bluuebunny/crossref_metadata_2025 huggingface dataset:
Coproducing Health Professions Education: A Prerequisite to Coproducing Health Care Services?
Authors: Englander Robert , Holmboe Eric , Batalden Paul , Caron Rosemary M. , Durham Carol F. , Foster Tina , Ogrinc Greg , Ercan-Fang Nacide , Batalden Maren
Published: December 2019

In 2016, Batalden et al proposed a coproduction model for health care services. Starting from the argument that health care services should demonstrate service-dominant rather than goods-dominant logic, they argued that health care outcomes are the result of the intricate interaction of the provider and patient in concert with the system, community, and, ultimately, society. The key notion is that the patient is as much an expert in determining outcomes as the provider, but with different expertise. Patients come to the table with expertise in their lived experiences and the context of their lives.

The authors posit that education, like health care services, should follow a service-dominant logic. Like the relationship between patients and providers, the relationship between learner and teacher requires the integrated expertise of each nested in the context of their system, community, and society to optimize outcomes. The authors then argue that health professions learners cannot be educated in a traditional, paternalistic model of education and then expected to practice in a manner that prioritizes coproductive partnerships with colleagues, patients, and families. They stress the necessity of adapting the health care services coproduction model to health professions education. Instead of asking whether the coproduction model is possible in the current system, they argue that the current system is not sustainable and not producing the desired kind of clinicians.

A current example from a longitudinal integrated clerkship highlights some possibilities with coproduced education. Finally, the authors offer some practical ways to begin changing from the traditional model. They thus provide a conceptual framework and ideas for practical implementation to move the educational model closer to the coproduction health care services model that many strive for and, through that alignment, to set the stage for improved health outcomes for all.
The Vanderbilt Program in Interprofessional Learning: Sustaining a Longitudinal, Clinical Experience That Aligns Practice With Education
Authors: Davidson Heather A. , Hilmes Melissa A. , Cole Shannon , Waynick-Rogers Pamela , Provine Allison , Rosenstiel Donna , Norman Linda , Miller Bonnie
Published: December 2019

Problem

Designing and sustaining a longitudinal, clinic-based interprofessional learning experience is logistically challenging, which has limited the educational opportunities available in health professions schools. The authors discuss the Vanderbilt Program in Interprofessional Learning (VPIL), which addresses some of the challenges facing clinic-based interprofessional experiences.

Approach

VPIL places first- and second-year students from 4 professional degree programs (medicine, nursing, pharmacy, social work) in Nashville, Tennessee, on teams where they work and learn together in authentic clinical environments over a 2-year period. The program was implemented in 2010 and includes 3 components: a summer immersion experience, seminar-based classroom and simulation sessions, and a weekly clinical experience. Students also complete a capstone quality improvement project. VPIL administrators have set up structures at the institutional, clinic, faculty, and student levels that have contributed to the sustainability of the program.

Outcomes

Between 2010 and 2019, VPIL admitted 398 students who participated on 91 clinical teams. In addition, 55 clinical preceptors and 12 core faculty trained students for future collaborative practice. The program has received consistently high ratings from students, who have produced 69 quality improvement projects at their clinics. These projects have addressed aspects of the care delivery process and produced durable materials, showing that the program has contributed to important innovations in the health system.

Next Steps

VPIL faculty continue to improve the curriculum and administrative structures and work to expand the program to reach a wider variety of health professions students. Going forward, lessons from the program could assist educators in creating opportunities for students to learn interprofessionally and deliver high value health care in increasingly complex delivery systems.
A Novel Surgical Technique for Ahmed Glaucoma Valve Implantation Without Plate Sutures
Authors: Sanvicente Carina T. , Moster Marlene R. , Lee Daniel , Menezes Alicia , Ghahramani Aria , Zhang Qiang , Hamershock Rose , Myers Jonathan S.
Published: December 2019

Précis:

A modification to the surgical technique of Ahmed glaucoma valve (AGV) implantation without plate sutures or surgical glue products has a similar safety and efficacy profile than the standard procedure, in the short and mid-term follow-up.

Purpose:

The purpose of this study was to assess the safety and efficacy of a modified AGV implantation technique without plate sutures.

Methods:

A retrospective case-control study including patients seen in the Glaucoma service of an academic institution. Patients that underwent a modified AGV implantation without plate sutures were included as cases and patients that underwent standard AGV implantation, as controls. Success was defined as intraocular pressure (IOP) reduction >20%, IOP >5 and <21 without the need for additional surgical intervention, and maintenance of light perception.

Results:

A total of 170 eyes were included. Mean (range) follow-up was 11.2±7.39 (3 to 24) months. There was no statistically significant difference in visual acuity and IOP between the groups during the postoperative period. In a univariate analysis, there was a larger decrease in IOP for the no plate suture group at the 6 months (−15.6±11.6 vs. −11.5±10.5, P=0.04) and 1 year (−16.4±10.4 vs. −11.1±10.4, P=0.02) visits. There was also a larger decrease in number of medications in the no plate suture group in the 3 months (−1.65±1.5 vs. −1.13±1.22, P=0.02), 6 months (−1.55±1.44 vs. −0.98±1.3, P=0.01) and 1 year (−1.70±1.5 vs. −1.04±1.2, P=0.04) visits. However, those differences were not confirmed by a multivariable model after adjusting for glaucoma type and number of previous glaucoma surgeries. No differences in the trajectory of the survival curves were noted between groups (P=0.36).

Conclusion:

The comparison of short and mid-term outcomes of patients undergoing AGV implantation using both techniques showed similar outcomes and success rates.
Risk Factors for Open-angle Glaucoma in Persons of Latin American Descent
Authors: Wurster Patrick , Harris Alon , Gonzalez Andrea C. , Adjei Susuana , Verticchio Vercellin Alice , Mathew Sunu , Lang Matt , Eikenberry Jennifer , Siesky Brent
Published: December 2019

Purpose:

The aim of this paper is to concisely summarize what is currently known about OAG among persons of LAD in the United States for the purpose of improving individualized care and highlighting areas requiring further study.

Materials and Methods:

Review of relevant literature was performed through PubMed and Google Scholar from October 1978 through November 11, 2019.

Results:

As the Latin American population grows within the United States, it is predicted that by 2050, men of LAD will make up the largest demographic group with OAG. Persons of LAD experience a greater increase in OAG prevalence per decade of life compared with persons of African descent and may have unique risk factors. In particular, those with African ancestry and hypertension are at greater risk of elevated intraocular pressure (IOP). Maximum IOP, variability in IOP, and diabetes are also important considerations. Unique anatomic and physiological characteristics such as scleral tensile strain, longer axial length, thin corneas, and corneal hysteresis may play a role in this population’s unique risk for the development and progression of OAG.

Conclusions:

OAG represents a growing concern among persons of LAD in the United States; however, information on specific risk factors in this population currently remains limited. Studies should be designed to investigate the LAD population and their respective structural, vascular, and social risk factors for the development and progression of OAG to assist clinicians in improving outcomes for this growing population.
Updated Guidelines for the Management of Acute Otitis Media in Children by the Italian Society of Pediatrics
Authors: Chiappini Elena , Ciarcià Martina , Bortone Barbara , Doria Mattia , Becherucci Paolo , Marseglia Gian Luigi , Motisi Marco Antonio , de Martino Maurizio , Galli Luisa , Licari Amelia , De Masi Salvatore , Lubrano Riccardo , Bettinelli Maria , Vicini Claudio , Felisati Giovanni , Villani Alberto , Marchisio Paola
Published: December 2019

Background:

In recent years, new progress has been made regarding the diagnosis, treatment and prevention of acute otitis media (AOM). The Italian Pediatric Society therefore decided to issue an update to the previous guidelines published in 2010.

Methods:

Literature searches were conducted on MEDLINE by Pubmed, including studies in children, in English or Italian, published between January 1, 2010, and December 31, 2018. The quality of the included studies was assessed using the grading of recommendations, assessment, development and evaluations (GRADE) methodology. In particular, the quality of the systematic reviews was evaluated using the AMSTAR 2 appraisal tool. The guidelines were formulated using the GRADE methodology by a multidisciplinary panel of experts.

Results:

The diagnosis of AOM is based on acute clinical symptoms and otoscopic evidence; alternatively, the presence of otorrhea associated with spontaneous tympanic membrane perforation allows the AOM diagnosis. The diagnosis of AOM must be certain and the use of a pneumatic otoscope is of fundamental importance. As an alternative to the pneumatic otoscope, pediatricians can use a static otoscope and a tympanometer. To objectively establish the severity of the episode for the formulation of a correct treatment program, an AOM severity scoring system taking into account clinical signs and otoscopic findings was developed.

Conclusions:

The diagnosis of AOM is clinical and requires the introduction of specific medical training programs. The use of pneumatic otoscopes must be promoted, as they are not sufficiently commonly used in routine practice in Italy.
Updated Guidelines for the Management of Acute Otitis Media in Children by the Italian Society of Pediatrics
Authors: Marchisio Paola , Galli Luisa , Bortone Barbara , Ciarcià Martina , Antonio Motisi Marco , Novelli Andrea , Pinto Luciano , Bottero Sergio , Pignataro Lorenzo , Piacentini Giorgio , Mattina Roberto , Cutrera Renato , Varicchio Attilio , Luigi Marseglia Gian , Villani Alberto , Chiappini Elena
Published: December 2019

Background:

New insights into the diagnosis, treatment and prevention of acute otitis media (AOM) have been gained in recent years. For this reason, the Italian Paediatric Society has updated its 2010 guidelines.

Methods:

A literature search was carried out on PubMed. Only pediatric studies published between January 1, 2010 and December 31, 2018 in English or Italian were included. Each included study was assessed according to the GRADE methodology. The quality of the systematic reviews was assessed using AMSTAR 2. The recommendations were formulated by a multidisciplinary panel of experts.

Results:

Prompt antibiotic treatment is recommended for children with otorrhea, intracranial complications and/or a history of recurrence and for children under the age of 6 months. For children 6 months to 2 years of age, prompt antibiotic treatment is recommended for all forms of unilateral and bilateral AOM, whether mild or severe. Prompt antibiotic treatment is also recommended for children over 2 years with severe bilateral AOM. A watchful-waiting approach can be applied to children over 2 years with mild or severe unilateral AOM or mild bilateral AOM. High doses of amoxicillin, or amoxicillin-clavulanic acid for patients with a high risk of infection by Beta-lactamase producing strains, remain the first-line antibiotics.

Conclusions:

AOM should be managed on a case-by-case basis that takes account of the child’s age, the severity of the episode and whether it is unilateral or bilateral. In patients under 2 years, prompt antibiotic treatment is always recommended.
Characterization of Circulating Clostridium difficile Strains, Host Response and Intestinal Microbiome in Hospitalized Children With Diarrhea
Authors: Lees Emily Ann , Carrol Enitan D. , Ellaby Nicholas A. F. , Roberts Paul , Corless Caroline E. , Lenzi Luca , Darby Alistair , O’Brien Sarah J. , Cunliffe Nigel A. , Turner Mark A. , Miyajima Fabio , Pirmohamed Munir
Published: December 2019

Background:

Clostridium difficile is capable of causing severe enterocolitis in adults. The significance of toxin-producing C. difficile in children with diarrhea is unclear and practice differs on whether to institute treatment. We aimed to characterize the microbiome in relation to the presence of C. difficile and co-infection with other pathogens and to describe host response to infection.

Methods:

Participants were children with acute diarrhea, 0–16 years of age, from whom stool samples had been submitted to the hospital laboratory for routine microbiology/virology. Convenience sampling was used for 50 prospective and 150 retrospective samples. No participants were treated for C. difficile. Rates of culture positivity for C. difficile, presence of toxin and PCR-ribotype were compared between age groups. Presence of other potential pathogens, comorbidities and complications were recorded. Microbiotal diversity was measured by 16S profiling.

Results:

Nineteen of 77 (25%) children <2 years of age and 13 of 119 (11%) children >2 years of age were C. difficile positive, of whom 10 (53%) and 9 (69%), respectively, carried toxigenic strains. Increased Shannon diversity was seen in children carrying C. difficile, with altered milieu. Presence of C. difficile was not associated with adverse clinical outcomes. In stools containing both Norovirus and C. difficile, there was increased relative abundance of verrucomicrobia.

Conclusions:

Children with diarrhea regularly carried toxigenic and non-toxigenic strains of C. difficile, demonstrating enhanced microbiotal diversity, and change in milieu, without apparent morbidity. This unexpected finding is contrary to that seen in adults with C. difficile disease.
Middle Ear Effusion in Children With Congenital Cytomegalovirus Infection
Authors: Chung Winnie , Leung Jessica , Lanzieri Tatiana M. , Blum Peggy , Demmler-Harrison Gail ,   for the Congenital Cytomegalovirus Longitudinal Study Group
Published: December 2019

Background:

Sensorineural hearing loss (SNHL) is well described in children with congenital cytomegalovirus (CMV) infection, but limited data are available on middle ear effusion (MEE) occurrence in this population. We assessed the prevalence of MEE and the degree of transient hearing change associated with MEE among children with congenital CMV infection.

Methods:

Children with congenital CMV infection enrolled in a longitudinal study received hearing and tympanometric testing during scheduled follow-up visits annually up to 6 years of age. We used a generalized linear mixed-effect logistic regression model to compare the odds of MEE, defined as type B tympanogram (normal ear canal volume with little tympanic membrane movement) among patients categorized as symptomatic or asymptomatic based on the presence of congenital CMV-associated signs in the newborn period.

Results:

Forty-four (61%) of 72 symptomatic and 24 (28%) of 87 asymptomatic patients had ≥1 visit with MEE. After controlling for the number of visits, symptomatic patients had significantly higher odds of MEE (odds ratio: 2.09; 95% confidence interval: 1.39–3.14) than asymptomatic patients. Transient hearing decrease associated with a type B tympanogram ranged from 10 to 40 dB, as measured by audiometric air-bone gap in 11 patients.

Conclusions:

Among children with congenital CMV, MEE can result in transient hearing decrease, which can reduce the efficacy of a hearing aid in those with SNHL. It is warranted that children with congenital CMV infection and SNHL receive routine audiologic and tympanometric testing to better manage hearing aid amplification levels.
Predictive Value of Serum Angiotensin-Converting Enzyme Titers in Sarcoid-Like Dacryoadenitis
Authors: Vahdani Kaveh , Rose Geoffrey E.
Published: December 2019

Purpose:

To compare serum angiotensin-converting enzyme (sACE) titers in patients with newly diagnosed sarcoid-like dacryoadenitis and nongranulomatous dacryoadenitis.

Study Design:

Retrospective comparative case series.

Patients and Methods:

Clinical details and presenting sACE titers were reviewed for patients with newly diagnosed sarcoid-like dacryoadenitis (SLD) and nongranulomatous dacryoadenitis (NGD). All sACE titers were expressed as a percentage of the upper end of normal range (“normalized”). Using Student t test, sACE titers for patients with unilateral SLD were compared with unilateral NGD and the sensitivity and specificity of sACE as a predictor for SLD calculated; this was repeated for patients with bilateral dacryoadenitis. The proportion of patients with raised sACE were compared in each group (Fisher exact test), and the mean sACE titers compared for these selected patients.

Results:

For unilateral SLD the mean sACE was 97%, compared with 57% in NGD (p=0.0010), and the sensitivity of sACE titer was 42%, specificity 92%, positive predictive value 75%, and negative predictive value 73%. Area under curve from receiver operating characteristic analysis for unilateral dacryoadenitis was 0.78 (p=0.0040). In contrast, there was no significant difference for bilateral disease (SLD 148%, NGD 82%; p=0.33), and somewhat lower positive predictive value (54%), negative predictive value (71%) and area under curve (0.71; p=0.070). Although not significantly so with bilateral disease, the proportion of patients with raised sACE was consistently greater in SLD as compared to NGD—being highest with bilateral SLD (7/12 patients; 58%) and lowest in unilateral NGD (2/26; 8%). Seventeen of the 27 patients with SLD were later found to have systemic involvement: where systemic disease was present, the mean sACE levels were significantly different in unilateral (102%) and bilateral dacryoadenitis (209%; p=0.029) disease, whereas there was no difference in the absence of systemic involvement (sACE with unilateral dacryoadenitis = 86%, bilateral = 75%; p=0.72).

Conclusions:

Normalized serum titers of ACE are minimally predictive for SLD, whether unilateral or bilateral, with some false negatives and false positives in all groups. However, with unilateral dacryoadenitis, an sACE of >125% maximum range appears absolutely predictive for SLD, and >150% maximum range for bilateral disease.
Conjunctival Pediatric Follicular Lymphoma: Case Report and Literature Review
Authors: AlSemari Mohammad A. , Maktabi Azza , AlSamnan Mazen S. , Alrajeh Mohammed S. , Strianese Diego
Published: December 2019

Follicular lymphoma (FL) is the second most commonly reported B-cell lymphoma and accounts for 6% of all orbital lymphomas. FL presentation in the pediatric population is rare. This study reported an 18-year-old male with a pink elevated lesion in the conjunctiva of the left eye and normal ocular parameters. Following a complete excisional biopsy, the lesion was oval and smooth grossly and showed dense proliferation with a high nuclear–cytoplasmic ratio microscopically. Immunohistochemical studies revealed positive CD20 and bcl-6 while bcl-2 was negative, which is a common feature for pediatric FL in contrast to bcl-2 positivity found by immunohistochemistry in FL occurring in adult patient population. No signs of recurrence were observed over 2 years of follow-up. This study adds a new case to the existing few reports. Interestingly, all reported cases were males including the patient, mean duration of onset was 5 months, and mean duration of follow-up was 18.4 months. The authors emphasize that total surgical excision with close monitoring is reasonable management of such clinical entity.

Follicular lymphoma (FL) is a rare entity in pediatric patients. Six cases have been reported with conjunctival FL in the literature (age between 6 and 21 years). Interestingly, all of them were male including the patient.
Unilateral Frontalis Suspension With Silicone Sling Without Levator Extirpation in Congenital Ptosis With Marcus Gunn Jaw Winking Synkinesis
Authors: Shah Gaurav , Khurana Deepika , Das Sima , Tiple Sweety , Honavar Santosh G.
Published: December 2019

Purpose:

To evaluate the efficacy of unilateral tarso-frontalis silicone sling without levator extirpation or disinsertion in dampening the jaw wink in patients with congenital ptosis associated with Marcus Gunn Jaw Winking synkinesis phenomenon.

Methods:

Retrospective review of medical records of all patients of congenital ptosis with moderate to severe Marcus Gunn jaw winking synkinesis who underwent unilateral tarsofrontal silicone sling surgery without extirpation of the levator muscle were retrospectively reviewed. Data were collected about the pre- and the postoperative severity of the ptosis and the amount of Marcus Gunn jaw winking excursion.

Results:

Twenty-three patients were included in the study. Mean postoperative follow up duration was 31.2 (range 6–208) weeks. The severity of the preoperative jaw wink was mild (<2 mm excursion) in 0 patient, moderate (2–5mm) in 15 (65%) patients, and severe (>5 mm eyelid excursion) in 8 (35%) patients. Postoperatively, 20 (87%) patients had mild residual jaw wink, 3 (13%) patients had moderate jaw wink and none of the patient had severe residual jaw wink.

Conclusion:

Unilateral tarsofrontal silicone sling without disinsertion or extirpation of the levator can reduce the severity of the jaw wink excursion in patients with congenital ptosis with moderate to severe preoperative Marcus Gunn jaw winking synkinesis.
Inflammatory Myofibroblastic Tumor of the Orbit in an 8-Month Old
Authors: Dermarkarian Christopher R. , Patel Kalyani R. , Fuller Maren Y. , Bernini Juan Carlos , Chévez-Barrios Patricia , Allen Richard C.
Published: December 2019

Inflammatory myofibroblastic tumor is a mesenchymal neoplasm, commonly seen in the lung and abdominopelvic region of children. The authors present an 8-month-old female with a 2-month history of left-sided proptosis. Examination was significant for left-sided proptosis, a left exotropia and hypotropia, left supraduction and adduction deficits, and left optic disc elevation. MRI imaging revealed an extraconal left superomedial orbital mass with globe displacement and proptosis. Left anterior orbitotomy with excisional biopsy showed a solid mass composed of an infiltrative proliferation of bland spindle cells in a variably myxoid background with associated perivascular lymphoplasmacytic infiltration. Immunohistochemistry was positive for ALK-1 and CD34 and demonstrated focal positivity for S100. Fluorescence in-situ hybridization showed an additional copy of the 3′ALK gene (46%) in interphase cells examined. Next generation targeted sequencing found a DCTN1/ALK fusion. Findings were consistent with inflammatory myofibroblastic tumor. To the authors′ knowledge, this is one of the largest primary orbital inflammatory myofibroblastic tumors in the youngest reported patient.
Electrocardiographic and Echocardiographic Findings in Elite Ghanaian Male Soccer Players
Authors: Pambo Prince , Adu-Adadey Martin , Agbodzakey Hope , Scharhag Jürgen
Published: December 2019

Objective:

To analyze the athlete's heart of adult and adolescent elite male soccer players by electrocardiography (ECG) and echocardiography (ECHO) and to describe typical ECG and ECHO findings in this cohort (West African elite soccer players).

Design:

A cross-sectional study of ECGs and ECHOs conducted as part of precompetition medical assessment for national male soccer teams preparing for various Fédération Internationale de Football Association (FIFA) tournaments in 2016 and 2017.

Setting:

Ghana National Football Association.

Participants:

One hundred fifty-nine players playing for the National male soccer teams preparing for tournaments in 2016 and 2017.

Interventions:

Precompetition medical assessment using ECGs and ECHOs.

Main Outcome Measures:

Number of athletes with abnormal ECGs and ECHO findings.

Results:

Twenty-three percent of the players had abnormal ECGs. Nine percent of the participants had T-wave inversions in lateral leads (V5–V6). Sokolow–Lyon criteria for left ventricular hypertrophy were present in 64% of participants. Thirty-six (23%) players had left ventricular wall thickness (LVWT) ≥13 mm, with no player exceeding 16 mm. Four percent of players had left ventricular cavity dimension greater than 60 mm. Relative wall thickness >0.42 was present in 44% of the players.

Conclusions:

Uncommon ECG changes seem to be more common in elite Ghanaian soccer players compared with previously reported results for Caucasians and even mixed populations of black athletes. Although ST elevation, T-wave inversions, and LVWT up to 15 mm are common, ST depression, deep T-waves in lateral leads, and LVWT ≥16 mm always warrant further clinical and scientific investigations.
Phase II study of vincristine, actinomycin-D, cyclophosphamide and irinotecan for patients with newly diagnosed low-risk subset B rhabdomyosarcoma
Authors: Miyachi Mitsuru , Tsuchiya Kunihiko , Hosono Ako , Ogawa Atsushi , Koh Katsuyoshi , Kikuta Atsushi , Hara Junichi , Teramukai Satoshi , Hosoi Hajime
Published: December 2019

Background:

Approximately 80% to 90% of patients with low-risk rhabdomyosarcoma can be cured. However, cured patients often face long-term complications associated with the treatment. An important factor in the treatment plan is the dose of cyclophosphamide administered because the dose can have both acute and long-term side effects. It is therefore essential to investigate whether the dose can be reduced without a negative effect on treatment outcome. The ARST0331 trial revealed that drastically reducing the cyclophosphamide dose to 4.8 g/m2 negatively affected treatment outcomes. The current study aims to determine whether reducing the cyclophosphamide dose to 10.8 g/m2 while introducing a new drug, irinotecan, can prevent the negative effect on treatment outcome. We also aim to investigate whether the reduced cyclophosphamide dose results in a decrease in infertility, one of the long-term complications of this treatment.

Methods:

The subjects are patients with stage 1 group III rhabdomyosarcoma (excluding those with orbital group III N0 and NX) or patients with stage 3 group I and II low-risk subset B embryonal rhabdomyosarcoma who will alternately undergo VAC 1.2 treatment (vincristine, actinomycin D, cyclophosphamide 1.2 g/m2) and VI treatment (vincristine, irinotecan). The effectiveness and safety of this treatment regimen will be assessed. Data will be presented at international conferences and will be published in peer-reviewed journals.

Discussion:

This study is significant because it aims to establish that the use of irinotecan in patients with low-risk subset B embryonal rhabdomyosarcoma (aged 30 or younger) allows the dose of cyclophosphamide to be reduced and is associated with few short-term adverse effects and long-term complications. The open-label and single-arm design of this study may be a limitation.

Trial registration and ethical approval:

The trial registration number is jRCTs051180200 (Japan Registry of Clinical Trials). The study protocol was approved by the institutional review board at each of the participating centers and the data will be presented at international conferences and published in peer-reviewed journals.
Systematic review and meta-analysis of whether cesarean section contributes to the incidence of allergic diseases in children
Authors: Gu Li , Zhang Weijian , Yang Wenhao , Liu Hanmin
Published: December 2019

Background:

As abundant evidence shows the composition of gut flora in children born by caesarean section is different from that of vaginal delivery children, studies on whether caesarean section would increase the offspring's risk of developing allergic disease attract extensive attention. However, the results of different researches are inconsistent. Therefore we conduct a systematic review and meta-analysis to explore the relationship between caesarean section and childhood allergic disease.

Methods:

The protocol followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Cohort studies for investigating the relationship between caesarean section and the risk of childhood allergic disease will be searched in 4 main databases (PubMed, EMBASE, the Cochrane Library, and the web of science). In addition, a manual search of the references of relevant published studies will also be considered. Four common allergic outcomes will be included: asthma, allergic rhinitis, food allergy, and atopic dermatitis. Studies selection, data extraction, and risk of bias assessment will be conducted by 2 independent reviewers. The primary outcome is the incidence of 4 allergic diseases.

Results:

The results will provide useful information on whether caesarean section contributes to the increase of allergic disease in children.

Conclusion:

The findings of this study will be published in a peer-reviewed journal.

PROSPERO registration number:

CRD42019135196.
Anaplastic lymphoma kinase-negative pulmonary inflammatory myofibroblastic tumor with multiple metastases and its treatment by Apatinib
Authors: Liu Qiuxia , Wei Jianguo , Liu Xizhong , Wang Jianfang
Published: December 2019

Rationale:

Primary pulmonary inflammatory myofibroblastic tumor (IMT) with distant metastasis is extremely rare. Moreover, metastasis of pulmonary IMT to bone marrow has never been reported in previous studies. Therapeutic approaches for anaplastic lymphoma kinase (ALK)-negative pulmonary IMT with metastasis are limited. Yet there is no report on the treatment of advanced IMT cases with anti-angiogenesis drugs.

Patient concerns:

We described a patient with a complaint of fatigue, with the chest computed tomography (CT) scan revealing 2 masses in bilateral lung.

Diagnoses:

The CT-guided lung biopsy examined 1 lesion in the right lung, and the post-operative pathological diagnosis of ALK-negative pulmonary IMT was recommended. However, the lung lesions were found significantly enlarged during the subsequent visit 8 months later, along with multiple metastases to the bone and abdominal cavity. A bone marrow biopsy revealed bone marrow infiltration by spindle cells.

Interventions:

The patient began to take Celecoxib due to the rapid progression of IMT, however, resulting in the aggravated gastric ulcer. He stopped taking the medicine 1 month later, with no remarkable change in the lesions by CT. Apatinib was administrated instead of Celecoxib.

Outcomes:

After the 5-month treatment of Apatinib, the mass in the abdominal cavity significantly shrank and the lung lesions slightly decreased in size. With the 9-month administration of Apatinib, the lung lesions and the abdominal mass kept stable, compared with the situation in the 5-month follow-up.

Lessons:

Although pulmonary IMT shows the potential of metastasis, its metastasizing to bone marrow is a highly unusual event. Apatinib is effective for pulmonary IMT, and should be taken into consideration for the treatment of inoperable pulmonary IMT patients who lack ALK rearrangement.
Modified tibial tunnel placement for single-bundle posterior cruciate ligament reconstruction reduces the “Killer Turn” in a biomechanical model
Authors: Wang Zhiqiang , Xiong Yan , Chen Gang , Tang Xin , Li Qi , Zhang Zhong , Shang Xiaoke , Yang Yuan , Sulaiman Yaxiaer , Li Jian
Published: December 2019

Background:

Our previous three-dimensional finite element analysis found that posterior cruciate ligament (PCL) reconstruction in the modified tibial tunneling placement (MTT, 10 mm inferior and 5 mm lateral to the PCL anatomical insertion) could reduce the peak stress of the graft and may reduce the killer turn. The purpose of the current study was to compare the biomechanical results between MTT and traditional tibial tunneling technique (TTT, PCL anatomical insertion) during transtibial PCL reconstruction.

Methods:

Fifty-six 3D-printed tibia models and fresh mature porcine flexor digitorum tendons were studied. The PCL reconstruction specimens were randomly divided into TTT group and MTT group based on tibial tunnel placement. A 50 to 300 N cyclic loading was applied using a material testing system. Each specimen completed 2000 cycles at a rate of 200 mm/min and a loading frequency of 80 cycles/min. Load–displacement curves, failure mode, and graft displacement were recorded. Mean maximum contact pressure was measured using a pressure-sensitive film. After cyclic loading test, the surviving grafts were randomly assigned to load-to-failure group or Scanning Electron Microscopy (SEM) group. Ultimate failure load and the appearance of graft abrasion were recorded and analyzed.

Result:

During the cyclic loading test, 3 samples in the TTT group, and 2 in the MTT group were excluded because of the graft pullout during the test. Mean maximum contact pressure of killer turn was 9.30 ± 0.29 MPa in the TTT group and 7.27 ± 0.25 MPa in MTT group (P < .05). Mean graft displacement was 4.54 ± 0.23 mm in the TTT group and 3.37 ± 3.56 mm in the MTT group (P < .05). Maximum failure load was 1886.0 ± 41.83 N in the TTT group and 2019.30 ± 20.10 N in the MTT group (P < .05). The SEM analysis showed heavy abrasion and fiber discontinuity in graft in the TTT group, while it showed slight abrasion and fiber arrangement disorders in the MTT group.

Conclusions:

The MTT PCL reconstruction significantly reduced stress concentration and graft abrasion as compared with the TTT PCL reconstruction, and it may be a better choice for the reduction of “killer Turn” effect during transtibial PCL construction.
Quadratus lumborum block versus transversus abdominis plane block for postoperative pain management after laparoscopic colorectal surgery
Authors: Deng Wei , Long Xiaofei , Li Manjun , Li Chang , Guo Liwei , Xu Guohai , Yu Shuchun
Published: December 2019

Background:

This study aimed to compare the quadratus lumborum block (QLB) method with transversus abdominis plane block (TAPB) for postoperative pain management in patients undergoing laparoscopic colorectal surgery.

Methods:

Seventy-four patients scheduled for laparoscopic colorectal surgery were randomly assigned into 2 groups. After surgery, patients received bilateral ultrasound-guided single-dose of QLB or TAPB. Each side was administered with 20 ml of 0.375% ropivacaine. All patients received sufentanil as patient-controlled intravenous analgesia (PCIA). Resting and moving numeric rating scale (NRS) were assessed at 2, 4, 6, 24, 48 hours postoperatively. The primary outcome measure was sufentanil consumption at predetermined time intervals after surgery.

Results:

Patients in the QLB group used significantly less sufentanil than TAPB group at 24 and 48 hours (P < .05), but not at 6 hours (P = .33) after laparoscopic colorectal surgery. No significant differences in NRS results were found between the two groups at rest or during movement (P > .05). Incidence of dizziness in the QLB group was lower than in TAPB group (P < .05).

Conclusions:

The QLB is a more effective postoperative analgesia as it reduces sufentanil consumption compared to TAPB in patients undergoing laparoscopic colorectal surgery.
Helicobacter pylori and gastrointestinal and neurological diseases
Authors: Wang Baoning , Zhang Jing , Chen Sihan , Bie Mingjiang
Published: December 2019

Background:

Systematic reviews showed that Helicobacter pylori (HP) infection is a major risk for developing gastric cancer and gastric ulcer and that it might be the cause of inflammatory bowel diseases, functional gastrointestinal disorders, and neurological diseases like Alzheimer disease. However, the robustness of the evidence was not tested. We will perform an umbrella review to systematically evaluate current evidence on the correlation between HP infection and gastrointestinal and neurological diseases.

Methods:

We will search OVID MEDLINE, EMBASE, and the Cochrane library for systematic reviews that evaluate the correlation of HP with gastrointestinal and neurological diseases, from inception to 1 July, 2019. Two reviewers will independently screen titles and abstracts of retrieved articles for eligible studies, and they will extract information for data analysis. We will assess heterogeneity between studies using I2 statistics and evaluate small-study effect in each systematic review through Egger test. Excess significance bias will be evaluated by compared the expected number of clinical studies with positive findings with the observed number. Quality of each systematic review will be assessed by using AMSTAR2 checklist.

Ethics and dissemination:

This umbrella review is anticipated to be finished in December 2019, and the results will be published in a peer-reviewed journal and disseminated through conference presentation or poster. Because all of the data used in this systematic review and meta-analysis has been published, this review does not require ethical approval.

Registration: PROSPERO CRD42019137226
Long non-coding RNA zinc finger antisense 1 expression associates with increased disease risk, elevated disease severity and higher inflammatory cytokines levels in patients with lumbar disc degeneration
Authors: Deng Ruo-Yu , Hong Tian , Li Chun-Ying , Shi Chun-Li , Liu Cheng , Jiang Fang-Yu , Li Jun , Fan Xiao-Man , Feng Shuang-Bing , Wang Yi-Fan
Published: December 2019

This study aimed to investigate the correlation of long noncoding RNA zinc finger antisense 1 (lncRNA ZFAS1) expression with disease risk, disease severity and inflammatory cytokines levels in lumbar disc degeneration (LDD) patients.

83 LDD patients underwent surgery and 28 traumatized, non-LDD patients underwent lumbar disc surgery (controls) were consecutively enrolled in this case-control study. Lumbar disc tissue was obtained during surgery and herniated nucleus pulposus (HNP) was isolated to detect lncRNA ZFAS1 expression and inflammatory cytokines mRNA levels by RT-qPCR, and determine protein levels of inflammatory cytokines by western blot.

HNP lncRNA ZFAS1 expression in LDD patients was up-regulated compared with controls (P < .001), and receiver operating characteristic (ROC) curve showed lncRNA ZFAS1 expression disclosed a good predictive value for LDD risk with area under curve (AUC) 0.753 (95% CI 0.646–0.859). And after adjustment by age, gender and body mass index (BMI), lncRNA ZFAS1 (P = .017) remained to be an independent predictive factor for higher LDD risk. In addition, lncRNA ZFAS1 expression was positively associated with Modified Pfirrmann Grade (P = .015). As to inflammatory cytokines, lncRNA ZFAS1 expression was observed to be positively correlated with TNF-α (P = .002), IL-1β (P = .007) and IL-6 (P = .015) mRNAs expressions while reversely associated with IL-10 mRNA level (P = .014); and lncRNA ZFAS1 expression was also positively correlated with protein levels of TNF-α (P = .038) and IL-6 (P = .027) while reversely associated with IL-10 protein expression (P = .039).

lncRNA ZFAS1 expression associates with increased risk, elevated disease severity and higher inflammatory cytokines levels in LDD patients.
Effectiveness of fecal microbiota transplantation for severe diarrhea after drug-induced hypersensitivity syndrome
Authors: Wei Yanling , Li Ning , Xing Hanyang , Guo Tianjiao , Gong Hao , Chen Dongfeng
Published: December 2019

The aim of this study was to assess effectiveness of fecal microbiota transplantation (FMT) in treating intestinal failure associated with drug-induced hypersensitivity syndrome (DIHS).

A 32-year-old Chinese woman, who developed DIHS-associated multiple organ dysfunction syndrome (MODS) manifesting as combined dysfunction of the intestine, liver, and kidney, was treated with 4 times of FMT at a frequency of once every 6 days. The structure and composition of the patient's fecal microbiota were analyzed by 16S rRNA-based molecular techniques. The clinical outcomes after FMT treatment were assessed by abdominal contrast-enhanced computed tomography (CT), characterization of fecal microbiota, measurement of serum inflammatory markers, and other clinical examinations.

After 4 rounds of FMT were administered, the patient showed dramatic improvement in MODS and severe diarrhea with these clinical conditions under control. We consistently observed significant alteration in her gut microbiota, mainly involving considerable enrichment in Firmicutes members and depletion of Proteobacteria opportunistic organisms. Moreover, this reconstituted bacterial community composition correlated with fecal output, T helper cells, and inflammatory markers. Abdominal contrast-enhanced CT scans before and after FMT indicated significant improvement in inflammation and edema within the small intestine and colon of the patient. Notably, after completion of the fourth FMT, the level of inflammation in the intestine and colon had returned to normal. Over 6 months of follow-up, the intestinal mucous remained normal.

Our results represent a breakthrough in the clinical management of MODS and suggest new therapeutic avenues to pursue for microbiota-related indications.
Auxiliary diagnosis of developmental dysplasia of the hip by automated detection of Sharp's angle on standardized anteroposterior pelvic radiographs
Authors: Li Qiang , Zhong Lei , Huang Hongnian , Liu He , Qin Yanguo , Wang Yiming , Zhou Zhe , Liu Heng , Yang Wenzhuo , Qin Meiting , Wang Jing , Wang Yanbo , Zhou Teng , Wang Dawei , Wang Jincheng , Xu Meng , Huang Ye
Published: December 2019

Developmental dysplasia of the hip (DDH) is common, and features a widened Sharp's angle as observed on pelvic x-ray images. Determination of Sharp's angle, essential for clinical decisions, can overwhelm the workload of orthopedic surgeons. To aid diagnosis of DDH and reduce false negative diagnoses, a simple and cost-effective tool is proposed. The model was designed using artificial intelligence (AI), and evaluated for its ability to screen anteroposterior pelvic radiographs automatically, accurately, and efficiently.

Orthotopic anterior pelvic x-ray images were retrospectively collected (n = 11574) from the PACS (Picture Archiving and Communication System) database at Second Hospital of Jilin University. The Mask regional convolutional neural network (R-CNN) model was utilized and finely modified to detect 4 key points that delineate Sharp's angle. Of these images, 11,473 were randomly selected, labeled, and used to train and validate the modified Mask R-CNN model. A test dataset comprised the remaining 101 images. Python-based utility software was applied to draw and calculate Sharp's angle automatically. The diagnoses of DDH obtained via the model or the traditional manual drawings of 3 orthopedic surgeons were compared, each based on the degree of Sharp's angle, and these were then evaluated relative to the final clinical diagnoses (based on medical history, symptoms, signs, x-ray films, and computed tomography images).

Sharp's angles on the left and right measured via the AI model (40.07° ± 4.09° and 40.65° ± 4.21°), were statistically similar to that of the surgeons’ (39.35° ± 6.74° and 39.82° ± 6.99°). The measurement time required by the AI model (1.11 ± 0.00 s) was significantly less than that of the doctors (86.72 ± 1.10, 93.26 ± 1.12, and 87.34 ± 0.80 s). The diagnostic sensitivity, specificity, and accuracy of the AI method for diagnosis of DDH were similar to that of the orthopedic surgeons; the diagnoses of both were moderately consistent with the final clinical diagnosis.

The proposed AI model can automatically measure Sharp's angle with a performance similar to that of orthopedic surgeons, but requires far less time. The AI model may be a viable auxiliary to clinical diagnosis of DDH.
Methodological quality of clinical practice guidelines for genetic testing in children
Authors: Jiao Xue-Feng , Li Hai-Long , Cheng Liang , Zhang Chuan , Yang Chun-Song , Han Jonathan , Yi Qiu-Sha , Chen Zhe , Zeng Li-Nan , Zhang Ling-Li
Published: December 2019

Genetic testing of children is faced with numerous problems. High-quality clinical practice guidelines (CPGs) are needed to ensure its safe, and appropriate use. This study aimed to systematically identify the current CPGs for genetic testing in children, and to assess the methodological quality of these CPGs.

We searched 6 databases, 3 guideline clearinghouses, and 9 web sites of relevant academic agencies from inception to February 2019. CPGs focused on genetic testing in children were included. Four reviewers independently appraised the quality of the eligible CPGs using the appraisal of guidelines for research, and evaluation (AGREE) II instrument.

Seventeen CPGs meeting our inclusion criteria were included. Among them, 16 CPGs were focused on the genetic diagnosis/evaluation of diseases, while only 1 CPG was focused on pharmacogenetics. The median domain scores from highest to lowest were: scope and purpose 80.56% (range: 56.95%–87.50%), clarity of presentation 72.22% (range: 45.83%–88.89%), stakeholder involvement 45.83% (range: 27.78%–55.56%), applicability 31.25% (range: 19.79%–54.17%), rigor of development 21.88%, (range: 13.02%–71.88%), and editorial independence 18.75% (range: 0%–83.33%). According to the overall quality, 6 (35%) CPGs were “not recommended,” 8 (47%) CPGs were “recommended with modifications,” and only 3 (18%) CPGs were “recommended.” The clinical topics of the “recommended” CPGs were warfarin, familial Mediterranean fever, and pediatric pulmonary arterial hypertension.

The quality of CPGs for genetic testing in children was generally low, and variable across different CPGs and different AGREE II domains. In future guideline development, more attention should be paid to the aspects of stakeholder involvement, rigor of development, applicability, and editorial independence. Not only will guideline users benefit from our results when determining whether to adopt related CPGs to guide genetic testing in children, but guideline developers could also take into account our results to improve the quality of future CPGs.
Plasma D-dimer as a novel biomarker for predicting poor outcomes in HBV-related decompensated cirrhosis
Authors: Zhou Jing , Mao WeiLin , Shen LiangJun , Huang HongGuang
Published: December 2019

This study aim was to evaluate whether plasma D-dimer levels could serve as a novel prognostic biomarker for 1-month mortality in patients with HBV-related decompensated cirrhosis (HBV-DeCi).

This was a retrospective study that enrolled 132 HBV-DeCi patients. Univariate and multivariate regression models were used to identify risk factors for mortality. The area under the receiver operating characteristic curve was calculated to estimate and compare the predictive values of different prognostic markers.

In the present study, the plasma D-dimer levels were higher in the nonsurviving group than in the surviving group. Additionally, the D-dimer level was positively correlated with the model for end-stage liver disease (MELD) score. The results of multivariate analysis showed that both the MELD score and D-dimer level are independent predictors of 1-month mortality in HBV-DeCi patients (both P < .01).

Plasma D-dimer can be considered a new additional prognostic marker for 1-month mortality in HBV-DeCi patients.