trials of new therapies in non-alcoholic steatohepatitis: a systematic review
Authors: Roskilly Anna , Shearer Jessica , Parker Richard , Rowe Ian A.
Published: January 2020

Background and aims:

Non-alcoholic fatty liver disease is common and there are a number of treatments in development. Patients with non-alcoholic steatohepatitis (NASH) and significant fibrosis are thought to be the population most in need of treatment. Identification of this group requires liver biopsy. The aim of this study was to identify the proportion of patients screened for phase 2 randomised controlled trials who subsequently entered these studies.

Methods:

Large, multicentre, phase 2 randomised controlled trials of pharmacological therapies for NASH were identified by systematic review. The pooled proportion of potential participants who entered the trials was estimated by meta-analysis. The reasons for trial ineligibility were separately extracted and analysed.

Results:

Thirteen reports of 14 trials were included. Overall, there were 4014 screened individuals included in the quantitative analyses and 53% were subsequently enrolled in a trial. Considering trials in which the entry criteria matched the current paradigm for treatment, that is, the presence of NASH and significant fibrosis, only 35% of screened individuals were eligible for trial entry. More than half of ineligible individuals were excluded on the basis of liver histology most often due to insufficient disease activity with or without insufficient fibrosis.

Conclusion:

The majority of patients considered at risk of NASH and fibrosis sufficient for treatment in randomised controlled trials are ineligible for trial entry. Most often, this is due to ineligible liver histology. These findings have implications for the design of future trials in NASH and for the applicability of treatments after licensing.
Predictors for the progression of hepatic cirrhosis to hepatocellular carcinoma under long-term antiviral therapy
Authors: Li Zhiqin , Hu Yushu , Wang Hongyan , Wang Meng , Gu Xinyu , Ping Yu , Zeng Qinglei , Li Hua , Yan Jingya , Yu Zujiang
Published: January 2020

Objective

Patients diagnosed with hepatitis B virus (HBV)-related hepatic cirrhosis have the potential for progression to hepatocellular carcinoma (HCC) even while undergoing long-term nucleos(t)ide analog (NA) therapy. This study investigated the predictors for the progression of hepatic cirrhosis to HCC under long-term NA therapy.

Methods

This retrospective study enrolled 898 patients diagnosed with HBV-related hepatic cirrhosis. They received NA therapy between January 2012 and January 2015. The values for the liver stiffness measurement (LSM), laboratory tests, and disease history were collected. The diagnostic specificity of the serum, was assessed with a receiver operating characteristic curve.

Results

The overall 2- and 3-year cumulative incidence of HCC was 6.8% and 15.15%, respectively. The LSM values were higher in the patients who had progressed to HCC. The serum PIVKA-II levels were more efficient than the serum AFP levels for the diagnosis of early HCC as the larger area under curve (0.866 vs. 0.687). The multivariate logistic regression analysis showed that HCC occurrence was significantly associated with the baseline LSM value (odds ratio = 1.035). At the end of the study, the death rate for the patients with larger LSM values was higher than that for those with lower LSM values (67.88% vs. 39.90%).

Conclusion

Patients with HBV-related cirrhosis have the potential for progression to HCC even under long-term NA therapy. The LSM value and the serum PIVKA-II level are significant predictors of HCC occurrence.
Infection as a predictor of mortality in decompensated liver cirrhosis: exploring the relationship to severity of liver failure
Authors: Grgurevic Ivica , Trkulja Vladimir , Bozin Tonci , Madir Anita , Miletic Maja , Marusic Srecko , Skrlin Jasenka , Sestan Crnek Sandra , Dobrovic Karolina
Published: January 2020

Background

Infections are common in patients with liver cirrhosis and increase mortality. We explored the relationship between infection and liver dysfunction in their effects on mortality.

Methods

Single-center data on decompensated liver cirrhosis patients hospitalized between March 2014 and December 2017 (index period) were reviewed until death, liver transplantation or 31 December 2018. Infections were classified as community-acquired infection (CAi) or hospital/healthcare associated infection (HCAi). Child-Pugh, model for the end-stage liver disease (MELD) and chronic liver failure-organ failure (CLiF-OF) scores indicated liver (dys)function.

Results

We enrolled 155 patients (85% alcoholic liver disease), 65 without infection at first hospitalization, 48 with CAi and 42 with HCAi. Multidrug resistant agents were confirmed in 2/48 (4.2%) CAi and 10/42 (23.8%) HCAi patients. At first hospitalization, infection was independently associated with worse liver dysfunction and vice versa, and with higher 30-day mortality [odds ratio (OR) = 2.73, 95% confidence interval (CI) 1.07–6.94]. The association was reduced with adjustment for MELD/CLiF-OF scores, but mediation analysis detected an indirect (via liver dysfunction) association. Twenty-eight patients were repeatedly hospitalized, 11 with new HCAi. HCAi was independently associated with twice higher risk of medium-term mortality and added an additional risk to any level of liver dysfunction, considering all or patients who survived the first 30 days. In those repeatedly hospitalized, HCAi appeared independently associated with a higher probability of infection and higher MELD scores at subsequent hospitalizations.

Conclusion

Infection (particularly HCAi) adds mortality risk to any level of liver dysfunction in decompensated liver cirrhosis patients. Mechanisms of long(er)-term effects (in acute episode survivors) seemingly include enhanced deterioration of liver function.
Comparison of 99mTc-DTPA and serum creatinine, cystatin C in detection of glomerular filtration rate: a retrospective clinical data analysis of 744 Chinese subjects
Authors: Yang Shi-kun , Zeng Ling-feng , Zhao Qing-yu , Zen Zheng-peng , Li Ai-mei , Zhang Lin-Wei , Li Liu , Song Na , Liu Yan , Zhang Hao
Published: January 2020

Background

To compare the accuracy of various equations for estimating glomerular filtration rate.

Methods

Chronic kidney disease was classified by 99mTc-DTPA scintigraphy (reference glomerular filtration rate), estimating glomerular filtration rate was estimated using various formulas. The similarity to reference glomerular filtration rate decide the accuracy of estimating glomerular filtration rate.

Results

Overall, the Fengscr-cys equation had significantly higher accuracy and correct proportion in chronic kidney disease stage classification than other equations. The subgroup analysis showed that Fengscr-cys equation was slightly more precise than other equations both in the male and female patients. Moreover, in patients older than 60 years or whose reference glomerular filtration rate was above 60 ml/min, Fengscr-cys equation also showed better accuracy.

Conclusion

Our data suggest that estimating glomerular filtration rate equations evaluated by serum cystatin C were better than serum creatinine-based equations, estimating glomerular filtration rate equations evaluated by both serum creatinine and cystatin C were better than those evaluated by serum creatinine or cystatin C alone. Among all enrolled equations, Fengscr-cys equation might be the best one to evaluate glomerular filtration rate in general Chinese paticipants.
The value of 18F-FDG PET-CT and 131I-norcholesterol scintigraphy in the characterization of high-risk adrenal masses
Authors: Riaz Saima , Syed Rizwan , Aziz Tarek Abdel , Alnaim Abdulrahman , Chung Teng Teng , Wan Simon , Kurzawinski Tom R. , Bomanji Jamshed
Published: January 2020

Purpose

To assess the value of 18F-FDG PET-computed tomography (CT) and 131I-norcholesterol scintigraphy in noninvasive characterization of high-risk adrenal lesions using surgical pathology as the gold standard.

Methods

We retrospectively reviewed clinical cases referred to the adrenal multidisciplinary team in a tertiary centre over the last 6 years. Inclusion criteria were the presence of indeterminate adrenal lesions and performance of combined imaging with 2-deoxy-2-[fluorine-18] fluoro- D-glucose Positron emission tomography/ computed tomography and 131I-norcholesterol scans. The accuracy of CT, PET-CT and 131I-norcholesterol findings was assessed by comparison with the postoperative histopathological outcome.

Results

Sixteen patients fulfilled the inclusion criteria. Ten underwent unilateral adrenalectomy, and six had clinical follow-up. The number of cases categorized as concerning on the basis of unenhanced CT, 18F-FDG PET-CT and 131I-norcholesterol was 11, 9 and 2, respectively. The mean diameter of adrenal lesions was 4.5 ± 1.9 cm. Average SUVmax of the FDG-avid adrenal lesions was 5.0 ± 2.0 (range 3.5–9.7). Fourteen adrenal masses showed 131I-norcholesterol uptake. All adrenal masses turned out to be benign lesions.

Conclusion

Conventional CT and FDG PET parameters are not adequately specific for determination of a benign lesion in this selected cohort of high-risk patients. Use of 131I-norcholesterol in this patient cohort may provide additional value.
Brain glucose metabolism in patients with newly diagnosed multiple myeloma significantly decreases after high-dose chemotherapy followed by autologous stem cell transplantation
Authors: Pourhassan Shamchi Sara , Zirakchian Zadeh Mahdi , Østergaard Brian , Kim Jennifer , Raynor William Y. , Khosravi Mohsen , Taghvaei Raheleh , Nielsen Anne L. , Gerke Oke , Werner Thomas J. , Holdgaard Paw , Abildgaard Niels , Revheim Mona-Elisabeth , Høilund-Carlsen Poul Flemming , Alavi Abass
Published: January 2020

Purpose

The aim of this study was to compare the effect of intensive therapy [consisting of high-dose chemotherapy followed by autologous stem cell transplantation (HDC/ASCT)] and conventional standard-dose chemotherapy (CDC) on brain 18FDG uptake, as an indicator of glucose metabolism, in multiple myeloma patients.

Materials and methods

Twenty-four patients with newly diagnosed multiple myeloma were included. Sixteen patients received HDC/ASCT, including bortezomib-based induction therapy, and eight patients received CDC. 18F-fluorodeoxyglucose (18FDG)-PET/computed tomography (CT) was performed 1 and 3 hours following tracer administration before and after the treatment. The manual segmentation of supratentorial and cerebellum of each patient was performed by two independent observers. The data were expressed as global mean standardized uptake values (GSUVmean). Wilcoxon signed-rank test was used to compare changes from before to after treatment.

Results

A significant decrease in the GSUVmean of supratentorial brain and cerebellum was observed after treatment in the patients who received HDC/ASCT (1 hour scans: 7.03 ± 1.18 vs. 6.56 ± 0.94; P = 0.03 and 7.01 ± 1.08 vs. 6.34 ± 0.93; P = 0.01, respectively). GSUVmean changes in the patients who received CDC were not significantly different after treatment (1 hour scans: 6.47 ± 1.16 vs. 6.21 ± 0.91; P = 0.40 and 6.30 ± 1.21 vs. 6.09 ± 0.86; P = 0.62, respectively). The same findings were observed for 3 hours scans. A high level of agreement was observed between two operators.

Conclusion

Multiple myeloma patients who received HDC/ASCT demonstrated a significant decrease in 18FDG uptake in the supratentorial brain and cerebellum, while patients who received CDC did not demonstrate significant changes in the brain 18FDG uptake.
Localized disease: types of reconstruction/plastic surgery techniques after glans resurfacing/glansectomy/partial/total penectomy
Authors: Alnajjar Hussain M. , Randhawa Karen , Muneer Asif
Published: January 2020

Purpose of review

The aim of this article is to provide an overview of the current literature specific to surgery for localized penile cancer including novel reconstructive techniques.

Centralization of penile cancer services in many European countries and in particular the United Kingdom has resulted in an increased proportion of men undergoing organ-sparing surgery (OSS) rather than partial or total penectomy. In this review, we focus on reconstructive techniques following surgery for the primary penile tumour.

Recent findings

The widespread adoption of penile preserving techniques in Europe and North America has shown both oncological safety as well as good cosmetic and functional outcomes. Recent evidence has suggested that narrower surgical margins do not affect overall cancer-specific survival or local recurrence rates. Therefore, excellent cosmetic and functional outcomes can be achieved using techniques such as glans resurfacing using split-thickness skin grafts, dorsal or ventral V–Y skin advancement and urethral centralization after partial penectomy. For patients requiring more radical surgery such as total penectomy, phallic reconstruction is a suitable option using free flaps or pedicled flaps.

The use of OSS has transformed the lives of penile cancer patients who can avoid the significant clinical and psychological consequences of more radical surgical treatments. Careful case selection and preoperative counselling is advised prior to reconstructive techniques. Close postoperative clinical surveillance is necessary for early detection of local recurrence.
Management of Severe Pain in Terminally Ill Patients at Home
Authors: Lowey Susan E.
Published: January 2020

The purpose of this article is to describe current evidence-based strategies to manage severe pain in patients living with terminal illnesses. A comprehensive pain assessment is a critical step in the initial development of a pain management plan and for ongoing evaluation of patients' pain. Although we have many effective clinical tools available for pain assessment, they are not always used consistently, which can negatively affect the pain management plan. Home care and hospice nurses need to be consistent in using the tools and documenting the patient's pain level and response to the pain management plan. Patients and caregivers have concerns and fears surrounding medication use, particularly with narcotic analgesics. It is vital that nurses provide thorough patient-centered teaching about medications to help address these concerns. Research has found that nurses who also provided validation to patients and families regarding their concerns, followed by education, were the most effective.