bluuebunny/crossref_metadata_2025 huggingface dataset:
Maintaining the Neutral Axis in the Treatment of Distal Femur Fractures Via Dual Plate or Nail Plate Combination Technique: When and How?
Authors: Liporace Frank A. , Aneja Arun , Carroll Eben A. , Yoon Richard S.
Published: September 2021

Distal femur fractures in the elderly have been historically treated with locked plating or retrograde intramedullary nailing with good, reliable results. However, in certain more complex fracture patterns (native or periprosthetic), increased density of fixation via dual-plate or nail plate combination can help achieve immediate weight-bearing. It can also potentially increase rates of union by shifting and maintaining the neutral axis, distributing forces more evenly across the fracture site. Here, we discuss the indications, pros and cons of both dual-plate and nail plate combination techniques in a concise case-based format.
Effect of Screw Configuration on the Rate of Correction for Guided Growth Using the Tension-band Plate
Authors: Kim Nak Tscheol , Kwon Soon-Sun , Choi Kug Jin , Park Moon Seok , Chung Ju Young , Han Hee Soo , Sung Ki Hyuk
Published: September 2021

Background:

This study investigated the effect of screw configuration on the rate of correction of coronal angular deformity of the knee joint in children who underwent guided growth using the tension-band plate.

Methods:

Consecutive patients (76 patients with 154 physes; mean age: 11.8±2.2 y) who underwent guided growth using the tension-band plate for coronal angular deformity (genu varum or genu valgum) were included. The mechanical lateral distal femoral angle, mechanical medial proximal tibial angle, and screw angle were measured from the teleroentgenograms of preoperative and postoperative periodic follow-up visits.

Results:

The mean initial screw angle and the mean rate of correction were 16.7±10.5 degrees and 6.5±5.3 degrees per year, respectively. The rate of correction was significantly affected by age at surgery, sex, physis treated, severity of deformity, and rate of change in screw angle (all P<0.001). However, the initial screw angle and type of deformity did not affect the rate of correction. The rate of correction per year was 3.6 degrees higher in boys than in girls and 2.8 degrees higher in the distal femur than in the proximal tibia. A 1 degree increase in the rate of change in screw angle was associated with a 0.5 degree increase in the correction rate. Screw angle significantly increased with follow-up duration (P<0.001) and the change in screw angle was significantly affected by age, sex, and physis treated (all P<0.001).

Conclusions:

This study demonstrated that screw configuration did not affect the correction rate of coronal angular deformity for guided growth using the tension-band plate. Therefore, surgeons only need to insert the screws according to anatomic restriction, not considering the screw configuration when using the tension-band plate for guided growth in children.

Level of Evidence:

Prognostic level III.
Immune Profiling Demonstrates a Common Immune Signature of Delayed Acquired Immunodeficiency in Patients With Various Etiologies of Severe Injury*
Authors: Venet Fabienne , Textoris Julien , Blein Sophie , Rol Mary-Luz , Bodinier Maxime , Canard Bertrand , Cortez Pierre , Meunier Boris , Tan Lionel K. , Tipple Craig , Quemeneur Laurence , Reynier Frédéric , Leissner Philippe , Védrine Christophe , Bouffard Yves , Delwarde Benjamin , Martin Olivier , Girardot Thibaut , Truc Cyrille , Griffiths Andrew D. , Moucadel Virginie , Pachot Alexandre , Monneret Guillaume , Rimmelé Thomas ,   for the REALISM study group
Published: September 2021

OBJECTIVES:

The host response plays a central role in the pathophysiology of sepsis and severe injuries. So far, no study has comprehensively described the overtime changes of the injury-induced immune profile in a large cohort of critically ill patients with different etiologies.

DESIGN:

Prospective observational cohort study.

SETTING:

Adult ICU in a University Hospital in Lyon, France.

PATIENTS:

Three hundred fifty-three septic, trauma, and surgical patients and 175 healthy volunteers were included in the REAnimation Low Immune Status Marker study.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Extensive immune profiling was performed by assessing cellular phenotypes and functions, protein, and messenger RNA levels at days 1–2, 3–4, and 5–7 after inclusion using a panel of 30 standardized immune markers. Using this immunomonitoring panel, no specificity in the immune profile was observed among septic, trauma, and surgical patients. This common injury-induced immune response was characterized by an initial adaptive (i.e., physiologic) response engaging all constituents of the immune system (pro- and anti-inflammatory cytokine releases, and innate and adaptive immune responses) but not associated with increased risk of secondary infections. In contrary, the persistence in a subgroup of patients of profound immune alterations at the end of the first week after admission was associated with increased risk of secondary infections independently of exposure to invasive devices. The combined monitoring of markers of pro-/anti-inflammatory, innate, and adaptive immune responses allowed a better enrichment of patients with risk of secondary infections in the selected population.

CONCLUSIONS:

Using REAnimation Low Immune Status Marker immunomonitoring panel, we detected delayed injury-acquired immunodeficiency in a subgroup of severely injured patients independently of primary disease. Critically ill patients’ immune status could be captured through the combined monitoring of a common panel of complementary markers of pro-/anti-inflammatory, innate, and adaptive immune responses. Such immune monitoring needs to be incorporated in larger study cohorts with more extensive immune surveillance to develop specific hypothesis allowing for identification of biological systems affecting altered immune function related to late infection in the setting of acute systemic injury.
Functional mitral regurgitation combined with increased early diastolic transmitral velocity to early mitral annulus diastolic velocity ratio is associated with a poor prognosis in patients with shock
Authors: Zhou Ran , Zou Tongjuan , Yin Wanhong , Wang Xiaoting , Kang Yan
Published: September 2021

Background:

Functional mitral regurgitation (FMR) is common in critically ill patients and may cause left atrial (LA) pressure elevation. This study aims to explore the prognostic impact of synergistic LA pressure elevation and FMR in patients with shock.

Methods:

We retrospectively screened 130 consecutive patients of 175 patients with shock from April 2016 to June 2017. The incidence and impact of FMR and early diastolic transmitral velocity to early mitral annulus diastolic velocity ratio (E/e’) ≥ 4 within 6 h of shock on the prognosis of patients were evaluated. Finally, the synergistic effect of FMR and E/e’ were assessed by combination, grouping, and trend analyses.

Results:

Forty-four patients (33.8%) had FMR, and 15 patients (11.5%) had E/e’ elevation. A multivariate analysis revealed FMR and E/e’ as independent correlated factors for 28-day mortality (P = 0.043 and 0.028, respectively). The Kaplan-Meier survival analysis revealed a significant difference in survival between patients with and without FMR (χ
2 = 7.672, P = 0.006) and between the E/e’ ≥ 14 and E/e’ < 14 groups (χ
2 = 19.351, P < 0.010). Twenty-eight-day mortality was significantly different among the four groups (χ
2 = 30.141, P < 0.010). The risk of 28-day mortality was significantly higher in group 4 (E/e’ ≥ 14 with FMR) compared with groups 1 (E/e’ < 14 without FMR) and 2 (E/e’ < 14 with FMR) (P = 0.001 and 0.046, respectively).

Conclusions:

Patients with shock can be identified by the presence of FMR. FMR and E/e’ are independent risk factors for a poor prognosis in these patients, and prognosis is worst when FMR and E/e’ ≥ 14 are present. It may be possible to improve prognosis by reducing LA pressure and E/e’.

Trial Registration:

ClinicalTrials.gov, NCT03082326.
Postpartum permanent contraception: updates on policy and access
Authors: Henkel Andrea , Beshar Isabel , Goldthwaite Lisa M.
Published: September 2021

Purpose of review

To describe barriers to provision of postpartum permanent contraception at patient, hospital, and insurance levels.

Recent findings

Permanent contraception remains the most commonly used form of contraception in the United States with the majority of procedures performed during birth-hospitalization. Many people live in regions with a high Catholic hospital market share where individual contraceptive plans may be refused based on religious doctrine. Obesity should not preclude an individual from receiving a postpartum tubal ligation as recent studies find that operative time is clinically similar with no increased risk of complications in obese compared with nonobese people. The largest barrier to provision of permanent contraception remains the federally mandated consent for sterilization for those with Medicaid insurance. State variation in enforcement of the Medicaid policy additionally contributes to unequal access and physician reimbursement. Although significant barriers exist in policy that will take time to improve, hospital-based interventions, such as listing postpartum tubal ligation as an ‘urgent’ procedure or scheduling interval laparoscopic salpingectomy prior to birth-hospitalization discharge can make a significant impact in actualization of desired permanent contraception for patients.

Unfulfilled requests for permanent contraception result in higher rates of unintended pregnancies, loss of self-efficacy, and higher costs. Hospital and federal policy should protect vulnerable populations while not preventing provision of desired contraception.
Deeper Understanding of Appearance in Orofacial Clefts: A Structural Equation Model of the CLEFT-Q Appearance Scales
Authors: Harrison Conrad J. , Sidey-Gibbons Chris J. , Klassen Anne F. , Wong Riff Karen W. Y. , Furniss Dominic , Swan Marc C. , Rodrigues Jeremy N.
Published: September 2021

Background:

The CLEFT-Q is a patient-reported outcome measure with seven scales measuring elements of facial appearance in cleft lip and/or palate. We built on the validated CLEFT-Q structural model to describe conceptual relationships between these scales, and tested our hypothesis through structural equation modeling (SEM). In our hypothesized model, the appearance of the nose, nostrils, teeth, jaw, lips, and cleft lip scar all contribute to overall facial appearance.

Methods:

We included 640 participants from the international CLEFT-Q field test. Model fit was assessed using weighted least squares mean and variance adjusted regression. The model was then refined through modification indices. The fit of the hypothesized model was confirmed in an independent sample of 452 participants.

Results:

The refined model demonstrated excellent fit to the data (comparative fit index 0.999, Tucker-Lewis index 0.999, root mean square error of approximation 0.036 and standardized root mean square residual 0.036). The confirmatory analysis also demonstrated excellent model fit.

Conclusion:

Our structural model, based on a clinical understanding of appearance in orofacial clefting, aligns with CLEFT-Q field test data. This supports the instrument’s use and the exploration of a wider range of applications, such as multidimensional computerized adaptive testing.
Immediate Lymphovenous Bypass Treated Donor Site Lymphedema during Phalloplasty for Gender Dysphoria
Authors: Lin Walter , Safa Bauback , Chen Mang , Cheng Ming-Huei
Published: September 2021

Demand for gender-affirming phalloplasty continues to grow worldwide, and the extended radial forearm flap phalloplasty remains one of the most commonly performed techniques. One potential morbidity that has emerged is postoperative donor site lymphedema, which was susceptible to develop after harvest of extended radial forearm flap. In the setting of preventative or immediate lymphovenous bypass (LVB) with axillary lymph node dissection for the treatment of breast cancer, it is possible that a subset of patients undergoing gender-affirmation surgery would benefit from immediate lymphatic reconstruction at the time of primary phalloplasty. Here, we report a case in which intraoperative indocyanine green lymphography demonstrated lymphatic obstruction within the left donor hand after flap harvest, and was treated with immediate LVB at the time of extended radial forearm phalloplasty. Two surgical teams operated simultaneously: the reconstructive urology team performed the vaginectomy, perineal urethral lengthening, scrotoplasty, and perineal reconstruction; and the microsurgery team harvested the extended radial forearm, constructed the penile urethra, shaped the phallus, and performed the immediate LVB. Lymphography showed no dermal backflow at 5 months follow-up; at 13 months, the patient demonstrated no signs or symptoms of lymphedema in the left forearm or hand. To the authors’ best knowledge, this is the first report of confirmed donor site lymphedema following extended radial forearm flap harvest, which was successfully treated with immediate LVB. Careful evaluation of lymphatic vessels with indocyanine green lymphography in the forearm before and after extended flap harvest may be warranted.
Acute COVID-19 Infection Associated With Necrotizing Disseminated Acute Leukoencephalopathy and Brain Microhemorrhages in a Pediatric Patient
Authors: De Avila Camila , Rauseo Lopez Luis F. , Mandelia Yamini
Published: September 2021

We present a case of a 14-year-old, previously healthy female, admitted with acute coronavirus disease 2019 infection and new-onset seizures secondary to virus-associated necrotizing disseminated acute leukoencephalopathy. Her symptoms resolved completely with intravenous immunoglobulin and steroids. Pathophysiology and prognosis of neurologic manifestations of coronavirus disease 2019 remain unclear.
Antibodies to Seasonal Coronaviruses Rarely Cross-React With SARS-CoV-2
Authors: Zar Heather J. , Nicol Mark P. , MacGinty Rae , Workman Lesley , Petersen Wonita , Johnson Marina , Goldblatt David
Published: September 2021

Antibodies to seasonal human-coronaviruses (sHCoV) may cross-protect against SARS-CoV-2. We investigated antibody responses in biobanked serum obtained before the pandemic from infants with polymerase chain reaction-confirmed sHCoV. Among 141 samples with antibodies to sHCoV, 4 (2.8%) were positive for SARS-CoV-2-S1 and 8 (5.7%) for SARS-CoV-2-S2. Antibodies to sHCoV rarely cross-react with SARS-CoV-2 antigens and are unlikely to account for mild pediatric illness.
Multisystem Inflammatory Syndrome in Children Presenting With Pseudotumor Cerebri and a Review of the Literature
Authors: Bilen Nimet Melis , Sahbudak Bal Zumrut , Yildirim Arslan Sema , Kanmaz Seda , Kurugol Zafer , Ozkinay Ferda
Published: September 2021

Multisystem inflammatory syndrome in children (MIS-C) is a rare but life-threatening inflammatory immune response associated with severe acute respiratory syndrome coronavirus 2 infection. The majority of patients have been presented with hypotension, shock, gastrointestinal, cardiovascular and mucocutaneous symptoms. The incidence of neurologic symptoms in MIS-C is of rising concern as they are not well described and reported in fewer patients. An 8-year-old boy was admitted to the hospital with headache, fever, conjunctivitis, and hyperinflammatory findings diagnosed as MIS-C. Fundus examination performed with complaints of headache, vomiting, and conjunctivitis showed bilateral papilledema. Pseudotumor cerebri is a rare manifestation of MIS-C that can lead to vision loss and may not only be resolved with the standard treatment for MIS-C. We report a case of MIS-C presented with neurologic symptoms due to pseudotumor cerebri and successfully treated with intravenous immunoglobulin and acetazolamide.
Investigation on the mechanisms of guiqi huoxue capsule for treating cervical spondylosis based on network pharmacology and molecular docking
Authors: Liu Yingying , Zhang Jingyuan , Liu Xinkui , Zhou Wei , Stalin Antony , Fu Changgeng , Wu Jiarui , Cheng Guoliang , Guo Siyu , Jia Shanshan , Li Bingbing , Wang Haojia , Li Jialin , Lu Shan
Published: September 2021

Background:

Guiqi huoxue capsule (GQHXC) is a patented Chinese medicine used for treating a liver and kidney deficiency and blood stasis syndrome due to qi deficiency. It is caused by cervical spondylosis (cervical spondylotic radiculopathy (CSR), mixed cervical spondylosis mainly composed of nerve root type). Its underlying mechanisms need, however, to be further clarified.

Methods:

In this study, collecting compounds, predicting therapeutic targets, constructing networks, and analyzing biological functions and pathways were based on network pharmacology analysis. In addition, molecular docking verification was engaged to assess the binding potential of selected target-compound pairs.

Results:

We established 5 networks: compound-putative target network of GQHXC, protein-protein interaction (PPI) network related to CSR, compound-CSR target network, potential therapeutic targets PPI network, and herb-compound-target-pathway network. Network analysis indicated that 7 targets (tumor necrosis factor [TNF], interleukin 6 [IL6], nitric oxide synthase 3 [NOS3], Interleukin-8 [CXCL8], prostaglandin-endoperoxide synthase 2 [PTGS2], vascular endothelial growth factor A [VEGFA], and AP-1 transcription factor subunit [JUN]) might be the therapeutic targets of GQHXC in CSR. Moreover, molecular docking verification showed that TNF, IL6, NOS3, CXCL8, PTGS2, VEGFA, and JUN had a good is interaction with the corresponding compounds. Furthermore, enrichment analysis indicated that GQHXC might exert a curative role in CSR by regulating some important pathways, such as TNF signaling pathway, NF–kappa B signaling pathway, AGE–RAGE signaling pathway in diabetic complications, and so on.

Conclusion:

Our study preliminarily explained the underlying mechanisms of GQHXC for treating CSR, and molecular docking verification was adopted as an additional verification. These findings laid a valuable foundation for experimental research and further application of GQHXC in the clinical treatment of CSR.
Mortality associated with stopping statins in the oldest-old – with and without ischemic heart disease
Authors: Ioffe Marina , Kremer Anjelika , Nachimov Irena , Swartzon Michael , Justo Dan
Published: September 2021

The association between stopping statins and 1-year mortality in the general population of the oldest-old – with or without ischemic heart disease (IHD) – has been studied herein for the first time.

This was a retrospective study. Included were all consecutive patients (n = 369) aged 80 years or more (mean age 87.8 years) hospitalized in a single Geriatrics department during 1 year. The study group included 140 patients in whom statins were stopped upon admission (statin stoppers). The control group included 229 patients who did not use statins in the first place (statin non-users). All-cause 1-year mortality rates were studied in both groups following propensity score matching and in IHD patients separately.

Overall, 110 (29.8%) patients died during the year following admission: 38 (27.1%) statin stoppers and 72 (31.4%) statin non-users (P = .498). Cox regression analysis showed no association between stopping statins and 1-year mortality in the crude analysis (hazard ratio [HR] 0.976, 95% confidence interval [CI] 0.651–1.463, P = .907) and following propensity score matching (HR 1.067, 95%CI 0.674–1.689, P = .782). Among 108 IHD patients, 38 (35.2%) patients died during the year following admission: 18 (27.7%) statin stoppers and 20 (46.5%) statin non-users (P = .059). Cox regression analysis showed a nearly significant association between stopping statins (rather than not using statins) in IHD patients and lower 1-year mortality (HR 0.524, 95%CI 0.259–1.060, P = .072).

Hence, stopping statins in the general population of the oldest-old – with or without IHD – is possibly safe. Future studies including the oldest-old statin continuers are warranted to confirm this observation.
Evaluation of efficacy and safety of propofol in the treatment of procedural sedation/anesthesia in neonates
Authors: Yu Pei-Xia , Bo Li-Jun
Published: September 2021

Background:

In newborns, propofol anesthesia is commonly utilized. Propofol is increasingly being shown to be effective and safe in treating procedural sedation and anesthesia in neonates. This research aims to evaluate the efficacy and safety of propofol in neonates using systematic review and meta-analysis methodologies.

Methods:

A thorough review and meta-analysis of studies on propofol anesthesia in neonates will be conducted. Conduct comprehensive searches in Web of Science, PubMed, Cochrane Library, EMBASE database, WanFang database, and Chinese biomedical literature database before May 25, 2021, to obtain published and qualified research. Two reviewers will assess the quality of the included papers and extract the data independently. Then, for meta-analysis, we will utilize RevMan 5.3 software.

Results:

This study will pool the data of separate trials to analyze the efficacy and safety of propofol in the treatment of procedural sedation/anesthesia in neonates.

Conclusion:

Our findings will give strong data for determining whether propofol is an effective treatment for procedural anesthesia in neonates.
Coffee consumption is associated with a decreased risk of incident chronic kidney disease
Authors: Li Yudong , Li Wenchang , Lu Yisheng , Zhang Jing
Published: September 2021

Background:

Recent studies have suggested a renal protective effect of coffee consumption against development of chronic kidney disease (CKD), although the results remain inconclusive. We performed a protocol for systematic review and meta-analysis to comprehensively investigate this association by summarizing all available data.

Methods:

An all-round retrieval will be performed in 5 electronic journal databases from their inception to June 2021, which comprise Medline, PubMed, Embase, ScienceDirect, and the Cochrane Library. The following key words were used on combination with Boolean operators AND or OR: “coffee,” “caffeine,” “renal insufficiency,” “chronic kidney diseases,” “chronic renal diseases.” Two authors completed the quality assessment using the Newcastle–Ottawa Scale for observational studies. The meta-analysis was conducted using Review Manager 5.3 software from the Cochrane Collaboration (London, UK).

Results:

The findings of this study will be submitted to peer-reviewed journals for publication.

Conclusion:

Coffee consumption may be associated with a lower risk of incident CKD.
Partial response of donafenib as the third-line therapy in metastatic colon cancer
Authors: Yang Yang , Zhu Hong , Li Qiu
Published: September 2021

Rationale:

Colorectal cancer (CRC) is a digestive tumor with high morbidity and mortality rates. After second-line treatment failure, third-line treatment options are limited, and the objective response rate is low. These patients are expected to have a short survival time. Therefore, it is very important to explore safer and more effective treatment options for patients with advanced colorectal cancer. Donafenib is a new type of tyrosine kinase inhibitor developed independently in China. Its effectiveness and safety as a first-line treatment for patients with advanced hepatocellular carcinoma in China have been verified.

Patient concerns:

The patient was a 60-year-old Asian man who presented with sudden lower abdominal pain, vomiting, anal exhaustion, and poor defecation, without an apparent cause. He had no history of type 2 diabetes, hypertension, or other relevant past illnesses.

Diagnosis:

Metastatic colon cancer (stage IV).

Interventions:

mFOLFOX6 chemotherapy was administered in 15 cycles as first-line therapy. FOLFIRI chemotherapy was administered in 8 cycles as second-line therapy. Donafenib was administered as third-line therapy.

Outcomes:

The patient achieved partial response. No serious adverse events (grades III–IV) occurred.

Lessons:

This case report provides clinicians with a safe and effective option for donafenib as a later-line treatment option for patients with metastatic colorectal cancer to improve their overall survival and quality of life.
MORC2 gene de novo mutation leads to Charcot–Marie–Tooth disease type 2Z
Authors: Yang Haiyan , Yang Sai , Kang Qingyun , Yang Liming , Liao Hongmei , Wu Liwen
Published: September 2021

Rationale:

Mutations of the MORC2 gene have most commonly been associated with autosomal-dominant Charcot–Marie–Tooth disease type 2Z (CMT 2Z), while the impact of MORC2 mutations in CMT 2Z on neuronal biology and their phenotypic consequences in patients remain to be clarified.

Patient concerns:

We reported a 27-month-old child with a developmental lag of more than 1 year. He had progressive fatigue for 4 months, accompanied by dysphagia, choking while eating, and progressive aggravation. A genetic study revealed a de novo variant of MORC2, which has not yet been reported.

Diagnosis:

According to the child's clinical manifestations, genetic pattern, and American College of Medical Genetics and Genomics pathogenicity analysis, the patient was diagnosed with CMT 2Z caused by MORC2 gene mutation.

Interventions:

Mitochondrial cocktail therapy (arginine, vitamin B1 tablets, vitamin B2 tablets, coenzyme Q10 capsules, L-carnitine oral liquid, idebenone tablets, etc) was given.

Outcomes:

Mitochondrial cocktail therapy did not significantly improve the child's condition, head magnetic resonance imaging lesions were not significantly improved at outpatient follow-up more than 1 month later, and the lesions were basically unchanged.

Lessons:

The clinical manifestations of the disease were similar to those of Leigh syndrome, and they were not significantly improved by cocktail therapy. This site has not been reported in the literature domestically or abroad, and the pathogenesis of CMT 2Z caused by this site mutation is indeed not related to mitochondrial dysfunction. Our study is helpful for clinicians with regard to the differential diagnosis of Leigh syndrome and CMT 2Z and improvement of clinicians’ understanding of CMT 2Z disease.
Chinese medicine therapies for neurogenic bladder after spinal cord injury
Authors: Zhu Zhihong , Zhuo Yue , Jin Haitao , Wu Boyu , Li Zhijie
Published: September 2021

Background:

Neurogenic bladder (NB), a refractory disease, is characterized by voiding dysfunction of bladder and/or urethra, and spinal cord injury (SCI) is a common cause. Chinese medicine therapies have been applied extensively in the treatment of NB, especially in China, and the results are promising but varying. Thus, the aim of this work is to assess the efficacy and safety of various Chinese medicine therapies for NB after SCI.

Methods:

A retrieval will be performed in 8 online databases (the Cochrane Library, Web of Science, PubMed, EMBASE Database, China Biological Medicine Database, Chinese Scientific Journals Database, Wan Fang databases, and China National Knowledge Infrastructure) from their inception throughout June 2021. Only randomized controlled trials of testing Chinese medicine therapies for NB after SCI will be enrolled. The outcome indicators measured will be overall response rate, urodynamic tests, clinical assessment, and safety assessments. The methodological quality of this Bayesian-based network meta-analysis will be conducted with the “Risk of Bias” tool. Stata14.0 and WinBUGS 1.4.3 will be used to analyze the data. Furthermore, the assessment of heterogeneity, inconsistency, subgroup, sensitivity, and publication bias will also be taken into consideration with the help of Cochrane Collaboration's tool.

Results:

The findings of this study will be submitted to a peer-reviewed journal for publication.

Conclusion:

This work will furnish evidence-based recommendations to figure out the optimal Chinese medicine therapy or their combinations for NB induced by SCI, and in turn contribute to further research and public health.
Prognostic value of pretreatment anemia in patients with soft tissue sarcoma
Authors: Shi Landa , Wang Yuqiang , Li Longqing , Chou Dean , Zhao Yao , Zhang Shuhao , Wang Limin , Zhang Min , Liu Yilin
Published: September 2021

Background:

Anemia is one of the most common manifestations in patients with cancer. Recently, multiple studies have shown a positive correlation between pretreatment anemia and tumor prognosis. Yet, the relationship between pretreatment anemia and the prognosis of soft tissue sarcomas (STS) is unclear.

Methods:

We searched the PubMed and EMBASE databases to identify relevant studies. Eligible studies were included according to the inclusion criteria to assess the relationship between pretreatment anemia and the prognosis of patients with STS. Prognostic significance was determined by studying hazard ratios (HR) and 95% confidence intervals (CIs).

Results:

A total of 12 studies are included. If there is significant heterogeneity, a random-effects model is used. Pooled data indicated that pretreatment anemia is related to poor overall survival (HR = 2.13; 95%CI = 1.52–2.98), disease-specific survival (HR = 1.53; 95%CI = 1.20–1.96), and disease-free survival (HR = 1.55; 95%CI = 1.10–2.17). The results of the subgroup analysis also support this conclusion.

Conclusion:

Our results suggest that pretreatment anemia may be a prognostic biomarker for STS.
Impact of wearing personal protective equipment on the performance and decision making of surgeons during the COVID-19 pandemic
Authors: Alarfaj Mosab A. , Foula Mohammed S. , Alshammary Shadi , Nwesar Fayrouz A. , Eldamati Ahmed M. , Alomar Abdullah , Abdulmomen Abdulrahim A. , Alarfaj Leenah , Almulhim Abdulmohsen , Alarfaj Odai , Zakaria Hazem M.
Published: September 2021

During the coronavirus disease 2019 (COVID-19) pandemic, the mandatory use of personal protective equipment (PPE) has resulted in a significant reduction in the infection rate among health care workers (HCWs). However, there are some ongoing concerns about the negative impact of using PPE for prolonged periods.

This study examined the impact of wearing PPE on surgeons’ performance and decision making during the COVID-19 pandemic.

In this cross-sectional study, an anonymous online questionnaire was created and disseminated to surgeons all over the Eastern Province of Saudi Arabia. The questionnaire included the demographic data, the local hospital policies, the non-technical skills (e.g., communication, vision, and comfort) and the technical skills, and the process of decision making.

From June 2020 to August 2020, 162 surgeons participated in this questionnaire. Of them, 80.2% were aged from 26 to 45 years, 70.4% have received a special training for PPE, and 59.3% of participants have operated on COVID-19 confirmed cases. A negative impact of wearing PPE was reported on their overall comfort, vision, and communication skills (92.6%, 95.1%, and 82.8%, respectively). The technical skills and decision making were not significantly affected (60.5% and 72.8%, respectively). More preference for conservative approach, damage control procedures, and/or open approach was reported.

Despite its benefits, PPE is associated with a significant negative impact on the non-technical skills (including vision, communication, and comfort) as well as a non-significant negative impact on technical skills and decision making of surgeons. Extra efforts should be directed to improve PPE, especially during lengthy pandemics.
Gastric emptying of preoperative carbohydrate in elderly assessed using gastric ultrasonography
Authors: Jeong Jae Yong , Ahn Jin Hee , Shim Jae-Geum , Lee Sung Hyun , Ryu Kyoung-Ho , Lee Sung-Ho , Cho Eun-Ah
Published: September 2021

Background:

Preoperative carbohydrate loading enhances postoperative recovery and reduces patient discomfort. However, gastric emptying of liquids can be delayed in elderly populations. Therefore, this study aimed to evaluate the gastric emptying of 400 mL of a carbohydrate drink ingested 2 hours before surgery in elderly patients.

Methods:

In this prospective, randomized controlled study, patients aged >65 years were allocated to either fast from midnight (nil per os [NPO] group, n = 29) or drink 400 mL of a carbohydrate drink 2 hours before surgery (carbohydrate group, n = 29). The gastric antrum was assessed using ultrasonography in the supine position, followed by the right lateral decubitus (RLD) position. The gastric antrum was graded as grade 0 (fluid not seen in both positions), grade 1 (fluid only seen in the RLD position), and grade 2 (fluid seen in both positions). The gastric antral cross-sectional area (CSA) and aspirated residual gastric volume were measured.

Results:

In 58 patients, the incidence of grade 2 stomach was 13.8% in NPO group and 17.2% in carbohydrate group (P = .790). The gastric antral CSA in the supine position was larger in carbohydrate group than in NPO group (4.42 [3.72–5.18] cm2 vs 5.31 [4.35–6.92] cm2, P = .018). The gastric antral CSA in the RLD position was not different in NPO and carbohydrate groups (P = .120). There was no difference in gastric volume (2 [0–7.5] vs 3 [0–13.4], P = .331) in NPO group versus carbohydrate group.

Conclusion:

The incidence of grade 2 stomach was not different between NPO group and carbohydrate group in elderly patients.
Variation in COVID-19 disease severity at hospital admission over time and across hospitals
Authors: Wayne Max T. , Weng Wenjing , O’Malley Megan , Bozyk Paul , Doshi Mona M. , Flanders Scott A. , McSparron Jakob I. , Sharma Pratima , Swaminathan Lakshmi , Prescott Hallie C.
Published: September 2021

During the spring 2020 COVID-19 surge, hospitals in Southeast Michigan were overwhelmed, and hospital beds were limited. However, it is unknown whether threshold for hospital admission varied across hospitals or over time.

Using a statewide registry, we performed a retrospective cohort study. We identified adult patients hospitalized with COVID-19 in Southeast Michigan (3/1/2020-6/1/2020). We classified disease severity on admission using the World Health Organization (WHO) ordinal scale. Our primary measure of interest was the proportion of patients admitted on room air. We also determined the proportion without acute organ dysfunction on admission or any point during hospitalization. We quantified variation across hospitals and over time by half-month epochs.

Among 1315 hospitalizations across 22 hospitals, 57.3% (754/1,315) were admitted on room air, and 26.1% (343/1,315) remained on room air for the duration of hospitalization. Across hospitals, the proportion of COVID-19 hospitalizations admitted on room air varied from 32.3% to 80.0%. Across half-month epochs, the proportion ranged from 49.4% to 69.4% and nadired in early April 2020. Among patients admitted on room air, 75.1% (566/754) had no acute organ dysfunction on admission, and 35.3% (266/754) never developed acute organ dysfunction at any point during hospitalization; there was marked variation in both proportions across hospitals. In-hospital mortality was 13.7% for patients admitted on room air vs 26.3% for patients requiring nasal cannula oxygen.

Among patients hospitalized with COVID-19 during the spring 2020 surge in Southeast Michigan, more than half were on room air and a third had no acute organ dysfunction upon admission, but experienced high rates of disease progression and in-hospital mortality.
The incidence of mumps in Taiwan and its association with the meteorological parameters
Authors: Lin Cheng-Yao , Su Shih-Bin , Peng Cheau-Jane , Chen Kow-Tong
Published: September 2021

Mumps is an acute and common childhood disease caused by paramyxovirus. It has been reported that the occurrence of mumps is influenced by seasonality. However, the role of meteorological variables in the incidence of mumps remains unclear. The purpose of this study was to explore the relationship between meteorological factors and the incidence of mumps infection. Poisson regression analysis was used to study the relationship between weather variability and the incidence of mumps in Taiwan. Between 2012 and 2018, 5459 cases of mumps cases were reported to the Centers for Disease Control, Taiwan (Taiwan CDC). The occurrence of mumps virus infections revealed significant seasonality in the spring and summer seasons in Taiwan. The incidence of mumps virus infections began to increase at temperatures of 15°C and started to decline if the temperature was higher than 29°C (r
2 = 0.387, P = .008). Similarly, the number of mumps cases began to increase at a relative humidity of 65% to 69% (r
2 = 0.838, P < .029). The number of mumps cases was positively associated with temperature and relative humidity during the period preceding the infection. This study showed that the occurrence of mumps is significantly associated with increasing temperature and relative humidity in Taiwan. Therefore, these factors could be regarded as early warning signals and indicate the need to strengthen the intervention and prevention of mumps.
Time from first tumor manifestation to diagnosis in patients with GEP-NET
Authors: Koch Christine , Koca Esra , Filmann Natalie , Husmann Gabriele , Bojunga Jörg
Published: September 2021

Patients with neuroendocrine tumors (NET) often go through a long phase between onset of symptoms and initial diagnosis.

Assessment of time to diagnosis and pre-clinical pathway in patients with gastroenteropancreatic NET (GEP-NET) with regard to metastases and symptoms.

Retrospective analysis of patients with GEP-NET at a tertiary referral center from 1984 to 2019; inclusion criteria: Patients ≥18 years, diagnosis of GEP-NET; statistical analysis using non-parametrical methods.

Four hundred eighty-six patients with 488 tumors were identified; median age at first diagnosis (478/486, 8 unknown) was 59 years; 52.9% male patients. Pancreatic NET: 143/488 tumors; 29.3%; small intestinal NET: 145/488 tumors, 29.7%. 128/303 patients (42.2%) showed NET specific and 122/486 (25%) patients other tumor-specific symptoms. 222/279 patients had distant metastases at initial diagnosis (187/222 liver metastases). 154/488 (31.6%) of GEP-NET were incidental findings. Median time from tumor manifestation (e.g., symptoms related to NET) to initial diagnosis across all entities was 19.5 (95% CI: 12–28) days. No significant difference in patients with or without distant metastases (median 73 vs 105 days, P = .42).

A large proportion of GEP-NET are incidental findings and only about half of all patients are symptomatic at the time of diagnosis. We did not find a significant influence of the presence of metastases on time to diagnosis, which shows a large variability with a median of <30 days.
Association between role conflict and ambiguity and stress among nurses in primary health care centers in Saudi Arabia during the coronavirus disease 2019 pandemic
Authors: Alyahya Saad A. , Al-Mansour Khalid A. , Alkohaiz Mohammed A. , Almalki Mansour A.
Published: September 2021

This study aimed to assess the association between role conflict and ambiguity among nurses in primary healthcare centers (PHCs) in Saudi Arabia and their stress levels during the coronavirus disease 2019 (COVID-19) pandemic.

In this online cross-sectional study, sociodemographic and occupational characteristics, role conflict, and ambiguity of 432 nurses were assessed using the Bowling Scale for Role Conflict and Ambiguity and stress was assessed using the 10-item Perceived Stress Scale from September 27 to October 17, 2020. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for above-median stress levels of nurses with average and high (2nd and 3rd tertiles) role conflict and ambiguity compared with nurses with low role conflict and ambiguity (1st tertile).

The mean (standard deviation) age of the nurses was 36.5 ± 6.6 years, and 25.9% of them were males. After adjusting for PHC type and working hours, nurses with average and high role conflict had significantly higher stress rates than those with low role conflict, with ORs (95% CIs) of 2.69 (1.62–4.46) and 6.31 (3.78–10.53), respectively. Similarly, nurses with average- and high-role ambiguity had significantly higher stress than those with low role ambiguity, with ORs (95% CIs) of 2.15 (1.30–3.55) and 7.68 (4.54–13.01), respectively. Increasing stress rates were detected across increasing categories of role conflict and ambiguity (P values for trend <.001).

We found that role conflict and ambiguity were associated with stress among nurses in PHCs in Saudi Arabia during the COVID-19 pandemic.
Emerging therapeutic and preventive approaches to transplant-associated thrombotic microangiopathy
Authors: Schoettler Michelle , Chonat Satheesh , Williams Kirsten , Lehmann Leslie
Published: September 2021

Purpose of review

Transplant-associated thrombotic microangiopathy (TA-TMA) is a complication that can occur in both allogeneic and autologous haematopoietic cellular therapy (HCT) recipients and is associated with significant morbidity and mortality. Although TA-TMA is a complex disease, there is emerging evidence that complement activation and endothelial dysfunction play a key role in the pathophysiology of the disease. The use of eculizumab has improved survival in patients with high risk and severe disease, but mortality rates in treated patients still exceed 30%, highlighting the need for novel approaches.

Recent findings

There are multiple ongoing and planned clinical trials investigating novel complement agents in TA-TMA and other TMAs. Drugs vary by targets of the complement system, mechanism, and form of administration. Clinical trial designs include single arm studies that span across multiple age groups including children, and double-blind, randomized, placebo-controlled studies. These studies will provide robust data to inform the care of patients with TA-TMA in the future. In addition to multiple promising therapeutic agents, preventing TA-TMA is an emerging strategy. Agents known to protect the endothelium from damage and augment endothelial function by promoting anti-inflammatory and antithrombotic effects may have a role in preventing TA-TMA or ameliorating the severity, though additional studies are needed.

Novel therapeutic agents for TA-TMA inhibition of the complement system are under investigation and prophylactic strategies of endothelial protection are emerging. Further understanding of the pathophysiology of the disease may identify additional therapeutic targets. Multiinstitutional, collaborative clinical trials are needed to determine the safety and efficacy of these agents going forward.
Racial Disparities in Stroke Readmissions Reduced in Hospitals With Better Nurse Staffing
Authors: Carthon J. Margo Brooks , Brom Heather , McHugh Matthew , Daus Marguerite , French Rachel , Sloane Douglas M. , Berg Robert , Merchant Raina , Aiken Linda H.
Published: September 2021

Background

Racial minorities are disproportionately affected by stroke, with Black patients experiencing worse poststroke outcomes than White patients. A modifiable aspect of acute stroke care delivery not yet examined is whether disparities in stroke outcomes are related to hospital nurse staffing levels.

Objectives

The aim of this study was to determine whether 7- and 30-day readmission disparities between Black and White patients were associated with nurse staffing levels.

Methods

We conducted a secondary analysis of 542 hospitals in four states. Risk-adjusted, logistic regression models were used to determine the association of nurse staffing with 7- and 30-day all-cause readmissions for Black and White ischemic stroke patients.

Results

Our sample included 98,150 ischemic stroke patients (87% White, 13% Black). Thirty-day readmission rates were 10.4% (12.7% for Black patients, 10.0% for White patients). In models accounting for hospital and patient characteristics, the odds of 30-day readmissions were higher for Black than White patients. A significant interaction was found between race and nurse staffing, with Black patients experiencing higher odds of 30- and 7-day readmissions for each additional patient cared for by a nurse. In the best-staffed hospitals (less than three patients per nurse), Black and White stroke patients’ disparities were no longer significant.

Discussion

Disparities in readmissions between Black and White stroke patients may be linked to the level of nurse staffing in the hospitals where they receive care. Tailoring nurse staffing levels to meet the needs of Black ischemic stroke patients represents a promising intervention to address systemic inequities linked to readmission disparities among minority stroke patients.
Long-term Effects of Perceived Stress, Anxiety, and Anger on Hospitalizations or Death and Health Status in Heart Failure Patients
Authors: Dimond Andrew J. , Krantz David S. , Waters Andrew J. , Liew Keen Seong , Gottlieb Stephen S.
Published: September 2021

Background

Chronic and acute stress and emotion predict incidence/recurrence of CHD, but long-term effects on HF exacerbations are poorly understood. This study determined long-term chronic and episodic effects of stress, anxiety, and anger on hospitalizations or death, and worsened health status in HF.

Methods and Results

147 patients with heart failure and reduced ejection fraction (HFrEF) completed measures of perceived stress (Perceived Stress Scale; PSS), state anxiety (STAI), recent anger (RA), and HF-related health status (Kansas City Cardiomyopathy Questionnaire; KCCQ) every 6 months for up to 39 months. Relationships of chronic (Mean) stress and emotion and episodic changes (Deviation) to subsequent hospitalizations or death and health status were determined utilizing Generalized Estimating Equation models. All-cause hospitalizations were predicted by chronic (Mean) PSS (OR=1.06, 95% CI 1.02-1.11, p=0.004), Mean STAI (OR=1.06, 95% CI=1.03, 1.10, p<0.001), and episodic (Deviation) PSS (OR=1.03, 95% CI 1.01-1.06, p=0.022). Mean PSS and Mean STAI also predicted cardiovascular hospitalizations. Each 1 standard deviation increase in Mean PSS and Mean STAI was associated, respectively, with a 61% and 79% increase in hospitalization or death. Anger was not associated with hospitalizations. Poorer KCCQ health status was related to higher Mean and Deviation PSS, STAI, and RA. Relationships to hospitalizations and health status were significant for Anxiety and Perceived Stress, independently of the other psychological measures.

Conclusions

In HF patients, chronic perceived stress and anxiety and episodic stress increases are predictive of hospitalizations or death and worsened health status over a >3-year period. Mechanisms may involve sympathetic activation, and/or exacerbations of perceived symptoms or health behaviors.